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This is VAERS ID 43529

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 43529
VAERS Form:
Age:0.3
Sex:Female
Location:South Carolina
Vaccinated:1992-06-19
Onset:1992-06-19
Submitted:1992-07-06
Entered:1992-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 320905 / 3 LL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M695HL / 3 RL / IM
MMR: MMR II / MSD 2028T / - LA / SC
OPV: ORIMUNE / LEDERLE 320946 / 2 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: SYNCOPE, PALLOR, CARDIOVASC DIS

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations: pt''s sibling exp rxn w/DTp @ 2mos #1 dose;
Other Medications: Oridol
Current Illness: runny nose, no fever or chest congestion
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: bone marrow-aspirations;
CDC 'Split Type':

Write-up: evening of day vax given mom noticed pt pale next few days became more pale; on 6th days p/vax passed out; seen by MD who noted heart murmur & pt adm to hospital for cardiac eval; dx TEC tx w/blood tranfusion;


Changed on 12/8/2009

VAERS ID: 43529 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:South Carolina
Vaccinated:1992-06-19
Onset:1992-06-19
Submitted:1992-07-06
Entered:1992-07-17 1992-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 320905 / 3 LL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M695HL / 3 RL / IM
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 2028T / - LA / SC
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 320946 / 2 - / PO

Administered by: Public      Purchased by: Unknown Public
Symptoms: Cardiovascular disorder, Pallor, Syncope, SYNCOPE, PALLOR, CARDIOVASC DIS

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations: pt''s sibling exp rxn w/DTp @ 2mos #1 dose;
Other Medications: Oridol
Current Illness: runny nose, no fever or chest congestion
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: bone marrow-aspirations;
CDC 'Split Type': (blank) SC92077

Write-up: evening of day vax given mom noticed pt pale next few days became more pale; on 6th days p/vax passed out; seen by MD who noted heart murmur & pt adm to hospital for cardiac eval; dx TEC tx w/blood tranfusion;


Changed on 5/14/2017

VAERS ID: 43529 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:South Carolina
Vaccinated:1992-06-19
Onset:1992-06-19
Submitted:1992-07-06
Entered:1992-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 320905 / 3 LL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M695HL / 3 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2028T / - LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 320946 / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Cardiovascular disorder, Pallor, Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations: pt''s sibling exp rxn w/DTp @ 2mos #1 dose; dose;~ ()~~~In Sibling
Other Medications: Oridol
Current Illness: runny nose, no fever or chest congestion
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: bone marrow-aspirations;
CDC 'Split Type': SC92077

Write-up: evening of day vax given mom noticed pt pale next few days became more pale; on 6th days p/vax passed out; seen by MD who noted heart murmur & pt adm to hospital for cardiac eval; dx TEC tx w/blood tranfusion;


Changed on 9/14/2017

VAERS ID: 43529 Before After
VAERS Form:(blank) 1
Age:0.3
Sex:Female
Location:South Carolina
Vaccinated:1992-06-19
Onset:1992-06-19
Submitted:1992-07-06
Entered:1992-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 320905 / 3 4 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M695HL / 3 4 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2028T / - UNK LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 320946 / 2 3 - MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Cardiovascular disorder, Pallor, Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations: pt''s sibling exp rxn w/DTp @ 2mos #1 dose;~ ()~~~In Sibling
Other Medications: Oridol
Current Illness: runny nose, no fever or chest congestion
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: bone marrow-aspirations;
CDC 'Split Type': SC92077

Write-up: evening of day vax given mom noticed pt pale next few days became more pale; on 6th days p/vax passed out; seen by MD who noted heart murmur & pt adm to hospital for cardiac eval; dx TEC tx w/blood tranfusion;


