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This is VAERS ID 189882

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 189882
VAERS Form:
Age:
Sex:Male
Location:New York
Vaccinated:1997-06-12
Onset:1997-06-12
Submitted:2002-09-03
Entered:2002-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / LEDERLE LABORATO 444259 / 3 - / LL
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECH 2371A2 / 3 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0009E / 1 - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / LEDERLE LABORATO 0760 / 2 - / LL

Administered by: Private      Purchased by: Unknown
Symptoms: SOMNOLENCE, DRUG DEPEND, CHROMOSOME ABNORM, DEATH

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2000-09-25
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:
Current Illness: NONE
Preexisting Conditions: Born with a 5mm ventrical septal defect-healed by age 20 mos.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt was given an ""extra hep B"" shot in error. He became lethargic for three days after the vaccines were administered. Pt died from Adrenoleukodystrophy. His mother was not the carrier, symptoms of ALD began three months after vaccines.


Changed on 12/8/2009

VAERS ID: 189882 Before After
VAERS Form:
Age:
Sex:Male
Location:New York
Vaccinated:1997-06-12
Onset:1997-06-12
Submitted:2002-09-03
Entered:2002-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / LEDERLE LABORATO LEDERLE LABORATORIES 444259 / 3 - LL / LL -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECH SMITHKLINE BEECHAM 2371A2 / 3 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0009E / 1 - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / LEDERLE LABORATO LEDERLE LABORATORIES 0760 / 2 - LL / LL -

Administered by: Private      Purchased by: Unknown Other
Symptoms: Chromosome abnormality, Lethargy, Drug administration error, SOMNOLENCE, DRUG DEPEND, CHROMOSOME ABNORM, DEATH

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2000-09-25
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:
Current Illness: NONE
Preexisting Conditions: Born with a 5mm ventrical septal defect-healed by age 20 mos.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt was given an ""extra "extra hep B"" B" shot in error. He became lethargic for three days after the vaccines were administered. Pt died from Adrenoleukodystrophy. His mother was not the carrier, symptoms of ALD began three months after vaccines.


Changed on 5/14/2017

VAERS ID: 189882 Before After
VAERS Form:
Age:
Sex:Male
Location:New York
Vaccinated:1997-06-12
Onset:1997-06-12
Submitted:2002-09-03
Entered:2002-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 444259 / 3 LL / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2371A2 / 3 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0009E / 1 - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / LEDERLE LABORATORIES PFIZER/WYETH 0760 / 2 LL / -

Administered by: Private      Purchased by: Other
Symptoms: Chromosome abnormality, Lethargy, Drug administration error

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2000-09-25
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:
Current Illness: NONE
Preexisting Conditions: Born with a 5mm ventrical septal defect-healed by age 20 mos.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt was given an "extra hep B" shot in error. He became lethargic for three days after the vaccines were administered. Pt died from Adrenoleukodystrophy. His mother was not the carrier, symptoms of ALD began three months after vaccines.


Changed on 9/14/2017

VAERS ID: 189882 Before After
VAERS Form:(blank) 1
Age:
Sex:Male
Location:New York
Vaccinated:1997-06-12
Onset:1997-06-12
Submitted:2002-09-03
Entered:2002-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 444259 / 3 4 LL / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2371A2 / 3 4 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0009E / 1 2 - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / PFIZER/WYETH 0760 / 2 3 LL / -

Administered by: Private      Purchased by: Other
Symptoms: Chromosome abnormality, Lethargy, Drug administration error

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2000-09-25
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:
Current Illness: NONE
Preexisting Conditions: Born with a 5mm ventrical septal defect-healed by age 20 mos.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt was given an "extra hep B" shot in error. He became lethargic for three days after the vaccines were administered. Pt died from Adrenoleukodystrophy. His mother was not the carrier, symptoms of ALD began three months after vaccines.


