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This is VAERS ID 43432

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 43432
VAERS Form:
Age:0.2
Sex:Female
Location:California
Vaccinated:1992-01-16
Onset:1992-01-19
Submitted:1992-07-06
Entered:1992-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 316976 / 0 LL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M175HH / 0 - / IM
IPV: POLIOVAX / CONNAUGHT LTD 60080 / 0 RL / IM

Administered by: Private      Purchased by: Unknown
Symptoms: AGITATION, VOMIT, BONE FRACT SPONTAN

Life Threatening? No
Birth Defect? No
Died? No
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? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CXR-fractured rib-pos;
CDC 'Split Type':

Write-up: pt recvd vax 16JAN92 & was fussy for next 3 days; seen by MD for extreme irritability adm r/o abd process x-ray neg (rub); d/c next day; f/u noted to have crepitus; CXR for fractured rib -pos;


Changed on 12/8/2009

VAERS ID: 43432 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:California
Vaccinated:1992-01-16
Onset:1992-01-19
Submitted:1992-07-06
Entered:1992-07-14 1992-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 316976 / 0 LL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M175HH / 0 - / IM
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. 60080 / 0 RL / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Agitation, Pathological fracture, Vomiting, AGITATION, VOMIT, BONE FRACT SPONTAN

Life Threatening? No
Birth Defect? No
Died? No
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? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CXR-fractured rib-pos;
CDC 'Split Type':

Write-up: pt recvd vax 16JAN92 & was fussy for next 3 days; seen by MD for extreme irritability adm r/o abd process x-ray neg (rub); d/c next day; f/u noted to have crepitus; CXR for fractured rib -pos;


Changed on 5/14/2017

VAERS ID: 43432 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:California
Vaccinated:1992-01-16
Onset:1992-01-19
Submitted:1992-07-06
Entered:1992-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 316976 / 0 LL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M175HH / 0 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 60080 / 0 RL / IM

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Pathological fracture, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
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? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CXR-fractured rib-pos;
CDC 'Split Type':

Write-up: pt recvd vax 16JAN92 & was fussy for next 3 days; seen by MD for extreme irritability adm r/o abd process x-ray neg (rub); d/c next day; f/u noted to have crepitus; CXR for fractured rib -pos;


Changed on 9/14/2017

VAERS ID: 43432 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Female
Location:California
Vaccinated:1992-01-16
Onset:1992-01-19
Submitted:1992-07-06
Entered:1992-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 316976 / 0 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M175HH / 0 1 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 60080 / 0 1 RL / IM

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Pathological fracture, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
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? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CXR-fractured rib-pos;
CDC 'Split Type':

Write-up: pt recvd vax 16JAN92 & was fussy for next 3 days; seen by MD for extreme irritability adm r/o abd process x-ray neg (rub); d/c next day; f/u noted to have crepitus; CXR for fractured rib -pos;


Changed on 2/14/2018

VAERS ID: 43432 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:California
Vaccinated:1992-01-16
Onset:1992-01-19
Submitted:1992-07-06
Entered:1992-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 316976 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M175HH / 1 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 60080 / 1 RL / IM

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Pathological fracture, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
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? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CXR-fractured rib-pos;
CDC 'Split Type':

Write-up: pt recvd vax 16JAN92 & was fussy for next 3 days; seen by MD for extreme irritability adm r/o abd process x-ray neg (rub); d/c next day; f/u noted to have crepitus; CXR for fractured rib -pos;


Changed on 6/14/2018

VAERS ID: 43432 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:California
Vaccinated:1992-01-16
Onset:1992-01-19
Submitted:1992-07-06
Entered:1992-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 316976 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M175HH / 1 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 60080 / 1 RL / IM

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Pathological fracture, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
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? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CXR-fractured rib-pos;
CDC 'Split Type':

Write-up: pt recvd vax 16JAN92 & was fussy for next 3 days; seen by MD for extreme irritability adm r/o abd process x-ray neg (rub); d/c next day; f/u noted to have crepitus; CXR for fractured rib -pos;


Changed on 8/14/2018

VAERS ID: 43432 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:California
Vaccinated:1992-01-16
Onset:1992-01-19
Submitted:1992-07-06
Entered:1992-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 316976 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M175HH / 1 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 60080 / 1 RL / IM

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Pathological fracture, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
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? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CXR-fractured rib-pos;
CDC 'Split Type':

Write-up: pt recvd vax 16JAN92 & was fussy for next 3 days; seen by MD for extreme irritability adm r/o abd process x-ray neg (rub); d/c next day; f/u noted to have crepitus; CXR for fractured rib -pos;


Changed on 9/14/2018

VAERS ID: 43432 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:California
Vaccinated:1992-01-16
Onset:1992-01-19
Submitted:1992-07-06
Entered:1992-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 316976 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M175HH / 1 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 60080 / 1 RL / IM

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Pathological fracture, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
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? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CXR-fractured rib-pos;
CDC 'Split Type':

Write-up: pt recvd vax 16JAN92 & was fussy for next 3 days; seen by MD for extreme irritability adm r/o abd process x-ray neg (rub); d/c next day; f/u noted to have crepitus; CXR for fractured rib -pos;


Changed on 10/14/2018

VAERS ID: 43432 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:California
Vaccinated:1992-01-16
Onset:1992-01-19
Submitted:1992-07-06
Entered:1992-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 316976 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M175HH / 1 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 60080 / 1 RL / IM

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Pathological fracture, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
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? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CXR-fractured rib-pos;
CDC 'Split Type':

Write-up: pt recvd vax 16JAN92 & was fussy for next 3 days; seen by MD for extreme irritability adm r/o abd process x-ray neg (rub); d/c next day; f/u noted to have crepitus; CXR for fractured rib -pos;

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=43432&WAYBACKHISTORY=ON


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