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This is VAERS ID 57496

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 57496
VAERS Form:
Age:4.7
Sex:Male
Location:Texas
Vaccinated:1992-10-10
Onset:1992-10-23
Submitted:1993-09-14
Entered:1993-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1993-1994 / CONNAUGHT LABS 2731143 / 0 LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: RASH, FLU SYND, ASTHENIA, LEUKEMIA ACUTE LYMPHO

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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 exp fever, abn cells viral infect relapsed leukemia @ 4 yrs w/DTP/IPOL/PPD #1
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NONE

Write-up: pt became ill w/acute lymphocytic leukemia on 23OCT93 soon p/flu vax; pt exp flu like sx & acted tired; pt had little red dots all over body; dx acute lymphoblastic leukemia;


Changed on 12/8/2009

VAERS ID: 57496 Before After
VAERS Form:
Age:4.7
Sex:Male
Location:Texas
Vaccinated:1992-10-10
Onset:1992-10-23
Submitted:1993-09-14
Entered:1993-11-24 1993-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUZONE 1993-1994 INFLUENZA (SEASONAL) (FLUZONE 93-94) / CONNAUGHT LABS CONNAUGHT LABORATORIES 2731143 / 0 LA / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Acute lymphocytic leukaemia, Asthenia, Influenza, Rash, RASH, FLU SYND, ASTHENIA, LEUKEMIA ACUTE LYMPHO

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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 exp fever, abn cells viral infect relapsed leukemia @ 4 yrs w/DTP/IPOL/PPD #1
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NONE

Write-up: pt became ill w/acute lymphocytic leukemia on 23OCT93 soon p/flu vax; pt exp flu like sx & acted tired; pt had little red dots all over body; dx acute lymphoblastic leukemia;


Changed on 8/31/2010

VAERS ID: 57496 Before After
VAERS Form:
Age:4.7
Sex:Male
Location:Texas
Vaccinated:1992-10-10
Onset:1992-10-23
Submitted:1993-09-14
Entered:1993-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE 93-94) INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 2731143 / 0 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Acute lymphocytic leukaemia, Asthenia, Influenza, Rash

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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 exp fever, abn cells viral infect relapsed leukemia @ 4 yrs w/DTP/IPOL/PPD #1
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NONE

Write-up: pt became ill w/acute lymphocytic leukemia on 23OCT93 soon p/flu vax; pt exp flu like sx & acted tired; pt had little red dots all over body; dx acute lymphoblastic leukemia;


Changed on 10/14/2012

VAERS ID: 57496 Before After
VAERS Form:
Age:4.7
Sex:Male
Location:Texas
Vaccinated:1992-10-10
Onset:1992-10-23
Submitted:1993-09-14
Entered:1993-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 2731143 / 0 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Acute lymphocytic leukaemia, Asthenia, Influenza, Rash

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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 exp fever, abn cells viral infect relapsed leukemia @ 4 yrs w/DTP/IPOL/PPD #1
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NONE (blank)

Write-up: pt became ill w/acute lymphocytic leukemia on 23OCT93 soon p/flu vax; pt exp flu like sx & acted tired; pt had little red dots all over body; dx acute lymphoblastic leukemia;


Changed on 7/7/2013

VAERS ID: 57496 Before After
VAERS Form:
Age:4.7
Sex:Male
Location:Texas
Vaccinated:1992-10-10
Onset:1992-10-23
Submitted:1993-09-14
Entered:1993-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 2731143 / 0 LA / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 2731143 / 0 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Acute lymphocytic leukaemia, Asthenia, Influenza, Rash

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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 exp fever, abn cells viral infect relapsed leukemia @ 4 yrs w/DTP/IPOL/PPD #1
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt became ill w/acute lymphocytic leukemia on 23OCT93 soon p/flu vax; pt exp flu like sx & acted tired; pt had little red dots all over body; dx acute lymphoblastic leukemia;


Changed on 2/14/2017

VAERS ID: 57496 Before After
VAERS Form:
Age:4.7 4.0
Sex:Male
Location:Texas
Vaccinated:1992-10-10
Onset:1992-10-23
Submitted:1993-09-14
Entered:1993-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 2731143 / 0 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Acute lymphocytic leukaemia, Asthenia, Influenza, Rash

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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 exp fever, abn cells viral infect relapsed leukemia @ 4 yrs w/DTP/IPOL/PPD #1
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt became ill w/acute lymphocytic leukemia on 23OCT93 soon p/flu vax; pt exp flu like sx & acted tired; pt had little red dots all over body; dx acute lymphoblastic leukemia;


