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This is VAERS ID 111980

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 111980
VAERS Form:
Age:1.3
Sex:Female
Location:Maryland
Vaccinated:1998-05-11
Onset:1998-05-15
Submitted:1998-06-04
Entered:1998-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIBTITER / LEDERLE(PRAXIS) M285RJ / 2 LL / IM
VARCEL: VARIVAX / MSD 1568E / 0 RL / SC

Administered by: Private      Purchased by: Unknown
Symptoms: SOMNOLENCE, INFECT, STUPOR, MENINGITIS, MYOCARDITIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-05-15
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? No
Previous Vaccinations: NONE
Other Medications: Suprax prescribed 11MAY p/vax given;
Current Illness: NONE
Preexisting Conditions: OM
Allergies:
Diagnostic Lab Data: case pending-MD medical examiners office;
CDC 'Split Type': OM

Write-up: 15MAY 6AM call from mom to report pt is unresponsive had been vomiting for 2 days & inc lethargic;advised to call 911-pt taken to hosp-resuscitation unsuccessful;


Changed on 12/8/2009

VAERS ID: 111980 Before After
VAERS Form:
Age:1.3
Sex:Female
Location:Maryland
Vaccinated:1998-05-11
Onset:1998-05-15
Submitted:1998-06-04
Entered:1998-06-23 1998-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M285RJ / 2 LL / IM
VARCEL: VARIVAX VARICELLA (VARIVAX) / MSD MERCK & CO. INC. 1568E / 0 RL / SC

Administered by: Private      Purchased by: Unknown Other
Symptoms: Infection, Meningitis, Myocarditis, Somnolence, Stupor, Vomiting, SOMNOLENCE, INFECT, STUPOR, MENINGITIS, MYOCARDITIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-05-15
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? No
Previous Vaccinations: NONE
Other Medications: Suprax prescribed 11MAY p/vax given;
Current Illness: NONE
Preexisting Conditions: OM
Allergies:
Diagnostic Lab Data: case pending-MD medical examiners office;
CDC 'Split Type': OM (blank)

Write-up: 15MAY 6AM call from mom to report pt is unresponsive had been vomiting for 2 days & inc lethargic;advised to call 911-pt taken to hosp-resuscitation unsuccessful;


Changed on 5/14/2017

VAERS ID: 111980 Before After
VAERS Form:
Age:1.3
Sex:Female
Location:Maryland
Vaccinated:1998-05-11
Onset:1998-05-15
Submitted:1998-06-04
Entered:1998-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M285RJ / 2 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1568E / 0 RL / SC

Administered by: Private      Purchased by: Other
Symptoms: Infection, Meningitis, Myocarditis, Somnolence, Stupor, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-05-15
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? No
Previous Vaccinations: NONE NONE~ ()~~~In patient
Other Medications: Suprax prescribed 11MAY p/vax given;
Current Illness: NONE
Preexisting Conditions: OM
Allergies:
Diagnostic Lab Data: case pending-MD medical examiners office;
CDC 'Split Type':

Write-up: 15MAY 6AM call from mom to report pt is unresponsive had been vomiting for 2 days & inc lethargic;advised to call 911-pt taken to hosp-resuscitation unsuccessful;


Changed on 9/14/2017

VAERS ID: 111980 Before After
VAERS Form:(blank) 1
Age:1.3
Sex:Female
Location:Maryland
Vaccinated:1998-05-11
Onset:1998-05-15
Submitted:1998-06-04
Entered:1998-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M285RJ / 2 3 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1568E / 0 1 RL / SC

Administered by: Private      Purchased by: Other
Symptoms: Infection, Meningitis, Myocarditis, Somnolence, Stupor, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-05-15
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? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Suprax prescribed 11MAY p/vax given;
Current Illness: NONE
Preexisting Conditions: OM
Allergies:
Diagnostic Lab Data: case pending-MD medical examiners office;
CDC 'Split Type':

Write-up: 15MAY 6AM call from mom to report pt is unresponsive had been vomiting for 2 days & inc lethargic;advised to call 911-pt taken to hosp-resuscitation unsuccessful;


