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This is VAERS ID 163135

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 163135
VAERS Form:
Age:1.3
Sex:Female
Location:Tennessee
Vaccinated:2000-09-05
Onset:2000-09-06
Submitted:2000-11-05
Entered:2000-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: INFANRIX / SMITHKLINE DTAP941A2 / 2 LA / IM
HEP: ENGERIX-B / SMITHKLINE ENG3142A2 / 1 LA / IM
HIBV: ACT-HIB / CONNAUGHT LABS UA524AA / 2 RA / IM
IPV: POLIOVAX / CONNAUGHT LTD R06913 / 1 LA / SC
MMR: MMR II / MSD 0539J / 0 RL / SC

Administered by: Public      Purchased by: Unknown
Symptoms: REACT UNEVAL, ASPHYXIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-06
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Infant was behind on immunizations. Mother gave a negative history for previous adverse reactions. Infant was put to bed for the evening and expired. Cause of death is undetermined. Autopsy states cause of death as asphyxia.


Changed on 12/8/2009

VAERS ID: 163135 Before After
VAERS Form:
Age:1.3
Sex:Female
Location:Tennessee
Vaccinated:2000-09-05
Onset:2000-09-06
Submitted:2000-11-05
Entered:2000-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: INFANRIX DTAP (INFANRIX) / SMITHKLINE SMITHKLINE BEECHAM DTAP941A2 941A2 / 2 LA / IM
HEP: ENGERIX-B HEP B (ENGERIX-B) / SMITHKLINE SMITHKLINE BEECHAM ENG3142A2 3142A2 / 1 LA / IM
HIBV: ACT-HIB HIB (ACTHIB) / CONNAUGHT LABS CONNAUGHT LABORATORIES UA524AA / 2 RA / IM
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. R06913 / 1 LA / SC
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 0539J / 0 RL / SC

Administered by: Public      Purchased by: Unknown Public
Symptoms: Asphyxia, Unevaluable event, REACT UNEVAL, ASPHYXIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-06
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Infant was behind on immunizations. Mother gave a negative history for previous adverse reactions. Infant was put to bed for the evening and expired. Cause of death is undetermined. Autopsy states cause of death as asphyxia.


Changed on 9/14/2017

VAERS ID: 163135 Before After
VAERS Form:(blank) 1
Age:1.3
Sex:Female
Location:Tennessee
Vaccinated:2000-09-05
Onset:2000-09-06
Submitted:2000-11-05
Entered:2000-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 941A2 / 2 3 LA / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 3142A2 / 1 2 LA / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA524AA / 2 3 RA / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R06913 / 1 2 LA / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0539J / 0 1 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Asphyxia, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-06
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Infant was behind on immunizations. Mother gave a negative history for previous adverse reactions. Infant was put to bed for the evening and expired. Cause of death is undetermined. Autopsy states cause of death as asphyxia.


Changed on 2/14/2018

VAERS ID: 163135 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:Tennessee
Vaccinated:2000-09-05
Onset:2000-09-06
Submitted:2000-11-05
Entered:2000-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 941A2 / 3 LA / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 3142A2 / 2 LA / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA524AA / 3 RA / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R06913 / 2 LA / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0539J / 1 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Asphyxia, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-06
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Infant was behind on immunizations. Mother gave a negative history for previous adverse reactions. Infant was put to bed for the evening and expired. Cause of death is undetermined. Autopsy states cause of death as asphyxia.


Changed on 6/14/2018

VAERS ID: 163135 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:Tennessee
Vaccinated:2000-09-05
Onset:2000-09-06
Submitted:2000-11-05
Entered:2000-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 941A2 / 3 LA / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 3142A2 / 2 LA / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA524AA / 3 RA / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R06913 / 2 LA / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0539J / 1 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Asphyxia, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-06
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Infant was behind on immunizations. Mother gave a negative history for previous adverse reactions. Infant was put to bed for the evening and expired. Cause of death is undetermined. Autopsy states cause of death as asphyxia.


Changed on 8/14/2018

VAERS ID: 163135 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:Tennessee
Vaccinated:2000-09-05
Onset:2000-09-06
Submitted:2000-11-05
Entered:2000-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 941A2 / 3 LA / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 3142A2 / 2 LA / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA524AA / 3 RA / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R06913 / 2 LA / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0539J / 1 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Asphyxia, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-06
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Infant was behind on immunizations. Mother gave a negative history for previous adverse reactions. Infant was put to bed for the evening and expired. Cause of death is undetermined. Autopsy states cause of death as asphyxia.


Changed on 9/14/2018

VAERS ID: 163135 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:Tennessee
Vaccinated:2000-09-05
Onset:2000-09-06
Submitted:2000-11-05
Entered:2000-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 941A2 / 3 LA / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 3142A2 / 2 LA / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA524AA / 3 RA / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R06913 / 2 LA / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0539J / 1 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Asphyxia, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-06
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Infant was behind on immunizations. Mother gave a negative history for previous adverse reactions. Infant was put to bed for the evening and expired. Cause of death is undetermined. Autopsy states cause of death as asphyxia.


Changed on 10/14/2018

VAERS ID: 163135 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:Tennessee
Vaccinated:2000-09-05
Onset:2000-09-06
Submitted:2000-11-05
Entered:2000-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 941A2 / 3 LA / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 3142A2 / 2 LA / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA524AA / 3 RA / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R06913 / 2 LA / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0539J / 1 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Asphyxia, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-06
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Infant was behind on immunizations. Mother gave a negative history for previous adverse reactions. Infant was put to bed for the evening and expired. Cause of death is undetermined. Autopsy states cause of death as asphyxia.

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