National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 101298

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 101298
VAERS Form:
Age:7.9
Sex:Female
Location:Pennsylvania
Vaccinated:1995-09-13
Onset:1995-09-21
Submitted:1997-08-01
Entered:1997-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: UNK. DT ADSORBED, PEDIATRIC / UNCLASSIFIED - / - - / -
MMR: MMR II / MSD - / - - / -
OPV: ORIMUNE / LEDERLE - / - - / -
VARCEL: VARIVAX / MSD 0434B / 0 - / SC

Administered by: Other      Purchased by: Unknown
Symptoms: ASTHMA, ENCEPHALITIS, EDEMA LUNG, COAGUL DIS, HEM

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1997-06-01
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Prednisone, ATB
Current Illness:
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data: polymerase chain rxn- wild type virus
CDC 'Split Type':

Write-up: 15sep95 pt recv vax; same day pt devel hives, on 01may97 pt was admitted to hosp w/ severe asthma. pt exp respiratory compromise & was incubated & ventilated. pt was thought to have a bacterial superinfection. pt also exp pneumonia,


Changed on 12/8/2009

VAERS ID: 101298 Before After
VAERS Form:
Age:7.9 7.0
Sex:Female
Location:Pennsylvania
Vaccinated:1995-09-13
Onset:1995-09-21
Submitted:1997-08-01
Entered:1997-08-06 1997-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: UNK. DT ADSORBED, PEDIATRIC DT ADSORBED (NO BRAND NAME) / UNCLASSIFIED UNKNOWN MANUFACTURER - / - - / -
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. - / - - / -
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES - / - - / -
VARCEL: VARIVAX VARICELLA (VARIVAX) / MSD MERCK & CO. INC. 0434B / 0 - / SC

Administered by: Other Unknown      Purchased by: Unknown
Symptoms: Asthma, Coagulopathy, Encephalitis, Hepatic failure, Infection, Pulmonary oedema, Haemorrhage, ASTHMA, ENCEPHALITIS, EDEMA LUNG, COAGUL DIS, HEM

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1997-06-01
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? Yes No
Previous Vaccinations:
Other Medications: Prednisone, ATB
Current Illness:
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data: polymerase chain rxn- wild type virus
CDC 'Split Type': (blank) WAES97062181

Write-up: 15sep95 pt recv vax; same day pt devel hives, on 01may97 pt was admitted to hosp w/ severe asthma. pt exp respiratory compromise & was incubated & ventilated. pt was thought to have a bacterial superinfection. pt also exp pneumonia,


Changed on 5/14/2017

VAERS ID: 101298 Before After
VAERS Form:
Age:7.0
Sex:Female
Location:Pennsylvania
Vaccinated:1995-09-13
Onset:1995-09-21
Submitted:1997-08-01
Entered:1997-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / - - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH - / - - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0434B / 0 - / SC

Administered by: Unknown Other      Purchased by: Unknown Other
Symptoms: Asthma, Coagulopathy, Encephalitis, Hepatic failure, Infection, Pulmonary oedema, Haemorrhage

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1997-06-01
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prednisone, ATB
Current Illness:
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data: polymerase chain rxn- wild type virus
CDC 'Split Type': WAES97062181

Write-up: 15sep95 pt recv vax; same day pt devel hives, on 01may97 pt was admitted to hosp w/ severe asthma. pt exp respiratory compromise & was incubated & ventilated. pt was thought to have a bacterial superinfection. pt also exp pneumonia,


Changed on 9/14/2017

VAERS ID: 101298 Before After
VAERS Form:(blank) 1
Age:7.0
Sex:Female
Location:Pennsylvania
Vaccinated:1995-09-13
Onset:1995-09-21
Submitted:1997-08-01
Entered:1997-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / - UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / - UNK - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0434B / 0 1 - / SC

Administered by: Other      Purchased by: Other
Symptoms: Asthma, Coagulopathy, Encephalitis, Hepatic failure, Infection, Pulmonary oedema, Haemorrhage

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1997-06-01
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prednisone, ATB
Current Illness:
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data: polymerase chain rxn- wild type virus
CDC 'Split Type': WAES97062181

Write-up: 15sep95 pt recv vax; same day pt devel hives, on 01may97 pt was admitted to hosp w/ severe asthma. pt exp respiratory compromise & was incubated & ventilated. pt was thought to have a bacterial superinfection. pt also exp pneumonia,


