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This is VAERS ID 113404

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 113404
VAERS Form:
Age:0.1
Sex:Male
Location:North Carolina
Vaccinated:1998-08-07
Onset:1998-08-08
Submitted:1998-08-09
Entered:1998-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: ENGERIX-B / SMITHKLINE 2425A2 / 1 LL / -

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-08-08
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: UNK
Current Illness: NONE
Preexisting Conditions: Pt mother hx of substance abuse through pregnancy.
Allergies:
Diagnostic Lab Data: AUTOPSY PENDING
CDC 'Split Type':

Write-up: Pt recv vax on 8/7/98. Pt presented DOA, presumably SIDS on 8/8/98.


Changed on 12/8/2009

VAERS ID: 113404 Before After
VAERS Form:
Age:0.1
Sex:Male
Location:North Carolina
Vaccinated:1998-08-07
Onset:1998-08-08
Submitted:1998-08-09
Entered:1998-08-15 1998-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: ENGERIX-B HEP B (ENGERIX-B) / SMITHKLINE SMITHKLINE BEECHAM 2425A2 / 1 LL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-08-08
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: UNK
Current Illness: NONE
Preexisting Conditions: Pt mother hx of substance abuse through pregnancy.
Allergies:
Diagnostic Lab Data: AUTOPSY PENDING
CDC 'Split Type':

Write-up: Pt recv vax on 8/7/98. Pt presented DOA, presumably SIDS on 8/8/98.


Changed on 5/14/2017

VAERS ID: 113404 Before After
VAERS Form:
Age:0.1
Sex:Male
Location:North Carolina
Vaccinated:1998-08-07
Onset:1998-08-08
Submitted:1998-08-09
Entered:1998-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2425A2 / 1 LL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-08-08
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: UNK
Current Illness: NONE
Preexisting Conditions: Pt mother hx of substance abuse through pregnancy.
Allergies:
Diagnostic Lab Data: AUTOPSY PENDING
CDC 'Split Type':

Write-up: Pt recv vax on 8/7/98. Pt presented DOA, presumably SIDS on 8/8/98.


Changed on 9/14/2017

VAERS ID: 113404 Before After
VAERS Form:(blank) 1
Age:0.1
Sex:Male
Location:North Carolina
Vaccinated:1998-08-07
Onset:1998-08-08
Submitted:1998-08-09
Entered:1998-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2425A2 / 1 2 LL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-08-08
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: UNK
Current Illness: NONE
Preexisting Conditions: Pt mother hx of substance abuse through pregnancy.
Allergies:
Diagnostic Lab Data: AUTOPSY PENDING
CDC 'Split Type':

Write-up: Pt recv vax on 8/7/98. Pt presented DOA, presumably SIDS on 8/8/98.


Changed on 2/14/2018

VAERS ID: 113404 Before After
VAERS Form:1
Age:0.1
Sex:Male
Location:North Carolina
Vaccinated:1998-08-07
Onset:1998-08-08
Submitted:1998-08-09
Entered:1998-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2425A2 / 2 LL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-08-08
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: UNK
Current Illness: NONE
Preexisting Conditions: Pt mother hx of substance abuse through pregnancy.
Allergies:
Diagnostic Lab Data: AUTOPSY PENDING
CDC 'Split Type':

Write-up: Pt recv vax on 8/7/98. Pt presented DOA, presumably SIDS on 8/8/98.


Changed on 6/14/2018

VAERS ID: 113404 Before After
VAERS Form:1
Age:0.1
Sex:Male
Location:North Carolina
Vaccinated:1998-08-07
Onset:1998-08-08
Submitted:1998-08-09
Entered:1998-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2425A2 / 2 LL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-08-08
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: UNK
Current Illness: NONE
Preexisting Conditions: Pt mother hx of substance abuse through pregnancy.
Allergies:
Diagnostic Lab Data: AUTOPSY PENDING
CDC 'Split Type':

Write-up: Pt recv vax on 8/7/98. Pt presented DOA, presumably SIDS on 8/8/98.


Changed on 8/14/2018

VAERS ID: 113404 Before After
VAERS Form:1
Age:0.1
Sex:Male
Location:North Carolina
Vaccinated:1998-08-07
Onset:1998-08-08
Submitted:1998-08-09
Entered:1998-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2425A2 / 2 LL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-08-08
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: UNK
Current Illness: NONE
Preexisting Conditions: Pt mother hx of substance abuse through pregnancy.
Allergies:
Diagnostic Lab Data: AUTOPSY PENDING
CDC 'Split Type':

Write-up: Pt recv vax on 8/7/98. Pt presented DOA, presumably SIDS on 8/8/98.


Changed on 9/14/2018

VAERS ID: 113404 Before After
VAERS Form:1
Age:0.1
Sex:Male
Location:North Carolina
Vaccinated:1998-08-07
Onset:1998-08-08
Submitted:1998-08-09
Entered:1998-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2425A2 / 2 LL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-08-08
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: UNK
Current Illness: NONE
Preexisting Conditions: Pt mother hx of substance abuse through pregnancy.
Allergies:
Diagnostic Lab Data: AUTOPSY PENDING
CDC 'Split Type':

Write-up: Pt recv vax on 8/7/98. Pt presented DOA, presumably SIDS on 8/8/98.


Changed on 10/14/2018

VAERS ID: 113404 Before After
VAERS Form:1
Age:0.1
Sex:Male
Location:North Carolina
Vaccinated:1998-08-07
Onset:1998-08-08
Submitted:1998-08-09
Entered:1998-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2425A2 / 2 LL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-08-08
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: UNK
Current Illness: NONE
Preexisting Conditions: Pt mother hx of substance abuse through pregnancy.
Allergies:
Diagnostic Lab Data: AUTOPSY PENDING
CDC 'Split Type':

Write-up: Pt recv vax on 8/7/98. Pt presented DOA, presumably SIDS on 8/8/98.

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