National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 201354

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 201354
VAERS Form:
Age:12.0
Sex:Female
Location:Florida
Vaccinated:1999-01-19
Onset:0000-00-00
Submitted:2003-04-08
Entered:2003-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECH 2710A2 / 0 - / RL
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0786H / 1 RL / SC
TD: TD ADSORBED, ADULT (NO BRAND NAME) / AVENTIS PASTEUR, C00934600 / 0 - / LL

Administered by: Public      Purchased by: Unknown
Symptoms: CONVULS, STUPOR, ASTHENIA, SALIVA INC, INCONTIN URIN

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-10-03
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: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Client received hep B #1 on 1/19/99, #2 on 4/7/99, #3 on 8/10/99. Parents stated that child started acting strange 24 hrs after first Hp B vaccine. She started staring into space, complained of being tired and grades dropped over period of time. She had t"he first seizure on 8/6/99 at a friend''s house and fell off the chair. After the second Hp B vaccine, she started drooling and wet the bed twice over a period of time. After the third vaccination, seizures became progressively worse. Child was under the c


Changed on 12/8/2009

VAERS ID: 201354 Before After
VAERS Form:
Age:12.0
Sex:Female
Location:Florida
Vaccinated:1999-01-19
Onset:0000-00-00
Submitted:2003-04-08
Entered:2003-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECH SMITHKLINE BEECHAM 2710A2 / 0 - RL / RL -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0786H / 1 RL / SC
TD: TD ADSORBED, ADULT (NO BRAND NAME) TD ADSORBED (NO BRAND NAME) / AVENTIS PASTEUR, AVENTIS PASTEUR C00934600 / 0 - LL / LL -

Administered by: Public      Purchased by: Unknown Public
Symptoms: Convulsion, Drooling, Fatigue, Staring, Urinary incontinence, CONVULS, STUPOR, ASTHENIA, SALIVA INC, INCONTIN URIN

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-10-03
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: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Client received hep B #1 on 1/19/99, #2 on 4/7/99, #3 on 8/10/99. Parents stated that child started acting strange 24 hrs after first Hp B vaccine. She started staring into space, complained of being tired and grades dropped over period of time. She had t"he the first seizure on 8/6/99 at a friend''s house and fell off the chair. After the second Hp B vaccine, she started drooling and wet the bed twice over a period of time. After the third vaccination, seizures became progressively worse. Child was under the c care of the neurologist and medical services. On 10/13/01 child died in her sleep as a result of a "brain seizure."


Changed on 5/14/2017

VAERS ID: 201354 Before After
VAERS Form:
Age:12.0
Sex:Female
Location:Florida
Vaccinated:1999-01-19
Onset:0000-00-00
Submitted:2003-04-08
Entered:2003-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2710A2 / 0 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0786H / 1 RL / SC
TD: TD ADSORBED (NO BRAND NAME) / AVENTIS PASTEUR SANOFI PASTEUR C00934600 / 0 LL / -

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Drooling, Fatigue, Staring, Urinary incontinence

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-10-03
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: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Client received hep B #1 on 1/19/99, #2 on 4/7/99, #3 on 8/10/99. Parents stated that child started acting strange 24 hrs after first Hp B vaccine. She started staring into space, complained of being tired and grades dropped over period of time. She had the first seizure on 8/6/99 at a friend''s house and fell off the chair. After the second Hp B vaccine, she started drooling and wet the bed twice over a period of time. After the third vaccination, seizures became progressively worse. Child was under the care of the neurologist and medical services. On 10/13/01 child died in her sleep as a result of a "brain seizure."


Changed on 9/14/2017

VAERS ID: 201354 Before After
VAERS Form:(blank) 1
Age:12.0
Sex:Female
Location:Florida
Vaccinated:1999-01-19
Onset:0000-00-00
Submitted:2003-04-08
Entered:2003-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2710A2 / 0 1 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0786H / 1 2 RL / SC
TD: TD ADSORBED (NO BRAND NAME) / SANOFI PASTEUR C00934600 / 0 1 LL / -

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Drooling, Fatigue, Staring, Urinary incontinence

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-10-03
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: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Client received hep B #1 on 1/19/99, #2 on 4/7/99, #3 on 8/10/99. Parents stated that child started acting strange 24 hrs after first Hp B vaccine. She started staring into space, complained of being tired and grades dropped over period of time. She had the first seizure on 8/6/99 at a friend''s house and fell off the chair. After the second Hp B vaccine, she started drooling and wet the bed twice over a period of time. After the third vaccination, seizures became progressively worse. Child was under the care of the neurologist and medical services. On 10/13/01 child died in her sleep as a result of a "brain seizure."


