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This is VAERS ID 46021

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 46021
VAERS Form:
Age:0.2
Sex:Female
Location:California
Vaccinated:1992-09-24
Onset:1992-09-24
Submitted:1992-09-25
Entered:1992-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP / CONNAUGHT LABS 1F31022 / 0 LL / IM
HEP: ENGERIX-B / SMITHKLINE 1024A2 / 1 LA / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M130JC / 0 RL / IM
OPV: ORIMUNE / LEDERLE 0657D / 0 - / PO

Administered by: Other      Purchased by: Unknown
Symptoms: SOMNOLENCE, PALLOR, RASH VESIC BULL, SKIN DISCOLOR, DERM EXFOL

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Reglan
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt recvd 2 doses of Engerix-B & 4 hrs later area around inject site turned black & skin sloughed; also devel vesicles & inflammation of lt lateral thigh & cheek & lethargy; described as dramatic lesions like a hematoma or bullous lesion;


Changed on 12/8/2009

VAERS ID: 46021 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:California
Vaccinated:1992-09-24
Onset:1992-09-24
Submitted:1992-09-25
Entered:1992-10-08 1992-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP DTP (NO BRAND NAME) / CONNAUGHT LABS CONNAUGHT LABORATORIES 1F31022 / 0 LL / IM
HEP: ENGERIX-B HEP B (ENGERIX-B) / SMITHKLINE SMITHKLINE BEECHAM 1024A2 / 1 LA / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M130JC / 0 RL / IM
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 0657D / 0 - / PO

Administered by: Other      Purchased by: Unknown Private
Symptoms: Dermatitis bullous, Dermatitis exfoliative, Pallor, Skin discolouration, Somnolence, SOMNOLENCE, PALLOR, RASH VESIC BULL, SKIN DISCOLOR, DERM EXFOL

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Reglan
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) EBU922342

Write-up: Pt recvd 2 doses of Engerix-B & 4 hrs later area around inject site turned black & skin sloughed; also devel vesicles & inflammation of lt lateral thigh & cheek & lethargy; described as dramatic lesions like a hematoma or bullous lesion;


Changed on 5/14/2017

VAERS ID: 46021 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:California
Vaccinated:1992-09-24
Onset:1992-09-24
Submitted:1992-09-25
Entered:1992-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1F31022 / 0 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1024A2 / 1 LA / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M130JC / 0 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 0657D / 0 - / PO

Administered by: Other      Purchased by: Private
Symptoms: Dermatitis bullous, Dermatitis exfoliative, Pallor, Skin discolouration, Somnolence

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: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Reglan
Current Illness:
Preexisting Conditions: GE reflux
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': EBU922342 (blank)

Write-up: Pt recvd 2 doses of Engerix-B & 4 hrs later area around inject site turned erythematous rash w/fine vesicles lt thigh; black & eschar lesion w/mild sloughing skin sloughed; lt upper arm; also devel vesicles & inflammation of lt lateral thigh & cheek & lethargy; described as dramatic lesions like a hematoma or bullous lesion; pale, lethargic;


Changed on 9/14/2017

VAERS ID: 46021 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Female
Location:California
Vaccinated:1992-09-24
Onset:1992-09-24
Submitted:1992-09-25
Entered:1992-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1F31022 / 0 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1024A2 / 1 2 LA / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M130JC / 0 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0657D / 0 1 - MO / PO

Administered by: Other      Purchased by: Private
Symptoms: Dermatitis bullous, Dermatitis exfoliative, Pallor, Skin discolouration, Somnolence

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: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Reglan
Current Illness:
Preexisting Conditions: GE reflux
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: erythematous rash w/fine vesicles lt thigh; black eschar lesion w/mild sloughing skin lt upper arm; also pale, lethargic;


Changed on 2/14/2018

VAERS ID: 46021 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:California
Vaccinated:1992-09-24
Onset:1992-09-24
Submitted:1992-09-25
Entered:1992-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1F31022 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1024A2 / 2 LA / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M130JC / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0657D / 1 MO / PO

Administered by: Other      Purchased by: Private
Symptoms: Dermatitis bullous, Dermatitis exfoliative, Pallor, Skin discolouration, Somnolence

