National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 114109

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 114109
VAERS Form:
Age:0.2
Sex:Female
Location:Idaho
Vaccinated:1998-06-16
Onset:1998-06-24
Submitted:1998-08-27
Entered:1998-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPH: TETRAMUNE / LEDERLE 449098 / 0 - / IM
HEP: ENGERIX-B / SMITHKLINE 2428A2 / 1 - / IM
IPV: POLIOVAX / CONNAUGHT LTD M1295 / 0 - / SC

Administered by: Private      Purchased by: Unknown
Symptoms: INFECT, LYMPHADENO, FLU SYND, EDEMA LUNG, CONJUNCTIVITIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-06-24
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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: positive haemophilus influenzae cult both lung (autopsy);
CDC 'Split Type':

Write-up: pt died 24JUN98;death certificate lists haemophilus influenzae/interstitial pneumonia;pt asymptomatic noc a/death;found dead in AM;SIDS ruled out ?;


Changed on 12/8/2009

VAERS ID: 114109 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Idaho
Vaccinated:1998-06-16
Onset:1998-06-24
Submitted:1998-08-27
Entered:1998-09-15 1998-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPH: TETRAMUNE / LEDERLE 449098 / 0 - / IM
DTPHIB: DTP + HIB (TETRAMUNE) / LEDERLE LABORATORIES 449098 / 0 - / IM
HEP: ENGERIX-B HEP B (ENGERIX-B) / SMITHKLINE SMITHKLINE BEECHAM 2428A2 / 1 - / IM
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. M1295 / 0 - / SC

Administered by: Private Unknown      Purchased by: Unknown
Symptoms: Conjunctivitis, Drug ineffective, Infection, Influenza, Lymphadenopathy, Neoplasm, Pneumonia, Pulmonary oedema, INFECT, LYMPHADENO, FLU SYND, EDEMA LUNG, CONJUNCTIVITIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-06-24
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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: positive haemophilus influenzae cult both lung (autopsy);
CDC 'Split Type': (blank) ID98039

Write-up: pt died 24JUN98;death certificate lists haemophilus influenzae/interstitial pneumonia;pt asymptomatic noc a/death;found dead in AM;SIDS ruled out ?;


Changed on 2/14/2017

VAERS ID: 114109 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Idaho
Vaccinated:1998-06-16
Onset:1998-06-24
Submitted:1998-08-27
Entered:1998-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 449098 / 0 - / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2428A2 / 1 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M1295 / 0 - / SC

Administered by: Unknown Private      Purchased by: Unknown Public
Symptoms: Conjunctivitis, Drug ineffective, Infection, Influenza, Lymphadenopathy, Neoplasm, Pneumonia, Pulmonary oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-06-24
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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: positive haemophilus influenzae cult both lung (autopsy);
CDC 'Split Type': ID98039

Write-up: pt died 24JUN98;death certificate lists haemophilus influenzae/interstitial pneumonia;pt asymptomatic noc a/death;found dead in AM;SIDS ruled out ?;


Changed on 9/14/2017

VAERS ID: 114109 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Female
Location:Idaho
Vaccinated:1998-06-16
Onset:1998-06-24
Submitted:1998-08-27
Entered:1998-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 449098 / 0 1 - / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2428A2 / 1 2 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M1295 / 0 1 - / SC

Administered by: Private      Purchased by: Public
Symptoms: Conjunctivitis, Drug ineffective, Infection, Influenza, Lymphadenopathy, Neoplasm, Pneumonia, Pulmonary oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-06-24
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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: positive haemophilus influenzae cult both lung (autopsy);
CDC 'Split Type': ID98039

Write-up: pt died 24JUN98;death certificate lists haemophilus influenzae/interstitial pneumonia;pt asymptomatic noc a/death;found dead in AM;SIDS ruled out ?;


