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This is VAERS ID 26973

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 26973
VAERS Form:
Age:3.6
Sex:Female
Location:California
Vaccinated:1990-07-17
Onset:1990-07-28
Submitted:1990-11-20
Entered:1990-12-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: PROHIBIT / CONNAUGHT LABS 9B11095 / 0 LA / -
OPV: ORIMUNE / LEDERLE 275910 / 2 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: APNEA, CONVULS GRAND MAL, ACIDOSIS, HEART ARREST, BRONCHIOLITIS

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1990-07-28
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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with TOPV/HIB It is not known if pt''s illness was in any way related to previous vaccinations. Death cert states: bronchiolitis w/focal early bronchial pneumonia.


Changed on 12/30/2006

VAERS ID: 26973 Before After
VAERS Form:
Age:3.6
Sex:Female
Location:California
Vaccinated:1990-07-17
Onset:1990-07-28
Submitted:1990-11-20
Entered:1990-12-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: PROHIBIT / CONNAUGHT LABS 9B11095 / 0 LA / -
OPV: ORIMUNE / LEDERLE 275910 / 2 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: APNEA, CONVULS GRAND MAL, ACIDOSIS, HEART ARREST, BRONCHIOLITIS

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1990-07-28
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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with TOPV/HIB It is not known if pt''s pt''''s illness was in any way related to previous vaccinations. Death cert states: bronchiolitis w/focal early bronchial pneumonia.


Changed on 12/8/2009

VAERS ID: 26973 Before After
VAERS Form:
Age:3.6
Sex:Female
Location:California
Vaccinated:1990-07-17
Onset:1990-07-28
Submitted:1990-11-20
Entered:1990-12-14 1990-12-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: PROHIBIT HIB (PROHIBIT) / CONNAUGHT LABS CONNAUGHT LABORATORIES 9B11095 / 0 LA / -
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 275910 / 2 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: Acidosis, Apnoea, Bronchiolitis, Cardiac arrest, Grand mal convulsion, Pneumonia, Sepsis, Shock, APNEA, CONVULS GRAND MAL, ACIDOSIS, HEART ARREST, BRONCHIOLITIS

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1990-07-28
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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) CA9017

Write-up: Pt vaccinated with TOPV/HIB It is not known if pt''''s pt''s illness was in any way related to previous vaccinations. Death cert states: bronchiolitis w/focal early bronchial pneumonia.


Changed on 2/14/2017

VAERS ID: 26973 Before After
VAERS Form:
Age:3.6 3.0
Sex:Female
Location:California
Vaccinated:1990-07-17
Onset:1990-07-28
Submitted:1990-11-20
Entered:1990-12-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 9B11095 / 0 LA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES 275910 / 2 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: Acidosis, Apnoea, Bronchiolitis, Cardiac arrest, Grand mal convulsion, Pneumonia, Sepsis, Shock

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1990-07-28
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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA9017

Write-up: Pt vaccinated with TOPV/HIB It is not known if pt''s illness was in any way related to previous vaccinations. Death cert states: bronchiolitis w/focal early bronchial pneumonia.


Changed on 5/14/2017

VAERS ID: 26973 Before After
VAERS Form:
Age:3.0
Sex:Female
Location:California
Vaccinated:1990-07-17
Onset:1990-07-28
Submitted:1990-11-20
Entered:1990-12-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 9B11095 / 0 LA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 275910 / 2 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: Acidosis, Apnoea, Bronchiolitis, Cardiac arrest, Grand mal convulsion, Pneumonia, Sepsis, Shock

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1990-07-28
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA9017

Write-up: Pt vaccinated with TOPV/HIB It is not known if pt''s illness was in any way related to previous vaccinations. Death cert states: bronchiolitis w/focal early bronchial pneumonia.


Changed on 9/14/2017

VAERS ID: 26973 Before After
VAERS Form:(blank) 1
Age:3.0
Sex:Female
Location:California
Vaccinated:1990-07-17
Onset:1990-07-28
Submitted:1990-11-20
Entered:1990-12-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 9B11095 / 0 1 LA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 275910 / 2 3 - MO / PO

Administered by: Public      Purchased by: Unknown
Symptoms: Acidosis, Apnoea, Bronchiolitis, Cardiac arrest, Grand mal convulsion, Pneumonia, Sepsis, Shock

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1990-07-28
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA9017

Write-up: Pt vaccinated with TOPV/HIB It is not known if pt''s illness was in any way related to previous vaccinations. Death cert states: bronchiolitis w/focal early bronchial pneumonia.


