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History of Changes from the VAERS Wayback Machine |
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;
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;
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;
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;
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;
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;
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;
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;
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;
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;
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;
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;
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;
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;
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;
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;
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;
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;
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;
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;
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;
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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