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This is VAERS ID 56175

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History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 56175
VAERS Form:
Age:5.4
Sex:Male
Location:Texas
Vaccinated:1993-07-23
Onset:1993-08-10
Submitted:1993-09-14
Entered:1993-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP / CONNAUGHT LABS 3J41061 / 0 RA / IM
IPV: IPV / MERIEUX INST J0225 / 0 LA / SC

Administered by: Private      Purchased by: Unknown
Symptoms: FEVER, INFECT, REACT AGGRAV

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? No
Previous Vaccinations: pt exp flu like sx, little red dots all over body probable leukemia w/ 1st flu
Other Medications: TB-PPD lederle lot# 350924;
Current Illness: 1st NONE-2nd Leukemia
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Leukemia MD confirmed by bone marrow test;
CDC 'Split Type': NONE

Write-up: pt became ill w/acute lymphocytic leukemia on 223OCT93 very soon p/receiving a flu shot; relapsed p/receiving school vax; relapse confirmation was 10AUG93; pt exp fever, blood test results indicated many abn cells; exp viral infect;


Changed on 12/8/2009

VAERS ID: 56175 Before After
VAERS Form:
Age:5.4
Sex:Male
Location:Texas
Vaccinated:1993-07-23
Onset:1993-08-10
Submitted:1993-09-14
Entered:1993-09-24 1993-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP DTP (NO BRAND NAME) / CONNAUGHT LABS CONNAUGHT LABORATORIES 3J41061 / 0 RA / IM
IPV: IPV POLIO VIRUS, INACT. (NO BRAND NAME) / MERIEUX INST PASTEUR MERIEUX INST. J0225 / 0 LA / SC

Administered by: Private      Purchased by: Unknown Private
Symptoms: Condition aggravated, Infection, Pyrexia, FEVER, INFECT, REACT AGGRAV

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? No
Previous Vaccinations: pt exp flu like sx, little red dots all over body probable leukemia w/ 1st flu
Other Medications: TB-PPD lederle lot# 350924;
Current Illness: 1st NONE-2nd Leukemia
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Leukemia MD confirmed by bone marrow test;
CDC 'Split Type': NONE

Write-up: pt became ill w/acute lymphocytic leukemia on 223OCT93 very soon p/receiving a flu shot; relapsed p/receiving school vax; relapse confirmation was 10AUG93; pt exp fever, blood test results indicated many abn cells; exp viral infect;


Changed on 10/14/2012

VAERS ID: 56175 Before After
VAERS Form:
Age:5.4
Sex:Male
Location:Texas
Vaccinated:1993-07-23
Onset:1993-08-10
Submitted:1993-09-14
Entered:1993-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3J41061 / 0 RA / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. J0225 / 0 LA / SC

Administered by: Private      Purchased by: Private
Symptoms: Condition aggravated, Infection, Pyrexia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? No
Previous Vaccinations: pt exp flu like sx, little red dots all over body probable leukemia w/ 1st flu
Other Medications: TB-PPD lederle lot# 350924;
Current Illness: 1st NONE-2nd Leukemia
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Leukemia MD confirmed by bone marrow test;
CDC 'Split Type': NONE (blank)

Write-up: pt became ill w/acute lymphocytic leukemia on 223OCT93 very soon p/receiving a flu shot; relapsed p/receiving school vax; relapse confirmation was 10AUG93; pt exp fever, blood test results indicated many abn cells; exp viral infect;


Changed on 2/14/2017

VAERS ID: 56175 Before After
VAERS Form:
Age:5.4 5.0
Sex:Male
Location:Texas
Vaccinated:1993-07-23
Onset:1993-08-10
Submitted:1993-09-14
Entered:1993-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3J41061 / 0 RA / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. J0225 / 0 LA / SC

