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This is VAERS ID 151082

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 151082
VAERS Form:
Age:2.7
Sex:Female
Location:New Hampshire
Vaccinated:2000-03-27
Onset:2000-03-29
Submitted:2000-04-25
Entered:2000-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: INFANRIX / SMITHKLINE 917A2 / - RL / IM
HEP: ENGERIX-B / SMITHKLINE ENG320909 / - LL / IM
HIBV: ACT-HIB / CONNAUGHT LABS UA497AA / - RL / IM
IPV: IPV / MERIEUX INST R0398 / - LL / -
MMR: MMR II / MSD 1267J / - LA / SC

Administered by: Public      Purchased by: Unknown
Symptoms: FEVER, DEHYDRAT, ANEMIA, EDEMA BRAIN, GASTROENTERITIS

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2000-04-25
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: 20     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Venous blood lead level-elevated at 391. Autopsy revealed the pt''s cause of death as cerebral edema complicating acute lead poisoning.
CDC 'Split Type':

Write-up: Post vax, on 3/29/2000, child presented at ED with fever. Discharged 4/17/2000. Presented at ED with vomiting and dehydration (admission dx; Gastroenteritis) anemia. Condition deteriorated and was transferred to another medical center on 4/18/2000. Deceas"ed on 4/21/2000.


Changed on 12/30/2006

VAERS ID: 151082 Before After
VAERS Form:
Age:2.7
Sex:Female
Location:New Hampshire
Vaccinated:2000-03-27
Onset:2000-03-29
Submitted:2000-04-25
Entered:2000-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: INFANRIX / SMITHKLINE 917A2 / - RL / IM
HEP: ENGERIX-B / SMITHKLINE ENG320909 / - LL / IM
HIBV: ACT-HIB / CONNAUGHT LABS UA497AA / - RL / IM
IPV: IPV / MERIEUX INST R0398 / - LL / -
MMR: MMR II / MSD 1267J / - LA / SC

Administered by: Public      Purchased by: Unknown
Symptoms: FEVER, DEHYDRAT, ANEMIA, EDEMA BRAIN, GASTROENTERITIS

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2000-04-25
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: 20     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Venous blood lead level-elevated at 391. Autopsy revealed the pt''s pt''''s cause of death as cerebral edema complicating acute lead poisoning.
CDC 'Split Type':

Write-up: Post vax, on 3/29/2000, child presented at ED with fever. Discharged 4/17/2000. Presented at ED with vomiting and dehydration (admission dx; Gastroenteritis) anemia. Condition deteriorated and was transferred to another medical center on 4/18/2000. Deceas"ed on 4/21/2000.


Changed on 12/8/2009

VAERS ID: 151082 Before After
VAERS Form:
Age:2.7 2.0
Sex:Female
Location:New Hampshire
Vaccinated:2000-03-27
Onset:2000-03-29
Submitted:2000-04-25
Entered:2000-04-26 2000-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: INFANRIX DTAP (INFANRIX) / SMITHKLINE SMITHKLINE BEECHAM 917A2 / - RL / IM
HEP: ENGERIX-B HEP B (ENGERIX-B) / SMITHKLINE SMITHKLINE BEECHAM ENG320909 / - LL / IM
HIBV: ACT-HIB HIB (ACTHIB) / CONNAUGHT LABS CONNAUGHT LABORATORIES UA497AA / - RL / IM
IPV: IPV POLIO VIRUS, INACT. (NO BRAND NAME) / MERIEUX INST PASTEUR MERIEUX INST. R0398 / - LL / -
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 1267J / - LA / SC

Administered by: Public      Purchased by: Unknown
Symptoms: Accident, Anaemia, Dehydration, Gastroenteritis, Laboratory test abnormal, Pyrexia, Vomiting, Brain oedema, FEVER, DEHYDRAT, ANEMIA, EDEMA BRAIN, GASTROENTERITIS

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2000-04-25
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: 20     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Venous blood lead level-elevated at 391. Autopsy revealed the pt''''s pt''s cause of death as cerebral edema complicating acute lead poisoning.
CDC 'Split Type':

Write-up: Post vax, on 3/29/2000, child presented at ED with fever. Discharged 4/17/2000. Presented at ED with vomiting and dehydration (admission dx; Gastroenteritis) anemia. Condition deteriorated and was transferred to another medical center on 4/18/2000. Deceas"ed Deceased on 4/21/2000.


Changed on 9/14/2017

VAERS ID: 151082 Before After
VAERS Form:(blank) 1
Age:2.0
Sex:Female
Location:New Hampshire
Vaccinated:2000-03-27
Onset:2000-03-29
Submitted:2000-04-25
Entered:2000-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 917A2 / - UNK RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM ENG320909 / - UNK LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA497AA / - UNK RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R0398 / - UNK LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1267J / - UNK LA / SC

Administered by: Public      Purchased by: Unknown
Symptoms: Accident, Anaemia, Dehydration, Gastroenteritis, Laboratory test abnormal, Pyrexia, Vomiting, Brain oedema

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2000-04-25
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: 20     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Venous blood lead level-elevated at 391. Autopsy revealed the pt''s cause of death as cerebral edema complicating acute lead poisoning.
CDC 'Split Type':

Write-up: Post vax, on 3/29/2000, child presented at ED with fever. Discharged 4/17/2000. Presented at ED with vomiting and dehydration (admission dx; Gastroenteritis) anemia. Condition deteriorated and was transferred to another medical center on 4/18/2000. Deceased on 4/21/2000.


