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This is VAERS ID 123218

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 123218
VAERS Form:
Age:1.3
Sex:Male
Location:Oregon
Vaccinated:1999-04-10
Onset:1999-04-30
Submitted:1999-05-21
Entered:1999-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA / CONNAUGHT LABS 0961040 / 3 RL / -
HIBV: ACT-HIB / CONNAUGHT LABS 0957700 / 3 RL / -
MMR: MMR II / MSD 1980H / 0 LL / -
VARCEL: VARIVAX / MSD 1671H / 0 RA / -

Administered by: Private      Purchased by: Unknown
Symptoms: FEVER, LYMPHOCYTOSIS, PANCYTOPENIA, RBC ABNORM

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:     Extended hospital stay? Yes
Previous Vaccinations: pt sibling had similar illness w/death p/vax in Romania 14yr ago @ 7mo
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: bone marrow, serum ferritin, pancytopenia
CDC 'Split Type': NONE

Write-up: hemophagocytic lymphohistiocytosis (HLH) on 4/30/99, 20 days p/vax;studies including bone marrow @ hosp revealed dx on 9th day of fever;pt on chemotherapy awaiting marrow transplant;viral infect, including varicella vax are known triggers


Changed on 12/8/2009

VAERS ID: 123218 Before After
VAERS Form:
Age:1.3
Sex:Male
Location:Oregon
Vaccinated:1999-04-10
Onset:1999-04-30
Submitted:1999-05-21
Entered:1999-06-03 1999-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA DTAP (TRIPEDIA) / CONNAUGHT LABS CONNAUGHT LABORATORIES 0961040 / 3 RL / -
HIBV: ACT-HIB HIB (ACTHIB) / CONNAUGHT LABS CONNAUGHT LABORATORIES 0957700 / 3 RL / -
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 1980H / 0 LL / -
VARCEL: VARIVAX VARICELLA (VARIVAX) / MSD MERCK & CO. INC. 1671H / 0 RA / -

Administered by: Private      Purchased by: Unknown Private
Symptoms: Lymphocytosis, Pancytopenia, Pyrexia, Red blood cell abnormality, FEVER, LYMPHOCYTOSIS, PANCYTOPENIA, RBC ABNORM

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:     Extended hospital stay? Yes
Previous Vaccinations: pt sibling had similar illness w/death p/vax in Romania 14yr ago @ 7mo
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: bone marrow, serum ferritin, pancytopenia
CDC 'Split Type': NONE (blank)

Write-up: hemophagocytic lymphohistiocytosis (HLH) on 4/30/99, 20 days p/vax;studies including bone marrow @ hosp revealed dx on 9th day of fever;pt on chemotherapy awaiting marrow transplant;viral infect, including varicella vax are known triggers


Changed on 5/14/2017

VAERS ID: 123218 Before After
VAERS Form:
Age:1.3
Sex:Male
Location:Oregon
Vaccinated:1999-04-10
Onset:1999-04-30
Submitted:1999-05-21
Entered:1999-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0961040 / 3 RL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 0957700 / 3 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1980H / 0 LL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1671H / 0 RA / -

Administered by: Private      Purchased by: Private
Symptoms: Lymphocytosis, Pancytopenia, Pyrexia, Red blood cell abnormality

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:     Extended hospital stay? Yes
Previous Vaccinations: pt sibling had similar illness w/death p/vax in Romania 14yr ago @ 7mo 7mo~ ()~~~In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: bone marrow, serum ferritin, pancytopenia
CDC 'Split Type':

Write-up: hemophagocytic lymphohistiocytosis (HLH) on 4/30/99, 20 days p/vax;studies including bone marrow @ hosp revealed dx on 9th day of fever;pt on chemotherapy awaiting marrow transplant;viral infect, including varicella vax are known triggers


Changed on 9/14/2017

VAERS ID: 123218 Before After
VAERS Form:(blank) 1
Age:1.3
Sex:Male
Location:Oregon
Vaccinated:1999-04-10
Onset:1999-04-30
Submitted:1999-05-21
Entered:1999-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0961040 / 3 4 RL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 0957700 / 3 4 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1980H / 0 1 LL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1671H / 0 1 RA / -

Administered by: Private      Purchased by: Private
Symptoms: Lymphocytosis, Pancytopenia, Pyrexia, Red blood cell abnormality

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:     Extended hospital stay? Yes
Previous Vaccinations: pt sibling had similar illness w/death p/vax in Romania 14yr ago @ 7mo~ ()~~~In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: bone marrow, serum ferritin, pancytopenia
CDC 'Split Type':

Write-up: hemophagocytic lymphohistiocytosis (HLH) on 4/30/99, 20 days p/vax;studies including bone marrow @ hosp revealed dx on 9th day of fever;pt on chemotherapy awaiting marrow transplant;viral infect, including varicella vax are known triggers


