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This is VAERS ID 66768

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 66768
VAERS Form:
Age:4.3
Sex:Male
Location:Alabama
Vaccinated:1994-07-27
Onset:0000-00-00
Submitted:1994-08-05
Entered:1994-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP / CONNAUGHT LABS 3F51124 / 4 RA / IM
MMR: MMR II / MSD 1743W / 1 RA / SC
OPV: ORIMUNE / LEDERLE 366957 / 3 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: INFECT, ENCEPHALOPATHY, EDEMA BRAIN, ANEMIA HEMOL, COLITIS PSEUDOMEM

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1994-08-02
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol, Pred
Current Illness: rash
Preexisting Conditions: RAD
Allergies:
Diagnostic Lab Data: WBC count 34000 w/hematocrit 42, platelet 243,000, WBC differential showing 76% segs, 16% bands, 4% lymphs, 4% monos; fluid balance panel showed sodium 125, potassium 4.4, chloride 94, bicarbonate 25, BUN 9; stool specimen-E. Coli 0157:H7
CDC 'Split Type':

Write-up: pt recvd vax & exp abdo pain; illness began 5 days prior to admission w/onset of acute abdo cramps, vomiting, diarrhea; stools have been bloody & mucousy times 2 days, one day prior to surgery; t101 x 1 day; pt underwent appendectomy;


Changed on 12/8/2009

VAERS ID: 66768 Before After
VAERS Form:
Age:4.3
Sex:Male
Location:Alabama
Vaccinated:1994-07-27
Onset:0000-00-00
Submitted:1994-08-05
Entered:1994-09-22 1994-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP DTP (NO BRAND NAME) / CONNAUGHT LABS CONNAUGHT LABORATORIES 3F51124 / 4 RA / IM
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 1743W / 1 RA / SC
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 366957 / 3 - / PO

Administered by: Public      Purchased by: Unknown Public
Symptoms: Azotaemia, Encephalopathy, Haemolytic anaemia, Infection, Pancreatitis haemorrhagic, Thrombocytopenia, Brain oedema, Clostridium colitis, INFECT, ENCEPHALOPATHY, EDEMA BRAIN, ANEMIA HEMOL, COLITIS PSEUDOMEM

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1994-08-02
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol, Pred
Current Illness: rash
Preexisting Conditions: RAD
Allergies:
Diagnostic Lab Data: WBC count 34000 w/hematocrit 42, platelet 243,000, WBC differential showing 76% segs, 16% bands, 4% lymphs, 4% monos; fluid balance panel showed sodium 125, potassium 4.4, chloride 94, bicarbonate 25, BUN 9; stool specimen-E. Coli 0157:H7
CDC 'Split Type': (blank) AL9433

Write-up: pt recvd vax & exp abdo pain; illness began 5 days prior to admission w/onset of acute abdo cramps, vomiting, diarrhea; stools have been bloody & mucousy times 2 days, one day prior to surgery; t101 x 1 day; pt underwent appendectomy;


Changed on 8/31/2010

VAERS ID: 66768 Before After
VAERS Form:
Age:4.3
Sex:Male
Location:Alabama
Vaccinated:1994-07-27
Onset:0000-00-00
Submitted:1994-08-05
Entered:1994-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3F51124 / 4 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1743W / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES 366957 / 3 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Azotaemia, Encephalopathy, Haemolytic anaemia, Infection, Pancreatitis haemorrhagic, Thrombocytopenia, Brain oedema, Clostridium colitis

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1994-08-02
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol, Pred
Current Illness: rash
Preexisting Conditions: RAD
Allergies:
Diagnostic Lab Data: WBC count 34000 w/hematocrit 42, platelet 243,000, WBC differential showing 76% segs, 16% bands, 4% lymphs, 4% monos; fluid balance panel showed sodium 125, potassium 4.4, chloride 94, bicarbonate 25, BUN 9; stool specimen-E. Coli 0157:H7
CDC 'Split Type': AL9433

Write-up: pt recvd vax & exp abdo pain; illness began 5 days prior to admission w/onset of acute abdo cramps, vomiting, diarrhea; stools have been bloody & mucousy times 2 days, one day prior to surgery; t101 x 1 day; pt underwent appendectomy;


Changed on 4/13/2011

VAERS ID: 66768 Before After
VAERS Form:
Age:4.3
Sex:Male
Location:Alabama
Vaccinated:1994-07-27
Onset:0000-00-00
Submitted:1994-08-05
Entered:1994-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3F51124 / 4 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1743W / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES 366957 / 3 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Azotaemia, Encephalopathy, Haemolytic anaemia, Infection, Pancreatitis haemorrhagic, Thrombocytopenia, Brain oedema, Clostridium colitis

