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This is VAERS ID 31415

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 31415
VAERS Form:
Age:0.3
Sex:Male
Location:Alaska
Vaccinated:1991-02-28
Onset:1991-03-28
Submitted:1991-06-13
Entered:1991-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: UNK. DTP / UNCLASSIFIED - / - - / -
HEP: RECOMBIVAX HB / MSD - / - - / -
HIBV: PEDVAXHIB / MSD 1726S / 0 - / -

Administered by: Other      Purchased by: Unknown
Symptoms: INFECT, MENINGITIS, NO DRUG EFFECT

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-05-26
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: 12     Extended hospital stay? No
Previous Vaccinations:
Other Medications: OPV vax given 2Mar91
Current Illness:
Preexisting Conditions: alaskan infant, 25 wks gestation & had bronchopulmonary dysplasia
Allergies:
Diagnostic Lab Data: A CSF & blood culture confirmed the DX of haemophilus influenzae,type of infect.28Mar91 Blood culture-Haemop Influ type B;28Mar91 CSF-haemop Influ type B
CDC 'Split Type':

Write-up: Pt vax w/HIBV/HEP/DTP/on 28FEB91. Vax w/ OPV 2MAR91. Pt hospitalized on 28MAR91 w/meningitis. Recovered w/o sequelae & D/C on 9APR91.


Changed on 12/8/2009

VAERS ID: 31415 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Alaska
Vaccinated:1991-02-28
Onset:1991-03-28
Submitted:1991-06-13
Entered:1991-06-21 1991-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: UNK. DTP DTP (NO BRAND NAME) / UNCLASSIFIED UNKNOWN MANUFACTURER - / - - / -
HEP: RECOMBIVAX HB HEP B (RECOMBIVAX HB) / MSD MERCK & CO. INC. - / - - / -
HIBV: PEDVAXHIB HIB (PEDVAXHIB) / MSD MERCK & CO. INC. 1726S / 0 - / -

Administered by: Other      Purchased by: Unknown Other
Symptoms: Drug ineffective, Infection, Meningitis, INFECT, MENINGITIS, NO DRUG EFFECT

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-05-26
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: 12     Extended hospital stay? No
Previous Vaccinations:
Other Medications: OPV vax given 2Mar91
Current Illness:
Preexisting Conditions: alaskan infant, 25 wks gestation & had bronchopulmonary dysplasia
Allergies:
Diagnostic Lab Data: A CSF & blood culture confirmed the DX of haemophilus influenzae,type of infect.28Mar91 Blood culture-Haemop Influ type B;28Mar91 CSF-haemop Influ type B
CDC 'Split Type': (blank) WAES91060089

Write-up: Pt vax w/HIBV/HEP/DTP/on 28FEB91. Vax w/ OPV 2MAR91. Pt hospitalized on 28MAR91 w/meningitis. Recovered w/o sequelae & D/C on 9APR91.


Changed on 5/14/2017

VAERS ID: 31415 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Alaska
Vaccinated:1991-02-28
Onset:1991-03-28
Submitted:1991-06-13
Entered:1991-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / - - / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1726S / 0 - / -

Administered by: Other      Purchased by: Other
Symptoms: Drug ineffective, Infection, Meningitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-05-26
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: 12     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: OPV vax given 2Mar91
Current Illness:
Preexisting Conditions: alaskan infant, 25 wks gestation & had bronchopulmonary dysplasia
Allergies:
Diagnostic Lab Data: A CSF & blood culture confirmed the DX of haemophilus influenzae,type of infect.28Mar91 Blood culture-Haemop Influ type B;28Mar91 CSF-haemop Influ type B
CDC 'Split Type': WAES91060089

Write-up: Pt vax w/HIBV/HEP/DTP/on 28FEB91. Vax w/ OPV 2MAR91. Pt hospitalized on 28MAR91 w/meningitis. Recovered w/o sequelae & D/C on 9APR91.


Changed on 9/14/2017

VAERS ID: 31415 Before After
VAERS Form:(blank) 1
Age:0.3
Sex:Male
Location:Alaska
Vaccinated:1991-02-28
Onset:1991-03-28
Submitted:1991-06-13
Entered:1991-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK - / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / - UNK - / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1726S / 0 1 - / -

Administered by: Other      Purchased by: Other
Symptoms: Drug ineffective, Infection, Meningitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-05-26
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: 12     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: OPV vax given 2Mar91
Current Illness:
Preexisting Conditions: alaskan infant, 25 wks gestation & had bronchopulmonary dysplasia
Allergies:
Diagnostic Lab Data: A CSF & blood culture confirmed the DX of haemophilus influenzae,type of infect.28Mar91 Blood culture-Haemop Influ type B;28Mar91 CSF-haemop Influ type B
CDC 'Split Type': WAES91060089

Write-up: Pt vax w/HIBV/HEP/DTP/on 28FEB91. Vax w/ OPV 2MAR91. Pt hospitalized on 28MAR91 w/meningitis. Recovered w/o sequelae & D/C on 9APR91.


