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This is VAERS ID 31738

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 31738
VAERS Form:
Age:0.4
Sex:Female
Location:Alaska
Vaccinated:1991-02-25
Onset:1991-03-06
Submitted:1991-06-20
Entered:1991-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: RECOMBIVAX HB / MSD - / 0 - / -
HIBV: PEDVAXHIB / MSD 1726S / 0 - / -

Administered by: Private      Purchased by: Unknown
Symptoms: FEVER, HYPOTENS, INFECT, BRADYCARDIA, CSF ABNORM

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-04-10
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 30     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Ceftriaxone, Rifampin, Phenobarbital
Current Illness:
Preexisting Conditions: Down''s synd, Tetralogy of fallot, Atelectasis;
Allergies:
Diagnostic Lab Data: CXR 7MAR91 RLL infiltrate, vertex Atelectas, CSF 7MAR91 Culture-negative, CSF 25MAR91 Cultur-Negative, CSF 7MAR91 - 47 RBC, 20 WBC, 80% PMN''s, 20% Lymphs, 54 PROTEIN, 41 GLUCOSE, Latex aggl HIB positive URINE, CSR 9MAR91 - HIB +;
CDC 'Split Type':

Write-up: Pt hospitalized on 1FEB91 for diarrhea, fever & breathing difficulties; Seen in ER; While hospitalized given vax & became irritable, temp 105, hypotensive, bradyarrhythmia, & poss pneumonia & died;


Changed on 12/8/2009

VAERS ID: 31738 Before After
VAERS Form:
Age:0.4
Sex:Female
Location:Alaska
Vaccinated:1991-02-25
Onset:1991-03-06
Submitted:1991-06-20
Entered:1991-06-27 1991-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: RECOMBIVAX HB HEP B (RECOMBIVAX HB) / MSD MERCK & CO. INC. - / 0 - / -
HIBV: PEDVAXHIB HIB (PEDVAXHIB) / MSD MERCK & CO. INC. 1726S / 0 - / -

Administered by: Private      Purchased by: Unknown Other
Symptoms: Bradycardia, Condition aggravated, Drug ineffective, Hypotension, Infection, Pneumonia, Pyrexia, CSF test abnormal, FEVER, HYPOTENS, INFECT, BRADYCARDIA, CSF ABNORM

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-04-10
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 30     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Ceftriaxone, Rifampin, Phenobarbital
Current Illness:
Preexisting Conditions: Down''s synd, Tetralogy of fallot, Atelectasis;
Allergies:
Diagnostic Lab Data: CXR 7MAR91 RLL infiltrate, vertex Atelectas, CSF 7MAR91 Culture-negative, CSF 25MAR91 Cultur-Negative, CSF 7MAR91 - 47 RBC, 20 WBC, 80% PMN''s, 20% Lymphs, 54 PROTEIN, 41 GLUCOSE, Latex aggl HIB positive URINE, CSR 9MAR91 - HIB +;
CDC 'Split Type': (blank) WAES91060083

Write-up: Pt hospitalized on 1FEB91 for diarrhea, fever & breathing difficulties; Seen in ER; While hospitalized given vax & became irritable, temp 105, hypotensive, bradyarrhythmia, & poss pneumonia & died;


Changed on 5/14/2017

VAERS ID: 31738 Before After
VAERS Form:
Age:0.4
Sex:Female
Location:Alaska
Vaccinated:1991-02-25
Onset:1991-03-06
Submitted:1991-06-20
Entered:1991-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 0 - / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1726S / 0 - / -

Administered by: Private      Purchased by: Other
Symptoms: Bradycardia, Condition aggravated, Drug ineffective, Hypotension, Infection, Pneumonia, Pyrexia, CSF test abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-04-10
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 30     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Ceftriaxone, Rifampin, Phenobarbital
Current Illness:
Preexisting Conditions: Down''s synd, Tetralogy of fallot, Atelectasis;
Allergies:
Diagnostic Lab Data: CXR 7MAR91 RLL infiltrate, vertex Atelectas, CSF 7MAR91 Culture-negative, CSF 25MAR91 Cultur-Negative, CSF 7MAR91 - 47 RBC, 20 WBC, 80% PMN''s, 20% Lymphs, 54 PROTEIN, 41 GLUCOSE, Latex aggl HIB positive URINE, CSR 9MAR91 - HIB +;
CDC 'Split Type': WAES91060083

