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History of Changes from the VAERS Wayback Machine |
VAERS ID: | 108795 |
VAERS Form: | |
Age: | 0.0 |
Sex: | Female |
Location: | New Hampshire |
Vaccinated: | 1996-04-13 |
Onset: | 1996-04-28 |
Submitted: | 1998-03-19 |
Entered: | 1998-03-24 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
HEP: RECOMBIVAX HB / MSD | 1163A / 0 | RL / - |
Administered by: Private Purchased by: Unknown
Symptoms: SIDS, ANOMALY CONGEN, CYST, SLEEP PAR BED
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1996-04-28
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: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: SIDS
Vaccinated: | 1996-04-13 |
Onset: | 1996-04-28 |
Submitted: | 1998-03-19 |
Entered: | 1998-03-24 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
HEP: RECOMBIVAX HB HEP B (RECOMBIVAX HB) / MSD MERCK & CO. INC. | 1163A / 0 | RL / - |
Administered by: Private Purchased by: Unknown Public
Symptoms: Congenital anomaly, Cyst, SIDS, Sudden infant death syndrome, Unevaluable event, ANOMALY CONGEN, CYST, SLEEP PAR BED
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1996-04-28
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: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) NH9634
Write-up: SIDS
Vaccinated: | 1996-04-13 |
Onset: | 1996-04-28 |
Submitted: | 1998-03-19 |
Entered: | 1998-03-24 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. | 1163A / 0 | RL / - |
Administered by: Private Purchased by: Public
Symptoms: Congenital anomaly, Cyst, Sudden infant death syndrome, Unevaluable event
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1996-04-28
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:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH9634
Write-up: SIDS
Vaccinated: | 1996-04-13 |
Onset: | 1996-04-28 |
Submitted: | 1998-03-19 |
Entered: | 1998-03-24 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. | 1163A / 0 1 | RL / - |
Administered by: Private Purchased by: Public
Symptoms: Congenital anomaly, Cyst, Sudden infant death syndrome, Unevaluable event
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1996-04-28
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:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH9634
Write-up: SIDS
Vaccinated: | 1996-04-13 |
Onset: | 1996-04-28 |
Submitted: | 1998-03-19 |
Entered: | 1998-03-24 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. | 1163A / 1 | RL / - |
Administered by: Private Purchased by: Public
Symptoms: Congenital anomaly, Cyst, Sudden infant death syndrome, Unevaluable event
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1996-04-28
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:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH9634
Write-up: SIDS
Vaccinated: | 1996-04-13 |
Onset: | 1996-04-28 |
Submitted: | 1998-03-19 |
Entered: | 1998-03-24 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. | 1163A / 1 | RL / - |
Administered by: Private Purchased by: Public
Symptoms: Congenital anomaly, Cyst, Sudden infant death syndrome, Unevaluable event
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1996-04-28
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:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH9634
Write-up: SIDS
Vaccinated: | 1996-04-13 |
Onset: | 1996-04-28 |
Submitted: | 1998-03-19 |
Entered: | 1998-03-24 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. | 1163A / 1 | RL / - |
Administered by: Private Purchased by: Public
Symptoms: Congenital anomaly, Cyst, Sudden infant death syndrome, Unevaluable event
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1996-04-28
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:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH9634
Write-up: SIDS
Vaccinated: | 1996-04-13 |
Onset: | 1996-04-28 |
Submitted: | 1998-03-19 |
Entered: | 1998-03-24 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. | 1163A / 1 | RL / - |
Administered by: Private Purchased by: Public
Symptoms: Congenital anomaly, Cyst, Sudden infant death syndrome, Unevaluable event
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1996-04-28
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:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH9634
Write-up: SIDS
Vaccinated: | 1996-04-13 |
Onset: | 1996-04-28 |
Submitted: | 1998-03-19 |
Entered: | 1998-03-24 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. | 1163A / 1 | RL / - |
Administered by: Private Purchased by: Public
Symptoms: Congenital anomaly, Cyst, Sudden infant death syndrome, Unevaluable event
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1996-04-28
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:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH9634
Write-up: SIDS
Vaccinated: | 1996-04-13 |
Onset: | 1996-04-28 |
Submitted: | 1998-03-19 |
Entered: | 1998-03-24 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. | 1163A / 1 | RL / - |
Administered by: Private Purchased by: Public
Symptoms: Congenital anomaly, Cyst, Sudden infant death syndrome, Unevaluable event
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1996-04-28
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:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH9634
Write-up: SIDS
Vaccinated: | 1996-04-13 |
Onset: | 1996-04-28 |
Submitted: | 1998-03-19 |
Entered: | 1998-03-24 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. | 1163A / 1 | RL / - |
Administered by: Private Purchased by: Public
Symptoms: Congenital anomaly, Cyst, Sudden infant death syndrome, Unevaluable event
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1996-04-28
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:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH9634
Write-up: SIDS
Vaccinated: | 1996-04-13 |
Onset: | 1996-04-28 |
Submitted: | 1998-03-19 |
Entered: | 1998-03-24 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. | 1163A / 1 | RL / - |
Administered by: Private Purchased by: Public
Symptoms: Congenital anomaly, Cyst, Sudden infant death syndrome, Unevaluable event
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1996-04-28
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:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH9634
Write-up: SIDS
Link To This Search Result:
https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=108795&WAYBACKHISTORY=ON
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