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This is VAERS ID 133412

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 133412
VAERS Form:
Age:0.2
Sex:Male
Location:Pennsylvania
Vaccinated:2000-01-03
Onset:2000-01-06
Submitted:2000-01-12
Entered:2000-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA / CONNAUGHT LABS 7387AA / 0 RL / IM
HEP: RECOMBIVAX HB / MSD 1527J / 0 LL / IM
HIBV: ACT-HIB / CONNAUGHT LABS UA462AB / 0 LL / IM
IPV: IPV / MERIEUX INST N04911 / 0 RL / SC

Administered by: Private      Purchased by: Unknown
Symptoms: HYPOTONIA, CONVULS, CYANOSIS, APNEA, HYPOXIA

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: LP-normal, CT scan - slight promonence of ventricles, EEG - normal
CDC 'Split Type':

Write-up: Pt developed episodes of cyanosis associated with apnea, low O2 sats and staring, limpness - dx seizures seen in ER on 1/8/00, parents stated some blueness around lips noted 36 hrs before being seen.


Changed on 12/8/2009

VAERS ID: 133412 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Pennsylvania
Vaccinated:2000-01-03
Onset:2000-01-06
Submitted:2000-01-12
Entered:2000-01-23 2000-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA DTAP (TRIPEDIA) / CONNAUGHT LABS CONNAUGHT LABORATORIES 7387AA / 0 RL / IM
HEP: RECOMBIVAX HB HEP B (RECOMBIVAX HB) / MSD MERCK & CO. INC. 1527J / 0 LL / IM
HIBV: ACT-HIB HIB (ACTHIB) / CONNAUGHT LABS CONNAUGHT LABORATORIES UA462AB / 0 LL / IM
IPV: IPV POLIO VIRUS, INACT. (NO BRAND NAME) / MERIEUX INST PASTEUR MERIEUX INST. N04911 / 0 RL / SC

Administered by: Private      Purchased by: Unknown Public
Symptoms: Apnoea, Convulsion, Cyanosis, Hypotonia, Hypoxia, Skin discolouration, Stupor, HYPOTONIA, CONVULS, CYANOSIS, APNEA, HYPOXIA

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: LP-normal, CT scan - slight promonence of ventricles, EEG - normal
CDC 'Split Type':

Write-up: Pt developed episodes of cyanosis associated with apnea, low O2 sats and staring, limpness - dx seizures seen in ER on 1/8/00, parents stated some blueness around lips noted 36 hrs before being seen.


Changed on 3/14/2014

VAERS ID: 133412 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Pennsylvania
Vaccinated:2000-01-03
Onset:2000-01-06
Submitted:2000-01-12
Entered:2000-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7387AA / 0 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1527J / 0 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA462AB / 0 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. PASTEUR MERIEUX CONNAUGHT N04911 N0491 / 0 RL / SC

Administered by: Private      Purchased by: Public
Symptoms: Apnoea, Convulsion, Cyanosis, Hypotonia, Hypoxia, Skin discolouration, Stupor

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: LP-normal, CT scan - slight promonence of ventricles, EEG - normal
CDC 'Split Type':

Write-up: Pt developed episodes of cyanosis associated with apnea, low O2 sats and staring, limpness - dx seizures seen in ER on 1/8/00, parents stated some blueness around lips noted 36 hrs before being seen.


Changed on 6/14/2014

VAERS ID: 133412 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Pennsylvania
Vaccinated:2000-01-03
Onset:2000-01-06
Submitted:2000-01-12
Entered:2000-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7387AA / 0 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1527J / 0 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA462AB / 0 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX CONNAUGHT N0491 / 0 RL / SC

Administered by: Private      Purchased by: Public
Symptoms: Apnoea, Convulsion, Cyanosis, Hypotonia, Hypoxia, Skin discolouration, Stupor

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: LP-normal, CT scan - slight promonence of ventricles, EEG - normal
CDC 'Split Type':

Write-up: Pt developed episodes of cyanosis associated with apnea, low O2 sats and staring, limpness - dx seizures seen in ER on 1/8/00, parents stated some blueness around lips noted 36 hrs before being seen.


Changed on 3/14/2015

VAERS ID: 133412 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Pennsylvania
Vaccinated:2000-01-03
Onset:2000-01-06
Submitted:2000-01-12
Entered:2000-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7387AA / 0 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1527J / 0 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA462AB / 0 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX CONNAUGHT N0491 / 0 RL / SC

Administered by: Private      Purchased by: Public
Symptoms: Apnoea, Convulsion, Cyanosis, Hypotonia, Hypoxia, Skin discolouration, Stupor

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: LP-normal, CT scan - slight promonence of ventricles, EEG - normal
CDC 'Split Type':

Write-up: Pt developed episodes of cyanosis associated with apnea, low O2 sats and staring, limpness - dx seizures seen in ER on 1/8/00, parents stated some blueness around lips noted 36 hrs before being seen.


