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This is VAERS ID 83713

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 83713
VAERS Form:
Age:1.3
Sex:Female
Location:Colorado
Vaccinated:1995-04-25
Onset:1995-05-05
Submitted:0000-00-00
Entered:1996-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA / CONNAUGHT LABS 4J51067 / 0 RL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M520LA / 3 LA / IM
MMR: MMR II / MSD 1744W / 0 LL / IM
OPV: ORIMUNE / LEDERLE 0707B / 3 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: CONVULS, BRADYCARDIA, APNEA, ENCEPHALITIS, BLIND

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
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? Yes
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CT-MRI scan-non specific viral related encephalitis, compounded by hypoxic ischemia-disseminated encephalomyelitis
CDC 'Split Type': NONE

Write-up: hypoxia,bradycardia,cyanosis,gen tonic clonic sz,petechiae over head & neck;transferred to hosp was intubated,end result of severe developmental delay,cortical blindness & cont sz activity


Changed on 12/8/2009

VAERS ID: 83713 Before After
VAERS Form:
Age:1.3
Sex:Female
Location:Colorado
Vaccinated:1995-04-25
Onset:1995-05-05
Submitted:0000-00-00
Entered:1996-03-19 1996-03-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA DTAP (TRIPEDIA) / CONNAUGHT LABS CONNAUGHT LABORATORIES 4J51067 / 0 RL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M520LA / 3 LA / IM
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 1744W / 0 LL / IM
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 0707B / 3 - / PO

Administered by: Public      Purchased by: Unknown Public
Symptoms: Apnoea, Blindness, Bradycardia, Convulsion, Encephalitis, Hypoxia, Mental retardation severity unspecified, Myelitis, CONVULS, BRADYCARDIA, APNEA, ENCEPHALITIS, BLIND

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
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? Yes
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CT-MRI scan-non specific viral related encephalitis, compounded by hypoxic ischemia-disseminated encephalomyelitis
CDC 'Split Type': NONE CO96010

Write-up: hypoxia,bradycardia,cyanosis,gen tonic clonic sz,petechiae over head & neck;transferred to hosp was intubated,end result of severe developmental delay,cortical blindness & cont sz activity


Changed on 5/14/2017

VAERS ID: 83713 Before After
VAERS Form:
Age:1.3
Sex:Female
Location:Colorado
Vaccinated:1995-04-25
Onset:1995-05-05
Submitted:0000-00-00
Entered:1996-03-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 4J51067 / 0 RL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M520LA / 3 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1744W / 0 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 0707B / 3 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Blindness, Bradycardia, Convulsion, Encephalitis, Hypoxia, Mental retardation severity unspecified, Myelitis

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
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? Yes
Previous Vaccinations: NONE NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CT-MRI scan-non specific viral related encephalitis, compounded by hypoxic ischemia-disseminated encephalomyelitis
CDC 'Split Type': CO96010

Write-up: hypoxia,bradycardia,cyanosis,gen tonic clonic sz,petechiae over head & neck;transferred to hosp was intubated,end result of severe developmental delay,cortical blindness & cont sz activity


Changed on 9/14/2017

VAERS ID: 83713 Before After
VAERS Form:(blank) 1
Age:1.3
Sex:Female
Location:Colorado
Vaccinated:1995-04-25
Onset:1995-05-05
Submitted:0000-00-00
Entered:1996-03-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 4J51067 / 0 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M520LA / 3 4 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1744W / 0 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0707B / 3 4 - MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Blindness, Bradycardia, Convulsion, Encephalitis, Hypoxia, Mental retardation severity unspecified, Myelitis

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
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? Yes
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CT-MRI scan-non specific viral related encephalitis, compounded by hypoxic ischemia-disseminated encephalomyelitis
CDC 'Split Type': CO96010

Write-up: hypoxia,bradycardia,cyanosis,gen tonic clonic sz,petechiae over head & neck;transferred to hosp was intubated,end result of severe developmental delay,cortical blindness & cont sz activity


