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This is VAERS ID 113383

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 113383
VAERS Form:
Age:0.2
Sex:Male
Location:California
Vaccinated:1980-05-01
Onset:1980-05-04
Submitted:1998-08-10
Entered:1998-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: UNK. DTP / UNCLASSIFIED - / - - / -
OPV: UNK. POLIOVIRUS LIVE ORAL TRIVALENT / UNCLASSIFIED - / - - / -

Administered by: Military      Purchased by: Unknown
Symptoms: REACT UNEVAL

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1980-05-04
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: pt sibling exp ITP @ 1 w/DTP/OPV/MMR dose 1;
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NONE

Write-up: On 5/1/80, pt recv vax and on 5/4/80, pt expired. Pt exp no fever, no crying, and no symptoms.


Changed on 12/8/2009

VAERS ID: 113383 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:California
Vaccinated:1980-05-01
Onset:1980-05-04
Submitted:1998-08-10
Entered:1998-08-13 1998-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: UNK. DTP DTP (NO BRAND NAME) / UNCLASSIFIED UNKNOWN MANUFACTURER - / - - / -
OPV: UNK. POLIOVIRUS LIVE ORAL TRIVALENT POLIO VIRUS, ORAL (NO BRAND NAME) / UNCLASSIFIED UNKNOWN MANUFACTURER - / - - / -

Administered by: Military      Purchased by: Unknown Military
Symptoms: Unevaluable event, REACT UNEVAL

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1980-05-04
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: pt sibling exp ITP @ 1 w/DTP/OPV/MMR dose 1;
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NONE (blank)

Write-up: On 5/1/80, pt recv vax and on 5/4/80, pt expired. Pt exp no fever, no crying, and no symptoms.


Changed on 5/14/2017

VAERS ID: 113383 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:California
Vaccinated:1980-05-01
Onset:1980-05-04
Submitted:1998-08-10
Entered:1998-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Military      Purchased by: Military
Symptoms: Unevaluable event

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1980-05-04
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: pt sibling exp ITP @ 1 w/DTP/OPV/MMR dose 1; 1;~ ()~~~In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: On 5/1/80, pt recv vax and on 5/4/80, pt expired. Pt exp no fever, no crying, and no symptoms.


Changed on 9/14/2017

VAERS ID: 113383 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:California
Vaccinated:1980-05-01
Onset:1980-05-04
Submitted:1998-08-10
Entered:1998-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK - / -

Administered by: Military      Purchased by: Military
Symptoms: Unevaluable event

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1980-05-04
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: pt sibling exp ITP @ 1 w/DTP/OPV/MMR dose 1;~ ()~~~In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: On 5/1/80, pt recv vax and on 5/4/80, pt expired. Pt exp no fever, no crying, and no symptoms.


Changed on 2/14/2018

VAERS ID: 113383 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:California
Vaccinated:1980-05-01
Onset:1980-05-04
Submitted:1998-08-10
Entered:1998-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Military      Purchased by: Military
Symptoms: Unevaluable event

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1980-05-04
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: pt sibling exp ITP @ 1 w/DTP/OPV/MMR dose 1;~ ()~~~In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: On 5/1/80, pt recv vax and on 5/4/80, pt expired. Pt exp no fever, no crying, and no symptoms.


Changed on 6/14/2018

VAERS ID: 113383 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:California
Vaccinated:1980-05-01
Onset:1980-05-04
Submitted:1998-08-10
Entered:1998-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Military      Purchased by: Military
Symptoms: Unevaluable event

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1980-05-04
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: pt sibling exp ITP @ 1 w/DTP/OPV/MMR dose 1;~ ()~~~In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: On 5/1/80, pt recv vax and on 5/4/80, pt expired. Pt exp no fever, no crying, and no symptoms.


Changed on 8/14/2018

VAERS ID: 113383 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:California
Vaccinated:1980-05-01
Onset:1980-05-04
Submitted:1998-08-10
Entered:1998-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Military      Purchased by: Military
Symptoms: Unevaluable event

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1980-05-04
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: pt sibling exp ITP @ 1 w/DTP/OPV/MMR dose 1;~ ()~~~In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: On 5/1/80, pt recv vax and on 5/4/80, pt expired. Pt exp no fever, no crying, and no symptoms.


Changed on 9/14/2018

VAERS ID: 113383 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:California
Vaccinated:1980-05-01
Onset:1980-05-04
Submitted:1998-08-10
Entered:1998-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Military      Purchased by: Military
Symptoms: Unevaluable event

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1980-05-04
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: pt sibling exp ITP @ 1 w/DTP/OPV/MMR dose 1;~ ()~~~In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: On 5/1/80, pt recv vax and on 5/4/80, pt expired. Pt exp no fever, no crying, and no symptoms.


Changed on 10/14/2018

VAERS ID: 113383 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:California
Vaccinated:1980-05-01
Onset:1980-05-04
Submitted:1998-08-10
Entered:1998-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Military      Purchased by: Military
Symptoms: Unevaluable event

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1980-05-04
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: pt sibling exp ITP @ 1 w/DTP/OPV/MMR dose 1;~ ()~~~In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: On 5/1/80, pt recv vax and on 5/4/80, pt expired. Pt exp no fever, no crying, and no symptoms.

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