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This is VAERS ID 106256

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 106256
VAERS Form:
Age:1.1
Sex:Male
Location:Texas
Vaccinated:1997-12-10
Onset:1997-12-14
Submitted:0000-00-00
Entered:1998-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA / CONNAUGHT LABS 7A81601 / 2 RL / -
HEP: RECOMBIVAX HB / MSD 0924C / 2 LL / -
HIBV: HIBTITER / LEDERLE(PRAXIS) M200RC / 2 LL / -
MMR: MMR II / MSD 0465E / 0 RL / -
VARCEL: VARIVAX / MSD 0543E / 0 LL / -

Administered by: Public      Purchased by: Unknown
Symptoms: CONVULS, FEVER, DYSPNEA, ANOREXIA, ASTHENIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-12-19
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? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations: NONE
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE MD recommended vax
Allergies:
Diagnostic Lab Data: parents stated spinal fluid test done-results unk;
CDC 'Split Type': NONE MD recommended vax

Write-up: pt recv vax 10DEC97 & 14DEC97 elevated temp, poor appetite, weakness;15DEC97 inc temp taken to hosp adm;16DEC97 inc temp convuls, diff breathing taken to hosp;17DEC97 dec temp condition unresponsive & unable to communicate;


Changed on 12/8/2009

VAERS ID: 106256 Before After
VAERS Form:
Age:1.1
Sex:Male
Location:Texas
Vaccinated:1997-12-10
Onset:1997-12-14
Submitted:0000-00-00
Entered:1998-01-12 1998-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA DTAP (TRIPEDIA) / CONNAUGHT LABS CONNAUGHT LABORATORIES 7A81601 / 2 RL / -
HEP: RECOMBIVAX HB HEP B (RECOMBIVAX HB) / MSD MERCK & CO. INC. 0924C / 2 LL / -
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M200RC / 2 LL / -
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 0465E / 0 RL / -
VARCEL: VARIVAX VARICELLA (VARIVAX) / MSD MERCK & CO. INC. 0543E / 0 LL / -

Administered by: Public      Purchased by: Unknown Public
Symptoms: Anorexia, Asthenia, Convulsion, Dyspnoea, Hypothermia, Pyrexia, Stupor, CONVULS, FEVER, DYSPNEA, ANOREXIA, ASTHENIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-12-19
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? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations: NONE
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE MD recommended vax
Allergies:
Diagnostic Lab Data: parents stated spinal fluid test done-results unk;
CDC 'Split Type': NONE MD recommended vax TX97167

Write-up: pt recv vax 10DEC97 & 14DEC97 elevated temp, poor appetite, weakness;15DEC97 inc temp taken to hosp adm;16DEC97 inc temp convuls, diff breathing taken to hosp;17DEC97 dec temp condition unresponsive & unable to communicate;


Changed on 5/14/2017

VAERS ID: 106256 Before After
VAERS Form:
Age:1.1
Sex:Male
Location:Texas
Vaccinated:1997-12-10
Onset:1997-12-14
Submitted:0000-00-00
Entered:1998-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7A81601 / 2 RL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0924C / 2 LL / -
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M200RC / 2 LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0465E / 0 RL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0543E / 0 LL / -

Administered by: Public      Purchased by: Public
Symptoms: Anorexia, Asthenia, Convulsion, Dyspnoea, Hypothermia, Pyrexia, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-12-19
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? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations: NONE NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE MD recommended vax
Allergies:
Diagnostic Lab Data: parents stated spinal fluid test done-results unk;
CDC 'Split Type': TX97167

Write-up: pt recv vax 10DEC97 & 14DEC97 elevated temp, poor appetite, weakness;15DEC97 inc temp taken to hosp adm;16DEC97 inc temp convuls, diff breathing taken to hosp;17DEC97 dec temp condition unresponsive & unable to communicate;


Changed on 9/14/2017

VAERS ID: 106256 Before After
VAERS Form:(blank) 1
Age:1.1
Sex:Male
Location:Texas
Vaccinated:1997-12-10
Onset:1997-12-14
Submitted:0000-00-00
Entered:1998-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7A81601 / 2 3 RL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0924C / 2 3 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200RC / 2 3 LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0465E / 0 1 RL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0543E / 0 1 LL / -

Administered by: Public      Purchased by: Public
Symptoms: Anorexia, Asthenia, Convulsion, Dyspnoea, Hypothermia, Pyrexia, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-12-19
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? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE MD recommended vax
Allergies:
Diagnostic Lab Data: parents stated spinal fluid test done-results unk;
CDC 'Split Type': TX97167

Write-up: pt recv vax 10DEC97 & 14DEC97 elevated temp, poor appetite, weakness;15DEC97 inc temp taken to hosp adm;16DEC97 inc temp convuls, diff breathing taken to hosp;17DEC97 dec temp condition unresponsive & unable to communicate;


