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This is VAERS ID 113477

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 113477
VAERS Form:
Age:0.2
Sex:Male
Location:American Samoa
Vaccinated:1998-07-29
Onset:1998-07-29
Submitted:1998-08-03
Entered:1998-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPH: TETRAMUNE / LEDERLE 449098 / 0 LL / IM
OPV: ORIMUNE / LEDERLE 0789E / 0 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: FEVER, CYANOSIS, APNEA, DYSPNEA, HEART ARREST

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-07-30
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:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COD uncertain;
CDC 'Split Type':

Write-up: pt recv vax & became feverish & fussy that afternoon (5-6 hr later) but still feeding;to ER 30JUL98 w/severe resp distress, grunting, cyanosis, drawing in of chest, semi-comatose shock, afeb;intubated;WBC 49.2, segs polys 33%,lymph 61%;


Changed on 12/8/2009

VAERS ID: 113477 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:American Samoa
Vaccinated:1998-07-29
Onset:1998-07-29
Submitted:1998-08-03
Entered:1998-08-19 1998-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPH: TETRAMUNE / LEDERLE 449098 / 0 LL / IM
DTPHIB: DTP + HIB (TETRAMUNE) / LEDERLE LABORATORIES 449098 / 0 LL / IM
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 0789E / 0 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: Apnoea, Cardiac arrest, Cyanosis, Dyspnoea, Lymphocytosis, Pyrexia, Sepsis, Shock, FEVER, CYANOSIS, APNEA, DYSPNEA, HEART ARREST

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-07-30
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:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COD uncertain;
CDC 'Split Type':

Write-up: pt recv vax & became feverish & fussy that afternoon (5-6 hr later) but still feeding;to ER 30JUL98 w/severe resp distress, grunting, cyanosis, drawing in of chest, semi-comatose shock, afeb;intubated;WBC 49.2, segs polys 33%,lymph 61%;


Changed on 5/14/2017

VAERS ID: 113477 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:American Samoa
Vaccinated:1998-07-29
Onset:1998-07-29
Submitted:1998-08-03
Entered:1998-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 449098 / 0 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 0789E / 0 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: Apnoea, Cardiac arrest, Cyanosis, Dyspnoea, Lymphocytosis, Pyrexia, Sepsis, Shock

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-07-30
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: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COD uncertain;
CDC 'Split Type':

Write-up: pt recv vax & became feverish & fussy that afternoon (5-6 hr later) but still feeding;to ER 30JUL98 w/severe resp distress, grunting, cyanosis, drawing in of chest, semi-comatose shock, afeb;intubated;WBC 49.2, segs polys 33%,lymph 61%;


Changed on 9/14/2017

VAERS ID: 113477 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:American Samoa
Vaccinated:1998-07-29
Onset:1998-07-29
Submitted:1998-08-03
Entered:1998-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 449098 / 0 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0789E / 0 1 - MO / PO

Administered by: Public      Purchased by: Unknown
Symptoms: Apnoea, Cardiac arrest, Cyanosis, Dyspnoea, Lymphocytosis, Pyrexia, Sepsis, Shock

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-07-30
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: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COD uncertain;
CDC 'Split Type':

Write-up: pt recv vax & became feverish & fussy that afternoon (5-6 hr later) but still feeding;to ER 30JUL98 w/severe resp distress, grunting, cyanosis, drawing in of chest, semi-comatose shock, afeb;intubated;WBC 49.2, segs polys 33%,lymph 61%;


Changed on 2/14/2018

VAERS ID: 113477 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:American Samoa
Vaccinated:1998-07-29
Onset:1998-07-29
Submitted:1998-08-03
Entered:1998-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 449098 / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0789E / 1 MO / PO

Administered by: Public      Purchased by: Unknown
Symptoms: Apnoea, Cardiac arrest, Cyanosis, Dyspnoea, Lymphocytosis, Pyrexia, Sepsis, Shock

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-07-30
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: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COD uncertain;
CDC 'Split Type':

Write-up: pt recv vax & became feverish & fussy that afternoon (5-6 hr later) but still feeding;to ER 30JUL98 w/severe resp distress, grunting, cyanosis, drawing in of chest, semi-comatose shock, afeb;intubated;WBC 49.2, segs polys 33%,lymph 61%;


Changed on 6/14/2018

VAERS ID: 113477 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:American Samoa
Vaccinated:1998-07-29
Onset:1998-07-29
Submitted:1998-08-03
Entered:1998-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 449098 / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0789E / 1 MO / PO

Administered by: Public      Purchased by: Unknown
Symptoms: Apnoea, Cardiac arrest, Cyanosis, Dyspnoea, Lymphocytosis, Pyrexia, Sepsis, Shock

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-07-30
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: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COD uncertain;
CDC 'Split Type':

Write-up: pt recv vax & became feverish & fussy that afternoon (5-6 hr later) but still feeding;to ER 30JUL98 w/severe resp distress, grunting, cyanosis, drawing in of chest, semi-comatose shock, afeb;intubated;WBC 49.2, segs polys 33%,lymph 61%;


Changed on 8/14/2018

VAERS ID: 113477 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:American Samoa
Vaccinated:1998-07-29
Onset:1998-07-29
Submitted:1998-08-03
Entered:1998-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 449098 / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0789E / 1 MO / PO

Administered by: Public      Purchased by: Unknown
Symptoms: Apnoea, Cardiac arrest, Cyanosis, Dyspnoea, Lymphocytosis, Pyrexia, Sepsis, Shock

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-07-30
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: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COD uncertain;
CDC 'Split Type':

Write-up: pt recv vax & became feverish & fussy that afternoon (5-6 hr later) but still feeding;to ER 30JUL98 w/severe resp distress, grunting, cyanosis, drawing in of chest, semi-comatose shock, afeb;intubated;WBC 49.2, segs polys 33%,lymph 61%;


Changed on 9/14/2018

VAERS ID: 113477 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:American Samoa
Vaccinated:1998-07-29
Onset:1998-07-29
Submitted:1998-08-03
Entered:1998-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 449098 / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0789E / 1 MO / PO

Administered by: Public      Purchased by: Unknown
Symptoms: Apnoea, Cardiac arrest, Cyanosis, Dyspnoea, Lymphocytosis, Pyrexia, Sepsis, Shock

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-07-30
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: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COD uncertain;
CDC 'Split Type':

Write-up: pt recv vax & became feverish & fussy that afternoon (5-6 hr later) but still feeding;to ER 30JUL98 w/severe resp distress, grunting, cyanosis, drawing in of chest, semi-comatose shock, afeb;intubated;WBC 49.2, segs polys 33%,lymph 61%;


Changed on 10/14/2018

VAERS ID: 113477 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:American Samoa
Vaccinated:1998-07-29
Onset:1998-07-29
Submitted:1998-08-03
Entered:1998-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 449098 / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0789E / 1 MO / PO

Administered by: Public      Purchased by: Unknown
Symptoms: Apnoea, Cardiac arrest, Cyanosis, Dyspnoea, Lymphocytosis, Pyrexia, Sepsis, Shock

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-07-30
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: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COD uncertain;
CDC 'Split Type':

Write-up: pt recv vax & became feverish & fussy that afternoon (5-6 hr later) but still feeding;to ER 30JUL98 w/severe resp distress, grunting, cyanosis, drawing in of chest, semi-comatose shock, afeb;intubated;WBC 49.2, segs polys 33%,lymph 61%;

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