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This is VAERS ID 113440

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 113440
VAERS Form:
Age:0.2
Sex:Male
Location:Ohio
Vaccinated:1998-07-21
Onset:1998-07-22
Submitted:1998-07-24
Entered:1998-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE / LEDERLE 451498 / 0 RL / IM
HBHEPB: COMVAX / MSD 0326H / - LL / IM
IPV: POLIOVAX / CONNAUGHT LTD N0147 / 0 LL / SC

Administered by: Public      Purchased by: Unknown
Symptoms: SIDS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-07-22
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: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NONE

Write-up: SIDS;


Changed on 12/8/2009

VAERS ID: 113440 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Ohio
Vaccinated:1998-07-21
Onset:1998-07-22
Submitted:1998-07-24
Entered:1998-08-18 1998-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE DTAP (ACEL-IMUNE) / LEDERLE LEDERLE LABORATORIES 451498 / 0 RL / IM
HBHEPB: COMVAX HIB + HEP B (COMVAX) / MSD MERCK & CO. INC. 0326H / - LL / IM
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. N0147 / 0 LL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-07-22
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: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NONE OH98051

Write-up: SIDS;


Changed on 5/14/2017

VAERS ID: 113440 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Ohio
Vaccinated:1998-07-21
Onset:1998-07-22
Submitted:1998-07-24
Entered:1998-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 451498 / 0 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0326H / - LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0147 / 0 LL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-07-22
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:
CDC 'Split Type': OH98051

Write-up: SIDS;


Changed on 9/14/2017

VAERS ID: 113440 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:Ohio
Vaccinated:1998-07-21
Onset:1998-07-22
Submitted:1998-07-24
Entered:1998-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 451498 / 0 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0326H / - UNK LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0147 / 0 1 LL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-07-22
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:
CDC 'Split Type': OH98051

Write-up: SIDS;


Changed on 2/14/2018

VAERS ID: 113440 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Ohio
Vaccinated:1998-07-21
Onset:1998-07-22
Submitted:1998-07-24
Entered:1998-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 451498 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0326H / UNK LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0147 / 1 LL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-07-22
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:
CDC 'Split Type': OH98051

Write-up: SIDS;


Changed on 6/14/2018

VAERS ID: 113440 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Ohio
Vaccinated:1998-07-21
Onset:1998-07-22
Submitted:1998-07-24
Entered:1998-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 451498 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0326H / UNK LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0147 / 1 LL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-07-22
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:
CDC 'Split Type': OH98051

Write-up: SIDS;


Changed on 8/14/2018

VAERS ID: 113440 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Ohio
Vaccinated:1998-07-21
Onset:1998-07-22
Submitted:1998-07-24
Entered:1998-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 451498 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0326H / UNK LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0147 / 1 LL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-07-22
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:
CDC 'Split Type': OH98051

Write-up: SIDS;


Changed on 9/14/2018

VAERS ID: 113440 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Ohio
Vaccinated:1998-07-21
Onset:1998-07-22
Submitted:1998-07-24
Entered:1998-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 451498 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0326H / UNK LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0147 / 1 LL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-07-22
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:
CDC 'Split Type': OH98051

Write-up: SIDS;


Changed on 10/14/2018

VAERS ID: 113440 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Ohio
Vaccinated:1998-07-21
Onset:1998-07-22
Submitted:1998-07-24
Entered:1998-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 451498 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0326H / UNK LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0147 / 1 LL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-07-22
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:
CDC 'Split Type': OH98051

Write-up: SIDS;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=113440&WAYBACKHISTORY=ON


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