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This is VAERS ID 35477

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 35477
VAERS Form:
Age:5.4
Sex:Male
Location:Louisiana
Vaccinated:1991-09-26
Onset:1991-09-26
Submitted:1991-09-30
Entered:1991-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED, PEDIATRIC / CONNAUGHT LABS 1L21055 / 3 LA / -
MMR: MMR II / MSD 1904S / 1 RA / SC
OPV: ORIMUNE / LEDERLE 304966 / 4 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: REACT UNEVAL

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-09-26
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: None known;
Other Medications:
Current Illness: None known;
Preexisting Conditions: Sz disorder, microcephaly, & mental retardation;
Allergies:
Diagnostic Lab Data: Unknown;
CDC 'Split Type': Sz disorder, microcephaly, & mental retardation;

Write-up: 27SEP91 recd call from friend of family informing Health Unit that PT died night of 26SEP91 @ hospital p/immunizations 26SEP91;


Changed on 12/8/2009

VAERS ID: 35477 Before After
VAERS Form:
Age:5.4
Sex:Male
Location:Louisiana
Vaccinated:1991-09-26
Onset:1991-09-26
Submitted:1991-09-30
Entered:1991-10-15 1991-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED, PEDIATRIC DT ADSORBED (NO BRAND NAME) / CONNAUGHT LABS CONNAUGHT LABORATORIES 1L21055 / 3 LA / -
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 1904S / 1 RA / SC
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 304966 / 4 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: Unevaluable event, REACT UNEVAL

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-09-26
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: None known;
Other Medications:
Current Illness: None known;
Preexisting Conditions: Sz disorder, microcephaly, & mental retardation;
Allergies:
Diagnostic Lab Data: Unknown;
CDC 'Split Type': Sz disorder, microcephaly, & mental retardation; LA911001

Write-up: 27SEP91 recd call from friend of family informing Health Unit that PT died night of 26SEP91 @ hospital p/immunizations 26SEP91;


Changed on 2/14/2017

VAERS ID: 35477 Before After
VAERS Form:
Age:5.4 5.0
Sex:Male
Location:Louisiana
Vaccinated:1991-09-26
Onset:1991-09-26
Submitted:1991-09-30
Entered:1991-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 1L21055 / 3 LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1904S / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES 304966 / 4 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-09-26
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: None known;
Other Medications:
Current Illness: None known;
Preexisting Conditions: Sz disorder, microcephaly, & mental retardation;
Allergies:
Diagnostic Lab Data: Unknown;
CDC 'Split Type': LA911001

Write-up: 27SEP91 recd call from friend of family informing Health Unit that PT died night of 26SEP91 @ hospital p/immunizations 26SEP91;


Changed on 5/14/2017

VAERS ID: 35477 Before After
VAERS Form:
Age:5.0
Sex:Male
Location:Louisiana
Vaccinated:1991-09-26
Onset:1991-09-26
Submitted:1991-09-30
Entered:1991-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 1L21055 / 3 LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1904S / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 304966 / 4 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-09-26
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: None known; known;~ ()~~~In patient
Other Medications:
Current Illness: None known;
Preexisting Conditions: Sz disorder, microcephaly, & mental retardation;
Allergies:
Diagnostic Lab Data: Unknown;
CDC 'Split Type': LA911001

Write-up: 27SEP91 recd call from friend of family informing Health Unit that PT died night of 26SEP91 @ hospital p/immunizations 26SEP91;


Changed on 9/14/2017

VAERS ID: 35477 Before After
VAERS Form:(blank) 1
Age:5.0
Sex:Male
Location:Louisiana
Vaccinated:1991-09-26
Onset:1991-09-26
Submitted:1991-09-30
Entered:1991-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 1L21055 / 3 4 LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1904S / 1 2 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 304966 / 4 5 - MO / PO

Administered by: Public      Purchased by: Unknown
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-09-26
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: None known;~ ()~~~In patient
Other Medications:
Current Illness: None known;
Preexisting Conditions: Sz disorder, microcephaly, & mental retardation;
Allergies:
Diagnostic Lab Data: Unknown;
CDC 'Split Type': LA911001

Write-up: 27SEP91 recd call from friend of family informing Health Unit that PT died night of 26SEP91 @ hospital p/immunizations 26SEP91;