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: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Reglan
Current Illness:
Preexisting Conditions: GE reflux
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: erythematous rash w/fine vesicles lt thigh; black eschar lesion w/mild sloughing skin lt upper arm; also pale, lethargic;


Changed on 6/14/2018

VAERS ID: 46021 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:California
Vaccinated:1992-09-24
Onset:1992-09-24
Submitted:1992-09-25
Entered:1992-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1F31022 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1024A2 / 2 LA / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M130JC / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0657D / 1 MO / PO

Administered by: Other      Purchased by: Private
Symptoms: Dermatitis bullous, Dermatitis exfoliative, Pallor, Skin discolouration, Somnolence

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: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Reglan
Current Illness:
Preexisting Conditions: GE reflux
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: erythematous rash w/fine vesicles lt thigh; black eschar lesion w/mild sloughing skin lt upper arm; also pale, lethargic;


Changed on 8/14/2018

VAERS ID: 46021 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:California
Vaccinated:1992-09-24
Onset:1992-09-24
Submitted:1992-09-25
Entered:1992-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1F31022 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1024A2 / 2 LA / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M130JC / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0657D / 1 MO / PO

Administered by: Other      Purchased by: Private
Symptoms: Dermatitis bullous, Dermatitis exfoliative, Pallor, Skin discolouration, Somnolence

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: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Reglan
Current Illness:
Preexisting Conditions: GE reflux
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: erythematous rash w/fine vesicles lt thigh; black eschar lesion w/mild sloughing skin lt upper arm; also pale, lethargic;


Changed on 9/14/2018

VAERS ID: 46021 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:California
Vaccinated:1992-09-24
Onset:1992-09-24
Submitted:1992-09-25
Entered:1992-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1F31022 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1024A2 / 2 LA / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M130JC / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0657D / 1 MO / PO

Administered by: Other      Purchased by: Private
Symptoms: Dermatitis bullous, Dermatitis exfoliative, Pallor, Skin discolouration, Somnolence

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: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Reglan
Current Illness:
Preexisting Conditions: GE reflux
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: erythematous rash w/fine vesicles lt thigh; black eschar lesion w/mild sloughing skin lt upper arm; also pale, lethargic;


Changed on 10/14/2018

VAERS ID: 46021 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:California
Vaccinated:1992-09-24
Onset:1992-09-24
Submitted:1992-09-25
Entered:1992-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1F31022 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1024A2 / 2 LA / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M130JC / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0657D / 1 MO / PO

Administered by: Other      Purchased by: Private
Symptoms: Dermatitis bullous, Dermatitis exfoliative, Pallor, Skin discolouration, Somnolence

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: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Reglan
Current Illness:
Preexisting Conditions: GE reflux
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: erythematous rash w/fine vesicles lt thigh; black eschar lesion w/mild sloughing skin lt upper arm; also pale, lethargic;


Changed on 12/24/2020

VAERS ID: 46021 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:California
Vaccinated:1992-09-24
Onset:1992-09-24
Submitted:1992-09-25
Entered:1992-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1F31022 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1024A2 / 2 LA / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M130JC / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0657D / 1 MO / PO

Administered by: Other      Purchased by: Private
Symptoms: Dermatitis bullous, Dermatitis exfoliative, Pallor, Skin discolouration, Somnolence

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: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Reglan
Current Illness:
Preexisting Conditions: GE reflux
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: erythematous rash w/fine vesicles lt thigh; black eschar lesion w/mild sloughing skin lt upper arm; also pale, lethargic;


Changed on 12/30/2020

VAERS ID: 46021 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:California
Vaccinated:1992-09-24
Onset:1992-09-24
Submitted:1992-09-25
Entered:1992-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1F31022 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1024A2 / 2 LA / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M130JC / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0657D / 1 MO / PO

Administered by: Other      Purchased by: Private
Symptoms: Dermatitis bullous, Dermatitis exfoliative, Pallor, Skin discolouration, Somnolence

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: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Reglan
Current Illness:
Preexisting Conditions: GE reflux
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: erythematous rash w/fine vesicles lt thigh; black eschar lesion w/mild sloughing skin lt upper arm; also pale, lethargic;

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