Administered by: Private      Purchased by: Private
Symptoms: Condition aggravated, Infection, Pyrexia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? No
Previous Vaccinations: pt exp flu like sx, little red dots all over body probable leukemia w/ 1st flu
Other Medications: TB-PPD lederle lot# 350924;
Current Illness: 1st NONE-2nd Leukemia
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Leukemia MD confirmed by bone marrow test;
CDC 'Split Type':

Write-up: pt became ill w/acute lymphocytic leukemia on 223OCT93 very soon p/receiving a flu shot; relapsed p/receiving school vax; relapse confirmation was 10AUG93; pt exp fever, blood test results indicated many abn cells; exp viral infect;


Changed on 5/14/2017

VAERS ID: 56175 Before After
VAERS Form:
Age:5.0
Sex:Male
Location:Texas
Vaccinated:1993-07-23
Onset:1993-08-10
Submitted:1993-09-14
Entered:1993-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3J41061 / 0 RA / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. J0225 / 0 LA / SC

Administered by: Private      Purchased by: Private
Symptoms: Condition aggravated, Infection, Pyrexia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? No
Previous Vaccinations: pt exp flu like sx, little red dots all over body probable leukemia w/ 1st flu flu~ ()~~~In patient
Other Medications: TB-PPD lederle lot# 350924;
Current Illness: 1st NONE-2nd Leukemia
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Leukemia MD confirmed by bone marrow test;
CDC 'Split Type':

Write-up: pt became ill w/acute lymphocytic leukemia on 223OCT93 very soon p/receiving a flu shot; relapsed p/receiving school vax; relapse confirmation was 10AUG93; pt exp fever, blood test results indicated many abn cells; exp viral infect;


Changed on 9/14/2017

VAERS ID: 56175 Before After
VAERS Form:(blank) 1
Age:5.0
Sex:Male
Location:Texas
Vaccinated:1993-07-23
Onset:1993-08-10
Submitted:1993-09-14
Entered:1993-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3J41061 / 0 1 RA / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. J0225 / 0 1 LA / SC

Administered by: Private      Purchased by: Private
Symptoms: Condition aggravated, Infection, Pyrexia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? No
Previous Vaccinations: pt exp flu like sx, little red dots all over body probable leukemia w/ 1st flu~ ()~~~In patient
Other Medications: TB-PPD lederle lot# 350924;
Current Illness: 1st NONE-2nd Leukemia
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Leukemia MD confirmed by bone marrow test;
CDC 'Split Type':

Write-up: pt became ill w/acute lymphocytic leukemia on 223OCT93 very soon p/receiving a flu shot; relapsed p/receiving school vax; relapse confirmation was 10AUG93; pt exp fever, blood test results indicated many abn cells; exp viral infect;


Changed on 2/14/2018

VAERS ID: 56175 Before After
VAERS Form:1
Age:5.0
Sex:Male
Location:Texas
Vaccinated:1993-07-23
Onset:1993-08-10
Submitted:1993-09-14
Entered:1993-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3J41061 / 1 RA / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. J0225 / 1 LA / SC

Administered by: Private      Purchased by: Private
Symptoms: Condition aggravated, Infection, Pyrexia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? No
Previous Vaccinations: pt exp flu like sx, little red dots all over body probable leukemia w/ 1st flu~ ()~~~In patient
Other Medications: TB-PPD lederle lot# 350924;
Current Illness: 1st NONE-2nd Leukemia
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Leukemia MD confirmed by bone marrow test;
CDC 'Split Type':

Write-up: pt became ill w/acute lymphocytic leukemia on 223OCT93 very soon p/receiving a flu shot; relapsed p/receiving school vax; relapse confirmation was 10AUG93; pt exp fever, blood test results indicated many abn cells; exp viral infect;


Changed on 6/14/2018

VAERS ID: 56175 Before After
VAERS Form:1
Age:5.0
Sex:Male
Location:Texas
Vaccinated:1993-07-23
Onset:1993-08-10
Submitted:1993-09-14
Entered:1993-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3J41061 / 1 RA / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. J0225 / 1 LA / SC

