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This is VAERS ID 118588

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History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 118588
VAERS Form:
Age:0.2
Sex:Female
Location:South Carolina
Vaccinated:1998-12-24
Onset:1999-01-05
Submitted:1999-01-22
Entered:1999-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE / LEDERLE 456818 / 0 RL / -
HEP: ENGERIX-B / SMITHKLINE 2726A2 / 1 RL / -
HIBV: HIBTITER / LEDERLE(PRAXIS) 0953210 / 0 LL / -
IPV: POLIOVAX / CONNAUGHT LTD NO492 / 0 LL / SC
RV: ROTASHIELD / WYETH 4988059 / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: INJURY ACCID, ASPHYXIA, HYPOXIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-01-05
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: UNK
Other Medications: NONE
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': UNK

Write-up: Pt recv vax on 12/24/98; on 1/5/99 pt expired


Changed on 12/8/2009

VAERS ID: 118588 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:South Carolina
Vaccinated:1998-12-24
Onset:1999-01-05
Submitted:1999-01-22
Entered:1999-02-09 1999-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE DTAP (ACEL-IMUNE) / LEDERLE LEDERLE LABORATORIES 456818 / 0 RL / -
HEP: ENGERIX-B HEP B (ENGERIX-B) / SMITHKLINE SMITHKLINE BEECHAM 2726A2 / 1 RL / -
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS 0953210 / 0 LL / -
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. NO492 / 0 LL / SC
RV: ROTASHIELD ROTAVIRUS (ROTASHIELD) / WYETH WYETH PHARMACEUTICALS, INC 4988059 / 0 - / PO

Administered by: Private      Purchased by: Unknown Other
Symptoms: Asphyxia, Hypoxia, Injury, INJURY ACCID, ASPHYXIA, HYPOXIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-01-05
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: UNK
Other Medications: NONE
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': UNK (blank)

Write-up: Pt recv vax on 12/24/98; on 1/5/99 pt expired


Changed on 8/31/2010

VAERS ID: 118588 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:South Carolina
Vaccinated:1998-12-24
Onset:1999-01-05
Submitted:1999-01-22
Entered:1999-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / LEDERLE LABORATORIES 456818 / 0 RL / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2726A2 / 1 RL / -
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS 0953210 / 0 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. NO492 / 0 LL / SC
RV: ROTAVIRUS (ROTASHIELD) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4988059 / 0 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Asphyxia, Hypoxia, Injury

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-01-05
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: UNK
Other Medications: NONE
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type':

Write-up: Pt recv vax on 12/24/98; on 1/5/99 pt expired


Changed on 5/14/2017

VAERS ID: 118588 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:South Carolina
Vaccinated:1998-12-24
Onset:1999-01-05
Submitted:1999-01-22
Entered:1999-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 456818 / 0 RL / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2726A2 / 1 RL / -
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH 0953210 / 0 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. NO492 / 0 LL / SC
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH 4988059 / 0 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Asphyxia, Hypoxia, Injury

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-01-05
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: UNK UNK~ ()~~~In patient
Other Medications: NONE
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type':

Write-up: Pt recv vax on 12/24/98; on 1/5/99 pt expired


Changed on 9/14/2017

VAERS ID: 118588 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Female
Location:South Carolina
Vaccinated:1998-12-24
Onset:1999-01-05
Submitted:1999-01-22
Entered:1999-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 456818 / 0 1 RL / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2726A2 / 1 2 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH 0953210 / 0 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. NO492 / 0 1 LL / SC
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH 4988059 / 0 1 - MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Asphyxia, Hypoxia, Injury

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-01-05
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: UNK~ ()~~~In patient
Other Medications: NONE
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type':

Write-up: Pt recv vax on 12/24/98; on 1/5/99 pt expired


Changed on 2/14/2018

VAERS ID: 118588 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:South Carolina
Vaccinated:1998-12-24
Onset:1999-01-05
Submitted:1999-01-22
Entered:1999-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 456818 / 1 RL / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2726A2 / 2 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH 0953210 / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. NO492 / 1 LL / SC
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH 4988059 / 1 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Asphyxia, Hypoxia, Injury

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-01-05
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: UNK~ ()~~~In patient
Other Medications: NONE
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type':

