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| History of Changes from the VAERS Wayback Machine |
| VAERS ID: | 223056 |
| VAERS Form: | |
| Age: | 27.0 |
| Sex: | Male |
| Location: | Unknown |
| Vaccinated: | 2003-05-16 |
| Onset: | 2003-05-18 |
| Submitted: | 2004-05-28 |
| Entered: | 2004-06-22 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route |
| HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE | - / - | - / - |
| IPV: POLIO VIRUS, INACT. (UNKNOWN MFR) / UNKNOWN MFR | - / - | - / - |
| MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. | 0004M / - | - / SC |
| MNC: MENINGOCOCCAL CONJUGATE VACCINE / UNKNOWN MFR | - / - | - / - |
| TYP: TYPHOID (VIVOTIF BERNA) / SWISS SERUM BERN | - / - | - / - |
Administered by: Unknown Purchased by: Unknown
Symptoms: EDEMA FACE, SIALADENITIS, PAIN EAR
Life Threatening? No
Birth Defect? No
Died? No
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:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type':
Write-up: Information has been received from a nurse concerning a 27 year old male with no drug allergies who on 16MAY2003 was vaccinated with measles virus vaccine live + mumps virus vaccine live + rubella virus vaccine live (second generation) 0.5 ml subcutaneous"ly. Concomitant therapy included hepatitis A vaccine, meningitis vaccine, poliovirus vaccine inactivated and yellow fever virus vaccine live. The health care provider reported that the patient was vaccinated with numerous vaccines on the same day. The vac
| Vaccinated: | 2003-05-16 |
| Onset: | 2003-05-18 |
| Submitted: | 2004-05-28 |
| Entered: | 2004-06-22 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route |
| HEPA: HEP A (HAVRIX) HEP A (HAVRIX) / GLAXOSMITHKLINE GLAXOSMITHKLINE BIOLOGICALS | - / - | - / - |
| IPV: POLIO VIRUS, INACT. (UNKNOWN MFR) POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MFR UNKNOWN MANUFACTURER | - / - | - / - |
| MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. | 0004M / - | - / SC |
| MNC: MENINGOCOCCAL CONJUGATE VACCINE MENINGOCOCCAL CONJUGATE (NO BRAND NAME) / UNKNOWN MFR UNKNOWN MANUFACTURER | - / - | - / - |
| TYP: TYPHOID (VIVOTIF BERNA) TYPHOID LIVE ORAL TY21A (VIVOTIF) / SWISS SERUM BERN BERNA BIOTECH, LTD | - / - | - / - |
Administered by: Unknown Purchased by: Unknown
Symptoms: Ear pain, Parotitis, Swelling face, EDEMA FACE, SIALADENITIS, PAIN EAR
Life Threatening? No
Birth Defect? No
Died? No
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:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': (blank) WAES0305USA02294
Write-up: Information has been received from a nurse concerning a 27 year old male with no drug allergies who on 16MAY2003 was vaccinated with measles virus vaccine live + mumps virus vaccine live + rubella virus vaccine live (second generation) 0.5 ml subcutaneous"ly. subcutaneously. Concomitant therapy included hepatitis A vaccine, meningitis vaccine, poliovirus vaccine inactivated and yellow fever virus vaccine live. The health care provider reported that the patient was vaccinated with numerous vaccines on the same day. The vac vaccines were administered at different anatomical sites. On 18MAY2003 the patient experienced left side parotiditis, ear pain and swelling of the mouth. The patient did seek medical attention and was using Tylenol and Aleve for relief, but the nurse said that no treatment was recommended at this time. At the time of this report the outcome was unknown. Additional information has been requested.
