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This is VAERS ID 129134

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 129134
VAERS Form:
Age:1.2
Sex:Male
Location:Virginia
Vaccinated:1999-09-09
Onset:1999-09-29
Submitted:1999-10-04
Entered:1999-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: INFANRIX / SMITHKLINE A909A2 / 3 LA / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) 423203A / 3 RA / IM
IPV: POLIOVAX / CONNAUGHT LTD N0699 / 2 RA / SC
MMR: MMR II / MSD 0540J / 0 RL / SC
VARCEL: VARIVAX / MSD 0308J / 0 LL / SC

Administered by: Private      Purchased by: Unknown
Symptoms: INFECT, LYMPHADENO, COUGH INC, BRONCHITIS, MYOCARDITIS

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1999-09-29
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: Infant vial albuterol via nebulizer
Current Illness: NONE
Preexisting Conditions: mild broncho spasm w/URI, passive tobacco smoke exposure;
Allergies:
Diagnostic Lab Data: autopsy done-final report pending;
CDC 'Split Type':

Write-up: child well until 1130PM 9/28/99;URI, cough, given neb;awoke well @ 230AM;found dead @ 530AM;autopsy done;lymphadenopathy;slides pending ;dx viremia on preliminary report;


Changed on 12/8/2009

VAERS ID: 129134 Before After
VAERS Form:
Age:1.2
Sex:Male
Location:Virginia
Vaccinated:1999-09-09
Onset:1999-09-29
Submitted:1999-10-04
Entered:1999-10-13 1999-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: INFANRIX DTAP (INFANRIX) / SMITHKLINE SMITHKLINE BEECHAM A909A2 / 3 LA / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS 423203A / 3 RA / IM
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. N0699 / 2 RA / SC
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 0540J / 0 RL / SC
VARCEL: VARIVAX VARICELLA (VARIVAX) / MSD MERCK & CO. INC. 0308J / 0 LL / SC

Administered by: Private      Purchased by: Unknown Private
Symptoms: Bronchitis, Cough, Infection, Lymphadenopathy, Myocarditis, Pharyngitis, Pneumonia, Sepsis, Splenomegaly, Unevaluable event, INFECT, LYMPHADENO, COUGH INC, BRONCHITIS, MYOCARDITIS

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1999-09-29
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: Infant vial albuterol via nebulizer
Current Illness: NONE
Preexisting Conditions: mild broncho spasm w/URI, passive tobacco smoke exposure;
Allergies:
Diagnostic Lab Data: autopsy done-final report pending;
CDC 'Split Type':

Write-up: child well until 1130PM 9/28/99;URI, cough, given neb;awoke well @ 230AM;found dead @ 530AM;autopsy done;lymphadenopathy;slides pending ;dx viremia on preliminary report;


Changed on 2/14/2017

VAERS ID: 129134 Before After
VAERS Form:
Age:1.2
Sex:Male
Location:Virginia
Vaccinated:1999-09-09
Onset:1999-09-29
Submitted:1999-10-04
Entered:1999-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM A909A2 / 3 LA / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH 423203A / 3 RA / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0699 / 2 RA / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0540J / 0 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0308J / 0 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Bronchitis, Cough, Infection, Lymphadenopathy, Myocarditis, Pharyngitis, Pneumonia, Sepsis, Splenomegaly, Unevaluable event

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1999-09-29
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: Infant vial albuterol via nebulizer
Current Illness: NONE
Preexisting Conditions: mild broncho spasm w/URI, passive tobacco smoke exposure;
Allergies:
Diagnostic Lab Data: autopsy done-final report pending;
CDC 'Split Type':

Write-up: child well until 1130PM 9/28/99;URI, cough, given neb;awoke well @ 230AM;found dead @ 530AM;autopsy done;lymphadenopathy;slides pending ;dx viremia on preliminary report;


Changed on 9/14/2017

VAERS ID: 129134 Before After
VAERS Form:(blank) 1
Age:1.2
Sex:Male
Location:Virginia
Vaccinated:1999-09-09
Onset:1999-09-29
Submitted:1999-10-04
Entered:1999-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM A909A2 / 3 4 LA / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 423203A / 3 4 RA / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0699 / 2 3 RA / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0540J / 0 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0308J / 0 1 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Bronchitis, Cough, Infection, Lymphadenopathy, Myocarditis, Pharyngitis, Pneumonia, Sepsis, Splenomegaly, Unevaluable event

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1999-09-29
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: Infant vial albuterol via nebulizer
Current Illness: NONE
Preexisting Conditions: mild broncho spasm w/URI, passive tobacco smoke exposure;
Allergies:
Diagnostic Lab Data: autopsy done-final report pending;
CDC 'Split Type':

Write-up: child well until 1130PM 9/28/99;URI, cough, given neb;awoke well @ 230AM;found dead @ 530AM;autopsy done;lymphadenopathy;slides pending ;dx viremia on preliminary report;


