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This is VAERS ID 111280

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 111280
VAERS Form:
Age:0.3
Sex:Male
Location:Oregon
Vaccinated:1998-03-24
Onset:1998-04-01
Submitted:1998-04-02
Entered:1998-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA / CONNAUGHT LABS 7L81673 / 0 LL / IM
HEP: ENGERIX-B / SMITHKLINE 2405A2 / 1 LL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M305PN / 0 RL / IM
IPV: POLIOVAX / CONNAUGHT LTD M0461 / 0 RL / SC

Administered by: Public      Purchased by: Unknown
Symptoms: SIDS, STUPOR, SLEEP POSITION, SLEEP MATERIALS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-01
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: unk
Current Illness: NONE
Preexisting Conditions: discharged from hosp for RSV 13MAR98;
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': discharged from hosp for RSV 13MAR98;

Write-up: pt mom reported finding pt unresponsive @ 10AM on 1APR98;911 was dispatched;pt was pronounced SIDS by medical examiner @ home;


Changed on 12/8/2009

VAERS ID: 111280 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Oregon
Vaccinated:1998-03-24
Onset:1998-04-01
Submitted:1998-04-02
Entered:1998-06-04 1998-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA DTAP (TRIPEDIA) / CONNAUGHT LABS CONNAUGHT LABORATORIES 7L81673 / 0 LL / IM
HEP: ENGERIX-B HEP B (ENGERIX-B) / SMITHKLINE SMITHKLINE BEECHAM 2405A2 / 1 LL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE LABORATORIES M305PN / 0 RL / IM
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. M0461 / 0 RL / SC

Administered by: Public Unknown      Purchased by: Unknown
Symptoms: SIDS, Stupor, Sudden infant death syndrome, Unevaluable event, STUPOR, SLEEP POSITION, SLEEP MATERIALS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-01
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: unk
Current Illness: NONE
Preexisting Conditions: discharged from hosp for RSV 13MAR98;
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': discharged from hosp for RSV 13MAR98; OR9805

Write-up: pt mom reported finding pt unresponsive @ 10AM on 1APR98;911 was dispatched;pt was pronounced SIDS by medical examiner @ home;


Changed on 5/14/2017

VAERS ID: 111280 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Oregon
Vaccinated:1998-03-24
Onset:1998-04-01
Submitted:1998-04-02
Entered:1998-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7L81673 / 0 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2405A2 / 1 LL / IM
HIBV: HIB (HIBTITER) / LEDERLE LABORATORIES PFIZER/WYETH M305PN / 0 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0461 / 0 RL / SC

Administered by: Unknown Public      Purchased by: Unknown Public
Symptoms: Stupor, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-01
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: unk
Current Illness: NONE
Preexisting Conditions: discharged from hosp for RSV 13MAR98;
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': OR9805

Write-up: pt mom reported finding pt unresponsive @ 10AM on 1APR98;911 was dispatched;pt was pronounced SIDS by medical examiner @ home;


Changed on 9/14/2017

VAERS ID: 111280 Before After
VAERS Form:(blank) 1
Age:0.3
Sex:Male
Location:Oregon
Vaccinated:1998-03-24
Onset:1998-04-01
Submitted:1998-04-02
Entered:1998-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7L81673 / 0 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2405A2 / 1 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M305PN / 0 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0461 / 0 1 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Stupor, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-01
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: unk
Current Illness: NONE
Preexisting Conditions: discharged from hosp for RSV 13MAR98;
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': OR9805

Write-up: pt mom reported finding pt unresponsive @ 10AM on 1APR98;911 was dispatched;pt was pronounced SIDS by medical examiner @ home;


Changed on 2/14/2018

VAERS ID: 111280 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Oregon
Vaccinated:1998-03-24
Onset:1998-04-01
Submitted:1998-04-02
Entered:1998-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7L81673 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2405A2 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M305PN / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0461 / 1 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Stupor, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-01
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: unk
Current Illness: NONE
Preexisting Conditions: discharged from hosp for RSV 13MAR98;
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': OR9805

Write-up: pt mom reported finding pt unresponsive @ 10AM on 1APR98;911 was dispatched;pt was pronounced SIDS by medical examiner @ home;


Changed on 6/14/2018

VAERS ID: 111280 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Oregon
Vaccinated:1998-03-24
Onset:1998-04-01
Submitted:1998-04-02
Entered:1998-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7L81673 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2405A2 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M305PN / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0461 / 1 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Stupor, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-01
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: unk
Current Illness: NONE
Preexisting Conditions: discharged from hosp for RSV 13MAR98;
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': OR9805

Write-up: pt mom reported finding pt unresponsive @ 10AM on 1APR98;911 was dispatched;pt was pronounced SIDS by medical examiner @ home;


Changed on 8/14/2018

VAERS ID: 111280 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Oregon
Vaccinated:1998-03-24
Onset:1998-04-01
Submitted:1998-04-02
Entered:1998-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7L81673 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2405A2 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M305PN / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0461 / 1 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Stupor, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-01
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: unk
Current Illness: NONE
Preexisting Conditions: discharged from hosp for RSV 13MAR98;
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': OR9805

Write-up: pt mom reported finding pt unresponsive @ 10AM on 1APR98;911 was dispatched;pt was pronounced SIDS by medical examiner @ home;


Changed on 9/14/2018

VAERS ID: 111280 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Oregon
Vaccinated:1998-03-24
Onset:1998-04-01
Submitted:1998-04-02
Entered:1998-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7L81673 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2405A2 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M305PN / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0461 / 1 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Stupor, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-01
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: unk
Current Illness: NONE
Preexisting Conditions: discharged from hosp for RSV 13MAR98;
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': OR9805

Write-up: pt mom reported finding pt unresponsive @ 10AM on 1APR98;911 was dispatched;pt was pronounced SIDS by medical examiner @ home;


Changed on 10/14/2018

VAERS ID: 111280 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Oregon
Vaccinated:1998-03-24
Onset:1998-04-01
Submitted:1998-04-02
Entered:1998-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7L81673 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2405A2 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M305PN / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0461 / 1 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Stupor, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-01
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: unk
Current Illness: NONE
Preexisting Conditions: discharged from hosp for RSV 13MAR98;
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': OR9805

Write-up: pt mom reported finding pt unresponsive @ 10AM on 1APR98;911 was dispatched;pt was pronounced SIDS by medical examiner @ home;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=111280&WAYBACKHISTORY=ON


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