Changed on 2/14/2018

VAERS ID: 123218 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Oregon
Vaccinated:1999-04-10
Onset:1999-04-30
Submitted:1999-05-21
Entered:1999-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0961040 / 4 RL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 0957700 / 4 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1980H / 1 LL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1671H / 1 RA / -

Administered by: Private      Purchased by: Private
Symptoms: Lymphocytosis, Pancytopenia, Pyrexia, Red blood cell abnormality

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:     Extended hospital stay? Yes
Previous Vaccinations: pt sibling had similar illness w/death p/vax in Romania 14yr ago @ 7mo~ ()~~~In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: bone marrow, serum ferritin, pancytopenia
CDC 'Split Type':

Write-up: hemophagocytic lymphohistiocytosis (HLH) on 4/30/99, 20 days p/vax;studies including bone marrow @ hosp revealed dx on 9th day of fever;pt on chemotherapy awaiting marrow transplant;viral infect, including varicella vax are known triggers


Changed on 6/14/2018

VAERS ID: 123218 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Oregon
Vaccinated:1999-04-10
Onset:1999-04-30
Submitted:1999-05-21
Entered:1999-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0961040 / 4 RL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 0957700 / 4 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1980H / 1 LL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1671H / 1 RA / -

Administered by: Private      Purchased by: Private
Symptoms: Lymphocytosis, Pancytopenia, Pyrexia, Red blood cell abnormality

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:     Extended hospital stay? Yes
Previous Vaccinations: pt sibling had similar illness w/death p/vax in Romania 14yr ago @ 7mo~ ()~~~In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: bone marrow, serum ferritin, pancytopenia
CDC 'Split Type':

Write-up: hemophagocytic lymphohistiocytosis (HLH) on 4/30/99, 20 days p/vax;studies including bone marrow @ hosp revealed dx on 9th day of fever;pt on chemotherapy awaiting marrow transplant;viral infect, including varicella vax are known triggers


Changed on 8/14/2018

VAERS ID: 123218 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Oregon
Vaccinated:1999-04-10
Onset:1999-04-30
Submitted:1999-05-21
Entered:1999-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0961040 / 4 RL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 0957700 / 4 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1980H / 1 LL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1671H / 1 RA / -

Administered by: Private      Purchased by: Private
Symptoms: Lymphocytosis, Pancytopenia, Pyrexia, Red blood cell abnormality

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:     Extended hospital stay? Yes
Previous Vaccinations: pt sibling had similar illness w/death p/vax in Romania 14yr ago @ 7mo~ ()~~~In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: bone marrow, serum ferritin, pancytopenia
CDC 'Split Type':

Write-up: hemophagocytic lymphohistiocytosis (HLH) on 4/30/99, 20 days p/vax;studies including bone marrow @ hosp revealed dx on 9th day of fever;pt on chemotherapy awaiting marrow transplant;viral infect, including varicella vax are known triggers


Changed on 9/14/2018

VAERS ID: 123218 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Oregon
Vaccinated:1999-04-10
Onset:1999-04-30
Submitted:1999-05-21
Entered:1999-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0961040 / 4 RL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 0957700 / 4 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1980H / 1 LL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1671H / 1 RA / -

Administered by: Private      Purchased by: Private
Symptoms: Lymphocytosis, Pancytopenia, Pyrexia, Red blood cell abnormality

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:     Extended hospital stay? Yes
Previous Vaccinations: pt sibling had similar illness w/death p/vax in Romania 14yr ago @ 7mo~ ()~~~In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: bone marrow, serum ferritin, pancytopenia
CDC 'Split Type':

Write-up: hemophagocytic lymphohistiocytosis (HLH) on 4/30/99, 20 days p/vax;studies including bone marrow @ hosp revealed dx on 9th day of fever;pt on chemotherapy awaiting marrow transplant;viral infect, including varicella vax are known triggers


Changed on 10/14/2018

VAERS ID: 123218 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Oregon
Vaccinated:1999-04-10
Onset:1999-04-30
Submitted:1999-05-21
Entered:1999-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0961040 / 4 RL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 0957700 / 4 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1980H / 1 LL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1671H / 1 RA / -

Administered by: Private      Purchased by: Private
Symptoms: Lymphocytosis, Pancytopenia, Pyrexia, Red blood cell abnormality

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:     Extended hospital stay? Yes
Previous Vaccinations: pt sibling had similar illness w/death p/vax in Romania 14yr ago @ 7mo~ ()~~~In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: bone marrow, serum ferritin, pancytopenia
CDC 'Split Type':

Write-up: hemophagocytic lymphohistiocytosis (HLH) on 4/30/99, 20 days p/vax;studies including bone marrow @ hosp revealed dx on 9th day of fever;pt on chemotherapy awaiting marrow transplant;viral infect, including varicella vax are known triggers

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=123218&WAYBACKHISTORY=ON


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