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1994-08-02
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol, Pred
Current Illness: rash
Preexisting Conditions: RAD
Allergies:
Diagnostic Lab Data: WBC count 34000 w/hematocrit 42, platelet 243,000, WBC differential showing 76% segs, 16% bands, 4% lymphs, 4% monos; fluid balance panel showed sodium 125, potassium 4.4, chloride 94, bicarbonate 25, BUN 9; stool specimen-E. Coli 0157:H7
CDC 'Split Type': AL9433

Write-up: pt recvd vax & exp abdo pain; illness began 5 days prior to admission w/onset of acute abdo cramps, vomiting, diarrhea; stools have been bloody & mucousy times 2 days, one day prior to surgery; t101 x 1 day; pt underwent appendectomy;


Changed on 5/13/2011

VAERS ID: 66768 Before After
VAERS Form:
Age:4.3
Sex:Male
Location:Alabama
Vaccinated:1994-07-27
Onset:0000-00-00
Submitted:1994-08-05
Entered:1994-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3F51124 / 4 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1743W / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES 366957 / 3 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Azotaemia, Encephalopathy, Haemolytic anaemia, Infection, Pancreatitis haemorrhagic, Thrombocytopenia, Brain oedema, Clostridium colitis

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1994-08-02
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol, Pred
Current Illness: rash
Preexisting Conditions: RAD
Allergies:
Diagnostic Lab Data: WBC count 34000 w/hematocrit 42, platelet 243,000, WBC differential showing 76% segs, 16% bands, 4% lymphs, 4% monos; fluid balance panel showed sodium 125, potassium 4.4, chloride 94, bicarbonate 25, BUN 9; stool specimen-E. Coli 0157:H7
CDC 'Split Type': AL9433

Write-up: pt recvd vax & exp abdo pain; illness began 5 days prior to admission w/onset of acute abdo cramps, vomiting, diarrhea; stools have been bloody & mucousy times 2 days, one day prior to surgery; t101 x 1 day; pt underwent appendectomy;


Changed on 6/11/2011

VAERS ID: 66768 Before After
VAERS Form:
Age:4.3
Sex:Male
Location:Alabama
Vaccinated:1994-07-27
Onset:0000-00-00
Submitted:1994-08-05
Entered:1994-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3F51124 / 4 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1743W / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES 366957 / 3 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Azotaemia, Encephalopathy, Haemolytic anaemia, Infection, Pancreatitis haemorrhagic, Thrombocytopenia, Brain oedema, Clostridium colitis

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1994-08-02
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol, Pred
Current Illness: rash
Preexisting Conditions: RAD
Allergies:
Diagnostic Lab Data: WBC count 34000 w/hematocrit 42, platelet 243,000, WBC differential showing 76% segs, 16% bands, 4% lymphs, 4% monos; fluid balance panel showed sodium 125, potassium 4.4, chloride 94, bicarbonate 25, BUN 9; stool specimen-E. Coli 0157:H7
CDC 'Split Type': AL9433

Write-up: pt recvd vax & exp abdo pain; illness began 5 days prior to admission w/onset of acute abdo cramps, vomiting, diarrhea; stools have been bloody & mucousy times 2 days, one day prior to surgery; t101 x 1 day; pt underwent appendectomy;


Changed on 2/14/2017

VAERS ID: 66768 Before After
VAERS Form:
Age:4.3 4.0
Sex:Male
Location:Alabama
Vaccinated:1994-07-27
Onset:0000-00-00
Submitted:1994-08-05
Entered:1994-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3F51124 / 4 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1743W / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES 366957 / 3 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Azotaemia, Encephalopathy, Haemolytic anaemia, Infection, Pancreatitis haemorrhagic, Thrombocytopenia, Brain oedema, Clostridium colitis

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1994-08-02
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol, Pred
Current Illness: rash
Preexisting Conditions: RAD
Allergies:
Diagnostic Lab Data: WBC count 34000 w/hematocrit 42, platelet 243,000, WBC differential showing 76% segs, 16% bands, 4% lymphs, 4% monos; fluid balance panel showed sodium 125, potassium 4.4, chloride 94, bicarbonate 25, BUN 9; stool specimen-E. Coli 0157:H7
CDC 'Split Type': AL9433

