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This is VAERS ID 41711

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 41711
VAERS Form:
Age:1.6
Sex:Male
Location:Louisiana
Vaccinated:1992-04-01
Onset:1992-04-01
Submitted:1992-04-13
Entered:1992-05-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 310967 / 3 RL / -
HEP: HEPTAVAX / MSD 2189S / 2 LL / -
HIBV: HIBTITER / LEDERLE(PRAXIS) M570HJ / 2 LL / -
MMR: MMR II / MSD 0860T / - LA / -
OPV: ORIMUNE / LEDERLE 0643B12 / 2 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: FEVER, APNEA, ANEMIA HYPOCHROM, HEART ARREST, HYPOXIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-04-01
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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: WBC-3.3; Hgb - 8.5; HCt - 26.1; Poly-15; Lymph-77;
CDC 'Split Type': NONE

Write-up: Pt brought to ER via ambulance w/CPR in progress; pt found by mom not breathing; pt recvd vax 31MAR92 & had been running fever; Resp distress;


Changed on 12/8/2009

VAERS ID: 41711 Before After
VAERS Form:
Age:1.6
Sex:Male
Location:Louisiana
Vaccinated:1992-04-01
Onset:1992-04-01
Submitted:1992-04-13
Entered:1992-05-08 1992-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 310967 / 3 RL / -
HEP: HEPTAVAX HEP B (HEPTAVAX) / MSD MERCK & CO. INC. 2189S / 2 LL / -
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M570HJ / 2 LL / -
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 0860T / - LA / -
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 0643B12 / 2 - / PO

Administered by: Public      Purchased by: Unknown Public
Symptoms: Apnoea, Cardiac arrest, Hypochromic anaemia, Hypoxia, Leukopenia, Lung disorder, Lymphocytosis, Pyrexia, FEVER, APNEA, ANEMIA HYPOCHROM, HEART ARREST, HYPOXIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-04-01
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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: WBC-3.3; Hgb - 8.5; HCt - 26.1; Poly-15; Lymph-77;
CDC 'Split Type': NONE LA920402

Write-up: Pt brought to ER via ambulance w/CPR in progress; pt found by mom not breathing; pt recvd vax 31MAR92 & had been running fever; Resp distress;


Changed on 8/31/2010

VAERS ID: 41711 Before After
VAERS Form:
Age:1.6
Sex:Male
Location:Louisiana
Vaccinated:1992-04-01
Onset:1992-04-01
Submitted:1992-04-13
Entered:1992-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 310967 / 3 RL / -
HEP: HEP B (HEPTAVAX) HEP B (FOREIGN) / MERCK & CO. INC. 2189S / 2 LL / -
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS M570HJ / 2 LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0860T / - LA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES 0643B12 / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Hypochromic anaemia, Hypoxia, Leukopenia, Lung disorder, Lymphocytosis, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-04-01
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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: WBC-3.3; Hgb - 8.5; HCt - 26.1; Poly-15; Lymph-77;
CDC 'Split Type': LA920402

Write-up: Pt brought to ER via ambulance w/CPR in progress; pt found by mom not breathing; pt recvd vax 31MAR92 & had been running fever; Resp distress;


Changed on 5/14/2017

VAERS ID: 41711 Before After
VAERS Form:
Age:1.6
Sex:Male
Location:Louisiana
Vaccinated:1992-04-01
Onset:1992-04-01
Submitted:1992-04-13
Entered:1992-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 310967 / 3 RL / -
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 2189S / 2 LL / -
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M570HJ / 2 LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0860T / - LA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 0643B12 / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Hypochromic anaemia, Hypoxia, Leukopenia, Lung disorder, Lymphocytosis, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-04-01
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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: WBC-3.3; Hgb - 8.5; HCt - 26.1; Poly-15; Lymph-77;
CDC 'Split Type': LA920402

Write-up: Pt brought to ER via ambulance w/CPR in progress; pt found by mom not breathing; pt recvd vax 31MAR92 & had been running fever; Resp distress;


Changed on 9/14/2017

VAERS ID: 41711 Before After
VAERS Form:(blank) 1
Age:1.6
Sex:Male
Location:Louisiana
Vaccinated:1992-04-01
Onset:1992-04-01
Submitted:1992-04-13
Entered:1992-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 310967 / 3 4 RL / -
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 2189S / 2 3 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M570HJ / 2 3 LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0860T / - UNK LA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0643B12 / 2 3 - MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Hypochromic anaemia, Hypoxia, Leukopenia, Lung disorder, Lymphocytosis, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-04-01
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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: WBC-3.3; Hgb - 8.5; HCt - 26.1; Poly-15; Lymph-77;
CDC 'Split Type': LA920402

