National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 113301

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 113301
VAERS Form:
Age:0.2
Sex:Male
Location:North Carolina
Vaccinated:1998-04-22
Onset:1998-04-25
Submitted:1998-07-01
Entered:1998-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA / CONNAUGHT LABS 7C91935 / 0 LL / -
HEP: ENGERIX-B / SMITHKLINE ERY2392AZ / 1 RL / -
HIBV: HIBTITER / LEDERLE(PRAXIS) 4165RH / 0 LL / -
IPV: POLIOVAX / CONNAUGHT LTD 41295 / 0 RL / -

Administered by: Private      Purchased by: Unknown
Symptoms: INFECT, APNEA, DYSPNEA, ANOREXIA, FLU SYND

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-25
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: Pediazole
Current Illness: Pneumonia
Preexisting Conditions: Prematurity
Allergies:
Diagnostic Lab Data: On 4/24/98 grandparents noted pt. holding his breath. On 4/25/98, pt. not breathing. Resuscitation not successful. Post mortem-Pneumonia/H.Influenza.
CDC 'Split Type':

Write-up: Pt. recv. vax. on 04/22/98. On 4/24/98, pt. slept between his two grandparents in the same bed. On 4/25/98, grandparents awoke and noted that the infant was no longer breathing. EMS called. Pt. taken to hospital.


Changed on 12/8/2009

VAERS ID: 113301 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:North Carolina
Vaccinated:1998-04-22
Onset:1998-04-25
Submitted:1998-07-01
Entered:1998-08-11 1998-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA DTAP (TRIPEDIA) / CONNAUGHT LABS CONNAUGHT LABORATORIES 7C91935 / 0 LL / -
HEP: ENGERIX-B HEP B (ENGERIX-B) / SMITHKLINE SMITHKLINE BEECHAM ERY2392AZ 2392AZ / 1 RL / -
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE LABORATORIES 4165RH / 0 LL / -
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. 41295 / 0 RL / -

Administered by: Private Unknown      Purchased by: Unknown
Symptoms: Anorexia, Apnoea, Dyspnoea, Infection, Influenza, Pneumonia, Unevaluable event, INFECT, APNEA, DYSPNEA, ANOREXIA, FLU SYND

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-25
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: Pediazole
Current Illness: Pneumonia
Preexisting Conditions: Prematurity
Allergies:
Diagnostic Lab Data: On 4/24/98 grandparents noted pt. holding his breath. On 4/25/98, pt. not breathing. Resuscitation not successful. Post mortem-Pneumonia/H.Influenza.
CDC 'Split Type':

Write-up: Pt. recv. vax. on 04/22/98. On 4/24/98, pt. slept between his two grandparents in the same bed. On 4/25/98, grandparents awoke and noted that the infant was no longer breathing. EMS called. Pt. taken to hospital.


Changed on 5/14/2017

VAERS ID: 113301 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:North Carolina
Vaccinated:1998-04-22
Onset:1998-04-25
Submitted:1998-07-01
Entered:1998-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7C91935 / 0 LL / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2392AZ / 1 RL / -
HIBV: HIB (HIBTITER) / LEDERLE LABORATORIES PFIZER/WYETH 4165RH / 0 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 41295 / 0 RL / -

Administered by: Unknown Private      Purchased by: Unknown Public
Symptoms: Anorexia, Apnoea, Dyspnoea, Infection, Influenza, Pneumonia, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-25
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: Pediazole
Current Illness: Pneumonia
Preexisting Conditions: Prematurity
Allergies:
Diagnostic Lab Data: On 4/24/98 grandparents noted pt. holding his breath. On 4/25/98, pt. not breathing. Resuscitation not successful. Post mortem-Pneumonia/H.Influenza.
CDC 'Split Type':

Write-up: Pt. recv. vax. on 04/22/98. On 4/24/98, pt. slept between his two grandparents in the same bed. On 4/25/98, grandparents awoke and noted that the infant was no longer breathing. EMS called. Pt. taken to hospital.


Changed on 9/14/2017

VAERS ID: 113301 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:North Carolina
Vaccinated:1998-04-22
Onset:1998-04-25
Submitted:1998-07-01
Entered:1998-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7C91935 / 0 1 LL / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2392AZ / 1 2 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH 4165RH / 0 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 41295 / 0 1 RL / -

Administered by: Private      Purchased by: Public
Symptoms: Anorexia, Apnoea, Dyspnoea, Infection, Influenza, Pneumonia, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-25
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: Pediazole
Current Illness: Pneumonia
Preexisting Conditions: Prematurity
Allergies:
Diagnostic Lab Data: On 4/24/98 grandparents noted pt. holding his breath. On 4/25/98, pt. not breathing. Resuscitation not successful. Post mortem-Pneumonia/H.Influenza.
CDC 'Split Type':

Write-up: Pt. recv. vax. on 04/22/98. On 4/24/98, pt. slept between his two grandparents in the same bed. On 4/25/98, grandparents awoke and noted that the infant was no longer breathing. EMS called. Pt. taken to hospital.