Changed on 2/14/2018

VAERS ID: 106256 Before After
VAERS Form:1
Age:1.1
Sex:Male
Location:Texas
Vaccinated:1997-12-10
Onset:1997-12-14
Submitted:0000-00-00
Entered:1998-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7A81601 / 3 RL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0924C / 3 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200RC / 3 LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0465E / 1 RL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0543E / 1 LL / -

Administered by: Public      Purchased by: Public
Symptoms: Anorexia, Asthenia, Convulsion, Dyspnoea, Hypothermia, Pyrexia, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-12-19
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? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE MD recommended vax
Allergies:
Diagnostic Lab Data: parents stated spinal fluid test done-results unk;
CDC 'Split Type': TX97167

Write-up: pt recv vax 10DEC97 & 14DEC97 elevated temp, poor appetite, weakness;15DEC97 inc temp taken to hosp adm;16DEC97 inc temp convuls, diff breathing taken to hosp;17DEC97 dec temp condition unresponsive & unable to communicate;


Changed on 6/14/2018

VAERS ID: 106256 Before After
VAERS Form:1
Age:1.1
Sex:Male
Location:Texas
Vaccinated:1997-12-10
Onset:1997-12-14
Submitted:0000-00-00
Entered:1998-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7A81601 / 3 RL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0924C / 3 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200RC / 3 LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0465E / 1 RL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0543E / 1 LL / -

Administered by: Public      Purchased by: Public
Symptoms: Anorexia, Asthenia, Convulsion, Dyspnoea, Hypothermia, Pyrexia, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-12-19
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? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE MD recommended vax
Allergies:
Diagnostic Lab Data: parents stated spinal fluid test done-results unk;
CDC 'Split Type': TX97167

Write-up: pt recv vax 10DEC97 & 14DEC97 elevated temp, poor appetite, weakness;15DEC97 inc temp taken to hosp adm;16DEC97 inc temp convuls, diff breathing taken to hosp;17DEC97 dec temp condition unresponsive & unable to communicate;


Changed on 8/14/2018

VAERS ID: 106256 Before After
VAERS Form:1
Age:1.1
Sex:Male
Location:Texas
Vaccinated:1997-12-10
Onset:1997-12-14
Submitted:0000-00-00
Entered:1998-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7A81601 / 3 RL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0924C / 3 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200RC / 3 LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0465E / 1 RL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0543E / 1 LL / -

Administered by: Public      Purchased by: Public
Symptoms: Anorexia, Asthenia, Convulsion, Dyspnoea, Hypothermia, Pyrexia, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-12-19
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? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE MD recommended vax
Allergies:
Diagnostic Lab Data: parents stated spinal fluid test done-results unk;
CDC 'Split Type': TX97167

Write-up: pt recv vax 10DEC97 & 14DEC97 elevated temp, poor appetite, weakness;15DEC97 inc temp taken to hosp adm;16DEC97 inc temp convuls, diff breathing taken to hosp;17DEC97 dec temp condition unresponsive & unable to communicate;


Changed on 9/14/2018

VAERS ID: 106256 Before After
VAERS Form:1
Age:1.1
Sex:Male
Location:Texas
Vaccinated:1997-12-10
Onset:1997-12-14
Submitted:0000-00-00
Entered:1998-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7A81601 / 3 RL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0924C / 3 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200RC / 3 LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0465E / 1 RL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0543E / 1 LL / -

Administered by: Public      Purchased by: Public
Symptoms: Anorexia, Asthenia, Convulsion, Dyspnoea, Hypothermia, Pyrexia, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-12-19
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? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE MD recommended vax
Allergies:
Diagnostic Lab Data: parents stated spinal fluid test done-results unk;
CDC 'Split Type': TX97167

Write-up: pt recv vax 10DEC97 & 14DEC97 elevated temp, poor appetite, weakness;15DEC97 inc temp taken to hosp adm;16DEC97 inc temp convuls, diff breathing taken to hosp;17DEC97 dec temp condition unresponsive & unable to communicate;


Changed on 10/14/2018

VAERS ID: 106256 Before After
VAERS Form:1
Age:1.1
Sex:Male
Location:Texas
Vaccinated:1997-12-10
Onset:1997-12-14
Submitted:0000-00-00
Entered:1998-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7A81601 / 3 RL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0924C / 3 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200RC / 3 LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0465E / 1 RL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0543E / 1 LL / -

Administered by: Public      Purchased by: Public
Symptoms: Anorexia, Asthenia, Convulsion, Dyspnoea, Hypothermia, Pyrexia, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-12-19
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? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE MD recommended vax
Allergies:
Diagnostic Lab Data: parents stated spinal fluid test done-results unk;
CDC 'Split Type': TX97167

Write-up: pt recv vax 10DEC97 & 14DEC97 elevated temp, poor appetite, weakness;15DEC97 inc temp taken to hosp adm;16DEC97 inc temp convuls, diff breathing taken to hosp;17DEC97 dec temp condition unresponsive & unable to communicate;

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