Write-up: Pt hospitalized on 1FEB91 for diarrhea, fever & breathing difficulties; Seen in ER; While hospitalized given vax & became irritable, temp 105, hypotensive, bradyarrhythmia, & poss pneumonia & died;


Changed on 9/14/2017

VAERS ID: 31738 Before After
VAERS Form:(blank) 1
Age:0.4
Sex:Female
Location:Alaska
Vaccinated:1991-02-25
Onset:1991-03-06
Submitted:1991-06-20
Entered:1991-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 0 1 - / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1726S / 0 1 - / -

Administered by: Private      Purchased by: Other
Symptoms: Bradycardia, Condition aggravated, Drug ineffective, Hypotension, Infection, Pneumonia, Pyrexia, CSF test abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-04-10
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 30     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Ceftriaxone, Rifampin, Phenobarbital
Current Illness:
Preexisting Conditions: Down''s synd, Tetralogy of fallot, Atelectasis;
Allergies:
Diagnostic Lab Data: CXR 7MAR91 RLL infiltrate, vertex Atelectas, CSF 7MAR91 Culture-negative, CSF 25MAR91 Cultur-Negative, CSF 7MAR91 - 47 RBC, 20 WBC, 80% PMN''s, 20% Lymphs, 54 PROTEIN, 41 GLUCOSE, Latex aggl HIB positive URINE, CSR 9MAR91 - HIB +;
CDC 'Split Type': WAES91060083

Write-up: Pt hospitalized on 1FEB91 for diarrhea, fever & breathing difficulties; Seen in ER; While hospitalized given vax & became irritable, temp 105, hypotensive, bradyarrhythmia, & poss pneumonia & died;


Changed on 2/14/2018

VAERS ID: 31738 Before After
VAERS Form:1
Age:0.4
Sex:Female
Location:Alaska
Vaccinated:1991-02-25
Onset:1991-03-06
Submitted:1991-06-20
Entered:1991-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 1 - / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1726S / 1 - / -

Administered by: Private      Purchased by: Other
Symptoms: Bradycardia, Condition aggravated, Drug ineffective, Hypotension, Infection, Pneumonia, Pyrexia, CSF test abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-04-10
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 30     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Ceftriaxone, Rifampin, Phenobarbital
Current Illness:
Preexisting Conditions: Down''s synd, Tetralogy of fallot, Atelectasis;
Allergies:
Diagnostic Lab Data: CXR 7MAR91 RLL infiltrate, vertex Atelectas, CSF 7MAR91 Culture-negative, CSF 25MAR91 Cultur-Negative, CSF 7MAR91 - 47 RBC, 20 WBC, 80% PMN''s, 20% Lymphs, 54 PROTEIN, 41 GLUCOSE, Latex aggl HIB positive URINE, CSR 9MAR91 - HIB +;
CDC 'Split Type': WAES91060083

Write-up: Pt hospitalized on 1FEB91 for diarrhea, fever & breathing difficulties; Seen in ER; While hospitalized given vax & became irritable, temp 105, hypotensive, bradyarrhythmia, & poss pneumonia & died;


Changed on 6/14/2018

VAERS ID: 31738 Before After
VAERS Form:1
Age:0.4
Sex:Female
Location:Alaska
Vaccinated:1991-02-25
Onset:1991-03-06
Submitted:1991-06-20
Entered:1991-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 1 - / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1726S / 1 - / -

Administered by: Private      Purchased by: Other
Symptoms: Bradycardia, Condition aggravated, Drug ineffective, Hypotension, Infection, Pneumonia, Pyrexia, CSF test abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-04-10
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 30     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Ceftriaxone, Rifampin, Phenobarbital
Current Illness:
Preexisting Conditions: Down''s synd, Tetralogy of fallot, Atelectasis;
Allergies:
Diagnostic Lab Data: CXR 7MAR91 RLL infiltrate, vertex Atelectas, CSF 7MAR91 Culture-negative, CSF 25MAR91 Cultur-Negative, CSF 7MAR91 - 47 RBC, 20 WBC, 80% PMN''s, 20% Lymphs, 54 PROTEIN, 41 GLUCOSE, Latex aggl HIB positive URINE, CSR 9MAR91 - HIB +;
CDC 'Split Type': WAES91060083