Changed on 2/14/2018

VAERS ID: 31415 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Alaska
Vaccinated:1991-02-28
Onset:1991-03-28
Submitted:1991-06-13
Entered:1991-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / UNK - / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1726S / 1 - / -

Administered by: Other      Purchased by: Other
Symptoms: Drug ineffective, Infection, Meningitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-05-26
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: 12     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: OPV vax given 2Mar91
Current Illness:
Preexisting Conditions: alaskan infant, 25 wks gestation & had bronchopulmonary dysplasia
Allergies:
Diagnostic Lab Data: A CSF & blood culture confirmed the DX of haemophilus influenzae,type of infect.28Mar91 Blood culture-Haemop Influ type B;28Mar91 CSF-haemop Influ type B
CDC 'Split Type': WAES91060089

Write-up: Pt vax w/HIBV/HEP/DTP/on 28FEB91. Vax w/ OPV 2MAR91. Pt hospitalized on 28MAR91 w/meningitis. Recovered w/o sequelae & D/C on 9APR91.


Changed on 6/14/2018

VAERS ID: 31415 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Alaska
Vaccinated:1991-02-28
Onset:1991-03-28
Submitted:1991-06-13
Entered:1991-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / UNK - / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1726S / 1 - / -

Administered by: Other      Purchased by: Other
Symptoms: Drug ineffective, Infection, Meningitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-05-26
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: 12     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: OPV vax given 2Mar91
Current Illness:
Preexisting Conditions: alaskan infant, 25 wks gestation & had bronchopulmonary dysplasia
Allergies:
Diagnostic Lab Data: A CSF & blood culture confirmed the DX of haemophilus influenzae,type of infect.28Mar91 Blood culture-Haemop Influ type B;28Mar91 CSF-haemop Influ type B
CDC 'Split Type': WAES91060089

Write-up: Pt vax w/HIBV/HEP/DTP/on 28FEB91. Vax w/ OPV 2MAR91. Pt hospitalized on 28MAR91 w/meningitis. Recovered w/o sequelae & D/C on 9APR91.


Changed on 8/14/2018

VAERS ID: 31415 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Alaska
Vaccinated:1991-02-28
Onset:1991-03-28
Submitted:1991-06-13
Entered:1991-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / UNK - / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1726S / 1 - / -

Administered by: Other      Purchased by: Other
Symptoms: Drug ineffective, Infection, Meningitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-05-26
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: 12     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: OPV vax given 2Mar91
Current Illness:
Preexisting Conditions: alaskan infant, 25 wks gestation & had bronchopulmonary dysplasia
Allergies:
Diagnostic Lab Data: A CSF & blood culture confirmed the DX of haemophilus influenzae,type of infect.28Mar91 Blood culture-Haemop Influ type B;28Mar91 CSF-haemop Influ type B
CDC 'Split Type': WAES91060089

Write-up: Pt vax w/HIBV/HEP/DTP/on 28FEB91. Vax w/ OPV 2MAR91. Pt hospitalized on 28MAR91 w/meningitis. Recovered w/o sequelae & D/C on 9APR91.


Changed on 9/14/2018

VAERS ID: 31415 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Alaska
Vaccinated:1991-02-28
Onset:1991-03-28
Submitted:1991-06-13
Entered:1991-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / UNK - / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1726S / 1 - / -

Administered by: Other      Purchased by: Other
Symptoms: Drug ineffective, Infection, Meningitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-05-26
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: 12     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: OPV vax given 2Mar91
Current Illness:
Preexisting Conditions: alaskan infant, 25 wks gestation & had bronchopulmonary dysplasia
Allergies:
Diagnostic Lab Data: A CSF & blood culture confirmed the DX of haemophilus influenzae,type of infect.28Mar91 Blood culture-Haemop Influ type B;28Mar91 CSF-haemop Influ type B
CDC 'Split Type': WAES91060089

Write-up: Pt vax w/HIBV/HEP/DTP/on 28FEB91. Vax w/ OPV 2MAR91. Pt hospitalized on 28MAR91 w/meningitis. Recovered w/o sequelae & D/C on 9APR91.


Changed on 10/14/2018

VAERS ID: 31415 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Alaska
Vaccinated:1991-02-28
Onset:1991-03-28
Submitted:1991-06-13
Entered:1991-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / UNK - / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1726S / 1 - / -

Administered by: Other      Purchased by: Other
Symptoms: Drug ineffective, Infection, Meningitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-05-26
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: 12     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: OPV vax given 2Mar91
Current Illness:
Preexisting Conditions: alaskan infant, 25 wks gestation & had bronchopulmonary dysplasia
Allergies:
Diagnostic Lab Data: A CSF & blood culture confirmed the DX of haemophilus influenzae,type of infect.28Mar91 Blood culture-Haemop Influ type B;28Mar91 CSF-haemop Influ type B
CDC 'Split Type': WAES91060089

Write-up: Pt vax w/HIBV/HEP/DTP/on 28FEB91. Vax w/ OPV 2MAR91. Pt hospitalized on 28MAR91 w/meningitis. Recovered w/o sequelae & D/C on 9APR91.

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