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This is VAERS ID 119691

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History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 119691
VAERS Form:
Age:0.2
Sex:Male
Location:Oregon
Vaccinated:1999-02-19
Onset:0000-00-00
Submitted:1999-02-24
Entered:1999-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA / CONNAUGHT LABS 457-791 / 0 LL / IM
HEP: ENGERIX-B / SMITHKLINE ENG2931A2 / 1 RL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) 423203A / 0 LL / IM
IPV: POLIOVAX / CONNAUGHT LTD N0727 / 0 RL / SC

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS

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: mild URI and thrush
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS. found unresponsive in crib @ 5:39a 2/23/99


Changed on 12/8/2009

VAERS ID: 119691 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Oregon
Vaccinated:1999-02-19
Onset:0000-00-00
Submitted:1999-02-24
Entered:1999-03-05 1999-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA DTAP (TRIPEDIA) / CONNAUGHT LABS CONNAUGHT LABORATORIES 457-791 457791 / 0 LL / IM
HEP: ENGERIX-B HEP B (ENGERIX-B) / SMITHKLINE SMITHKLINE BEECHAM ENG2931A2 2931A2 / 1 RL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE LABORATORIES 423203A / 0 LL / IM
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. N0727 / 0 RL / SC

Administered by: Private Unknown      Purchased by: Unknown
Symptoms: SIDS, Sudden infant death syndrome

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: mild URI and thrush
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS. found unresponsive in crib @ 5:39a 2/23/99


Changed on 5/14/2017

VAERS ID: 119691 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Oregon
Vaccinated:1999-02-19
Onset:0000-00-00
Submitted:1999-02-24
Entered:1999-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 457791 / 0 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2931A2 / 1 RL / IM
HIBV: HIB (HIBTITER) / LEDERLE LABORATORIES PFIZER/WYETH 423203A / 0 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0727 / 0 RL / SC

Administered by: Unknown Private      Purchased by: Unknown Private
Symptoms: Sudden infant death syndrome

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: mild URI and thrush
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS. found unresponsive in crib @ 5:39a 2/23/99


Changed on 9/14/2017

VAERS ID: 119691 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:Oregon
Vaccinated:1999-02-19
Onset:0000-00-00
Submitted:1999-02-24
Entered:1999-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 457791 / 0 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2931A2 / 1 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 423203A / 0 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0727 / 0 1 RL / SC

Administered by: Private      Purchased by: Private
Symptoms: Sudden infant death syndrome

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: mild URI and thrush
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS. found unresponsive in crib @ 5:39a 2/23/99


Changed on 2/14/2018

VAERS ID: 119691 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Oregon
Vaccinated:1999-02-19
Onset:0000-00-00
Submitted:1999-02-24
Entered:1999-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 457791 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2931A2 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 423203A / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0727 / 1 RL / SC

Administered by: Private      Purchased by: Private
Symptoms: Sudden infant death syndrome

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: mild URI and thrush
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS. found unresponsive in crib @ 5:39a 2/23/99


Changed on 6/14/2018

VAERS ID: 119691 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Oregon
Vaccinated:1999-02-19
Onset:0000-00-00
Submitted:1999-02-24
Entered:1999-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 457791 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2931A2 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 423203A / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0727 / 1 RL / SC

Administered by: Private      Purchased by: Private
Symptoms: Sudden infant death syndrome

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: mild URI and thrush
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS. found unresponsive in crib @ 5:39a 2/23/99


Changed on 8/14/2018

VAERS ID: 119691 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Oregon
Vaccinated:1999-02-19
Onset:0000-00-00
Submitted:1999-02-24
Entered:1999-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 457791 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2931A2 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 423203A / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0727 / 1 RL / SC

Administered by: Private      Purchased by: Private
Symptoms: Sudden infant death syndrome

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: mild URI and thrush
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS. found unresponsive in crib @ 5:39a 2/23/99


Changed on 9/14/2018

VAERS ID: 119691 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Oregon
Vaccinated:1999-02-19
Onset:0000-00-00
Submitted:1999-02-24
Entered:1999-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 457791 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2931A2 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 423203A / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0727 / 1 RL / SC

Administered by: Private      Purchased by: Private
Symptoms: Sudden infant death syndrome

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: mild URI and thrush
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS. found unresponsive in crib @ 5:39a 2/23/99


Changed on 10/14/2018

VAERS ID: 119691 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Oregon
Vaccinated:1999-02-19
Onset:0000-00-00
Submitted:1999-02-24
Entered:1999-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 457791 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2931A2 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 423203A / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0727 / 1 RL / SC

Administered by: Private      Purchased by: Private
Symptoms: Sudden infant death syndrome

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: mild URI and thrush
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS. found unresponsive in crib @ 5:39a 2/23/99


Changed on 12/24/2020

VAERS ID: 119691 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Oregon
Vaccinated:1999-02-19
Onset:0000-00-00
Submitted:1999-02-24
Entered:1999-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 457791 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2931A2 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 423203A / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0727 / 1 RL / SC

Administered by: Private      Purchased by: Private
Symptoms: Sudden infant death syndrome

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: mild URI and thrush
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS. found unresponsive in crib @ 5:39a 2/23/99


Changed on 12/30/2020

VAERS ID: 119691 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Oregon
Vaccinated:1999-02-19
Onset:0000-00-00
Submitted:1999-02-24
Entered:1999-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 457791 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2931A2 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 423203A / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0727 / 1 RL / SC

Administered by: Private      Purchased by: Private
Symptoms: Sudden infant death syndrome

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: mild URI and thrush
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS. found unresponsive in crib @ 5:39a 2/23/99


Changed on 5/7/2021

VAERS ID: 119691 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Oregon
Vaccinated:1999-02-19
Onset:0000-00-00
Submitted:1999-02-24
Entered:1999-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 457791 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2931A2 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 423203A / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0727 / 1 RL / SC

Administered by: Private      Purchased by: Private
Symptoms: Sudden infant death syndrome

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: mild URI and thrush
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS. found unresponsive in crib @ 5:39a 2/23/99


Changed on 5/21/2021

VAERS ID: 119691 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Oregon
Vaccinated:1999-02-19
Onset:0000-00-00
Submitted:1999-02-24
Entered:1999-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 457791 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2931A2 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 423203A / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0727 / 1 RL / SC

Administered by: Private      Purchased by: Private
Symptoms: Sudden infant death syndrome

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: mild URI and thrush
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS. found unresponsive in crib @ 5:39a 2/23/99

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