Changed on 2/14/2017

VAERS ID: 133412 Before After
VAERS Form:
Age:0.2 0.17
Sex:Male
Location:Pennsylvania
Vaccinated:2000-01-03
Onset:2000-01-06
Submitted:2000-01-12
Entered:2000-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7387AA / 0 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1527J / 0 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA462AB / 0 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX CONNAUGHT N0491 / 0 RL / SC

Administered by: Private      Purchased by: Public
Symptoms: Apnoea, Convulsion, Cyanosis, Hypotonia, Hypoxia, Skin discolouration, Stupor

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: LP-normal, CT scan - slight promonence of ventricles, EEG - normal
CDC 'Split Type':

Write-up: Pt developed episodes of cyanosis associated with apnea, low O2 sats and staring, limpness - dx seizures seen in ER on 1/8/00, parents stated some blueness around lips noted 36 hrs before being seen.


Changed on 9/14/2017

VAERS ID: 133412 Before After
VAERS Form:(blank) 1
Age:0.17
Sex:Male
Location:Pennsylvania
Vaccinated:2000-01-03
Onset:2000-01-06
Submitted:2000-01-12
Entered:2000-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7387AA / 0 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1527J / 0 1 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA462AB / 0 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX CONNAUGHT N0491 / 0 1 RL / SC

Administered by: Private      Purchased by: Public
Symptoms: Apnoea, Convulsion, Cyanosis, Hypotonia, Hypoxia, Skin discolouration, Stupor

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: LP-normal, CT scan - slight promonence of ventricles, EEG - normal
CDC 'Split Type':

Write-up: Pt developed episodes of cyanosis associated with apnea, low O2 sats and staring, limpness - dx seizures seen in ER on 1/8/00, parents stated some blueness around lips noted 36 hrs before being seen.


Changed on 2/14/2018

VAERS ID: 133412 Before After
VAERS Form:1
Age:0.17
Sex:Male
Location:Pennsylvania
Vaccinated:2000-01-03
Onset:2000-01-06
Submitted:2000-01-12
Entered:2000-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7387AA / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1527J / 1 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA462AB / 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX CONNAUGHT N0491 / 1 RL / SC

Administered by: Private      Purchased by: Public
Symptoms: Apnoea, Convulsion, Cyanosis, Hypotonia, Hypoxia, Skin discolouration, Stupor

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: LP-normal, CT scan - slight promonence of ventricles, EEG - normal
CDC 'Split Type':

Write-up: Pt developed episodes of cyanosis associated with apnea, low O2 sats and staring, limpness - dx seizures seen in ER on 1/8/00, parents stated some blueness around lips noted 36 hrs before being seen.


Changed on 6/14/2018

VAERS ID: 133412 Before After
VAERS Form:1
Age:0.17
Sex:Male
Location:Pennsylvania
Vaccinated:2000-01-03
Onset:2000-01-06
Submitted:2000-01-12
Entered:2000-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7387AA / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1527J / 1 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA462AB / 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX CONNAUGHT N0491 / 1 RL / SC

Administered by: Private      Purchased by: Public
Symptoms: Apnoea, Convulsion, Cyanosis, Hypotonia, Hypoxia, Skin discolouration, Stupor

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: LP-normal, CT scan - slight promonence of ventricles, EEG - normal
CDC 'Split Type':

Write-up: Pt developed episodes of cyanosis associated with apnea, low O2 sats and staring, limpness - dx seizures seen in ER on 1/8/00, parents stated some blueness around lips noted 36 hrs before being seen.


Changed on 8/14/2018

VAERS ID: 133412 Before After
VAERS Form:1
Age:0.17
Sex:Male
Location:Pennsylvania
Vaccinated:2000-01-03
Onset:2000-01-06
Submitted:2000-01-12
Entered:2000-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7387AA / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1527J / 1 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA462AB / 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX CONNAUGHT N0491 / 1 RL / SC

Administered by: Private      Purchased by: Public
Symptoms: Apnoea, Convulsion, Cyanosis, Hypotonia, Hypoxia, Skin discolouration, Stupor

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: LP-normal, CT scan - slight promonence of ventricles, EEG - normal
CDC 'Split Type':

Write-up: Pt developed episodes of cyanosis associated with apnea, low O2 sats and staring, limpness - dx seizures seen in ER on 1/8/00, parents stated some blueness around lips noted 36 hrs before being seen.


