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This is VAERS ID 215919

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2004

VAERS ID: 215919
VAERS Form:
Age:1.0
Sex:Female
Location:Missouri
Vaccinated:2003-12-09
Onset:2003-12-11
Submitted:2004-01-29
Entered:2004-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR, UA859AA / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0100N / 0 LA / SC
PNC: PNEUMO, 7-VALENT (PREVNAR) / LEDERLE LABORATO 493264 / 3 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0544N / 0 LA / SC

Administered by: Public      Purchased by: Unknown
Symptoms: DIARRHEA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2003-12-11
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: NONE
Current Illness: NONE
Preexisting Conditions: Allergic to PCN
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: None. Had diarrhea 2 weeks before.


Changed on 12/8/2009

VAERS ID: 215919 Before After
VAERS Form:
Age:1.0
Sex:Female
Location:Missouri
Vaccinated:2003-12-09
Onset:2003-12-11
Submitted:2004-01-29
Entered:2004-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR, AVENTIS PASTEUR UA859AA / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0100N / 0 LA / SC
PNC: PNEUMO, 7-VALENT (PREVNAR) PNEUMO (PREVNAR) / LEDERLE LABORATO LEDERLE LABORATORIES 493264 / 3 RL / IM
VARCEL: VARICELLA (VARIVAX) VARICELLA (VARIVAX) / MERCK & CO. INC. 0544N / 0 LA / SC

Administered by: Public      Purchased by: Unknown Public
Symptoms: Diarrhoea, DIARRHEA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2003-12-11
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: NONE
Current Illness: NONE
Preexisting Conditions: Allergic to PCN
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: None. Had diarrhea 2 weeks before.


Changed on 3/2/2010

VAERS ID: 215919 Before After
VAERS Form:
Age:1.0
Sex:Female
Location:Missouri
Vaccinated:2003-12-09
Onset:2003-12-11
Submitted:2004-01-29
Entered:2004-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UA859AA / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0100N / 0 LA / SC
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / LEDERLE LABORATORIES 493264 / 3 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0544N / 0 LA / SC

Administered by: Public      Purchased by: Public
Symptoms: Diarrhoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2003-12-11
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: NONE
Current Illness: NONE
Preexisting Conditions: Allergic to PCN
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: None. Had diarrhea 2 weeks before.


Changed on 4/7/2010

VAERS ID: 215919 Before After
VAERS Form:
Age:1.0
Sex:Female
Location:Missouri
Vaccinated:2003-12-09
Onset:2003-12-11
Submitted:2004-01-29
Entered:2004-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UA859AA / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0100N / 0 LA / SC
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / LEDERLE LABORATORIES 493264 / 3 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0544N / 0 LA / SC

Administered by: Public      Purchased by: Public
Symptoms: Diarrhoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2003-12-11
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: NONE
Current Illness: NONE
Preexisting Conditions: Allergic to PCN
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: None. Had diarrhea 2 weeks before.


Changed on 5/14/2017

VAERS ID: 215919 Before After
VAERS Form:
Age:1.0
Sex:Female
Location:Missouri
Vaccinated:2003-12-09
Onset:2003-12-11
Submitted:2004-01-29
Entered:2004-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR SANOFI PASTEUR UA859AA / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0100N / 0 LA / SC
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES PFIZER/WYETH 493264 / 3 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0544N / 0 LA / SC

Administered by: Public      Purchased by: Public
Symptoms: Diarrhoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2003-12-11
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: NONE
Current Illness: NONE
Preexisting Conditions: Allergic to PCN
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: None. Had diarrhea 2 weeks before.


Changed on 9/14/2017

VAERS ID: 215919 Before After
VAERS Form:(blank) 1
Age:1.0
Sex:Female
Location:Missouri
Vaccinated:2003-12-09
Onset:2003-12-11
Submitted:2004-01-29
Entered:2004-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UA859AA / 3 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0100N / 0 1 LA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 493264 / 3 4 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0544N / 0 1 LA / SC

Administered by: Public      Purchased by: Public
Symptoms: Diarrhoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2003-12-11
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: NONE
Current Illness: NONE
Preexisting Conditions: Allergic to PCN
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: None. Had diarrhea 2 weeks before.


Changed on 2/14/2018

VAERS ID: 215919 Before After
VAERS Form:1
Age:1.0
Sex:Female
Location:Missouri
Vaccinated:2003-12-09
Onset:2003-12-11
Submitted:2004-01-29
Entered:2004-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UA859AA / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0100N / 1 LA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 493264 / 4 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0544N / 1 LA / SC

Administered by: Public      Purchased by: Public
Symptoms: Diarrhoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2003-12-11
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: NONE
Current Illness: NONE
Preexisting Conditions: Allergic to PCN
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: None. Had diarrhea 2 weeks before.


Changed on 6/14/2018

VAERS ID: 215919 Before After
VAERS Form:1
Age:1.0
Sex:Female
Location:Missouri
Vaccinated:2003-12-09
Onset:2003-12-11
Submitted:2004-01-29
Entered:2004-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UA859AA / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0100N / 1 LA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 493264 / 4 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0544N / 1 LA / SC

Administered by: Public      Purchased by: Public
Symptoms: Diarrhoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2003-12-11
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: NONE
Current Illness: NONE
Preexisting Conditions: Allergic to PCN
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: None. Had diarrhea 2 weeks before.


Changed on 8/14/2018

VAERS ID: 215919 Before After
VAERS Form:1
Age:1.0
Sex:Female
Location:Missouri
Vaccinated:2003-12-09
Onset:2003-12-11
Submitted:2004-01-29
Entered:2004-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UA859AA / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0100N / 1 LA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 493264 / 4 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0544N / 1 LA / SC

Administered by: Public      Purchased by: Public
Symptoms: Diarrhoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2003-12-11
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: NONE
Current Illness: NONE
Preexisting Conditions: Allergic to PCN
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: None. Had diarrhea 2 weeks before.


Changed on 9/14/2018

VAERS ID: 215919 Before After
VAERS Form:1
Age:1.0
Sex:Female
Location:Missouri
Vaccinated:2003-12-09
Onset:2003-12-11
Submitted:2004-01-29
Entered:2004-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UA859AA / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0100N / 1 LA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 493264 / 4 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0544N / 1 LA / SC

Administered by: Public      Purchased by: Public
Symptoms: Diarrhoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2003-12-11
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: NONE
Current Illness: NONE
Preexisting Conditions: Allergic to PCN
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: None. Had diarrhea 2 weeks before.


Changed on 10/14/2018

VAERS ID: 215919 Before After
VAERS Form:1
Age:1.0
Sex:Female
Location:Missouri
Vaccinated:2003-12-09
Onset:2003-12-11
Submitted:2004-01-29
Entered:2004-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UA859AA / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0100N / 1 LA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 493264 / 4 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0544N / 1 LA / SC

Administered by: Public      Purchased by: Public
Symptoms: Diarrhoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2003-12-11
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: NONE
Current Illness: NONE
Preexisting Conditions: Allergic to PCN
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: None. Had diarrhea 2 weeks before.

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