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This is VAERS ID 113437

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 113437
VAERS Form:
Age:0.2
Sex:Male
Location:California
Vaccinated:1998-06-05
Onset:1998-06-07
Submitted:1998-08-12
Entered:1998-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: INFANRIX / SMITHKLINE A840A2 / - RL / -
HIBV: HIBTITER / LEDERLE(PRAXIS) 7C91702 / - LL / -

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS, CYANOSIS, ANOREXIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-06-07
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: NA
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': NONE

Write-up: pt was seen for immun;pt was okay @ that time;2 days p/had poor feeding; found blue in crib;taken to hosp pt was found dead possible SIDS;


Changed on 12/8/2009

VAERS ID: 113437 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:California
Vaccinated:1998-06-05
Onset:1998-06-07
Submitted:1998-08-12
Entered:1998-08-18 1998-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: INFANRIX DTAP (INFANRIX) / SMITHKLINE SMITHKLINE BEECHAM A840A2 / - RL / -
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS 7C91702 / - LL / -

Administered by: Private      Purchased by: Unknown Public
Symptoms: Anorexia, Cyanosis, SIDS, Sudden infant death syndrome, CYANOSIS, ANOREXIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-06-07
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: NA
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': NONE (blank)

Write-up: pt was seen for immun;pt was okay @ that time;2 days p/had poor feeding; found blue in crib;taken to hosp pt was found dead possible SIDS;


Changed on 5/14/2017

VAERS ID: 113437 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:California
Vaccinated:1998-06-05
Onset:1998-06-07
Submitted:1998-08-12
Entered:1998-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM A840A2 / - RL / -
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH 7C91702 / - LL / -

Administered by: Private      Purchased by: Public
Symptoms: Anorexia, Cyanosis, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-06-07
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: NA NA~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type':

Write-up: pt was seen for immun;pt was okay @ that time;2 days p/had poor feeding; found blue in crib;taken to hosp pt was found dead possible SIDS;


Changed on 9/14/2017

VAERS ID: 113437 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:California
Vaccinated:1998-06-05
Onset:1998-06-07
Submitted:1998-08-12
Entered:1998-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM A840A2 / - UNK RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH 7C91702 / - UNK LL / -

Administered by: Private      Purchased by: Public
Symptoms: Anorexia, Cyanosis, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-06-07
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: NA~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type':

Write-up: pt was seen for immun;pt was okay @ that time;2 days p/had poor feeding; found blue in crib;taken to hosp pt was found dead possible SIDS;


Changed on 2/14/2018

VAERS ID: 113437 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:California
Vaccinated:1998-06-05
Onset:1998-06-07
Submitted:1998-08-12
Entered:1998-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM A840A2 / UNK RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH 7C91702 / UNK LL / -

Administered by: Private      Purchased by: Public
Symptoms: Anorexia, Cyanosis, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-06-07
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: NA~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type':

Write-up: pt was seen for immun;pt was okay @ that time;2 days p/had poor feeding; found blue in crib;taken to hosp pt was found dead possible SIDS;


Changed on 6/14/2018

VAERS ID: 113437 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:California
Vaccinated:1998-06-05
Onset:1998-06-07
Submitted:1998-08-12
Entered:1998-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM A840A2 / UNK RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH 7C91702 / UNK LL / -

Administered by: Private      Purchased by: Public
Symptoms: Anorexia, Cyanosis, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-06-07
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: NA~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type':

Write-up: pt was seen for immun;pt was okay @ that time;2 days p/had poor feeding; found blue in crib;taken to hosp pt was found dead possible SIDS;


Changed on 8/14/2018

VAERS ID: 113437 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:California
Vaccinated:1998-06-05
Onset:1998-06-07
Submitted:1998-08-12
Entered:1998-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM A840A2 / UNK RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH 7C91702 / UNK LL / -

Administered by: Private      Purchased by: Public
Symptoms: Anorexia, Cyanosis, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-06-07
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: NA~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type':

Write-up: pt was seen for immun;pt was okay @ that time;2 days p/had poor feeding; found blue in crib;taken to hosp pt was found dead possible SIDS;


Changed on 9/14/2018

VAERS ID: 113437 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:California
Vaccinated:1998-06-05
Onset:1998-06-07
Submitted:1998-08-12
Entered:1998-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM A840A2 / UNK RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH 7C91702 / UNK LL / -

Administered by: Private      Purchased by: Public
Symptoms: Anorexia, Cyanosis, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-06-07
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: NA~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type':

Write-up: pt was seen for immun;pt was okay @ that time;2 days p/had poor feeding; found blue in crib;taken to hosp pt was found dead possible SIDS;


Changed on 10/14/2018

VAERS ID: 113437 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:California
Vaccinated:1998-06-05
Onset:1998-06-07
Submitted:1998-08-12
Entered:1998-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM A840A2 / UNK RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH 7C91702 / UNK LL / -

Administered by: Private      Purchased by: Public
Symptoms: Anorexia, Cyanosis, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-06-07
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: NA~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type':

Write-up: pt was seen for immun;pt was okay @ that time;2 days p/had poor feeding; found blue in crib;taken to hosp pt was found dead possible SIDS;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=113437&WAYBACKHISTORY=ON


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