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This is VAERS ID 120891

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History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 120891
VAERS Form:
Age:0.3
Sex:Female
Location:Texas
Vaccinated:1999-03-17
Onset:0000-00-00
Submitted:1999-03-31
Entered:1999-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE / LEDERLE 453846 / 0 LL / -
HEP: RECOMBIVAX HB / MSD 0987H / 1 RL / -
HIBV: PEDVAXHIB / MSD 0897H / 0 LL / -
IPV: POLIOVAX / CONNAUGHT LTD M1069 / 0 RL / -

Administered by: Private      Purchased by: Unknown
Symptoms: INFECT, PNEUMONIA, DEHYDRAT, HEART ARREST, BRONCHITIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-03-19
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: none
Other Medications: HBV #1 @ birth
Current Illness: cold-nasal drainage, resp rate 36
Preexisting Conditions: none;family hx + for SIDS and possible sickle cell trait
Allergies:
Diagnostic Lab Data: nasopharyngeal-+RSV; blood cx-+ Grp D Strep,Enterococcus, Klebsiella pneumoniae; spleen viral cx-+ Cytomegalovirus
CDC 'Split Type': none;family hx + for SIDS and possible sickle cell trait

Write-up: (null)


Changed on 12/8/2009

VAERS ID: 120891 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:Texas
Vaccinated:1999-03-17
Onset:0000-00-00
Submitted:1999-03-31
Entered:1999-04-06 1999-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE DTAP (ACEL-IMUNE) / LEDERLE LEDERLE LABORATORIES 453846 / 0 LL / -
HEP: RECOMBIVAX HB HEP B (RECOMBIVAX HB) / MSD MERCK & CO. INC. 0987H / 1 RL / -
HIBV: PEDVAXHIB HIB (PEDVAXHIB) / MSD MERCK & CO. INC. 0897H / 0 LL / -
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. M1069 / 0 RL / -

Administered by: Private      Purchased by: Unknown Public
Symptoms: Bronchitis, Cardiac arrest, Dehydration, Infection, Pneumonia, INFECT, PNEUMONIA, DEHYDRAT, HEART ARREST, BRONCHITIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-03-19
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: none
Other Medications: HBV #1 @ birth
Current Illness: cold-nasal drainage, resp rate 36
Preexisting Conditions: none;family hx + for SIDS and possible sickle cell trait
Allergies:
Diagnostic Lab Data: nasopharyngeal-+RSV; blood cx-+ Grp D Strep,Enterococcus, Klebsiella pneumoniae; spleen viral cx-+ Cytomegalovirus
CDC 'Split Type': none;family hx + for SIDS and possible sickle cell trait (blank)

Write-up: (null)


Changed on 5/14/2017

VAERS ID: 120891 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:Texas
Vaccinated:1999-03-17
Onset:0000-00-00
Submitted:1999-03-31
Entered:1999-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 453846 / 0 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0987H / 1 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0897H / 0 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M1069 / 0 RL / -

Administered by: Private      Purchased by: Public
Symptoms: Bronchitis, Cardiac arrest, Dehydration, Infection, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-03-19
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: none none~ ()~~~In patient
Other Medications: HBV #1 @ birth
Current Illness: cold-nasal drainage, resp rate 36
Preexisting Conditions: none;family hx + for SIDS and possible sickle cell trait
Allergies:
Diagnostic Lab Data: nasopharyngeal-+RSV; blood cx-+ Grp D Strep,Enterococcus, Klebsiella pneumoniae; spleen viral cx-+ Cytomegalovirus
CDC 'Split Type':

Write-up: (null)


Changed on 9/14/2017

VAERS ID: 120891 Before After
VAERS Form:(blank) 1
Age:0.3
Sex:Female
Location:Texas
Vaccinated:1999-03-17
Onset:0000-00-00
Submitted:1999-03-31
Entered:1999-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 453846 / 0 1 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0987H / 1 2 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0897H / 0 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M1069 / 0 1 RL / -

