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This is VAERS ID 108799

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 108799
VAERS Form:
Age:0.3
Sex:Male
Location:Washington
Vaccinated:1998-03-17
Onset:1998-03-18
Submitted:1998-03-18
Entered:1998-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA / CONNAUGHT LABS 7B91821 / 1 LL / -
HIBV: PEDVAXHIB / MSD 1484E / 1 RL / -
IPV: IPV / MERIEUX INST M1070 / 1 RL / SC

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS, AGITATION, CHILLS, OTITIS MED, MONILIA ORAL

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-03-18
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: Amox given 17MAR98;Nystatin oral susp
Current Illness: URI & OM
Preexisting Conditions: eczema & seborrhea dermatitis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt found deceased in crib this AM <24hr p/vax;

Changed on 12/8/2009

VAERS ID: 108799 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Washington
Vaccinated:1998-03-17
Onset:1998-03-18
Submitted:1998-03-18
Entered:1998-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA DTAP (TRIPEDIA) / CONNAUGHT LABS CONNAUGHT LABORATORIES 7B91821 / 1 LL / -
HIBV: PEDVAXHIB HIB (PEDVAXHIB) / MSD MERCK & CO. INC. 1484E / 1 RL / -
IPV: IPV POLIO VIRUS, INACT. (NO BRAND NAME) / MERIEUX INST PASTEUR MERIEUX INST. M1070 / 1 RL / SC

Administered by: Private      Purchased by: Unknown Public
Symptoms: Agitation, Chills, Oral candidiasis, Otitis media, SIDS, Stupor, Sudden infant death syndrome, Unevaluable event, AGITATION, CHILLS, OTITIS MED, MONILIA ORAL

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-03-18
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: Amox given 17MAR98;Nystatin oral susp
Current Illness: URI & OM
Preexisting Conditions: eczema & seborrhea dermatitis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt found deceased in crib this AM <24hr p/vax;

Changed on 5/14/2017

VAERS ID: 108799 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Washington
Vaccinated:1998-03-17
Onset:1998-03-18
Submitted:1998-03-18
Entered:1998-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7B91821 / 1 LL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1484E / 1 RL / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. M1070 / 1 RL / SC

Administered by: Private      Purchased by: Public
Symptoms: Agitation, Chills, Oral candidiasis, Otitis media, Stupor, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-03-18
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: Amox given 17MAR98;Nystatin oral susp
Current Illness: URI & OM
Preexisting Conditions: eczema & seborrhea dermatitis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt found deceased in crib this AM <24hr p/vax;

Changed on 9/14/2017

VAERS ID: 108799 Before After
VAERS Form:(blank) 1
Age:0.3
Sex:Male
Location:Washington
Vaccinated:1998-03-17
Onset:1998-03-18
Submitted:1998-03-18
Entered:1998-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7B91821 / 1 2 LL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1484E / 1 2 RL / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. M1070 / 1 2 RL / SC

Administered by: Private      Purchased by: Public
Symptoms: Agitation, Chills, Oral candidiasis, Otitis media, Stupor, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-03-18
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: Amox given 17MAR98;Nystatin oral susp
Current Illness: URI & OM
Preexisting Conditions: eczema & seborrhea dermatitis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt found deceased in crib this AM <24hr p/vax;

Changed on 2/14/2018

VAERS ID: 108799 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Washington
Vaccinated:1998-03-17
Onset:1998-03-18
Submitted:1998-03-18
Entered:1998-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7B91821 / 2 LL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1484E / 2 RL / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. M1070 / 2 RL / SC

Administered by: Private      Purchased by: Public
Symptoms: Agitation, Chills, Oral candidiasis, Otitis media, Stupor, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-03-18
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: Amox given 17MAR98;Nystatin oral susp
Current Illness: URI & OM
Preexisting Conditions: eczema & seborrhea dermatitis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt found deceased in crib this AM <24hr p/vax;

Changed on 6/14/2018

VAERS ID: 108799 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Washington
Vaccinated:1998-03-17
Onset:1998-03-18
Submitted:1998-03-18
Entered:1998-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7B91821 / 2 LL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1484E / 2 RL / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. M1070 / 2 RL / SC

Administered by: Private      Purchased by: Public
Symptoms: Agitation, Chills, Oral candidiasis, Otitis media, Stupor, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-03-18
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: Amox given 17MAR98;Nystatin oral susp
Current Illness: URI & OM
Preexisting Conditions: eczema & seborrhea dermatitis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt found deceased in crib this AM <24hr p/vax;

Changed on 8/14/2018

VAERS ID: 108799 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Washington
Vaccinated:1998-03-17
Onset:1998-03-18
Submitted:1998-03-18
Entered:1998-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7B91821 / 2 LL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1484E / 2 RL / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. M1070 / 2 RL / SC

Administered by: Private      Purchased by: Public
Symptoms: Agitation, Chills, Oral candidiasis, Otitis media, Stupor, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-03-18
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: Amox given 17MAR98;Nystatin oral susp
Current Illness: URI & OM
Preexisting Conditions: eczema & seborrhea dermatitis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt found deceased in crib this AM <24hr p/vax;

Changed on 9/14/2018

VAERS ID: 108799 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Washington
Vaccinated:1998-03-17
Onset:1998-03-18
Submitted:1998-03-18
Entered:1998-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7B91821 / 2 LL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1484E / 2 RL / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. M1070 / 2 RL / SC

Administered by: Private      Purchased by: Public
Symptoms: Agitation, Chills, Oral candidiasis, Otitis media, Stupor, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-03-18
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: Amox given 17MAR98;Nystatin oral susp
Current Illness: URI & OM
Preexisting Conditions: eczema & seborrhea dermatitis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt found deceased in crib this AM <24hr p/vax;

Changed on 10/14/2018

VAERS ID: 108799 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Washington
Vaccinated:1998-03-17
Onset:1998-03-18
Submitted:1998-03-18
Entered:1998-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7B91821 / 2 LL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1484E / 2 RL / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. M1070 / 2 RL / SC

Administered by: Private      Purchased by: Public
Symptoms: Agitation, Chills, Oral candidiasis, Otitis media, Stupor, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-03-18
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: Amox given 17MAR98;Nystatin oral susp
Current Illness: URI & OM
Preexisting Conditions: eczema & seborrhea dermatitis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt found deceased in crib this AM <24hr p/vax;

Changed on 12/24/2020

VAERS ID: 108799 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Washington
Vaccinated:1998-03-17
Onset:1998-03-18
Submitted:1998-03-18
Entered:1998-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7B91821 / 2 LL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1484E / 2 RL / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. M1070 / 2 RL / SC

Administered by: Private      Purchased by: Public
Symptoms: Agitation, Chills, Oral candidiasis, Otitis media, Stupor, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-03-18
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: Amox given 17MAR98;Nystatin oral susp
Current Illness: URI & OM
Preexisting Conditions: eczema & seborrhea dermatitis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt found deceased in crib this AM <24hr p/vax;

Changed on 12/30/2020

VAERS ID: 108799 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Washington
Vaccinated:1998-03-17
Onset:1998-03-18
Submitted:1998-03-18
Entered:1998-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7B91821 / 2 LL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1484E / 2 RL / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. M1070 / 2 RL / SC

Administered by: Private      Purchased by: Public
Symptoms: Agitation, Chills, Oral candidiasis, Otitis media, Stupor, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-03-18
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: Amox given 17MAR98;Nystatin oral susp
Current Illness: URI & OM
Preexisting Conditions: eczema & seborrhea dermatitis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt found deceased in crib this AM <24hr p/vax;

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=108799&WAYBACKHISTORY=ON


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