| Vaccinated: | 2003-05-16 |
| Onset: | 2003-05-18 |
| Submitted: | 2004-05-28 |
| Entered: | 2004-06-22 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route |
| HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS | - / - | - / - |
| IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER | - / - | - / - |
| MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. | 0004M / - | - / SC |
| MNC: MENINGOCOCCAL CONJUGATE (NO BRAND NAME) / UNKNOWN MANUFACTURER | - / - | - / - |
| MNQ: MENINGOCOCCAL CONJUGATE (NO BRAND NAME) / UNKNOWN MANUFACTURER | - / - | - / - |
| TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD | - / - | - / - |
Administered by: Unknown Purchased by: Unknown
Symptoms: Ear pain, Parotitis, Swelling face
Life Threatening? No
Birth Defect? No
Died? No
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:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES0305USA02294
Write-up: Information has been received from a nurse concerning a 27 year old male with no drug allergies who on 16MAY2003 was vaccinated with measles virus vaccine live + mumps virus vaccine live + rubella virus vaccine live (second generation) 0.5 ml subcutaneously. Concomitant therapy included hepatitis A vaccine, meningitis vaccine, poliovirus vaccine inactivated and yellow fever virus vaccine live. The health care provider reported that the patient was vaccinated with numerous vaccines on the same day. The vaccines were administered at different anatomical sites. On 18MAY2003 the patient experienced left side parotiditis, ear pain and swelling of the mouth. The patient did seek medical attention and was using Tylenol and Aleve for relief, but the nurse said that no treatment was recommended at this time. At the time of this report the outcome was unknown. Additional information has been requested.
| Vaccinated: | 2003-05-16 |
| Onset: | 2003-05-18 |
| Submitted: | 2004-05-28 |
| Entered: | 2004-06-22 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route |
| HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS | - / - UNK | - / - |
| IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER | - / - UNK | - / - |
| MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. | 0004M / - UNK | - / SC |
| MNQ: MENINGOCOCCAL CONJUGATE (NO BRAND NAME) / UNKNOWN MANUFACTURER | - / - UNK | - / - |
| TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD | - / - UNK | - / - |
Administered by: Unknown Purchased by: Unknown
Symptoms: Ear pain, Parotitis, Swelling face
Life Threatening? No
Birth Defect? No
Died? No
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:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES0305USA02294
Write-up: Information has been received from a nurse concerning a 27 year old male with no drug allergies who on 16MAY2003 was vaccinated with measles virus vaccine live + mumps virus vaccine live + rubella virus vaccine live (second generation) 0.5 ml subcutaneously. Concomitant therapy included hepatitis A vaccine, meningitis vaccine, poliovirus vaccine inactivated and yellow fever virus vaccine live. The health care provider reported that the patient was vaccinated with numerous vaccines on the same day. The vaccines were administered at different anatomical sites. On 18MAY2003 the patient experienced left side parotiditis, ear pain and swelling of the mouth. The patient did seek medical attention and was using Tylenol and Aleve for relief, but the nurse said that no treatment was recommended at this time. At the time of this report the outcome was unknown. Additional information has been requested.
| Vaccinated: | 2003-05-16 |
| Onset: | 2003-05-18 |
| Submitted: | 2004-05-28 |
| Entered: | 2004-06-22 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route |
| HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS | - / UNK | - / - |
| IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER | - / UNK | - / - |
| MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. | 0004M / UNK | - / SC |
| MNQ: MENINGOCOCCAL CONJUGATE (NO BRAND NAME) / UNKNOWN MANUFACTURER | - / UNK | - / - |
| TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD BERNA BIOTECH, LTD. | - / UNK | - / - |
Administered by: Unknown Purchased by: Unknown
Symptoms: Ear pain, Parotitis, Swelling face
Life Threatening? No
Birth Defect? No
Died? No
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:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES0305USA02294
Write-up: Information has been received from a nurse concerning a 27 year old male with no drug allergies who on 16MAY2003 was vaccinated with measles virus vaccine live + mumps virus vaccine live + rubella virus vaccine live (second generation) 0.5 ml subcutaneously. Concomitant therapy included hepatitis A vaccine, meningitis vaccine, poliovirus vaccine inactivated and yellow fever virus vaccine live. The health care provider reported that the patient was vaccinated with numerous vaccines on the same day. The vaccines were administered at different anatomical sites. On 18MAY2003 the patient experienced left side parotiditis, ear pain and swelling of the mouth. The patient did seek medical attention and was using Tylenol and Aleve for relief, but the nurse said that no treatment was recommended at this time. At the time of this report the outcome was unknown. Additional information has been requested.
