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This is VAERS ID 41739

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 41739
VAERS Form:
Age:0.1
Sex:Male
Location:California
Vaccinated:1992-04-30
Onset:1992-04-30
Submitted:1992-05-01
Entered:1992-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 316916 / 0 RL / IM
HEP: ENGERIX-B / SMITHKLINE 821B2 / 0 LL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) 155HN / 0 RL / IM
OPV: ORIMUNE / LEDERLE 0646H / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: HYPOKINESIA, HYPOTONIA, CYANOSIS, STUPOR

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? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NONE

Write-up: Hypotonic-hyporesponsive collapse immediately p/inject w/DTP (w/in one minute); pt limp & non responsive, cyanosis from nose to below chin, required aggressive stimulation & 02 via mask to recover pt;


Changed on 12/8/2009

VAERS ID: 41739 Before After
VAERS Form:
Age:0.1
Sex:Male
Location:California
Vaccinated:1992-04-30
Onset:1992-04-30
Submitted:1992-05-01
Entered:1992-05-11 1992-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 316916 / 0 RL / IM
HEP: ENGERIX-B HEP B (ENGERIX-B) / SMITHKLINE SMITHKLINE BEECHAM 821B2 / 0 LL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS 155HN / 0 RL / IM
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 0646H / 0 - / PO

Administered by: Private      Purchased by: Unknown Private
Symptoms: Cyanosis, Hypokinesia, Hypotonia, Stupor, HYPOKINESIA, HYPOTONIA, CYANOSIS, STUPOR

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? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NONE (blank)

Write-up: Hypotonic-hyporesponsive collapse immediately p/inject w/DTP (w/in one minute); pt limp & non responsive, cyanosis from nose to below chin, required aggressive stimulation & 02 via mask to recover pt;


Changed on 5/14/2017

VAERS ID: 41739 Before After
VAERS Form:
Age:0.1
Sex:Male
Location:California
Vaccinated:1992-04-30
Onset:1992-04-30
Submitted:1992-05-01
Entered:1992-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 316916 / 0 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 821B2 / 0 LL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH 155HN / 0 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 0646H / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Cyanosis, Hypokinesia, Hypotonia, Stupor

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? No
Previous Vaccinations: NONE NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Hypotonic-hyporesponsive collapse immediately p/inject w/DTP (w/in one minute); pt limp & non responsive, cyanosis from nose to below chin, required aggressive stimulation & 02 via mask to recover pt;


Changed on 9/14/2017

VAERS ID: 41739 Before After
VAERS Form:(blank) 1
Age:0.1
Sex:Male
Location:California
Vaccinated:1992-04-30
Onset:1992-04-30
Submitted:1992-05-01
Entered:1992-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 316916 / 0 1 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 821B2 / 0 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 155HN / 0 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0646H / 0 1 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Cyanosis, Hypokinesia, Hypotonia, Stupor

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? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Hypotonic-hyporesponsive collapse immediately p/inject w/DTP (w/in one minute); pt limp & non responsive, cyanosis from nose to below chin, required aggressive stimulation & 02 via mask to recover pt;


Changed on 2/14/2018

VAERS ID: 41739 Before After
VAERS Form:1
Age:0.1
Sex:Male
Location:California
Vaccinated:1992-04-30
Onset:1992-04-30
Submitted:1992-05-01
Entered:1992-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 316916 / 1 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 821B2 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 155HN / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0646H / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Cyanosis, Hypokinesia, Hypotonia, Stupor

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? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Hypotonic-hyporesponsive collapse immediately p/inject w/DTP (w/in one minute); pt limp & non responsive, cyanosis from nose to below chin, required aggressive stimulation & 02 via mask to recover pt;


Changed on 6/14/2018

VAERS ID: 41739 Before After
VAERS Form:1
Age:0.1
Sex:Male
Location:California
Vaccinated:1992-04-30
Onset:1992-04-30
Submitted:1992-05-01
Entered:1992-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 316916 / 1 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 821B2 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 155HN / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0646H / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Cyanosis, Hypokinesia, Hypotonia, Stupor

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? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Hypotonic-hyporesponsive collapse immediately p/inject w/DTP (w/in one minute); pt limp & non responsive, cyanosis from nose to below chin, required aggressive stimulation & 02 via mask to recover pt;


Changed on 8/14/2018

VAERS ID: 41739 Before After
VAERS Form:1
Age:0.1
Sex:Male
Location:California
Vaccinated:1992-04-30
Onset:1992-04-30
Submitted:1992-05-01
Entered:1992-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 316916 / 1 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 821B2 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 155HN / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0646H / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Cyanosis, Hypokinesia, Hypotonia, Stupor

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? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Hypotonic-hyporesponsive collapse immediately p/inject w/DTP (w/in one minute); pt limp & non responsive, cyanosis from nose to below chin, required aggressive stimulation & 02 via mask to recover pt;


Changed on 9/14/2018

VAERS ID: 41739 Before After
VAERS Form:1
Age:0.1
Sex:Male
Location:California
Vaccinated:1992-04-30
Onset:1992-04-30
Submitted:1992-05-01
Entered:1992-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 316916 / 1 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 821B2 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 155HN / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0646H / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Cyanosis, Hypokinesia, Hypotonia, Stupor

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? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Hypotonic-hyporesponsive collapse immediately p/inject w/DTP (w/in one minute); pt limp & non responsive, cyanosis from nose to below chin, required aggressive stimulation & 02 via mask to recover pt;


Changed on 10/14/2018

VAERS ID: 41739 Before After
VAERS Form:1
Age:0.1
Sex:Male
Location:California
Vaccinated:1992-04-30
Onset:1992-04-30
Submitted:1992-05-01
Entered:1992-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 316916 / 1 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 821B2 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 155HN / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0646H / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Cyanosis, Hypokinesia, Hypotonia, Stupor

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? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Hypotonic-hyporesponsive collapse immediately p/inject w/DTP (w/in one minute); pt limp & non responsive, cyanosis from nose to below chin, required aggressive stimulation & 02 via mask to recover pt;

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