Changed on 2/14/2018

VAERS ID: 111980 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:Maryland
Vaccinated:1998-05-11
Onset:1998-05-15
Submitted:1998-06-04
Entered:1998-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M285RJ / 3 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1568E / 1 RL / SC

Administered by: Private      Purchased by: Other
Symptoms: Infection, Meningitis, Myocarditis, Somnolence, Stupor, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-05-15
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? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Suprax prescribed 11MAY p/vax given;
Current Illness: NONE
Preexisting Conditions: OM
Allergies:
Diagnostic Lab Data: case pending-MD medical examiners office;
CDC 'Split Type':

Write-up: 15MAY 6AM call from mom to report pt is unresponsive had been vomiting for 2 days & inc lethargic;advised to call 911-pt taken to hosp-resuscitation unsuccessful;


Changed on 6/14/2018

VAERS ID: 111980 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:Maryland
Vaccinated:1998-05-11
Onset:1998-05-15
Submitted:1998-06-04
Entered:1998-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M285RJ / 3 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1568E / 1 RL / SC

Administered by: Private      Purchased by: Other
Symptoms: Infection, Meningitis, Myocarditis, Somnolence, Stupor, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-05-15
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? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Suprax prescribed 11MAY p/vax given;
Current Illness: NONE
Preexisting Conditions: OM
Allergies:
Diagnostic Lab Data: case pending-MD medical examiners office;
CDC 'Split Type':

Write-up: 15MAY 6AM call from mom to report pt is unresponsive had been vomiting for 2 days & inc lethargic;advised to call 911-pt taken to hosp-resuscitation unsuccessful;


Changed on 8/14/2018

VAERS ID: 111980 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:Maryland
Vaccinated:1998-05-11
Onset:1998-05-15
Submitted:1998-06-04
Entered:1998-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M285RJ / 3 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1568E / 1 RL / SC

Administered by: Private      Purchased by: Other
Symptoms: Infection, Meningitis, Myocarditis, Somnolence, Stupor, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-05-15
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? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Suprax prescribed 11MAY p/vax given;
Current Illness: NONE
Preexisting Conditions: OM
Allergies:
Diagnostic Lab Data: case pending-MD medical examiners office;
CDC 'Split Type':

Write-up: 15MAY 6AM call from mom to report pt is unresponsive had been vomiting for 2 days & inc lethargic;advised to call 911-pt taken to hosp-resuscitation unsuccessful;


Changed on 9/14/2018

VAERS ID: 111980 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:Maryland
Vaccinated:1998-05-11
Onset:1998-05-15
Submitted:1998-06-04
Entered:1998-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M285RJ / 3 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1568E / 1 RL / SC

Administered by: Private      Purchased by: Other
Symptoms: Infection, Meningitis, Myocarditis, Somnolence, Stupor, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-05-15
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? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Suprax prescribed 11MAY p/vax given;
Current Illness: NONE
Preexisting Conditions: OM
Allergies:
Diagnostic Lab Data: case pending-MD medical examiners office;
CDC 'Split Type':

Write-up: 15MAY 6AM call from mom to report pt is unresponsive had been vomiting for 2 days & inc lethargic;advised to call 911-pt taken to hosp-resuscitation unsuccessful;


Changed on 10/14/2018

VAERS ID: 111980 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:Maryland
Vaccinated:1998-05-11
Onset:1998-05-15
Submitted:1998-06-04
Entered:1998-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M285RJ / 3 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1568E / 1 RL / SC

Administered by: Private      Purchased by: Other
Symptoms: Infection, Meningitis, Myocarditis, Somnolence, Stupor, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-05-15
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? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Suprax prescribed 11MAY p/vax given;
Current Illness: NONE
Preexisting Conditions: OM
Allergies:
Diagnostic Lab Data: case pending-MD medical examiners office;
CDC 'Split Type':

Write-up: 15MAY 6AM call from mom to report pt is unresponsive had been vomiting for 2 days & inc lethargic;advised to call 911-pt taken to hosp-resuscitation unsuccessful;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=111980&WAYBACKHISTORY=ON


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