National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 35663

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 35663
VAERS Form:
Age:5.4
Sex:Male
Location:Louisiana
Vaccinated:1991-09-10
Onset:1991-09-20
Submitted:1991-09-24
Entered:1991-10-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 295975 / 4 LA / IM
MMR: MMR II / MSD 0858T / 1 RA / SC
OPV: ORIMUNE / LEDERLE 302934 / 3 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: FEVER, MENINGITIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-09-21
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: H. Influenza meningitis;
CDC 'Split Type':

Write-up: Began inc temp 20SEP91 to hosp 3AM; 21SEP91 w/t106.6 R & was DOA;


Changed on 12/8/2009

VAERS ID: 35663 Before After
VAERS Form:
Age:5.4
Sex:Male
Location:Louisiana
Vaccinated:1991-09-10
Onset:1991-09-20
Submitted:1991-09-24
Entered:1991-10-23 1991-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 295975 / 4 LA / IM
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 0858T / 1 RA / SC
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 302934 / 3 - / PO

Administered by: Public      Purchased by: Unknown Public
Symptoms: Meningitis, Pyrexia, FEVER, MENINGITIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-09-21
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: H. Influenza meningitis;
CDC 'Split Type': (blank) LA911004

Write-up: Began inc temp 20SEP91 to hosp 3AM; 21SEP91 w/t106.6 R & was DOA;


Changed on 2/14/2017

VAERS ID: 35663 Before After
VAERS Form:
Age:5.4 5.0
Sex:Male
Location:Louisiana
Vaccinated:1991-09-10
Onset:1991-09-20
Submitted:1991-09-24
Entered:1991-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 295975 / 4 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0858T / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES 302934 / 3 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Meningitis, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-09-21
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: H. Influenza meningitis;
CDC 'Split Type': LA911004

Write-up: Began inc temp 20SEP91 to hosp 3AM; 21SEP91 w/t106.6 R & was DOA;


Changed on 5/14/2017

VAERS ID: 35663 Before After
VAERS Form:
Age:5.0
Sex:Male
Location:Louisiana
Vaccinated:1991-09-10
Onset:1991-09-20
Submitted:1991-09-24
Entered:1991-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 295975 / 4 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0858T / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 302934 / 3 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Meningitis, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-09-21
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: H. Influenza meningitis;
CDC 'Split Type': LA911004

Write-up: Began inc temp 20SEP91 to hosp 3AM; 21SEP91 w/t106.6 R & was DOA;


Changed on 9/14/2017

VAERS ID: 35663 Before After
VAERS Form:(blank) 1
Age:5.0
Sex:Male
Location:Louisiana
Vaccinated:1991-09-10
Onset:1991-09-20
Submitted:1991-09-24
Entered:1991-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 295975 / 4 5 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0858T / 1 2 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 302934 / 3 4 - MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Meningitis, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-09-21
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: H. Influenza meningitis;
CDC 'Split Type': LA911004

Write-up: Began inc temp 20SEP91 to hosp 3AM; 21SEP91 w/t106.6 R & was DOA;


Changed on 2/14/2018

VAERS ID: 35663 Before After
VAERS Form:1
Age:5.0
Sex:Male
Location:Louisiana
Vaccinated:1991-09-10
Onset:1991-09-20
Submitted:1991-09-24
Entered:1991-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 295975 / 5 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0858T / 2 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 302934 / 4 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Meningitis, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-09-21
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: H. Influenza meningitis;
CDC 'Split Type': LA911004

Write-up: Began inc temp 20SEP91 to hosp 3AM; 21SEP91 w/t106.6 R & was DOA;


Changed on 6/14/2018

VAERS ID: 35663 Before After
VAERS Form:1
Age:5.0
Sex:Male
Location:Louisiana
Vaccinated:1991-09-10
Onset:1991-09-20
Submitted:1991-09-24
Entered:1991-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 295975 / 5 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0858T / 2 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 302934 / 4 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Meningitis, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-09-21
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: H. Influenza meningitis;
CDC 'Split Type': LA911004

Write-up: Began inc temp 20SEP91 to hosp 3AM; 21SEP91 w/t106.6 R & was DOA;


Changed on 8/14/2018

VAERS ID: 35663 Before After
VAERS Form:1
Age:5.0
Sex:Male
Location:Louisiana
Vaccinated:1991-09-10
Onset:1991-09-20
Submitted:1991-09-24
Entered:1991-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 295975 / 5 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0858T / 2 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 302934 / 4 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Meningitis, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-09-21
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: H. Influenza meningitis;
CDC 'Split Type': LA911004

Write-up: Began inc temp 20SEP91 to hosp 3AM; 21SEP91 w/t106.6 R & was DOA;


Changed on 9/14/2018

VAERS ID: 35663 Before After
VAERS Form:1
Age:5.0
Sex:Male
Location:Louisiana
Vaccinated:1991-09-10
Onset:1991-09-20
Submitted:1991-09-24
Entered:1991-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 295975 / 5 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0858T / 2 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 302934 / 4 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Meningitis, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-09-21
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: H. Influenza meningitis;
CDC 'Split Type': LA911004

Write-up: Began inc temp 20SEP91 to hosp 3AM; 21SEP91 w/t106.6 R & was DOA;


Changed on 10/14/2018

VAERS ID: 35663 Before After
VAERS Form:1
Age:5.0
Sex:Male
Location:Louisiana
Vaccinated:1991-09-10
Onset:1991-09-20
Submitted:1991-09-24
Entered:1991-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 295975 / 5 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0858T / 2 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 302934 / 4 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Meningitis, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-09-21
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: H. Influenza meningitis;
CDC 'Split Type': LA911004

Write-up: Began inc temp 20SEP91 to hosp 3AM; 21SEP91 w/t106.6 R & was DOA;

New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=35663&WAYBACKHISTORY=ON


Copyright © 2019 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166