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This is VAERS ID 57905

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 57905
VAERS Form:
Age:1.4
Sex:Female
Location:Michigan
Vaccinated:1993-06-14
Onset:1993-06-15
Submitted:1993-09-20
Entered:1993-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP MICH. PHD. / MICHIGAN DPH TR1219A / 2 RL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M15JL / 2 LL / IM
MMR: MMR II / MSD 0118W / 0 LL / IM

Administered by: Private      Purchased by: Unknown
Symptoms: LYMPHADENO

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-06-15
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: NA
Other Medications: NONE
Current Illness: Lt conjunctivitis;
Preexisting Conditions: allergy to PCN, single febrile sz @ 14mo; functional heart murmur grad II;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': allergy to PCN, single febrile sz @ 14mo; functional heart murmur grad II;

Write-up: pt was seen in office for well child exam & updating immun; pt was found to be in good hlth by MD x/for eye infect; pt appeared normal that noc; following AM pt was found dead in bed;


Changed on 12/8/2009

VAERS ID: 57905 Before After
VAERS Form:
Age:1.4
Sex:Female
Location:Michigan
Vaccinated:1993-06-14
Onset:1993-06-15
Submitted:1993-09-20
Entered:1993-12-13 1993-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP MICH. PHD. DTP (NO BRAND NAME) / MICHIGAN DPH MICHIGAN DEPT PUB HLTH TR1219A / 2 RL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M15JL / 2 LL / IM
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 0118W / 0 LL / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Lymphadenopathy, LYMPHADENO

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-06-15
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: NA
Other Medications: NONE
Current Illness: Lt conjunctivitis;
Preexisting Conditions: allergy to PCN, single febrile sz @ 14mo; functional heart murmur grad II;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': allergy to PCN, single febrile sz @ 14mo; functional heart murmur grad II; MI93130

Write-up: pt was seen in office for well child exam & updating immun; pt was found to be in good hlth by MD x/for eye infect; pt appeared normal that noc; following AM pt was found dead in bed;


Changed on 5/14/2017

VAERS ID: 57905 Before After
VAERS Form:
Age:1.4
Sex:Female
Location:Michigan
Vaccinated:1993-06-14
Onset:1993-06-15
Submitted:1993-09-20
Entered:1993-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH TR1219A / 2 RL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M15JL / 2 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0118W / 0 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Lymphadenopathy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-06-15
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: NA NA~ ()~~~In patient
Other Medications: NONE
Current Illness: Lt conjunctivitis;
Preexisting Conditions: allergy to PCN, single febrile sz @ 14mo; functional heart murmur grad II;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MI93130

Write-up: pt was seen in office for well child exam & updating immun; pt was found to be in good hlth by MD x/for eye infect; pt appeared normal that noc; following AM pt was found dead in bed;


Changed on 9/14/2017

VAERS ID: 57905 Before After
VAERS Form:(blank) 1
Age:1.4
Sex:Female
Location:Michigan
Vaccinated:1993-06-14
Onset:1993-06-15
Submitted:1993-09-20
Entered:1993-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH TR1219A / 2 3 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M15JL / 2 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0118W / 0 1 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Lymphadenopathy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-06-15
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: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: Lt conjunctivitis;
Preexisting Conditions: allergy to PCN, single febrile sz @ 14mo; functional heart murmur grad II;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MI93130

Write-up: pt was seen in office for well child exam & updating immun; pt was found to be in good hlth by MD x/for eye infect; pt appeared normal that noc; following AM pt was found dead in bed;


Changed on 2/14/2018

VAERS ID: 57905 Before After
VAERS Form:1
Age:1.4
Sex:Female
Location:Michigan
Vaccinated:1993-06-14
Onset:1993-06-15
Submitted:1993-09-20
Entered:1993-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH TR1219A / 3 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M15JL / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0118W / 1 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Lymphadenopathy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-06-15
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: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: Lt conjunctivitis;
Preexisting Conditions: allergy to PCN, single febrile sz @ 14mo; functional heart murmur grad II;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MI93130

Write-up: pt was seen in office for well child exam & updating immun; pt was found to be in good hlth by MD x/for eye infect; pt appeared normal that noc; following AM pt was found dead in bed;


Changed on 6/14/2018

VAERS ID: 57905 Before After
VAERS Form:1
Age:1.4
Sex:Female
Location:Michigan
Vaccinated:1993-06-14
Onset:1993-06-15
Submitted:1993-09-20
Entered:1993-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH TR1219A / 3 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M15JL / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0118W / 1 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Lymphadenopathy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-06-15
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: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: Lt conjunctivitis;
Preexisting Conditions: allergy to PCN, single febrile sz @ 14mo; functional heart murmur grad II;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MI93130

Write-up: pt was seen in office for well child exam & updating immun; pt was found to be in good hlth by MD x/for eye infect; pt appeared normal that noc; following AM pt was found dead in bed;


Changed on 8/14/2018

VAERS ID: 57905 Before After
VAERS Form:1
Age:1.4
Sex:Female
Location:Michigan
Vaccinated:1993-06-14
Onset:1993-06-15
Submitted:1993-09-20
Entered:1993-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH TR1219A / 3 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M15JL / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0118W / 1 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Lymphadenopathy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-06-15
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: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: Lt conjunctivitis;
Preexisting Conditions: allergy to PCN, single febrile sz @ 14mo; functional heart murmur grad II;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MI93130

Write-up: pt was seen in office for well child exam & updating immun; pt was found to be in good hlth by MD x/for eye infect; pt appeared normal that noc; following AM pt was found dead in bed;


Changed on 9/14/2018

VAERS ID: 57905 Before After
VAERS Form:1
Age:1.4
Sex:Female
Location:Michigan
Vaccinated:1993-06-14
Onset:1993-06-15
Submitted:1993-09-20
Entered:1993-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH TR1219A / 3 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M15JL / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0118W / 1 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Lymphadenopathy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-06-15
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: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: Lt conjunctivitis;
Preexisting Conditions: allergy to PCN, single febrile sz @ 14mo; functional heart murmur grad II;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MI93130

Write-up: pt was seen in office for well child exam & updating immun; pt was found to be in good hlth by MD x/for eye infect; pt appeared normal that noc; following AM pt was found dead in bed;


Changed on 10/14/2018

VAERS ID: 57905 Before After
VAERS Form:1
Age:1.4
Sex:Female
Location:Michigan
Vaccinated:1993-06-14
Onset:1993-06-15
Submitted:1993-09-20
Entered:1993-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH TR1219A / 3 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M15JL / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0118W / 1 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Lymphadenopathy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-06-15
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: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: Lt conjunctivitis;
Preexisting Conditions: allergy to PCN, single febrile sz @ 14mo; functional heart murmur grad II;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MI93130

Write-up: pt was seen in office for well child exam & updating immun; pt was found to be in good hlth by MD x/for eye infect; pt appeared normal that noc; following AM pt was found dead in bed;

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=57905&WAYBACKHISTORY=ON


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