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This is VAERS ID 65748

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History of Changes from the VAERS Wayback Machine

First Appeared on 2/14/2017

VAERS ID: 65748
VAERS Form:
Age:0.4
Sex:Male
Location:Maryland
Vaccinated:1994-06-06
Onset:1994-06-07
Submitted:1994-07-29
Entered:1994-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51058 / 1 - / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1693W / 2 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. J0690 / 1 - / SC

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: ~ ()~~~In patient
Other Medications: Bactrim
Current Illness:
Preexisting Conditions: surgery, aorta; defect, heart, congenital; Digeorge''s synd
Allergies:
Diagnostic Lab Data: No relevant data
CDC 'Split Type': WAES94070425

Write-up: Pt recvd vax 7JUN94 & 7JUN94 had an acute onset of apnea, cyanosis & resp arrest & died; @ the time of the report the results of blood & organ cultures were pending; addtl info has been requested;


Changed on 9/14/2017

VAERS ID: 65748 Before After
VAERS Form:(blank) 1
Age:0.4
Sex:Male
Location:Maryland
Vaccinated:1994-06-06
Onset:1994-06-07
Submitted:1994-07-29
Entered:1994-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51058 / 1 2 - / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1693W / 2 3 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. J0690 / 1 2 - / SC

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: ~ ()~~~In patient
Other Medications: Bactrim
Current Illness:
Preexisting Conditions: surgery, aorta; defect, heart, congenital; Digeorge''s synd
Allergies:
Diagnostic Lab Data: No relevant data
CDC 'Split Type': WAES94070425

Write-up: Pt recvd vax 7JUN94 & 7JUN94 had an acute onset of apnea, cyanosis & resp arrest & died; @ the time of the report the results of blood & organ cultures were pending; addtl info has been requested;


Changed on 2/14/2018

VAERS ID: 65748 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Maryland
Vaccinated:1994-06-06
Onset:1994-06-07
Submitted:1994-07-29
Entered:1994-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51058 / 2 - / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1693W / 3 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. J0690 / 2 - / SC

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: ~ ()~~~In patient
Other Medications: Bactrim
Current Illness:
Preexisting Conditions: surgery, aorta; defect, heart, congenital; Digeorge''s synd
Allergies:
Diagnostic Lab Data: No relevant data
CDC 'Split Type': WAES94070425

Write-up: Pt recvd vax 7JUN94 & 7JUN94 had an acute onset of apnea, cyanosis & resp arrest & died; @ the time of the report the results of blood & organ cultures were pending; addtl info has been requested;


Changed on 6/14/2018

VAERS ID: 65748 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Maryland
Vaccinated:1994-06-06
Onset:1994-06-07
Submitted:1994-07-29
Entered:1994-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51058 / 2 - / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1693W / 3 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. J0690 / 2 - / SC

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: ~ ()~~~In patient
Other Medications: Bactrim
Current Illness:
Preexisting Conditions: surgery, aorta; defect, heart, congenital; Digeorge''s synd
Allergies:
Diagnostic Lab Data: No relevant data
CDC 'Split Type': WAES94070425

Write-up: Pt recvd vax 7JUN94 & 7JUN94 had an acute onset of apnea, cyanosis & resp arrest & died; @ the time of the report the results of blood & organ cultures were pending; addtl info has been requested;


Changed on 8/14/2018

VAERS ID: 65748 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Maryland
Vaccinated:1994-06-06
Onset:1994-06-07
Submitted:1994-07-29
Entered:1994-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51058 / 2 - / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1693W / 3 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. J0690 / 2 - / SC

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: ~ ()~~~In patient
Other Medications: Bactrim
Current Illness:
Preexisting Conditions: surgery, aorta; defect, heart, congenital; Digeorge''s synd
Allergies:
Diagnostic Lab Data: No relevant data
CDC 'Split Type': WAES94070425

Write-up: Pt recvd vax 7JUN94 & 7JUN94 had an acute onset of apnea, cyanosis & resp arrest & died; @ the time of the report the results of blood & organ cultures were pending; addtl info has been requested;


Changed on 9/14/2018

VAERS ID: 65748 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Maryland
Vaccinated:1994-06-06
Onset:1994-06-07
Submitted:1994-07-29
Entered:1994-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51058 / 2 - / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1693W / 3 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. J0690 / 2 - / SC