Changed on 2/14/2018

VAERS ID: 35477 Before After
VAERS Form:1
Age:5.0
Sex:Male
Location:Louisiana
Vaccinated:1991-09-26
Onset:1991-09-26
Submitted:1991-09-30
Entered:1991-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 1L21055 / 4 LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1904S / 2 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 304966 / 5 MO / PO

Administered by: Public      Purchased by: Unknown
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-09-26
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: None known;~ ()~~~In patient
Other Medications:
Current Illness: None known;
Preexisting Conditions: Sz disorder, microcephaly, & mental retardation;
Allergies:
Diagnostic Lab Data: Unknown;
CDC 'Split Type': LA911001

Write-up: 27SEP91 recd call from friend of family informing Health Unit that PT died night of 26SEP91 @ hospital p/immunizations 26SEP91;


Changed on 6/14/2018

VAERS ID: 35477 Before After
VAERS Form:1
Age:5.0
Sex:Male
Location:Louisiana
Vaccinated:1991-09-26
Onset:1991-09-26
Submitted:1991-09-30
Entered:1991-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 1L21055 / 4 LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1904S / 2 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 304966 / 5 MO / PO

Administered by: Public      Purchased by: Unknown
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-09-26
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: None known;~ ()~~~In patient
Other Medications:
Current Illness: None known;
Preexisting Conditions: Sz disorder, microcephaly, & mental retardation;
Allergies:
Diagnostic Lab Data: Unknown;
CDC 'Split Type': LA911001

Write-up: 27SEP91 recd call from friend of family informing Health Unit that PT died night of 26SEP91 @ hospital p/immunizations 26SEP91;


Changed on 8/14/2018

VAERS ID: 35477 Before After
VAERS Form:1
Age:5.0
Sex:Male
Location:Louisiana
Vaccinated:1991-09-26
Onset:1991-09-26
Submitted:1991-09-30
Entered:1991-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 1L21055 / 4 LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1904S / 2 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 304966 / 5 MO / PO

Administered by: Public      Purchased by: Unknown
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-09-26
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: None known;~ ()~~~In patient
Other Medications:
Current Illness: None known;
Preexisting Conditions: Sz disorder, microcephaly, & mental retardation;
Allergies:
Diagnostic Lab Data: Unknown;
CDC 'Split Type': LA911001

Write-up: 27SEP91 recd call from friend of family informing Health Unit that PT died night of 26SEP91 @ hospital p/immunizations 26SEP91;


Changed on 9/14/2018

VAERS ID: 35477 Before After
VAERS Form:1
Age:5.0
Sex:Male
Location:Louisiana
Vaccinated:1991-09-26
Onset:1991-09-26
Submitted:1991-09-30
Entered:1991-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 1L21055 / 4 LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1904S / 2 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 304966 / 5 MO / PO

Administered by: Public      Purchased by: Unknown
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-09-26
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: None known;~ ()~~~In patient
Other Medications:
Current Illness: None known;
Preexisting Conditions: Sz disorder, microcephaly, & mental retardation;
Allergies:
Diagnostic Lab Data: Unknown;
CDC 'Split Type': LA911001

Write-up: 27SEP91 recd call from friend of family informing Health Unit that PT died night of 26SEP91 @ hospital p/immunizations 26SEP91;


Changed on 10/14/2018

VAERS ID: 35477 Before After
VAERS Form:1
Age:5.0
Sex:Male
Location:Louisiana
Vaccinated:1991-09-26
Onset:1991-09-26
Submitted:1991-09-30
Entered:1991-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 1L21055 / 4 LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1904S / 2 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 304966 / 5 MO / PO

Administered by: Public      Purchased by: Unknown
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-09-26
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: None known;~ ()~~~In patient
Other Medications:
Current Illness: None known;
Preexisting Conditions: Sz disorder, microcephaly, & mental retardation;
Allergies:
Diagnostic Lab Data: Unknown;
CDC 'Split Type': LA911001

Write-up: 27SEP91 recd call from friend of family informing Health Unit that PT died night of 26SEP91 @ hospital p/immunizations 26SEP91;

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=35477&WAYBACKHISTORY=ON


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