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This is VAERS ID 445693

History of Changes from the VAERS Wayback Machine

First Appeared on 1/15/2012

VAERS ID: 445693
VAERS Form:
Age:1.0
Sex:Male
Location:D.C.
Vaccinated:2011-11-28
Onset:2011-12-02
Submitted:2011-12-16
Entered:2011-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C39999AA / 3 RL / IM
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1068AA / 0 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0513AA / 0 RL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916921 / 3 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0950AA / 0 LL / SC

Administered by: Unknown      Purchased by: Public
Symptoms: Coagulopathy, Epistaxis, Haemoptysis, Peritoneal dialysis, Platelet count decreased, Renal failure acute, Respiratory failure

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: Pulmicort, Albuterol, Poly-vi-sol with iron, ibuprofen
Current Illness: no
Preexisting Conditions: Prematurity (born at 29 weeks gestation) Hx of thrombocytopenia and hepatitis in NICU - resolved Asthma/chronic lung disease Developmental delay
Allergies:
Diagnostic Lab Data: unknown - evaluation at Hospital
CDC 'Split Type':

Write-up: Patient traveled to another country on 12/1/11. Following day, began bleeding from his nose and coughing up blood. Found to have low platelets and profound coagulopathy. Subsequently has developed respiratory failure and acute renal failure requiring peritoneal dialysis. No infectious or other etiology identified to date.


Changed on 6/14/2014

VAERS ID: 445693 Before After
VAERS Form:
Age:1.0
Sex:Male
Location:D.C.
Vaccinated:2011-11-28
Onset:2011-12-02
Submitted:2011-12-16
Entered:2011-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C39999AA / 3 RL / IM
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1068AA / 0 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0513AA / 0 RL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916921 / 3 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0950AA / 0 LL / SC

Administered by: Unknown      Purchased by: Public
Symptoms: Coagulopathy, Epistaxis, Haemoptysis, Peritoneal dialysis, Platelet count decreased, Renal failure acute, Respiratory failure

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: Pulmicort, Albuterol, Poly-vi-sol with iron, ibuprofen
Current Illness: no
Preexisting Conditions: Prematurity (born at 29 weeks gestation) Hx of thrombocytopenia and hepatitis in NICU - resolved Asthma/chronic lung disease Developmental delay
Allergies:
Diagnostic Lab Data: unknown - evaluation at Hospital
CDC 'Split Type':

Write-up: Patient traveled to another country on 12/1/11. Following day, began bleeding from his nose and coughing up blood. Found to have low platelets and profound coagulopathy. Subsequently has developed respiratory failure and acute renal failure requiring peritoneal dialysis. No infectious or other etiology identified to date.


Changed on 3/14/2015

VAERS ID: 445693 Before After
VAERS Form:
Age:1.0
Sex:Male
Location:D.C.
Vaccinated:2011-11-28
Onset:2011-12-02
Submitted:2011-12-16
Entered:2011-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C39999AA / 3 RL / IM
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1068AA / 0 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0513AA / 0 RL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916921 / 3 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0950AA / 0 LL / SC

Administered by: Unknown      Purchased by: Public
Symptoms: Coagulopathy, Epistaxis, Haemoptysis, Peritoneal dialysis, Platelet count decreased, Renal failure acute, Respiratory failure

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: Pulmicort, Albuterol, Poly-vi-sol with iron, ibuprofen
Current Illness: no
Preexisting Conditions: Prematurity (born at 29 weeks gestation) Hx of thrombocytopenia and hepatitis in NICU - resolved Asthma/chronic lung disease Developmental delay
Allergies:
Diagnostic Lab Data: unknown - evaluation at Hospital
CDC 'Split Type':

Write-up: Patient traveled to another country on 12/1/11. Following day, began bleeding from his nose and coughing up blood. Found to have low platelets and profound coagulopathy. Subsequently has developed respiratory failure and acute renal failure requiring peritoneal dialysis. No infectious or other etiology identified to date.


