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This is VAERS ID 35495

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 35495
VAERS Form:
Age:0.4
Sex:Female
Location:New York
Vaccinated:1991-09-25
Onset:1991-09-26
Submitted:0000-00-00
Entered:1991-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP / CONNAUGHT LABS 1J21062 / 1 RL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M140HF / 1 LL / IM
OPV: ORIMUNE / LEDERLE 0627D / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: AGITATION, FEVER, MENINGITIS, NO DRUG EFFECT, SHOCK

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1991-09-29
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: LP-pneumococcal meningitis;
CDC 'Split Type':

Write-up: W/in 24 hrs pt irritable, fever, lethargy; Seen 2nd day pt shocky & moribund; had pneumococcal meningitis by LP;


Changed on 12/8/2009

VAERS ID: 35495 Before After
VAERS Form:
Age:0.4
Sex:Female
Location:New York
Vaccinated:1991-09-25
Onset:1991-09-26
Submitted:0000-00-00
Entered:1991-10-17 1991-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP DTP (NO BRAND NAME) / CONNAUGHT LABS CONNAUGHT LABORATORIES 1J21062 / 1 RL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M140HF / 1 LL / IM
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 0627D / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Agitation, Drug ineffective, Meningitis, Pyrexia, Shock, Somnolence, AGITATION, FEVER, MENINGITIS, NO DRUG EFFECT, SHOCK

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1991-09-29
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: LP-pneumococcal meningitis;
CDC 'Split Type':

Write-up: W/in 24 hrs pt irritable, fever, lethargy; Seen 2nd day pt shocky & moribund; had pneumococcal meningitis by LP;


Changed on 5/14/2017

VAERS ID: 35495 Before After
VAERS Form:
Age:0.4
Sex:Female
Location:New York
Vaccinated:1991-09-25
Onset:1991-09-26
Submitted:0000-00-00
Entered:1991-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1J21062 / 1 RL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M140HF / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 0627D / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Agitation, Drug ineffective, Meningitis, Pyrexia, Shock, Somnolence

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1991-09-29
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: LP-pneumococcal meningitis;
CDC 'Split Type':

Write-up: W/in 24 hrs pt irritable, fever, lethargy; Seen 2nd day pt shocky & moribund; had pneumococcal meningitis by LP;


Changed on 9/14/2017

VAERS ID: 35495 Before After
VAERS Form:(blank) 1
Age:0.4
Sex:Female
Location:New York
Vaccinated:1991-09-25
Onset:1991-09-26
Submitted:0000-00-00
Entered:1991-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1J21062 / 1 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M140HF / 1 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0627D / 1 2 - MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Agitation, Drug ineffective, Meningitis, Pyrexia, Shock, Somnolence

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1991-09-29
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: LP-pneumococcal meningitis;
CDC 'Split Type':

Write-up: W/in 24 hrs pt irritable, fever, lethargy; Seen 2nd day pt shocky & moribund; had pneumococcal meningitis by LP;


Changed on 2/14/2018

VAERS ID: 35495 Before After
VAERS Form:1
Age:0.4
Sex:Female
Location:New York
Vaccinated:1991-09-25
Onset:1991-09-26
Submitted:0000-00-00
Entered:1991-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1J21062 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M140HF / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0627D / 2 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Agitation, Drug ineffective, Meningitis, Pyrexia, Shock, Somnolence

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1991-09-29
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: LP-pneumococcal meningitis;
CDC 'Split Type':

Write-up: W/in 24 hrs pt irritable, fever, lethargy; Seen 2nd day pt shocky & moribund; had pneumococcal meningitis by LP;


Changed on 6/14/2018

VAERS ID: 35495 Before After
VAERS Form:1
Age:0.4
Sex:Female
Location:New York
Vaccinated:1991-09-25
Onset:1991-09-26
Submitted:0000-00-00
Entered:1991-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1J21062 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M140HF / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0627D / 2 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Agitation, Drug ineffective, Meningitis, Pyrexia, Shock, Somnolence

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1991-09-29
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: LP-pneumococcal meningitis;
CDC 'Split Type':

Write-up: W/in 24 hrs pt irritable, fever, lethargy; Seen 2nd day pt shocky & moribund; had pneumococcal meningitis by LP;


Changed on 8/14/2018

VAERS ID: 35495 Before After
VAERS Form:1
Age:0.4
Sex:Female
Location:New York
Vaccinated:1991-09-25
Onset:1991-09-26
Submitted:0000-00-00
Entered:1991-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1J21062 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M140HF / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0627D / 2 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Agitation, Drug ineffective, Meningitis, Pyrexia, Shock, Somnolence

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1991-09-29
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: LP-pneumococcal meningitis;
CDC 'Split Type':

Write-up: W/in 24 hrs pt irritable, fever, lethargy; Seen 2nd day pt shocky & moribund; had pneumococcal meningitis by LP;


Changed on 9/14/2018

VAERS ID: 35495 Before After
VAERS Form:1
Age:0.4
Sex:Female
Location:New York
Vaccinated:1991-09-25
Onset:1991-09-26
Submitted:0000-00-00
Entered:1991-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1J21062 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M140HF / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0627D / 2 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Agitation, Drug ineffective, Meningitis, Pyrexia, Shock, Somnolence

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1991-09-29
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: LP-pneumococcal meningitis;
CDC 'Split Type':

Write-up: W/in 24 hrs pt irritable, fever, lethargy; Seen 2nd day pt shocky & moribund; had pneumococcal meningitis by LP;


Changed on 10/14/2018

VAERS ID: 35495 Before After
VAERS Form:1
Age:0.4
Sex:Female
Location:New York
Vaccinated:1991-09-25
Onset:1991-09-26
Submitted:0000-00-00
Entered:1991-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1J21062 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M140HF / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0627D / 2 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Agitation, Drug ineffective, Meningitis, Pyrexia, Shock, Somnolence

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1991-09-29
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: LP-pneumococcal meningitis;
CDC 'Split Type':

Write-up: W/in 24 hrs pt irritable, fever, lethargy; Seen 2nd day pt shocky & moribund; had pneumococcal meningitis by LP;

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=35495&WAYBACKHISTORY=ON


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