National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 68431

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 68431
VAERS Form:
Age:1.4
Sex:Female
Location:Illinois
Vaccinated:1994-10-31
Onset:1994-11-01
Submitted:1994-11-04
Entered:1994-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP / CONNAUGHT LABS 4H51123 / 3 RA / -
HIBV: ACT-HIB / CONNAUGHT LABS 4H51123 / - RA / -
MMR: MMR II / MSD 0403A / 0 LA / -

Administered by: Other      Purchased by: Unknown
Symptoms: PNEUMONIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1994-11-01
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: phenobarbital;
Current Illness: sz dis,poss ?;poor growth;cerebral palsy
Preexisting Conditions: h/o 32 wk premature, twin A: h/o apnea bradycardia, sz disorder; mixed cerebral palsy;
Allergies:
Diagnostic Lab Data: unofficial result of autopsy is pneumonia;
CDC 'Split Type':

Write-up: pt recvd vax on 31oct94 am; at 11:30am on 1nov94 laughing, playfull & took nap; at 1:15pm found in crib by pub hlth nurse cold & pulseness; to er, t 88.9 rectally; resucitation unsuccessful; pronounced dead at 2pm;


Changed on 12/8/2009

VAERS ID: 68431 Before After
VAERS Form:
Age:1.4
Sex:Female
Location:Illinois
Vaccinated:1994-10-31
Onset:1994-11-01
Submitted:1994-11-04
Entered:1994-11-23 1994-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP DTP (NO BRAND NAME) / CONNAUGHT LABS CONNAUGHT LABORATORIES 4H51123 / 3 RA / -
HIBV: ACT-HIB HIB (ACTHIB) / CONNAUGHT LABS CONNAUGHT LABORATORIES 4H51123 / - RA / -
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 0403A / 0 LA / -

Administered by: Other      Purchased by: Unknown Public
Symptoms: Pneumonia, PNEUMONIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1994-11-01
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: phenobarbital;
Current Illness: sz dis,poss ?;poor growth;cerebral palsy
Preexisting Conditions: h/o 32 wk premature, twin A: h/o apnea bradycardia, sz disorder; mixed cerebral palsy;
Allergies:
Diagnostic Lab Data: unofficial result of autopsy is pneumonia;
CDC 'Split Type':

Write-up: pt recvd vax on 31oct94 am; at 11:30am on 1nov94 laughing, playfull & took nap; at 1:15pm found in crib by pub hlth nurse cold & pulseness; to er, t 88.9 rectally; resucitation unsuccessful; pronounced dead at 2pm;


Changed on 5/14/2017

VAERS ID: 68431 Before After
VAERS Form:
Age:1.4
Sex:Female
Location:Illinois
Vaccinated:1994-10-31
Onset:1994-11-01
Submitted:1994-11-04
Entered:1994-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51123 / 3 RA / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4H51123 / - RA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0403A / 0 LA / -

Administered by: Other      Purchased by: Public
Symptoms: Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1994-11-01
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: phenobarbital;
Current Illness: sz dis,poss ?;poor growth;cerebral palsy
Preexisting Conditions: h/o 32 wk premature, twin A: h/o apnea bradycardia, sz disorder; mixed cerebral palsy;
Allergies:
Diagnostic Lab Data: unofficial result of autopsy is pneumonia;
CDC 'Split Type':

Write-up: pt recvd vax on 31oct94 am; at 11:30am on 1nov94 laughing, playfull & took nap; at 1:15pm found in crib by pub hlth nurse cold & pulseness; to er, t 88.9 rectally; resucitation unsuccessful; pronounced dead at 2pm;


Changed on 9/14/2017

VAERS ID: 68431 Before After
VAERS Form:(blank) 1
Age:1.4
Sex:Female
Location:Illinois
Vaccinated:1994-10-31
Onset:1994-11-01
Submitted:1994-11-04
Entered:1994-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51123 / 3 4 RA / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4H51123 / - UNK RA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0403A / 0 1 LA / -

Administered by: Other      Purchased by: Public
Symptoms: Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1994-11-01
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: phenobarbital;
Current Illness: sz dis,poss ?;poor growth;cerebral palsy
Preexisting Conditions: h/o 32 wk premature, twin A: h/o apnea bradycardia, sz disorder; mixed cerebral palsy;
Allergies:
Diagnostic Lab Data: unofficial result of autopsy is pneumonia;
CDC 'Split Type':

Write-up: pt recvd vax on 31oct94 am; at 11:30am on 1nov94 laughing, playfull & took nap; at 1:15pm found in crib by pub hlth nurse cold & pulseness; to er, t 88.9 rectally; resucitation unsuccessful; pronounced dead at 2pm;


Changed on 2/14/2018

VAERS ID: 68431 Before After
VAERS Form:1
Age:1.4
Sex:Female
Location:Illinois
Vaccinated:1994-10-31
Onset:1994-11-01
Submitted:1994-11-04
Entered:1994-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51123 / 4 RA / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4H51123 / UNK RA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0403A / 1 LA / -

