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This is VAERS ID 150875

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 150875
VAERS Form:
Age:5.0
Sex:Male
Location:Indiana
Vaccinated:1999-08-27
Onset:1999-09-01
Submitted:2000-03-06
Entered:2000-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA / CONNAUGHT LABS 0970140 / 4 LA / IM
MMR: MMR II / MSD 1552H / 1 RA / SC
OPV: ORIMUNE / LEDERLE 0798L / 3 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: FEVER, VOMIT, DIARRHEA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-09-02
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: Mantoux-TB
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy report revealed the cause of death to be subacute myocardititis with heart failure.
CDC 'Split Type':

Write-up: September 1, 1999, woke at 2:00 AM with fever. Had diarrhea at 13:30 PM and threw up at 15:00 PM. Gave Tylenol for fever. Passed away during the night. Pronounced dead on September 2, 1999.


Changed on 12/8/2009

VAERS ID: 150875 Before After
VAERS Form:
Age:5.0
Sex:Male
Location:Indiana
Vaccinated:1999-08-27
Onset:1999-09-01
Submitted:2000-03-06
Entered:2000-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA DTAP (TRIPEDIA) / CONNAUGHT LABS CONNAUGHT LABORATORIES 0970140 / 4 LA / IM
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 1552H / 1 RA / SC
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 0798L / 3 - / PO

Administered by: Public      Purchased by: Unknown Public
Symptoms: Diarrhoea, Pyrexia, Vomiting, FEVER, VOMIT, DIARRHEA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-09-02
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: Mantoux-TB
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy report revealed the cause of death to be subacute myocardititis with heart failure.
CDC 'Split Type':

Write-up: September 1, 1999, woke at 2:00 AM with fever. Had diarrhea at 13:30 PM and threw up at 15:00 PM. Gave Tylenol for fever. Passed away during the night. Pronounced dead on September 2, 1999.


Changed on 5/14/2017

VAERS ID: 150875 Before After
VAERS Form:
Age:5.0
Sex:Male
Location:Indiana
Vaccinated:1999-08-27
Onset:1999-09-01
Submitted:2000-03-06
Entered:2000-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0970140 / 4 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1552H / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 0798L / 3 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Diarrhoea, Pyrexia, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-09-02
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: Mantoux-TB
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy report revealed the cause of death to be subacute myocardititis with heart failure.
CDC 'Split Type':

Write-up: September 1, 1999, woke at 2:00 AM with fever. Had diarrhea at 13:30 PM and threw up at 15:00 PM. Gave Tylenol for fever. Passed away during the night. Pronounced dead on September 2, 1999.


Changed on 9/14/2017

VAERS ID: 150875 Before After
VAERS Form:(blank) 1
Age:5.0
Sex:Male
Location:Indiana
Vaccinated:1999-08-27
Onset:1999-09-01
Submitted:2000-03-06
Entered:2000-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0970140 / 4 5 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1552H / 1 2 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0798L / 3 4 - MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Diarrhoea, Pyrexia, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-09-02
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: Mantoux-TB
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy report revealed the cause of death to be subacute myocardititis with heart failure.
CDC 'Split Type':

Write-up: September 1, 1999, woke at 2:00 AM with fever. Had diarrhea at 13:30 PM and threw up at 15:00 PM. Gave Tylenol for fever. Passed away during the night. Pronounced dead on September 2, 1999.


Changed on 2/14/2018

VAERS ID: 150875 Before After
VAERS Form:1
Age:5.0
Sex:Male
Location:Indiana
Vaccinated:1999-08-27
Onset:1999-09-01
Submitted:2000-03-06
Entered:2000-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0970140 / 5 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1552H / 2 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0798L / 4 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Diarrhoea, Pyrexia, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-09-02
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: Mantoux-TB
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy report revealed the cause of death to be subacute myocardititis with heart failure.
CDC 'Split Type':

Write-up: September 1, 1999, woke at 2:00 AM with fever. Had diarrhea at 13:30 PM and threw up at 15:00 PM. Gave Tylenol for fever. Passed away during the night. Pronounced dead on September 2, 1999.


Changed on 6/14/2018

VAERS ID: 150875 Before After
VAERS Form:1
Age:5.0
Sex:Male
Location:Indiana
Vaccinated:1999-08-27
Onset:1999-09-01
Submitted:2000-03-06
Entered:2000-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0970140 / 5 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1552H / 2 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0798L / 4 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Diarrhoea, Pyrexia, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-09-02
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: Mantoux-TB
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy report revealed the cause of death to be subacute myocardititis with heart failure.
CDC 'Split Type':

Write-up: September 1, 1999, woke at 2:00 AM with fever. Had diarrhea at 13:30 PM and threw up at 15:00 PM. Gave Tylenol for fever. Passed away during the night. Pronounced dead on September 2, 1999.


Changed on 8/14/2018

VAERS ID: 150875 Before After
VAERS Form:1
Age:5.0
Sex:Male
Location:Indiana
Vaccinated:1999-08-27
Onset:1999-09-01
Submitted:2000-03-06
Entered:2000-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0970140 / 5 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1552H / 2 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0798L / 4 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Diarrhoea, Pyrexia, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-09-02
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: Mantoux-TB
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy report revealed the cause of death to be subacute myocardititis with heart failure.
CDC 'Split Type':

Write-up: September 1, 1999, woke at 2:00 AM with fever. Had diarrhea at 13:30 PM and threw up at 15:00 PM. Gave Tylenol for fever. Passed away during the night. Pronounced dead on September 2, 1999.


Changed on 9/14/2018

VAERS ID: 150875 Before After
VAERS Form:1
Age:5.0
Sex:Male
Location:Indiana
Vaccinated:1999-08-27
Onset:1999-09-01
Submitted:2000-03-06
Entered:2000-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0970140 / 5 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1552H / 2 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0798L / 4 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Diarrhoea, Pyrexia, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-09-02
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: Mantoux-TB
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy report revealed the cause of death to be subacute myocardititis with heart failure.
CDC 'Split Type':

Write-up: September 1, 1999, woke at 2:00 AM with fever. Had diarrhea at 13:30 PM and threw up at 15:00 PM. Gave Tylenol for fever. Passed away during the night. Pronounced dead on September 2, 1999.


Changed on 10/14/2018

VAERS ID: 150875 Before After
VAERS Form:1
Age:5.0
Sex:Male
Location:Indiana
Vaccinated:1999-08-27
Onset:1999-09-01
Submitted:2000-03-06
Entered:2000-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0970140 / 5 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1552H / 2 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0798L / 4 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Diarrhoea, Pyrexia, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-09-02
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: Mantoux-TB
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy report revealed the cause of death to be subacute myocardititis with heart failure.
CDC 'Split Type':

Write-up: September 1, 1999, woke at 2:00 AM with fever. Had diarrhea at 13:30 PM and threw up at 15:00 PM. Gave Tylenol for fever. Passed away during the night. Pronounced dead on September 2, 1999.

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