Changed on 2/14/2018

VAERS ID: 151082 Before After
VAERS Form:1
Age:2.0
Sex:Female
Location:New Hampshire
Vaccinated:2000-03-27
Onset:2000-03-29
Submitted:2000-04-25
Entered:2000-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 917A2 / UNK RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM ENG320909 / UNK LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA497AA / UNK RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R0398 / UNK LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1267J / UNK LA / SC

Administered by: Public      Purchased by: Unknown
Symptoms: Accident, Anaemia, Dehydration, Gastroenteritis, Laboratory test abnormal, Pyrexia, Vomiting, Brain oedema

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2000-04-25
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: 20     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Venous blood lead level-elevated at 391. Autopsy revealed the pt''s cause of death as cerebral edema complicating acute lead poisoning.
CDC 'Split Type':

Write-up: Post vax, on 3/29/2000, child presented at ED with fever. Discharged 4/17/2000. Presented at ED with vomiting and dehydration (admission dx; Gastroenteritis) anemia. Condition deteriorated and was transferred to another medical center on 4/18/2000. Deceased on 4/21/2000.


Changed on 6/14/2018

VAERS ID: 151082 Before After
VAERS Form:1
Age:2.0
Sex:Female
Location:New Hampshire
Vaccinated:2000-03-27
Onset:2000-03-29
Submitted:2000-04-25
Entered:2000-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 917A2 / UNK RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM ENG320909 / UNK LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA497AA / UNK RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R0398 / UNK LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1267J / UNK LA / SC

Administered by: Public      Purchased by: Unknown
Symptoms: Accident, Anaemia, Dehydration, Gastroenteritis, Laboratory test abnormal, Pyrexia, Vomiting, Brain oedema

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2000-04-25
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: 20     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Venous blood lead level-elevated at 391. Autopsy revealed the pt''s cause of death as cerebral edema complicating acute lead poisoning.
CDC 'Split Type':

Write-up: Post vax, on 3/29/2000, child presented at ED with fever. Discharged 4/17/2000. Presented at ED with vomiting and dehydration (admission dx; Gastroenteritis) anemia. Condition deteriorated and was transferred to another medical center on 4/18/2000. Deceased on 4/21/2000.


Changed on 8/14/2018

VAERS ID: 151082 Before After
VAERS Form:1
Age:2.0
Sex:Female
Location:New Hampshire
Vaccinated:2000-03-27
Onset:2000-03-29
Submitted:2000-04-25
Entered:2000-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 917A2 / UNK RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM ENG320909 / UNK LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA497AA / UNK RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R0398 / UNK LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1267J / UNK LA / SC

Administered by: Public      Purchased by: Unknown
Symptoms: Accident, Anaemia, Dehydration, Gastroenteritis, Laboratory test abnormal, Pyrexia, Vomiting, Brain oedema

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2000-04-25
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: 20     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Venous blood lead level-elevated at 391. Autopsy revealed the pt''s cause of death as cerebral edema complicating acute lead poisoning.
CDC 'Split Type':

Write-up: Post vax, on 3/29/2000, child presented at ED with fever. Discharged 4/17/2000. Presented at ED with vomiting and dehydration (admission dx; Gastroenteritis) anemia. Condition deteriorated and was transferred to another medical center on 4/18/2000. Deceased on 4/21/2000.


Changed on 9/14/2018

VAERS ID: 151082 Before After
VAERS Form:1
Age:2.0
Sex:Female
Location:New Hampshire
Vaccinated:2000-03-27
Onset:2000-03-29
Submitted:2000-04-25
Entered:2000-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 917A2 / UNK RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM ENG320909 / UNK LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA497AA / UNK RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R0398 / UNK LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1267J / UNK LA / SC

Administered by: Public      Purchased by: Unknown
Symptoms: Accident, Anaemia, Dehydration, Gastroenteritis, Laboratory test abnormal, Pyrexia, Vomiting, Brain oedema

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2000-04-25
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: 20     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Venous blood lead level-elevated at 391. Autopsy revealed the pt''s cause of death as cerebral edema complicating acute lead poisoning.
CDC 'Split Type':

Write-up: Post vax, on 3/29/2000, child presented at ED with fever. Discharged 4/17/2000. Presented at ED with vomiting and dehydration (admission dx; Gastroenteritis) anemia. Condition deteriorated and was transferred to another medical center on 4/18/2000. Deceased on 4/21/2000.


Changed on 10/14/2018

VAERS ID: 151082 Before After
VAERS Form:1
Age:2.0
Sex:Female
Location:New Hampshire
Vaccinated:2000-03-27
Onset:2000-03-29
Submitted:2000-04-25
Entered:2000-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 917A2 / UNK RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM ENG320909 / UNK LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA497AA / UNK RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R0398 / UNK LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1267J / UNK LA / SC

Administered by: Public      Purchased by: Unknown
Symptoms: Accident, Anaemia, Dehydration, Gastroenteritis, Laboratory test abnormal, Pyrexia, Vomiting, Brain oedema

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2000-04-25
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: 20     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Venous blood lead level-elevated at 391. Autopsy revealed the pt''s cause of death as cerebral edema complicating acute lead poisoning.
CDC 'Split Type':

Write-up: Post vax, on 3/29/2000, child presented at ED with fever. Discharged 4/17/2000. Presented at ED with vomiting and dehydration (admission dx; Gastroenteritis) anemia. Condition deteriorated and was transferred to another medical center on 4/18/2000. Deceased on 4/21/2000.

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