Administered by: Other      Purchased by: Public
Symptoms: Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1994-11-01
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: phenobarbital;
Current Illness: sz dis,poss ?;poor growth;cerebral palsy
Preexisting Conditions: h/o 32 wk premature, twin A: h/o apnea bradycardia, sz disorder; mixed cerebral palsy;
Allergies:
Diagnostic Lab Data: unofficial result of autopsy is pneumonia;
CDC 'Split Type':

Write-up: pt recvd vax on 31oct94 am; at 11:30am on 1nov94 laughing, playfull & took nap; at 1:15pm found in crib by pub hlth nurse cold & pulseness; to er, t 88.9 rectally; resucitation unsuccessful; pronounced dead at 2pm;


Changed on 6/14/2018

VAERS ID: 68431 Before After
VAERS Form:1
Age:1.4
Sex:Female
Location:Illinois
Vaccinated:1994-10-31
Onset:1994-11-01
Submitted:1994-11-04
Entered:1994-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51123 / 4 RA / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4H51123 / UNK RA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0403A / 1 LA / -

Administered by: Other      Purchased by: Public
Symptoms: Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1994-11-01
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: phenobarbital;
Current Illness: sz dis,poss ?;poor growth;cerebral palsy
Preexisting Conditions: h/o 32 wk premature, twin A: h/o apnea bradycardia, sz disorder; mixed cerebral palsy;
Allergies:
Diagnostic Lab Data: unofficial result of autopsy is pneumonia;
CDC 'Split Type':

Write-up: pt recvd vax on 31oct94 am; at 11:30am on 1nov94 laughing, playfull & took nap; at 1:15pm found in crib by pub hlth nurse cold & pulseness; to er, t 88.9 rectally; resucitation unsuccessful; pronounced dead at 2pm;


Changed on 8/14/2018

VAERS ID: 68431 Before After
VAERS Form:1
Age:1.4
Sex:Female
Location:Illinois
Vaccinated:1994-10-31
Onset:1994-11-01
Submitted:1994-11-04
Entered:1994-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51123 / 4 RA / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4H51123 / UNK RA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0403A / 1 LA / -

Administered by: Other      Purchased by: Public
Symptoms: Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1994-11-01
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: phenobarbital;
Current Illness: sz dis,poss ?;poor growth;cerebral palsy
Preexisting Conditions: h/o 32 wk premature, twin A: h/o apnea bradycardia, sz disorder; mixed cerebral palsy;
Allergies:
Diagnostic Lab Data: unofficial result of autopsy is pneumonia;
CDC 'Split Type':

Write-up: pt recvd vax on 31oct94 am; at 11:30am on 1nov94 laughing, playfull & took nap; at 1:15pm found in crib by pub hlth nurse cold & pulseness; to er, t 88.9 rectally; resucitation unsuccessful; pronounced dead at 2pm;


Changed on 9/14/2018

VAERS ID: 68431 Before After
VAERS Form:1
Age:1.4
Sex:Female
Location:Illinois
Vaccinated:1994-10-31
Onset:1994-11-01
Submitted:1994-11-04
Entered:1994-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51123 / 4 RA / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4H51123 / UNK RA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0403A / 1 LA / -

Administered by: Other      Purchased by: Public
Symptoms: Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1994-11-01
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: phenobarbital;
Current Illness: sz dis,poss ?;poor growth;cerebral palsy
Preexisting Conditions: h/o 32 wk premature, twin A: h/o apnea bradycardia, sz disorder; mixed cerebral palsy;
Allergies:
Diagnostic Lab Data: unofficial result of autopsy is pneumonia;
CDC 'Split Type':

Write-up: pt recvd vax on 31oct94 am; at 11:30am on 1nov94 laughing, playfull & took nap; at 1:15pm found in crib by pub hlth nurse cold & pulseness; to er, t 88.9 rectally; resucitation unsuccessful; pronounced dead at 2pm;


Changed on 10/14/2018

VAERS ID: 68431 Before After
VAERS Form:1
Age:1.4
Sex:Female
Location:Illinois
Vaccinated:1994-10-31
Onset:1994-11-01
Submitted:1994-11-04
Entered:1994-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51123 / 4 RA / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4H51123 / UNK RA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0403A / 1 LA / -

Administered by: Other      Purchased by: Public
Symptoms: Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1994-11-01
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: phenobarbital;
Current Illness: sz dis,poss ?;poor growth;cerebral palsy
Preexisting Conditions: h/o 32 wk premature, twin A: h/o apnea bradycardia, sz disorder; mixed cerebral palsy;
Allergies:
Diagnostic Lab Data: unofficial result of autopsy is pneumonia;
CDC 'Split Type':

Write-up: pt recvd vax on 31oct94 am; at 11:30am on 1nov94 laughing, playfull & took nap; at 1:15pm found in crib by pub hlth nurse cold & pulseness; to er, t 88.9 rectally; resucitation unsuccessful; pronounced dead at 2pm;

New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=68431&WAYBACKHISTORY=ON


Copyright © 2019 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166