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This is VAERS ID 63834

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History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 63834
VAERS Form:
Age:0.4
Sex:Male
Location:Maryland
Vaccinated:1994-06-06
Onset:1994-06-07
Submitted:1994-06-10
Entered:1994-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP / CONNAUGHT LABS 4H51058 / 1 LL / -
HEP: RECOMBIVAX HB / MSD 1693W / 2 RL / -
IPV: IPV / MERIEUX INST J0690 / 1 RL / -

Administered by: Private      Purchased by: Unknown
Symptoms: CYANOSIS, APNEA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1994-06-07
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: Bactrim
Current Illness: NONE
Preexisting Conditions: Degeorge''s synd, congenital interrupted aortic arch;
Allergies:
Diagnostic Lab Data: blood & organ cultures-results pending;
CDC 'Split Type':

Write-up: pt had no sx following injects; had acute onset of cyanosis & resp arrest 1 day p/immun; pt had congenital birth defect, Degeorge''s synd w/aortoplasty done 17MAY94;


Changed on 12/8/2009

VAERS ID: 63834 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:Maryland
Vaccinated:1994-06-06
Onset:1994-06-07
Submitted:1994-06-10
Entered:1994-06-27 1994-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP DTP (NO BRAND NAME) / CONNAUGHT LABS CONNAUGHT LABORATORIES 4H51058 / 1 LL / -
HEP: RECOMBIVAX HB HEP B (RECOMBIVAX HB) / MSD MERCK & CO. INC. 1693W / 2 RL / -
IPV: IPV POLIO VIRUS, INACT. (NO BRAND NAME) / MERIEUX INST PASTEUR MERIEUX INST. J0690 / 1 RL / -

Administered by: Private Unknown      Purchased by: Unknown
Symptoms: Apnoea, Cyanosis, CYANOSIS, APNEA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1994-06-07
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: Bactrim
Current Illness: NONE
Preexisting Conditions: Degeorge''s synd, congenital interrupted aortic arch;
Allergies:
Diagnostic Lab Data: blood & organ cultures-results pending;
CDC 'Split Type': (blank) MD94018

Write-up: pt had no sx following injects; had acute onset of cyanosis & resp arrest 1 day p/immun; pt had congenital birth defect, Degeorge''s synd w/aortoplasty done 17MAY94;


Changed on 5/14/2017

VAERS ID: 63834 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:Maryland
Vaccinated:1994-06-06
Onset:1994-06-07
Submitted:1994-06-10
Entered:1994-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51058 / 1 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1693W / 2 RL / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. J0690 / 1 RL / -

Administered by: Unknown Private      Purchased by: Unknown Public
Symptoms: Apnoea, Cyanosis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1994-06-07
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: Bactrim
Current Illness: NONE
Preexisting Conditions: Degeorge''s synd, congenital interrupted aortic arch;
Allergies:
Diagnostic Lab Data: blood & organ cultures-results pending;
CDC 'Split Type': MD94018

Write-up: pt had no sx following injects; had acute onset of cyanosis & resp arrest 1 day p/immun; pt had congenital birth defect, Degeorge''s synd w/aortoplasty done 17MAY94;


Changed on 9/14/2017

VAERS ID: 63834 Before After
VAERS Form:(blank) 1
Age:0.4
Sex:Male
Location:Maryland
Vaccinated:1994-06-06
Onset:1994-06-07
Submitted:1994-06-10
Entered:1994-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51058 / 1 2 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1693W / 2 3 RL / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. J0690 / 1 2 RL / -

Administered by: Private      Purchased by: Public
Symptoms: Apnoea, Cyanosis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1994-06-07
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: Bactrim
Current Illness: NONE
Preexisting Conditions: Degeorge''s synd, congenital interrupted aortic arch;
Allergies:
Diagnostic Lab Data: blood & organ cultures-results pending;
CDC 'Split Type': MD94018

Write-up: pt had no sx following injects; had acute onset of cyanosis & resp arrest 1 day p/immun; pt had congenital birth defect, Degeorge''s synd w/aortoplasty done 17MAY94;


Changed on 2/14/2018

VAERS ID: 63834 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Maryland
Vaccinated:1994-06-06
Onset:1994-06-07
Submitted:1994-06-10
Entered:1994-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51058 / 2 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1693W / 3 RL / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. J0690 / 2 RL / -

Administered by: Private      Purchased by: Public
Symptoms: Apnoea, Cyanosis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1994-06-07
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: Bactrim
Current Illness: NONE
Preexisting Conditions: Degeorge''s synd, congenital interrupted aortic arch;
Allergies:
Diagnostic Lab Data: blood & organ cultures-results pending;
CDC 'Split Type': MD94018

Write-up: pt had no sx following injects; had acute onset of cyanosis & resp arrest 1 day p/immun; pt had congenital birth defect, Degeorge''s synd w/aortoplasty done 17MAY94;


Changed on 6/14/2018

VAERS ID: 63834 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Maryland
Vaccinated:1994-06-06
Onset:1994-06-07
Submitted:1994-06-10
Entered:1994-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51058 / 2 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1693W / 3 RL / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. J0690 / 2 RL / -

Administered by: Private      Purchased by: Public
Symptoms: Apnoea, Cyanosis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1994-06-07
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: Bactrim
Current Illness: NONE
Preexisting Conditions: Degeorge''s synd, congenital interrupted aortic arch;
Allergies:
Diagnostic Lab Data: blood & organ cultures-results pending;
CDC 'Split Type': MD94018

Write-up: pt had no sx following injects; had acute onset of cyanosis & resp arrest 1 day p/immun; pt had congenital birth defect, Degeorge''s synd w/aortoplasty done 17MAY94;


