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This is VAERS ID 73024

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 73024
VAERS Form:
Age:1.0
Sex:Male
Location:Mississippi
Vaccinated:1995-03-17
Onset:1995-03-24
Submitted:1995-03-28
Entered:1995-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP MICH. PHD. / MICHIGAN DPH TR1225ASB / 3 RL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M305LF / 3 LL / IM
MMR: MMR II / MSD 0885A / 0 RA / SC
OPV: ORIMUNE / LEDERLE 0715H / 2 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: INFECT, PNEUMONIA, LUNG DIS, GASTROENTERITIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-03-24
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: asthma meds;(name unk)
Current Illness: cold
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recvd vax;pt died;autopsy performed;rpt indicated that pin point lesions were found on the large intestines,there was no stool(s) in the large intestines;?viral gastroenteritis,lungs were hard & firm, ?viral pneumonia,liver soft & firm;


Changed on 12/8/2009

VAERS ID: 73024 Before After
VAERS Form:
Age:1.0
Sex:Male
Location:Mississippi
Vaccinated:1995-03-17
Onset:1995-03-24
Submitted:1995-03-28
Entered:1995-04-11 1995-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP MICH. PHD. DTP (NO BRAND NAME) / MICHIGAN DPH MICHIGAN DEPT PUB HLTH TR1225ASB / 3 RL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M305LF / 3 LL / IM
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 0885A / 0 RA / SC
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 0715H / 2 - / PO

Administered by: Public      Purchased by: Unknown Public
Symptoms: Gastroenteritis, Infection, Lung disorder, Pneumonia, INFECT, PNEUMONIA, LUNG DIS, GASTROENTERITIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-03-24
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: asthma meds;(name unk)
Current Illness: cold
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) MS95013

Write-up: pt recvd vax;pt died;autopsy performed;rpt indicated that pin point lesions were found on the large intestines,there was no stool(s) in the large intestines;?viral gastroenteritis,lungs were hard & firm, ?viral pneumonia,liver soft & firm;


Changed on 5/14/2017

VAERS ID: 73024 Before After
VAERS Form:
Age:1.0
Sex:Male
Location:Mississippi
Vaccinated:1995-03-17
Onset:1995-03-24
Submitted:1995-03-28
Entered:1995-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH TR1225ASB / 3 RL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M305LF / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0885A / 0 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 0715H / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Gastroenteritis, Infection, Lung disorder, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-03-24
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: asthma meds;(name unk)
Current Illness: cold
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MS95013

Write-up: pt recvd vax;pt died;autopsy performed;rpt indicated that pin point lesions were found on the large intestines,there was no stool(s) in the large intestines;?viral gastroenteritis,lungs were hard & firm, ?viral pneumonia,liver soft & firm;


Changed on 9/14/2017

VAERS ID: 73024 Before After
VAERS Form:(blank) 1
Age:1.0
Sex:Male
Location:Mississippi
Vaccinated:1995-03-17
Onset:1995-03-24
Submitted:1995-03-28
Entered:1995-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH TR1225ASB / 3 4 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M305LF / 3 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0885A / 0 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0715H / 2 3 - MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Gastroenteritis, Infection, Lung disorder, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-03-24
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: asthma meds;(name unk)
Current Illness: cold
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MS95013

Write-up: pt recvd vax;pt died;autopsy performed;rpt indicated that pin point lesions were found on the large intestines,there was no stool(s) in the large intestines;?viral gastroenteritis,lungs were hard & firm, ?viral pneumonia,liver soft & firm;


Changed on 2/14/2018

VAERS ID: 73024 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Mississippi
Vaccinated:1995-03-17
Onset:1995-03-24
Submitted:1995-03-28
Entered:1995-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH TR1225ASB / 4 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M305LF / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0885A / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0715H / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Gastroenteritis, Infection, Lung disorder, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-03-24
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: asthma meds;(name unk)
Current Illness: cold
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MS95013

Write-up: pt recvd vax;pt died;autopsy performed;rpt indicated that pin point lesions were found on the large intestines,there was no stool(s) in the large intestines;?viral gastroenteritis,lungs were hard & firm, ?viral pneumonia,liver soft & firm;


Changed on 6/14/2018

VAERS ID: 73024 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Mississippi
Vaccinated:1995-03-17
Onset:1995-03-24
Submitted:1995-03-28
Entered:1995-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH TR1225ASB / 4 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M305LF / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0885A / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0715H / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Gastroenteritis, Infection, Lung disorder, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-03-24
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: asthma meds;(name unk)
Current Illness: cold
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MS95013

Write-up: pt recvd vax;pt died;autopsy performed;rpt indicated that pin point lesions were found on the large intestines,there was no stool(s) in the large intestines;?viral gastroenteritis,lungs were hard & firm, ?viral pneumonia,liver soft & firm;


Changed on 8/14/2018

VAERS ID: 73024 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Mississippi
Vaccinated:1995-03-17
Onset:1995-03-24
Submitted:1995-03-28
Entered:1995-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH TR1225ASB / 4 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M305LF / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0885A / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0715H / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Gastroenteritis, Infection, Lung disorder, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-03-24
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: asthma meds;(name unk)
Current Illness: cold
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MS95013

Write-up: pt recvd vax;pt died;autopsy performed;rpt indicated that pin point lesions were found on the large intestines,there was no stool(s) in the large intestines;?viral gastroenteritis,lungs were hard & firm, ?viral pneumonia,liver soft & firm;


Changed on 9/14/2018

VAERS ID: 73024 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Mississippi
Vaccinated:1995-03-17
Onset:1995-03-24
Submitted:1995-03-28
Entered:1995-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH TR1225ASB / 4 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M305LF / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0885A / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0715H / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Gastroenteritis, Infection, Lung disorder, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-03-24
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: asthma meds;(name unk)
Current Illness: cold
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MS95013

Write-up: pt recvd vax;pt died;autopsy performed;rpt indicated that pin point lesions were found on the large intestines,there was no stool(s) in the large intestines;?viral gastroenteritis,lungs were hard & firm, ?viral pneumonia,liver soft & firm;


Changed on 10/14/2018

VAERS ID: 73024 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Mississippi
Vaccinated:1995-03-17
Onset:1995-03-24
Submitted:1995-03-28
Entered:1995-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH TR1225ASB / 4 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M305LF / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0885A / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0715H / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Gastroenteritis, Infection, Lung disorder, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-03-24
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: asthma meds;(name unk)
Current Illness: cold
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MS95013

Write-up: pt recvd vax;pt died;autopsy performed;rpt indicated that pin point lesions were found on the large intestines,there was no stool(s) in the large intestines;?viral gastroenteritis,lungs were hard & firm, ?viral pneumonia,liver soft & firm;

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=73024&WAYBACKHISTORY=ON


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