Changed on 2/14/2018

VAERS ID: 43529 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:South Carolina
Vaccinated:1992-06-19
Onset:1992-06-19
Submitted:1992-07-06
Entered:1992-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 320905 / 4 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M695HL / 4 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2028T / UNK LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 320946 / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Cardiovascular disorder, Pallor, Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations: pt''s sibling exp rxn w/DTp @ 2mos #1 dose;~ ()~~~In Sibling
Other Medications: Oridol
Current Illness: runny nose, no fever or chest congestion
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: bone marrow-aspirations;
CDC 'Split Type': SC92077

Write-up: evening of day vax given mom noticed pt pale next few days became more pale; on 6th days p/vax passed out; seen by MD who noted heart murmur & pt adm to hospital for cardiac eval; dx TEC tx w/blood tranfusion;


Changed on 6/14/2018

VAERS ID: 43529 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:South Carolina
Vaccinated:1992-06-19
Onset:1992-06-19
Submitted:1992-07-06
Entered:1992-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 320905 / 4 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M695HL / 4 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2028T / UNK LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 320946 / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Cardiovascular disorder, Pallor, Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations: pt''s sibling exp rxn w/DTp @ 2mos #1 dose;~ ()~~~In Sibling
Other Medications: Oridol
Current Illness: runny nose, no fever or chest congestion
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: bone marrow-aspirations;
CDC 'Split Type': SC92077

Write-up: evening of day vax given mom noticed pt pale next few days became more pale; on 6th days p/vax passed out; seen by MD who noted heart murmur & pt adm to hospital for cardiac eval; dx TEC tx w/blood tranfusion;


Changed on 8/14/2018

VAERS ID: 43529 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:South Carolina
Vaccinated:1992-06-19
Onset:1992-06-19
Submitted:1992-07-06
Entered:1992-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 320905 / 4 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M695HL / 4 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2028T / UNK LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 320946 / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Cardiovascular disorder, Pallor, Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations: pt''s sibling exp rxn w/DTp @ 2mos #1 dose;~ ()~~~In Sibling
Other Medications: Oridol
Current Illness: runny nose, no fever or chest congestion
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: bone marrow-aspirations;
CDC 'Split Type': SC92077

Write-up: evening of day vax given mom noticed pt pale next few days became more pale; on 6th days p/vax passed out; seen by MD who noted heart murmur & pt adm to hospital for cardiac eval; dx TEC tx w/blood tranfusion;


Changed on 9/14/2018

VAERS ID: 43529 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:South Carolina
Vaccinated:1992-06-19
Onset:1992-06-19
Submitted:1992-07-06
Entered:1992-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 320905 / 4 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M695HL / 4 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2028T / UNK LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 320946 / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Cardiovascular disorder, Pallor, Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations: pt''s sibling exp rxn w/DTp @ 2mos #1 dose;~ ()~~~In Sibling
Other Medications: Oridol
Current Illness: runny nose, no fever or chest congestion
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: bone marrow-aspirations;
CDC 'Split Type': SC92077

Write-up: evening of day vax given mom noticed pt pale next few days became more pale; on 6th days p/vax passed out; seen by MD who noted heart murmur & pt adm to hospital for cardiac eval; dx TEC tx w/blood tranfusion;


Changed on 10/14/2018

VAERS ID: 43529 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:South Carolina
Vaccinated:1992-06-19
Onset:1992-06-19
Submitted:1992-07-06
Entered:1992-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 320905 / 4 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M695HL / 4 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2028T / UNK LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 320946 / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Cardiovascular disorder, Pallor, Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations: pt''s sibling exp rxn w/DTp @ 2mos #1 dose;~ ()~~~In Sibling
Other Medications: Oridol
Current Illness: runny nose, no fever or chest congestion
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: bone marrow-aspirations;
CDC 'Split Type': SC92077

Write-up: evening of day vax given mom noticed pt pale next few days became more pale; on 6th days p/vax passed out; seen by MD who noted heart murmur & pt adm to hospital for cardiac eval; dx TEC tx w/blood tranfusion;

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=43529&WAYBACKHISTORY=ON


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