Write-up: Pt recv vax on 12/24/98; on 1/5/99 pt expired


Changed on 6/14/2018

VAERS ID: 118588 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:South Carolina
Vaccinated:1998-12-24
Onset:1999-01-05
Submitted:1999-01-22
Entered:1999-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 456818 / 1 RL / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2726A2 / 2 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH 0953210 / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. NO492 / 1 LL / SC
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH 4988059 / 1 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Asphyxia, Hypoxia, Injury

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-01-05
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: UNK~ ()~~~In patient
Other Medications: NONE
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type':

Write-up: Pt recv vax on 12/24/98; on 1/5/99 pt expired


Changed on 8/14/2018

VAERS ID: 118588 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:South Carolina
Vaccinated:1998-12-24
Onset:1999-01-05
Submitted:1999-01-22
Entered:1999-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 456818 / 1 RL / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2726A2 / 2 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH 0953210 / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. NO492 / 1 LL / SC
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH 4988059 / 1 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Asphyxia, Hypoxia, Injury

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-01-05
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: UNK~ ()~~~In patient
Other Medications: NONE
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type':

Write-up: Pt recv vax on 12/24/98; on 1/5/99 pt expired


Changed on 9/14/2018

VAERS ID: 118588 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:South Carolina
Vaccinated:1998-12-24
Onset:1999-01-05
Submitted:1999-01-22
Entered:1999-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 456818 / 1 RL / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2726A2 / 2 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH 0953210 / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. NO492 / 1 LL / SC
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH 4988059 / 1 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Asphyxia, Hypoxia, Injury

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-01-05
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: UNK~ ()~~~In patient
Other Medications: NONE
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type':

Write-up: Pt recv vax on 12/24/98; on 1/5/99 pt expired


Changed on 10/14/2018

VAERS ID: 118588 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:South Carolina
Vaccinated:1998-12-24
Onset:1999-01-05
Submitted:1999-01-22
Entered:1999-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 456818 / 1 RL / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2726A2 / 2 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH 0953210 / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. NO492 / 1 LL / SC
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH 4988059 / 1 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Asphyxia, Hypoxia, Injury

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-01-05
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: UNK~ ()~~~In patient
Other Medications: NONE
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type':

Write-up: Pt recv vax on 12/24/98; on 1/5/99 pt expired


Changed on 12/24/2020

VAERS ID: 118588 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:South Carolina
Vaccinated:1998-12-24
Onset:1999-01-05
Submitted:1999-01-22
Entered:1999-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 456818 / 1 RL / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2726A2 / 2 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH 0953210 / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. NO492 / 1 LL / SC
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH 4988059 / 1 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Asphyxia, Hypoxia, Injury

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-01-05
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: UNK~ ()~~~In patient
Other Medications: NONE
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type':

Write-up: Pt recv vax on 12/24/98; on 1/5/99 pt expired


Changed on 12/30/2020

VAERS ID: 118588 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:South Carolina
Vaccinated:1998-12-24
Onset:1999-01-05
Submitted:1999-01-22
Entered:1999-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 456818 / 1 RL / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2726A2 / 2 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH 0953210 / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. NO492 / 1 LL / SC
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH 4988059 / 1 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Asphyxia, Hypoxia, Injury

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-01-05
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: UNK~ ()~~~In patient
Other Medications: NONE
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type':

Write-up: Pt recv vax on 12/24/98; on 1/5/99 pt expired


Changed on 5/7/2021

VAERS ID: 118588 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:South Carolina
Vaccinated:1998-12-24
Onset:1999-01-05
Submitted:1999-01-22
Entered:1999-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 456818 / 1 RL / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2726A2 / 2 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH 0953210 / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. NO492 / 1 LL / SC
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH 4988059 / 1 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Asphyxia, Hypoxia, Injury

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-01-05
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: UNK~ ()~~~In patient
Other Medications: NONE
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type':

Write-up: Pt recv vax on 12/24/98; on 1/5/99 pt expired


Changed on 5/21/2021

VAERS ID: 118588 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:South Carolina
Vaccinated:1998-12-24
Onset:1999-01-05
Submitted:1999-01-22
Entered:1999-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 456818 / 1 RL / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2726A2 / 2 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH 0953210 / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. NO492 / 1 LL / SC
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH 4988059 / 1 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Asphyxia, Hypoxia, Injury

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-01-05
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: UNK~ ()~~~In patient
Other Medications: NONE
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type':

Write-up: Pt recv vax on 12/24/98; on 1/5/99 pt expired

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=118588&WAYBACKHISTORY=ON


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