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This is VAERS ID 159083

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 159083
VAERS Form:
Age:1.1
Sex:Female
Location:New Hampshire
Vaccinated:2000-08-15
Onset:2000-08-15
Submitted:2000-08-16
Entered:2000-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: ENGERIX-B / SMITHKLINE 3199A2 / 2 - / IM
VARCEL: VARIVAX / MSD 1450J / 0 - / SC

Administered by: Private      Purchased by: Unknown
Symptoms: FEVER, CYANOSIS, BRADYCARDIA, APNEA, BLOOD DYSCRASIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-08-15
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:
Other Medications: Aspirin, Catopril, Digoxin, Lasix
Current Illness: NONE
Preexisting Conditions: Tricuspid atresia, pulmonary atresia, unrestricted ASD
Allergies:
Diagnostic Lab Data: CBC, WBC, BUN, H/H-17.7/52.3, GLU-165
CDC 'Split Type':

Write-up: The pt developed a fever and vomiting with cyanosis on evening of immunization. In the ER the pulse ox was 50% (normal for her is 78). The pt developed bradycardia and respiratory arrest. Full CPR performed for 70-80 minutes before pronounced.


Changed on 12/8/2009

VAERS ID: 159083 Before After
VAERS Form:
Age:1.1
Sex:Female
Location:New Hampshire
Vaccinated:2000-08-15
Onset:2000-08-15
Submitted:2000-08-16
Entered:2000-08-24 2000-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: ENGERIX-B HEP B (ENGERIX-B) / SMITHKLINE SMITHKLINE BEECHAM 3199A2 / 2 - / IM
VARCEL: VARIVAX VARICELLA (VARIVAX) / MSD MERCK & CO. INC. 1450J / 0 - / SC

Administered by: Private      Purchased by: Unknown Public
Symptoms: Blood glucose increased, Bradycardia, Cyanosis, Haemolysis, Hypoxia, Pyrexia, Respiratory arrest, Vomiting, Blood disorder, FEVER, CYANOSIS, BRADYCARDIA, APNEA, BLOOD DYSCRASIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-08-15
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:
Other Medications: Aspirin, Catopril, Digoxin, Lasix
Current Illness: NONE
Preexisting Conditions: Tricuspid atresia, pulmonary atresia, unrestricted ASD
Allergies:
Diagnostic Lab Data: CBC, WBC, BUN, H/H-17.7/52.3, GLU-165
CDC 'Split Type':

Write-up: The pt developed a fever and vomiting with cyanosis on evening of immunization. In the ER the pulse ox was 50% (normal for her is 78). The pt developed bradycardia and respiratory arrest. Full CPR performed for 70-80 minutes before pronounced. 3


Changed on 2/14/2017

VAERS ID: 159083 Before After
VAERS Form:
Age:1.1 1.08
Sex:Female
Location:New Hampshire
Vaccinated:2000-08-15
Onset:2000-08-15
Submitted:2000-08-16
Entered:2000-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 3199A2 / 2 - / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1450J / 0 - / SC

Administered by: Private      Purchased by: Public
Symptoms: Blood glucose increased, Bradycardia, Cyanosis, Haemolysis, Hypoxia, Pyrexia, Respiratory arrest, Vomiting, Blood disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-08-15
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:
Other Medications: Aspirin, Catopril, Digoxin, Lasix
Current Illness: NONE
Preexisting Conditions: Tricuspid atresia, pulmonary atresia, unrestricted ASD
Allergies:
Diagnostic Lab Data: CBC, WBC, BUN, H/H-17.7/52.3, GLU-165
CDC 'Split Type':

Write-up: The pt developed a fever and vomiting with cyanosis on evening of immunization. In the ER the pulse ox was 50% (normal for her is 78). The pt developed bradycardia and respiratory arrest. Full CPR performed for 70-80 minutes before pronounced. 3


