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This is VAERS ID 113478

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 113478
VAERS Form:
Age:0.0
Sex:Male
Location:New Hampshire
Vaccinated:1997-11-24
Onset:1997-12-26
Submitted:1998-08-01
Entered:1998-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: RECOMBIVAX HB / MSD 0424E / 0 RL / -

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-12-26
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:
Preexisting Conditions: port wine stain rt eyelid consistant w/opthamic portion of 5th cranial nerves;discoloration;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': port wine stain rt eyelid consistant w/opthamic portion of 5th cranial nerves;discoloration;

Write-up: SIDS;


Changed on 12/8/2009

VAERS ID: 113478 Before After
VAERS Form:
Age:0.0
Sex:Male
Location:New Hampshire
Vaccinated:1997-11-24
Onset:1997-12-26
Submitted:1998-08-01
Entered:1998-08-19 1998-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: RECOMBIVAX HB HEP B (RECOMBIVAX HB) / MSD MERCK & CO. INC. 0424E / 0 RL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-12-26
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:
Preexisting Conditions: port wine stain rt eyelid consistant w/opthamic portion of 5th cranial nerves;discoloration;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': port wine stain rt eyelid consistant w/opthamic portion of 5th cranial nerves;discoloration; NH97

Write-up: SIDS;


Changed on 5/14/2017

VAERS ID: 113478 Before After
VAERS Form:
Age:0.0
Sex:Male
Location:New Hampshire
Vaccinated:1997-11-24
Onset:1997-12-26
Submitted:1998-08-01
Entered:1998-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0424E / 0 RL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-12-26
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:
Preexisting Conditions: port wine stain rt eyelid consistant w/opthamic portion of 5th cranial nerves;discoloration;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NH97

Write-up: SIDS;


Changed on 9/14/2017

VAERS ID: 113478 Before After
VAERS Form:(blank) 1
Age:0.0
Sex:Male
Location:New Hampshire
Vaccinated:1997-11-24
Onset:1997-12-26
Submitted:1998-08-01
Entered:1998-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0424E / 0 1 RL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-12-26
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:
Preexisting Conditions: port wine stain rt eyelid consistant w/opthamic portion of 5th cranial nerves;discoloration;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NH97

Write-up: SIDS;


Changed on 2/14/2018

VAERS ID: 113478 Before After
VAERS Form:1
Age:0.0
Sex:Male
Location:New Hampshire
Vaccinated:1997-11-24
Onset:1997-12-26
Submitted:1998-08-01
Entered:1998-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0424E / 1 RL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-12-26
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:
Preexisting Conditions: port wine stain rt eyelid consistant w/opthamic portion of 5th cranial nerves;discoloration;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NH97

Write-up: SIDS;


Changed on 6/14/2018

VAERS ID: 113478 Before After
VAERS Form:1
Age:0.0
Sex:Male
Location:New Hampshire
Vaccinated:1997-11-24
Onset:1997-12-26
Submitted:1998-08-01
Entered:1998-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0424E / 1 RL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-12-26
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:
Preexisting Conditions: port wine stain rt eyelid consistant w/opthamic portion of 5th cranial nerves;discoloration;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NH97

Write-up: SIDS;


Changed on 8/14/2018

VAERS ID: 113478 Before After
VAERS Form:1
Age:0.0
Sex:Male
Location:New Hampshire
Vaccinated:1997-11-24
Onset:1997-12-26
Submitted:1998-08-01
Entered:1998-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0424E / 1 RL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-12-26
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:
Preexisting Conditions: port wine stain rt eyelid consistant w/opthamic portion of 5th cranial nerves;discoloration;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NH97

Write-up: SIDS;


Changed on 9/14/2018

VAERS ID: 113478 Before After
VAERS Form:1
Age:0.0
Sex:Male
Location:New Hampshire
Vaccinated:1997-11-24
Onset:1997-12-26
Submitted:1998-08-01
Entered:1998-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0424E / 1 RL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-12-26
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:
Preexisting Conditions: port wine stain rt eyelid consistant w/opthamic portion of 5th cranial nerves;discoloration;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NH97

Write-up: SIDS;


Changed on 10/14/2018

VAERS ID: 113478 Before After
VAERS Form:1
Age:0.0
Sex:Male
Location:New Hampshire
Vaccinated:1997-11-24
Onset:1997-12-26
Submitted:1998-08-01
Entered:1998-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0424E / 1 RL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-12-26
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:
Preexisting Conditions: port wine stain rt eyelid consistant w/opthamic portion of 5th cranial nerves;discoloration;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NH97

Write-up: SIDS;


Changed on 7/14/2019

VAERS ID: 113478 Before After
VAERS Form:1
Age:0.0 (blank)
Sex:Male
Location:New Hampshire
Vaccinated:1997-11-24
Onset:1997-12-26
Submitted:1998-08-01
Entered:1998-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0424E / 1 RL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-12-26
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:
Preexisting Conditions: port wine stain rt eyelid consistant w/opthamic portion of 5th cranial nerves;discoloration;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NH97

Write-up: SIDS;

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