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This is VAERS ID 112811

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 112811
VAERS Form:
Age:0.2
Sex:Male
Location:Oregon
Vaccinated:1998-07-10
Onset:1998-07-11
Submitted:1998-07-14
Entered:1998-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE / LEDERLE 455838 / 0 RL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M285RJ / 0 LL / IM

Administered by: Private      Purchased by: Unknown
Symptoms: ACIDOSIS, ANOMALY HEART, ANOMALY CONGEN, HYPERKALEM

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1998-07-11
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: Reglan, Digoxin
Current Illness: s/p transposition repair @ birth
Preexisting Conditions: congenital heart defect;
Allergies:
Diagnostic Lab Data: metabolic acidosis & hyperkalemia;
CDC 'Split Type': congenital heart defect;

Write-up: in less than 24hr of vax pt died-presumably of rt heart ischemia secondary to repair of transposition of the great vessels @ birth;


Changed on 12/8/2009

VAERS ID: 112811 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Oregon
Vaccinated:1998-07-10
Onset:1998-07-11
Submitted:1998-07-14
Entered:1998-07-23 1998-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE DTAP (ACEL-IMUNE) / LEDERLE LEDERLE LABORATORIES 455838 / 0 RL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M285RJ / 0 LL / IM

Administered by: Private      Purchased by: Unknown Public
Symptoms: Acidosis, Congenital anomaly, Heart disease congenital, Hyperkalaemia, ACIDOSIS, ANOMALY HEART, ANOMALY CONGEN, HYPERKALEM

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1998-07-11
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: Reglan, Digoxin
Current Illness: s/p transposition repair @ birth
Preexisting Conditions: congenital heart defect;
Allergies:
Diagnostic Lab Data: metabolic acidosis & hyperkalemia;
CDC 'Split Type': congenital heart defect; (blank)

Write-up: in less than 24hr of vax pt died-presumably of rt heart ischemia secondary to repair of transposition of the great vessels @ birth;


Changed on 5/14/2017

VAERS ID: 112811 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Oregon
Vaccinated:1998-07-10
Onset:1998-07-11
Submitted:1998-07-14
Entered:1998-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 455838 / 0 RL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M285RJ / 0 LL / IM

Administered by: Private      Purchased by: Public
Symptoms: Acidosis, Congenital anomaly, Heart disease congenital, Hyperkalaemia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1998-07-11
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: NONE NONE~ ()~~~In patient
Other Medications: Reglan, Digoxin
Current Illness: s/p transposition repair @ birth
Preexisting Conditions: congenital heart defect;
Allergies:
Diagnostic Lab Data: metabolic acidosis & hyperkalemia;
CDC 'Split Type':

Write-up: in less than 24hr of vax pt died-presumably of rt heart ischemia secondary to repair of transposition of the great vessels @ birth;


Changed on 9/14/2017

VAERS ID: 112811 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:Oregon
Vaccinated:1998-07-10
Onset:1998-07-11
Submitted:1998-07-14
Entered:1998-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 455838 / 0 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M285RJ / 0 1 LL / IM

Administered by: Private      Purchased by: Public
Symptoms: Acidosis, Congenital anomaly, Heart disease congenital, Hyperkalaemia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1998-07-11
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Reglan, Digoxin
Current Illness: s/p transposition repair @ birth
Preexisting Conditions: congenital heart defect;
Allergies:
Diagnostic Lab Data: metabolic acidosis & hyperkalemia;
CDC 'Split Type':

Write-up: in less than 24hr of vax pt died-presumably of rt heart ischemia secondary to repair of transposition of the great vessels @ birth;


Changed on 2/14/2018

VAERS ID: 112811 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Oregon
Vaccinated:1998-07-10
Onset:1998-07-11
Submitted:1998-07-14
Entered:1998-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 455838 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M285RJ / 1 LL / IM

Administered by: Private      Purchased by: Public
Symptoms: Acidosis, Congenital anomaly, Heart disease congenital, Hyperkalaemia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1998-07-11
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Reglan, Digoxin
Current Illness: s/p transposition repair @ birth
Preexisting Conditions: congenital heart defect;
Allergies:
Diagnostic Lab Data: metabolic acidosis & hyperkalemia;
CDC 'Split Type':

Write-up: in less than 24hr of vax pt died-presumably of rt heart ischemia secondary to repair of transposition of the great vessels @ birth;


Changed on 6/14/2018

VAERS ID: 112811 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Oregon
Vaccinated:1998-07-10
Onset:1998-07-11
Submitted:1998-07-14
Entered:1998-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 455838 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M285RJ / 1 LL / IM

Administered by: Private      Purchased by: Public
Symptoms: Acidosis, Congenital anomaly, Heart disease congenital, Hyperkalaemia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1998-07-11
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Reglan, Digoxin
Current Illness: s/p transposition repair @ birth
Preexisting Conditions: congenital heart defect;
Allergies:
Diagnostic Lab Data: metabolic acidosis & hyperkalemia;
CDC 'Split Type':

Write-up: in less than 24hr of vax pt died-presumably of rt heart ischemia secondary to repair of transposition of the great vessels @ birth;


Changed on 8/14/2018

VAERS ID: 112811 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Oregon
Vaccinated:1998-07-10
Onset:1998-07-11
Submitted:1998-07-14
Entered:1998-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 455838 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M285RJ / 1 LL / IM

Administered by: Private      Purchased by: Public
Symptoms: Acidosis, Congenital anomaly, Heart disease congenital, Hyperkalaemia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1998-07-11
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Reglan, Digoxin
Current Illness: s/p transposition repair @ birth
Preexisting Conditions: congenital heart defect;
Allergies:
Diagnostic Lab Data: metabolic acidosis & hyperkalemia;
CDC 'Split Type':

Write-up: in less than 24hr of vax pt died-presumably of rt heart ischemia secondary to repair of transposition of the great vessels @ birth;


Changed on 9/14/2018

VAERS ID: 112811 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Oregon
Vaccinated:1998-07-10
Onset:1998-07-11
Submitted:1998-07-14
Entered:1998-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 455838 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M285RJ / 1 LL / IM

Administered by: Private      Purchased by: Public
Symptoms: Acidosis, Congenital anomaly, Heart disease congenital, Hyperkalaemia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1998-07-11
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Reglan, Digoxin
Current Illness: s/p transposition repair @ birth
Preexisting Conditions: congenital heart defect;
Allergies:
Diagnostic Lab Data: metabolic acidosis & hyperkalemia;
CDC 'Split Type':

Write-up: in less than 24hr of vax pt died-presumably of rt heart ischemia secondary to repair of transposition of the great vessels @ birth;


Changed on 10/14/2018

VAERS ID: 112811 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Oregon
Vaccinated:1998-07-10
Onset:1998-07-11
Submitted:1998-07-14
Entered:1998-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 455838 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M285RJ / 1 LL / IM

Administered by: Private      Purchased by: Public
Symptoms: Acidosis, Congenital anomaly, Heart disease congenital, Hyperkalaemia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1998-07-11
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Reglan, Digoxin
Current Illness: s/p transposition repair @ birth
Preexisting Conditions: congenital heart defect;
Allergies:
Diagnostic Lab Data: metabolic acidosis & hyperkalemia;
CDC 'Split Type':

Write-up: in less than 24hr of vax pt died-presumably of rt heart ischemia secondary to repair of transposition of the great vessels @ birth;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=112811&WAYBACKHISTORY=ON


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