Administered by: Private      Purchased by: Public
Symptoms: Bronchitis, Cardiac arrest, Dehydration, Infection, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-03-19
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: HBV #1 @ birth
Current Illness: cold-nasal drainage, resp rate 36
Preexisting Conditions: none;family hx + for SIDS and possible sickle cell trait
Allergies:
Diagnostic Lab Data: nasopharyngeal-+RSV; blood cx-+ Grp D Strep,Enterococcus, Klebsiella pneumoniae; spleen viral cx-+ Cytomegalovirus
CDC 'Split Type':

Write-up: (null)


Changed on 2/14/2018

VAERS ID: 120891 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:Texas
Vaccinated:1999-03-17
Onset:0000-00-00
Submitted:1999-03-31
Entered:1999-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 453846 / 1 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0987H / 2 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0897H / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M1069 / 1 RL / -

Administered by: Private      Purchased by: Public
Symptoms: Bronchitis, Cardiac arrest, Dehydration, Infection, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-03-19
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: HBV #1 @ birth
Current Illness: cold-nasal drainage, resp rate 36
Preexisting Conditions: none;family hx + for SIDS and possible sickle cell trait
Allergies:
Diagnostic Lab Data: nasopharyngeal-+RSV; blood cx-+ Grp D Strep,Enterococcus, Klebsiella pneumoniae; spleen viral cx-+ Cytomegalovirus
CDC 'Split Type':

Write-up: (null)


Changed on 6/14/2018

VAERS ID: 120891 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:Texas
Vaccinated:1999-03-17
Onset:0000-00-00
Submitted:1999-03-31
Entered:1999-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 453846 / 1 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0987H / 2 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0897H / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M1069 / 1 RL / -

Administered by: Private      Purchased by: Public
Symptoms: Bronchitis, Cardiac arrest, Dehydration, Infection, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-03-19
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: HBV #1 @ birth
Current Illness: cold-nasal drainage, resp rate 36
Preexisting Conditions: none;family hx + for SIDS and possible sickle cell trait
Allergies:
Diagnostic Lab Data: nasopharyngeal-+RSV; blood cx-+ Grp D Strep,Enterococcus, Klebsiella pneumoniae; spleen viral cx-+ Cytomegalovirus
CDC 'Split Type':

Write-up: (null)


Changed on 8/14/2018

VAERS ID: 120891 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:Texas
Vaccinated:1999-03-17
Onset:0000-00-00
Submitted:1999-03-31
Entered:1999-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 453846 / 1 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0987H / 2 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0897H / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M1069 / 1 RL / -

Administered by: Private      Purchased by: Public
Symptoms: Bronchitis, Cardiac arrest, Dehydration, Infection, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-03-19
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: HBV #1 @ birth
Current Illness: cold-nasal drainage, resp rate 36
Preexisting Conditions: none;family hx + for SIDS and possible sickle cell trait
Allergies:
Diagnostic Lab Data: nasopharyngeal-+RSV; blood cx-+ Grp D Strep,Enterococcus, Klebsiella pneumoniae; spleen viral cx-+ Cytomegalovirus
CDC 'Split Type':

Write-up: (null)


Changed on 9/14/2018

VAERS ID: 120891 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:Texas
Vaccinated:1999-03-17
Onset:0000-00-00
Submitted:1999-03-31
Entered:1999-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 453846 / 1 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0987H / 2 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0897H / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M1069 / 1 RL / -

Administered by: Private      Purchased by: Public
Symptoms: Bronchitis, Cardiac arrest, Dehydration, Infection, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-03-19
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: HBV #1 @ birth
Current Illness: cold-nasal drainage, resp rate 36
Preexisting Conditions: none;family hx + for SIDS and possible sickle cell trait
Allergies:
Diagnostic Lab Data: nasopharyngeal-+RSV; blood cx-+ Grp D Strep,Enterococcus, Klebsiella pneumoniae; spleen viral cx-+ Cytomegalovirus
CDC 'Split Type':

Write-up: (null)


Changed on 10/14/2018

VAERS ID: 120891 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:Texas
Vaccinated:1999-03-17
Onset:0000-00-00
Submitted:1999-03-31
Entered:1999-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 453846 / 1 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0987H / 2 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0897H / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M1069 / 1 RL / -