Write-up: Pt brought to ER via ambulance w/CPR in progress; pt found by mom not breathing; pt recvd vax 31MAR92 & had been running fever; Resp distress;


Changed on 2/14/2018

VAERS ID: 41711 Before After
VAERS Form:1
Age:1.6
Sex:Male
Location:Louisiana
Vaccinated:1992-04-01
Onset:1992-04-01
Submitted:1992-04-13
Entered:1992-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 310967 / 4 RL / -
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 2189S / 3 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M570HJ / 3 LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0860T / UNK LA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0643B12 / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Hypochromic anaemia, Hypoxia, Leukopenia, Lung disorder, Lymphocytosis, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-04-01
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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: WBC-3.3; Hgb - 8.5; HCt - 26.1; Poly-15; Lymph-77;
CDC 'Split Type': LA920402

Write-up: Pt brought to ER via ambulance w/CPR in progress; pt found by mom not breathing; pt recvd vax 31MAR92 & had been running fever; Resp distress;


Changed on 6/14/2018

VAERS ID: 41711 Before After
VAERS Form:1
Age:1.6
Sex:Male
Location:Louisiana
Vaccinated:1992-04-01
Onset:1992-04-01
Submitted:1992-04-13
Entered:1992-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 310967 / 4 RL / -
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 2189S / 3 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M570HJ / 3 LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0860T / UNK LA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0643B12 / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Hypochromic anaemia, Hypoxia, Leukopenia, Lung disorder, Lymphocytosis, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-04-01
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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: WBC-3.3; Hgb - 8.5; HCt - 26.1; Poly-15; Lymph-77;
CDC 'Split Type': LA920402

Write-up: Pt brought to ER via ambulance w/CPR in progress; pt found by mom not breathing; pt recvd vax 31MAR92 & had been running fever; Resp distress;


Changed on 8/14/2018

VAERS ID: 41711 Before After
VAERS Form:1
Age:1.6
Sex:Male
Location:Louisiana
Vaccinated:1992-04-01
Onset:1992-04-01
Submitted:1992-04-13
Entered:1992-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 310967 / 4 RL / -
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 2189S / 3 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M570HJ / 3 LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0860T / UNK LA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0643B12 / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Hypochromic anaemia, Hypoxia, Leukopenia, Lung disorder, Lymphocytosis, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-04-01
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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: WBC-3.3; Hgb - 8.5; HCt - 26.1; Poly-15; Lymph-77;
CDC 'Split Type': LA920402

Write-up: Pt brought to ER via ambulance w/CPR in progress; pt found by mom not breathing; pt recvd vax 31MAR92 & had been running fever; Resp distress;


Changed on 9/14/2018

VAERS ID: 41711 Before After
VAERS Form:1
Age:1.6
Sex:Male
Location:Louisiana
Vaccinated:1992-04-01
Onset:1992-04-01
Submitted:1992-04-13
Entered:1992-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 310967 / 4 RL / -
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 2189S / 3 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M570HJ / 3 LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0860T / UNK LA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0643B12 / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Hypochromic anaemia, Hypoxia, Leukopenia, Lung disorder, Lymphocytosis, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-04-01
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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: WBC-3.3; Hgb - 8.5; HCt - 26.1; Poly-15; Lymph-77;
CDC 'Split Type': LA920402

Write-up: Pt brought to ER via ambulance w/CPR in progress; pt found by mom not breathing; pt recvd vax 31MAR92 & had been running fever; Resp distress;


Changed on 10/14/2018

VAERS ID: 41711 Before After
VAERS Form:1
Age:1.6
Sex:Male
Location:Louisiana
Vaccinated:1992-04-01
Onset:1992-04-01
Submitted:1992-04-13
Entered:1992-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 310967 / 4 RL / -
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 2189S / 3 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M570HJ / 3 LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0860T / UNK LA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0643B12 / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Hypochromic anaemia, Hypoxia, Leukopenia, Lung disorder, Lymphocytosis, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-04-01
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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: WBC-3.3; Hgb - 8.5; HCt - 26.1; Poly-15; Lymph-77;
CDC 'Split Type': LA920402

Write-up: Pt brought to ER via ambulance w/CPR in progress; pt found by mom not breathing; pt recvd vax 31MAR92 & had been running fever; Resp distress;

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