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This is VAERS ID 34373

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 34373
VAERS Form:
Age:1.3
Sex:Male
Location:New York
Vaccinated:1991-04-17
Onset:1991-04-20
Submitted:1991-04-22
Entered:1991-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIBTITER / LEDERLE(PRAXIS) M705FE / 0 LA / -
MMR: MMR II / MSD 1570S / 0 RA / -

Administered by: Public      Purchased by: Unknown
Symptoms: HYPOTONIA, FEVER, RASH, MENINGITIS, NO DRUG EFFECT

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-04-21
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: Aplitest by Parke-Davis lot# 01990P lt forearm
Current Illness: neg
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Gram Stain CSF-Neisseria Meningitis
CDC 'Split Type':

Write-up: On 20APR91, pt devel temp, rash on body in AM, by late evening became flaccid rushed to ER about 1250AM 21APR91 pronounced dead 124AM;


Changed on 12/8/2009

VAERS ID: 34373 Before After
VAERS Form:
Age:1.3
Sex:Male
Location:New York
Vaccinated:1991-04-17
Onset:1991-04-20
Submitted:1991-04-22
Entered:1991-09-04 1991-08-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M705FE / 0 LA / -
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 1570S / 0 RA / -

Administered by: Public      Purchased by: Unknown Public
Symptoms: Drug ineffective, Hypotonia, Meningitis, Pyrexia, Rash, HYPOTONIA, FEVER, RASH, MENINGITIS, NO DRUG EFFECT

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-04-21
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: Aplitest by Parke-Davis lot# 01990P lt forearm
Current Illness: neg
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Gram Stain CSF-Neisseria Meningitis
CDC 'Split Type': (blank) NYS91064

Write-up: On 20APR91, pt devel temp, rash on body in AM, by late evening became flaccid rushed to ER about 1250AM 21APR91 pronounced dead 124AM;


Changed on 5/14/2017

VAERS ID: 34373 Before After
VAERS Form:
Age:1.3
Sex:Male
Location:New York
Vaccinated:1991-04-17
Onset:1991-04-20
Submitted:1991-04-22
Entered:1991-08-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M705FE / 0 LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1570S / 0 RA / -

Administered by: Public      Purchased by: Public
Symptoms: Drug ineffective, Hypotonia, Meningitis, Pyrexia, Rash

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-04-21
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: Aplitest by Parke-Davis lot# 01990P lt forearm
Current Illness: neg
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Gram Stain CSF-Neisseria Meningitis
CDC 'Split Type': NYS91064

Write-up: On 20APR91, pt devel temp, rash on body in AM, by late evening became flaccid rushed to ER about 1250AM 21APR91 pronounced dead 124AM;


Changed on 9/14/2017

VAERS ID: 34373 Before After
VAERS Form:(blank) 1
Age:1.3
Sex:Male
Location:New York
Vaccinated:1991-04-17
Onset:1991-04-20
Submitted:1991-04-22
Entered:1991-08-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M705FE / 0 1 LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1570S / 0 1 RA / -

Administered by: Public      Purchased by: Public
Symptoms: Drug ineffective, Hypotonia, Meningitis, Pyrexia, Rash

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-04-21
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: Aplitest by Parke-Davis lot# 01990P lt forearm
Current Illness: neg
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Gram Stain CSF-Neisseria Meningitis
CDC 'Split Type': NYS91064

Write-up: On 20APR91, pt devel temp, rash on body in AM, by late evening became flaccid rushed to ER about 1250AM 21APR91 pronounced dead 124AM;


Changed on 2/14/2018

VAERS ID: 34373 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:New York
Vaccinated:1991-04-17
Onset:1991-04-20
Submitted:1991-04-22
Entered:1991-08-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M705FE / 1 LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1570S / 1 RA / -

Administered by: Public      Purchased by: Public
Symptoms: Drug ineffective, Hypotonia, Meningitis, Pyrexia, Rash

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-04-21
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: Aplitest by Parke-Davis lot# 01990P lt forearm
Current Illness: neg
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Gram Stain CSF-Neisseria Meningitis
CDC 'Split Type': NYS91064

Write-up: On 20APR91, pt devel temp, rash on body in AM, by late evening became flaccid rushed to ER about 1250AM 21APR91 pronounced dead 124AM;


Changed on 6/14/2018

VAERS ID: 34373 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:New York
Vaccinated:1991-04-17
Onset:1991-04-20
Submitted:1991-04-22
Entered:1991-08-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M705FE / 1 LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1570S / 1 RA / -

Administered by: Public      Purchased by: Public
Symptoms: Drug ineffective, Hypotonia, Meningitis, Pyrexia, Rash

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-04-21
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: Aplitest by Parke-Davis lot# 01990P lt forearm
Current Illness: neg
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Gram Stain CSF-Neisseria Meningitis
CDC 'Split Type': NYS91064

Write-up: On 20APR91, pt devel temp, rash on body in AM, by late evening became flaccid rushed to ER about 1250AM 21APR91 pronounced dead 124AM;


Changed on 8/14/2018

VAERS ID: 34373 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:New York
Vaccinated:1991-04-17
Onset:1991-04-20
Submitted:1991-04-22
Entered:1991-08-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M705FE / 1 LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1570S / 1 RA / -

Administered by: Public      Purchased by: Public
Symptoms: Drug ineffective, Hypotonia, Meningitis, Pyrexia, Rash

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-04-21
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: Aplitest by Parke-Davis lot# 01990P lt forearm
Current Illness: neg
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Gram Stain CSF-Neisseria Meningitis
CDC 'Split Type': NYS91064

Write-up: On 20APR91, pt devel temp, rash on body in AM, by late evening became flaccid rushed to ER about 1250AM 21APR91 pronounced dead 124AM;


Changed on 9/14/2018

VAERS ID: 34373 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:New York
Vaccinated:1991-04-17
Onset:1991-04-20
Submitted:1991-04-22
Entered:1991-08-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M705FE / 1 LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1570S / 1 RA / -

Administered by: Public      Purchased by: Public
Symptoms: Drug ineffective, Hypotonia, Meningitis, Pyrexia, Rash

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-04-21
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: Aplitest by Parke-Davis lot# 01990P lt forearm
Current Illness: neg
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Gram Stain CSF-Neisseria Meningitis
CDC 'Split Type': NYS91064

Write-up: On 20APR91, pt devel temp, rash on body in AM, by late evening became flaccid rushed to ER about 1250AM 21APR91 pronounced dead 124AM;


Changed on 10/14/2018

VAERS ID: 34373 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:New York
Vaccinated:1991-04-17
Onset:1991-04-20
Submitted:1991-04-22
Entered:1991-08-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M705FE / 1 LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1570S / 1 RA / -

Administered by: Public      Purchased by: Public
Symptoms: Drug ineffective, Hypotonia, Meningitis, Pyrexia, Rash

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-04-21
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: Aplitest by Parke-Davis lot# 01990P lt forearm
Current Illness: neg
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Gram Stain CSF-Neisseria Meningitis
CDC 'Split Type': NYS91064

Write-up: On 20APR91, pt devel temp, rash on body in AM, by late evening became flaccid rushed to ER about 1250AM 21APR91 pronounced dead 124AM;

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