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This is VAERS ID 27313

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 27313
VAERS Form:
Age:1.6
Sex:Male
Location:West Virginia
Vaccinated:1989-07-17
Onset:1990-12-03
Submitted:1990-12-27
Entered:1991-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP / CONNAUGHT LABS - / - - / -
HIBV: PROHIBIT / CONNAUGHT LABS 8J01171 / 0 - / -
OPV: ORIMUNE / LEDERLE - / - - / -

Administered by: Private      Purchased by: Unknown
Symptoms: MENINGITIS, NO DRUG EFFECT, SEPSIS, IMMUNE SYSTEM DIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-05
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Blood Culture positive for H. Influenza type B
CDC 'Split Type':

Write-up: Died after developing Hib meningitis. MD sending samples to CDC for analysis. Reported that the child had some form of immune deficiency. Father told MD he also had a form of immune deficiency.


Changed on 12/8/2009

VAERS ID: 27313 Before After
VAERS Form:
Age:1.6
Sex:Male
Location:West Virginia
Vaccinated:1989-07-17
Onset:1990-12-03
Submitted:1990-12-27
Entered:1991-01-09 1991-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP DTP (NO BRAND NAME) / CONNAUGHT LABS CONNAUGHT LABORATORIES - / - - / -
HIBV: PROHIBIT HIB (PROHIBIT) / CONNAUGHT LABS CONNAUGHT LABORATORIES 8J01171 / 0 - / -
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES - / - - / -

Administered by: Private      Purchased by: Unknown Private
Symptoms: Drug ineffective, Immune system disorder, Meningitis, Sepsis, MENINGITIS, NO DRUG EFFECT, SEPSIS, IMMUNE SYSTEM DIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-05
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Blood Culture positive for H. Influenza type B
CDC 'Split Type': (blank) CO3731

Write-up: Died after developing Hib meningitis. MD sending samples to CDC for analysis. Reported that the child had some form of immune deficiency. Father told MD he also had a form of immune deficiency.


Changed on 5/14/2017

VAERS ID: 27313 Before After
VAERS Form:
Age:1.6
Sex:Male
Location:West Virginia
Vaccinated:1989-07-17
Onset:1990-12-03
Submitted:1990-12-27
Entered:1991-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES - / - - / -
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 8J01171 / 0 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH - / - - / -

Administered by: Private      Purchased by: Private
Symptoms: Drug ineffective, Immune system disorder, Meningitis, Sepsis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-05
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Blood Culture positive for H. Influenza type B
CDC 'Split Type': CO3731

Write-up: Died after developing Hib meningitis. MD sending samples to CDC for analysis. Reported that the child had some form of immune deficiency. Father told MD he also had a form of immune deficiency.


Changed on 9/14/2017

VAERS ID: 27313 Before After
VAERS Form:(blank) 1
Age:1.6
Sex:Male
Location:West Virginia
Vaccinated:1989-07-17
Onset:1990-12-03
Submitted:1990-12-27
Entered:1991-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES - / - UNK - / -
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 8J01171 / 0 1 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / - UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Drug ineffective, Immune system disorder, Meningitis, Sepsis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-05
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Blood Culture positive for H. Influenza type B
CDC 'Split Type': CO3731

Write-up: Died after developing Hib meningitis. MD sending samples to CDC for analysis. Reported that the child had some form of immune deficiency. Father told MD he also had a form of immune deficiency.


Changed on 2/14/2018

VAERS ID: 27313 Before After
VAERS Form:1
Age:1.6
Sex:Male
Location:West Virginia
Vaccinated:1989-07-17
Onset:1990-12-03
Submitted:1990-12-27
Entered:1991-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES - / UNK - / -
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 8J01171 / 1 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Drug ineffective, Immune system disorder, Meningitis, Sepsis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-05
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Blood Culture positive for H. Influenza type B
CDC 'Split Type': CO3731

Write-up: Died after developing Hib meningitis. MD sending samples to CDC for analysis. Reported that the child had some form of immune deficiency. Father told MD he also had a form of immune deficiency.


Changed on 6/14/2018

VAERS ID: 27313 Before After
VAERS Form:1
Age:1.6
Sex:Male
Location:West Virginia
Vaccinated:1989-07-17
Onset:1990-12-03
Submitted:1990-12-27
Entered:1991-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES - / UNK - / -
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 8J01171 / 1 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Drug ineffective, Immune system disorder, Meningitis, Sepsis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-05
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Blood Culture positive for H. Influenza type B
CDC 'Split Type': CO3731

Write-up: Died after developing Hib meningitis. MD sending samples to CDC for analysis. Reported that the child had some form of immune deficiency. Father told MD he also had a form of immune deficiency.


Changed on 8/14/2018

VAERS ID: 27313 Before After
VAERS Form:1
Age:1.6
Sex:Male
Location:West Virginia
Vaccinated:1989-07-17
Onset:1990-12-03
Submitted:1990-12-27
Entered:1991-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES - / UNK - / -
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 8J01171 / 1 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Drug ineffective, Immune system disorder, Meningitis, Sepsis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-05
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Blood Culture positive for H. Influenza type B
CDC 'Split Type': CO3731

Write-up: Died after developing Hib meningitis. MD sending samples to CDC for analysis. Reported that the child had some form of immune deficiency. Father told MD he also had a form of immune deficiency.


Changed on 9/14/2018

VAERS ID: 27313 Before After
VAERS Form:1
Age:1.6
Sex:Male
Location:West Virginia
Vaccinated:1989-07-17
Onset:1990-12-03
Submitted:1990-12-27
Entered:1991-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES - / UNK - / -
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 8J01171 / 1 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Drug ineffective, Immune system disorder, Meningitis, Sepsis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-05
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Blood Culture positive for H. Influenza type B
CDC 'Split Type': CO3731

Write-up: Died after developing Hib meningitis. MD sending samples to CDC for analysis. Reported that the child had some form of immune deficiency. Father told MD he also had a form of immune deficiency.


Changed on 10/14/2018

VAERS ID: 27313 Before After
VAERS Form:1
Age:1.6
Sex:Male
Location:West Virginia
Vaccinated:1989-07-17
Onset:1990-12-03
Submitted:1990-12-27
Entered:1991-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES - / UNK - / -
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 8J01171 / 1 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Drug ineffective, Immune system disorder, Meningitis, Sepsis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-05
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Blood Culture positive for H. Influenza type B
CDC 'Split Type': CO3731

Write-up: Died after developing Hib meningitis. MD sending samples to CDC for analysis. Reported that the child had some form of immune deficiency. Father told MD he also had a form of immune deficiency.

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