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This is VAERS ID 111282

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 111282
VAERS Form:
Age:0.2
Sex:Male
Location:Alabama
Vaccinated:1998-05-14
Onset:1998-05-19
Submitted:1998-05-20
Entered:1998-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: INFANRIX / SMITHKLINE 847A2 / 0 LL / IM
HEP: RECOMBIVAX HB / MSD 1226E / 0 RL / IM
HIBV: PROHIBIT / CONNAUGHT LABS 7E91927 / 0 LL / IM
IPV: POLIOVAX / CONNAUGHT LTD M0843 / 0 RL / SC

Administered by: Public      Purchased by: Unknown
Symptoms: SIDS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-05-19
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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: death-19MAY98;coroner says SIDS-unable to obtain death certificate d/t state privacy laws


Changed on 12/8/2009

VAERS ID: 111282 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Alabama
Vaccinated:1998-05-14
Onset:1998-05-19
Submitted:1998-05-20
Entered:1998-06-04 1998-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: INFANRIX DTAP (INFANRIX) / SMITHKLINE SMITHKLINE BEECHAM 847A2 / 0 LL / IM
HEP: RECOMBIVAX HB HEP B (RECOMBIVAX HB) / MSD MERCK & CO. INC. 1226E / 0 RL / IM
HIBV: PROHIBIT HIB (PROHIBIT) / CONNAUGHT LABS CONNAUGHT LABORATORIES 7E91927 / 0 LL / IM
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. M0843 / 0 RL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-05-19
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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) AL984

Write-up: death-19MAY98;coroner says SIDS-unable to obtain death certificate d/t state privacy laws


Changed on 5/14/2017

VAERS ID: 111282 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Alabama
Vaccinated:1998-05-14
Onset:1998-05-19
Submitted:1998-05-20
Entered:1998-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 847A2 / 0 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1226E / 0 RL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 7E91927 / 0 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0843 / 0 RL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-05-19
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: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': AL984

Write-up: death-19MAY98;coroner says SIDS-unable to obtain death certificate d/t state privacy laws


Changed on 9/14/2017

VAERS ID: 111282 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:Alabama
Vaccinated:1998-05-14
Onset:1998-05-19
Submitted:1998-05-20
Entered:1998-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 847A2 / 0 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1226E / 0 1 RL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 7E91927 / 0 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0843 / 0 1 RL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-05-19
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: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': AL984

Write-up: death-19MAY98;coroner says SIDS-unable to obtain death certificate d/t state privacy laws


Changed on 2/14/2018

VAERS ID: 111282 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Alabama
Vaccinated:1998-05-14
Onset:1998-05-19
Submitted:1998-05-20
Entered:1998-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 847A2 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1226E / 1 RL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 7E91927 / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0843 / 1 RL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-05-19
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: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': AL984

Write-up: death-19MAY98;coroner says SIDS-unable to obtain death certificate d/t state privacy laws


Changed on 6/14/2018

VAERS ID: 111282 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Alabama
Vaccinated:1998-05-14
Onset:1998-05-19
Submitted:1998-05-20
Entered:1998-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 847A2 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1226E / 1 RL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 7E91927 / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0843 / 1 RL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-05-19
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: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': AL984

Write-up: death-19MAY98;coroner says SIDS-unable to obtain death certificate d/t state privacy laws


Changed on 8/14/2018

VAERS ID: 111282 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Alabama
Vaccinated:1998-05-14
Onset:1998-05-19
Submitted:1998-05-20
Entered:1998-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 847A2 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1226E / 1 RL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 7E91927 / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0843 / 1 RL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-05-19
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: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': AL984

Write-up: death-19MAY98;coroner says SIDS-unable to obtain death certificate d/t state privacy laws


Changed on 9/14/2018

VAERS ID: 111282 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Alabama
Vaccinated:1998-05-14
Onset:1998-05-19
Submitted:1998-05-20
Entered:1998-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 847A2 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1226E / 1 RL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 7E91927 / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0843 / 1 RL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-05-19
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: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': AL984

Write-up: death-19MAY98;coroner says SIDS-unable to obtain death certificate d/t state privacy laws


Changed on 10/14/2018

VAERS ID: 111282 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Alabama
Vaccinated:1998-05-14
Onset:1998-05-19
Submitted:1998-05-20
Entered:1998-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 847A2 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1226E / 1 RL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 7E91927 / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0843 / 1 RL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-05-19
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: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': AL984

Write-up: death-19MAY98;coroner says SIDS-unable to obtain death certificate d/t state privacy laws

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