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This is VAERS ID 114975

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 114975
VAERS Form:
Age:0.2
Sex:Female
Location:New York
Vaccinated:1998-10-07
Onset:1998-10-08
Submitted:1998-10-08
Entered:1998-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE / LEDERLE 454759 / 0 LL / -
HIBV: HIBTITER / LEDERLE(PRAXIS) 361453A / 0 LL / -
IPV: POLIOVAX / CONNAUGHT LTD N01462 / 0 RL / -

Administered by: Private      Purchased by: Unknown
Symptoms: STUPOR

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1998-10-08
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: APAP
Current Illness: sniffles
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: found, pink but unresponsive, could not be revived-prev noc fed well;


Changed on 12/8/2009

VAERS ID: 114975 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:New York
Vaccinated:1998-10-07
Onset:1998-10-08
Submitted:1998-10-08
Entered:1998-10-19 1998-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE DTAP (ACEL-IMUNE) / LEDERLE LEDERLE LABORATORIES 454759 / 0 LL / -
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS 361453A / 0 LL / -
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. N01462 / 0 RL / -

Administered by: Private      Purchased by: Unknown Private
Symptoms: Stupor, STUPOR

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1998-10-08
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: APAP
Current Illness: sniffles
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: found, pink but unresponsive, could not be revived-prev noc fed well;


Changed on 5/14/2017

VAERS ID: 114975 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:New York
Vaccinated:1998-10-07
Onset:1998-10-08
Submitted:1998-10-08
Entered:1998-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 454759 / 0 LL / -
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH 361453A / 0 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N01462 / 0 RL / -

Administered by: Private      Purchased by: Private
Symptoms: Stupor

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1998-10-08
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: APAP
Current Illness: sniffles
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: found, pink but unresponsive, could not be revived-prev noc fed well;


Changed on 9/14/2017

VAERS ID: 114975 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Female
Location:New York
Vaccinated:1998-10-07
Onset:1998-10-08
Submitted:1998-10-08
Entered:1998-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 454759 / 0 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH 361453A / 0 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N01462 / 0 1 RL / -

Administered by: Private      Purchased by: Private
Symptoms: Stupor

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1998-10-08
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: APAP
Current Illness: sniffles
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: found, pink but unresponsive, could not be revived-prev noc fed well;


Changed on 2/14/2018

VAERS ID: 114975 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:New York
Vaccinated:1998-10-07
Onset:1998-10-08
Submitted:1998-10-08
Entered:1998-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 454759 / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH 361453A / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N01462 / 1 RL / -

Administered by: Private      Purchased by: Private
Symptoms: Stupor

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1998-10-08
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: APAP
Current Illness: sniffles
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: found, pink but unresponsive, could not be revived-prev noc fed well;


Changed on 6/14/2018

VAERS ID: 114975 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:New York
Vaccinated:1998-10-07
Onset:1998-10-08
Submitted:1998-10-08
Entered:1998-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 454759 / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH 361453A / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N01462 / 1 RL / -

Administered by: Private      Purchased by: Private
Symptoms: Stupor

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1998-10-08
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: APAP
Current Illness: sniffles
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: found, pink but unresponsive, could not be revived-prev noc fed well;


Changed on 8/14/2018

VAERS ID: 114975 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:New York
Vaccinated:1998-10-07
Onset:1998-10-08
Submitted:1998-10-08
Entered:1998-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 454759 / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH 361453A / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N01462 / 1 RL / -

Administered by: Private      Purchased by: Private
Symptoms: Stupor

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1998-10-08
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: APAP
Current Illness: sniffles
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: found, pink but unresponsive, could not be revived-prev noc fed well;


Changed on 9/14/2018

VAERS ID: 114975 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:New York
Vaccinated:1998-10-07
Onset:1998-10-08
Submitted:1998-10-08
Entered:1998-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 454759 / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH 361453A / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N01462 / 1 RL / -

Administered by: Private      Purchased by: Private
Symptoms: Stupor

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1998-10-08
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: APAP
Current Illness: sniffles
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: found, pink but unresponsive, could not be revived-prev noc fed well;


Changed on 10/14/2018

VAERS ID: 114975 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:New York
Vaccinated:1998-10-07
Onset:1998-10-08
Submitted:1998-10-08
Entered:1998-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 454759 / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH 361453A / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N01462 / 1 RL / -

Administered by: Private      Purchased by: Private
Symptoms: Stupor

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1998-10-08
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: APAP
Current Illness: sniffles
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: found, pink but unresponsive, could not be revived-prev noc fed well;

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