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This is VAERS ID 113800

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 113800
VAERS Form:
Age:0.2
Sex:Female
Location:Missouri
Vaccinated:1998-07-25
Onset:1998-07-29
Submitted:1998-08-04
Entered:1998-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE / LEDERLE 456295 / 0 LL / -
HEP: RECOMBIVAX HB / MSD 1221E / 1 RL / -
HIBV: HIBTITER / LEDERLE(PRAXIS) M255RJ / 0 RL / -
IPV: POLIOVAX / CONNAUGHT LTD N0032 / 0 RL / -

Administered by: Public      Purchased by: Unknown
Symptoms: SIDS, LUNG DIS, PETECHIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-07-29
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: variety done on post mortem exam;some still pending;
CDC 'Split Type':

Write-up: death certificate recv by hlth dept 30JUL;pt recv vax 25JUL98 per nurse @ local hosp;pt arrived DOA per pathologist probable cause of death SIDS;


Changed on 12/8/2009

VAERS ID: 113800 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Missouri
Vaccinated:1998-07-25
Onset:1998-07-29
Submitted:1998-08-04
Entered:1998-09-02 1998-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE DTAP (ACEL-IMUNE) / LEDERLE LEDERLE LABORATORIES 456295 / 0 LL / -
HEP: RECOMBIVAX HB HEP B (RECOMBIVAX HB) / MSD MERCK & CO. INC. 1221E / 1 RL / -
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE LABORATORIES M255RJ / 0 RL / -
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. N0032 / 0 RL / -

Administered by: Public Unknown      Purchased by: Unknown
Symptoms: Lung disorder, Petechiae, SIDS, Sudden infant death syndrome, LUNG DIS, PETECHIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-07-29
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: variety done on post mortem exam;some still pending;
CDC 'Split Type': (blank) MO98041

Write-up: death certificate recv by hlth dept 30JUL;pt recv vax 25JUL98 per nurse @ local hosp;pt arrived DOA per pathologist probable cause of death SIDS;


Changed on 5/14/2017

VAERS ID: 113800 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Missouri
Vaccinated:1998-07-25
Onset:1998-07-29
Submitted:1998-08-04
Entered:1998-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 456295 / 0 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1221E / 1 RL / -
HIBV: HIB (HIBTITER) / LEDERLE LABORATORIES PFIZER/WYETH M255RJ / 0 RL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0032 / 0 RL / -

Administered by: Unknown Public      Purchased by: Unknown Public
Symptoms: Lung disorder, Petechiae, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-07-29
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: variety done on post mortem exam;some still pending;
CDC 'Split Type': MO98041

Write-up: death certificate recv by hlth dept 30JUL;pt recv vax 25JUL98 per nurse @ local hosp;pt arrived DOA per pathologist probable cause of death SIDS;


Changed on 9/14/2017

VAERS ID: 113800 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Female
Location:Missouri
Vaccinated:1998-07-25
Onset:1998-07-29
Submitted:1998-08-04
Entered:1998-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 456295 / 0 1 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1221E / 1 2 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M255RJ / 0 1 RL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0032 / 0 1 RL / -

Administered by: Public      Purchased by: Public
Symptoms: Lung disorder, Petechiae, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-07-29
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: variety done on post mortem exam;some still pending;
CDC 'Split Type': MO98041

Write-up: death certificate recv by hlth dept 30JUL;pt recv vax 25JUL98 per nurse @ local hosp;pt arrived DOA per pathologist probable cause of death SIDS;


Changed on 2/14/2018

VAERS ID: 113800 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Missouri
Vaccinated:1998-07-25
Onset:1998-07-29
Submitted:1998-08-04
Entered:1998-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 456295 / 1 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1221E / 2 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M255RJ / 1 RL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0032 / 1 RL / -

Administered by: Public      Purchased by: Public
Symptoms: Lung disorder, Petechiae, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-07-29
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: variety done on post mortem exam;some still pending;
CDC 'Split Type': MO98041

Write-up: death certificate recv by hlth dept 30JUL;pt recv vax 25JUL98 per nurse @ local hosp;pt arrived DOA per pathologist probable cause of death SIDS;


Changed on 6/14/2018

VAERS ID: 113800 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Missouri
Vaccinated:1998-07-25
Onset:1998-07-29
Submitted:1998-08-04
Entered:1998-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 456295 / 1 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1221E / 2 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M255RJ / 1 RL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0032 / 1 RL / -

Administered by: Public      Purchased by: Public
Symptoms: Lung disorder, Petechiae, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-07-29
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: variety done on post mortem exam;some still pending;
CDC 'Split Type': MO98041

Write-up: death certificate recv by hlth dept 30JUL;pt recv vax 25JUL98 per nurse @ local hosp;pt arrived DOA per pathologist probable cause of death SIDS;


Changed on 8/14/2018

VAERS ID: 113800 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Missouri
Vaccinated:1998-07-25
Onset:1998-07-29
Submitted:1998-08-04
Entered:1998-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 456295 / 1 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1221E / 2 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M255RJ / 1 RL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0032 / 1 RL / -

Administered by: Public      Purchased by: Public
Symptoms: Lung disorder, Petechiae, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-07-29
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: variety done on post mortem exam;some still pending;
CDC 'Split Type': MO98041

Write-up: death certificate recv by hlth dept 30JUL;pt recv vax 25JUL98 per nurse @ local hosp;pt arrived DOA per pathologist probable cause of death SIDS;


Changed on 9/14/2018

VAERS ID: 113800 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Missouri
Vaccinated:1998-07-25
Onset:1998-07-29
Submitted:1998-08-04
Entered:1998-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 456295 / 1 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1221E / 2 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M255RJ / 1 RL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0032 / 1 RL / -

Administered by: Public      Purchased by: Public
Symptoms: Lung disorder, Petechiae, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-07-29
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: variety done on post mortem exam;some still pending;
CDC 'Split Type': MO98041

Write-up: death certificate recv by hlth dept 30JUL;pt recv vax 25JUL98 per nurse @ local hosp;pt arrived DOA per pathologist probable cause of death SIDS;


Changed on 10/14/2018

VAERS ID: 113800 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Missouri
Vaccinated:1998-07-25
Onset:1998-07-29
Submitted:1998-08-04
Entered:1998-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 456295 / 1 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1221E / 2 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M255RJ / 1 RL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0032 / 1 RL / -

Administered by: Public      Purchased by: Public
Symptoms: Lung disorder, Petechiae, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-07-29
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: variety done on post mortem exam;some still pending;
CDC 'Split Type': MO98041

Write-up: death certificate recv by hlth dept 30JUL;pt recv vax 25JUL98 per nurse @ local hosp;pt arrived DOA per pathologist probable cause of death SIDS;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=113800&WAYBACKHISTORY=ON


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