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This is VAERS ID 71851

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 71851
VAERS Form:
Age:2.1
Sex:Male
Location:California
Vaccinated:1995-01-25
Onset:1995-01-27
Submitted:1995-01-30
Entered:1995-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP / CONNAUGHT LABS 4H51056 / 2 - / IM
HIBV: ACT-HIB / CONNAUGHT LABS 4K51059 / - - / -
MMR: MMR II / MSD 0683A / 0 - / SC
OPV: ORIMUNE / LEDERLE 0708M / 2 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: REACT UNEVAL

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-01-27
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:
Current Illness: PAR denied any illnesses
Preexisting Conditions: NKA per PAR;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recvd vax 3rd dose of OPV, 3rd dose DTP/HIB & 1st dose of MMR on 25jan95; pt died at home 27jan95;


Changed on 12/8/2009

VAERS ID: 71851 Before After
VAERS Form:
Age:2.1
Sex:Male
Location:California
Vaccinated:1995-01-25
Onset:1995-01-27
Submitted:1995-01-30
Entered:1995-03-07 1995-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP DTP (NO BRAND NAME) / CONNAUGHT LABS CONNAUGHT LABORATORIES 4H51056 / 2 - / IM
HIBV: ACT-HIB HIB (ACTHIB) / CONNAUGHT LABS CONNAUGHT LABORATORIES 4K51059 / - - / -
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 0683A / 0 - / SC
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 0708M / 2 - / PO

Administered by: Public      Purchased by: Unknown Public
Symptoms: Unevaluable event, REACT UNEVAL

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-01-27
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:
Current Illness: PAR denied any illnesses
Preexisting Conditions: NKA per PAR;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) CA95027

Write-up: pt recvd vax 3rd dose of OPV, 3rd dose DTP/HIB & 1st dose of MMR on 25jan95; pt died at home 27jan95;


Changed on 2/14/2017

VAERS ID: 71851 Before After
VAERS Form:
Age:2.1 2.0
Sex:Male
Location:California
Vaccinated:1995-01-25
Onset:1995-01-27
Submitted:1995-01-30
Entered:1995-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51056 / 2 - / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4K51059 / - - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0683A / 0 - / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES 0708M / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-01-27
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:
Current Illness: PAR denied any illnesses
Preexisting Conditions: NKA per PAR;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA95027

Write-up: pt recvd vax 3rd dose of OPV, 3rd dose DTP/HIB & 1st dose of MMR on 25jan95; pt died at home 27jan95;


Changed on 5/14/2017

VAERS ID: 71851 Before After
VAERS Form:
Age:2.0
Sex:Male
Location:California
Vaccinated:1995-01-25
Onset:1995-01-27
Submitted:1995-01-30
Entered:1995-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51056 / 2 - / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4K51059 / - - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0683A / 0 - / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 0708M / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-01-27
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:
Current Illness: PAR denied any illnesses
Preexisting Conditions: NKA per PAR;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA95027

Write-up: pt recvd vax 3rd dose of OPV, 3rd dose DTP/HIB & 1st dose of MMR on 25jan95; pt died at home 27jan95;


Changed on 9/14/2017

VAERS ID: 71851 Before After
VAERS Form:(blank) 1
Age:2.0
Sex:Male
Location:California
Vaccinated:1995-01-25
Onset:1995-01-27
Submitted:1995-01-30
Entered:1995-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51056 / 2 3 - / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4K51059 / - UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0683A / 0 1 - / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0708M / 2 3 - MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-01-27
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:
Current Illness: PAR denied any illnesses
Preexisting Conditions: NKA per PAR;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA95027

Write-up: pt recvd vax 3rd dose of OPV, 3rd dose DTP/HIB & 1st dose of MMR on 25jan95; pt died at home 27jan95;


Changed on 2/14/2018

VAERS ID: 71851 Before After
VAERS Form:1
Age:2.0
Sex:Male
Location:California
Vaccinated:1995-01-25
Onset:1995-01-27
Submitted:1995-01-30
Entered:1995-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51056 / 3 - / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4K51059 / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0683A / 1 - / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0708M / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-01-27
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:
Current Illness: PAR denied any illnesses
Preexisting Conditions: NKA per PAR;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA95027

Write-up: pt recvd vax 3rd dose of OPV, 3rd dose DTP/HIB & 1st dose of MMR on 25jan95; pt died at home 27jan95;


Changed on 6/14/2018

VAERS ID: 71851 Before After
VAERS Form:1
Age:2.0
Sex:Male
Location:California
Vaccinated:1995-01-25
Onset:1995-01-27
Submitted:1995-01-30
Entered:1995-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51056 / 3 - / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4K51059 / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0683A / 1 - / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0708M / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-01-27
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:
Current Illness: PAR denied any illnesses
Preexisting Conditions: NKA per PAR;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA95027

Write-up: pt recvd vax 3rd dose of OPV, 3rd dose DTP/HIB & 1st dose of MMR on 25jan95; pt died at home 27jan95;


Changed on 8/14/2018

VAERS ID: 71851 Before After
VAERS Form:1
Age:2.0
Sex:Male
Location:California
Vaccinated:1995-01-25
Onset:1995-01-27
Submitted:1995-01-30
Entered:1995-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51056 / 3 - / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4K51059 / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0683A / 1 - / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0708M / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-01-27
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:
Current Illness: PAR denied any illnesses
Preexisting Conditions: NKA per PAR;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA95027

Write-up: pt recvd vax 3rd dose of OPV, 3rd dose DTP/HIB & 1st dose of MMR on 25jan95; pt died at home 27jan95;


Changed on 9/14/2018

VAERS ID: 71851 Before After
VAERS Form:1
Age:2.0
Sex:Male
Location:California
Vaccinated:1995-01-25
Onset:1995-01-27
Submitted:1995-01-30
Entered:1995-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51056 / 3 - / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4K51059 / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0683A / 1 - / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0708M / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-01-27
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:
Current Illness: PAR denied any illnesses
Preexisting Conditions: NKA per PAR;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA95027

Write-up: pt recvd vax 3rd dose of OPV, 3rd dose DTP/HIB & 1st dose of MMR on 25jan95; pt died at home 27jan95;


Changed on 10/14/2018

VAERS ID: 71851 Before After
VAERS Form:1
Age:2.0
Sex:Male
Location:California
Vaccinated:1995-01-25
Onset:1995-01-27
Submitted:1995-01-30
Entered:1995-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51056 / 3 - / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4K51059 / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0683A / 1 - / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0708M / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-01-27
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:
Current Illness: PAR denied any illnesses
Preexisting Conditions: NKA per PAR;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA95027

Write-up: pt recvd vax 3rd dose of OPV, 3rd dose DTP/HIB & 1st dose of MMR on 25jan95; pt died at home 27jan95;

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=71851&WAYBACKHISTORY=ON


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