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This is VAERS ID 129511

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 129511
VAERS Form:
Age:1.3
Sex:Male
Location:California
Vaccinated:1999-07-08
Onset:1999-09-14
Submitted:1999-10-14
Entered:1999-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA / CONNAUGHT LABS 0942540 / 3 - / -
HBHEPB: COMVAX / MSD 119H / 2 - / -
IPV: POLIOVAX / CONNAUGHT LTD N0700 / 2 - / -
MMR: MMR II / MSD 1184H / 0 - / -
VARCEL: VARIVAX / MSD 1671H / 0 - / -

Administered by: Private      Purchased by: Unknown
Symptoms: AGITATION, ANOREXIA, ASTHENIA, COUGH INC, CARDIOVASC DIS

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1999-09-14
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: fever, sleepy
Preexisting Conditions: hypospadins, chordee
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': hypospadins, chordee

Write-up: p/vax pt devel T103.3, irritable & cranky, fever, not eating;cough, tired, lethargic, not self, not playful, fussy, no sleep, rapid heart beats, lt side of chest larger, nose flaring, trouble breathing;to ER found heart disease;


Changed on 12/8/2009

VAERS ID: 129511 Before After
VAERS Form:
Age:1.3
Sex:Male
Location:California
Vaccinated:1999-07-08
Onset:1999-09-14
Submitted:1999-10-14
Entered:1999-10-22 1999-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA DTAP (TRIPEDIA) / CONNAUGHT LABS CONNAUGHT LABORATORIES 0942540 / 3 - / -
HBHEPB: COMVAX HIB + HEP B (COMVAX) / MSD MERCK & CO. INC. 119H / 2 - / -
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. N0700 / 2 - / -
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 1184H / 0 - / -
VARCEL: VARIVAX VARICELLA (VARIVAX) / MSD MERCK & CO. INC. 1671H / 0 - / -

Administered by: Private      Purchased by: Unknown Other
Symptoms: Agitation, Anorexia, Asthenia, Cardiovascular disorder, Cough, Dyspnoea, Insomnia, Personality disorder, Pyrexia, Somnolence, Tachycardia, AGITATION, ANOREXIA, ASTHENIA, COUGH INC, CARDIOVASC DIS

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1999-09-14
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: fever, sleepy
Preexisting Conditions: hypospadins, chordee
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': hypospadins, chordee (blank)

Write-up: p/vax pt devel T103.3, irritable & cranky, fever, not eating;cough, tired, lethargic, not self, not playful, fussy, no sleep, rapid heart beats, lt side of chest larger, nose flaring, trouble breathing;to ER found heart disease;


Changed on 5/14/2017

VAERS ID: 129511 Before After
VAERS Form:
Age:1.3
Sex:Male
Location:California
Vaccinated:1999-07-08
Onset:1999-09-14
Submitted:1999-10-14
Entered:1999-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0942540 / 3 - / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 119H / 2 - / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0700 / 2 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1184H / 0 - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1671H / 0 - / -

Administered by: Private      Purchased by: Other
Symptoms: Agitation, Anorexia, Asthenia, Cardiovascular disorder, Cough, Dyspnoea, Insomnia, Personality disorder, Pyrexia, Somnolence, Tachycardia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1999-09-14
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: NONE NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: fever, sleepy
Preexisting Conditions: hypospadins, chordee
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: p/vax pt devel T103.3, irritable & cranky, fever, not eating;cough, tired, lethargic, not self, not playful, fussy, no sleep, rapid heart beats, lt side of chest larger, nose flaring, trouble breathing;to ER found heart disease;


Changed on 9/14/2017

VAERS ID: 129511 Before After
VAERS Form:(blank) 1
Age:1.3
Sex:Male
Location:California
Vaccinated:1999-07-08
Onset:1999-09-14
Submitted:1999-10-14
Entered:1999-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0942540 / 3 4 - / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 119H / 2 3 - / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0700 / 2 3 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1184H / 0 1 - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1671H / 0 1 - / -

Administered by: Private      Purchased by: Other
Symptoms: Agitation, Anorexia, Asthenia, Cardiovascular disorder, Cough, Dyspnoea, Insomnia, Personality disorder, Pyrexia, Somnolence, Tachycardia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1999-09-14
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: fever, sleepy
Preexisting Conditions: hypospadins, chordee
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: p/vax pt devel T103.3, irritable & cranky, fever, not eating;cough, tired, lethargic, not self, not playful, fussy, no sleep, rapid heart beats, lt side of chest larger, nose flaring, trouble breathing;to ER found heart disease;


