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This is VAERS ID 113916

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 113916
VAERS Form:
Age:0.2
Sex:Male
Location:Alaska
Vaccinated:1998-07-27
Onset:1998-08-13
Submitted:1998-08-14
Entered:1998-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE / LEDERLE 451498 / 0 LL / IM
HEP: RECOMBIVAX HB / MSD 0238H / 1 RL / IM
HIBV: PEDVAXHIB / MSD 1177E / 0 RL / IM
IPV: POLIOVAX / CONNAUGHT LTD M12952 / 0 LL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-08-13
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: unk
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE (infant-prenatal hx of drug use by mom)
Allergies:
Diagnostic Lab Data: autopsy performed-unk results as to cause of death
CDC 'Split Type': NONE (infant-prenatal hx of drug use by mom)

Write-up: no adverse events reported by grandmo (caregiver) she stated did fine & no problems;


Changed on 12/8/2009

VAERS ID: 113916 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Alaska
Vaccinated:1998-07-27
Onset:1998-08-13
Submitted:1998-08-14
Entered:1998-09-10 1998-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE DTAP (ACEL-IMUNE) / LEDERLE LEDERLE LABORATORIES 451498 / 0 LL / IM
HEP: RECOMBIVAX HB HEP B (RECOMBIVAX HB) / MSD MERCK & CO. INC. 0238H / 1 RL / IM
HIBV: PEDVAXHIB HIB (PEDVAXHIB) / MSD MERCK & CO. INC. 1177E / 0 RL / IM
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. M12952 / 0 LL / SC

Administered by: Public      Purchased by: Unknown Public
Symptoms: Unevaluable event, REACT UNEVAL

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-08-13
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: unk
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE (infant-prenatal hx of drug use by mom)
Allergies:
Diagnostic Lab Data: autopsy performed-unk results as to cause of death
CDC 'Split Type': NONE (infant-prenatal hx of drug use by mom) AK9199811

Write-up: no adverse events reported by grandmo (caregiver) she stated did fine & no problems;


Changed on 5/14/2017

VAERS ID: 113916 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Alaska
Vaccinated:1998-07-27
Onset:1998-08-13
Submitted:1998-08-14
Entered:1998-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 451498 / 0 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0238H / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1177E / 0 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M12952 / 0 LL / SC

Administered by: Public      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-08-13
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: unk unk~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE (infant-prenatal hx of drug use by mom)
Allergies:
Diagnostic Lab Data: autopsy performed-unk results as to cause of death
CDC 'Split Type': AK9199811

Write-up: no adverse events reported by grandmo (caregiver) she stated did fine & no problems;


Changed on 9/14/2017

VAERS ID: 113916 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:Alaska
Vaccinated:1998-07-27
Onset:1998-08-13
Submitted:1998-08-14
Entered:1998-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 451498 / 0 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0238H / 1 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1177E / 0 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M12952 / 0 1 LL / SC

Administered by: Public      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-08-13
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: unk~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE (infant-prenatal hx of drug use by mom)
Allergies:
Diagnostic Lab Data: autopsy performed-unk results as to cause of death
CDC 'Split Type': AK9199811

Write-up: no adverse events reported by grandmo (caregiver) she stated did fine & no problems;


Changed on 2/14/2018

VAERS ID: 113916 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Alaska
Vaccinated:1998-07-27
Onset:1998-08-13
Submitted:1998-08-14
Entered:1998-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 451498 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0238H / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1177E / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M12952 / 1 LL / SC

Administered by: Public      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-08-13
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: unk~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE (infant-prenatal hx of drug use by mom)
Allergies:
Diagnostic Lab Data: autopsy performed-unk results as to cause of death
CDC 'Split Type': AK9199811

Write-up: no adverse events reported by grandmo (caregiver) she stated did fine & no problems;


Changed on 6/14/2018

VAERS ID: 113916 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Alaska
Vaccinated:1998-07-27
Onset:1998-08-13
Submitted:1998-08-14
Entered:1998-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 451498 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0238H / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1177E / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M12952 / 1 LL / SC

Administered by: Public      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-08-13
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: unk~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE (infant-prenatal hx of drug use by mom)
Allergies:
Diagnostic Lab Data: autopsy performed-unk results as to cause of death
CDC 'Split Type': AK9199811

Write-up: no adverse events reported by grandmo (caregiver) she stated did fine & no problems;


Changed on 8/14/2018

VAERS ID: 113916 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Alaska
Vaccinated:1998-07-27
Onset:1998-08-13
Submitted:1998-08-14
Entered:1998-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 451498 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0238H / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1177E / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M12952 / 1 LL / SC

Administered by: Public      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-08-13
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: unk~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE (infant-prenatal hx of drug use by mom)
Allergies:
Diagnostic Lab Data: autopsy performed-unk results as to cause of death
CDC 'Split Type': AK9199811

Write-up: no adverse events reported by grandmo (caregiver) she stated did fine & no problems;


Changed on 9/14/2018

VAERS ID: 113916 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Alaska
Vaccinated:1998-07-27
Onset:1998-08-13
Submitted:1998-08-14
Entered:1998-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 451498 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0238H / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1177E / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M12952 / 1 LL / SC

Administered by: Public      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-08-13
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: unk~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE (infant-prenatal hx of drug use by mom)
Allergies:
Diagnostic Lab Data: autopsy performed-unk results as to cause of death
CDC 'Split Type': AK9199811

Write-up: no adverse events reported by grandmo (caregiver) she stated did fine & no problems;


Changed on 10/14/2018

VAERS ID: 113916 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Alaska
Vaccinated:1998-07-27
Onset:1998-08-13
Submitted:1998-08-14
Entered:1998-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 451498 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0238H / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1177E / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M12952 / 1 LL / SC

Administered by: Public      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-08-13
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: unk~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE (infant-prenatal hx of drug use by mom)
Allergies:
Diagnostic Lab Data: autopsy performed-unk results as to cause of death
CDC 'Split Type': AK9199811

Write-up: no adverse events reported by grandmo (caregiver) she stated did fine & no problems;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=113916&WAYBACKHISTORY=ON


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