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This is VAERS ID 111826

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 111826
VAERS Form:
Age:79.1
Sex:Female
Location:Ohio
Vaccinated:1998-05-19
Onset:1998-05-23
Submitted:1998-06-09
Entered:1998-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
YF: YELLOW FEVER / CONNAUGHT LABS 0922800 / 0 - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: DYSPNEA, CONFUS, DIARRHEA, MYOCARDITIS, KIDNEY FAIL

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: 21     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recv vax 19MAY98 & 4 days later pt exp diarrhea, confusion & abd pains;some time later the pt exp resp distress, renal failure, myocarditis & septic shock;pt seen by MD & sent to ER:pt adm to ICU;1JUN98 pt still on ventilator-stable;


Changed on 12/8/2009

VAERS ID: 111826 Before After
VAERS Form:
Age:79.1
Sex:Female
Location:Ohio
Vaccinated:1998-05-19
Onset:1998-05-23
Submitted:1998-06-09
Entered:1998-06-16 1998-06-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
YF: YELLOW FEVER YELLOW FEVER (YF-VAX) / CONNAUGHT LABS CONNAUGHT LABORATORIES 0922800 / 0 - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Confusional state, Diarrhoea, Dyspnoea, Myocarditis, Renal failure, Sepsis, Shock, DYSPNEA, CONFUS, DIARRHEA, MYOCARDITIS, KIDNEY FAIL

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: 21     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) U199800261

Write-up: pt recv vax 19MAY98 & 4 days later pt exp diarrhea, confusion & abd pains;some time later the pt exp resp distress, renal failure, myocarditis & septic shock;pt seen by MD & sent to ER:pt adm to ICU;1JUN98 pt still on ventilator-stable;


Changed on 2/14/2017

VAERS ID: 111826 Before After
VAERS Form:
Age:79.1 79.0
Sex:Female
Location:Ohio
Vaccinated:1998-05-19
Onset:1998-05-23
Submitted:1998-06-09
Entered:1998-06-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES 0922800 / 0 - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Confusional state, Diarrhoea, Dyspnoea, Myocarditis, Renal failure, Sepsis, Shock

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: 21     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': U199800261

Write-up: pt recv vax 19MAY98 & 4 days later pt exp diarrhea, confusion & abd pains;some time later the pt exp resp distress, renal failure, myocarditis & septic shock;pt seen by MD & sent to ER:pt adm to ICU;1JUN98 pt still on ventilator-stable;


Changed on 5/14/2017

VAERS ID: 111826 Before After
VAERS Form:
Age:79.0
Sex:Female
Location:Ohio
Vaccinated:1998-05-19
Onset:1998-05-23
Submitted:1998-06-09
Entered:1998-06-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES 0922800 / 0 - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Confusional state, Diarrhoea, Dyspnoea, Myocarditis, Renal failure, Sepsis, Shock

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: 21     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': U199800261

Write-up: pt recv vax 19MAY98 & 4 days later pt exp diarrhea, confusion & abd pains;some time later the pt exp resp distress, renal failure, myocarditis & septic shock;pt seen by MD & sent to ER:pt adm to ICU;1JUN98 pt still on ventilator-stable;


Changed on 9/14/2017

VAERS ID: 111826 Before After
VAERS Form:(blank) 1
Age:79.0
Sex:Female
Location:Ohio
Vaccinated:1998-05-19
Onset:1998-05-23
Submitted:1998-06-09
Entered:1998-06-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES 0922800 / 0 1 - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Confusional state, Diarrhoea, Dyspnoea, Myocarditis, Renal failure, Sepsis, Shock

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: 21     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': U199800261

Write-up: pt recv vax 19MAY98 & 4 days later pt exp diarrhea, confusion & abd pains;some time later the pt exp resp distress, renal failure, myocarditis & septic shock;pt seen by MD & sent to ER:pt adm to ICU;1JUN98 pt still on ventilator-stable;


Changed on 2/14/2018

VAERS ID: 111826 Before After
VAERS Form:1
Age:79.0
Sex:Female
Location:Ohio
Vaccinated:1998-05-19
Onset:1998-05-23
Submitted:1998-06-09
Entered:1998-06-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES 0922800 / 1 - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Confusional state, Diarrhoea, Dyspnoea, Myocarditis, Renal failure, Sepsis, Shock

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: 21     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': U199800261

Write-up: pt recv vax 19MAY98 & 4 days later pt exp diarrhea, confusion & abd pains;some time later the pt exp resp distress, renal failure, myocarditis & septic shock;pt seen by MD & sent to ER:pt adm to ICU;1JUN98 pt still on ventilator-stable;


Changed on 6/14/2018

VAERS ID: 111826 Before After
VAERS Form:1
Age:79.0
Sex:Female
Location:Ohio
Vaccinated:1998-05-19
Onset:1998-05-23
Submitted:1998-06-09
Entered:1998-06-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES 0922800 / 1 - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Confusional state, Diarrhoea, Dyspnoea, Myocarditis, Renal failure, Sepsis, Shock

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: 21     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': U199800261

Write-up: pt recv vax 19MAY98 & 4 days later pt exp diarrhea, confusion & abd pains;some time later the pt exp resp distress, renal failure, myocarditis & septic shock;pt seen by MD & sent to ER:pt adm to ICU;1JUN98 pt still on ventilator-stable;


Changed on 8/14/2018

VAERS ID: 111826 Before After
VAERS Form:1
Age:79.0
Sex:Female
Location:Ohio
Vaccinated:1998-05-19
Onset:1998-05-23
Submitted:1998-06-09
Entered:1998-06-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES 0922800 / 1 - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Confusional state, Diarrhoea, Dyspnoea, Myocarditis, Renal failure, Sepsis, Shock

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: 21     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': U199800261

Write-up: pt recv vax 19MAY98 & 4 days later pt exp diarrhea, confusion & abd pains;some time later the pt exp resp distress, renal failure, myocarditis & septic shock;pt seen by MD & sent to ER:pt adm to ICU;1JUN98 pt still on ventilator-stable;


Changed on 9/14/2018

VAERS ID: 111826 Before After
VAERS Form:1
Age:79.0
Sex:Female
Location:Ohio
Vaccinated:1998-05-19
Onset:1998-05-23
Submitted:1998-06-09
Entered:1998-06-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES 0922800 / 1 - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Confusional state, Diarrhoea, Dyspnoea, Myocarditis, Renal failure, Sepsis, Shock

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: 21     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': U199800261

Write-up: pt recv vax 19MAY98 & 4 days later pt exp diarrhea, confusion & abd pains;some time later the pt exp resp distress, renal failure, myocarditis & septic shock;pt seen by MD & sent to ER:pt adm to ICU;1JUN98 pt still on ventilator-stable;


Changed on 10/14/2018

VAERS ID: 111826 Before After
VAERS Form:1
Age:79.0
Sex:Female
Location:Ohio
Vaccinated:1998-05-19
Onset:1998-05-23
Submitted:1998-06-09
Entered:1998-06-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES 0922800 / 1 - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Confusional state, Diarrhoea, Dyspnoea, Myocarditis, Renal failure, Sepsis, Shock

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: 21     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': U199800261

Write-up: pt recv vax 19MAY98 & 4 days later pt exp diarrhea, confusion & abd pains;some time later the pt exp resp distress, renal failure, myocarditis & septic shock;pt seen by MD & sent to ER:pt adm to ICU;1JUN98 pt still on ventilator-stable;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=111826&WAYBACKHISTORY=ON


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