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This is VAERS ID 105295

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History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 105295
VAERS Form:
Age:0.3
Sex:Female
Location:North Carolina
Vaccinated:1997-11-12
Onset:1997-11-14
Submitted:1997-11-24
Entered:1997-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA / CONNAUGHT LABS 7L81673 / 1 RL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M165RH / 1 RL / IM
IPV: POLIOVAX / CONNAUGHT LTD M0443 / 1 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-11-14
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: nONE
Allergies:
Diagnostic Lab Data: autopsy results pending
CDC 'Split Type':

Write-up: pt found unresponsive sleeping w/mom on couch @ home;DOA


Changed on 12/8/2009

VAERS ID: 105295 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:North Carolina
Vaccinated:1997-11-12
Onset:1997-11-14
Submitted:1997-11-24
Entered:1997-12-03 1997-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA DTAP (TRIPEDIA) / CONNAUGHT LABS CONNAUGHT LABORATORIES 7L81673 / 1 RL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M165RH / 1 RL / IM
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. M0443 / 1 LL / IM

Administered by: Private      Purchased by: Unknown Public
Symptoms: Asphyxia, Stupor, STUPOR, ASPHYXIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-11-14
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: nONE
Allergies:
Diagnostic Lab Data: autopsy results pending
CDC 'Split Type':

Write-up: pt found unresponsive sleeping w/mom on couch @ home;DOA


Changed on 5/14/2017

VAERS ID: 105295 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:North Carolina
Vaccinated:1997-11-12
Onset:1997-11-14
Submitted:1997-11-24
Entered:1997-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7L81673 / 1 RL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M165RH / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0443 / 1 LL / IM

Administered by: Private      Purchased by: Public
Symptoms: Asphyxia, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-11-14
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: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: nONE
Allergies:
Diagnostic Lab Data: autopsy results pending
CDC 'Split Type':

Write-up: pt found unresponsive sleeping w/mom on couch @ home;DOA


Changed on 9/14/2017

VAERS ID: 105295 Before After
VAERS Form:(blank) 1
Age:0.3
Sex:Female
Location:North Carolina
Vaccinated:1997-11-12
Onset:1997-11-14
Submitted:1997-11-24
Entered:1997-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7L81673 / 1 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M165RH / 1 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0443 / 1 2 LL / IM

Administered by: Private      Purchased by: Public
Symptoms: Asphyxia, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-11-14
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: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: nONE
Allergies:
Diagnostic Lab Data: autopsy results pending
CDC 'Split Type':

Write-up: pt found unresponsive sleeping w/mom on couch @ home;DOA


Changed on 2/14/2018

VAERS ID: 105295 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:North Carolina
Vaccinated:1997-11-12
Onset:1997-11-14
Submitted:1997-11-24
Entered:1997-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7L81673 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M165RH / 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0443 / 2 LL / IM

Administered by: Private      Purchased by: Public
Symptoms: Asphyxia, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-11-14
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: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: nONE
Allergies:
Diagnostic Lab Data: autopsy results pending
CDC 'Split Type':

Write-up: pt found unresponsive sleeping w/mom on couch @ home;DOA


Changed on 6/14/2018

VAERS ID: 105295 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:North Carolina
Vaccinated:1997-11-12
Onset:1997-11-14
Submitted:1997-11-24
Entered:1997-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7L81673 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M165RH / 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0443 / 2 LL / IM

Administered by: Private      Purchased by: Public
Symptoms: Asphyxia, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-11-14
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: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: nONE
Allergies:
Diagnostic Lab Data: autopsy results pending
CDC 'Split Type':

Write-up: pt found unresponsive sleeping w/mom on couch @ home;DOA


Changed on 8/14/2018

VAERS ID: 105295 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:North Carolina
Vaccinated:1997-11-12
Onset:1997-11-14
Submitted:1997-11-24
Entered:1997-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7L81673 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M165RH / 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0443 / 2 LL / IM

Administered by: Private      Purchased by: Public
Symptoms: Asphyxia, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-11-14
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: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: nONE
Allergies:
Diagnostic Lab Data: autopsy results pending
CDC 'Split Type':

Write-up: pt found unresponsive sleeping w/mom on couch @ home;DOA


Changed on 9/14/2018

VAERS ID: 105295 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:North Carolina
Vaccinated:1997-11-12
Onset:1997-11-14
Submitted:1997-11-24
Entered:1997-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7L81673 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M165RH / 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0443 / 2 LL / IM

Administered by: Private      Purchased by: Public
Symptoms: Asphyxia, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-11-14
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: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: nONE
Allergies:
Diagnostic Lab Data: autopsy results pending
CDC 'Split Type':

Write-up: pt found unresponsive sleeping w/mom on couch @ home;DOA


Changed on 10/14/2018

VAERS ID: 105295 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:North Carolina
Vaccinated:1997-11-12
Onset:1997-11-14
Submitted:1997-11-24
Entered:1997-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7L81673 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M165RH / 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0443 / 2 LL / IM

Administered by: Private      Purchased by: Public
Symptoms: Asphyxia, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-11-14
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: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: nONE
Allergies:
Diagnostic Lab Data: autopsy results pending
CDC 'Split Type':

Write-up: pt found unresponsive sleeping w/mom on couch @ home;DOA


Changed on 12/24/2020

VAERS ID: 105295 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:North Carolina
Vaccinated:1997-11-12
Onset:1997-11-14
Submitted:1997-11-24
Entered:1997-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7L81673 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M165RH / 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0443 / 2 LL / IM

Administered by: Private      Purchased by: Public
Symptoms: Asphyxia, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-11-14
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: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: nONE
Allergies:
Diagnostic Lab Data: autopsy results pending
CDC 'Split Type':

Write-up: pt found unresponsive sleeping w/mom on couch @ home;DOA


Changed on 12/30/2020

VAERS ID: 105295 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:North Carolina
Vaccinated:1997-11-12
Onset:1997-11-14
Submitted:1997-11-24
Entered:1997-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7L81673 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M165RH / 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0443 / 2 LL / IM

Administered by: Private      Purchased by: Public
Symptoms: Asphyxia, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-11-14
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: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: nONE
Allergies:
Diagnostic Lab Data: autopsy results pending
CDC 'Split Type':

Write-up: pt found unresponsive sleeping w/mom on couch @ home;DOA


Changed on 5/7/2021

VAERS ID: 105295 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:North Carolina
Vaccinated:1997-11-12
Onset:1997-11-14
Submitted:1997-11-24
Entered:1997-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7L81673 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M165RH / 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0443 / 2 LL / IM

Administered by: Private      Purchased by: Public
Symptoms: Asphyxia, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-11-14
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: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: nONE
Allergies:
Diagnostic Lab Data: autopsy results pending
CDC 'Split Type':

Write-up: pt found unresponsive sleeping w/mom on couch @ home;DOA


Changed on 5/21/2021

VAERS ID: 105295 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:North Carolina
Vaccinated:1997-11-12
Onset:1997-11-14
Submitted:1997-11-24
Entered:1997-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7L81673 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M165RH / 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0443 / 2 LL / IM

Administered by: Private      Purchased by: Public
Symptoms: Asphyxia, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-11-14
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: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: nONE
Allergies:
Diagnostic Lab Data: autopsy results pending
CDC 'Split Type':

Write-up: pt found unresponsive sleeping w/mom on couch @ home;DOA

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=105295&WAYBACKHISTORY=ON


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