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This is VAERS ID 57571

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 57571
VAERS Form:
Age:1.4
Sex:Male
Location:Georgia
Vaccinated:1993-07-27
Onset:0000-00-00
Submitted:1993-09-28
Entered:1993-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA / CONNAUGHT LABS 3G41024 / 0 LL / IM
HIBV: PROHIBIT / CONNAUGHT LABS 2J41090 / 0 RL / IM
MMR: MMR II / MSD 1508V / 0 RL / SC
OPV: ORIMUNE / LEDERLE 678E1 / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: AGITATION, INFECT, EFFUS PERICARD, CARDIOMEGALY, ASCITES

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-08-14
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:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: NONE reported to hlth center; TARS: pt had fussiness & runny nose for a day or 2 prior to death; pt went into sudden arrest;


Changed on 12/8/2009

VAERS ID: 57571 Before After
VAERS Form:
Age:1.4
Sex:Male
Location:Georgia
Vaccinated:1993-07-27
Onset:0000-00-00
Submitted:1993-09-28
Entered:1993-12-01 1993-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA DTAP (TRIPEDIA) / CONNAUGHT LABS CONNAUGHT LABORATORIES 3G41024 / 0 LL / IM
HIBV: PROHIBIT HIB (PROHIBIT) / CONNAUGHT LABS CONNAUGHT LABORATORIES 2J41090 / 0 RL / IM
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 1508V / 0 RL / SC
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 678E1 / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Agitation, Ascites, Cardiomegaly, Infection, Myocarditis, Necrosis, Pericardial effusion, Rhinitis, AGITATION, INFECT, EFFUS PERICARD, CARDIOMEGALY, ASCITES

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-08-14
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:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) GA93193

Write-up: NONE reported to hlth center; TARS: pt had fussiness & runny nose for a day or 2 prior to death; pt went into sudden arrest;


Changed on 5/14/2017

VAERS ID: 57571 Before After
VAERS Form:
Age:1.4
Sex:Male
Location:Georgia
Vaccinated:1993-07-27
Onset:0000-00-00
Submitted:1993-09-28
Entered:1993-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 3G41024 / 0 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 2J41090 / 0 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1508V / 0 RL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 678E1 / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Agitation, Ascites, Cardiomegaly, Infection, Myocarditis, Necrosis, Pericardial effusion, Rhinitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-08-14
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: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA93193

Write-up: NONE reported to hlth center; TARS: pt had fussiness & runny nose for a day or 2 prior to death; pt went into sudden arrest;


Changed on 9/14/2017

VAERS ID: 57571 Before After
VAERS Form:(blank) 1
Age:1.4
Sex:Male
Location:Georgia
Vaccinated:1993-07-27
Onset:0000-00-00
Submitted:1993-09-28
Entered:1993-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 3G41024 / 0 1 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 2J41090 / 0 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1508V / 0 1 RL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 678E1 / 2 3 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Agitation, Ascites, Cardiomegaly, Infection, Myocarditis, Necrosis, Pericardial effusion, Rhinitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-08-14
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: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA93193

Write-up: NONE reported to hlth center; TARS: pt had fussiness & runny nose for a day or 2 prior to death; pt went into sudden arrest;


Changed on 2/14/2018

VAERS ID: 57571 Before After
VAERS Form:1
Age:1.4
Sex:Male
Location:Georgia
Vaccinated:1993-07-27
Onset:0000-00-00
Submitted:1993-09-28
Entered:1993-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 3G41024 / 1 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 2J41090 / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1508V / 1 RL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 678E1 / 3 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Agitation, Ascites, Cardiomegaly, Infection, Myocarditis, Necrosis, Pericardial effusion, Rhinitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-08-14
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: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA93193

Write-up: NONE reported to hlth center; TARS: pt had fussiness & runny nose for a day or 2 prior to death; pt went into sudden arrest;


Changed on 6/14/2018

VAERS ID: 57571 Before After
VAERS Form:1
Age:1.4
Sex:Male
Location:Georgia
Vaccinated:1993-07-27
Onset:0000-00-00
Submitted:1993-09-28
Entered:1993-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 3G41024 / 1 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 2J41090 / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1508V / 1 RL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 678E1 / 3 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Agitation, Ascites, Cardiomegaly, Infection, Myocarditis, Necrosis, Pericardial effusion, Rhinitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-08-14
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: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA93193

Write-up: NONE reported to hlth center; TARS: pt had fussiness & runny nose for a day or 2 prior to death; pt went into sudden arrest;


Changed on 8/14/2018

VAERS ID: 57571 Before After
VAERS Form:1
Age:1.4
Sex:Male
Location:Georgia
Vaccinated:1993-07-27
Onset:0000-00-00
Submitted:1993-09-28
Entered:1993-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 3G41024 / 1 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 2J41090 / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1508V / 1 RL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 678E1 / 3 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Agitation, Ascites, Cardiomegaly, Infection, Myocarditis, Necrosis, Pericardial effusion, Rhinitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-08-14
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: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA93193

Write-up: NONE reported to hlth center; TARS: pt had fussiness & runny nose for a day or 2 prior to death; pt went into sudden arrest;


Changed on 9/14/2018

VAERS ID: 57571 Before After
VAERS Form:1
Age:1.4
Sex:Male
Location:Georgia
Vaccinated:1993-07-27
Onset:0000-00-00
Submitted:1993-09-28
Entered:1993-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 3G41024 / 1 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 2J41090 / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1508V / 1 RL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 678E1 / 3 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Agitation, Ascites, Cardiomegaly, Infection, Myocarditis, Necrosis, Pericardial effusion, Rhinitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-08-14
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: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA93193

Write-up: NONE reported to hlth center; TARS: pt had fussiness & runny nose for a day or 2 prior to death; pt went into sudden arrest;


Changed on 10/14/2018

VAERS ID: 57571 Before After
VAERS Form:1
Age:1.4
Sex:Male
Location:Georgia
Vaccinated:1993-07-27
Onset:0000-00-00
Submitted:1993-09-28
Entered:1993-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 3G41024 / 1 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 2J41090 / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1508V / 1 RL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 678E1 / 3 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Agitation, Ascites, Cardiomegaly, Infection, Myocarditis, Necrosis, Pericardial effusion, Rhinitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-08-14
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: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA93193

Write-up: NONE reported to hlth center; TARS: pt had fussiness & runny nose for a day or 2 prior to death; pt went into sudden arrest;

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