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This is VAERS ID 31362

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 31362
VAERS Form:
Age:1.8
Sex:Female
Location:Georgia
Vaccinated:1991-05-08
Onset:1991-05-11
Submitted:1991-06-05
Entered:1991-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 271965 / 3 RL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M560FP / 0 LL / IM
MMR: MMR II / MSD 1343S / 0 RA / SC
OPV: ORIMUNE / LEDERLE 0627L / 2 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: FEVER, VOMIT, CYANOSIS, DYSPNEA

Life Threatening? No
Birth Defect? No
Died? No
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? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations: Father states sister had asthma p/#1 DTP;
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Hx of asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': Hx of asthma

Write-up: 11MAY91 onset couldn''t breathe - hx of asthma taken to ER; 12MAY91 started vomiting, trouble breathing lips cyanotic returned to Hosp admited til 14AUG91, placed on 02 had fever fr 8MAY91-17MAY91 102-103;


Changed on 12/8/2009

VAERS ID: 31362 Before After
VAERS Form:
Age:1.8
Sex:Female
Location:Georgia
Vaccinated:1991-05-08
Onset:1991-05-11
Submitted:1991-06-05
Entered:1991-06-21 1991-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 271965 / 3 RL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M560FP / 0 LL / IM
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 1343S / 0 RA / SC
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 0627L / 2 - / PO

Administered by: Public      Purchased by: Unknown Public
Symptoms: Cyanosis, Dyspnoea, Pyrexia, Vomiting, FEVER, VOMIT, CYANOSIS, DYSPNEA

Life Threatening? No
Birth Defect? No
Died? No
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? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations: Father states sister had asthma p/#1 DTP;
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Hx of asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': Hx of asthma GA91141

Write-up: 11MAY91 onset couldn''t breathe - hx of asthma taken to ER; 12MAY91 started vomiting, trouble breathing lips cyanotic returned to Hosp admited til 14AUG91, placed on 02 had fever fr 8MAY91-17MAY91 102-103;


Changed on 5/14/2017

VAERS ID: 31362 Before After
VAERS Form:
Age:1.8
Sex:Female
Location:Georgia
Vaccinated:1991-05-08
Onset:1991-05-11
Submitted:1991-06-05
Entered:1991-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271965 / 3 RL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M560FP / 0 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1343S / 0 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 0627L / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Cyanosis, Dyspnoea, Pyrexia, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
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? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations: Father states sister had asthma p/#1 DTP; DTP;~ ()~~~In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Hx of asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA91141

Write-up: 11MAY91 onset couldn''t breathe - hx of asthma taken to ER; 12MAY91 started vomiting, trouble breathing lips cyanotic returned to Hosp admited til 14AUG91, placed on 02 had fever fr 8MAY91-17MAY91 102-103;


Changed on 9/14/2017

VAERS ID: 31362 Before After
VAERS Form:(blank) 1
Age:1.8
Sex:Female
Location:Georgia
Vaccinated:1991-05-08
Onset:1991-05-11
Submitted:1991-06-05
Entered:1991-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271965 / 3 4 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M560FP / 0 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1343S / 0 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0627L / 2 3 - MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Cyanosis, Dyspnoea, Pyrexia, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
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? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations: Father states sister had asthma p/#1 DTP;~ ()~~~In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Hx of asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA91141

Write-up: 11MAY91 onset couldn''t breathe - hx of asthma taken to ER; 12MAY91 started vomiting, trouble breathing lips cyanotic returned to Hosp admited til 14AUG91, placed on 02 had fever fr 8MAY91-17MAY91 102-103;


Changed on 2/14/2018

VAERS ID: 31362 Before After
VAERS Form:1
Age:1.8
Sex:Female
Location:Georgia
Vaccinated:1991-05-08
Onset:1991-05-11
Submitted:1991-06-05
Entered:1991-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271965 / 4 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M560FP / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1343S / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0627L / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Cyanosis, Dyspnoea, Pyrexia, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
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? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations: Father states sister had asthma p/#1 DTP;~ ()~~~In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Hx of asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA91141

Write-up: 11MAY91 onset couldn''t breathe - hx of asthma taken to ER; 12MAY91 started vomiting, trouble breathing lips cyanotic returned to Hosp admited til 14AUG91, placed on 02 had fever fr 8MAY91-17MAY91 102-103;


Changed on 6/14/2018

VAERS ID: 31362 Before After
VAERS Form:1
Age:1.8
Sex:Female
Location:Georgia
Vaccinated:1991-05-08
Onset:1991-05-11
Submitted:1991-06-05
Entered:1991-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271965 / 4 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M560FP / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1343S / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0627L / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Cyanosis, Dyspnoea, Pyrexia, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
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? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations: Father states sister had asthma p/#1 DTP;~ ()~~~In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Hx of asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA91141

Write-up: 11MAY91 onset couldn''t breathe - hx of asthma taken to ER; 12MAY91 started vomiting, trouble breathing lips cyanotic returned to Hosp admited til 14AUG91, placed on 02 had fever fr 8MAY91-17MAY91 102-103;


Changed on 8/14/2018

VAERS ID: 31362 Before After
VAERS Form:1
Age:1.8
Sex:Female
Location:Georgia
Vaccinated:1991-05-08
Onset:1991-05-11
Submitted:1991-06-05
Entered:1991-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271965 / 4 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M560FP / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1343S / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0627L / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Cyanosis, Dyspnoea, Pyrexia, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
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? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations: Father states sister had asthma p/#1 DTP;~ ()~~~In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Hx of asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA91141

Write-up: 11MAY91 onset couldn''t breathe - hx of asthma taken to ER; 12MAY91 started vomiting, trouble breathing lips cyanotic returned to Hosp admited til 14AUG91, placed on 02 had fever fr 8MAY91-17MAY91 102-103;


Changed on 9/14/2018

VAERS ID: 31362 Before After
VAERS Form:1
Age:1.8
Sex:Female
Location:Georgia
Vaccinated:1991-05-08
Onset:1991-05-11
Submitted:1991-06-05
Entered:1991-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271965 / 4 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M560FP / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1343S / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0627L / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Cyanosis, Dyspnoea, Pyrexia, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
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? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations: Father states sister had asthma p/#1 DTP;~ ()~~~In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Hx of asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA91141

Write-up: 11MAY91 onset couldn''t breathe - hx of asthma taken to ER; 12MAY91 started vomiting, trouble breathing lips cyanotic returned to Hosp admited til 14AUG91, placed on 02 had fever fr 8MAY91-17MAY91 102-103;


Changed on 10/14/2018

VAERS ID: 31362 Before After
VAERS Form:1
Age:1.8
Sex:Female
Location:Georgia
Vaccinated:1991-05-08
Onset:1991-05-11
Submitted:1991-06-05
Entered:1991-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271965 / 4 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M560FP / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1343S / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0627L / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Cyanosis, Dyspnoea, Pyrexia, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
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? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations: Father states sister had asthma p/#1 DTP;~ ()~~~In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Hx of asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA91141

Write-up: 11MAY91 onset couldn''t breathe - hx of asthma taken to ER; 12MAY91 started vomiting, trouble breathing lips cyanotic returned to Hosp admited til 14AUG91, placed on 02 had fever fr 8MAY91-17MAY91 102-103;

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