Changed on 2/14/2017

VAERS ID: 445693 Before After
VAERS Form:
Age:1.0 1.01
Sex:Male
Location:D.C.
Vaccinated:2011-11-28
Onset:2011-12-02
Submitted:2011-12-16
Entered:2011-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C39999AA / 3 RL / IM
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1068AA / 0 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0513AA / 0 RL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916921 / 3 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0950AA / 0 LL / SC

Administered by: Unknown      Purchased by: Public
Symptoms: Coagulopathy, Epistaxis, Haemoptysis, Peritoneal dialysis, Platelet count decreased, Renal failure acute, Respiratory failure

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: Pulmicort, Albuterol, Poly-vi-sol with iron, ibuprofen
Current Illness: no
Preexisting Conditions: Prematurity (born at 29 weeks gestation) Hx of thrombocytopenia and hepatitis in NICU - resolved Asthma/chronic lung disease Developmental delay
Allergies:
Diagnostic Lab Data: unknown - evaluation at Hospital
CDC 'Split Type':

Write-up: Patient traveled to another country on 12/1/11. Following day, began bleeding from his nose and coughing up blood. Found to have low platelets and profound coagulopathy. Subsequently has developed respiratory failure and acute renal failure requiring peritoneal dialysis. No infectious or other etiology identified to date.


Changed on 9/14/2017

VAERS ID: 445693 Before After
VAERS Form:(blank) 1
Age:1.01
Sex:Male
Location:D.C.
Vaccinated:2011-11-28
Onset:2011-12-02
Submitted:2011-12-16
Entered:2011-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C39999AA / 3 4 RL / IM
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1068AA / 0 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0513AA / 0 1 RL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916921 / 3 4 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0950AA / 0 1 LL / SC

Administered by: Unknown      Purchased by: Public
Symptoms: Coagulopathy, Epistaxis, Haemoptysis, Peritoneal dialysis, Platelet count decreased, Renal failure acute, Respiratory failure

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: Pulmicort, Albuterol, Poly-vi-sol with iron, ibuprofen
Current Illness: no
Preexisting Conditions: Prematurity (born at 29 weeks gestation) Hx of thrombocytopenia and hepatitis in NICU - resolved Asthma/chronic lung disease Developmental delay
Allergies:
Diagnostic Lab Data: unknown - evaluation at Hospital
CDC 'Split Type':

Write-up: Patient traveled to another country on 12/1/11. Following day, began bleeding from his nose and coughing up blood. Found to have low platelets and profound coagulopathy. Subsequently has developed respiratory failure and acute renal failure requiring peritoneal dialysis. No infectious or other etiology identified to date.


Changed on 2/14/2018

VAERS ID: 445693 Before After
VAERS Form:1
Age:1.01
Sex:Male
Location:D.C.
Vaccinated:2011-11-28
Onset:2011-12-02
Submitted:2011-12-16
Entered:2011-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C39999AA / 4 RL / IM
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1068AA / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0513AA / 1 RL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916921 / 4 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0950AA / 1 LL / SC

Administered by: Unknown      Purchased by: Public
Symptoms: Coagulopathy, Epistaxis, Haemoptysis, Peritoneal dialysis, Platelet count decreased, Renal failure acute, Respiratory failure

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: Pulmicort, Albuterol, Poly-vi-sol with iron, ibuprofen
Current Illness: no
Preexisting Conditions: Prematurity (born at 29 weeks gestation) Hx of thrombocytopenia and hepatitis in NICU - resolved Asthma/chronic lung disease Developmental delay
Allergies:
Diagnostic Lab Data: unknown - evaluation at Hospital
CDC 'Split Type':

Write-up: Patient traveled to another country on 12/1/11. Following day, began bleeding from his nose and coughing up blood. Found to have low platelets and profound coagulopathy. Subsequently has developed respiratory failure and acute renal failure requiring peritoneal dialysis. No infectious or other etiology identified to date.


Changed on 6/14/2018

VAERS ID: 445693 Before After
VAERS Form:1
Age:1.01
Sex:Male
Location:D.C.
Vaccinated:2011-11-28
Onset:2011-12-02
Submitted:2011-12-16
Entered:2011-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C39999AA / 4 RL / IM
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1068AA / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0513AA / 1 RL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916921 / 4 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0950AA / 1 LL / SC

Administered by: Unknown      Purchased by: Public
Symptoms: Coagulopathy, Epistaxis, Haemoptysis, Peritoneal dialysis, Platelet count decreased, Renal failure acute, Respiratory failure

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: Pulmicort, Albuterol, Poly-vi-sol with iron, ibuprofen
Current Illness: no
Preexisting Conditions: Prematurity (born at 29 weeks gestation) Hx of thrombocytopenia and hepatitis in NICU - resolved Asthma/chronic lung disease Developmental delay
Allergies:
Diagnostic Lab Data: unknown - evaluation at Hospital
CDC 'Split Type':

Write-up: Patient traveled to another country on 12/1/11. Following day, began bleeding from his nose and coughing up blood. Found to have low platelets and profound coagulopathy. Subsequently has developed respiratory failure and acute renal failure requiring peritoneal dialysis. No infectious or other etiology identified to date.