Write-up: pt recvd vax & exp abdo pain; illness began 5 days prior to admission w/onset of acute abdo cramps, vomiting, diarrhea; stools have been bloody & mucousy times 2 days, one day prior to surgery; t101 x 1 day; pt underwent appendectomy;


Changed on 5/14/2017

VAERS ID: 66768 Before After
VAERS Form:
Age:4.0
Sex:Male
Location:Alabama
Vaccinated:1994-07-27
Onset:0000-00-00
Submitted:1994-08-05
Entered:1994-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3F51124 / 4 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1743W / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 366957 / 3 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Azotaemia, Encephalopathy, Haemolytic anaemia, Infection, Pancreatitis haemorrhagic, Thrombocytopenia, Brain oedema, Clostridium colitis

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1994-08-02
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Albuterol, Pred
Current Illness: rash
Preexisting Conditions: RAD
Allergies:
Diagnostic Lab Data: WBC count 34000 w/hematocrit 42, platelet 243,000, WBC differential showing 76% segs, 16% bands, 4% lymphs, 4% monos; fluid balance panel showed sodium 125, potassium 4.4, chloride 94, bicarbonate 25, BUN 9; stool specimen-E. Coli 0157:H7
CDC 'Split Type': AL9433

Write-up: pt recvd vax & exp abdo pain; illness began 5 days prior to admission w/onset of acute abdo cramps, vomiting, diarrhea; stools have been bloody & mucousy times 2 days, one day prior to surgery; t101 x 1 day; pt underwent appendectomy;


Changed on 9/14/2017

VAERS ID: 66768 Before After
VAERS Form:(blank) 1
Age:4.0
Sex:Male
Location:Alabama
Vaccinated:1994-07-27
Onset:0000-00-00
Submitted:1994-08-05
Entered:1994-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3F51124 / 4 5 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1743W / 1 2 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 366957 / 3 4 - MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Azotaemia, Encephalopathy, Haemolytic anaemia, Infection, Pancreatitis haemorrhagic, Thrombocytopenia, Brain oedema, Clostridium colitis

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1994-08-02
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Albuterol, Pred
Current Illness: rash
Preexisting Conditions: RAD
Allergies:
Diagnostic Lab Data: WBC count 34000 w/hematocrit 42, platelet 243,000, WBC differential showing 76% segs, 16% bands, 4% lymphs, 4% monos; fluid balance panel showed sodium 125, potassium 4.4, chloride 94, bicarbonate 25, BUN 9; stool specimen-E. Coli 0157:H7
CDC 'Split Type': AL9433

Write-up: pt recvd vax & exp abdo pain; illness began 5 days prior to admission w/onset of acute abdo cramps, vomiting, diarrhea; stools have been bloody & mucousy times 2 days, one day prior to surgery; t101 x 1 day; pt underwent appendectomy;


Changed on 2/14/2018

VAERS ID: 66768 Before After
VAERS Form:1
Age:4.0
Sex:Male
Location:Alabama
Vaccinated:1994-07-27
Onset:0000-00-00
Submitted:1994-08-05
Entered:1994-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3F51124 / 5 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1743W / 2 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 366957 / 4 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Azotaemia, Encephalopathy, Haemolytic anaemia, Infection, Pancreatitis haemorrhagic, Thrombocytopenia, Brain oedema, Clostridium colitis

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1994-08-02
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Albuterol, Pred
Current Illness: rash
Preexisting Conditions: RAD
Allergies:
Diagnostic Lab Data: WBC count 34000 w/hematocrit 42, platelet 243,000, WBC differential showing 76% segs, 16% bands, 4% lymphs, 4% monos; fluid balance panel showed sodium 125, potassium 4.4, chloride 94, bicarbonate 25, BUN 9; stool specimen-E. Coli 0157:H7
CDC 'Split Type': AL9433

Write-up: pt recvd vax & exp abdo pain; illness began 5 days prior to admission w/onset of acute abdo cramps, vomiting, diarrhea; stools have been bloody & mucousy times 2 days, one day prior to surgery; t101 x 1 day; pt underwent appendectomy;


Changed on 6/14/2018

VAERS ID: 66768 Before After
VAERS Form:1
Age:4.0
Sex:Male
Location:Alabama
Vaccinated:1994-07-27
Onset:0000-00-00
Submitted:1994-08-05
Entered:1994-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3F51124 / 5 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1743W / 2 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 366957 / 4 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Azotaemia, Encephalopathy, Haemolytic anaemia, Infection, Pancreatitis haemorrhagic, Thrombocytopenia, Brain oedema, Clostridium colitis

