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This is VAERS ID 113915

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 113915
VAERS Form:
Age:0.1
Sex:Female
Location:Minnesota
Vaccinated:1998-09-03
Onset:1998-09-03
Submitted:1998-09-03
Entered:1998-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: ENGERIX-B / SMITHKLINE 2705A2 / 0 LL / IM

Administered by: Private      Purchased by: Unknown
Symptoms: REACT UNEVAL

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-09-03
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':

Write-up: preliminary rpeort baby died in car ride home, no preceding sx, signs;EMS called @ 942AM autopsy currently being done;


Changed on 12/8/2009

VAERS ID: 113915 Before After
VAERS Form:
Age:0.1
Sex:Female
Location:Minnesota
Vaccinated:1998-09-03
Onset:1998-09-03
Submitted:1998-09-03
Entered:1998-09-09 1998-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: ENGERIX-B HEP B (ENGERIX-B) / SMITHKLINE SMITHKLINE BEECHAM 2705A2 / 0 LL / IM

Administered by: Private Unknown      Purchased by: Unknown
Symptoms: Cardiac failure, Cardiomegaly, Congenital anomaly, REACT UNEVAL

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-09-03
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':

Write-up: preliminary rpeort baby died in car ride home, no preceding sx, signs;EMS called @ 942AM autopsy currently being done;


Changed on 5/14/2017

VAERS ID: 113915 Before After
VAERS Form:
Age:0.1
Sex:Female
Location:Minnesota
Vaccinated:1998-09-03
Onset:1998-09-03
Submitted:1998-09-03
Entered:1998-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2705A2 / 0 LL / IM

Administered by: Unknown Private      Purchased by: Unknown Private
Symptoms: Cardiac failure, Cardiomegaly, Congenital anomaly

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-09-03
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':

Write-up: preliminary rpeort baby died in car ride home, no preceding sx, signs;EMS called @ 942AM autopsy currently being done;


Changed on 9/14/2017

VAERS ID: 113915 Before After
VAERS Form:(blank) 1
Age:0.1
Sex:Female
Location:Minnesota
Vaccinated:1998-09-03
Onset:1998-09-03
Submitted:1998-09-03
Entered:1998-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2705A2 / 0 1 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Cardiac failure, Cardiomegaly, Congenital anomaly

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-09-03
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':

Write-up: preliminary rpeort baby died in car ride home, no preceding sx, signs;EMS called @ 942AM autopsy currently being done;


Changed on 2/14/2018

VAERS ID: 113915 Before After
VAERS Form:1
Age:0.1
Sex:Female
Location:Minnesota
Vaccinated:1998-09-03
Onset:1998-09-03
Submitted:1998-09-03
Entered:1998-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2705A2 / 1 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Cardiac failure, Cardiomegaly, Congenital anomaly

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-09-03
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':

Write-up: preliminary rpeort baby died in car ride home, no preceding sx, signs;EMS called @ 942AM autopsy currently being done;


Changed on 6/14/2018

VAERS ID: 113915 Before After
VAERS Form:1
Age:0.1
Sex:Female
Location:Minnesota
Vaccinated:1998-09-03
Onset:1998-09-03
Submitted:1998-09-03
Entered:1998-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2705A2 / 1 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Cardiac failure, Cardiomegaly, Congenital anomaly

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-09-03
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':

Write-up: preliminary rpeort baby died in car ride home, no preceding sx, signs;EMS called @ 942AM autopsy currently being done;


Changed on 8/14/2018

VAERS ID: 113915 Before After
VAERS Form:1
Age:0.1
Sex:Female
Location:Minnesota
Vaccinated:1998-09-03
Onset:1998-09-03
Submitted:1998-09-03
Entered:1998-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2705A2 / 1 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Cardiac failure, Cardiomegaly, Congenital anomaly

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-09-03
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':

Write-up: preliminary rpeort baby died in car ride home, no preceding sx, signs;EMS called @ 942AM autopsy currently being done;


Changed on 9/14/2018

VAERS ID: 113915 Before After
VAERS Form:1
Age:0.1
Sex:Female
Location:Minnesota
Vaccinated:1998-09-03
Onset:1998-09-03
Submitted:1998-09-03
Entered:1998-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2705A2 / 1 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Cardiac failure, Cardiomegaly, Congenital anomaly

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-09-03
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':

Write-up: preliminary rpeort baby died in car ride home, no preceding sx, signs;EMS called @ 942AM autopsy currently being done;


Changed on 10/14/2018

VAERS ID: 113915 Before After
VAERS Form:1
Age:0.1
Sex:Female
Location:Minnesota
Vaccinated:1998-09-03
Onset:1998-09-03
Submitted:1998-09-03
Entered:1998-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2705A2 / 1 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Cardiac failure, Cardiomegaly, Congenital anomaly

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-09-03
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':

Write-up: preliminary rpeort baby died in car ride home, no preceding sx, signs;EMS called @ 942AM autopsy currently being done;

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