Changed on 8/14/2018

VAERS ID: 63834 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Maryland
Vaccinated:1994-06-06
Onset:1994-06-07
Submitted:1994-06-10
Entered:1994-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51058 / 2 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1693W / 3 RL / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. J0690 / 2 RL / -

Administered by: Private      Purchased by: Public
Symptoms: Apnoea, Cyanosis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1994-06-07
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: Bactrim
Current Illness: NONE
Preexisting Conditions: Degeorge''s synd, congenital interrupted aortic arch;
Allergies:
Diagnostic Lab Data: blood & organ cultures-results pending;
CDC 'Split Type': MD94018

Write-up: pt had no sx following injects; had acute onset of cyanosis & resp arrest 1 day p/immun; pt had congenital birth defect, Degeorge''s synd w/aortoplasty done 17MAY94;


Changed on 9/14/2018

VAERS ID: 63834 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Maryland
Vaccinated:1994-06-06
Onset:1994-06-07
Submitted:1994-06-10
Entered:1994-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51058 / 2 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1693W / 3 RL / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. J0690 / 2 RL / -

Administered by: Private      Purchased by: Public
Symptoms: Apnoea, Cyanosis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1994-06-07
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: Bactrim
Current Illness: NONE
Preexisting Conditions: Degeorge''s synd, congenital interrupted aortic arch;
Allergies:
Diagnostic Lab Data: blood & organ cultures-results pending;
CDC 'Split Type': MD94018

Write-up: pt had no sx following injects; had acute onset of cyanosis & resp arrest 1 day p/immun; pt had congenital birth defect, Degeorge''s synd w/aortoplasty done 17MAY94;


Changed on 10/14/2018

VAERS ID: 63834 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Maryland
Vaccinated:1994-06-06
Onset:1994-06-07
Submitted:1994-06-10
Entered:1994-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51058 / 2 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1693W / 3 RL / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. J0690 / 2 RL / -

Administered by: Private      Purchased by: Public
Symptoms: Apnoea, Cyanosis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1994-06-07
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: Bactrim
Current Illness: NONE
Preexisting Conditions: Degeorge''s synd, congenital interrupted aortic arch;
Allergies:
Diagnostic Lab Data: blood & organ cultures-results pending;
CDC 'Split Type': MD94018

Write-up: pt had no sx following injects; had acute onset of cyanosis & resp arrest 1 day p/immun; pt had congenital birth defect, Degeorge''s synd w/aortoplasty done 17MAY94;


Changed on 12/24/2020

VAERS ID: 63834 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Maryland
Vaccinated:1994-06-06
Onset:1994-06-07
Submitted:1994-06-10
Entered:1994-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51058 / 2 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1693W / 3 RL / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. J0690 / 2 RL / -

Administered by: Private      Purchased by: Public
Symptoms: Apnoea, Cyanosis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1994-06-07
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: Bactrim
Current Illness: NONE
Preexisting Conditions: Degeorge''s synd, congenital interrupted aortic arch;
Allergies:
Diagnostic Lab Data: blood & organ cultures-results pending;
CDC 'Split Type': MD94018

Write-up: pt had no sx following injects; had acute onset of cyanosis & resp arrest 1 day p/immun; pt had congenital birth defect, Degeorge''s synd w/aortoplasty done 17MAY94;


Changed on 12/30/2020

VAERS ID: 63834 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Maryland
Vaccinated:1994-06-06
Onset:1994-06-07
Submitted:1994-06-10
Entered:1994-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51058 / 2 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1693W / 3 RL / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. J0690 / 2 RL / -

Administered by: Private      Purchased by: Public
Symptoms: Apnoea, Cyanosis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1994-06-07
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: Bactrim
Current Illness: NONE
Preexisting Conditions: Degeorge''s synd, congenital interrupted aortic arch;
Allergies:
Diagnostic Lab Data: blood & organ cultures-results pending;
CDC 'Split Type': MD94018

Write-up: pt had no sx following injects; had acute onset of cyanosis & resp arrest 1 day p/immun; pt had congenital birth defect, Degeorge''s synd w/aortoplasty done 17MAY94;


Changed on 5/7/2021

VAERS ID: 63834 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Maryland
Vaccinated:1994-06-06
Onset:1994-06-07
Submitted:1994-06-10
Entered:1994-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51058 / 2 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1693W / 3 RL / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. J0690 / 2 RL / -

Administered by: Private      Purchased by: Public
Symptoms: Apnoea, Cyanosis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1994-06-07
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: Bactrim
Current Illness: NONE
Preexisting Conditions: Degeorge''s synd, congenital interrupted aortic arch;
Allergies:
Diagnostic Lab Data: blood & organ cultures-results pending;
CDC 'Split Type': MD94018

Write-up: pt had no sx following injects; had acute onset of cyanosis & resp arrest 1 day p/immun; pt had congenital birth defect, Degeorge''s synd w/aortoplasty done 17MAY94;


Changed on 5/14/2021

VAERS ID: 63834 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Maryland
Vaccinated:1994-06-06
Onset:1994-06-07
Submitted:1994-06-10
Entered:1994-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51058 / 2 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1693W / 3 RL / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. J0690 / 2 RL / -

Administered by: Private      Purchased by: Public
Symptoms: Apnoea, Cyanosis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1994-06-07
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: Bactrim
Current Illness: NONE
Preexisting Conditions: Degeorge''s synd, congenital interrupted aortic arch;
Allergies:
Diagnostic Lab Data: blood & organ cultures-results pending;
CDC 'Split Type': MD94018

Write-up: pt had no sx following injects; had acute onset of cyanosis & resp arrest 1 day p/immun; pt had congenital birth defect, Degeorge''s synd w/aortoplasty done 17MAY94;

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