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This is VAERS ID 239968

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 239968
VAERS Form:
Age:1.0
Sex:Female
Location:Ohio
Vaccinated:2004-10-19
Onset:2004-10-21
Submitted:2004-11-09
Entered:2005-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR, UE118AA / 3 RL / IM
MMR: MEASLES MUMPS RUBELLA (VIRIVAC) / MERCK & CO. INC. 0821N / 0 LA / SC
PPV: PNEUMO, 23-VALENT (PNU-IMUNE) / LEDERLE LABORATO A74399K / 2 LL / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: AGITATION, BRADYCARDIA, DEHYDRAT, COUGH INC, EDEMA BRAIN

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Slight Cough - T99.8 - Lungs clear
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Blood sugars, Blood tests, X-rays
CDC 'Split Type':

Write-up: Had been to MD week of 10/18 with normal well child exam. 10/19/2004 slight cough, chest clear temp 99.8 in our office. To MD office 10/21/04 - Dx beginning pneumonia. Antibiotic inj. given and sent home. 10/22/04 Rapid progression of pneumonia at ER. Blo"od sugar 700+ Dx: Diabetic Ketoacidosis. Life flight to Hosp. Brain stem swelling. Pt died 10/24


Changed on 12/8/2009

VAERS ID: 239968 Before After
VAERS Form:
Age:1.0
Sex:Female
Location:Ohio
Vaccinated:2004-10-19
Onset:2004-10-21
Submitted:2004-11-09
Entered:2005-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR, AVENTIS PASTEUR UE118AA / 3 RL / IM
MMR: MEASLES MUMPS RUBELLA (VIRIVAC) MEASLES + MUMPS + RUBELLA (VIRIVAC) / MERCK & CO. INC. 0821N / 0 LA / SC
PPV: PNEUMO, 23-VALENT (PNU-IMUNE) PNEUMO (PNU-IMUNE) / LEDERLE LABORATO LEDERLE LABORATORIES A74399K / 2 LL / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood glucose increased, Bradycardia, Cough, Dehydration, Hyponatraemia, Hypoventilation, Irritability, Ketoacidosis, Lethargy, Pain, Pallor, Pneumonia, Polyuria, Pyrexia, Tachycardia, Weight decreased, Brain oedema, AGITATION, BRADYCARDIA, DEHYDRAT, COUGH INC, EDEMA BRAIN

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Slight Cough - T99.8 - Lungs clear
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Blood sugars, Blood tests, X-rays
CDC 'Split Type':

Write-up: Had been to MD week of 10/18 with normal well child exam. 10/19/2004 slight cough, chest clear temp 99.8 in our office. To MD office 10/21/04 - Dx beginning pneumonia. Antibiotic inj. given and sent home. 10/22/04 Rapid progression of pneumonia at ER. Blo"od Blood sugar 700+ Dx: Diabetic Ketoacidosis. Life flight to Hosp. Brain stem swelling. Pt died 10/24 10/24. Added code of dehydration from Death Certificate rec''d 06/13/2005. From discharge Summary rec''d 06/21/2005, added terms are polyuris, lethargy, weight loss, tachycardia, dehydration, irritable, bradycardia, hypoventilation, pain, hyperventilation, pallow, and hyponatremia.


Changed on 2/14/2017

VAERS ID: 239968 Before After
VAERS Form:
Age:1.0 1.04
Sex:Female
Location:Ohio
Vaccinated:2004-10-19
Onset:2004-10-21
Submitted:2004-11-09
Entered:2005-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR SANOFI PASTEUR UE118AA / 3 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (VIRIVAC) / MERCK & CO. INC. 0821N / 0 LA / SC
PPV: PNEUMO (PNU-IMUNE) / LEDERLE LABORATORIES PFIZER/WYETH A74399K / 2 LL / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood glucose increased, Bradycardia, Cough, Dehydration, Hyponatraemia, Hypoventilation, Irritability, Ketoacidosis, Lethargy, Pain, Pallor, Pneumonia, Polyuria, Pyrexia, Tachycardia, Weight decreased, Brain oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Slight Cough - T99.8 - Lungs clear
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Blood sugars, Blood tests, X-rays
CDC 'Split Type':

Write-up: Had been to MD week of 10/18 with normal well child exam. 10/19/2004 slight cough, chest clear temp 99.8 in our office. To MD office 10/21/04 - Dx beginning pneumonia. Antibiotic inj. given and sent home. 10/22/04 Rapid progression of pneumonia at ER. Blood sugar 700+ Dx: Diabetic Ketoacidosis. Life flight to Hosp. Brain stem swelling. Pt died 10/24. Added code of dehydration from Death Certificate rec''d 06/13/2005. From discharge Summary rec''d 06/21/2005, added terms are polyuris, lethargy, weight loss, tachycardia, dehydration, irritable, bradycardia, hypoventilation, pain, hyperventilation, pallow, and hyponatremia.