Changed on 2/14/2018

VAERS ID: 201354 Before After
VAERS Form:1
Age:12.0
Sex:Female
Location:Florida
Vaccinated:1999-01-19
Onset:0000-00-00
Submitted:2003-04-08
Entered:2003-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2710A2 / 1 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0786H / 2 RL / SC
TD: TD ADSORBED (NO BRAND NAME) / SANOFI PASTEUR C00934600 / 1 LL / -

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Drooling, Fatigue, Staring, Urinary incontinence

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-10-03
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: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Client received hep B #1 on 1/19/99, #2 on 4/7/99, #3 on 8/10/99. Parents stated that child started acting strange 24 hrs after first Hp B vaccine. She started staring into space, complained of being tired and grades dropped over period of time. She had the first seizure on 8/6/99 at a friend''s house and fell off the chair. After the second Hp B vaccine, she started drooling and wet the bed twice over a period of time. After the third vaccination, seizures became progressively worse. Child was under the care of the neurologist and medical services. On 10/13/01 child died in her sleep as a result of a "brain seizure."


Changed on 6/14/2018

VAERS ID: 201354 Before After
VAERS Form:1
Age:12.0
Sex:Female
Location:Florida
Vaccinated:1999-01-19
Onset:0000-00-00
Submitted:2003-04-08
Entered:2003-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2710A2 / 1 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0786H / 2 RL / SC
TD: TD ADSORBED (NO BRAND NAME) / SANOFI PASTEUR C00934600 / 1 LL / -

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Drooling, Fatigue, Staring, Urinary incontinence

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-10-03
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: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Client received hep B #1 on 1/19/99, #2 on 4/7/99, #3 on 8/10/99. Parents stated that child started acting strange 24 hrs after first Hp B vaccine. She started staring into space, complained of being tired and grades dropped over period of time. She had the first seizure on 8/6/99 at a friend''s house and fell off the chair. After the second Hp B vaccine, she started drooling and wet the bed twice over a period of time. After the third vaccination, seizures became progressively worse. Child was under the care of the neurologist and medical services. On 10/13/01 child died in her sleep as a result of a "brain seizure."


Changed on 8/14/2018

VAERS ID: 201354 Before After
VAERS Form:1
Age:12.0
Sex:Female
Location:Florida
Vaccinated:1999-01-19
Onset:0000-00-00
Submitted:2003-04-08
Entered:2003-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2710A2 / 1 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0786H / 2 RL / SC
TD: TD ADSORBED (NO BRAND NAME) / SANOFI PASTEUR C00934600 / 1 LL / -

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Drooling, Fatigue, Staring, Urinary incontinence

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-10-03
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: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Client received hep B #1 on 1/19/99, #2 on 4/7/99, #3 on 8/10/99. Parents stated that child started acting strange 24 hrs after first Hp B vaccine. She started staring into space, complained of being tired and grades dropped over period of time. She had the first seizure on 8/6/99 at a friend''s house and fell off the chair. After the second Hp B vaccine, she started drooling and wet the bed twice over a period of time. After the third vaccination, seizures became progressively worse. Child was under the care of the neurologist and medical services. On 10/13/01 child died in her sleep as a result of a "brain seizure."


Changed on 9/14/2018

VAERS ID: 201354 Before After
VAERS Form:1
Age:12.0
Sex:Female
Location:Florida
Vaccinated:1999-01-19
Onset:0000-00-00
Submitted:2003-04-08
Entered:2003-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2710A2 / 1 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0786H / 2 RL / SC
TD: TD ADSORBED (NO BRAND NAME) / SANOFI PASTEUR C00934600 / 1 LL / -

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Drooling, Fatigue, Staring, Urinary incontinence

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-10-03
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: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Client received hep B #1 on 1/19/99, #2 on 4/7/99, #3 on 8/10/99. Parents stated that child started acting strange 24 hrs after first Hp B vaccine. She started staring into space, complained of being tired and grades dropped over period of time. She had the first seizure on 8/6/99 at a friend''s house and fell off the chair. After the second Hp B vaccine, she started drooling and wet the bed twice over a period of time. After the third vaccination, seizures became progressively worse. Child was under the care of the neurologist and medical services. On 10/13/01 child died in her sleep as a result of a "brain seizure."


Changed on 10/14/2018

VAERS ID: 201354 Before After
VAERS Form:1
Age:12.0
Sex:Female
Location:Florida
Vaccinated:1999-01-19
Onset:0000-00-00
Submitted:2003-04-08
Entered:2003-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2710A2 / 1 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0786H / 2 RL / SC
TD: TD ADSORBED (NO BRAND NAME) / SANOFI PASTEUR C00934600 / 1 LL / -

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Drooling, Fatigue, Staring, Urinary incontinence

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-10-03
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: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Client received hep B #1 on 1/19/99, #2 on 4/7/99, #3 on 8/10/99. Parents stated that child started acting strange 24 hrs after first Hp B vaccine. She started staring into space, complained of being tired and grades dropped over period of time. She had the first seizure on 8/6/99 at a friend''s house and fell off the chair. After the second Hp B vaccine, she started drooling and wet the bed twice over a period of time. After the third vaccination, seizures became progressively worse. Child was under the care of the neurologist and medical services. On 10/13/01 child died in her sleep as a result of a "brain seizure."

New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=201354&WAYBACKHISTORY=ON


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