Administered by: Private      Purchased by: Private
Symptoms: Condition aggravated, Infection, Pyrexia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? No
Previous Vaccinations: pt exp flu like sx, little red dots all over body probable leukemia w/ 1st flu~ ()~~~In patient
Other Medications: TB-PPD lederle lot# 350924;
Current Illness: 1st NONE-2nd Leukemia
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Leukemia MD confirmed by bone marrow test;
CDC 'Split Type':

Write-up: pt became ill w/acute lymphocytic leukemia on 223OCT93 very soon p/receiving a flu shot; relapsed p/receiving school vax; relapse confirmation was 10AUG93; pt exp fever, blood test results indicated many abn cells; exp viral infect;


Changed on 8/14/2018

VAERS ID: 56175 Before After
VAERS Form:1
Age:5.0
Sex:Male
Location:Texas
Vaccinated:1993-07-23
Onset:1993-08-10
Submitted:1993-09-14
Entered:1993-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3J41061 / 1 RA / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. J0225 / 1 LA / SC

Administered by: Private      Purchased by: Private
Symptoms: Condition aggravated, Infection, Pyrexia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? No
Previous Vaccinations: pt exp flu like sx, little red dots all over body probable leukemia w/ 1st flu~ ()~~~In patient
Other Medications: TB-PPD lederle lot# 350924;
Current Illness: 1st NONE-2nd Leukemia
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Leukemia MD confirmed by bone marrow test;
CDC 'Split Type':

Write-up: pt became ill w/acute lymphocytic leukemia on 223OCT93 very soon p/receiving a flu shot; relapsed p/receiving school vax; relapse confirmation was 10AUG93; pt exp fever, blood test results indicated many abn cells; exp viral infect;


Changed on 9/14/2018

VAERS ID: 56175 Before After
VAERS Form:1
Age:5.0
Sex:Male
Location:Texas
Vaccinated:1993-07-23
Onset:1993-08-10
Submitted:1993-09-14
Entered:1993-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3J41061 / 1 RA / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. J0225 / 1 LA / SC

Administered by: Private      Purchased by: Private
Symptoms: Condition aggravated, Infection, Pyrexia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? No
Previous Vaccinations: pt exp flu like sx, little red dots all over body probable leukemia w/ 1st flu~ ()~~~In patient
Other Medications: TB-PPD lederle lot# 350924;
Current Illness: 1st NONE-2nd Leukemia
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Leukemia MD confirmed by bone marrow test;
CDC 'Split Type':

Write-up: pt became ill w/acute lymphocytic leukemia on 223OCT93 very soon p/receiving a flu shot; relapsed p/receiving school vax; relapse confirmation was 10AUG93; pt exp fever, blood test results indicated many abn cells; exp viral infect;


Changed on 10/14/2018

VAERS ID: 56175 Before After
VAERS Form:1
Age:5.0
Sex:Male
Location:Texas
Vaccinated:1993-07-23
Onset:1993-08-10
Submitted:1993-09-14
Entered:1993-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3J41061 / 1 RA / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. J0225 / 1 LA / SC

Administered by: Private      Purchased by: Private
Symptoms: Condition aggravated, Infection, Pyrexia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? No
Previous Vaccinations: pt exp flu like sx, little red dots all over body probable leukemia w/ 1st flu~ ()~~~In patient
Other Medications: TB-PPD lederle lot# 350924;
Current Illness: 1st NONE-2nd Leukemia
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Leukemia MD confirmed by bone marrow test;
CDC 'Split Type':

Write-up: pt became ill w/acute lymphocytic leukemia on 223OCT93 very soon p/receiving a flu shot; relapsed p/receiving school vax; relapse confirmation was 10AUG93; pt exp fever, blood test results indicated many abn cells; exp viral infect;


Changed on 12/24/2020

VAERS ID: 56175 Before After
VAERS Form:1
Age:5.0
Sex:Male
Location:Texas
Vaccinated:1993-07-23
Onset:1993-08-10
Submitted:1993-09-14
Entered:1993-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3J41061 / 1 RA / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. J0225 / 1 LA / SC