Administered by: Private      Purchased by: Public
Symptoms: Bronchitis, Cardiac arrest, Dehydration, Infection, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-03-19
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: HBV #1 @ birth
Current Illness: cold-nasal drainage, resp rate 36
Preexisting Conditions: none;family hx + for SIDS and possible sickle cell trait
Allergies:
Diagnostic Lab Data: nasopharyngeal-+RSV; blood cx-+ Grp D Strep,Enterococcus, Klebsiella pneumoniae; spleen viral cx-+ Cytomegalovirus
CDC 'Split Type':

Write-up: (null)


Changed on 12/24/2020

VAERS ID: 120891 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:Texas
Vaccinated:1999-03-17
Onset:0000-00-00
Submitted:1999-03-31
Entered:1999-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 453846 / 1 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0987H / 2 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0897H / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M1069 / 1 RL / -

Administered by: Private      Purchased by: Public
Symptoms: Bronchitis, Cardiac arrest, Dehydration, Infection, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-03-19
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: HBV #1 @ birth
Current Illness: cold-nasal drainage, resp rate 36
Preexisting Conditions: none;family hx + for SIDS and possible sickle cell trait
Allergies:
Diagnostic Lab Data: nasopharyngeal-+RSV; blood cx-+ Grp D Strep,Enterococcus, Klebsiella pneumoniae; spleen viral cx-+ Cytomegalovirus
CDC 'Split Type':

Write-up: (null)


Changed on 12/30/2020

VAERS ID: 120891 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:Texas
Vaccinated:1999-03-17
Onset:0000-00-00
Submitted:1999-03-31
Entered:1999-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 453846 / 1 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0987H / 2 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0897H / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M1069 / 1 RL / -

Administered by: Private      Purchased by: Public
Symptoms: Bronchitis, Cardiac arrest, Dehydration, Infection, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-03-19
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: HBV #1 @ birth
Current Illness: cold-nasal drainage, resp rate 36
Preexisting Conditions: none;family hx + for SIDS and possible sickle cell trait
Allergies:
Diagnostic Lab Data: nasopharyngeal-+RSV; blood cx-+ Grp D Strep,Enterococcus, Klebsiella pneumoniae; spleen viral cx-+ Cytomegalovirus
CDC 'Split Type':

Write-up: (null)


Changed on 5/7/2021

VAERS ID: 120891 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:Texas
Vaccinated:1999-03-17
Onset:0000-00-00
Submitted:1999-03-31
Entered:1999-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 453846 / 1 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0987H / 2 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0897H / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M1069 / 1 RL / -

Administered by: Private      Purchased by: Public
Symptoms: Bronchitis, Cardiac arrest, Dehydration, Infection, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-03-19
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: HBV #1 @ birth
Current Illness: cold-nasal drainage, resp rate 36
Preexisting Conditions: none;family hx + for SIDS and possible sickle cell trait
Allergies:
Diagnostic Lab Data: nasopharyngeal-+RSV; blood cx-+ Grp D Strep,Enterococcus, Klebsiella pneumoniae; spleen viral cx-+ Cytomegalovirus
CDC 'Split Type':

Write-up: (null)


Changed on 5/21/2021

VAERS ID: 120891 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:Texas
Vaccinated:1999-03-17
Onset:0000-00-00
Submitted:1999-03-31
Entered:1999-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 453846 / 1 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0987H / 2 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0897H / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M1069 / 1 RL / -

Administered by: Private      Purchased by: Public
Symptoms: Bronchitis, Cardiac arrest, Dehydration, Infection, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-03-19
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications: HBV #1 @ birth
Current Illness: cold-nasal drainage, resp rate 36
Preexisting Conditions: none;family hx + for SIDS and possible sickle cell trait
Allergies:
Diagnostic Lab Data: nasopharyngeal-+RSV; blood cx-+ Grp D Strep,Enterococcus, Klebsiella pneumoniae; spleen viral cx-+ Cytomegalovirus
CDC 'Split Type':

Write-up: (null)

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