Changed on 9/14/2017

VAERS ID: 239968 Before After
VAERS Form:(blank) 1
Age:1.04
Sex:Female
Location:Ohio
Vaccinated:2004-10-19
Onset:2004-10-21
Submitted:2004-11-09
Entered:2005-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE118AA / 3 4 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (VIRIVAC) / MERCK & CO. INC. 0821N / 0 1 LA / SC
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH A74399K / 2 3 LL / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood glucose increased, Bradycardia, Cough, Dehydration, Hyponatraemia, Hypoventilation, Irritability, Ketoacidosis, Lethargy, Pain, Pallor, Pneumonia, Polyuria, Pyrexia, Tachycardia, Weight decreased, Brain oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Slight Cough - T99.8 - Lungs clear
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Blood sugars, Blood tests, X-rays
CDC 'Split Type':

Write-up: Had been to MD week of 10/18 with normal well child exam. 10/19/2004 slight cough, chest clear temp 99.8 in our office. To MD office 10/21/04 - Dx beginning pneumonia. Antibiotic inj. given and sent home. 10/22/04 Rapid progression of pneumonia at ER. Blood sugar 700+ Dx: Diabetic Ketoacidosis. Life flight to Hosp. Brain stem swelling. Pt died 10/24. Added code of dehydration from Death Certificate rec''d 06/13/2005. From discharge Summary rec''d 06/21/2005, added terms are polyuris, lethargy, weight loss, tachycardia, dehydration, irritable, bradycardia, hypoventilation, pain, hyperventilation, pallow, and hyponatremia.


Changed on 2/14/2018

VAERS ID: 239968 Before After
VAERS Form:1
Age:1.04
Sex:Female
Location:Ohio
Vaccinated:2004-10-19
Onset:2004-10-21
Submitted:2004-11-09
Entered:2005-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE118AA / 4 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (VIRIVAC) / MERCK & CO. INC. 0821N / 1 LA / SC
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH A74399K / 3 LL / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood glucose increased, Bradycardia, Cough, Dehydration, Hyponatraemia, Hypoventilation, Irritability, Ketoacidosis, Lethargy, Pain, Pallor, Pneumonia, Polyuria, Pyrexia, Tachycardia, Weight decreased, Brain oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Slight Cough - T99.8 - Lungs clear
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Blood sugars, Blood tests, X-rays
CDC 'Split Type':

Write-up: Had been to MD week of 10/18 with normal well child exam. 10/19/2004 slight cough, chest clear temp 99.8 in our office. To MD office 10/21/04 - Dx beginning pneumonia. Antibiotic inj. given and sent home. 10/22/04 Rapid progression of pneumonia at ER. Blood sugar 700+ Dx: Diabetic Ketoacidosis. Life flight to Hosp. Brain stem swelling. Pt died 10/24. Added code of dehydration from Death Certificate rec''d 06/13/2005. From discharge Summary rec''d 06/21/2005, added terms are polyuris, lethargy, weight loss, tachycardia, dehydration, irritable, bradycardia, hypoventilation, pain, hyperventilation, pallow, and hyponatremia.


Changed on 6/14/2018

VAERS ID: 239968 Before After
VAERS Form:1
Age:1.04
Sex:Female
Location:Ohio
Vaccinated:2004-10-19
Onset:2004-10-21
Submitted:2004-11-09
Entered:2005-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE118AA / 4 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (VIRIVAC) / MERCK & CO. INC. 0821N / 1 LA / SC
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH A74399K / 3 LL / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood glucose increased, Bradycardia, Cough, Dehydration, Hyponatraemia, Hypoventilation, Irritability, Ketoacidosis, Lethargy, Pain, Pallor, Pneumonia, Polyuria, Pyrexia, Tachycardia, Weight decreased, Brain oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Slight Cough - T99.8 - Lungs clear
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Blood sugars, Blood tests, X-rays
CDC 'Split Type':

Write-up: Had been to MD week of 10/18 with normal well child exam. 10/19/2004 slight cough, chest clear temp 99.8 in our office. To MD office 10/21/04 - Dx beginning pneumonia. Antibiotic inj. given and sent home. 10/22/04 Rapid progression of pneumonia at ER. Blood sugar 700+ Dx: Diabetic Ketoacidosis. Life flight to Hosp. Brain stem swelling. Pt died 10/24. Added code of dehydration from Death Certificate rec''d 06/13/2005. From discharge Summary rec''d 06/21/2005, added terms are polyuris, lethargy, weight loss, tachycardia, dehydration, irritable, bradycardia, hypoventilation, pain, hyperventilation, pallow, and hyponatremia.