Administered by: Private      Purchased by: Private
Symptoms: Condition aggravated, Infection, Pyrexia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? No
Previous Vaccinations: pt exp flu like sx, little red dots all over body probable leukemia w/ 1st flu~ ()~~~In patient
Other Medications: TB-PPD lederle lot# 350924;
Current Illness: 1st NONE-2nd Leukemia
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Leukemia MD confirmed by bone marrow test;
CDC 'Split Type':

Write-up: pt became ill w/acute lymphocytic leukemia on 223OCT93 very soon p/receiving a flu shot; relapsed p/receiving school vax; relapse confirmation was 10AUG93; pt exp fever, blood test results indicated many abn cells; exp viral infect;


Changed on 12/30/2020

VAERS ID: 56175 Before After
VAERS Form:1
Age:5.0
Sex:Male
Location:Texas
Vaccinated:1993-07-23
Onset:1993-08-10
Submitted:1993-09-14
Entered:1993-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3J41061 / 1 RA / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. J0225 / 1 LA / SC

Administered by: Private      Purchased by: Private
Symptoms: Condition aggravated, Infection, Pyrexia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? No
Previous Vaccinations: pt exp flu like sx, little red dots all over body probable leukemia w/ 1st flu~ ()~~~In patient
Other Medications: TB-PPD lederle lot# 350924;
Current Illness: 1st NONE-2nd Leukemia
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Leukemia MD confirmed by bone marrow test;
CDC 'Split Type':

Write-up: pt became ill w/acute lymphocytic leukemia on 223OCT93 very soon p/receiving a flu shot; relapsed p/receiving school vax; relapse confirmation was 10AUG93; pt exp fever, blood test results indicated many abn cells; exp viral infect;


Changed on 5/7/2021

VAERS ID: 56175 Before After
VAERS Form:1
Age:5.0
Sex:Male
Location:Texas
Vaccinated:1993-07-23
Onset:1993-08-10
Submitted:1993-09-14
Entered:1993-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3J41061 / 1 RA / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. J0225 / 1 LA / SC

Administered by: Private      Purchased by: Private
Symptoms: Condition aggravated, Infection, Pyrexia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? No
Previous Vaccinations: pt exp flu like sx, little red dots all over body probable leukemia w/ 1st flu~ ()~~~In patient
Other Medications: TB-PPD lederle lot# 350924;
Current Illness: 1st NONE-2nd Leukemia
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Leukemia MD confirmed by bone marrow test;
CDC 'Split Type':

Write-up: pt became ill w/acute lymphocytic leukemia on 223OCT93 very soon p/receiving a flu shot; relapsed p/receiving school vax; relapse confirmation was 10AUG93; pt exp fever, blood test results indicated many abn cells; exp viral infect;


Changed on 5/14/2021

VAERS ID: 56175 Before After
VAERS Form:1
Age:5.0
Sex:Male
Location:Texas
Vaccinated:1993-07-23
Onset:1993-08-10
Submitted:1993-09-14
Entered:1993-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3J41061 / 1 RA / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. J0225 / 1 LA / SC

Administered by: Private      Purchased by: Private
Symptoms: Condition aggravated, Infection, Pyrexia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? No
Previous Vaccinations: pt exp flu like sx, little red dots all over body probable leukemia w/ 1st flu~ ()~~~In patient
Other Medications: TB-PPD lederle lot# 350924;
Current Illness: 1st NONE-2nd Leukemia
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Leukemia MD confirmed by bone marrow test;
CDC 'Split Type':

Write-up: pt became ill w/acute lymphocytic leukemia on 223OCT93 very soon p/receiving a flu shot; relapsed p/receiving school vax; relapse confirmation was 10AUG93; pt exp fever, blood test results indicated many abn cells; exp viral infect;

New Search

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=56175&WAYBACKHISTORY=ON


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