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: ~ ()~~~In patient
Other Medications: Bactrim
Current Illness:
Preexisting Conditions: surgery, aorta; defect, heart, congenital; Digeorge''s synd
Allergies:
Diagnostic Lab Data: No relevant data
CDC 'Split Type': WAES94070425

Write-up: Pt recvd vax 7JUN94 & 7JUN94 had an acute onset of apnea, cyanosis & resp arrest & died; @ the time of the report the results of blood & organ cultures were pending; addtl info has been requested;


Changed on 10/14/2018

VAERS ID: 65748 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Maryland
Vaccinated:1994-06-06
Onset:1994-06-07
Submitted:1994-07-29
Entered:1994-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51058 / 2 - / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1693W / 3 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. J0690 / 2 - / SC

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: ~ ()~~~In patient
Other Medications: Bactrim
Current Illness:
Preexisting Conditions: surgery, aorta; defect, heart, congenital; Digeorge''s synd
Allergies:
Diagnostic Lab Data: No relevant data
CDC 'Split Type': WAES94070425

Write-up: Pt recvd vax 7JUN94 & 7JUN94 had an acute onset of apnea, cyanosis & resp arrest & died; @ the time of the report the results of blood & organ cultures were pending; addtl info has been requested;


Changed on 12/24/2020

VAERS ID: 65748 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Maryland
Vaccinated:1994-06-06
Onset:1994-06-07
Submitted:1994-07-29
Entered:1994-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51058 / 2 - / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1693W / 3 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. J0690 / 2 - / SC

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: ~ ()~~~In patient
Other Medications: Bactrim
Current Illness:
Preexisting Conditions: surgery, aorta; defect, heart, congenital; Digeorge''s synd
Allergies:
Diagnostic Lab Data: No relevant data
CDC 'Split Type': WAES94070425

Write-up: Pt recvd vax 7JUN94 & 7JUN94 had an acute onset of apnea, cyanosis & resp arrest & died; @ the time of the report the results of blood & organ cultures were pending; addtl info has been requested;


Changed on 12/30/2020

VAERS ID: 65748 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Maryland
Vaccinated:1994-06-06
Onset:1994-06-07
Submitted:1994-07-29
Entered:1994-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51058 / 2 - / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1693W / 3 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. J0690 / 2 - / SC

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: ~ ()~~~In patient
Other Medications: Bactrim
Current Illness:
Preexisting Conditions: surgery, aorta; defect, heart, congenital; Digeorge''s synd
Allergies:
Diagnostic Lab Data: No relevant data
CDC 'Split Type': WAES94070425

Write-up: Pt recvd vax 7JUN94 & 7JUN94 had an acute onset of apnea, cyanosis & resp arrest & died; @ the time of the report the results of blood & organ cultures were pending; addtl info has been requested;


Changed on 5/7/2021

VAERS ID: 65748 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Maryland
Vaccinated:1994-06-06
Onset:1994-06-07
Submitted:1994-07-29
Entered:1994-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51058 / 2 - / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1693W / 3 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. J0690 / 2 - / SC

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: ~ ()~~~In patient
Other Medications: Bactrim
Current Illness:
Preexisting Conditions: surgery, aorta; defect, heart, congenital; Digeorge''s synd
Allergies:
Diagnostic Lab Data: No relevant data
CDC 'Split Type': WAES94070425

Write-up: Pt recvd vax 7JUN94 & 7JUN94 had an acute onset of apnea, cyanosis & resp arrest & died; @ the time of the report the results of blood & organ cultures were pending; addtl info has been requested;


Changed on 5/14/2021

VAERS ID: 65748 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Maryland
Vaccinated:1994-06-06
Onset:1994-06-07
Submitted:1994-07-29
Entered:1994-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51058 / 2 - / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1693W / 3 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. J0690 / 2 - / SC

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: ~ ()~~~In patient
Other Medications: Bactrim
Current Illness:
Preexisting Conditions: surgery, aorta; defect, heart, congenital; Digeorge''s synd
Allergies:
Diagnostic Lab Data: No relevant data
CDC 'Split Type': WAES94070425

Write-up: Pt recvd vax 7JUN94 & 7JUN94 had an acute onset of apnea, cyanosis & resp arrest & died; @ the time of the report the results of blood & organ cultures were pending; addtl info has been requested;

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=65748&WAYBACKHISTORY=ON


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