Changed on 2/14/2018

VAERS ID: 129134 Before After
VAERS Form:1
Age:1.2
Sex:Male
Location:Virginia
Vaccinated:1999-09-09
Onset:1999-09-29
Submitted:1999-10-04
Entered:1999-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM A909A2 / 4 LA / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 423203A / 4 RA / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0699 / 3 RA / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0540J / 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0308J / 1 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Bronchitis, Cough, Infection, Lymphadenopathy, Myocarditis, Pharyngitis, Pneumonia, Sepsis, Splenomegaly, Unevaluable event

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1999-09-29
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: Infant vial albuterol via nebulizer
Current Illness: NONE
Preexisting Conditions: mild broncho spasm w/URI, passive tobacco smoke exposure;
Allergies:
Diagnostic Lab Data: autopsy done-final report pending;
CDC 'Split Type':

Write-up: child well until 1130PM 9/28/99;URI, cough, given neb;awoke well @ 230AM;found dead @ 530AM;autopsy done;lymphadenopathy;slides pending ;dx viremia on preliminary report;


Changed on 6/14/2018

VAERS ID: 129134 Before After
VAERS Form:1
Age:1.2
Sex:Male
Location:Virginia
Vaccinated:1999-09-09
Onset:1999-09-29
Submitted:1999-10-04
Entered:1999-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM A909A2 / 4 LA / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 423203A / 4 RA / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0699 / 3 RA / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0540J / 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0308J / 1 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Bronchitis, Cough, Infection, Lymphadenopathy, Myocarditis, Pharyngitis, Pneumonia, Sepsis, Splenomegaly, Unevaluable event

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1999-09-29
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: Infant vial albuterol via nebulizer
Current Illness: NONE
Preexisting Conditions: mild broncho spasm w/URI, passive tobacco smoke exposure;
Allergies:
Diagnostic Lab Data: autopsy done-final report pending;
CDC 'Split Type':

Write-up: child well until 1130PM 9/28/99;URI, cough, given neb;awoke well @ 230AM;found dead @ 530AM;autopsy done;lymphadenopathy;slides pending ;dx viremia on preliminary report;


Changed on 8/14/2018

VAERS ID: 129134 Before After
VAERS Form:1
Age:1.2
Sex:Male
Location:Virginia
Vaccinated:1999-09-09
Onset:1999-09-29
Submitted:1999-10-04
Entered:1999-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM A909A2 / 4 LA / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 423203A / 4 RA / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0699 / 3 RA / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0540J / 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0308J / 1 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Bronchitis, Cough, Infection, Lymphadenopathy, Myocarditis, Pharyngitis, Pneumonia, Sepsis, Splenomegaly, Unevaluable event

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1999-09-29
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: Infant vial albuterol via nebulizer
Current Illness: NONE
Preexisting Conditions: mild broncho spasm w/URI, passive tobacco smoke exposure;
Allergies:
Diagnostic Lab Data: autopsy done-final report pending;
CDC 'Split Type':

Write-up: child well until 1130PM 9/28/99;URI, cough, given neb;awoke well @ 230AM;found dead @ 530AM;autopsy done;lymphadenopathy;slides pending ;dx viremia on preliminary report;


Changed on 9/14/2018

VAERS ID: 129134 Before After
VAERS Form:1
Age:1.2
Sex:Male
Location:Virginia
Vaccinated:1999-09-09
Onset:1999-09-29
Submitted:1999-10-04
Entered:1999-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM A909A2 / 4 LA / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 423203A / 4 RA / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0699 / 3 RA / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0540J / 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0308J / 1 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Bronchitis, Cough, Infection, Lymphadenopathy, Myocarditis, Pharyngitis, Pneumonia, Sepsis, Splenomegaly, Unevaluable event

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1999-09-29
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: Infant vial albuterol via nebulizer
Current Illness: NONE
Preexisting Conditions: mild broncho spasm w/URI, passive tobacco smoke exposure;
Allergies:
Diagnostic Lab Data: autopsy done-final report pending;
CDC 'Split Type':

Write-up: child well until 1130PM 9/28/99;URI, cough, given neb;awoke well @ 230AM;found dead @ 530AM;autopsy done;lymphadenopathy;slides pending ;dx viremia on preliminary report;


Changed on 10/14/2018

VAERS ID: 129134 Before After
VAERS Form:1
Age:1.2
Sex:Male
Location:Virginia
Vaccinated:1999-09-09
Onset:1999-09-29
Submitted:1999-10-04
Entered:1999-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM A909A2 / 4 LA / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 423203A / 4 RA / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0699 / 3 RA / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0540J / 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0308J / 1 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Bronchitis, Cough, Infection, Lymphadenopathy, Myocarditis, Pharyngitis, Pneumonia, Sepsis, Splenomegaly, Unevaluable event

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1999-09-29
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: Infant vial albuterol via nebulizer
Current Illness: NONE
Preexisting Conditions: mild broncho spasm w/URI, passive tobacco smoke exposure;
Allergies:
Diagnostic Lab Data: autopsy done-final report pending;
CDC 'Split Type':

Write-up: child well until 1130PM 9/28/99;URI, cough, given neb;awoke well @ 230AM;found dead @ 530AM;autopsy done;lymphadenopathy;slides pending ;dx viremia on preliminary report;

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