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This is VAERS ID 33613

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 33613
VAERS Form:
Age:0.2
Sex:Male
Location:Massachusetts
Vaccinated:1991-07-24
Onset:1991-07-25
Submitted:1991-08-07
Entered:1991-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE DTP271 / 0 LL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M115HA / 0 RL / IM
OPV: ORIMUNE / LEDERLE 298952 / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: INFECT, SHOCK

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Blood culture- H. Flu
CDC 'Split Type': NONE

Write-up: Pt presented in Septic shock w/ DIC around MN on day of receiving 1st set of immun; Pt blood grew H. Flu from blood culture;


Changed on 12/8/2009

VAERS ID: 33613 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Massachusetts
Vaccinated:1991-07-24
Onset:1991-07-25
Submitted:1991-08-07
Entered:1991-08-15 1991-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES DTP271 / 0 LL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M115HA / 0 RL / IM
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 298952 / 0 - / PO

Administered by: Private      Purchased by: Unknown Public
Symptoms: Infection, Shock, INFECT, SHOCK

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Blood culture- H. Flu
CDC 'Split Type': NONE (blank)

Write-up: Pt presented in Septic shock w/ DIC around MN on day of receiving 1st set of immun; Pt blood grew H. Flu from blood culture;


Changed on 5/14/2017

VAERS ID: 33613 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Massachusetts
Vaccinated:1991-07-24
Onset:1991-07-25
Submitted:1991-08-07
Entered:1991-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES DTP271 / 0 LL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M115HA / 0 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 298952 / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Infection, Shock

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: NONE NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Blood culture- H. Flu
CDC 'Split Type':

Write-up: Pt presented in Septic shock w/ DIC around MN on day of receiving 1st set of immun; Pt blood grew H. Flu from blood culture;


Changed on 9/14/2017

VAERS ID: 33613 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:Massachusetts
Vaccinated:1991-07-24
Onset:1991-07-25
Submitted:1991-08-07
Entered:1991-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES DTP271 / 0 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M115HA / 0 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 298952 / 0 1 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Infection, Shock

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Blood culture- H. Flu
CDC 'Split Type':

Write-up: Pt presented in Septic shock w/ DIC around MN on day of receiving 1st set of immun; Pt blood grew H. Flu from blood culture;


Changed on 2/14/2018

VAERS ID: 33613 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Massachusetts
Vaccinated:1991-07-24
Onset:1991-07-25
Submitted:1991-08-07
Entered:1991-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES DTP271 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M115HA / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 298952 / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Infection, Shock

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Blood culture- H. Flu
CDC 'Split Type':

Write-up: Pt presented in Septic shock w/ DIC around MN on day of receiving 1st set of immun; Pt blood grew H. Flu from blood culture;


Changed on 6/14/2018

VAERS ID: 33613 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Massachusetts
Vaccinated:1991-07-24
Onset:1991-07-25
Submitted:1991-08-07
Entered:1991-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES DTP271 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M115HA / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 298952 / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Infection, Shock

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Blood culture- H. Flu
CDC 'Split Type':

Write-up: Pt presented in Septic shock w/ DIC around MN on day of receiving 1st set of immun; Pt blood grew H. Flu from blood culture;


Changed on 8/14/2018

VAERS ID: 33613 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Massachusetts
Vaccinated:1991-07-24
Onset:1991-07-25
Submitted:1991-08-07
Entered:1991-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES DTP271 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M115HA / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 298952 / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Infection, Shock

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Blood culture- H. Flu
CDC 'Split Type':

Write-up: Pt presented in Septic shock w/ DIC around MN on day of receiving 1st set of immun; Pt blood grew H. Flu from blood culture;


Changed on 9/14/2018

VAERS ID: 33613 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Massachusetts
Vaccinated:1991-07-24
Onset:1991-07-25
Submitted:1991-08-07
Entered:1991-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES DTP271 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M115HA / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 298952 / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Infection, Shock

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Blood culture- H. Flu
CDC 'Split Type':

Write-up: Pt presented in Septic shock w/ DIC around MN on day of receiving 1st set of immun; Pt blood grew H. Flu from blood culture;


Changed on 10/14/2018

VAERS ID: 33613 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Massachusetts
Vaccinated:1991-07-24
Onset:1991-07-25
Submitted:1991-08-07
Entered:1991-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES DTP271 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M115HA / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 298952 / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Infection, Shock

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Blood culture- H. Flu
CDC 'Split Type':

Write-up: Pt presented in Septic shock w/ DIC around MN on day of receiving 1st set of immun; Pt blood grew H. Flu from blood culture;

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