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This is VAERS ID 41374

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 41374
VAERS Form:
Age:1.7
Sex:Male
Location:New Hampshire
Vaccinated:1992-02-26
Onset:1992-03-19
Submitted:1992-03-26
Entered:1992-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 318907 / 3 RL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M560FP / 1 LL / IM
MMR: MMR II / MSD 0985T / 0 RA / SC
OPV: ORIMUNE / LEDERLE 0648E / 3 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: DEHYDRAT, GASTROENTERITIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-03-21
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: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': NONE

Write-up: Unaware of any adverse rxn post vax 26NOV91 & 26FEB92; pt died 21MAR92 w/dehydration, post gastroenteritis x 2 days prior to death; MD called & stated pt had vax less than 1 month ago @ clinic;


Changed on 12/8/2009

VAERS ID: 41374 Before After
VAERS Form:
Age:1.7
Sex:Male
Location:New Hampshire
Vaccinated:1992-02-26
Onset:1992-03-19
Submitted:1992-03-26
Entered:1992-04-28 1992-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 318907 / 3 RL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M560FP / 1 LL / IM
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 0985T / 0 RA / SC
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 0648E / 3 - / PO

Administered by: Public      Purchased by: Unknown Public
Symptoms: Dehydration, Gastroenteritis, DEHYDRAT, GASTROENTERITIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-03-21
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: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': NONE NH92005

Write-up: Unaware of any adverse rxn post vax 26NOV91 & 26FEB92; pt died 21MAR92 w/dehydration, post gastroenteritis x 2 days prior to death; MD called & stated pt had vax less than 1 month ago @ clinic;


Changed on 5/14/2017

VAERS ID: 41374 Before After
VAERS Form:
Age:1.7
Sex:Male
Location:New Hampshire
Vaccinated:1992-02-26
Onset:1992-03-19
Submitted:1992-03-26
Entered:1992-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 318907 / 3 RL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M560FP / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0985T / 0 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 0648E / 3 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Dehydration, Gastroenteritis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-03-21
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: NONE NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': NH92005

Write-up: Unaware of any adverse rxn post vax 26NOV91 & 26FEB92; pt died 21MAR92 w/dehydration, post gastroenteritis x 2 days prior to death; MD called & stated pt had vax less than 1 month ago @ clinic;


Changed on 9/14/2017

VAERS ID: 41374 Before After
VAERS Form:(blank) 1
Age:1.7
Sex:Male
Location:New Hampshire
Vaccinated:1992-02-26
Onset:1992-03-19
Submitted:1992-03-26
Entered:1992-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 318907 / 3 4 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M560FP / 1 2 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0985T / 0 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0648E / 3 4 - MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Dehydration, Gastroenteritis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-03-21
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': NH92005

Write-up: Unaware of any adverse rxn post vax 26NOV91 & 26FEB92; pt died 21MAR92 w/dehydration, post gastroenteritis x 2 days prior to death; MD called & stated pt had vax less than 1 month ago @ clinic;


Changed on 2/14/2018

VAERS ID: 41374 Before After
VAERS Form:1
Age:1.7
Sex:Male
Location:New Hampshire
Vaccinated:1992-02-26
Onset:1992-03-19
Submitted:1992-03-26
Entered:1992-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 318907 / 4 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M560FP / 2 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0985T / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0648E / 4 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Dehydration, Gastroenteritis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-03-21
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': NH92005

Write-up: Unaware of any adverse rxn post vax 26NOV91 & 26FEB92; pt died 21MAR92 w/dehydration, post gastroenteritis x 2 days prior to death; MD called & stated pt had vax less than 1 month ago @ clinic;


Changed on 6/14/2018

VAERS ID: 41374 Before After
VAERS Form:1
Age:1.7
Sex:Male
Location:New Hampshire
Vaccinated:1992-02-26
Onset:1992-03-19
Submitted:1992-03-26
Entered:1992-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 318907 / 4 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M560FP / 2 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0985T / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0648E / 4 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Dehydration, Gastroenteritis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-03-21
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': NH92005

Write-up: Unaware of any adverse rxn post vax 26NOV91 & 26FEB92; pt died 21MAR92 w/dehydration, post gastroenteritis x 2 days prior to death; MD called & stated pt had vax less than 1 month ago @ clinic;


Changed on 8/14/2018

VAERS ID: 41374 Before After
VAERS Form:1
Age:1.7
Sex:Male
Location:New Hampshire
Vaccinated:1992-02-26
Onset:1992-03-19
Submitted:1992-03-26
Entered:1992-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 318907 / 4 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M560FP / 2 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0985T / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0648E / 4 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Dehydration, Gastroenteritis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-03-21
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': NH92005

Write-up: Unaware of any adverse rxn post vax 26NOV91 & 26FEB92; pt died 21MAR92 w/dehydration, post gastroenteritis x 2 days prior to death; MD called & stated pt had vax less than 1 month ago @ clinic;


Changed on 9/14/2018

VAERS ID: 41374 Before After
VAERS Form:1
Age:1.7
Sex:Male
Location:New Hampshire
Vaccinated:1992-02-26
Onset:1992-03-19
Submitted:1992-03-26
Entered:1992-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 318907 / 4 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M560FP / 2 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0985T / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0648E / 4 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Dehydration, Gastroenteritis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-03-21
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': NH92005

Write-up: Unaware of any adverse rxn post vax 26NOV91 & 26FEB92; pt died 21MAR92 w/dehydration, post gastroenteritis x 2 days prior to death; MD called & stated pt had vax less than 1 month ago @ clinic;


Changed on 10/14/2018

VAERS ID: 41374 Before After
VAERS Form:1
Age:1.7
Sex:Male
Location:New Hampshire
Vaccinated:1992-02-26
Onset:1992-03-19
Submitted:1992-03-26
Entered:1992-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 318907 / 4 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M560FP / 2 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0985T / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0648E / 4 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Dehydration, Gastroenteritis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-03-21
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': NH92005

Write-up: Unaware of any adverse rxn post vax 26NOV91 & 26FEB92; pt died 21MAR92 w/dehydration, post gastroenteritis x 2 days prior to death; MD called & stated pt had vax less than 1 month ago @ clinic;

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