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History of Changes from the VAERS Wayback Machine |
VAERS ID: | 107414 |
VAERS Form: | |
Age: | 0.0 |
Sex: | Female |
Location: | Ohio |
Vaccinated: | 1996-04-03 |
Onset: | 0000-00-00 |
Submitted: | 1998-02-02 |
Entered: | 1998-02-13 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
HEP: ENGERIX-B / SMITHKLINE | 1611B2 / - | - / - |
Administered by: Unknown Purchased by: Unknown
Symptoms: AGITATION, APNEA, HEART ARREST, LUNG DIS, CRY ABNORMAL
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1996-05-11
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: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: sudden agitation, screams, vomited frequently then died;
Vaccinated: | 1996-04-03 |
Onset: | 0000-00-00 |
Submitted: | 1998-02-02 |
Entered: | 1998-02-13 1998-02-11 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
HEP: ENGERIX-B HEP B (ENGERIX-B) / SMITHKLINE SMITHKLINE BEECHAM | 1611B2 / - | - / - |
Administered by: Unknown Purchased by: Unknown
Symptoms: Agitation, Apnoea, Cardiac arrest, Crying, Lung disorder, Rash, Sudden infant death syndrome, Vomiting, AGITATION, APNEA, HEART ARREST, LUNG DIS, CRY ABNORMAL
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1996-05-11
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: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: sudden agitation, screams, vomited frequently then died;
Vaccinated: | 1996-04-03 |
Onset: | 0000-00-00 |
Submitted: | 1998-02-02 |
Entered: | 1998-02-11 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM | 1611B2 / - | - / - |
Administered by: Unknown Purchased by: Unknown
Symptoms: Agitation, Apnoea, Cardiac arrest, Crying, Lung disorder, Rash, Sudden infant death syndrome, Vomiting
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1996-05-11
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: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: sudden agitation, screams, vomited frequently then died;
Vaccinated: | 1996-04-03 |
Onset: | 0000-00-00 |
Submitted: | 1998-02-02 |
Entered: | 1998-02-11 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM | 1611B2 / - UNK | - / - |
Administered by: Unknown Purchased by: Unknown
Symptoms: Agitation, Apnoea, Cardiac arrest, Crying, Lung disorder, Rash, Sudden infant death syndrome, Vomiting
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1996-05-11
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: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: sudden agitation, screams, vomited frequently then died;
Vaccinated: | 1996-04-03 |
Onset: | 0000-00-00 |
Submitted: | 1998-02-02 |
Entered: | 1998-02-11 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM | 1611B2 / UNK | - / - |
Administered by: Unknown Purchased by: Unknown
Symptoms: Agitation, Apnoea, Cardiac arrest, Crying, Lung disorder, Rash, Sudden infant death syndrome, Vomiting
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1996-05-11
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: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: sudden agitation, screams, vomited frequently then died;
Vaccinated: | 1996-04-03 |
Onset: | 0000-00-00 |
Submitted: | 1998-02-02 |
Entered: | 1998-02-11 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM | 1611B2 / UNK | - / - |
Administered by: Unknown Purchased by: Unknown
Symptoms: Agitation, Apnoea, Cardiac arrest, Crying, Lung disorder, Rash, Sudden infant death syndrome, Vomiting
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1996-05-11
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: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: sudden agitation, screams, vomited frequently then died;
Vaccinated: | 1996-04-03 |
Onset: | 0000-00-00 |
Submitted: | 1998-02-02 |
Entered: | 1998-02-11 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM | 1611B2 / UNK | - / - |
Administered by: Unknown Purchased by: Unknown
Symptoms: Agitation, Apnoea, Cardiac arrest, Crying, Lung disorder, Rash, Sudden infant death syndrome, Vomiting
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1996-05-11
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: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: sudden agitation, screams, vomited frequently then died;
Vaccinated: | 1996-04-03 |
Onset: | 0000-00-00 |
Submitted: | 1998-02-02 |
Entered: | 1998-02-11 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM | 1611B2 / UNK | - / - |
Administered by: Unknown Purchased by: Unknown
Symptoms: Agitation, Apnoea, Cardiac arrest, Crying, Lung disorder, Rash, Sudden infant death syndrome, Vomiting
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1996-05-11
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: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: sudden agitation, screams, vomited frequently then died;
Vaccinated: | 1996-04-03 |
Onset: | 0000-00-00 |
Submitted: | 1998-02-02 |
Entered: | 1998-02-11 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM | 1611B2 / UNK | - / - |
Administered by: Unknown Purchased by: Unknown
Symptoms: Agitation, Apnoea, Cardiac arrest, Crying, Lung disorder, Rash, Sudden infant death syndrome, Vomiting
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1996-05-11
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: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: sudden agitation, screams, vomited frequently then died;
Vaccinated: | 1996-04-03 |
Onset: | 0000-00-00 |
Submitted: | 1998-02-02 |
Entered: | 1998-02-11 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM | 1611B2 / UNK | - / - |
Administered by: Unknown Purchased by: Unknown
Symptoms: Agitation, Apnoea, Cardiac arrest, Crying, Lung disorder, Rash, Sudden infant death syndrome, Vomiting
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1996-05-11
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: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: sudden agitation, screams, vomited frequently then died;
Vaccinated: | 1996-04-03 |
Onset: | 0000-00-00 |
Submitted: | 1998-02-02 |
Entered: | 1998-02-11 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM | 1611B2 / UNK | - / - |
Administered by: Unknown Purchased by: Unknown
Symptoms: Agitation, Apnoea, Cardiac arrest, Crying, Lung disorder, Rash, Sudden infant death syndrome, Vomiting
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1996-05-11
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: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: sudden agitation, screams, vomited frequently then died;
Vaccinated: | 1996-04-03 |
Onset: | 0000-00-00 |
Submitted: | 1998-02-02 |
Entered: | 1998-02-11 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM | 1611B2 / UNK | - / - |
Administered by: Unknown Purchased by: Unknown
Symptoms: Agitation, Apnoea, Cardiac arrest, Crying, Lung disorder, Rash, Sudden infant death syndrome, Vomiting
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1996-05-11
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: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: sudden agitation, screams, vomited frequently then died;
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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=107414&WAYBACKHISTORY=ON
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