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This is VAERS ID 114230

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 114230
VAERS Form:
Age:0.4
Sex:Female
Location:Arkansas
Vaccinated:1998-09-10
Onset:1998-09-10
Submitted:1998-09-11
Entered:1998-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA / CONNAUGHT LABS 453846 / 1 LL / IM
HIBV: PROHIBIT / CONNAUGHT LABS 0942550 / 1 RL / IM
IPV: POLIOVAX / CONNAUGHT LTD N00321 / 1 RL / SC

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-09-10
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: NONE
Other Medications: Lactalose;Cardac Dm
Current Illness: nasal congestion
Preexisting Conditions: constipation
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': constipation

Write-up: pt was seen in the office on 10SEP98 for 4mo check up;recv vax died early evening on 10SEP98;15SEP98 MD reports poss SIDS:vaccine related pending;


Changed on 12/8/2009

VAERS ID: 114230 Before After
VAERS Form:
Age:0.4
Sex:Female
Location:Arkansas
Vaccinated:1998-09-10
Onset:1998-09-10
Submitted:1998-09-11
Entered:1998-09-22 1998-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA DTAP (TRIPEDIA) / CONNAUGHT LABS CONNAUGHT LABORATORIES 453846 / 1 LL / IM
HIBV: PROHIBIT HIB (PROHIBIT) / CONNAUGHT LABS CONNAUGHT LABORATORIES 0942550 / 1 RL / IM
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. N00321 / 1 RL / SC

Administered by: Private      Purchased by: Unknown Public
Symptoms: SIDS, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-09-10
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: NONE
Other Medications: Lactalose;Cardac Dm
Current Illness: nasal congestion
Preexisting Conditions: constipation
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': constipation AR9852

Write-up: pt was seen in the office on 10SEP98 for 4mo check up;recv vax died early evening on 10SEP98;15SEP98 MD reports poss SIDS:vaccine related pending;


Changed on 5/14/2017

VAERS ID: 114230 Before After
VAERS Form:
Age:0.4
Sex:Female
Location:Arkansas
Vaccinated:1998-09-10
Onset:1998-09-10
Submitted:1998-09-11
Entered:1998-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 453846 / 1 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0942550 / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N00321 / 1 RL / SC

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-09-10
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: NONE NONE~ ()~~~In patient
Other Medications: Lactalose;Cardac Dm
Current Illness: nasal congestion
Preexisting Conditions: constipation
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': AR9852

Write-up: pt was seen in the office on 10SEP98 for 4mo check up;recv vax died early evening on 10SEP98;15SEP98 MD reports poss SIDS:vaccine related pending;


Changed on 9/14/2017

VAERS ID: 114230 Before After
VAERS Form:(blank) 1
Age:0.4
Sex:Female
Location:Arkansas
Vaccinated:1998-09-10
Onset:1998-09-10
Submitted:1998-09-11
Entered:1998-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 453846 / 1 2 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0942550 / 1 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N00321 / 1 2 RL / SC

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-09-10
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: NONE~ ()~~~In patient
Other Medications: Lactalose;Cardac Dm
Current Illness: nasal congestion
Preexisting Conditions: constipation
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': AR9852

Write-up: pt was seen in the office on 10SEP98 for 4mo check up;recv vax died early evening on 10SEP98;15SEP98 MD reports poss SIDS:vaccine related pending;


Changed on 2/14/2018

VAERS ID: 114230 Before After
VAERS Form:1
Age:0.4
Sex:Female
Location:Arkansas
Vaccinated:1998-09-10
Onset:1998-09-10
Submitted:1998-09-11
Entered:1998-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 453846 / 2 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0942550 / 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N00321 / 2 RL / SC

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-09-10
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: NONE~ ()~~~In patient
Other Medications: Lactalose;Cardac Dm
Current Illness: nasal congestion
Preexisting Conditions: constipation
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': AR9852

Write-up: pt was seen in the office on 10SEP98 for 4mo check up;recv vax died early evening on 10SEP98;15SEP98 MD reports poss SIDS:vaccine related pending;


Changed on 6/14/2018

VAERS ID: 114230 Before After
VAERS Form:1
Age:0.4
Sex:Female
Location:Arkansas
Vaccinated:1998-09-10
Onset:1998-09-10
Submitted:1998-09-11
Entered:1998-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 453846 / 2 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0942550 / 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N00321 / 2 RL / SC

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-09-10
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: NONE~ ()~~~In patient
Other Medications: Lactalose;Cardac Dm
Current Illness: nasal congestion
Preexisting Conditions: constipation
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': AR9852

Write-up: pt was seen in the office on 10SEP98 for 4mo check up;recv vax died early evening on 10SEP98;15SEP98 MD reports poss SIDS:vaccine related pending;


Changed on 8/14/2018

VAERS ID: 114230 Before After
VAERS Form:1
Age:0.4
Sex:Female
Location:Arkansas
Vaccinated:1998-09-10
Onset:1998-09-10
Submitted:1998-09-11
Entered:1998-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 453846 / 2 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0942550 / 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N00321 / 2 RL / SC

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-09-10
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: NONE~ ()~~~In patient
Other Medications: Lactalose;Cardac Dm
Current Illness: nasal congestion
Preexisting Conditions: constipation
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': AR9852

Write-up: pt was seen in the office on 10SEP98 for 4mo check up;recv vax died early evening on 10SEP98;15SEP98 MD reports poss SIDS:vaccine related pending;


Changed on 9/14/2018

VAERS ID: 114230 Before After
VAERS Form:1
Age:0.4
Sex:Female
Location:Arkansas
Vaccinated:1998-09-10
Onset:1998-09-10
Submitted:1998-09-11
Entered:1998-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 453846 / 2 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0942550 / 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N00321 / 2 RL / SC

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-09-10
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: NONE~ ()~~~In patient
Other Medications: Lactalose;Cardac Dm
Current Illness: nasal congestion
Preexisting Conditions: constipation
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': AR9852

Write-up: pt was seen in the office on 10SEP98 for 4mo check up;recv vax died early evening on 10SEP98;15SEP98 MD reports poss SIDS:vaccine related pending;


Changed on 10/14/2018

VAERS ID: 114230 Before After
VAERS Form:1
Age:0.4
Sex:Female
Location:Arkansas
Vaccinated:1998-09-10
Onset:1998-09-10
Submitted:1998-09-11
Entered:1998-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 453846 / 2 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0942550 / 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N00321 / 2 RL / SC

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-09-10
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: NONE~ ()~~~In patient
Other Medications: Lactalose;Cardac Dm
Current Illness: nasal congestion
Preexisting Conditions: constipation
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': AR9852

Write-up: pt was seen in the office on 10SEP98 for 4mo check up;recv vax died early evening on 10SEP98;15SEP98 MD reports poss SIDS:vaccine related pending;

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