Write-up: Pt hospitalized on 1FEB91 for diarrhea, fever & breathing difficulties; Seen in ER; While hospitalized given vax & became irritable, temp 105, hypotensive, bradyarrhythmia, & poss pneumonia & died;


Changed on 8/14/2018

VAERS ID: 31738 Before After
VAERS Form:1
Age:0.4
Sex:Female
Location:Alaska
Vaccinated:1991-02-25
Onset:1991-03-06
Submitted:1991-06-20
Entered:1991-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 1 - / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1726S / 1 - / -

Administered by: Private      Purchased by: Other
Symptoms: Bradycardia, Condition aggravated, Drug ineffective, Hypotension, Infection, Pneumonia, Pyrexia, CSF test abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-04-10
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 30     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Ceftriaxone, Rifampin, Phenobarbital
Current Illness:
Preexisting Conditions: Down''s synd, Tetralogy of fallot, Atelectasis;
Allergies:
Diagnostic Lab Data: CXR 7MAR91 RLL infiltrate, vertex Atelectas, CSF 7MAR91 Culture-negative, CSF 25MAR91 Cultur-Negative, CSF 7MAR91 - 47 RBC, 20 WBC, 80% PMN''s, 20% Lymphs, 54 PROTEIN, 41 GLUCOSE, Latex aggl HIB positive URINE, CSR 9MAR91 - HIB +;
CDC 'Split Type': WAES91060083

Write-up: Pt hospitalized on 1FEB91 for diarrhea, fever & breathing difficulties; Seen in ER; While hospitalized given vax & became irritable, temp 105, hypotensive, bradyarrhythmia, & poss pneumonia & died;


Changed on 9/14/2018

VAERS ID: 31738 Before After
VAERS Form:1
Age:0.4
Sex:Female
Location:Alaska
Vaccinated:1991-02-25
Onset:1991-03-06
Submitted:1991-06-20
Entered:1991-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 1 - / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1726S / 1 - / -

Administered by: Private      Purchased by: Other
Symptoms: Bradycardia, Condition aggravated, Drug ineffective, Hypotension, Infection, Pneumonia, Pyrexia, CSF test abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-04-10
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 30     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Ceftriaxone, Rifampin, Phenobarbital
Current Illness:
Preexisting Conditions: Down''s synd, Tetralogy of fallot, Atelectasis;
Allergies:
Diagnostic Lab Data: CXR 7MAR91 RLL infiltrate, vertex Atelectas, CSF 7MAR91 Culture-negative, CSF 25MAR91 Cultur-Negative, CSF 7MAR91 - 47 RBC, 20 WBC, 80% PMN''s, 20% Lymphs, 54 PROTEIN, 41 GLUCOSE, Latex aggl HIB positive URINE, CSR 9MAR91 - HIB +;
CDC 'Split Type': WAES91060083

Write-up: Pt hospitalized on 1FEB91 for diarrhea, fever & breathing difficulties; Seen in ER; While hospitalized given vax & became irritable, temp 105, hypotensive, bradyarrhythmia, & poss pneumonia & died;


Changed on 10/14/2018

VAERS ID: 31738 Before After
VAERS Form:1
Age:0.4
Sex:Female
Location:Alaska
Vaccinated:1991-02-25
Onset:1991-03-06
Submitted:1991-06-20
Entered:1991-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 1 - / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1726S / 1 - / -

Administered by: Private      Purchased by: Other
Symptoms: Bradycardia, Condition aggravated, Drug ineffective, Hypotension, Infection, Pneumonia, Pyrexia, CSF test abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-04-10
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 30     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Ceftriaxone, Rifampin, Phenobarbital
Current Illness:
Preexisting Conditions: Down''s synd, Tetralogy of fallot, Atelectasis;
Allergies:
Diagnostic Lab Data: CXR 7MAR91 RLL infiltrate, vertex Atelectas, CSF 7MAR91 Culture-negative, CSF 25MAR91 Cultur-Negative, CSF 7MAR91 - 47 RBC, 20 WBC, 80% PMN''s, 20% Lymphs, 54 PROTEIN, 41 GLUCOSE, Latex aggl HIB positive URINE, CSR 9MAR91 - HIB +;
CDC 'Split Type': WAES91060083

Write-up: Pt hospitalized on 1FEB91 for diarrhea, fever & breathing difficulties; Seen in ER; While hospitalized given vax & became irritable, temp 105, hypotensive, bradyarrhythmia, & poss pneumonia & died;

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