Changed on 2/14/2018

VAERS ID: 26973 Before After
VAERS Form:1
Age:3.0
Sex:Female
Location:California
Vaccinated:1990-07-17
Onset:1990-07-28
Submitted:1990-11-20
Entered:1990-12-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 9B11095 / 1 LA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 275910 / 3 MO / PO

Administered by: Public      Purchased by: Unknown
Symptoms: Acidosis, Apnoea, Bronchiolitis, Cardiac arrest, Grand mal convulsion, Pneumonia, Sepsis, Shock

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1990-07-28
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA9017

Write-up: Pt vaccinated with TOPV/HIB It is not known if pt''s illness was in any way related to previous vaccinations. Death cert states: bronchiolitis w/focal early bronchial pneumonia.


Changed on 6/14/2018

VAERS ID: 26973 Before After
VAERS Form:1
Age:3.0
Sex:Female
Location:California
Vaccinated:1990-07-17
Onset:1990-07-28
Submitted:1990-11-20
Entered:1990-12-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 9B11095 / 1 LA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 275910 / 3 MO / PO

Administered by: Public      Purchased by: Unknown
Symptoms: Acidosis, Apnoea, Bronchiolitis, Cardiac arrest, Grand mal convulsion, Pneumonia, Sepsis, Shock

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1990-07-28
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA9017

Write-up: Pt vaccinated with TOPV/HIB It is not known if pt''s illness was in any way related to previous vaccinations. Death cert states: bronchiolitis w/focal early bronchial pneumonia.


Changed on 8/14/2018

VAERS ID: 26973 Before After
VAERS Form:1
Age:3.0
Sex:Female
Location:California
Vaccinated:1990-07-17
Onset:1990-07-28
Submitted:1990-11-20
Entered:1990-12-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 9B11095 / 1 LA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 275910 / 3 MO / PO

Administered by: Public      Purchased by: Unknown
Symptoms: Acidosis, Apnoea, Bronchiolitis, Cardiac arrest, Grand mal convulsion, Pneumonia, Sepsis, Shock

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1990-07-28
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA9017

Write-up: Pt vaccinated with TOPV/HIB It is not known if pt''s illness was in any way related to previous vaccinations. Death cert states: bronchiolitis w/focal early bronchial pneumonia.


Changed on 9/14/2018

VAERS ID: 26973 Before After
VAERS Form:1
Age:3.0
Sex:Female
Location:California
Vaccinated:1990-07-17
Onset:1990-07-28
Submitted:1990-11-20
Entered:1990-12-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 9B11095 / 1 LA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 275910 / 3 MO / PO

Administered by: Public      Purchased by: Unknown
Symptoms: Acidosis, Apnoea, Bronchiolitis, Cardiac arrest, Grand mal convulsion, Pneumonia, Sepsis, Shock

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1990-07-28
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA9017

Write-up: Pt vaccinated with TOPV/HIB It is not known if pt''s illness was in any way related to previous vaccinations. Death cert states: bronchiolitis w/focal early bronchial pneumonia.


Changed on 10/14/2018

VAERS ID: 26973 Before After
VAERS Form:1
Age:3.0
Sex:Female
Location:California
Vaccinated:1990-07-17
Onset:1990-07-28
Submitted:1990-11-20
Entered:1990-12-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 9B11095 / 1 LA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 275910 / 3 MO / PO

Administered by: Public      Purchased by: Unknown
Symptoms: Acidosis, Apnoea, Bronchiolitis, Cardiac arrest, Grand mal convulsion, Pneumonia, Sepsis, Shock

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1990-07-28
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA9017

Write-up: Pt vaccinated with TOPV/HIB It is not known if pt''s illness was in any way related to previous vaccinations. Death cert states: bronchiolitis w/focal early bronchial pneumonia.

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