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This is VAERS ID 116613

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 116613
VAERS Form:
Age:1.1
Sex:Male
Location:Ohio
Vaccinated:1998-09-17
Onset:1998-09-23
Submitted:1998-11-06
Entered:1998-11-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIBTITER / LEDERLE(PRAXIS) M240RL / 3 LL / IM
MMR: MMR II / MSD 1679E / 0 LA / SC
OPV: ORIMUNE / LEDERLE 0792H / 2 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: INFECT, SEPSIS, HEART ARREST, CARDIOVASC DIS, EDEMA BRAIN

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-09-23
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: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy performed to determine COD sepsis & salmonella serotype B infect;
CDC 'Split Type': NONE

Write-up: no adverse signs or symptom were observed by parent p/immun;


Changed on 12/8/2009

VAERS ID: 116613 Before After
VAERS Form:
Age:1.1
Sex:Male
Location:Ohio
Vaccinated:1998-09-17
Onset:1998-09-23
Submitted:1998-11-06
Entered:1998-11-25 1998-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M240RL / 3 LL / IM
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 1679E / 0 LA / SC
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 0792H / 2 - / PO

Administered by: Public      Purchased by: Unknown Public
Symptoms: Cardiac arrest, Cardiovascular disorder, Infection, Sepsis, Brain oedema, INFECT, SEPSIS, HEART ARREST, CARDIOVASC DIS, EDEMA BRAIN

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-09-23
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: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy performed to determine COD sepsis & salmonella serotype B infect;
CDC 'Split Type': NONE OH98097

Write-up: no adverse signs or symptom were observed by parent p/immun;


Changed on 5/14/2017

VAERS ID: 116613 Before After
VAERS Form:
Age:1.1
Sex:Male
Location:Ohio
Vaccinated:1998-09-17
Onset:1998-09-23
Submitted:1998-11-06
Entered:1998-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M240RL / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1679E / 0 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 0792H / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Cardiac arrest, Cardiovascular disorder, Infection, Sepsis, Brain oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-09-23
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: NONE NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy performed to determine COD sepsis & salmonella serotype B infect;
CDC 'Split Type': OH98097

Write-up: no adverse signs or symptom were observed by parent p/immun;


Changed on 9/14/2017

VAERS ID: 116613 Before After
VAERS Form:(blank) 1
Age:1.1
Sex:Male
Location:Ohio
Vaccinated:1998-09-17
Onset:1998-09-23
Submitted:1998-11-06
Entered:1998-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M240RL / 3 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1679E / 0 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0792H / 2 3 - MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Cardiac arrest, Cardiovascular disorder, Infection, Sepsis, Brain oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-09-23
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy performed to determine COD sepsis & salmonella serotype B infect;
CDC 'Split Type': OH98097

Write-up: no adverse signs or symptom were observed by parent p/immun;


Changed on 2/14/2018

VAERS ID: 116613 Before After
VAERS Form:1
Age:1.1
Sex:Male
Location:Ohio
Vaccinated:1998-09-17
Onset:1998-09-23
Submitted:1998-11-06
Entered:1998-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M240RL / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1679E / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0792H / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Cardiac arrest, Cardiovascular disorder, Infection, Sepsis, Brain oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-09-23
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy performed to determine COD sepsis & salmonella serotype B infect;
CDC 'Split Type': OH98097

Write-up: no adverse signs or symptom were observed by parent p/immun;


Changed on 6/14/2018

VAERS ID: 116613 Before After
VAERS Form:1
Age:1.1
Sex:Male
Location:Ohio
Vaccinated:1998-09-17
Onset:1998-09-23
Submitted:1998-11-06
Entered:1998-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M240RL / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1679E / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0792H / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Cardiac arrest, Cardiovascular disorder, Infection, Sepsis, Brain oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-09-23
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy performed to determine COD sepsis & salmonella serotype B infect;
CDC 'Split Type': OH98097

Write-up: no adverse signs or symptom were observed by parent p/immun;


Changed on 8/14/2018

VAERS ID: 116613 Before After
VAERS Form:1
Age:1.1
Sex:Male
Location:Ohio
Vaccinated:1998-09-17
Onset:1998-09-23
Submitted:1998-11-06
Entered:1998-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M240RL / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1679E / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0792H / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Cardiac arrest, Cardiovascular disorder, Infection, Sepsis, Brain oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-09-23
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy performed to determine COD sepsis & salmonella serotype B infect;
CDC 'Split Type': OH98097

Write-up: no adverse signs or symptom were observed by parent p/immun;


Changed on 9/14/2018

VAERS ID: 116613 Before After
VAERS Form:1
Age:1.1
Sex:Male
Location:Ohio
Vaccinated:1998-09-17
Onset:1998-09-23
Submitted:1998-11-06
Entered:1998-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M240RL / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1679E / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0792H / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Cardiac arrest, Cardiovascular disorder, Infection, Sepsis, Brain oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-09-23
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy performed to determine COD sepsis & salmonella serotype B infect;
CDC 'Split Type': OH98097

Write-up: no adverse signs or symptom were observed by parent p/immun;


Changed on 10/14/2018

VAERS ID: 116613 Before After
VAERS Form:1
Age:1.1
Sex:Male
Location:Ohio
Vaccinated:1998-09-17
Onset:1998-09-23
Submitted:1998-11-06
Entered:1998-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M240RL / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1679E / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0792H / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Cardiac arrest, Cardiovascular disorder, Infection, Sepsis, Brain oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-09-23
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy performed to determine COD sepsis & salmonella serotype B infect;
CDC 'Split Type': OH98097

Write-up: no adverse signs or symptom were observed by parent p/immun;

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