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This is VAERS ID 85376

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History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 85376
VAERS Form:
Age:0.1
Sex:Male
Location:California
Vaccinated:1996-04-18
Onset:1996-04-19
Submitted:1996-04-22
Entered:1996-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP / CONNAUGHT LABS 5H61047 / 0 - / IM
HEP: ENGERIX-B / SMITHKLINE 1944A2 / 1 - / IM
HIBV: ACT-HIB / CONNAUGHT LABS 5H61156 / 0 - / IM
IPV: POLIOVAX / CONNAUGHT LTD K1016 / 0 - / SC

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS, SLEEP POSITION

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-04-19
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: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt was found dead in crib on 19APR96;pt recv vax 18APR96;pt was laid on belly to sleep


Changed on 12/8/2009

VAERS ID: 85376 Before After
VAERS Form:
Age:0.1
Sex:Male
Location:California
Vaccinated:1996-04-18
Onset:1996-04-19
Submitted:1996-04-22
Entered:1996-05-01 1996-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP DTP (NO BRAND NAME) / CONNAUGHT LABS CONNAUGHT LABORATORIES 5H61047 / 0 - / IM
HEP: ENGERIX-B HEP B (ENGERIX-B) / SMITHKLINE SMITHKLINE BEECHAM 1944A2 / 1 - / IM
HIBV: ACT-HIB HIB (ACTHIB) / CONNAUGHT LABS CONNAUGHT LABORATORIES 5H61156 / 0 - / IM
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. K1016 / 0 - / SC

Administered by: Private      Purchased by: Unknown Public
Symptoms: SIDS, Sudden infant death syndrome, Unevaluable event, SLEEP POSITION

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-04-19
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: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt was found dead in crib on 19APR96;pt recv vax 18APR96;pt was laid on belly to sleep


Changed on 5/14/2017

VAERS ID: 85376 Before After
VAERS Form:
Age:0.1
Sex:Male
Location:California
Vaccinated:1996-04-18
Onset:1996-04-19
Submitted:1996-04-22
Entered:1996-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 5H61047 / 0 - / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1944A2 / 1 - / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 5H61156 / 0 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. K1016 / 0 - / SC

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-04-19
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: NONE NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt was found dead in crib on 19APR96;pt recv vax 18APR96;pt was laid on belly to sleep


Changed on 9/14/2017

VAERS ID: 85376 Before After
VAERS Form:(blank) 1
Age:0.1
Sex:Male
Location:California
Vaccinated:1996-04-18
Onset:1996-04-19
Submitted:1996-04-22
Entered:1996-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 5H61047 / 0 1 - / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1944A2 / 1 2 - / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 5H61156 / 0 1 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. K1016 / 0 1 - / SC

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-04-19
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt was found dead in crib on 19APR96;pt recv vax 18APR96;pt was laid on belly to sleep


Changed on 2/14/2018

VAERS ID: 85376 Before After
VAERS Form:1
Age:0.1
Sex:Male
Location:California
Vaccinated:1996-04-18
Onset:1996-04-19
Submitted:1996-04-22
Entered:1996-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 5H61047 / 1 - / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1944A2 / 2 - / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 5H61156 / 1 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. K1016 / 1 - / SC

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-04-19
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt was found dead in crib on 19APR96;pt recv vax 18APR96;pt was laid on belly to sleep


Changed on 6/14/2018

VAERS ID: 85376 Before After
VAERS Form:1
Age:0.1
Sex:Male
Location:California
Vaccinated:1996-04-18
Onset:1996-04-19
Submitted:1996-04-22
Entered:1996-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 5H61047 / 1 - / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1944A2 / 2 - / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 5H61156 / 1 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. K1016 / 1 - / SC

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-04-19
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt was found dead in crib on 19APR96;pt recv vax 18APR96;pt was laid on belly to sleep


Changed on 8/14/2018

VAERS ID: 85376 Before After
VAERS Form:1
Age:0.1
Sex:Male
Location:California
Vaccinated:1996-04-18
Onset:1996-04-19
Submitted:1996-04-22
Entered:1996-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 5H61047 / 1 - / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1944A2 / 2 - / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 5H61156 / 1 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. K1016 / 1 - / SC

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-04-19
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt was found dead in crib on 19APR96;pt recv vax 18APR96;pt was laid on belly to sleep


Changed on 9/14/2018

VAERS ID: 85376 Before After
VAERS Form:1
Age:0.1
Sex:Male
Location:California
Vaccinated:1996-04-18
Onset:1996-04-19
Submitted:1996-04-22
Entered:1996-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 5H61047 / 1 - / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1944A2 / 2 - / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 5H61156 / 1 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. K1016 / 1 - / SC

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-04-19
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt was found dead in crib on 19APR96;pt recv vax 18APR96;pt was laid on belly to sleep


Changed on 10/14/2018

VAERS ID: 85376 Before After
VAERS Form:1
Age:0.1
Sex:Male
Location:California
Vaccinated:1996-04-18
Onset:1996-04-19
Submitted:1996-04-22
Entered:1996-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 5H61047 / 1 - / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1944A2 / 2 - / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 5H61156 / 1 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. K1016 / 1 - / SC

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-04-19
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt was found dead in crib on 19APR96;pt recv vax 18APR96;pt was laid on belly to sleep


Changed on 12/24/2020

VAERS ID: 85376 Before After
VAERS Form:1
Age:0.1
Sex:Male
Location:California
Vaccinated:1996-04-18
Onset:1996-04-19
Submitted:1996-04-22
Entered:1996-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 5H61047 / 1 - / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1944A2 / 2 - / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 5H61156 / 1 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. K1016 / 1 - / SC

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-04-19
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt was found dead in crib on 19APR96;pt recv vax 18APR96;pt was laid on belly to sleep


Changed on 12/30/2020

VAERS ID: 85376 Before After
VAERS Form:1
Age:0.1
Sex:Male
Location:California
Vaccinated:1996-04-18
Onset:1996-04-19
Submitted:1996-04-22
Entered:1996-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 5H61047 / 1 - / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1944A2 / 2 - / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 5H61156 / 1 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. K1016 / 1 - / SC

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-04-19
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt was found dead in crib on 19APR96;pt recv vax 18APR96;pt was laid on belly to sleep


Changed on 5/7/2021

VAERS ID: 85376 Before After
VAERS Form:1
Age:0.1
Sex:Male
Location:California
Vaccinated:1996-04-18
Onset:1996-04-19
Submitted:1996-04-22
Entered:1996-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 5H61047 / 1 - / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1944A2 / 2 - / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 5H61156 / 1 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. K1016 / 1 - / SC

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-04-19
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt was found dead in crib on 19APR96;pt recv vax 18APR96;pt was laid on belly to sleep


Changed on 5/14/2021

VAERS ID: 85376 Before After
VAERS Form:1
Age:0.1
Sex:Male
Location:California
Vaccinated:1996-04-18
Onset:1996-04-19
Submitted:1996-04-22
Entered:1996-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 5H61047 / 1 - / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1944A2 / 2 - / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 5H61156 / 1 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. K1016 / 1 - / SC

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-04-19
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt was found dead in crib on 19APR96;pt recv vax 18APR96;pt was laid on belly to sleep

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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=85376&WAYBACKHISTORY=ON


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