Changed on 2/14/2018

VAERS ID: 129511 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:California
Vaccinated:1999-07-08
Onset:1999-09-14
Submitted:1999-10-14
Entered:1999-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0942540 / 4 - / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 119H / 3 - / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0700 / 3 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1184H / 1 - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1671H / 1 - / -

Administered by: Private      Purchased by: Other
Symptoms: Agitation, Anorexia, Asthenia, Cardiovascular disorder, Cough, Dyspnoea, Insomnia, Personality disorder, Pyrexia, Somnolence, Tachycardia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1999-09-14
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: fever, sleepy
Preexisting Conditions: hypospadins, chordee
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: p/vax pt devel T103.3, irritable & cranky, fever, not eating;cough, tired, lethargic, not self, not playful, fussy, no sleep, rapid heart beats, lt side of chest larger, nose flaring, trouble breathing;to ER found heart disease;


Changed on 6/14/2018

VAERS ID: 129511 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:California
Vaccinated:1999-07-08
Onset:1999-09-14
Submitted:1999-10-14
Entered:1999-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0942540 / 4 - / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 119H / 3 - / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0700 / 3 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1184H / 1 - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1671H / 1 - / -

Administered by: Private      Purchased by: Other
Symptoms: Agitation, Anorexia, Asthenia, Cardiovascular disorder, Cough, Dyspnoea, Insomnia, Personality disorder, Pyrexia, Somnolence, Tachycardia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1999-09-14
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: fever, sleepy
Preexisting Conditions: hypospadins, chordee
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: p/vax pt devel T103.3, irritable & cranky, fever, not eating;cough, tired, lethargic, not self, not playful, fussy, no sleep, rapid heart beats, lt side of chest larger, nose flaring, trouble breathing;to ER found heart disease;


Changed on 8/14/2018

VAERS ID: 129511 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:California
Vaccinated:1999-07-08
Onset:1999-09-14
Submitted:1999-10-14
Entered:1999-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0942540 / 4 - / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 119H / 3 - / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0700 / 3 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1184H / 1 - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1671H / 1 - / -

Administered by: Private      Purchased by: Other
Symptoms: Agitation, Anorexia, Asthenia, Cardiovascular disorder, Cough, Dyspnoea, Insomnia, Personality disorder, Pyrexia, Somnolence, Tachycardia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1999-09-14
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: fever, sleepy
Preexisting Conditions: hypospadins, chordee
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: p/vax pt devel T103.3, irritable & cranky, fever, not eating;cough, tired, lethargic, not self, not playful, fussy, no sleep, rapid heart beats, lt side of chest larger, nose flaring, trouble breathing;to ER found heart disease;


Changed on 9/14/2018

VAERS ID: 129511 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:California
Vaccinated:1999-07-08
Onset:1999-09-14
Submitted:1999-10-14
Entered:1999-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0942540 / 4 - / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 119H / 3 - / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0700 / 3 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1184H / 1 - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1671H / 1 - / -

Administered by: Private      Purchased by: Other
Symptoms: Agitation, Anorexia, Asthenia, Cardiovascular disorder, Cough, Dyspnoea, Insomnia, Personality disorder, Pyrexia, Somnolence, Tachycardia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1999-09-14
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: fever, sleepy
Preexisting Conditions: hypospadins, chordee
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: p/vax pt devel T103.3, irritable & cranky, fever, not eating;cough, tired, lethargic, not self, not playful, fussy, no sleep, rapid heart beats, lt side of chest larger, nose flaring, trouble breathing;to ER found heart disease;


Changed on 10/14/2018

VAERS ID: 129511 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:California
Vaccinated:1999-07-08
Onset:1999-09-14
Submitted:1999-10-14
Entered:1999-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0942540 / 4 - / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 119H / 3 - / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0700 / 3 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1184H / 1 - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1671H / 1 - / -

Administered by: Private      Purchased by: Other
Symptoms: Agitation, Anorexia, Asthenia, Cardiovascular disorder, Cough, Dyspnoea, Insomnia, Personality disorder, Pyrexia, Somnolence, Tachycardia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1999-09-14
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: fever, sleepy
Preexisting Conditions: hypospadins, chordee
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: p/vax pt devel T103.3, irritable & cranky, fever, not eating;cough, tired, lethargic, not self, not playful, fussy, no sleep, rapid heart beats, lt side of chest larger, nose flaring, trouble breathing;to ER found heart disease;

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