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This is VAERS ID 75867

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 75867
VAERS Form:
Age:1.5
Sex:Female
Location:Pennsylvania
Vaccinated:1995-05-19
Onset:1995-05-21
Submitted:1995-06-23
Entered:1995-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP / CONNAUGHT LABS 4B61026 / 2 LL / IM
HEP: RECOMBIVAX HB / MSD 0875A / 2 RL / IM
HIBV: ACT-HIB / CONNAUGHT LABS 4B61026 / 2 LL / IM
MMR: MMR II / MSD 0986A / 1 LL / SC
OPV: ORIMUNE / LEDERLE 0718B / 2 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: APNEA, ASTHMA, HEART ARREST, BRONCHITIS, CARDIOVASC DIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-05-21
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: none
Other Medications: ventolin prn, feso4 drops, ped decongestant drops;
Current Illness: nl pe; lungs clear; home nebulizer
Preexisting Conditions: asthma, pneumonia 3MAY-6MAY on in home nebulizer
Allergies:
Diagnostic Lab Data: AEMC/ER - unable to get info at this time;
CDC 'Split Type': asthma, pneumonia 3MAY-6MAY on in home nebulizer

Write-up: pt recv vax;mild asthma day p/ vax;rx @ home via nebulizer x3 & APAP x 3; no h/o fever;next am was found not breathing by grandma but had weak pulse;CPR given;called 911;to er;pt died 21may95;


Changed on 12/8/2009

VAERS ID: 75867 Before After
VAERS Form:
Age:1.5
Sex:Female
Location:Pennsylvania
Vaccinated:1995-05-19
Onset:1995-05-21
Submitted:1995-06-23
Entered:1995-07-17 1995-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP DTP (NO BRAND NAME) / CONNAUGHT LABS CONNAUGHT LABORATORIES 4B61026 / 2 LL / IM
HEP: RECOMBIVAX HB HEP B (RECOMBIVAX HB) / MSD MERCK & CO. INC. 0875A / 2 RL / IM
HIBV: ACT-HIB HIB (ACTHIB) / CONNAUGHT LABS CONNAUGHT LABORATORIES 4B61026 / 2 LL / IM
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 0986A / 1 LL / SC
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 0718B / 2 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: Apnoea, Asthma, Bronchitis, Cardiac arrest, Cardiovascular disorder, Condition aggravated, Pneumonia, APNEA, ASTHMA, HEART ARREST, BRONCHITIS, CARDIOVASC DIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-05-21
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: none
Other Medications: ventolin prn, feso4 drops, ped decongestant drops;
Current Illness: nl pe; lungs clear; home nebulizer
Preexisting Conditions: asthma, pneumonia 3MAY-6MAY on in home nebulizer
Allergies:
Diagnostic Lab Data: AEMC/ER - unable to get info at this time;
CDC 'Split Type': asthma, pneumonia 3MAY-6MAY on in home nebulizer PA95166

Write-up: pt recv vax;mild asthma day p/ vax;rx @ home via nebulizer x3 & APAP x 3; no h/o fever;next am was found not breathing by grandma but had weak pulse;CPR given;called 911;to er;pt died 21may95;


Changed on 5/14/2017

VAERS ID: 75867 Before After
VAERS Form:
Age:1.5
Sex:Female
Location:Pennsylvania
Vaccinated:1995-05-19
Onset:1995-05-21
Submitted:1995-06-23
Entered:1995-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4B61026 / 2 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0875A / 2 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4B61026 / 2 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0986A / 1 LL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 0718B / 2 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: Apnoea, Asthma, Bronchitis, Cardiac arrest, Cardiovascular disorder, Condition aggravated, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-05-21
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: none none~ ()~~~In patient
Other Medications: ventolin prn, feso4 drops, ped decongestant drops;
Current Illness: nl pe; lungs clear; home nebulizer
Preexisting Conditions: asthma, pneumonia 3MAY-6MAY on in home nebulizer
Allergies:
Diagnostic Lab Data: AEMC/ER - unable to get info at this time;
CDC 'Split Type': PA95166

