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This is VAERS ID 112938

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 112938
VAERS Form:
Age:1.5
Sex:Female
Location:New Jersey
Vaccinated:1997-11-05
Onset:1998-01-02
Submitted:1998-07-23
Entered:1998-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: UNK. DTP / UNCLASSIFIED 444256 / 3 - / -
OPV: ORIMUNE / LEDERLE 0775A / 2 - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: RASH, APNEA, ANOREXIA, DIARRHEA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-02
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? No
Previous Vaccinations: pt exp rash/temp @ 16mo w/MMR dose 1;
Other Medications: Nigerol
Current Illness: yeast infect
Preexisting Conditions: ear infect, devel delay physically, gag reflex disorder;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': ear infect, devel delay physically, gag reflex disorder;

Write-up: pt began not eating well, had diarrhea x 1 day, devel sl rash on face & on vaginal area;pt put down for a nap-was found in bed not breathing, pronounced dead @ hosp;


Changed on 12/8/2009

VAERS ID: 112938 Before After
VAERS Form:
Age:1.5
Sex:Female
Location:New Jersey
Vaccinated:1997-11-05
Onset:1998-01-02
Submitted:1998-07-23
Entered:1998-07-31 1998-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: UNK. DTP DTP (NO BRAND NAME) / UNCLASSIFIED UNKNOWN MANUFACTURER 444256 / 3 - / -
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 0775A / 2 - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Anorexia, Apnoea, Diarrhoea, Rash, RASH, APNEA, ANOREXIA, DIARRHEA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-02
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? No
Previous Vaccinations: pt exp rash/temp @ 16mo w/MMR dose 1;
Other Medications: Nigerol
Current Illness: yeast infect
Preexisting Conditions: ear infect, devel delay physically, gag reflex disorder;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': ear infect, devel delay physically, gag reflex disorder; (blank)

Write-up: pt began not eating well, had diarrhea x 1 day, devel sl rash on face & on vaginal area;pt put down for a nap-was found in bed not breathing, pronounced dead @ hosp;


Changed on 5/14/2017

VAERS ID: 112938 Before After
VAERS Form:
Age:1.5
Sex:Female
Location:New Jersey
Vaccinated:1997-11-05
Onset:1998-01-02
Submitted:1998-07-23
Entered:1998-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER 444256 / 3 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 0775A / 2 - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Anorexia, Apnoea, Diarrhoea, Rash

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-02
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? No
Previous Vaccinations:
Other Medications: Nigerol
Current Illness: yeast infect
Preexisting Conditions: ear infect, devel delay physically, gag reflex disorder;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: pt began not eating well, had diarrhea x 1 day, devel sl rash on face & on vaginal area;pt put down for a nap-was found in bed not breathing, pronounced dead @ hosp;


Changed on 9/14/2017

VAERS ID: 112938 Before After
VAERS Form:(blank) 1
Age:1.5
Sex:Female
Location:New Jersey
Vaccinated:1997-11-05
Onset:1998-01-02
Submitted:1998-07-23
Entered:1998-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER 444256 / 3 4 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0775A / 2 3 - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Anorexia, Apnoea, Diarrhoea, Rash

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-02
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? No
Previous Vaccinations:
Other Medications: Nigerol
Current Illness: yeast infect
Preexisting Conditions: ear infect, devel delay physically, gag reflex disorder;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: pt began not eating well, had diarrhea x 1 day, devel sl rash on face & on vaginal area;pt put down for a nap-was found in bed not breathing, pronounced dead @ hosp;


Changed on 2/14/2018

VAERS ID: 112938 Before After
VAERS Form:1
Age:1.5
Sex:Female
Location:New Jersey
Vaccinated:1997-11-05
Onset:1998-01-02
Submitted:1998-07-23
Entered:1998-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER 444256 / 4 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0775A / 3 - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Anorexia, Apnoea, Diarrhoea, Rash

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-02
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? No
Previous Vaccinations:
Other Medications: Nigerol
Current Illness: yeast infect
Preexisting Conditions: ear infect, devel delay physically, gag reflex disorder;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: pt began not eating well, had diarrhea x 1 day, devel sl rash on face & on vaginal area;pt put down for a nap-was found in bed not breathing, pronounced dead @ hosp;


Changed on 6/14/2018

VAERS ID: 112938 Before After
VAERS Form:1
Age:1.5
Sex:Female
Location:New Jersey
Vaccinated:1997-11-05
Onset:1998-01-02
Submitted:1998-07-23
Entered:1998-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER 444256 / 4 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0775A / 3 - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Anorexia, Apnoea, Diarrhoea, Rash

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-02
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? No
Previous Vaccinations:
Other Medications: Nigerol
Current Illness: yeast infect
Preexisting Conditions: ear infect, devel delay physically, gag reflex disorder;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: pt began not eating well, had diarrhea x 1 day, devel sl rash on face & on vaginal area;pt put down for a nap-was found in bed not breathing, pronounced dead @ hosp;


Changed on 8/14/2018

VAERS ID: 112938 Before After
VAERS Form:1
Age:1.5
Sex:Female
Location:New Jersey
Vaccinated:1997-11-05
Onset:1998-01-02
Submitted:1998-07-23
Entered:1998-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER 444256 / 4 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0775A / 3 - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Anorexia, Apnoea, Diarrhoea, Rash

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-02
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? No
Previous Vaccinations:
Other Medications: Nigerol
Current Illness: yeast infect
Preexisting Conditions: ear infect, devel delay physically, gag reflex disorder;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: pt began not eating well, had diarrhea x 1 day, devel sl rash on face & on vaginal area;pt put down for a nap-was found in bed not breathing, pronounced dead @ hosp;


Changed on 9/14/2018

VAERS ID: 112938 Before After
VAERS Form:1
Age:1.5
Sex:Female
Location:New Jersey
Vaccinated:1997-11-05
Onset:1998-01-02
Submitted:1998-07-23
Entered:1998-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER 444256 / 4 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0775A / 3 - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Anorexia, Apnoea, Diarrhoea, Rash

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-02
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? No
Previous Vaccinations:
Other Medications: Nigerol
Current Illness: yeast infect
Preexisting Conditions: ear infect, devel delay physically, gag reflex disorder;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: pt began not eating well, had diarrhea x 1 day, devel sl rash on face & on vaginal area;pt put down for a nap-was found in bed not breathing, pronounced dead @ hosp;


Changed on 10/14/2018

VAERS ID: 112938 Before After
VAERS Form:1
Age:1.5
Sex:Female
Location:New Jersey
Vaccinated:1997-11-05
Onset:1998-01-02
Submitted:1998-07-23
Entered:1998-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER 444256 / 4 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0775A / 3 - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Anorexia, Apnoea, Diarrhoea, Rash

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-02
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? No
Previous Vaccinations:
Other Medications: Nigerol
Current Illness: yeast infect
Preexisting Conditions: ear infect, devel delay physically, gag reflex disorder;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: pt began not eating well, had diarrhea x 1 day, devel sl rash on face & on vaginal area;pt put down for a nap-was found in bed not breathing, pronounced dead @ hosp;

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