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This is VAERS ID 111281

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 111281
VAERS Form:
Age:0.5
Sex:Male
Location:Oregon
Vaccinated:1998-02-17
Onset:1998-02-26
Submitted:1998-03-18
Entered:1998-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA / CONNAUGHT LABS 444071 / 2 LL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M200RJ / 2 RL / IM
IPV: POLIOVAX / CONNAUGHT LTD M0443 / 2 LL / SC

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-26
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: fluoride drops
Current Illness: nasal congestion only
Preexisting Conditions: diastasis recti, yeast diaper rash
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': diastasis recti, yeast diaper rash

Write-up: no adverse effects noted in period immed p/vax;pt died SIDS death 26FEB98 @ home;


Changed on 12/8/2009

VAERS ID: 111281 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Oregon
Vaccinated:1998-02-17
Onset:1998-02-26
Submitted:1998-03-18
Entered:1998-06-04 1998-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA DTAP (TRIPEDIA) / CONNAUGHT LABS CONNAUGHT LABORATORIES 444071 / 2 LL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE LABORATORIES M200RJ / 2 RL / IM
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. M0443 / 2 LL / SC

Administered by: Private Unknown      Purchased by: Unknown
Symptoms: SIDS, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-26
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: fluoride drops
Current Illness: nasal congestion only
Preexisting Conditions: diastasis recti, yeast diaper rash
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': diastasis recti, yeast diaper rash OR9803

Write-up: no adverse effects noted in period immed p/vax;pt died SIDS death 26FEB98 @ home;


Changed on 5/14/2017

VAERS ID: 111281 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Oregon
Vaccinated:1998-02-17
Onset:1998-02-26
Submitted:1998-03-18
Entered:1998-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 444071 / 2 LL / IM
HIBV: HIB (HIBTITER) / LEDERLE LABORATORIES PFIZER/WYETH M200RJ / 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0443 / 2 LL / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-26
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: fluoride drops
Current Illness: nasal congestion only
Preexisting Conditions: diastasis recti, yeast diaper rash
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': OR9803

Write-up: no adverse effects noted in period immed p/vax;pt died SIDS death 26FEB98 @ home;


Changed on 9/14/2017

VAERS ID: 111281 Before After
VAERS Form:(blank) 1
Age:0.5
Sex:Male
Location:Oregon
Vaccinated:1998-02-17
Onset:1998-02-26
Submitted:1998-03-18
Entered:1998-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 444071 / 2 3 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200RJ / 2 3 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0443 / 2 3 LL / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-26
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: fluoride drops
Current Illness: nasal congestion only
Preexisting Conditions: diastasis recti, yeast diaper rash
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': OR9803

Write-up: no adverse effects noted in period immed p/vax;pt died SIDS death 26FEB98 @ home;


Changed on 2/14/2018

VAERS ID: 111281 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:Oregon
Vaccinated:1998-02-17
Onset:1998-02-26
Submitted:1998-03-18
Entered:1998-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 444071 / 3 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200RJ / 3 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0443 / 3 LL / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-26
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: fluoride drops
Current Illness: nasal congestion only
Preexisting Conditions: diastasis recti, yeast diaper rash
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': OR9803

Write-up: no adverse effects noted in period immed p/vax;pt died SIDS death 26FEB98 @ home;


Changed on 6/14/2018

VAERS ID: 111281 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:Oregon
Vaccinated:1998-02-17
Onset:1998-02-26
Submitted:1998-03-18
Entered:1998-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 444071 / 3 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200RJ / 3 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0443 / 3 LL / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-26
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: fluoride drops
Current Illness: nasal congestion only
Preexisting Conditions: diastasis recti, yeast diaper rash
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': OR9803

Write-up: no adverse effects noted in period immed p/vax;pt died SIDS death 26FEB98 @ home;


Changed on 8/14/2018

VAERS ID: 111281 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:Oregon
Vaccinated:1998-02-17
Onset:1998-02-26
Submitted:1998-03-18
Entered:1998-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 444071 / 3 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200RJ / 3 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0443 / 3 LL / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-26
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: fluoride drops
Current Illness: nasal congestion only
Preexisting Conditions: diastasis recti, yeast diaper rash
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': OR9803

Write-up: no adverse effects noted in period immed p/vax;pt died SIDS death 26FEB98 @ home;


Changed on 9/14/2018

VAERS ID: 111281 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:Oregon
Vaccinated:1998-02-17
Onset:1998-02-26
Submitted:1998-03-18
Entered:1998-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 444071 / 3 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200RJ / 3 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0443 / 3 LL / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-26
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: fluoride drops
Current Illness: nasal congestion only
Preexisting Conditions: diastasis recti, yeast diaper rash
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': OR9803

Write-up: no adverse effects noted in period immed p/vax;pt died SIDS death 26FEB98 @ home;


Changed on 10/14/2018

VAERS ID: 111281 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:Oregon
Vaccinated:1998-02-17
Onset:1998-02-26
Submitted:1998-03-18
Entered:1998-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 444071 / 3 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200RJ / 3 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0443 / 3 LL / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-26
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: fluoride drops
Current Illness: nasal congestion only
Preexisting Conditions: diastasis recti, yeast diaper rash
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': OR9803

Write-up: no adverse effects noted in period immed p/vax;pt died SIDS death 26FEB98 @ home;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=111281&WAYBACKHISTORY=ON


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