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This is VAERS ID 113718

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 113718
VAERS Form:
Age:0.4
Sex:Male
Location:Pennsylvania
Vaccinated:1998-07-15
Onset:1998-07-15
Submitted:1998-08-27
Entered:1998-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA / CONNAUGHT LABS 0925880 / 1 LL / IM
HIBV: ACT-HIB / CONNAUGHT LABS 094642 / 1 RL / IM
IPV: POLIOVAX / CONNAUGHT LTD N02912 / 1 RL / IM

Administered by: Private      Purchased by: Unknown
Symptoms: AGITATION, APNEA, HEART ARREST

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-07-19
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: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: pt reported to have been mildly irritable the day & the day p/vax;on the 4th day p/vax pt had bottle in AM (8AM) & was put down for a nap around noon & was found dead about 30min later;


Changed on 12/8/2009

VAERS ID: 113718 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:Pennsylvania
Vaccinated:1998-07-15
Onset:1998-07-15
Submitted:1998-08-27
Entered:1998-09-01 1998-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA DTAP (TRIPEDIA) / CONNAUGHT LABS CONNAUGHT LABORATORIES 0925880 / 1 LL / IM
HIBV: ACT-HIB HIB (ACTHIB) / CONNAUGHT LABS CONNAUGHT LABORATORIES 094642 / 1 RL / IM
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. N02912 / 1 RL / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Agitation, Apnoea, Cardiac arrest, AGITATION, APNEA, HEART ARREST

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-07-19
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: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: pt reported to have been mildly irritable the day & the day p/vax;on the 4th day p/vax pt had bottle in AM (8AM) & was put down for a nap around noon & was found dead about 30min later;


Changed on 5/14/2017

VAERS ID: 113718 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:Pennsylvania
Vaccinated:1998-07-15
Onset:1998-07-15
Submitted:1998-08-27
Entered:1998-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0925880 / 1 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 094642 / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N02912 / 1 RL / IM

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Apnoea, Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-07-19
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:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: pt reported to have been mildly irritable the day & the day p/vax;on the 4th day p/vax pt had bottle in AM (8AM) & was put down for a nap around noon & was found dead about 30min later;


Changed on 9/14/2017

VAERS ID: 113718 Before After
VAERS Form:(blank) 1
Age:0.4
Sex:Male
Location:Pennsylvania
Vaccinated:1998-07-15
Onset:1998-07-15
Submitted:1998-08-27
Entered:1998-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0925880 / 1 2 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 094642 / 1 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N02912 / 1 2 RL / IM

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Apnoea, Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-07-19
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:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: pt reported to have been mildly irritable the day & the day p/vax;on the 4th day p/vax pt had bottle in AM (8AM) & was put down for a nap around noon & was found dead about 30min later;


Changed on 2/14/2018

VAERS ID: 113718 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Pennsylvania
Vaccinated:1998-07-15
Onset:1998-07-15
Submitted:1998-08-27
Entered:1998-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0925880 / 2 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 094642 / 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N02912 / 2 RL / IM

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Apnoea, Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-07-19
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:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: pt reported to have been mildly irritable the day & the day p/vax;on the 4th day p/vax pt had bottle in AM (8AM) & was put down for a nap around noon & was found dead about 30min later;


Changed on 6/14/2018

VAERS ID: 113718 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Pennsylvania
Vaccinated:1998-07-15
Onset:1998-07-15
Submitted:1998-08-27
Entered:1998-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0925880 / 2 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 094642 / 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N02912 / 2 RL / IM

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Apnoea, Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-07-19
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:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: pt reported to have been mildly irritable the day & the day p/vax;on the 4th day p/vax pt had bottle in AM (8AM) & was put down for a nap around noon & was found dead about 30min later;


Changed on 8/14/2018

VAERS ID: 113718 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Pennsylvania
Vaccinated:1998-07-15
Onset:1998-07-15
Submitted:1998-08-27
Entered:1998-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0925880 / 2 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 094642 / 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N02912 / 2 RL / IM

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Apnoea, Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-07-19
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:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: pt reported to have been mildly irritable the day & the day p/vax;on the 4th day p/vax pt had bottle in AM (8AM) & was put down for a nap around noon & was found dead about 30min later;


Changed on 9/14/2018

VAERS ID: 113718 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Pennsylvania
Vaccinated:1998-07-15
Onset:1998-07-15
Submitted:1998-08-27
Entered:1998-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0925880 / 2 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 094642 / 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N02912 / 2 RL / IM

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Apnoea, Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-07-19
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:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: pt reported to have been mildly irritable the day & the day p/vax;on the 4th day p/vax pt had bottle in AM (8AM) & was put down for a nap around noon & was found dead about 30min later;


Changed on 10/14/2018

VAERS ID: 113718 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Pennsylvania
Vaccinated:1998-07-15
Onset:1998-07-15
Submitted:1998-08-27
Entered:1998-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0925880 / 2 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 094642 / 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N02912 / 2 RL / IM

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Apnoea, Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-07-19
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:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: pt reported to have been mildly irritable the day & the day p/vax;on the 4th day p/vax pt had bottle in AM (8AM) & was put down for a nap around noon & was found dead about 30min later;

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