| Vaccinated: | 2003-05-16 |
| Onset: | 2003-05-18 |
| Submitted: | 2004-05-28 |
| Entered: | 2004-06-22 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route |
| HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS | - / UNK | - / - |
| IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER | - / UNK | - / - |
| MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. | 0004M / UNK | - / SC |
| MNQ: MENINGOCOCCAL CONJUGATE (NO BRAND NAME) / UNKNOWN MANUFACTURER | - / UNK | - / - |
| TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD. | - / UNK | - / - |
Administered by: Unknown Purchased by: Unknown
Symptoms: Ear pain, Parotitis, Swelling face
Life Threatening? No
Birth Defect? No
Died? No
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:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES0305USA02294
Write-up: Information has been received from a nurse concerning a 27 year old male with no drug allergies who on 16MAY2003 was vaccinated with measles virus vaccine live + mumps virus vaccine live + rubella virus vaccine live (second generation) 0.5 ml subcutaneously. Concomitant therapy included hepatitis A vaccine, meningitis vaccine, poliovirus vaccine inactivated and yellow fever virus vaccine live. The health care provider reported that the patient was vaccinated with numerous vaccines on the same day. The vaccines were administered at different anatomical sites. On 18MAY2003 the patient experienced left side parotiditis, ear pain and swelling of the mouth. The patient did seek medical attention and was using Tylenol and Aleve for relief, but the nurse said that no treatment was recommended at this time. At the time of this report the outcome was unknown. Additional information has been requested.
| Vaccinated: | 2003-05-16 |
| Onset: | 2003-05-18 |
| Submitted: | 2004-05-28 |
| Entered: | 2004-06-22 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route |
| HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS | - / UNK | - / - |
| IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER | - / UNK | - / - |
| MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. | 0004M / UNK | - / SC |
| MNQ: MENINGOCOCCAL CONJUGATE (NO BRAND NAME) / UNKNOWN MANUFACTURER | - / UNK | - / - |
| TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD. | - / UNK | - / - |
Administered by: Unknown Purchased by: Unknown
Symptoms: Ear pain, Parotitis, Swelling face
Life Threatening? No
Birth Defect? No
Died? No
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:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES0305USA02294
Write-up: Information has been received from a nurse concerning a 27 year old male with no drug allergies who on 16MAY2003 was vaccinated with measles virus vaccine live + mumps virus vaccine live + rubella virus vaccine live (second generation) 0.5 ml subcutaneously. Concomitant therapy included hepatitis A vaccine, meningitis vaccine, poliovirus vaccine inactivated and yellow fever virus vaccine live. The health care provider reported that the patient was vaccinated with numerous vaccines on the same day. The vaccines were administered at different anatomical sites. On 18MAY2003 the patient experienced left side parotiditis, ear pain and swelling of the mouth. The patient did seek medical attention and was using Tylenol and Aleve for relief, but the nurse said that no treatment was recommended at this time. At the time of this report the outcome was unknown. Additional information has been requested.
