National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 113425

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 113425
VAERS Form:
Age:0.2
Sex:Male
Location:Virginia
Vaccinated:1998-07-23
Onset:1998-07-25
Submitted:1998-08-07
Entered:1998-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE / LEDERLE 453845 / 0 LL / IM
HBHEPB: COMVAX / MSD 0435H / 1 RL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M010RN / 0 RL / IM
IPV: POLIOVAX / CONNAUGHT LTD N0291 / 0 LL / SC

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS, CYANOSIS, HEART ARREST

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-07-25
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 7/27/98-Autopsy by VA Chief Medical Examiner, Richmond, VA
CDC 'Split Type':

Write-up: Pt recv vax on 7/23/98; on 7/25/98 pt found blue in bed. Pt exp cardiopulmonary arrest; autopsy c/w SIDS.


Changed on 12/8/2009

VAERS ID: 113425 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Virginia
Vaccinated:1998-07-23
Onset:1998-07-25
Submitted:1998-08-07
Entered:1998-08-17 1998-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE DTAP (ACEL-IMUNE) / LEDERLE LEDERLE LABORATORIES 453845 / 0 LL / IM
HBHEPB: COMVAX HIB + HEP B (COMVAX) / MSD MERCK & CO. INC. 0435H / 1 RL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M010RN / 0 RL / IM
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. N0291 / 0 LL / SC

Administered by: Private      Purchased by: Unknown Private
Symptoms: Cardiac arrest, Cyanosis, SIDS, Sudden infant death syndrome, CYANOSIS, HEART ARREST

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-07-25
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 7/27/98-Autopsy by VA Chief Medical Examiner, Richmond, VA
CDC 'Split Type':

Write-up: Pt recv vax on 7/23/98; on 7/25/98 pt found blue in bed. Pt exp cardiopulmonary arrest; autopsy c/w SIDS.


Changed on 5/14/2017

VAERS ID: 113425 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Virginia
Vaccinated:1998-07-23
Onset:1998-07-25
Submitted:1998-08-07
Entered:1998-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 453845 / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0435H / 1 RL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M010RN / 0 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0291 / 0 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Cardiac arrest, Cyanosis, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-07-25
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: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 7/27/98-Autopsy by VA Chief Medical Examiner, Richmond, VA
CDC 'Split Type':

Write-up: Pt recv vax on 7/23/98; on 7/25/98 pt found blue in bed. Pt exp cardiopulmonary arrest; autopsy c/w SIDS.


Changed on 9/14/2017

VAERS ID: 113425 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:Virginia
Vaccinated:1998-07-23
Onset:1998-07-25
Submitted:1998-08-07
Entered:1998-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 453845 / 0 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0435H / 1 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M010RN / 0 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0291 / 0 1 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Cardiac arrest, Cyanosis, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-07-25
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: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 7/27/98-Autopsy by VA Chief Medical Examiner, Richmond, VA
CDC 'Split Type':

Write-up: Pt recv vax on 7/23/98; on 7/25/98 pt found blue in bed. Pt exp cardiopulmonary arrest; autopsy c/w SIDS.


Changed on 2/14/2018

VAERS ID: 113425 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Virginia
Vaccinated:1998-07-23
Onset:1998-07-25
Submitted:1998-08-07
Entered:1998-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 453845 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0435H / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M010RN / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0291 / 1 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Cardiac arrest, Cyanosis, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-07-25
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: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 7/27/98-Autopsy by VA Chief Medical Examiner, Richmond, VA
CDC 'Split Type':

Write-up: Pt recv vax on 7/23/98; on 7/25/98 pt found blue in bed. Pt exp cardiopulmonary arrest; autopsy c/w SIDS.


Changed on 6/14/2018

VAERS ID: 113425 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Virginia
Vaccinated:1998-07-23
Onset:1998-07-25
Submitted:1998-08-07
Entered:1998-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 453845 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0435H / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M010RN / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0291 / 1 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Cardiac arrest, Cyanosis, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-07-25
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: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 7/27/98-Autopsy by VA Chief Medical Examiner, Richmond, VA
CDC 'Split Type':

Write-up: Pt recv vax on 7/23/98; on 7/25/98 pt found blue in bed. Pt exp cardiopulmonary arrest; autopsy c/w SIDS.


Changed on 8/14/2018

VAERS ID: 113425 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Virginia
Vaccinated:1998-07-23
Onset:1998-07-25
Submitted:1998-08-07
Entered:1998-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 453845 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0435H / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M010RN / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0291 / 1 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Cardiac arrest, Cyanosis, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-07-25
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: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 7/27/98-Autopsy by VA Chief Medical Examiner, Richmond, VA
CDC 'Split Type':

Write-up: Pt recv vax on 7/23/98; on 7/25/98 pt found blue in bed. Pt exp cardiopulmonary arrest; autopsy c/w SIDS.


Changed on 9/14/2018

VAERS ID: 113425 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Virginia
Vaccinated:1998-07-23
Onset:1998-07-25
Submitted:1998-08-07
Entered:1998-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 453845 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0435H / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M010RN / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0291 / 1 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Cardiac arrest, Cyanosis, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-07-25
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: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 7/27/98-Autopsy by VA Chief Medical Examiner, Richmond, VA
CDC 'Split Type':

Write-up: Pt recv vax on 7/23/98; on 7/25/98 pt found blue in bed. Pt exp cardiopulmonary arrest; autopsy c/w SIDS.


Changed on 10/14/2018

VAERS ID: 113425 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Virginia
Vaccinated:1998-07-23
Onset:1998-07-25
Submitted:1998-08-07
Entered:1998-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 453845 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0435H / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M010RN / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0291 / 1 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Cardiac arrest, Cyanosis, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-07-25
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: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 7/27/98-Autopsy by VA Chief Medical Examiner, Richmond, VA
CDC 'Split Type':

Write-up: Pt recv vax on 7/23/98; on 7/25/98 pt found blue in bed. Pt exp cardiopulmonary arrest; autopsy c/w SIDS.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=113425&WAYBACKHISTORY=ON


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