Changed on 5/14/2017

VAERS ID: 159083 Before After
VAERS Form:
Age:1.08
Sex:Female
Location:New Hampshire
Vaccinated:2000-08-15
Onset:2000-08-15
Submitted:2000-08-16
Entered:2000-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 3199A2 / 2 - / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1450J / 0 - / SC

Administered by: Private      Purchased by: Public
Symptoms: Blood glucose increased, Bradycardia, Cyanosis, Haemolysis, Hypoxia, Pyrexia, Respiratory arrest, Vomiting, Blood disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-08-15
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:
Other Medications: Aspirin, Catopril, Digoxin, Lasix
Current Illness: NONE
Preexisting Conditions: Tricuspid atresia, pulmonary atresia, unrestricted ASD
Allergies:
Diagnostic Lab Data: CBC, WBC, BUN, H/H-17.7/52.3, GLU-165
CDC 'Split Type':

Write-up: The pt developed a fever and vomiting with cyanosis on evening of immunization. In the ER the pulse ox was 50% (normal for her is 78). The pt developed bradycardia and respiratory arrest. Full CPR performed for 70-80 minutes before pronounced. 3


Changed on 9/14/2017

VAERS ID: 159083 Before After
VAERS Form:(blank) 1
Age:1.08
Sex:Female
Location:New Hampshire
Vaccinated:2000-08-15
Onset:2000-08-15
Submitted:2000-08-16
Entered:2000-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 3199A2 / 2 3 - / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1450J / 0 1 - / SC

Administered by: Private      Purchased by: Public
Symptoms: Blood glucose increased, Bradycardia, Cyanosis, Haemolysis, Hypoxia, Pyrexia, Respiratory arrest, Vomiting, Blood disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-08-15
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:
Other Medications: Aspirin, Catopril, Digoxin, Lasix
Current Illness: NONE
Preexisting Conditions: Tricuspid atresia, pulmonary atresia, unrestricted ASD
Allergies:
Diagnostic Lab Data: CBC, WBC, BUN, H/H-17.7/52.3, GLU-165
CDC 'Split Type':

Write-up: The pt developed a fever and vomiting with cyanosis on evening of immunization. In the ER the pulse ox was 50% (normal for her is 78). The pt developed bradycardia and respiratory arrest. Full CPR performed for 70-80 minutes before pronounced.


Changed on 2/14/2018

VAERS ID: 159083 Before After
VAERS Form:1
Age:1.08
Sex:Female
Location:New Hampshire
Vaccinated:2000-08-15
Onset:2000-08-15
Submitted:2000-08-16
Entered:2000-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 3199A2 / 3 - / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1450J / 1 - / SC

Administered by: Private      Purchased by: Public
Symptoms: Blood glucose increased, Bradycardia, Cyanosis, Haemolysis, Hypoxia, Pyrexia, Respiratory arrest, Vomiting, Blood disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-08-15
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:
Other Medications: Aspirin, Catopril, Digoxin, Lasix
Current Illness: NONE
Preexisting Conditions: Tricuspid atresia, pulmonary atresia, unrestricted ASD
Allergies:
Diagnostic Lab Data: CBC, WBC, BUN, H/H-17.7/52.3, GLU-165
CDC 'Split Type':

Write-up: The pt developed a fever and vomiting with cyanosis on evening of immunization. In the ER the pulse ox was 50% (normal for her is 78). The pt developed bradycardia and respiratory arrest. Full CPR performed for 70-80 minutes before pronounced.


Changed on 6/14/2018

VAERS ID: 159083 Before After
VAERS Form:1
Age:1.08
Sex:Female
Location:New Hampshire
Vaccinated:2000-08-15
Onset:2000-08-15
Submitted:2000-08-16
Entered:2000-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 3199A2 / 3 - / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1450J / 1 - / SC

Administered by: Private      Purchased by: Public
Symptoms: Blood glucose increased, Bradycardia, Cyanosis, Haemolysis, Hypoxia, Pyrexia, Respiratory arrest, Vomiting, Blood disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-08-15
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:
Other Medications: Aspirin, Catopril, Digoxin, Lasix
Current Illness: NONE
Preexisting Conditions: Tricuspid atresia, pulmonary atresia, unrestricted ASD
Allergies:
Diagnostic Lab Data: CBC, WBC, BUN, H/H-17.7/52.3, GLU-165
CDC 'Split Type':

Write-up: The pt developed a fever and vomiting with cyanosis on evening of immunization. In the ER the pulse ox was 50% (normal for her is 78). The pt developed bradycardia and respiratory arrest. Full CPR performed for 70-80 minutes before pronounced.