| Vaccinated: | 2003-05-16 |
| Onset: | 2003-05-18 |
| Submitted: | 2004-05-28 |
| Entered: | 2004-06-22 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route |
| HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS | - / UNK | - / - |
| IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER | - / UNK | - / - |
| MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. | 0004M / UNK | - / SC |
| MNQ: MENINGOCOCCAL CONJUGATE (NO BRAND NAME) / UNKNOWN MANUFACTURER | - / UNK | - / - |
| TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD. | - / UNK | - / - |
Administered by: Unknown Purchased by: Unknown
Symptoms: Ear pain, Parotitis, Swelling face
Life Threatening? No
Birth Defect? No
Died? No
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:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES0305USA02294
Write-up: Information has been received from a nurse concerning a 27 year old male with no drug allergies who on 16MAY2003 was vaccinated with measles virus vaccine live + mumps virus vaccine live + rubella virus vaccine live (second generation) 0.5 ml subcutaneously. Concomitant therapy included hepatitis A vaccine, meningitis vaccine, poliovirus vaccine inactivated and yellow fever virus vaccine live. The health care provider reported that the patient was vaccinated with numerous vaccines on the same day. The vaccines were administered at different anatomical sites. On 18MAY2003 the patient experienced left side parotiditis, ear pain and swelling of the mouth. The patient did seek medical attention and was using Tylenol and Aleve for relief, but the nurse said that no treatment was recommended at this time. At the time of this report the outcome was unknown. Additional information has been requested.
| Vaccinated: | 2003-05-16 |
| Onset: | 2003-05-18 |
| Submitted: | 2004-05-28 |
| Entered: | 2004-06-22 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route |
| HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS | - / UNK | - / - |
| IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER | - / UNK | - / - |
| MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. | 0004M / UNK | - / SC |
| MNQ: MENINGOCOCCAL CONJUGATE (NO BRAND NAME) / UNKNOWN MANUFACTURER | - / UNK | - / - |
| TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD. | - / UNK | - / - |
Administered by: Unknown Purchased by: Unknown
Symptoms: Ear pain, Parotitis, Swelling face
Life Threatening? No
Birth Defect? No
Died? No
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:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES0305USA02294
Write-up: Information has been received from a nurse concerning a 27 year old male with no drug allergies who on 16MAY2003 was vaccinated with measles virus vaccine live + mumps virus vaccine live + rubella virus vaccine live (second generation) 0.5 ml subcutaneously. Concomitant therapy included hepatitis A vaccine, meningitis vaccine, poliovirus vaccine inactivated and yellow fever virus vaccine live. The health care provider reported that the patient was vaccinated with numerous vaccines on the same day. The vaccines were administered at different anatomical sites. On 18MAY2003 the patient experienced left side parotiditis, ear pain and swelling of the mouth. The patient did seek medical attention and was using Tylenol and Aleve for relief, but the nurse said that no treatment was recommended at this time. At the time of this report the outcome was unknown. Additional information has been requested.
| Vaccinated: | 2003-05-16 |
| Onset: | 2003-05-18 |
| Submitted: | 2004-05-28 |
| Entered: | 2004-06-22 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route |
| HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS | - / UNK | - / - |
| IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER | - / UNK | - / - |
| MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. | 0004M / UNK | - / SC |
| MNQ: MENINGOCOCCAL CONJUGATE (NO BRAND NAME) / UNKNOWN MANUFACTURER | - / UNK | - / - |
| TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD. | - / UNK | - / - |
Administered by: Unknown Purchased by: Unknown
Symptoms: Ear pain, Parotitis, Swelling face
Life Threatening? No
Birth Defect? No
Died? No
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:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES0305USA02294
Write-up: Information has been received from a nurse concerning a 27 year old male with no drug allergies who on 16MAY2003 was vaccinated with measles virus vaccine live + mumps virus vaccine live + rubella virus vaccine live (second generation) 0.5 ml subcutaneously. Concomitant therapy included hepatitis A vaccine, meningitis vaccine, poliovirus vaccine inactivated and yellow fever virus vaccine live. The health care provider reported that the patient was vaccinated with numerous vaccines on the same day. The vaccines were administered at different anatomical sites. On 18MAY2003 the patient experienced left side parotiditis, ear pain and swelling of the mouth. The patient did seek medical attention and was using Tylenol and Aleve for relief, but the nurse said that no treatment was recommended at this time. At the time of this report the outcome was unknown. Additional information has been requested.
Link To This Search Result:
https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=223056&WAYBACKHISTORY=ON
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