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This is VAERS ID 133531

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 133531
VAERS Form:
Age:0.1
Sex:Female
Location:New York
Vaccinated:2000-01-19
Onset:2000-01-19
Submitted:2000-01-21
Entered:2000-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA / CONNAUGHT LABS U0039CA / 0 - / -
HBHEPB: COMVAX / MSD 12453 / 0 - / -
IPV: IPV / MERIEUX INST R0395 / 0 - / -

Administered by: Other      Purchased by: Unknown
Symptoms: STUPOR, HYPERTONIA, SKIN DISCOLOR, SALIVA INC

Life Threatening? Yes
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: To be performed, CBC, BC, U, C, LP, labs were nml.
CDC 'Split Type':

Write-up: 45 min post vax, pt develops foaming mouth, stiffening, ashen color, not responsive for couple of seconds. Pt taken to ER. Admitted for full sepsis work up and seizure work up. Tx w/ amipicillin.


Changed on 12/8/2009

VAERS ID: 133531 Before After
VAERS Form:
Age:0.1
Sex:Female
Location:New York
Vaccinated:2000-01-19
Onset:2000-01-19
Submitted:2000-01-21
Entered:2000-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA DTAP (TRIPEDIA) / CONNAUGHT LABS CONNAUGHT LABORATORIES U0039CA / 0 - / -
HBHEPB: COMVAX HIB + HEP B (COMVAX) / MSD MERCK & CO. INC. 12453 / 0 - / -
IPV: IPV POLIO VIRUS, INACT. (NO BRAND NAME) / MERIEUX INST PASTEUR MERIEUX INST. R0395 / 0 - / -

Administered by: Other      Purchased by: Unknown Other
Symptoms: Hypertonia, Salivary hypersecretion, Skin discolouration, Stupor, STUPOR, HYPERTONIA, SKIN DISCOLOR, SALIVA INC

Life Threatening? Yes
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: To be performed, CBC, BC, U, C, LP, labs were nml.
CDC 'Split Type':

Write-up: 45 min post vax, pt develops foaming mouth, stiffening, ashen color, not responsive for couple of seconds. Pt taken to ER. Admitted for full sepsis work up and seizure work up. Tx w/ amipicillin.


Changed on 5/14/2017

VAERS ID: 133531 Before After
VAERS Form:
Age:0.1
Sex:Female
Location:New York
Vaccinated:2000-01-19
Onset:2000-01-19
Submitted:2000-01-21
Entered:2000-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0039CA / 0 - RL / - IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 12453 / 0 - RL / - SC
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R0395 / 0 - RL / - SC

Administered by: Other Private      Purchased by: Other Private
Symptoms: Hypertonia, Salivary hypersecretion, Skin discolouration, Stupor

Life Threatening? Yes
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: To be performed, CBC, BC, U, C, LP, labs were nml.
CDC 'Split Type':

Write-up: 45 min post vax, pt develops foaming mouth, stiffening, ashen color, not responsive for couple of seconds. Pt taken to ER. Admitted for full sepsis work up and seizure work up. Tx w/ amipicillin.


Changed on 9/14/2017

VAERS ID: 133531 Before After
VAERS Form:(blank) 1
Age:0.1
Sex:Female
Location:New York
Vaccinated:2000-01-19
Onset:2000-01-19
Submitted:2000-01-21
Entered:2000-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0039CA / 0 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 12453 / 0 1 RL / SC
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R0395 / 0 1 RL / SC

Administered by: Private      Purchased by: Private
Symptoms: Hypertonia, Salivary hypersecretion, Skin discolouration, Stupor

Life Threatening? Yes
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: To be performed, CBC, BC, U, C, LP, labs were nml.
CDC 'Split Type':

Write-up: 45 min post vax, pt develops foaming mouth, stiffening, ashen color, not responsive for couple of seconds. Pt taken to ER. Admitted for full sepsis work up and seizure work up. Tx w/ amipicillin.


Changed on 2/14/2018

VAERS ID: 133531 Before After
VAERS Form:1
Age:0.1
Sex:Female
Location:New York
Vaccinated:2000-01-19
Onset:2000-01-19
Submitted:2000-01-21
Entered:2000-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0039CA / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 12453 / 1 RL / SC
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R0395 / 1 RL / SC

Administered by: Private      Purchased by: Private
Symptoms: Hypertonia, Salivary hypersecretion, Skin discolouration, Stupor

Life Threatening? Yes
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: To be performed, CBC, BC, U, C, LP, labs were nml.
CDC 'Split Type':

Write-up: 45 min post vax, pt develops foaming mouth, stiffening, ashen color, not responsive for couple of seconds. Pt taken to ER. Admitted for full sepsis work up and seizure work up. Tx w/ amipicillin.


