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This is VAERS ID 161757

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 161757
VAERS Form:
Age:4.0
Sex:Female
Location:Nevada
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2000-11-07
Entered:2000-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: ENGERIX-B / SMITHKLINE - / 1 - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: CARDIOVASC DIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Preexisting Conditions: The pt had a sibling that died from crib death "years ago"
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Two weeks following dose 2 of Engerix-B, the vaccinee died. The autopsy showed that the vaccinee had a hole in her heart.


Changed on 12/8/2009

VAERS ID: 161757 Before After
VAERS Form:
Age:4.0
Sex:Female
Location:Nevada
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2000-11-07
Entered:2000-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: ENGERIX-B HEP B (ENGERIX-B) / SMITHKLINE SMITHKLINE BEECHAM - / 1 - / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Cardiac disorder, CARDIOVASC DIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Preexisting Conditions: The pt had a sibling that died from crib death "years ago"
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) 20000321491

Write-up: Two weeks following dose 2 of Engerix-B, the vaccinee died. The autopsy showed that the vaccinee had a hole in her heart.


Changed on 9/14/2017

VAERS ID: 161757 Before After
VAERS Form:(blank) 1
Age:4.0
Sex:Female
Location:Nevada
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2000-11-07
Entered:2000-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / 1 2 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Cardiac disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Preexisting Conditions: The pt had a sibling that died from crib death "years ago"
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 20000321491

Write-up: Two weeks following dose 2 of Engerix-B, the vaccinee died. The autopsy showed that the vaccinee had a hole in her heart.


Changed on 2/14/2018

VAERS ID: 161757 Before After
VAERS Form:1
Age:4.0
Sex:Female
Location:Nevada
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2000-11-07
Entered:2000-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / 2 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Cardiac disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Preexisting Conditions: The pt had a sibling that died from crib death "years ago"
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 20000321491

Write-up: Two weeks following dose 2 of Engerix-B, the vaccinee died. The autopsy showed that the vaccinee had a hole in her heart.


Changed on 6/14/2018

VAERS ID: 161757 Before After
VAERS Form:1
Age:4.0
Sex:Female
Location:Nevada
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2000-11-07
Entered:2000-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / 2 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Cardiac disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Preexisting Conditions: The pt had a sibling that died from crib death "years ago"
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 20000321491

Write-up: Two weeks following dose 2 of Engerix-B, the vaccinee died. The autopsy showed that the vaccinee had a hole in her heart.


Changed on 8/14/2018

VAERS ID: 161757 Before After
VAERS Form:1
Age:4.0
Sex:Female
Location:Nevada
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2000-11-07
Entered:2000-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / 2 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Cardiac disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Preexisting Conditions: The pt had a sibling that died from crib death "years ago"
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 20000321491

Write-up: Two weeks following dose 2 of Engerix-B, the vaccinee died. The autopsy showed that the vaccinee had a hole in her heart.


Changed on 9/14/2018

VAERS ID: 161757 Before After
VAERS Form:1
Age:4.0
Sex:Female
Location:Nevada
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2000-11-07
Entered:2000-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / 2 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Cardiac disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Preexisting Conditions: The pt had a sibling that died from crib death "years ago"
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 20000321491

Write-up: Two weeks following dose 2 of Engerix-B, the vaccinee died. The autopsy showed that the vaccinee had a hole in her heart.


Changed on 10/14/2018

VAERS ID: 161757 Before After
VAERS Form:1
Age:4.0
Sex:Female
Location:Nevada
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2000-11-07
Entered:2000-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / 2 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Cardiac disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Preexisting Conditions: The pt had a sibling that died from crib death "years ago"
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 20000321491

Write-up: Two weeks following dose 2 of Engerix-B, the vaccinee died. The autopsy showed that the vaccinee had a hole in her heart.

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