National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 133895

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 133895
VAERS Form:
Age:5.0
Sex:Female
Location:New Jersey
Vaccinated:2000-01-25
Onset:2000-02-01
Submitted:2000-02-04
Entered:2000-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 466022 / 4 - / -
MMR: MMR II / MSD 12755 / 1 - / -
OPV: ORIMUNE / LEDERLE 80045 / 3 - / PO

Administered by: Other      Purchased by: Unknown
Symptoms: ENCEPHALOPATHY

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-02-04
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:
Other Medications: Montoux, Parker (mfr), 250611 (Lot) ID/LForearm, 1 previous dose
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 1 wk post vax, pt devel severe fatal encephalopathy.


Changed on 12/8/2009

VAERS ID: 133895 Before After
VAERS Form:
Age:5.0
Sex:Female
Location:New Jersey
Vaccinated:2000-01-25
Onset:2000-02-01
Submitted:2000-02-04
Entered:2000-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 466022 / 4 - / -
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 12755 / 1 - / -
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 80045 / 3 - / PO

Administered by: Other      Purchased by: Unknown Other
Symptoms: Encephalopathy, ENCEPHALOPATHY

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-02-04
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:
Other Medications: Montoux, Parker (mfr), 250611 (Lot) ID/LForearm, 1 previous dose
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 1 wk post vax, pt devel severe fatal encephalopathy.


Changed on 5/14/2017

VAERS ID: 133895 Before After
VAERS Form:
Age:5.0
Sex:Female
Location:New Jersey
Vaccinated:2000-01-25
Onset:2000-02-01
Submitted:2000-02-04
Entered:2000-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 466022 / 4 - RA / - IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 12755 / 1 - LA / - SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 80045 / 3 - / PO

Administered by: Other Private      Purchased by: Other Private
Symptoms: Encephalopathy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-02-04
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: ~ ()~~~In patient
Other Medications: Montoux, Parker (mfr), 250611 (Lot) ID/LForearm, 1 previous dose
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 1 wk post vax, pt devel severe fatal encephalopathy.


Changed on 9/14/2017

VAERS ID: 133895 Before After
VAERS Form:(blank) 1
Age:5.0
Sex:Female
Location:New Jersey
Vaccinated:2000-01-25
Onset:2000-02-01
Submitted:2000-02-04
Entered:2000-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 466022 / 4 5 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 12755 / 1 2 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 80045 / 3 4 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Encephalopathy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-02-04
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: ~ ()~~~In patient
Other Medications: Montoux, Parker (mfr), 250611 (Lot) ID/LForearm, 1 previous dose
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 1 wk post vax, pt devel severe fatal encephalopathy.


Changed on 2/14/2018

VAERS ID: 133895 Before After
VAERS Form:1
Age:5.0
Sex:Female
Location:New Jersey
Vaccinated:2000-01-25
Onset:2000-02-01
Submitted:2000-02-04
Entered:2000-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 466022 / 5 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 12755 / 2 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 80045 / 4 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Encephalopathy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-02-04
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: ~ ()~~~In patient
Other Medications: Montoux, Parker (mfr), 250611 (Lot) ID/LForearm, 1 previous dose
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 1 wk post vax, pt devel severe fatal encephalopathy.


Changed on 6/14/2018

VAERS ID: 133895 Before After
VAERS Form:1
Age:5.0
Sex:Female
Location:New Jersey
Vaccinated:2000-01-25
Onset:2000-02-01
Submitted:2000-02-04
Entered:2000-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 466022 / 5 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 12755 / 2 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 80045 / 4 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Encephalopathy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-02-04
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: ~ ()~~~In patient
Other Medications: Montoux, Parker (mfr), 250611 (Lot) ID/LForearm, 1 previous dose
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 1 wk post vax, pt devel severe fatal encephalopathy.


Changed on 8/14/2018

VAERS ID: 133895 Before After
VAERS Form:1
Age:5.0
Sex:Female
Location:New Jersey
Vaccinated:2000-01-25
Onset:2000-02-01
Submitted:2000-02-04
Entered:2000-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 466022 / 5 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 12755 / 2 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 80045 / 4 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Encephalopathy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-02-04
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: ~ ()~~~In patient
Other Medications: Montoux, Parker (mfr), 250611 (Lot) ID/LForearm, 1 previous dose
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 1 wk post vax, pt devel severe fatal encephalopathy.


Changed on 9/14/2018

VAERS ID: 133895 Before After
VAERS Form:1
Age:5.0
Sex:Female
Location:New Jersey
Vaccinated:2000-01-25
Onset:2000-02-01
Submitted:2000-02-04
Entered:2000-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 466022 / 5 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 12755 / 2 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 80045 / 4 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Encephalopathy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-02-04
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: ~ ()~~~In patient
Other Medications: Montoux, Parker (mfr), 250611 (Lot) ID/LForearm, 1 previous dose
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 1 wk post vax, pt devel severe fatal encephalopathy.


Changed on 10/14/2018

VAERS ID: 133895 Before After
VAERS Form:1
Age:5.0
Sex:Female
Location:New Jersey
Vaccinated:2000-01-25
Onset:2000-02-01
Submitted:2000-02-04
Entered:2000-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 466022 / 5 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 12755 / 2 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 80045 / 4 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Encephalopathy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-02-04
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: ~ ()~~~In patient
Other Medications: Montoux, Parker (mfr), 250611 (Lot) ID/LForearm, 1 previous dose
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 1 wk post vax, pt devel severe fatal encephalopathy.

New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=133895&WAYBACKHISTORY=ON


Copyright © 2019 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166