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This is VAERS ID 89957

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 89957
VAERS Form:
Age:1.5
Sex:Male
Location:Arizona
Vaccinated:1996-09-09
Onset:1996-09-09
Submitted:1996-09-11
Entered:1996-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPH: TETRAMUNE / LEDERLE 436792 / 1 LL / IM
HEP: ENGERIX-B / SMITHKLINE 204392 / 0 RL / IM
MMR: MMR II / MSD 0394D / 0 LA / SC
OPV: ORIMUNE / LEDERLE 0738C / 1 - / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-09-09
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: NONE
Current Illness: NONE
Preexisting Conditions: 10DEC95 sz;virus
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt dead-autopsy inconclusive @ this time;


Changed on 12/8/2009

VAERS ID: 89957 Before After
VAERS Form:
Age:1.5
Sex:Male
Location:Arizona
Vaccinated:1996-09-09
Onset:1996-09-09
Submitted:1996-09-11
Entered:1996-09-19 1996-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPH: TETRAMUNE / LEDERLE 436792 / 1 LL / IM
DTPHIB: DTP + HIB (TETRAMUNE) / LEDERLE LABORATORIES 436792 / 1 LL / IM
HEP: ENGERIX-B HEP B (ENGERIX-B) / SMITHKLINE SMITHKLINE BEECHAM 204392 / 0 RL / IM
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 0394D / 0 LA / SC
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 0738C / 1 - / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-09-09
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: NONE
Current Illness: NONE
Preexisting Conditions: 10DEC95 sz;virus
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt dead-autopsy inconclusive @ this time;


Changed on 5/14/2017

VAERS ID: 89957 Before After
VAERS Form:
Age:1.5
Sex:Male
Location:Arizona
Vaccinated:1996-09-09
Onset:1996-09-09
Submitted:1996-09-11
Entered:1996-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 436792 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 204392 / 0 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0394D / 0 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 0738C / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-09-09
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: NONE
Current Illness: NONE
Preexisting Conditions: 10DEC95 sz;virus
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt dead-autopsy inconclusive @ this time;


Changed on 9/14/2017

VAERS ID: 89957 Before After
VAERS Form:(blank) 1
Age:1.5
Sex:Male
Location:Arizona
Vaccinated:1996-09-09
Onset:1996-09-09
Submitted:1996-09-11
Entered:1996-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 436792 / 1 2 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 204392 / 0 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0394D / 0 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0738C / 1 2 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-09-09
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: NONE
Current Illness: NONE
Preexisting Conditions: 10DEC95 sz;virus
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt dead-autopsy inconclusive @ this time;


Changed on 2/14/2018

VAERS ID: 89957 Before After
VAERS Form:1
Age:1.5
Sex:Male
Location:Arizona
Vaccinated:1996-09-09
Onset:1996-09-09
Submitted:1996-09-11
Entered:1996-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 436792 / 2 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 204392 / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0394D / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0738C / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-09-09
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: NONE
Current Illness: NONE
Preexisting Conditions: 10DEC95 sz;virus
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt dead-autopsy inconclusive @ this time;


Changed on 6/14/2018

VAERS ID: 89957 Before After
VAERS Form:1
Age:1.5
Sex:Male
Location:Arizona
Vaccinated:1996-09-09
Onset:1996-09-09
Submitted:1996-09-11
Entered:1996-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 436792 / 2 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 204392 / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0394D / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0738C / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-09-09
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: NONE
Current Illness: NONE
Preexisting Conditions: 10DEC95 sz;virus
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt dead-autopsy inconclusive @ this time;


Changed on 8/14/2018

VAERS ID: 89957 Before After
VAERS Form:1
Age:1.5
Sex:Male
Location:Arizona
Vaccinated:1996-09-09
Onset:1996-09-09
Submitted:1996-09-11
Entered:1996-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 436792 / 2 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 204392 / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0394D / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0738C / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-09-09
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: NONE
Current Illness: NONE
Preexisting Conditions: 10DEC95 sz;virus
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt dead-autopsy inconclusive @ this time;


Changed on 9/14/2018

VAERS ID: 89957 Before After
VAERS Form:1
Age:1.5
Sex:Male
Location:Arizona
Vaccinated:1996-09-09
Onset:1996-09-09
Submitted:1996-09-11
Entered:1996-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 436792 / 2 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 204392 / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0394D / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0738C / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-09-09
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: NONE
Current Illness: NONE
Preexisting Conditions: 10DEC95 sz;virus
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt dead-autopsy inconclusive @ this time;


Changed on 10/14/2018

VAERS ID: 89957 Before After
VAERS Form:1
Age:1.5
Sex:Male
Location:Arizona
Vaccinated:1996-09-09
Onset:1996-09-09
Submitted:1996-09-11
Entered:1996-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 436792 / 2 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 204392 / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0394D / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0738C / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-09-09
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: NONE
Current Illness: NONE
Preexisting Conditions: 10DEC95 sz;virus
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt dead-autopsy inconclusive @ this time;

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