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This is VAERS ID 112005

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 112005
VAERS Form:
Age:0.2
Sex:Male
Location:Arkansas
Vaccinated:1998-05-13
Onset:1998-05-31
Submitted:0000-00-00
Entered:1998-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: INFANRIX / SMITHKLINE 841A2 / 0 RL / IM
HEP: ENGERIX-B / SMITHKLINE 2368A2 / 1 LL / IM
HIBV: PEDVAXHIB / MSD 0216H / 0 LL / IM
IPV: POLIOVAX / CONNAUGHT LTD N0031 / 0 RL / SC

Administered by: Public      Purchased by: Unknown
Symptoms: SLEEP MATERIALS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-05-31
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:
Allergies:
Diagnostic Lab Data: autopsy was done;
CDC 'Split Type':

Write-up: pt was red 1130Pm placed on abd on waterbed;pt was discovered by grandfather when pt had not awaken by 8AM; taken to hosp pronounced dead by MD;


Changed on 12/8/2009

VAERS ID: 112005 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Arkansas
Vaccinated:1998-05-13
Onset:1998-05-31
Submitted:0000-00-00
Entered:1998-06-23 1998-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: INFANRIX DTAP (INFANRIX) / SMITHKLINE SMITHKLINE BEECHAM 841A2 / 0 RL / IM
HEP: ENGERIX-B HEP B (ENGERIX-B) / SMITHKLINE SMITHKLINE BEECHAM 2368A2 / 1 LL / IM
HIBV: PEDVAXHIB HIB (PEDVAXHIB) / MSD MERCK & CO. INC. 0216H / 0 LL / IM
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. N0031 / 0 RL / SC

Administered by: Public      Purchased by: Unknown Public
Symptoms: Unevaluable event, SLEEP MATERIALS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-05-31
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:
Allergies:
Diagnostic Lab Data: autopsy was done;
CDC 'Split Type': (blank) AR9836

Write-up: pt was red 1130Pm placed on abd on waterbed;pt was discovered by grandfather when pt had not awaken by 8AM; taken to hosp pronounced dead by MD;


Changed on 5/14/2017

VAERS ID: 112005 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Arkansas
Vaccinated:1998-05-13
Onset:1998-05-31
Submitted:0000-00-00
Entered:1998-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 841A2 / 0 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2368A2 / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0216H / 0 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0031 / 0 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-05-31
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:
Allergies:
Diagnostic Lab Data: autopsy was done;
CDC 'Split Type': AR9836

Write-up: pt was red 1130Pm placed on abd on waterbed;pt was discovered by grandfather when pt had not awaken by 8AM; taken to hosp pronounced dead by MD;


Changed on 9/14/2017

VAERS ID: 112005 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:Arkansas
Vaccinated:1998-05-13
Onset:1998-05-31
Submitted:0000-00-00
Entered:1998-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 841A2 / 0 1 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2368A2 / 1 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0216H / 0 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0031 / 0 1 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-05-31
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:
Allergies:
Diagnostic Lab Data: autopsy was done;
CDC 'Split Type': AR9836

Write-up: pt was red 1130Pm placed on abd on waterbed;pt was discovered by grandfather when pt had not awaken by 8AM; taken to hosp pronounced dead by MD;


Changed on 2/14/2018

VAERS ID: 112005 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Arkansas
Vaccinated:1998-05-13
Onset:1998-05-31
Submitted:0000-00-00
Entered:1998-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 841A2 / 1 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2368A2 / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0216H / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0031 / 1 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-05-31
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:
Allergies:
Diagnostic Lab Data: autopsy was done;
CDC 'Split Type': AR9836

Write-up: pt was red 1130Pm placed on abd on waterbed;pt was discovered by grandfather when pt had not awaken by 8AM; taken to hosp pronounced dead by MD;


Changed on 6/14/2018

VAERS ID: 112005 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Arkansas
Vaccinated:1998-05-13
Onset:1998-05-31
Submitted:0000-00-00
Entered:1998-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 841A2 / 1 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2368A2 / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0216H / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0031 / 1 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-05-31
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:
Allergies:
Diagnostic Lab Data: autopsy was done;
CDC 'Split Type': AR9836

Write-up: pt was red 1130Pm placed on abd on waterbed;pt was discovered by grandfather when pt had not awaken by 8AM; taken to hosp pronounced dead by MD;


Changed on 8/14/2018

VAERS ID: 112005 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Arkansas
Vaccinated:1998-05-13
Onset:1998-05-31
Submitted:0000-00-00
Entered:1998-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 841A2 / 1 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2368A2 / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0216H / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0031 / 1 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-05-31
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:
Allergies:
Diagnostic Lab Data: autopsy was done;
CDC 'Split Type': AR9836

Write-up: pt was red 1130Pm placed on abd on waterbed;pt was discovered by grandfather when pt had not awaken by 8AM; taken to hosp pronounced dead by MD;


Changed on 9/14/2018

VAERS ID: 112005 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Arkansas
Vaccinated:1998-05-13
Onset:1998-05-31
Submitted:0000-00-00
Entered:1998-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 841A2 / 1 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2368A2 / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0216H / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0031 / 1 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-05-31
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:
Allergies:
Diagnostic Lab Data: autopsy was done;
CDC 'Split Type': AR9836

Write-up: pt was red 1130Pm placed on abd on waterbed;pt was discovered by grandfather when pt had not awaken by 8AM; taken to hosp pronounced dead by MD;


Changed on 10/14/2018

VAERS ID: 112005 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Arkansas
Vaccinated:1998-05-13
Onset:1998-05-31
Submitted:0000-00-00
Entered:1998-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 841A2 / 1 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2368A2 / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0216H / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0031 / 1 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-05-31
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:
Allergies:
Diagnostic Lab Data: autopsy was done;
CDC 'Split Type': AR9836

Write-up: pt was red 1130Pm placed on abd on waterbed;pt was discovered by grandfather when pt had not awaken by 8AM; taken to hosp pronounced dead by MD;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=112005&WAYBACKHISTORY=ON


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