Changed on 8/14/2018

VAERS ID: 239968 Before After
VAERS Form:1
Age:1.04
Sex:Female
Location:Ohio
Vaccinated:2004-10-19
Onset:2004-10-21
Submitted:2004-11-09
Entered:2005-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE118AA / 4 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (VIRIVAC) / MERCK & CO. INC. 0821N / 1 LA / SC
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH A74399K / 3 LL / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood glucose increased, Bradycardia, Cough, Dehydration, Hyponatraemia, Hypoventilation, Irritability, Ketoacidosis, Lethargy, Pain, Pallor, Pneumonia, Polyuria, Pyrexia, Tachycardia, Weight decreased, Brain oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Slight Cough - T99.8 - Lungs clear
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Blood sugars, Blood tests, X-rays
CDC 'Split Type':

Write-up: Had been to MD week of 10/18 with normal well child exam. 10/19/2004 slight cough, chest clear temp 99.8 in our office. To MD office 10/21/04 - Dx beginning pneumonia. Antibiotic inj. given and sent home. 10/22/04 Rapid progression of pneumonia at ER. Blood sugar 700+ Dx: Diabetic Ketoacidosis. Life flight to Hosp. Brain stem swelling. Pt died 10/24. Added code of dehydration from Death Certificate rec''d 06/13/2005. From discharge Summary rec''d 06/21/2005, added terms are polyuris, lethargy, weight loss, tachycardia, dehydration, irritable, bradycardia, hypoventilation, pain, hyperventilation, pallow, and hyponatremia.


Changed on 9/14/2018

VAERS ID: 239968 Before After
VAERS Form:1
Age:1.04
Sex:Female
Location:Ohio
Vaccinated:2004-10-19
Onset:2004-10-21
Submitted:2004-11-09
Entered:2005-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE118AA / 4 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (VIRIVAC) / MERCK & CO. INC. 0821N / 1 LA / SC
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH A74399K / 3 LL / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood glucose increased, Bradycardia, Cough, Dehydration, Hyponatraemia, Hypoventilation, Irritability, Ketoacidosis, Lethargy, Pain, Pallor, Pneumonia, Polyuria, Pyrexia, Tachycardia, Weight decreased, Brain oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Slight Cough - T99.8 - Lungs clear
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Blood sugars, Blood tests, X-rays
CDC 'Split Type':

Write-up: Had been to MD week of 10/18 with normal well child exam. 10/19/2004 slight cough, chest clear temp 99.8 in our office. To MD office 10/21/04 - Dx beginning pneumonia. Antibiotic inj. given and sent home. 10/22/04 Rapid progression of pneumonia at ER. Blood sugar 700+ Dx: Diabetic Ketoacidosis. Life flight to Hosp. Brain stem swelling. Pt died 10/24. Added code of dehydration from Death Certificate rec''d 06/13/2005. From discharge Summary rec''d 06/21/2005, added terms are polyuris, lethargy, weight loss, tachycardia, dehydration, irritable, bradycardia, hypoventilation, pain, hyperventilation, pallow, and hyponatremia.


Changed on 10/14/2018

VAERS ID: 239968 Before After
VAERS Form:1
Age:1.04
Sex:Female
Location:Ohio
Vaccinated:2004-10-19
Onset:2004-10-21
Submitted:2004-11-09
Entered:2005-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE118AA / 4 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (VIRIVAC) / MERCK & CO. INC. 0821N / 1 LA / SC
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH A74399K / 3 LL / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood glucose increased, Bradycardia, Cough, Dehydration, Hyponatraemia, Hypoventilation, Irritability, Ketoacidosis, Lethargy, Pain, Pallor, Pneumonia, Polyuria, Pyrexia, Tachycardia, Weight decreased, Brain oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Slight Cough - T99.8 - Lungs clear
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Blood sugars, Blood tests, X-rays
CDC 'Split Type':

Write-up: Had been to MD week of 10/18 with normal well child exam. 10/19/2004 slight cough, chest clear temp 99.8 in our office. To MD office 10/21/04 - Dx beginning pneumonia. Antibiotic inj. given and sent home. 10/22/04 Rapid progression of pneumonia at ER. Blood sugar 700+ Dx: Diabetic Ketoacidosis. Life flight to Hosp. Brain stem swelling. Pt died 10/24. Added code of dehydration from Death Certificate rec''d 06/13/2005. From discharge Summary rec''d 06/21/2005, added terms are polyuris, lethargy, weight loss, tachycardia, dehydration, irritable, bradycardia, hypoventilation, pain, hyperventilation, pallow, and hyponatremia.

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