Changed on 2/14/2018

VAERS ID: 101298 Before After
VAERS Form:1
Age:7.0
Sex:Female
Location:Pennsylvania
Vaccinated:1995-09-13
Onset:1995-09-21
Submitted:1997-08-01
Entered:1997-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / UNK - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0434B / 1 - / SC

Administered by: Other      Purchased by: Other
Symptoms: Asthma, Coagulopathy, Encephalitis, Hepatic failure, Infection, Pulmonary oedema, Haemorrhage

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1997-06-01
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prednisone, ATB
Current Illness:
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data: polymerase chain rxn- wild type virus
CDC 'Split Type': WAES97062181

Write-up: 15sep95 pt recv vax; same day pt devel hives, on 01may97 pt was admitted to hosp w/ severe asthma. pt exp respiratory compromise & was incubated & ventilated. pt was thought to have a bacterial superinfection. pt also exp pneumonia,


Changed on 6/14/2018

VAERS ID: 101298 Before After
VAERS Form:1
Age:7.0
Sex:Female
Location:Pennsylvania
Vaccinated:1995-09-13
Onset:1995-09-21
Submitted:1997-08-01
Entered:1997-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / UNK - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0434B / 1 - / SC

Administered by: Other      Purchased by: Other
Symptoms: Asthma, Coagulopathy, Encephalitis, Hepatic failure, Infection, Pulmonary oedema, Haemorrhage

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1997-06-01
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prednisone, ATB
Current Illness:
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data: polymerase chain rxn- wild type virus
CDC 'Split Type': WAES97062181

Write-up: 15sep95 pt recv vax; same day pt devel hives, on 01may97 pt was admitted to hosp w/ severe asthma. pt exp respiratory compromise & was incubated & ventilated. pt was thought to have a bacterial superinfection. pt also exp pneumonia,


Changed on 8/14/2018

VAERS ID: 101298 Before After
VAERS Form:1
Age:7.0
Sex:Female
Location:Pennsylvania
Vaccinated:1995-09-13
Onset:1995-09-21
Submitted:1997-08-01
Entered:1997-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / UNK - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0434B / 1 - / SC

Administered by: Other      Purchased by: Other
Symptoms: Asthma, Coagulopathy, Encephalitis, Hepatic failure, Infection, Pulmonary oedema, Haemorrhage

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1997-06-01
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prednisone, ATB
Current Illness:
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data: polymerase chain rxn- wild type virus
CDC 'Split Type': WAES97062181

Write-up: 15sep95 pt recv vax; same day pt devel hives, on 01may97 pt was admitted to hosp w/ severe asthma. pt exp respiratory compromise & was incubated & ventilated. pt was thought to have a bacterial superinfection. pt also exp pneumonia,


Changed on 9/14/2018

VAERS ID: 101298 Before After
VAERS Form:1
Age:7.0
Sex:Female
Location:Pennsylvania
Vaccinated:1995-09-13
Onset:1995-09-21
Submitted:1997-08-01
Entered:1997-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / UNK - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0434B / 1 - / SC

Administered by: Other      Purchased by: Other
Symptoms: Asthma, Coagulopathy, Encephalitis, Hepatic failure, Infection, Pulmonary oedema, Haemorrhage

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1997-06-01
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prednisone, ATB
Current Illness:
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data: polymerase chain rxn- wild type virus
CDC 'Split Type': WAES97062181

Write-up: 15sep95 pt recv vax; same day pt devel hives, on 01may97 pt was admitted to hosp w/ severe asthma. pt exp respiratory compromise & was incubated & ventilated. pt was thought to have a bacterial superinfection. pt also exp pneumonia,


Changed on 10/14/2018

VAERS ID: 101298 Before After
VAERS Form:1
Age:7.0
Sex:Female
Location:Pennsylvania
Vaccinated:1995-09-13
Onset:1995-09-21
Submitted:1997-08-01
Entered:1997-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / UNK - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0434B / 1 - / SC

Administered by: Other      Purchased by: Other
Symptoms: Asthma, Coagulopathy, Encephalitis, Hepatic failure, Infection, Pulmonary oedema, Haemorrhage

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1997-06-01
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prednisone, ATB
Current Illness:
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data: polymerase chain rxn- wild type virus
CDC 'Split Type': WAES97062181

Write-up: 15sep95 pt recv vax; same day pt devel hives, on 01may97 pt was admitted to hosp w/ severe asthma. pt exp respiratory compromise & was incubated & ventilated. pt was thought to have a bacterial superinfection. pt also exp pneumonia,

New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=101298&WAYBACKHISTORY=ON


Copyright © 2019 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166