Write-up: pt recv vax;mild asthma day p/ vax;rx @ home via nebulizer x3 & APAP x 3; no h/o fever;next am was found not breathing by grandma but had weak pulse;CPR given;called 911;to er;pt died 21may95;


Changed on 9/14/2017

VAERS ID: 75867 Before After
VAERS Form:(blank) 1
Age:1.5
Sex:Female
Location:Pennsylvania
Vaccinated:1995-05-19
Onset:1995-05-21
Submitted:1995-06-23
Entered:1995-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4B61026 / 2 3 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0875A / 2 3 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4B61026 / 2 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0986A / 1 2 LL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0718B / 2 3 - MO / PO

Administered by: Public      Purchased by: Unknown
Symptoms: Apnoea, Asthma, Bronchitis, Cardiac arrest, Cardiovascular disorder, Condition aggravated, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-05-21
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: none~ ()~~~In patient
Other Medications: ventolin prn, feso4 drops, ped decongestant drops;
Current Illness: nl pe; lungs clear; home nebulizer
Preexisting Conditions: asthma, pneumonia 3MAY-6MAY on in home nebulizer
Allergies:
Diagnostic Lab Data: AEMC/ER - unable to get info at this time;
CDC 'Split Type': PA95166

Write-up: pt recv vax;mild asthma day p/ vax;rx @ home via nebulizer x3 & APAP x 3; no h/o fever;next am was found not breathing by grandma but had weak pulse;CPR given;called 911;to er;pt died 21may95;


Changed on 2/14/2018

VAERS ID: 75867 Before After
VAERS Form:1
Age:1.5
Sex:Female
Location:Pennsylvania
Vaccinated:1995-05-19
Onset:1995-05-21
Submitted:1995-06-23
Entered:1995-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4B61026 / 3 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0875A / 3 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4B61026 / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0986A / 2 LL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0718B / 3 MO / PO

Administered by: Public      Purchased by: Unknown
Symptoms: Apnoea, Asthma, Bronchitis, Cardiac arrest, Cardiovascular disorder, Condition aggravated, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-05-21
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: none~ ()~~~In patient
Other Medications: ventolin prn, feso4 drops, ped decongestant drops;
Current Illness: nl pe; lungs clear; home nebulizer
Preexisting Conditions: asthma, pneumonia 3MAY-6MAY on in home nebulizer
Allergies:
Diagnostic Lab Data: AEMC/ER - unable to get info at this time;
CDC 'Split Type': PA95166

Write-up: pt recv vax;mild asthma day p/ vax;rx @ home via nebulizer x3 & APAP x 3; no h/o fever;next am was found not breathing by grandma but had weak pulse;CPR given;called 911;to er;pt died 21may95;


Changed on 6/14/2018

VAERS ID: 75867 Before After
VAERS Form:1
Age:1.5
Sex:Female
Location:Pennsylvania
Vaccinated:1995-05-19
Onset:1995-05-21
Submitted:1995-06-23
Entered:1995-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4B61026 / 3 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0875A / 3 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4B61026 / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0986A / 2 LL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0718B / 3 MO / PO

Administered by: Public      Purchased by: Unknown
Symptoms: Apnoea, Asthma, Bronchitis, Cardiac arrest, Cardiovascular disorder, Condition aggravated, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-05-21
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: none~ ()~~~In patient
Other Medications: ventolin prn, feso4 drops, ped decongestant drops;
Current Illness: nl pe; lungs clear; home nebulizer
Preexisting Conditions: asthma, pneumonia 3MAY-6MAY on in home nebulizer
Allergies:
Diagnostic Lab Data: AEMC/ER - unable to get info at this time;
CDC 'Split Type': PA95166