Changed on 2/14/2018

VAERS ID: 189882 Before After
VAERS Form:1
Age:
Sex:Male
Location:New York
Vaccinated:1997-06-12
Onset:1997-06-12
Submitted:2002-09-03
Entered:2002-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 444259 / 4 LL / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2371A2 / 4 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0009E / 2 - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / PFIZER/WYETH 0760 / 3 LL / -

Administered by: Private      Purchased by: Other
Symptoms: Chromosome abnormality, Lethargy, Drug administration error

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2000-09-25
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:
Current Illness: NONE
Preexisting Conditions: Born with a 5mm ventrical septal defect-healed by age 20 mos.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt was given an "extra hep B" shot in error. He became lethargic for three days after the vaccines were administered. Pt died from Adrenoleukodystrophy. His mother was not the carrier, symptoms of ALD began three months after vaccines.


Changed on 6/14/2018

VAERS ID: 189882 Before After
VAERS Form:1
Age:
Sex:Male
Location:New York
Vaccinated:1997-06-12
Onset:1997-06-12
Submitted:2002-09-03
Entered:2002-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 444259 / 4 LL / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2371A2 / 4 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0009E / 2 - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / PFIZER/WYETH 0760 / 3 LL / -

Administered by: Private      Purchased by: Other
Symptoms: Chromosome abnormality, Lethargy, Drug administration error

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2000-09-25
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:
Current Illness: NONE
Preexisting Conditions: Born with a 5mm ventrical septal defect-healed by age 20 mos.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt was given an "extra hep B" shot in error. He became lethargic for three days after the vaccines were administered. Pt died from Adrenoleukodystrophy. His mother was not the carrier, symptoms of ALD began three months after vaccines.


Changed on 8/14/2018

VAERS ID: 189882 Before After
VAERS Form:1
Age:
Sex:Male
Location:New York
Vaccinated:1997-06-12
Onset:1997-06-12
Submitted:2002-09-03
Entered:2002-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 444259 / 4 LL / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2371A2 / 4 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0009E / 2 - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / PFIZER/WYETH 0760 / 3 LL / -

Administered by: Private      Purchased by: Other
Symptoms: Chromosome abnormality, Lethargy, Drug administration error

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2000-09-25
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:
Current Illness: NONE
Preexisting Conditions: Born with a 5mm ventrical septal defect-healed by age 20 mos.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt was given an "extra hep B" shot in error. He became lethargic for three days after the vaccines were administered. Pt died from Adrenoleukodystrophy. His mother was not the carrier, symptoms of ALD began three months after vaccines.


Changed on 9/14/2018

VAERS ID: 189882 Before After
VAERS Form:1
Age:
Sex:Male
Location:New York
Vaccinated:1997-06-12
Onset:1997-06-12
Submitted:2002-09-03
Entered:2002-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 444259 / 4 LL / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2371A2 / 4 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0009E / 2 - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / PFIZER/WYETH 0760 / 3 LL / -

Administered by: Private      Purchased by: Other
Symptoms: Chromosome abnormality, Lethargy, Drug administration error

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2000-09-25
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:
Current Illness: NONE
Preexisting Conditions: Born with a 5mm ventrical septal defect-healed by age 20 mos.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt was given an "extra hep B" shot in error. He became lethargic for three days after the vaccines were administered. Pt died from Adrenoleukodystrophy. His mother was not the carrier, symptoms of ALD began three months after vaccines.


Changed on 10/14/2018

VAERS ID: 189882 Before After
VAERS Form:1
Age:
Sex:Male
Location:New York
Vaccinated:1997-06-12
Onset:1997-06-12
Submitted:2002-09-03
Entered:2002-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 444259 / 4 LL / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2371A2 / 4 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0009E / 2 - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / PFIZER/WYETH 0760 / 3 LL / -

Administered by: Private      Purchased by: Other
Symptoms: Chromosome abnormality, Lethargy, Drug administration error

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2000-09-25
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:
Current Illness: NONE
Preexisting Conditions: Born with a 5mm ventrical septal defect-healed by age 20 mos.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt was given an "extra hep B" shot in error. He became lethargic for three days after the vaccines were administered. Pt died from Adrenoleukodystrophy. His mother was not the carrier, symptoms of ALD began three months after vaccines.

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