Changed on 8/14/2018

VAERS ID: 445693 Before After
VAERS Form:1
Age:1.01
Sex:Male
Location:D.C.
Vaccinated:2011-11-28
Onset:2011-12-02
Submitted:2011-12-16
Entered:2011-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C39999AA / 4 RL / IM
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1068AA / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0513AA / 1 RL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916921 / 4 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0950AA / 1 LL / SC

Administered by: Unknown      Purchased by: Public
Symptoms: Coagulopathy, Epistaxis, Haemoptysis, Peritoneal dialysis, Platelet count decreased, Renal failure acute, Respiratory failure

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: Pulmicort, Albuterol, Poly-vi-sol with iron, ibuprofen
Current Illness: no
Preexisting Conditions: Prematurity (born at 29 weeks gestation) Hx of thrombocytopenia and hepatitis in NICU - resolved Asthma/chronic lung disease Developmental delay
Allergies:
Diagnostic Lab Data: unknown - evaluation at Hospital
CDC 'Split Type':

Write-up: Patient traveled to another country on 12/1/11. Following day, began bleeding from his nose and coughing up blood. Found to have low platelets and profound coagulopathy. Subsequently has developed respiratory failure and acute renal failure requiring peritoneal dialysis. No infectious or other etiology identified to date.


Changed on 9/14/2018

VAERS ID: 445693 Before After
VAERS Form:1
Age:1.01
Sex:Male
Location:D.C.
Vaccinated:2011-11-28
Onset:2011-12-02
Submitted:2011-12-16
Entered:2011-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C39999AA / 4 RL / IM
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1068AA / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0513AA / 1 RL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916921 / 4 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0950AA / 1 LL / SC

Administered by: Unknown      Purchased by: Public
Symptoms: Coagulopathy, Epistaxis, Haemoptysis, Peritoneal dialysis, Platelet count decreased, Renal failure acute, Respiratory failure

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: Pulmicort, Albuterol, Poly-vi-sol with iron, ibuprofen
Current Illness: no
Preexisting Conditions: Prematurity (born at 29 weeks gestation) Hx of thrombocytopenia and hepatitis in NICU - resolved Asthma/chronic lung disease Developmental delay
Allergies:
Diagnostic Lab Data: unknown - evaluation at Hospital
CDC 'Split Type':

Write-up: Patient traveled to another country on 12/1/11. Following day, began bleeding from his nose and coughing up blood. Found to have low platelets and profound coagulopathy. Subsequently has developed respiratory failure and acute renal failure requiring peritoneal dialysis. No infectious or other etiology identified to date.


Changed on 10/14/2018

VAERS ID: 445693 Before After
VAERS Form:1
Age:1.01
Sex:Male
Location:D.C.
Vaccinated:2011-11-28
Onset:2011-12-02
Submitted:2011-12-16
Entered:2011-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C39999AA / 4 RL / IM
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1068AA / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0513AA / 1 RL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916921 / 4 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0950AA / 1 LL / SC

Administered by: Unknown      Purchased by: Public
Symptoms: Coagulopathy, Epistaxis, Haemoptysis, Peritoneal dialysis, Platelet count decreased, Renal failure acute, Respiratory failure

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: Pulmicort, Albuterol, Poly-vi-sol with iron, ibuprofen
Current Illness: no
Preexisting Conditions: Prematurity (born at 29 weeks gestation) Hx of thrombocytopenia and hepatitis in NICU - resolved Asthma/chronic lung disease Developmental delay
Allergies:
Diagnostic Lab Data: unknown - evaluation at Hospital
CDC 'Split Type':

Write-up: Patient traveled to another country on 12/1/11. Following day, began bleeding from his nose and coughing up blood. Found to have low platelets and profound coagulopathy. Subsequently has developed respiratory failure and acute renal failure requiring peritoneal dialysis. No infectious or other etiology identified to date.

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