Changed on 2/14/2018

VAERS ID: 114109 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Idaho
Vaccinated:1998-06-16
Onset:1998-06-24
Submitted:1998-08-27
Entered:1998-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 449098 / 1 - / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2428A2 / 2 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M1295 / 1 - / SC

Administered by: Private      Purchased by: Public
Symptoms: Conjunctivitis, Drug ineffective, Infection, Influenza, Lymphadenopathy, Neoplasm, Pneumonia, Pulmonary oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-06-24
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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: positive haemophilus influenzae cult both lung (autopsy);
CDC 'Split Type': ID98039

Write-up: pt died 24JUN98;death certificate lists haemophilus influenzae/interstitial pneumonia;pt asymptomatic noc a/death;found dead in AM;SIDS ruled out ?;


Changed on 6/14/2018

VAERS ID: 114109 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Idaho
Vaccinated:1998-06-16
Onset:1998-06-24
Submitted:1998-08-27
Entered:1998-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 449098 / 1 - / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2428A2 / 2 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M1295 / 1 - / SC

Administered by: Private      Purchased by: Public
Symptoms: Conjunctivitis, Drug ineffective, Infection, Influenza, Lymphadenopathy, Neoplasm, Pneumonia, Pulmonary oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-06-24
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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: positive haemophilus influenzae cult both lung (autopsy);
CDC 'Split Type': ID98039

Write-up: pt died 24JUN98;death certificate lists haemophilus influenzae/interstitial pneumonia;pt asymptomatic noc a/death;found dead in AM;SIDS ruled out ?;


Changed on 8/14/2018

VAERS ID: 114109 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Idaho
Vaccinated:1998-06-16
Onset:1998-06-24
Submitted:1998-08-27
Entered:1998-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 449098 / 1 - / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2428A2 / 2 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M1295 / 1 - / SC

Administered by: Private      Purchased by: Public
Symptoms: Conjunctivitis, Drug ineffective, Infection, Influenza, Lymphadenopathy, Neoplasm, Pneumonia, Pulmonary oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-06-24
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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: positive haemophilus influenzae cult both lung (autopsy);
CDC 'Split Type': ID98039

Write-up: pt died 24JUN98;death certificate lists haemophilus influenzae/interstitial pneumonia;pt asymptomatic noc a/death;found dead in AM;SIDS ruled out ?;


Changed on 9/14/2018

VAERS ID: 114109 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Idaho
Vaccinated:1998-06-16
Onset:1998-06-24
Submitted:1998-08-27
Entered:1998-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 449098 / 1 - / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2428A2 / 2 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M1295 / 1 - / SC

Administered by: Private      Purchased by: Public
Symptoms: Conjunctivitis, Drug ineffective, Infection, Influenza, Lymphadenopathy, Neoplasm, Pneumonia, Pulmonary oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-06-24
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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: positive haemophilus influenzae cult both lung (autopsy);
CDC 'Split Type': ID98039

Write-up: pt died 24JUN98;death certificate lists haemophilus influenzae/interstitial pneumonia;pt asymptomatic noc a/death;found dead in AM;SIDS ruled out ?;


Changed on 10/14/2018

VAERS ID: 114109 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Idaho
Vaccinated:1998-06-16
Onset:1998-06-24
Submitted:1998-08-27
Entered:1998-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 449098 / 1 - / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2428A2 / 2 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M1295 / 1 - / SC

Administered by: Private      Purchased by: Public
Symptoms: Conjunctivitis, Drug ineffective, Infection, Influenza, Lymphadenopathy, Neoplasm, Pneumonia, Pulmonary oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-06-24
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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: positive haemophilus influenzae cult both lung (autopsy);
CDC 'Split Type': ID98039

Write-up: pt died 24JUN98;death certificate lists haemophilus influenzae/interstitial pneumonia;pt asymptomatic noc a/death;found dead in AM;SIDS ruled out ?;

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=114109&WAYBACKHISTORY=ON


Copyright © 2020 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166