Changed on 8/14/2018

VAERS ID: 159083 Before After
VAERS Form:1
Age:1.08
Sex:Female
Location:New Hampshire
Vaccinated:2000-08-15
Onset:2000-08-15
Submitted:2000-08-16
Entered:2000-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 3199A2 / 3 - / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1450J / 1 - / SC

Administered by: Private      Purchased by: Public
Symptoms: Blood glucose increased, Bradycardia, Cyanosis, Haemolysis, Hypoxia, Pyrexia, Respiratory arrest, Vomiting, Blood disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-08-15
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:
Other Medications: Aspirin, Catopril, Digoxin, Lasix
Current Illness: NONE
Preexisting Conditions: Tricuspid atresia, pulmonary atresia, unrestricted ASD
Allergies:
Diagnostic Lab Data: CBC, WBC, BUN, H/H-17.7/52.3, GLU-165
CDC 'Split Type':

Write-up: The pt developed a fever and vomiting with cyanosis on evening of immunization. In the ER the pulse ox was 50% (normal for her is 78). The pt developed bradycardia and respiratory arrest. Full CPR performed for 70-80 minutes before pronounced.


Changed on 9/14/2018

VAERS ID: 159083 Before After
VAERS Form:1
Age:1.08
Sex:Female
Location:New Hampshire
Vaccinated:2000-08-15
Onset:2000-08-15
Submitted:2000-08-16
Entered:2000-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 3199A2 / 3 - / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1450J / 1 - / SC

Administered by: Private      Purchased by: Public
Symptoms: Blood glucose increased, Bradycardia, Cyanosis, Haemolysis, Hypoxia, Pyrexia, Respiratory arrest, Vomiting, Blood disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-08-15
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:
Other Medications: Aspirin, Catopril, Digoxin, Lasix
Current Illness: NONE
Preexisting Conditions: Tricuspid atresia, pulmonary atresia, unrestricted ASD
Allergies:
Diagnostic Lab Data: CBC, WBC, BUN, H/H-17.7/52.3, GLU-165
CDC 'Split Type':

Write-up: The pt developed a fever and vomiting with cyanosis on evening of immunization. In the ER the pulse ox was 50% (normal for her is 78). The pt developed bradycardia and respiratory arrest. Full CPR performed for 70-80 minutes before pronounced.


Changed on 10/14/2018

VAERS ID: 159083 Before After
VAERS Form:1
Age:1.08
Sex:Female
Location:New Hampshire
Vaccinated:2000-08-15
Onset:2000-08-15
Submitted:2000-08-16
Entered:2000-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 3199A2 / 3 - / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1450J / 1 - / SC

Administered by: Private      Purchased by: Public
Symptoms: Blood glucose increased, Bradycardia, Cyanosis, Haemolysis, Hypoxia, Pyrexia, Respiratory arrest, Vomiting, Blood disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-08-15
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:
Other Medications: Aspirin, Catopril, Digoxin, Lasix
Current Illness: NONE
Preexisting Conditions: Tricuspid atresia, pulmonary atresia, unrestricted ASD
Allergies:
Diagnostic Lab Data: CBC, WBC, BUN, H/H-17.7/52.3, GLU-165
CDC 'Split Type':

Write-up: The pt developed a fever and vomiting with cyanosis on evening of immunization. In the ER the pulse ox was 50% (normal for her is 78). The pt developed bradycardia and respiratory arrest. Full CPR performed for 70-80 minutes before pronounced.

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