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This is VAERS ID 31770

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 31770
VAERS Form:
Age:1.3
Sex:Male
Location:Alaska
Vaccinated:1991-05-21
Onset:1991-05-24
Submitted:1991-05-28
Entered:1991-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 291929 / 3 LL / IM
HEP: RECOMBIVAX HB / MSD 1693R / 2 RL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M655FB / - RL / IM
MMR: MMR II / MSD 2263R / 0 LL / SC
OPV: ORIMUNE / LEDERLE 297949 / 2 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: FEVER, RESPIRAT DIS

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: As infant on nutragema formula due to poss lactose intolerance;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': As infant on nutragema formula due to poss lactose intolerance;

Write-up: 24MAY91 MD visit & hosp w/resp illness 103.2R & fever;


Changed on 12/8/2009

VAERS ID: 31770 Before After
VAERS Form:
Age:1.3
Sex:Male
Location:Alaska
Vaccinated:1991-05-21
Onset:1991-05-24
Submitted:1991-05-28
Entered:1991-07-01 1991-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 291929 / 3 LL / IM
HEP: RECOMBIVAX HB HEP B (RECOMBIVAX HB) / MSD MERCK & CO. INC. 1693R / 2 RL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M655FB / - RL / IM
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 2263R / 0 LL / SC
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 297949 / 2 - / PO

Administered by: Public      Purchased by: Unknown Public
Symptoms: Pyrexia, Respiratory disorder, FEVER, RESPIRAT DIS

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: As infant on nutragema formula due to poss lactose intolerance;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': As infant on nutragema formula due to poss lactose intolerance; AKO14

Write-up: 24MAY91 MD visit & hosp w/resp illness 103.2R & fever;


Changed on 5/14/2017

VAERS ID: 31770 Before After
VAERS Form:
Age:1.3
Sex:Male
Location:Alaska
Vaccinated:1991-05-21
Onset:1991-05-24
Submitted:1991-05-28
Entered:1991-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291929 / 3 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1693R / 2 RL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M655FB / - RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2263R / 0 LL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 297949 / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Pyrexia, Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations: NONE NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: As infant on nutragema formula due to poss lactose intolerance;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': AKO14

Write-up: 24MAY91 MD visit & hosp w/resp illness 103.2R & fever;


Changed on 9/14/2017

VAERS ID: 31770 Before After
VAERS Form:(blank) 1
Age:1.3
Sex:Male
Location:Alaska
Vaccinated:1991-05-21
Onset:1991-05-24
Submitted:1991-05-28
Entered:1991-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291929 / 3 4 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1693R / 2 3 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M655FB / - UNK RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2263R / 0 1 LL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 297949 / 2 3 - MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Pyrexia, Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: As infant on nutragema formula due to poss lactose intolerance;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': AKO14

Write-up: 24MAY91 MD visit & hosp w/resp illness 103.2R & fever;


Changed on 2/14/2018

VAERS ID: 31770 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Alaska
Vaccinated:1991-05-21
Onset:1991-05-24
Submitted:1991-05-28
Entered:1991-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291929 / 4 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1693R / 3 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M655FB / UNK RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2263R / 1 LL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 297949 / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Pyrexia, Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: As infant on nutragema formula due to poss lactose intolerance;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': AKO14

Write-up: 24MAY91 MD visit & hosp w/resp illness 103.2R & fever;


Changed on 6/14/2018

VAERS ID: 31770 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Alaska
Vaccinated:1991-05-21
Onset:1991-05-24
Submitted:1991-05-28
Entered:1991-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291929 / 4 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1693R / 3 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M655FB / UNK RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2263R / 1 LL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 297949 / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Pyrexia, Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: As infant on nutragema formula due to poss lactose intolerance;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': AKO14

Write-up: 24MAY91 MD visit & hosp w/resp illness 103.2R & fever;


Changed on 8/14/2018

VAERS ID: 31770 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Alaska
Vaccinated:1991-05-21
Onset:1991-05-24
Submitted:1991-05-28
Entered:1991-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291929 / 4 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1693R / 3 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M655FB / UNK RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2263R / 1 LL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 297949 / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Pyrexia, Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: As infant on nutragema formula due to poss lactose intolerance;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': AKO14

Write-up: 24MAY91 MD visit & hosp w/resp illness 103.2R & fever;


Changed on 9/14/2018

VAERS ID: 31770 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Alaska
Vaccinated:1991-05-21
Onset:1991-05-24
Submitted:1991-05-28
Entered:1991-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291929 / 4 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1693R / 3 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M655FB / UNK RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2263R / 1 LL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 297949 / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Pyrexia, Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: As infant on nutragema formula due to poss lactose intolerance;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': AKO14

Write-up: 24MAY91 MD visit & hosp w/resp illness 103.2R & fever;


Changed on 10/14/2018

VAERS ID: 31770 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Alaska
Vaccinated:1991-05-21
Onset:1991-05-24
Submitted:1991-05-28
Entered:1991-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291929 / 4 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1693R / 3 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M655FB / UNK RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2263R / 1 LL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 297949 / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Pyrexia, Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: As infant on nutragema formula due to poss lactose intolerance;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': AKO14

Write-up: 24MAY91 MD visit & hosp w/resp illness 103.2R & fever;

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