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This is VAERS ID 25922

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 25922
VAERS Form:
Age:1.3
Sex:Male
Location:Ohio
Vaccinated:1990-08-14
Onset:1990-08-24
Submitted:1990-09-08
Entered:1990-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIBTITER / LEDERLE(PRAXIS) M205EP / - A / SC
MMR: MMR II / MSD 1494S / - A / SC

Administered by: Private      Purchased by: Unknown
Symptoms: CONVULS, FEVER, RASH, PALLOR, RASH MAC PAP

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? Yes, days: 9     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hearing loss - Rx PET - Chronic ear infection; premature 3 wks early, developmental delay, febrile seizure MAR 90.
Allergies:
Diagnostic Lab Data: EEG 21AUG showed seizure activity w/slowing background - CT & MRI scan normal - Metabolic tests done w/elevated pyruvate & _____ still in progress. Hx of prior developemental delay prior to vaccine.
CDC 'Split Type':

Write-up: Pt vaccinated with MMR/HIB developed fever X 24hrs w/mild erythema rash upper trunk - Macular papular on 27AUG90; Reevaluated- fever, fading of rash. Short periods of starring, face color changed & dazed state seizure were short. See WORM.


Changed on 12/8/2009

VAERS ID: 25922 Before After
VAERS Form:
Age:1.3
Sex:Male
Location:Ohio
Vaccinated:1990-08-14
Onset:1990-08-24
Submitted:1990-09-08
Entered:1990-09-20 1990-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M205EP / - A / SC
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 1494S / - A / SC

Administered by: Private      Purchased by: Unknown Private
Symptoms: Convulsion, Pallor, Pyrexia, Rash, Rash maculo-papular, Stupor, CONVULS, FEVER, RASH, PALLOR, RASH MAC PAP

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? Yes, days: 9     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hearing loss - Rx PET - Chronic ear infection; premature 3 wks early, developmental delay, febrile seizure MAR 90.
Allergies:
Diagnostic Lab Data: EEG 21AUG showed seizure activity w/slowing background - CT & MRI scan normal - Metabolic tests done w/elevated pyruvate & _____ still in progress. Hx of prior developemental delay prior to vaccine.
CDC 'Split Type':

Write-up: Pt vaccinated with MMR/HIB developed fever X 24hrs w/mild erythema rash upper trunk - Macular papular on 27AUG90; Reevaluated- fever, fading of rash. Short periods of starring, face color changed & dazed state seizure were short. See WORM.


Changed on 5/14/2017

VAERS ID: 25922 Before After
VAERS Form:
Age:1.3
Sex:Male
Location:Ohio
Vaccinated:1990-08-14
Onset:1990-08-24
Submitted:1990-09-08
Entered:1990-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M205EP / - A - / SC SC A
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1494S / - A - / SC SC A

Administered by: Private      Purchased by: Private
Symptoms: Convulsion, Pallor, Pyrexia, Rash, Rash maculo-papular, Stupor

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? Yes, days: 9     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Hearing loss - Rx PET - Chronic ear infection; premature 3 wks early, developmental delay, febrile seizure MAR 90.
Allergies:
Diagnostic Lab Data: EEG 21AUG showed seizure activity w/slowing background - CT & MRI scan normal - Metabolic tests done w/elevated pyruvate & _____ still in progress. Hx of prior developemental delay prior to vaccine.
CDC 'Split Type':

Write-up: Pt vaccinated with MMR/HIB developed fever X 24hrs w/mild erythema rash upper trunk - Macular papular on 27AUG90; Reevaluated- fever, fading of rash. Short periods of starring, face color changed & dazed state seizure were short. See WORM.


Changed on 9/14/2017

VAERS ID: 25922 Before After
VAERS Form:(blank) 1
Age:1.3
Sex:Male
Location:Ohio
Vaccinated:1990-08-14
Onset:1990-08-24
Submitted:1990-09-08
Entered:1990-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M205EP / - UNK - / SC A
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1494S / - UNK - / SC A

Administered by: Private      Purchased by: Private
Symptoms: Convulsion, Pallor, Pyrexia, Rash, Rash maculo-papular, Stupor

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? Yes, days: 9     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Hearing loss - Rx PET - Chronic ear infection; premature 3 wks early, developmental delay, febrile seizure MAR 90.
Allergies:
Diagnostic Lab Data: EEG 21AUG showed seizure activity w/slowing background - CT & MRI scan normal - Metabolic tests done w/elevated pyruvate & _____ still in progress. Hx of prior developemental delay prior to vaccine.
CDC 'Split Type':

Write-up: Pt vaccinated with MMR/HIB developed fever X 24hrs w/mild erythema rash upper trunk - Macular papular on 27AUG90; Reevaluated- fever, fading of rash. Short periods of starring, face color changed & dazed state seizure were short. See WORM.