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1994-08-02
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Albuterol, Pred
Current Illness: rash
Preexisting Conditions: RAD
Allergies:
Diagnostic Lab Data: WBC count 34000 w/hematocrit 42, platelet 243,000, WBC differential showing 76% segs, 16% bands, 4% lymphs, 4% monos; fluid balance panel showed sodium 125, potassium 4.4, chloride 94, bicarbonate 25, BUN 9; stool specimen-E. Coli 0157:H7
CDC 'Split Type': AL9433

Write-up: pt recvd vax & exp abdo pain; illness began 5 days prior to admission w/onset of acute abdo cramps, vomiting, diarrhea; stools have been bloody & mucousy times 2 days, one day prior to surgery; t101 x 1 day; pt underwent appendectomy;


Changed on 8/14/2018

VAERS ID: 66768 Before After
VAERS Form:1
Age:4.0
Sex:Male
Location:Alabama
Vaccinated:1994-07-27
Onset:0000-00-00
Submitted:1994-08-05
Entered:1994-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3F51124 / 5 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1743W / 2 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 366957 / 4 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Azotaemia, Encephalopathy, Haemolytic anaemia, Infection, Pancreatitis haemorrhagic, Thrombocytopenia, Brain oedema, Clostridium colitis

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1994-08-02
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Albuterol, Pred
Current Illness: rash
Preexisting Conditions: RAD
Allergies:
Diagnostic Lab Data: WBC count 34000 w/hematocrit 42, platelet 243,000, WBC differential showing 76% segs, 16% bands, 4% lymphs, 4% monos; fluid balance panel showed sodium 125, potassium 4.4, chloride 94, bicarbonate 25, BUN 9; stool specimen-E. Coli 0157:H7
CDC 'Split Type': AL9433

Write-up: pt recvd vax & exp abdo pain; illness began 5 days prior to admission w/onset of acute abdo cramps, vomiting, diarrhea; stools have been bloody & mucousy times 2 days, one day prior to surgery; t101 x 1 day; pt underwent appendectomy;


Changed on 9/14/2018

VAERS ID: 66768 Before After
VAERS Form:1
Age:4.0
Sex:Male
Location:Alabama
Vaccinated:1994-07-27
Onset:0000-00-00
Submitted:1994-08-05
Entered:1994-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3F51124 / 5 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1743W / 2 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 366957 / 4 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Azotaemia, Encephalopathy, Haemolytic anaemia, Infection, Pancreatitis haemorrhagic, Thrombocytopenia, Brain oedema, Clostridium colitis

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1994-08-02
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Albuterol, Pred
Current Illness: rash
Preexisting Conditions: RAD
Allergies:
Diagnostic Lab Data: WBC count 34000 w/hematocrit 42, platelet 243,000, WBC differential showing 76% segs, 16% bands, 4% lymphs, 4% monos; fluid balance panel showed sodium 125, potassium 4.4, chloride 94, bicarbonate 25, BUN 9; stool specimen-E. Coli 0157:H7
CDC 'Split Type': AL9433

Write-up: pt recvd vax & exp abdo pain; illness began 5 days prior to admission w/onset of acute abdo cramps, vomiting, diarrhea; stools have been bloody & mucousy times 2 days, one day prior to surgery; t101 x 1 day; pt underwent appendectomy;


Changed on 10/14/2018

VAERS ID: 66768 Before After
VAERS Form:1
Age:4.0
Sex:Male
Location:Alabama
Vaccinated:1994-07-27
Onset:0000-00-00
Submitted:1994-08-05
Entered:1994-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3F51124 / 5 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1743W / 2 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 366957 / 4 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Azotaemia, Encephalopathy, Haemolytic anaemia, Infection, Pancreatitis haemorrhagic, Thrombocytopenia, Brain oedema, Clostridium colitis

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1994-08-02
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Albuterol, Pred
Current Illness: rash
Preexisting Conditions: RAD
Allergies:
Diagnostic Lab Data: WBC count 34000 w/hematocrit 42, platelet 243,000, WBC differential showing 76% segs, 16% bands, 4% lymphs, 4% monos; fluid balance panel showed sodium 125, potassium 4.4, chloride 94, bicarbonate 25, BUN 9; stool specimen-E. Coli 0157:H7
CDC 'Split Type': AL9433

Write-up: pt recvd vax & exp abdo pain; illness began 5 days prior to admission w/onset of acute abdo cramps, vomiting, diarrhea; stools have been bloody & mucousy times 2 days, one day prior to surgery; t101 x 1 day; pt underwent appendectomy;

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