Changed on 2/14/2018

VAERS ID: 83713 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:Colorado
Vaccinated:1995-04-25
Onset:1995-05-05
Submitted:0000-00-00
Entered:1996-03-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 4J51067 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M520LA / 4 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1744W / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0707B / 4 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Blindness, Bradycardia, Convulsion, Encephalitis, Hypoxia, Mental retardation severity unspecified, Myelitis

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
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? Yes
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CT-MRI scan-non specific viral related encephalitis, compounded by hypoxic ischemia-disseminated encephalomyelitis
CDC 'Split Type': CO96010

Write-up: hypoxia,bradycardia,cyanosis,gen tonic clonic sz,petechiae over head & neck;transferred to hosp was intubated,end result of severe developmental delay,cortical blindness & cont sz activity


Changed on 6/14/2018

VAERS ID: 83713 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:Colorado
Vaccinated:1995-04-25
Onset:1995-05-05
Submitted:0000-00-00
Entered:1996-03-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 4J51067 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M520LA / 4 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1744W / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0707B / 4 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Blindness, Bradycardia, Convulsion, Encephalitis, Hypoxia, Mental retardation severity unspecified, Myelitis

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
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? Yes
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CT-MRI scan-non specific viral related encephalitis, compounded by hypoxic ischemia-disseminated encephalomyelitis
CDC 'Split Type': CO96010

Write-up: hypoxia,bradycardia,cyanosis,gen tonic clonic sz,petechiae over head & neck;transferred to hosp was intubated,end result of severe developmental delay,cortical blindness & cont sz activity


Changed on 8/14/2018

VAERS ID: 83713 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:Colorado
Vaccinated:1995-04-25
Onset:1995-05-05
Submitted:0000-00-00
Entered:1996-03-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 4J51067 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M520LA / 4 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1744W / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0707B / 4 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Blindness, Bradycardia, Convulsion, Encephalitis, Hypoxia, Mental retardation severity unspecified, Myelitis

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
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? Yes
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CT-MRI scan-non specific viral related encephalitis, compounded by hypoxic ischemia-disseminated encephalomyelitis
CDC 'Split Type': CO96010

Write-up: hypoxia,bradycardia,cyanosis,gen tonic clonic sz,petechiae over head & neck;transferred to hosp was intubated,end result of severe developmental delay,cortical blindness & cont sz activity


Changed on 9/14/2018

VAERS ID: 83713 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:Colorado
Vaccinated:1995-04-25
Onset:1995-05-05
Submitted:0000-00-00
Entered:1996-03-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 4J51067 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M520LA / 4 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1744W / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0707B / 4 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Blindness, Bradycardia, Convulsion, Encephalitis, Hypoxia, Mental retardation severity unspecified, Myelitis

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
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? Yes
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CT-MRI scan-non specific viral related encephalitis, compounded by hypoxic ischemia-disseminated encephalomyelitis
CDC 'Split Type': CO96010

Write-up: hypoxia,bradycardia,cyanosis,gen tonic clonic sz,petechiae over head & neck;transferred to hosp was intubated,end result of severe developmental delay,cortical blindness & cont sz activity


Changed on 10/14/2018

VAERS ID: 83713 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:Colorado
Vaccinated:1995-04-25
Onset:1995-05-05
Submitted:0000-00-00
Entered:1996-03-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 4J51067 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M520LA / 4 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1744W / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0707B / 4 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Blindness, Bradycardia, Convulsion, Encephalitis, Hypoxia, Mental retardation severity unspecified, Myelitis

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
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? Yes
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CT-MRI scan-non specific viral related encephalitis, compounded by hypoxic ischemia-disseminated encephalomyelitis
CDC 'Split Type': CO96010

Write-up: hypoxia,bradycardia,cyanosis,gen tonic clonic sz,petechiae over head & neck;transferred to hosp was intubated,end result of severe developmental delay,cortical blindness & cont sz activity

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