Write-up: pt recv vax;mild asthma day p/ vax;rx @ home via nebulizer x3 & APAP x 3; no h/o fever;next am was found not breathing by grandma but had weak pulse;CPR given;called 911;to er;pt died 21may95;


Changed on 8/14/2018

VAERS ID: 75867 Before After
VAERS Form:1
Age:1.5
Sex:Female
Location:Pennsylvania
Vaccinated:1995-05-19
Onset:1995-05-21
Submitted:1995-06-23
Entered:1995-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4B61026 / 3 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0875A / 3 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4B61026 / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0986A / 2 LL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0718B / 3 MO / PO

Administered by: Public      Purchased by: Unknown
Symptoms: Apnoea, Asthma, Bronchitis, Cardiac arrest, Cardiovascular disorder, Condition aggravated, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-05-21
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: none~ ()~~~In patient
Other Medications: ventolin prn, feso4 drops, ped decongestant drops;
Current Illness: nl pe; lungs clear; home nebulizer
Preexisting Conditions: asthma, pneumonia 3MAY-6MAY on in home nebulizer
Allergies:
Diagnostic Lab Data: AEMC/ER - unable to get info at this time;
CDC 'Split Type': PA95166

Write-up: pt recv vax;mild asthma day p/ vax;rx @ home via nebulizer x3 & APAP x 3; no h/o fever;next am was found not breathing by grandma but had weak pulse;CPR given;called 911;to er;pt died 21may95;


Changed on 9/14/2018

VAERS ID: 75867 Before After
VAERS Form:1
Age:1.5
Sex:Female
Location:Pennsylvania
Vaccinated:1995-05-19
Onset:1995-05-21
Submitted:1995-06-23
Entered:1995-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4B61026 / 3 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0875A / 3 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4B61026 / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0986A / 2 LL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0718B / 3 MO / PO

Administered by: Public      Purchased by: Unknown
Symptoms: Apnoea, Asthma, Bronchitis, Cardiac arrest, Cardiovascular disorder, Condition aggravated, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-05-21
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: none~ ()~~~In patient
Other Medications: ventolin prn, feso4 drops, ped decongestant drops;
Current Illness: nl pe; lungs clear; home nebulizer
Preexisting Conditions: asthma, pneumonia 3MAY-6MAY on in home nebulizer
Allergies:
Diagnostic Lab Data: AEMC/ER - unable to get info at this time;
CDC 'Split Type': PA95166

Write-up: pt recv vax;mild asthma day p/ vax;rx @ home via nebulizer x3 & APAP x 3; no h/o fever;next am was found not breathing by grandma but had weak pulse;CPR given;called 911;to er;pt died 21may95;


Changed on 10/14/2018

VAERS ID: 75867 Before After
VAERS Form:1
Age:1.5
Sex:Female
Location:Pennsylvania
Vaccinated:1995-05-19
Onset:1995-05-21
Submitted:1995-06-23
Entered:1995-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4B61026 / 3 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0875A / 3 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4B61026 / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0986A / 2 LL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0718B / 3 MO / PO

Administered by: Public      Purchased by: Unknown
Symptoms: Apnoea, Asthma, Bronchitis, Cardiac arrest, Cardiovascular disorder, Condition aggravated, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-05-21
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: none~ ()~~~In patient
Other Medications: ventolin prn, feso4 drops, ped decongestant drops;
Current Illness: nl pe; lungs clear; home nebulizer
Preexisting Conditions: asthma, pneumonia 3MAY-6MAY on in home nebulizer
Allergies:
Diagnostic Lab Data: AEMC/ER - unable to get info at this time;
CDC 'Split Type': PA95166

Write-up: pt recv vax;mild asthma day p/ vax;rx @ home via nebulizer x3 & APAP x 3; no h/o fever;next am was found not breathing by grandma but had weak pulse;CPR given;called 911;to er;pt died 21may95;

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