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This is VAERS ID 80949

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 80949
VAERS Form:
Age:1.3
Sex:Male
Location:Connecticut
Vaccinated:1996-01-11
Onset:1996-01-15
Submitted:1996-01-15
Entered:1996-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIBTITER / LEDERLE(PRAXIS) M265L5 / 3 RL / -
MMR: MMR II / MSD 1320A / 0 LL / -

Administered by: Private      Purchased by: Unknown
Symptoms: CHILLS, VOMIT, DIARRHEA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-01-15
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EMTS w/ lividity & rigor
CDC 'Split Type': NONE

Write-up: pt recvd vax 11JAN96 & exp emesis on 11JAN;well 12JAN;14NOV diarrhea stool;put to bed 14NOV & found DOA 7AM 15NOV by parents;


Changed on 12/8/2009

VAERS ID: 80949 Before After
VAERS Form:
Age:1.3
Sex:Male
Location:Connecticut
Vaccinated:1996-01-11
Onset:1996-01-15
Submitted:1996-01-15
Entered:1996-01-23 1996-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M265L5 / 3 RL / -
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 1320A / 0 LL / -

Administered by: Private      Purchased by: Unknown Private
Symptoms: Chills, Diarrhoea, Vomiting, CHILLS, VOMIT, DIARRHEA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-01-15
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EMTS w/ lividity & rigor
CDC 'Split Type': NONE (blank)

Write-up: pt recvd vax 11JAN96 & exp emesis on 11JAN;well 12JAN;14NOV diarrhea stool;put to bed 14NOV & found DOA 7AM 15NOV by parents;


Changed on 5/14/2017

VAERS ID: 80949 Before After
VAERS Form:
Age:1.3
Sex:Male
Location:Connecticut
Vaccinated:1996-01-11
Onset:1996-01-15
Submitted:1996-01-15
Entered:1996-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M265L5 / 3 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1320A / 0 LL / -

Administered by: Private      Purchased by: Private
Symptoms: Chills, Diarrhoea, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-01-15
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EMTS w/ lividity & rigor
CDC 'Split Type':

Write-up: pt recvd vax 11JAN96 & exp emesis on 11JAN;well 12JAN;14NOV diarrhea stool;put to bed 14NOV & found DOA 7AM 15NOV by parents;


Changed on 9/14/2017

VAERS ID: 80949 Before After
VAERS Form:(blank) 1
Age:1.3
Sex:Male
Location:Connecticut
Vaccinated:1996-01-11
Onset:1996-01-15
Submitted:1996-01-15
Entered:1996-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M265L5 / 3 4 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1320A / 0 1 LL / -

Administered by: Private      Purchased by: Private
Symptoms: Chills, Diarrhoea, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-01-15
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EMTS w/ lividity & rigor
CDC 'Split Type':

Write-up: pt recvd vax 11JAN96 & exp emesis on 11JAN;well 12JAN;14NOV diarrhea stool;put to bed 14NOV & found DOA 7AM 15NOV by parents;


Changed on 2/14/2018

VAERS ID: 80949 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Connecticut
Vaccinated:1996-01-11
Onset:1996-01-15
Submitted:1996-01-15
Entered:1996-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M265L5 / 4 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1320A / 1 LL / -

Administered by: Private      Purchased by: Private
Symptoms: Chills, Diarrhoea, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-01-15
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EMTS w/ lividity & rigor
CDC 'Split Type':

Write-up: pt recvd vax 11JAN96 & exp emesis on 11JAN;well 12JAN;14NOV diarrhea stool;put to bed 14NOV & found DOA 7AM 15NOV by parents;


Changed on 6/14/2018

VAERS ID: 80949 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Connecticut
Vaccinated:1996-01-11
Onset:1996-01-15
Submitted:1996-01-15
Entered:1996-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M265L5 / 4 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1320A / 1 LL / -

Administered by: Private      Purchased by: Private
Symptoms: Chills, Diarrhoea, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-01-15
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EMTS w/ lividity & rigor
CDC 'Split Type':

Write-up: pt recvd vax 11JAN96 & exp emesis on 11JAN;well 12JAN;14NOV diarrhea stool;put to bed 14NOV & found DOA 7AM 15NOV by parents;


Changed on 8/14/2018

VAERS ID: 80949 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Connecticut
Vaccinated:1996-01-11
Onset:1996-01-15
Submitted:1996-01-15
Entered:1996-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M265L5 / 4 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1320A / 1 LL / -

Administered by: Private      Purchased by: Private
Symptoms: Chills, Diarrhoea, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-01-15
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EMTS w/ lividity & rigor
CDC 'Split Type':

Write-up: pt recvd vax 11JAN96 & exp emesis on 11JAN;well 12JAN;14NOV diarrhea stool;put to bed 14NOV & found DOA 7AM 15NOV by parents;


Changed on 9/14/2018

VAERS ID: 80949 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Connecticut
Vaccinated:1996-01-11
Onset:1996-01-15
Submitted:1996-01-15
Entered:1996-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M265L5 / 4 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1320A / 1 LL / -

Administered by: Private      Purchased by: Private
Symptoms: Chills, Diarrhoea, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-01-15
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EMTS w/ lividity & rigor
CDC 'Split Type':

Write-up: pt recvd vax 11JAN96 & exp emesis on 11JAN;well 12JAN;14NOV diarrhea stool;put to bed 14NOV & found DOA 7AM 15NOV by parents;


Changed on 10/14/2018

VAERS ID: 80949 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Connecticut
Vaccinated:1996-01-11
Onset:1996-01-15
Submitted:1996-01-15
Entered:1996-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M265L5 / 4 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1320A / 1 LL / -

Administered by: Private      Purchased by: Private
Symptoms: Chills, Diarrhoea, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-01-15
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EMTS w/ lividity & rigor
CDC 'Split Type':

Write-up: pt recvd vax 11JAN96 & exp emesis on 11JAN;well 12JAN;14NOV diarrhea stool;put to bed 14NOV & found DOA 7AM 15NOV by parents;

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=80949&WAYBACKHISTORY=ON


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