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This is VAERS ID 110712

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 110712
VAERS Form:
Age:23.3
Sex:Male
Location:Massachusetts
Vaccinated:1998-01-15
Onset:1998-01-30
Submitted:1998-05-05
Entered:1998-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED, ADULT MASS. DPH. / MASS. DPH TD61 / - - / -

Administered by: Private      Purchased by: Unknown
Symptoms: CONVULS, REACT AGGRAV

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-30
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: Dilantin;Tegretol
Current Illness: Epilepsy
Preexisting Conditions: epilepsy
Allergies:
Diagnostic Lab Data: medical autopsy found no other abnormalities
CDC 'Split Type': epilepsy

Write-up: 14 days p/vax pt died of sz disorder;had 2yr hx of sz, most recently determined to be epilepsy


Changed on 12/8/2009

VAERS ID: 110712 Before After
VAERS Form:
Age:23.3 23.0
Sex:Male
Location:Massachusetts
Vaccinated:1998-01-15
Onset:1998-01-30
Submitted:1998-05-05
Entered:1998-05-13 1998-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED, ADULT MASS. DPH. TD ADSORBED (NO BRAND NAME) / MASS. DPH MASS. PUB HLTH BIOL LAB TD61 / - - / -

Administered by: Private Unknown      Purchased by: Unknown
Symptoms: Condition aggravated, Convulsion, CONVULS, REACT AGGRAV

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-30
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: Dilantin;Tegretol
Current Illness: Epilepsy
Preexisting Conditions: epilepsy
Allergies:
Diagnostic Lab Data: medical autopsy found no other abnormalities abnormalities. The autopsy report states seizure disorder.
CDC 'Split Type': epilepsy (blank)

Write-up: 14 days p/vax pt died of sz disorder;had 2yr hx of sz, most recently determined to be epilepsy epilepsy. The autopsy report states seizure disorder.


Changed on 5/14/2017

VAERS ID: 110712 Before After
VAERS Form:
Age:23.0
Sex:Male
Location:Massachusetts
Vaccinated:1998-01-15
Onset:1998-01-30
Submitted:1998-05-05
Entered:1998-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / MASS. PUB HLTH BIOL LAB TD61 / - - / -

Administered by: Unknown Private      Purchased by: Unknown Other
Symptoms: Condition aggravated, Convulsion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-30
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Dilantin;Tegretol
Current Illness: Epilepsy
Preexisting Conditions: epilepsy
Allergies:
Diagnostic Lab Data: medical autopsy found no other abnormalities. The autopsy report states seizure disorder.
CDC 'Split Type':

Write-up: 14 days p/vax pt died of sz disorder;had 2yr hx of sz, most recently determined to be epilepsy. The autopsy report states seizure disorder.


Changed on 9/14/2017

VAERS ID: 110712 Before After
VAERS Form:(blank) 1
Age:23.0
Sex:Male
Location:Massachusetts
Vaccinated:1998-01-15
Onset:1998-01-30
Submitted:1998-05-05
Entered:1998-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / MASS. PUB HLTH BIOL LAB TD61 / - UNK - / -

Administered by: Private      Purchased by: Other
Symptoms: Condition aggravated, Convulsion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-30
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Dilantin;Tegretol
Current Illness: Epilepsy
Preexisting Conditions: epilepsy
Allergies:
Diagnostic Lab Data: medical autopsy found no other abnormalities. The autopsy report states seizure disorder.
CDC 'Split Type':

Write-up: 14 days p/vax pt died of sz disorder;had 2yr hx of sz, most recently determined to be epilepsy. The autopsy report states seizure disorder.


Changed on 2/14/2018

VAERS ID: 110712 Before After
VAERS Form:1
Age:23.0
Sex:Male
Location:Massachusetts
Vaccinated:1998-01-15
Onset:1998-01-30
Submitted:1998-05-05
Entered:1998-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / MASS. PUB HLTH BIOL LAB TD61 / UNK - / -

Administered by: Private      Purchased by: Other
Symptoms: Condition aggravated, Convulsion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-30
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Dilantin;Tegretol
Current Illness: Epilepsy
Preexisting Conditions: epilepsy
Allergies:
Diagnostic Lab Data: medical autopsy found no other abnormalities. The autopsy report states seizure disorder.
CDC 'Split Type':

Write-up: 14 days p/vax pt died of sz disorder;had 2yr hx of sz, most recently determined to be epilepsy. The autopsy report states seizure disorder.


