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History of Changes from the VAERS Wayback Machine |
VAERS ID: | 113721 |
VAERS Form: | |
Age: | 0.3 |
Sex: | Male |
Location: | New Jersey |
Vaccinated: | 1998-08-14 |
Onset: | 1998-08-23 |
Submitted: | 1998-08-26 |
Entered: | 1998-09-01 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: TRIPEDIA / CONNAUGHT LABS | 934790 / 1 | RL / IM |
HIBV: ACT-HIB / CONNAUGHT LABS | 2699H2 / 1 | LL / IM |
IPV: POLIOVAX / CONNAUGHT LTD | N0492 / 1 | LL / IM |
Administered by: Private Purchased by: Unknown
Symptoms: SLEEP POSITION
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1998-08-23
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: gross autopsy reported to have shown no identifiable cause of death;
CDC 'Split Type':
Write-up: pt found lifeless in bed;
Vaccinated: | 1998-08-14 |
Onset: | 1998-08-23 |
Submitted: | 1998-08-26 |
Entered: | 1998-09-01 1998-08-31 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: TRIPEDIA DTAP (TRIPEDIA) / CONNAUGHT LABS CONNAUGHT LABORATORIES | 934790 / 1 | RL / IM |
HIBV: ACT-HIB HIB (ACTHIB) / CONNAUGHT LABS CONNAUGHT LABORATORIES | 2699H2 / 1 | LL / IM |
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. | N0492 / 1 | LL / IM |
Administered by: Private Purchased by: Unknown Private
Symptoms: Unevaluable event, SLEEP POSITION
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1998-08-23
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: gross autopsy reported to have shown no identifiable cause of death;
CDC 'Split Type':
Write-up: pt found lifeless in bed;
Vaccinated: | 1998-08-14 |
Onset: | 1998-08-23 |
Submitted: | 1998-08-26 |
Entered: | 1998-08-31 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES | 934790 / 1 | RL / IM |
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES | 2699H2 / 1 | LL / IM |
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. | N0492 / 1 | LL / IM |
Administered by: Private Purchased by: Private
Symptoms: Unevaluable event
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1998-08-23
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: gross autopsy reported to have shown no identifiable cause of death;
CDC 'Split Type':
Write-up: pt found lifeless in bed;
Vaccinated: | 1998-08-14 |
Onset: | 1998-08-23 |
Submitted: | 1998-08-26 |
Entered: | 1998-08-31 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES | 934790 / 1 2 | RL / IM |
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES | 2699H2 / 1 2 | LL / IM |
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. | N0492 / 1 2 | LL / IM |
Administered by: Private Purchased by: Private
Symptoms: Unevaluable event
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1998-08-23
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: gross autopsy reported to have shown no identifiable cause of death;
CDC 'Split Type':
Write-up: pt found lifeless in bed;
Vaccinated: | 1998-08-14 |
Onset: | 1998-08-23 |
Submitted: | 1998-08-26 |
Entered: | 1998-08-31 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES | 934790 / 2 | RL / IM |
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES | 2699H2 / 2 | LL / IM |
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. | N0492 / 2 | LL / IM |
Administered by: Private Purchased by: Private
Symptoms: Unevaluable event
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1998-08-23
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: gross autopsy reported to have shown no identifiable cause of death;
CDC 'Split Type':
Write-up: pt found lifeless in bed;
Vaccinated: | 1998-08-14 |
Onset: | 1998-08-23 |
Submitted: | 1998-08-26 |
Entered: | 1998-08-31 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES | 934790 / 2 | RL / IM |
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES | 2699H2 / 2 | LL / IM |
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. | N0492 / 2 | LL / IM |
Administered by: Private Purchased by: Private
Symptoms: Unevaluable event
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1998-08-23
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: gross autopsy reported to have shown no identifiable cause of death;
CDC 'Split Type':
Write-up: pt found lifeless in bed;
Vaccinated: | 1998-08-14 |
Onset: | 1998-08-23 |
Submitted: | 1998-08-26 |
Entered: | 1998-08-31 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES | 934790 / 2 | RL / IM |
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES | 2699H2 / 2 | LL / IM |
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. | N0492 / 2 | LL / IM |
Administered by: Private Purchased by: Private
Symptoms: Unevaluable event
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1998-08-23
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: gross autopsy reported to have shown no identifiable cause of death;
CDC 'Split Type':
Write-up: pt found lifeless in bed;
Vaccinated: | 1998-08-14 |
Onset: | 1998-08-23 |
Submitted: | 1998-08-26 |
Entered: | 1998-08-31 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES | 934790 / 2 | RL / IM |
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES | 2699H2 / 2 | LL / IM |
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. | N0492 / 2 | LL / IM |
Administered by: Private Purchased by: Private
Symptoms: Unevaluable event
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1998-08-23
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: gross autopsy reported to have shown no identifiable cause of death;
CDC 'Split Type':
Write-up: pt found lifeless in bed;
Vaccinated: | 1998-08-14 |
Onset: | 1998-08-23 |
Submitted: | 1998-08-26 |
Entered: | 1998-08-31 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES | 934790 / 2 | RL / IM |
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES | 2699H2 / 2 | LL / IM |
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. | N0492 / 2 | LL / IM |
Administered by: Private Purchased by: Private
Symptoms: Unevaluable event
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1998-08-23
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: gross autopsy reported to have shown no identifiable cause of death;
CDC 'Split Type':
Write-up: pt found lifeless in bed;
Vaccinated: | 1998-08-14 |
Onset: | 1998-08-23 |
Submitted: | 1998-08-26 |
Entered: | 1998-08-31 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES | 934790 / 2 | RL / IM |
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES | 2699H2 / 2 | LL / IM |
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. | N0492 / 2 | LL / IM |
Administered by: Private Purchased by: Private
Symptoms: Unevaluable event
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1998-08-23
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: gross autopsy reported to have shown no identifiable cause of death;
CDC 'Split Type':
Write-up: pt found lifeless in bed;
Vaccinated: | 1998-08-14 |
Onset: | 1998-08-23 |
Submitted: | 1998-08-26 |
Entered: | 1998-08-31 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES | 934790 / 2 | RL / IM |
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES | 2699H2 / 2 | LL / IM |
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. | N0492 / 2 | LL / IM |
Administered by: Private Purchased by: Private
Symptoms: Unevaluable event
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1998-08-23
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: gross autopsy reported to have shown no identifiable cause of death;
CDC 'Split Type':
Write-up: pt found lifeless in bed;
Link To This Search Result:
https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=113721&WAYBACKHISTORY=ON
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