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This is VAERS ID 44528

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 44528
VAERS Form:
Age:0.4
Sex:Male
Location:Kansas
Vaccinated:1992-07-24
Onset:1992-07-24
Submitted:1992-08-18
Entered:1992-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP / CONNAUGHT LABS 2H31068 / 1 LL / IM
HEP: ENGERIX-B / SMITHKLINE 1002A2 / 0 RL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M700AE / 1 LL / IM
OPV: ORIMUNE / LEDERLE 0648L / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: SYNCOPE, CYANOSIS, PALLOR

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

Write-up: circumoral pallor & cyanosis, passed out lasting few seconds; pt hospitalized;


Changed on 12/8/2009

VAERS ID: 44528 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:Kansas
Vaccinated:1992-07-24
Onset:1992-07-24
Submitted:1992-08-18
Entered:1992-08-26 1992-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP DTP (NO BRAND NAME) / CONNAUGHT LABS CONNAUGHT LABORATORIES 2H31068 / 1 LL / IM
HEP: ENGERIX-B HEP B (ENGERIX-B) / SMITHKLINE SMITHKLINE BEECHAM 1002A2 / 0 RL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M700AE / 1 LL / IM
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 0648L / 1 - / PO

Administered by: Private      Purchased by: Unknown Private
Symptoms: Cyanosis, Pallor, Syncope, SYNCOPE, CYANOSIS, PALLOR

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

Write-up: circumoral pallor & cyanosis, passed out lasting few seconds; pt hospitalized;


Changed on 5/14/2017

VAERS ID: 44528 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:Kansas
Vaccinated:1992-07-24
Onset:1992-07-24
Submitted:1992-08-18
Entered:1992-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2H31068 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1002A2 / 0 RL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M700AE / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 0648L / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Cyanosis, 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: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NA
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type':

Write-up: circumoral pallor & cyanosis, passed out lasting few seconds; pt hospitalized;


Changed on 9/14/2017

VAERS ID: 44528 Before After
VAERS Form:(blank) 1
Age:0.4
Sex:Male
Location:Kansas
Vaccinated:1992-07-24
Onset:1992-07-24
Submitted:1992-08-18
Entered:1992-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2H31068 / 1 2 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1002A2 / 0 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M700AE / 1 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0648L / 1 2 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Cyanosis, 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: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NA
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type':

Write-up: circumoral pallor & cyanosis, passed out lasting few seconds; pt hospitalized;


Changed on 2/14/2018

VAERS ID: 44528 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Kansas
Vaccinated:1992-07-24
Onset:1992-07-24
Submitted:1992-08-18
Entered:1992-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2H31068 / 2 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1002A2 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M700AE / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0648L / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Cyanosis, 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: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NA
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type':

Write-up: circumoral pallor & cyanosis, passed out lasting few seconds; pt hospitalized;


Changed on 6/14/2018

VAERS ID: 44528 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Kansas
Vaccinated:1992-07-24
Onset:1992-07-24
Submitted:1992-08-18
Entered:1992-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2H31068 / 2 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1002A2 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M700AE / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0648L / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Cyanosis, 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: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NA
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type':

Write-up: circumoral pallor & cyanosis, passed out lasting few seconds; pt hospitalized;


Changed on 8/14/2018

VAERS ID: 44528 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Kansas
Vaccinated:1992-07-24
Onset:1992-07-24
Submitted:1992-08-18
Entered:1992-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2H31068 / 2 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1002A2 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M700AE / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0648L / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Cyanosis, 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: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NA
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type':

Write-up: circumoral pallor & cyanosis, passed out lasting few seconds; pt hospitalized;


Changed on 9/14/2018

VAERS ID: 44528 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Kansas
Vaccinated:1992-07-24
Onset:1992-07-24
Submitted:1992-08-18
Entered:1992-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2H31068 / 2 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1002A2 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M700AE / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0648L / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Cyanosis, 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: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NA
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type':

Write-up: circumoral pallor & cyanosis, passed out lasting few seconds; pt hospitalized;


Changed on 10/14/2018

VAERS ID: 44528 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Kansas
Vaccinated:1992-07-24
Onset:1992-07-24
Submitted:1992-08-18
Entered:1992-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2H31068 / 2 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1002A2 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M700AE / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0648L / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Cyanosis, 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: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NA
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type':

Write-up: circumoral pallor & cyanosis, passed out lasting few seconds; pt hospitalized;

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