Changed on 2/14/2018

VAERS ID: 113301 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:North Carolina
Vaccinated:1998-04-22
Onset:1998-04-25
Submitted:1998-07-01
Entered:1998-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7C91935 / 1 LL / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2392AZ / 2 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH 4165RH / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 41295 / 1 RL / -

Administered by: Private      Purchased by: Public
Symptoms: Anorexia, Apnoea, Dyspnoea, Infection, Influenza, Pneumonia, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-25
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: Pediazole
Current Illness: Pneumonia
Preexisting Conditions: Prematurity
Allergies:
Diagnostic Lab Data: On 4/24/98 grandparents noted pt. holding his breath. On 4/25/98, pt. not breathing. Resuscitation not successful. Post mortem-Pneumonia/H.Influenza.
CDC 'Split Type':

Write-up: Pt. recv. vax. on 04/22/98. On 4/24/98, pt. slept between his two grandparents in the same bed. On 4/25/98, grandparents awoke and noted that the infant was no longer breathing. EMS called. Pt. taken to hospital.


Changed on 6/14/2018

VAERS ID: 113301 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:North Carolina
Vaccinated:1998-04-22
Onset:1998-04-25
Submitted:1998-07-01
Entered:1998-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7C91935 / 1 LL / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2392AZ / 2 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH 4165RH / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 41295 / 1 RL / -

Administered by: Private      Purchased by: Public
Symptoms: Anorexia, Apnoea, Dyspnoea, Infection, Influenza, Pneumonia, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-25
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: Pediazole
Current Illness: Pneumonia
Preexisting Conditions: Prematurity
Allergies:
Diagnostic Lab Data: On 4/24/98 grandparents noted pt. holding his breath. On 4/25/98, pt. not breathing. Resuscitation not successful. Post mortem-Pneumonia/H.Influenza.
CDC 'Split Type':

Write-up: Pt. recv. vax. on 04/22/98. On 4/24/98, pt. slept between his two grandparents in the same bed. On 4/25/98, grandparents awoke and noted that the infant was no longer breathing. EMS called. Pt. taken to hospital.


Changed on 8/14/2018

VAERS ID: 113301 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:North Carolina
Vaccinated:1998-04-22
Onset:1998-04-25
Submitted:1998-07-01
Entered:1998-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7C91935 / 1 LL / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2392AZ / 2 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH 4165RH / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 41295 / 1 RL / -

Administered by: Private      Purchased by: Public
Symptoms: Anorexia, Apnoea, Dyspnoea, Infection, Influenza, Pneumonia, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-25
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: Pediazole
Current Illness: Pneumonia
Preexisting Conditions: Prematurity
Allergies:
Diagnostic Lab Data: On 4/24/98 grandparents noted pt. holding his breath. On 4/25/98, pt. not breathing. Resuscitation not successful. Post mortem-Pneumonia/H.Influenza.
CDC 'Split Type':

Write-up: Pt. recv. vax. on 04/22/98. On 4/24/98, pt. slept between his two grandparents in the same bed. On 4/25/98, grandparents awoke and noted that the infant was no longer breathing. EMS called. Pt. taken to hospital.


Changed on 9/14/2018

VAERS ID: 113301 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:North Carolina
Vaccinated:1998-04-22
Onset:1998-04-25
Submitted:1998-07-01
Entered:1998-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7C91935 / 1 LL / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2392AZ / 2 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH 4165RH / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 41295 / 1 RL / -

Administered by: Private      Purchased by: Public
Symptoms: Anorexia, Apnoea, Dyspnoea, Infection, Influenza, Pneumonia, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-25
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: Pediazole
Current Illness: Pneumonia
Preexisting Conditions: Prematurity
Allergies:
Diagnostic Lab Data: On 4/24/98 grandparents noted pt. holding his breath. On 4/25/98, pt. not breathing. Resuscitation not successful. Post mortem-Pneumonia/H.Influenza.
CDC 'Split Type':

Write-up: Pt. recv. vax. on 04/22/98. On 4/24/98, pt. slept between his two grandparents in the same bed. On 4/25/98, grandparents awoke and noted that the infant was no longer breathing. EMS called. Pt. taken to hospital.


Changed on 10/14/2018

VAERS ID: 113301 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:North Carolina
Vaccinated:1998-04-22
Onset:1998-04-25
Submitted:1998-07-01
Entered:1998-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7C91935 / 1 LL / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2392AZ / 2 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH 4165RH / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 41295 / 1 RL / -

Administered by: Private      Purchased by: Public
Symptoms: Anorexia, Apnoea, Dyspnoea, Infection, Influenza, Pneumonia, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-25
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: Pediazole
Current Illness: Pneumonia
Preexisting Conditions: Prematurity
Allergies:
Diagnostic Lab Data: On 4/24/98 grandparents noted pt. holding his breath. On 4/25/98, pt. not breathing. Resuscitation not successful. Post mortem-Pneumonia/H.Influenza.
CDC 'Split Type':

Write-up: Pt. recv. vax. on 04/22/98. On 4/24/98, pt. slept between his two grandparents in the same bed. On 4/25/98, grandparents awoke and noted that the infant was no longer breathing. EMS called. Pt. taken to hospital.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=113301&WAYBACKHISTORY=ON


Copyright © 2020 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166