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This is VAERS ID 162102

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 162102
VAERS Form:
Age:0.2
Sex:Male
Location:Florida
Vaccinated:2000-11-07
Onset:2000-11-07
Submitted:2000-11-15
Entered:2000-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: ENGERIX-B / SMITHKLINE ENG3222A2 / 0 LL / IM

Administered by: Private      Purchased by: Unknown
Symptoms: RESPIRAT DIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-11-09
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: NONE
Current Illness: NONE
Preexisting Conditions: Trisomy 21, questionable history of holes in heart.
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type':

Write-up: Pt was seen 11/07 for 2 month physical evaluation and received Hepatitis B vax. No problems occurred while in the office. He apparently developed respiratory problems on the car ride home and was transferred to the hospital ER and then to another hospital"by ambulance. He expired on 11/09/2000.


Changed on 12/8/2009

VAERS ID: 162102 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Florida
Vaccinated:2000-11-07
Onset:2000-11-07
Submitted:2000-11-15
Entered:2000-11-20 2000-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: ENGERIX-B HEP B (ENGERIX-B) / SMITHKLINE SMITHKLINE BEECHAM ENG3222A2 / 0 LL / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Respiratory disorder, RESPIRAT DIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-11-09
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: NONE
Current Illness: NONE
Preexisting Conditions: Trisomy 21, questionable history of holes in heart.
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type':

Write-up: Pt was seen 11/07 for 2 month physical evaluation and received Hepatitis B vax. No problems occurred while in the office. He apparently developed respiratory problems on the car ride home and was transferred to the hospital ER and then to another hospital"by hospital by ambulance. He expired on 11/09/2000.


Changed on 9/14/2017

VAERS ID: 162102 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:Florida
Vaccinated:2000-11-07
Onset:2000-11-07
Submitted:2000-11-15
Entered:2000-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM ENG3222A2 / 0 1 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-11-09
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: NONE
Current Illness: NONE
Preexisting Conditions: Trisomy 21, questionable history of holes in heart.
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type':

Write-up: Pt was seen 11/07 for 2 month physical evaluation and received Hepatitis B vax. No problems occurred while in the office. He apparently developed respiratory problems on the car ride home and was transferred to the hospital ER and then to another hospital by ambulance. He expired on 11/09/2000.


Changed on 2/14/2018

VAERS ID: 162102 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Florida
Vaccinated:2000-11-07
Onset:2000-11-07
Submitted:2000-11-15
Entered:2000-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM ENG3222A2 / 1 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-11-09
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: NONE
Current Illness: NONE
Preexisting Conditions: Trisomy 21, questionable history of holes in heart.
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type':

Write-up: Pt was seen 11/07 for 2 month physical evaluation and received Hepatitis B vax. No problems occurred while in the office. He apparently developed respiratory problems on the car ride home and was transferred to the hospital ER and then to another hospital by ambulance. He expired on 11/09/2000.


Changed on 6/14/2018

VAERS ID: 162102 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Florida
Vaccinated:2000-11-07
Onset:2000-11-07
Submitted:2000-11-15
Entered:2000-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM ENG3222A2 / 1 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-11-09
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: NONE
Current Illness: NONE
Preexisting Conditions: Trisomy 21, questionable history of holes in heart.
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type':

Write-up: Pt was seen 11/07 for 2 month physical evaluation and received Hepatitis B vax. No problems occurred while in the office. He apparently developed respiratory problems on the car ride home and was transferred to the hospital ER and then to another hospital by ambulance. He expired on 11/09/2000.


Changed on 8/14/2018

VAERS ID: 162102 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Florida
Vaccinated:2000-11-07
Onset:2000-11-07
Submitted:2000-11-15
Entered:2000-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM ENG3222A2 / 1 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-11-09
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: NONE
Current Illness: NONE
Preexisting Conditions: Trisomy 21, questionable history of holes in heart.
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type':

Write-up: Pt was seen 11/07 for 2 month physical evaluation and received Hepatitis B vax. No problems occurred while in the office. He apparently developed respiratory problems on the car ride home and was transferred to the hospital ER and then to another hospital by ambulance. He expired on 11/09/2000.


Changed on 9/14/2018

VAERS ID: 162102 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Florida
Vaccinated:2000-11-07
Onset:2000-11-07
Submitted:2000-11-15
Entered:2000-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM ENG3222A2 / 1 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-11-09
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: NONE
Current Illness: NONE
Preexisting Conditions: Trisomy 21, questionable history of holes in heart.
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type':

Write-up: Pt was seen 11/07 for 2 month physical evaluation and received Hepatitis B vax. No problems occurred while in the office. He apparently developed respiratory problems on the car ride home and was transferred to the hospital ER and then to another hospital by ambulance. He expired on 11/09/2000.


Changed on 10/14/2018

VAERS ID: 162102 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Florida
Vaccinated:2000-11-07
Onset:2000-11-07
Submitted:2000-11-15
Entered:2000-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM ENG3222A2 / 1 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-11-09
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: NONE
Current Illness: NONE
Preexisting Conditions: Trisomy 21, questionable history of holes in heart.
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type':

Write-up: Pt was seen 11/07 for 2 month physical evaluation and received Hepatitis B vax. No problems occurred while in the office. He apparently developed respiratory problems on the car ride home and was transferred to the hospital ER and then to another hospital by ambulance. He expired on 11/09/2000.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=162102&WAYBACKHISTORY=ON


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