Changed on 6/14/2018

VAERS ID: 110712 Before After
VAERS Form:1
Age:23.0
Sex:Male
Location:Massachusetts
Vaccinated:1998-01-15
Onset:1998-01-30
Submitted:1998-05-05
Entered:1998-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / MASS. PUB HLTH BIOL LAB TD61 / UNK - / -

Administered by: Private      Purchased by: Other
Symptoms: Condition aggravated, Convulsion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-30
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Dilantin;Tegretol
Current Illness: Epilepsy
Preexisting Conditions: epilepsy
Allergies:
Diagnostic Lab Data: medical autopsy found no other abnormalities. The autopsy report states seizure disorder.
CDC 'Split Type':

Write-up: 14 days p/vax pt died of sz disorder;had 2yr hx of sz, most recently determined to be epilepsy. The autopsy report states seizure disorder.


Changed on 8/14/2018

VAERS ID: 110712 Before After
VAERS Form:1
Age:23.0
Sex:Male
Location:Massachusetts
Vaccinated:1998-01-15
Onset:1998-01-30
Submitted:1998-05-05
Entered:1998-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / MASS. PUB HLTH BIOL LAB TD61 / UNK - / -

Administered by: Private      Purchased by: Other
Symptoms: Condition aggravated, Convulsion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-30
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Dilantin;Tegretol
Current Illness: Epilepsy
Preexisting Conditions: epilepsy
Allergies:
Diagnostic Lab Data: medical autopsy found no other abnormalities. The autopsy report states seizure disorder.
CDC 'Split Type':

Write-up: 14 days p/vax pt died of sz disorder;had 2yr hx of sz, most recently determined to be epilepsy. The autopsy report states seizure disorder.


Changed on 9/14/2018

VAERS ID: 110712 Before After
VAERS Form:1
Age:23.0
Sex:Male
Location:Massachusetts
Vaccinated:1998-01-15
Onset:1998-01-30
Submitted:1998-05-05
Entered:1998-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / MASS. PUB HLTH BIOL LAB TD61 / UNK - / -

Administered by: Private      Purchased by: Other
Symptoms: Condition aggravated, Convulsion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-30
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Dilantin;Tegretol
Current Illness: Epilepsy
Preexisting Conditions: epilepsy
Allergies:
Diagnostic Lab Data: medical autopsy found no other abnormalities. The autopsy report states seizure disorder.
CDC 'Split Type':

Write-up: 14 days p/vax pt died of sz disorder;had 2yr hx of sz, most recently determined to be epilepsy. The autopsy report states seizure disorder.


Changed on 10/14/2018

VAERS ID: 110712 Before After
VAERS Form:1
Age:23.0
Sex:Male
Location:Massachusetts
Vaccinated:1998-01-15
Onset:1998-01-30
Submitted:1998-05-05
Entered:1998-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / MASS. PUB HLTH BIOL LAB TD61 / UNK - / -

Administered by: Private      Purchased by: Other
Symptoms: Condition aggravated, Convulsion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-30
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Dilantin;Tegretol
Current Illness: Epilepsy
Preexisting Conditions: epilepsy
Allergies:
Diagnostic Lab Data: medical autopsy found no other abnormalities. The autopsy report states seizure disorder.
CDC 'Split Type':

Write-up: 14 days p/vax pt died of sz disorder;had 2yr hx of sz, most recently determined to be epilepsy. The autopsy report states seizure disorder.


Changed on 4/14/2019

VAERS ID: 110712 Before After
VAERS Form:1
Age:23.0
Sex:Male
Location:Massachusetts
Vaccinated:1998-01-15
Onset:1998-01-30
Submitted:1998-05-05
Entered:1998-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) TD ADSORBED (TDVAX) / MASS. PUB HLTH BIOL LAB TD61 / UNK - / -

Administered by: Private      Purchased by: Other
Symptoms: Condition aggravated, Convulsion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-30
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Dilantin;Tegretol
Current Illness: Epilepsy
Preexisting Conditions: epilepsy
Allergies:
Diagnostic Lab Data: medical autopsy found no other abnormalities. The autopsy report states seizure disorder.
CDC 'Split Type':

Write-up: 14 days p/vax pt died of sz disorder;had 2yr hx of sz, most recently determined to be epilepsy. The autopsy report states seizure disorder.

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