Changed on 5/14/2017

VAERS ID: 57496 Before After
VAERS Form:
Age:4.0
Sex:Male
Location:Texas
Vaccinated:1992-10-10
Onset:1992-10-23
Submitted:1993-09-14
Entered:1993-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 2731143 / 0 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Acute lymphocytic leukaemia, Asthenia, Influenza, Rash

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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 exp fever, abn cells viral infect relapsed leukemia @ 4 yrs w/DTP/IPOL/PPD #1 #1~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt became ill w/acute lymphocytic leukemia on 23OCT93 soon p/flu vax; pt exp flu like sx & acted tired; pt had little red dots all over body; dx acute lymphoblastic leukemia;


Changed on 9/14/2017

VAERS ID: 57496 Before After
VAERS Form:(blank) 1
Age:4.0
Sex:Male
Location:Texas
Vaccinated:1992-10-10
Onset:1992-10-23
Submitted:1993-09-14
Entered:1993-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 2731143 / 0 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Acute lymphocytic leukaemia, Asthenia, Influenza, Rash

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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 exp fever, abn cells viral infect relapsed leukemia @ 4 yrs w/DTP/IPOL/PPD #1~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt became ill w/acute lymphocytic leukemia on 23OCT93 soon p/flu vax; pt exp flu like sx & acted tired; pt had little red dots all over body; dx acute lymphoblastic leukemia;


Changed on 2/14/2018

VAERS ID: 57496 Before After
VAERS Form:1
Age:4.0
Sex:Male
Location:Texas
Vaccinated:1992-10-10
Onset:1992-10-23
Submitted:1993-09-14
Entered:1993-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 2731143 / 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Acute lymphocytic leukaemia, Asthenia, Influenza, Rash

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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 exp fever, abn cells viral infect relapsed leukemia @ 4 yrs w/DTP/IPOL/PPD #1~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt became ill w/acute lymphocytic leukemia on 23OCT93 soon p/flu vax; pt exp flu like sx & acted tired; pt had little red dots all over body; dx acute lymphoblastic leukemia;


Changed on 6/14/2018

VAERS ID: 57496 Before After
VAERS Form:1
Age:4.0
Sex:Male
Location:Texas
Vaccinated:1992-10-10
Onset:1992-10-23
Submitted:1993-09-14
Entered:1993-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 2731143 / 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Acute lymphocytic leukaemia, Asthenia, Influenza, Rash

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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 exp fever, abn cells viral infect relapsed leukemia @ 4 yrs w/DTP/IPOL/PPD #1~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt became ill w/acute lymphocytic leukemia on 23OCT93 soon p/flu vax; pt exp flu like sx & acted tired; pt had little red dots all over body; dx acute lymphoblastic leukemia;


Changed on 8/14/2018

VAERS ID: 57496 Before After
VAERS Form:1
Age:4.0
Sex:Male
Location:Texas
Vaccinated:1992-10-10
Onset:1992-10-23
Submitted:1993-09-14
Entered:1993-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 2731143 / 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Acute lymphocytic leukaemia, Asthenia, Influenza, Rash

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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 exp fever, abn cells viral infect relapsed leukemia @ 4 yrs w/DTP/IPOL/PPD #1~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt became ill w/acute lymphocytic leukemia on 23OCT93 soon p/flu vax; pt exp flu like sx & acted tired; pt had little red dots all over body; dx acute lymphoblastic leukemia;


Changed on 9/14/2018

VAERS ID: 57496 Before After
VAERS Form:1
Age:4.0
Sex:Male
Location:Texas
Vaccinated:1992-10-10
Onset:1992-10-23
Submitted:1993-09-14
Entered:1993-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 2731143 / 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Acute lymphocytic leukaemia, Asthenia, Influenza, Rash

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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 exp fever, abn cells viral infect relapsed leukemia @ 4 yrs w/DTP/IPOL/PPD #1~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt became ill w/acute lymphocytic leukemia on 23OCT93 soon p/flu vax; pt exp flu like sx & acted tired; pt had little red dots all over body; dx acute lymphoblastic leukemia;


Changed on 10/14/2018

VAERS ID: 57496 Before After
VAERS Form:1
Age:4.0
Sex:Male
Location:Texas
Vaccinated:1992-10-10
Onset:1992-10-23
Submitted:1993-09-14
Entered:1993-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 2731143 / 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Acute lymphocytic leukaemia, Asthenia, Influenza, Rash

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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 exp fever, abn cells viral infect relapsed leukemia @ 4 yrs w/DTP/IPOL/PPD #1~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt became ill w/acute lymphocytic leukemia on 23OCT93 soon p/flu vax; pt exp flu like sx & acted tired; pt had little red dots all over body; dx acute lymphoblastic leukemia;

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=57496&WAYBACKHISTORY=ON


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