Changed on 6/14/2018

VAERS ID: 133531 Before After
VAERS Form:1
Age:0.1
Sex:Female
Location:New York
Vaccinated:2000-01-19
Onset:2000-01-19
Submitted:2000-01-21
Entered:2000-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0039CA / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 12453 / 1 RL / SC
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R0395 / 1 RL / SC

Administered by: Private      Purchased by: Private
Symptoms: Hypertonia, Salivary hypersecretion, Skin discolouration, Stupor

Life Threatening? Yes
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: To be performed, CBC, BC, U, C, LP, labs were nml.
CDC 'Split Type':

Write-up: 45 min post vax, pt develops foaming mouth, stiffening, ashen color, not responsive for couple of seconds. Pt taken to ER. Admitted for full sepsis work up and seizure work up. Tx w/ amipicillin.


Changed on 8/14/2018

VAERS ID: 133531 Before After
VAERS Form:1
Age:0.1
Sex:Female
Location:New York
Vaccinated:2000-01-19
Onset:2000-01-19
Submitted:2000-01-21
Entered:2000-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0039CA / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 12453 / 1 RL / SC
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R0395 / 1 RL / SC

Administered by: Private      Purchased by: Private
Symptoms: Hypertonia, Salivary hypersecretion, Skin discolouration, Stupor

Life Threatening? Yes
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: To be performed, CBC, BC, U, C, LP, labs were nml.
CDC 'Split Type':

Write-up: 45 min post vax, pt develops foaming mouth, stiffening, ashen color, not responsive for couple of seconds. Pt taken to ER. Admitted for full sepsis work up and seizure work up. Tx w/ amipicillin.


Changed on 9/14/2018

VAERS ID: 133531 Before After
VAERS Form:1
Age:0.1
Sex:Female
Location:New York
Vaccinated:2000-01-19
Onset:2000-01-19
Submitted:2000-01-21
Entered:2000-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0039CA / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 12453 / 1 RL / SC
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R0395 / 1 RL / SC

Administered by: Private      Purchased by: Private
Symptoms: Hypertonia, Salivary hypersecretion, Skin discolouration, Stupor

Life Threatening? Yes
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: To be performed, CBC, BC, U, C, LP, labs were nml.
CDC 'Split Type':

Write-up: 45 min post vax, pt develops foaming mouth, stiffening, ashen color, not responsive for couple of seconds. Pt taken to ER. Admitted for full sepsis work up and seizure work up. Tx w/ amipicillin.


Changed on 10/14/2018

VAERS ID: 133531 Before After
VAERS Form:1
Age:0.1
Sex:Female
Location:New York
Vaccinated:2000-01-19
Onset:2000-01-19
Submitted:2000-01-21
Entered:2000-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0039CA / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 12453 / 1 RL / SC
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R0395 / 1 RL / SC

Administered by: Private      Purchased by: Private
Symptoms: Hypertonia, Salivary hypersecretion, Skin discolouration, Stupor

Life Threatening? Yes
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: To be performed, CBC, BC, U, C, LP, labs were nml.
CDC 'Split Type':

Write-up: 45 min post vax, pt develops foaming mouth, stiffening, ashen color, not responsive for couple of seconds. Pt taken to ER. Admitted for full sepsis work up and seizure work up. Tx w/ amipicillin.


Changed on 12/24/2020

VAERS ID: 133531 Before After
VAERS Form:1
Age:0.1
Sex:Female
Location:New York
Vaccinated:2000-01-19
Onset:2000-01-19
Submitted:2000-01-21
Entered:2000-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0039CA / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 12453 / 1 RL / SC
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R0395 / 1 RL / SC

Administered by: Private      Purchased by: Private
Symptoms: Hypertonia, Salivary hypersecretion, Skin discolouration, Stupor

Life Threatening? Yes
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: To be performed, CBC, BC, U, C, LP, labs were nml.
CDC 'Split Type':

Write-up: 45 min post vax, pt develops foaming mouth, stiffening, ashen color, not responsive for couple of seconds. Pt taken to ER. Admitted for full sepsis work up and seizure work up. Tx w/ amipicillin.


Changed on 12/30/2020

VAERS ID: 133531 Before After
VAERS Form:1
Age:0.1
Sex:Female
Location:New York
Vaccinated:2000-01-19
Onset:2000-01-19
Submitted:2000-01-21
Entered:2000-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0039CA / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 12453 / 1 RL / SC
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R0395 / 1 RL / SC

Administered by: Private      Purchased by: Private
Symptoms: Hypertonia, Salivary hypersecretion, Skin discolouration, Stupor

Life Threatening? Yes
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: To be performed, CBC, BC, U, C, LP, labs were nml.
CDC 'Split Type':

Write-up: 45 min post vax, pt develops foaming mouth, stiffening, ashen color, not responsive for couple of seconds. Pt taken to ER. Admitted for full sepsis work up and seizure work up. Tx w/ amipicillin.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=133531&WAYBACKHISTORY=ON


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