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This is VAERS ID 28528

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 28528
VAERS Form:
Age:0.6
Sex:Male
Location:New Jersey
Vaccinated:1991-02-18
Onset:1991-02-18
Submitted:1991-02-19
Entered:1991-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP / CONNAUGHT LABS 0C21045 / 2 - / -
HIBV: HIBTITER / LEDERLE(PRAXIS) M635FN / 2 - / -

Administered by: Private      Purchased by: Unknown
Symptoms: CONVULS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-02-18
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: Digoxin, aspirin
Current Illness:
Preexisting Conditions: Congental Heart Disease
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Expired p/having sz. Occurred 5 hrs post vax.


Changed on 12/8/2009

VAERS ID: 28528 Before After
VAERS Form:
Age:0.6
Sex:Male
Location:New Jersey
Vaccinated:1991-02-18
Onset:1991-02-18
Submitted:1991-02-19
Entered:1991-03-07 1991-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP DTP (NO BRAND NAME) / CONNAUGHT LABS CONNAUGHT LABORATORIES 0C21045 / 2 - / -
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M635FN / 2 - / -

Administered by: Private      Purchased by: Unknown Private
Symptoms: Convulsion, CONVULS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-02-18
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: Digoxin, aspirin
Current Illness:
Preexisting Conditions: Congental Heart Disease
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) CO3790

Write-up: Expired p/having sz. Occurred 5 hrs post vax.


Changed on 5/14/2017

VAERS ID: 28528 Before After
VAERS Form:
Age:0.6
Sex:Male
Location:New Jersey
Vaccinated:1991-02-18
Onset:1991-02-18
Submitted:1991-02-19
Entered:1991-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0C21045 / 2 - / -
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M635FN / 2 - / -

Administered by: Private      Purchased by: Private
Symptoms: Convulsion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-02-18
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: Digoxin, aspirin
Current Illness:
Preexisting Conditions: Congental Heart Disease
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO3790

Write-up: Expired p/having sz. Occurred 5 hrs post vax.


Changed on 9/14/2017

VAERS ID: 28528 Before After
VAERS Form:(blank) 1
Age:0.6
Sex:Male
Location:New Jersey
Vaccinated:1991-02-18
Onset:1991-02-18
Submitted:1991-02-19
Entered:1991-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0C21045 / 2 3 - / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M635FN / 2 3 - / -

Administered by: Private      Purchased by: Private
Symptoms: Convulsion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-02-18
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: Digoxin, aspirin
Current Illness:
Preexisting Conditions: Congental Heart Disease
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO3790

Write-up: Expired p/having sz. Occurred 5 hrs post vax.


Changed on 2/14/2018

VAERS ID: 28528 Before After
VAERS Form:1
Age:0.6
Sex:Male
Location:New Jersey
Vaccinated:1991-02-18
Onset:1991-02-18
Submitted:1991-02-19
Entered:1991-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0C21045 / 3 - / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M635FN / 3 - / -

Administered by: Private      Purchased by: Private
Symptoms: Convulsion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-02-18
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: Digoxin, aspirin
Current Illness:
Preexisting Conditions: Congental Heart Disease
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO3790

Write-up: Expired p/having sz. Occurred 5 hrs post vax.


Changed on 6/14/2018

VAERS ID: 28528 Before After
VAERS Form:1
Age:0.6
Sex:Male
Location:New Jersey
Vaccinated:1991-02-18
Onset:1991-02-18
Submitted:1991-02-19
Entered:1991-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0C21045 / 3 - / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M635FN / 3 - / -

Administered by: Private      Purchased by: Private
Symptoms: Convulsion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-02-18
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: Digoxin, aspirin
Current Illness:
Preexisting Conditions: Congental Heart Disease
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO3790

Write-up: Expired p/having sz. Occurred 5 hrs post vax.


Changed on 8/14/2018

VAERS ID: 28528 Before After
VAERS Form:1
Age:0.6
Sex:Male
Location:New Jersey
Vaccinated:1991-02-18
Onset:1991-02-18
Submitted:1991-02-19
Entered:1991-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0C21045 / 3 - / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M635FN / 3 - / -

Administered by: Private      Purchased by: Private
Symptoms: Convulsion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-02-18
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: Digoxin, aspirin
Current Illness:
Preexisting Conditions: Congental Heart Disease
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO3790

Write-up: Expired p/having sz. Occurred 5 hrs post vax.


Changed on 9/14/2018

VAERS ID: 28528 Before After
VAERS Form:1
Age:0.6
Sex:Male
Location:New Jersey
Vaccinated:1991-02-18
Onset:1991-02-18
Submitted:1991-02-19
Entered:1991-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0C21045 / 3 - / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M635FN / 3 - / -

Administered by: Private      Purchased by: Private
Symptoms: Convulsion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-02-18
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: Digoxin, aspirin
Current Illness:
Preexisting Conditions: Congental Heart Disease
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO3790

Write-up: Expired p/having sz. Occurred 5 hrs post vax.


Changed on 10/14/2018

VAERS ID: 28528 Before After
VAERS Form:1
Age:0.6
Sex:Male
Location:New Jersey
Vaccinated:1991-02-18
Onset:1991-02-18
Submitted:1991-02-19
Entered:1991-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0C21045 / 3 - / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M635FN / 3 - / -

Administered by: Private      Purchased by: Private
Symptoms: Convulsion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-02-18
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: Digoxin, aspirin
Current Illness:
Preexisting Conditions: Congental Heart Disease
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CO3790

Write-up: Expired p/having sz. Occurred 5 hrs post vax.

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