Changed on 9/14/2018

VAERS ID: 133412 Before After
VAERS Form:1
Age:0.17
Sex:Male
Location:Pennsylvania
Vaccinated:2000-01-03
Onset:2000-01-06
Submitted:2000-01-12
Entered:2000-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7387AA / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1527J / 1 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA462AB / 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX CONNAUGHT N0491 / 1 RL / SC

Administered by: Private      Purchased by: Public
Symptoms: Apnoea, Convulsion, Cyanosis, Hypotonia, Hypoxia, Skin discolouration, Stupor

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: LP-normal, CT scan - slight promonence of ventricles, EEG - normal
CDC 'Split Type':

Write-up: Pt developed episodes of cyanosis associated with apnea, low O2 sats and staring, limpness - dx seizures seen in ER on 1/8/00, parents stated some blueness around lips noted 36 hrs before being seen.


Changed on 10/14/2018

VAERS ID: 133412 Before After
VAERS Form:1
Age:0.17
Sex:Male
Location:Pennsylvania
Vaccinated:2000-01-03
Onset:2000-01-06
Submitted:2000-01-12
Entered:2000-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7387AA / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1527J / 1 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA462AB / 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX CONNAUGHT N0491 / 1 RL / SC

Administered by: Private      Purchased by: Public
Symptoms: Apnoea, Convulsion, Cyanosis, Hypotonia, Hypoxia, Skin discolouration, Stupor

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: LP-normal, CT scan - slight promonence of ventricles, EEG - normal
CDC 'Split Type':

Write-up: Pt developed episodes of cyanosis associated with apnea, low O2 sats and staring, limpness - dx seizures seen in ER on 1/8/00, parents stated some blueness around lips noted 36 hrs before being seen.


Changed on 12/24/2020

VAERS ID: 133412 Before After
VAERS Form:1
Age:0.17
Sex:Male
Location:Pennsylvania
Vaccinated:2000-01-03
Onset:2000-01-06
Submitted:2000-01-12
Entered:2000-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7387AA / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1527J / 1 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA462AB / 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX CONNAUGHT N0491 / 1 RL / SC

Administered by: Private      Purchased by: Public
Symptoms: Apnoea, Convulsion, Cyanosis, Hypotonia, Hypoxia, Skin discolouration, Stupor

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: LP-normal, CT scan - slight promonence of ventricles, EEG - normal
CDC 'Split Type':

Write-up: Pt developed episodes of cyanosis associated with apnea, low O2 sats and staring, limpness - dx seizures seen in ER on 1/8/00, parents stated some blueness around lips noted 36 hrs before being seen.


Changed on 12/30/2020

VAERS ID: 133412 Before After
VAERS Form:1
Age:0.17
Sex:Male
Location:Pennsylvania
Vaccinated:2000-01-03
Onset:2000-01-06
Submitted:2000-01-12
Entered:2000-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7387AA / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1527J / 1 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA462AB / 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX CONNAUGHT N0491 / 1 RL / SC

Administered by: Private      Purchased by: Public
Symptoms: Apnoea, Convulsion, Cyanosis, Hypotonia, Hypoxia, Skin discolouration, Stupor

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: LP-normal, CT scan - slight promonence of ventricles, EEG - normal
CDC 'Split Type':

Write-up: Pt developed episodes of cyanosis associated with apnea, low O2 sats and staring, limpness - dx seizures seen in ER on 1/8/00, parents stated some blueness around lips noted 36 hrs before being seen.


Changed on 5/7/2021

VAERS ID: 133412 Before After
VAERS Form:1
Age:0.17
Sex:Male
Location:Pennsylvania
Vaccinated:2000-01-03
Onset:2000-01-06
Submitted:2000-01-12
Entered:2000-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7387AA / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1527J / 1 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA462AB / 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX CONNAUGHT N0491 / 1 RL / SC

Administered by: Private      Purchased by: Public
Symptoms: Apnoea, Convulsion, Cyanosis, Hypotonia, Hypoxia, Skin discolouration, Stupor

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: LP-normal, CT scan - slight promonence of ventricles, EEG - normal
CDC 'Split Type':

Write-up: Pt developed episodes of cyanosis associated with apnea, low O2 sats and staring, limpness - dx seizures seen in ER on 1/8/00, parents stated some blueness around lips noted 36 hrs before being seen.


Changed on 5/14/2021

VAERS ID: 133412 Before After
VAERS Form:1
Age:0.17
Sex:Male
Location:Pennsylvania
Vaccinated:2000-01-03
Onset:2000-01-06
Submitted:2000-01-12
Entered:2000-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7387AA / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1527J / 1 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA462AB / 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX CONNAUGHT N0491 / 1 RL / SC

Administered by: Private      Purchased by: Public
Symptoms: Apnoea, Convulsion, Cyanosis, Hypotonia, Hypoxia, Skin discolouration, Stupor

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: LP-normal, CT scan - slight promonence of ventricles, EEG - normal
CDC 'Split Type':

Write-up: Pt developed episodes of cyanosis associated with apnea, low O2 sats and staring, limpness - dx seizures seen in ER on 1/8/00, parents stated some blueness around lips noted 36 hrs before being seen.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=133412&WAYBACKHISTORY=ON


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