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This is VAERS ID 79601

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History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 79601
VAERS Form:
Age:0.2
Sex:Female
Location:Utah
Vaccinated:1995-11-03
Onset:1995-11-04
Submitted:1995-11-07
Entered:1995-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPH: TETRAMUNE / LEDERLE 428039 / 0 LL / IM
HEP: ENGERIX-B / SMITHKLINE 1664B2 / 1 RL / IM
IPV: IPV / MERIEUX INST L0227 / 0 RL / SC

Administered by: Private      Purchased by: Unknown
Symptoms: CYANOSIS, STUPOR

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-11-04
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: Dimetapp, APAP
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: baby found blue & unresponsive


Changed on 12/8/2009

VAERS ID: 79601 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Utah
Vaccinated:1995-11-03
Onset:1995-11-04
Submitted:1995-11-07
Entered:1995-12-01 1995-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPH: TETRAMUNE / LEDERLE 428039 / 0 LL / IM
DTPHIB: DTP + HIB (TETRAMUNE) / LEDERLE LABORATORIES 428039 / 0 LL / IM
HEP: ENGERIX-B HEP B (ENGERIX-B) / SMITHKLINE SMITHKLINE BEECHAM 1664B2 / 1 RL / IM
IPV: IPV POLIO VIRUS, INACT. (NO BRAND NAME) / MERIEUX INST PASTEUR MERIEUX INST. L0227 / 0 RL / SC

Administered by: Private      Purchased by: Unknown Private
Symptoms: Cyanosis, Stupor, CYANOSIS, STUPOR

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-11-04
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: Dimetapp, APAP
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: baby found blue & unresponsive


Changed on 5/14/2017

VAERS ID: 79601 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Utah
Vaccinated:1995-11-03
Onset:1995-11-04
Submitted:1995-11-07
Entered:1995-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 428039 / 0 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1664B2 / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. L0227 / 0 RL / SC

Administered by: Private      Purchased by: Private
Symptoms: Cyanosis, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-11-04
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: Dimetapp, APAP
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: baby found blue & unresponsive


Changed on 9/14/2017

VAERS ID: 79601 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Female
Location:Utah
Vaccinated:1995-11-03
Onset:1995-11-04
Submitted:1995-11-07
Entered:1995-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 428039 / 0 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1664B2 / 1 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. L0227 / 0 1 RL / SC

Administered by: Private      Purchased by: Private
Symptoms: Cyanosis, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-11-04
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: Dimetapp, APAP
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: baby found blue & unresponsive


Changed on 2/14/2018

VAERS ID: 79601 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Utah
Vaccinated:1995-11-03
Onset:1995-11-04
Submitted:1995-11-07
Entered:1995-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 428039 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1664B2 / 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. L0227 / 1 RL / SC

Administered by: Private      Purchased by: Private
Symptoms: Cyanosis, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-11-04
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: Dimetapp, APAP
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: baby found blue & unresponsive


Changed on 6/14/2018

VAERS ID: 79601 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Utah
Vaccinated:1995-11-03
Onset:1995-11-04
Submitted:1995-11-07
Entered:1995-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 428039 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1664B2 / 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. L0227 / 1 RL / SC

Administered by: Private      Purchased by: Private
Symptoms: Cyanosis, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-11-04
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: Dimetapp, APAP
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: baby found blue & unresponsive


Changed on 8/14/2018

VAERS ID: 79601 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Utah
Vaccinated:1995-11-03
Onset:1995-11-04
Submitted:1995-11-07
Entered:1995-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 428039 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1664B2 / 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. L0227 / 1 RL / SC

Administered by: Private      Purchased by: Private
Symptoms: Cyanosis, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-11-04
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: Dimetapp, APAP
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: baby found blue & unresponsive


Changed on 9/14/2018

VAERS ID: 79601 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Utah
Vaccinated:1995-11-03
Onset:1995-11-04
Submitted:1995-11-07
Entered:1995-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 428039 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1664B2 / 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. L0227 / 1 RL / SC

Administered by: Private      Purchased by: Private
Symptoms: Cyanosis, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-11-04
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: Dimetapp, APAP
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: baby found blue & unresponsive


Changed on 10/14/2018

VAERS ID: 79601 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Utah
Vaccinated:1995-11-03
Onset:1995-11-04
Submitted:1995-11-07
Entered:1995-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 428039 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1664B2 / 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. L0227 / 1 RL / SC

Administered by: Private      Purchased by: Private
Symptoms: Cyanosis, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-11-04
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: Dimetapp, APAP
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: baby found blue & unresponsive


Changed on 12/24/2020

VAERS ID: 79601 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Utah
Vaccinated:1995-11-03
Onset:1995-11-04
Submitted:1995-11-07
Entered:1995-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 428039 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1664B2 / 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. L0227 / 1 RL / SC

Administered by: Private      Purchased by: Private
Symptoms: Cyanosis, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-11-04
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: Dimetapp, APAP
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: baby found blue & unresponsive


Changed on 12/30/2020

VAERS ID: 79601 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Utah
Vaccinated:1995-11-03
Onset:1995-11-04
Submitted:1995-11-07
Entered:1995-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 428039 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1664B2 / 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. L0227 / 1 RL / SC

Administered by: Private      Purchased by: Private
Symptoms: Cyanosis, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-11-04
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: Dimetapp, APAP
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: baby found blue & unresponsive


Changed on 5/7/2021

VAERS ID: 79601 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Utah
Vaccinated:1995-11-03
Onset:1995-11-04
Submitted:1995-11-07
Entered:1995-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 428039 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1664B2 / 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. L0227 / 1 RL / SC

Administered by: Private      Purchased by: Private
Symptoms: Cyanosis, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-11-04
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: Dimetapp, APAP
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: baby found blue & unresponsive


Changed on 5/14/2021

VAERS ID: 79601 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Utah
Vaccinated:1995-11-03
Onset:1995-11-04
Submitted:1995-11-07
Entered:1995-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 428039 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1664B2 / 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. L0227 / 1 RL / SC

Administered by: Private      Purchased by: Private
Symptoms: Cyanosis, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-11-04
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: Dimetapp, APAP
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: baby found blue & unresponsive

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=79601&WAYBACKHISTORY=ON


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