Changed on 2/14/2018

VAERS ID: 25922 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Ohio
Vaccinated:1990-08-14
Onset:1990-08-24
Submitted:1990-09-08
Entered:1990-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M205EP / UNK - / SC A
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1494S / UNK - / SC A

Administered by: Private      Purchased by: Private
Symptoms: Convulsion, Pallor, Pyrexia, Rash, Rash maculo-papular, Stupor

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? Yes, days: 9     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Hearing loss - Rx PET - Chronic ear infection; premature 3 wks early, developmental delay, febrile seizure MAR 90.
Allergies:
Diagnostic Lab Data: EEG 21AUG showed seizure activity w/slowing background - CT & MRI scan normal - Metabolic tests done w/elevated pyruvate & _____ still in progress. Hx of prior developemental delay prior to vaccine.
CDC 'Split Type':

Write-up: Pt vaccinated with MMR/HIB developed fever X 24hrs w/mild erythema rash upper trunk - Macular papular on 27AUG90; Reevaluated- fever, fading of rash. Short periods of starring, face color changed & dazed state seizure were short. See WORM.


Changed on 6/14/2018

VAERS ID: 25922 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Ohio
Vaccinated:1990-08-14
Onset:1990-08-24
Submitted:1990-09-08
Entered:1990-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M205EP / UNK - / SC A
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1494S / UNK - / SC A

Administered by: Private      Purchased by: Private
Symptoms: Convulsion, Pallor, Pyrexia, Rash, Rash maculo-papular, Stupor

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? Yes, days: 9     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Hearing loss - Rx PET - Chronic ear infection; premature 3 wks early, developmental delay, febrile seizure MAR 90.
Allergies:
Diagnostic Lab Data: EEG 21AUG showed seizure activity w/slowing background - CT & MRI scan normal - Metabolic tests done w/elevated pyruvate & _____ still in progress. Hx of prior developemental delay prior to vaccine.
CDC 'Split Type':

Write-up: Pt vaccinated with MMR/HIB developed fever X 24hrs w/mild erythema rash upper trunk - Macular papular on 27AUG90; Reevaluated- fever, fading of rash. Short periods of starring, face color changed & dazed state seizure were short. See WORM.


Changed on 8/14/2018

VAERS ID: 25922 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Ohio
Vaccinated:1990-08-14
Onset:1990-08-24
Submitted:1990-09-08
Entered:1990-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M205EP / UNK - / SC A
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1494S / UNK - / SC A

Administered by: Private      Purchased by: Private
Symptoms: Convulsion, Pallor, Pyrexia, Rash, Rash maculo-papular, Stupor

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? Yes, days: 9     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Hearing loss - Rx PET - Chronic ear infection; premature 3 wks early, developmental delay, febrile seizure MAR 90.
Allergies:
Diagnostic Lab Data: EEG 21AUG showed seizure activity w/slowing background - CT & MRI scan normal - Metabolic tests done w/elevated pyruvate & _____ still in progress. Hx of prior developemental delay prior to vaccine.
CDC 'Split Type':

Write-up: Pt vaccinated with MMR/HIB developed fever X 24hrs w/mild erythema rash upper trunk - Macular papular on 27AUG90; Reevaluated- fever, fading of rash. Short periods of starring, face color changed & dazed state seizure were short. See WORM.


Changed on 9/14/2018

VAERS ID: 25922 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Ohio
Vaccinated:1990-08-14
Onset:1990-08-24
Submitted:1990-09-08
Entered:1990-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M205EP / UNK - / SC A
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1494S / UNK - / SC A

Administered by: Private      Purchased by: Private
Symptoms: Convulsion, Pallor, Pyrexia, Rash, Rash maculo-papular, Stupor

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? Yes, days: 9     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Hearing loss - Rx PET - Chronic ear infection; premature 3 wks early, developmental delay, febrile seizure MAR 90.
Allergies:
Diagnostic Lab Data: EEG 21AUG showed seizure activity w/slowing background - CT & MRI scan normal - Metabolic tests done w/elevated pyruvate & _____ still in progress. Hx of prior developemental delay prior to vaccine.
CDC 'Split Type':

Write-up: Pt vaccinated with MMR/HIB developed fever X 24hrs w/mild erythema rash upper trunk - Macular papular on 27AUG90; Reevaluated- fever, fading of rash. Short periods of starring, face color changed & dazed state seizure were short. See WORM.


Changed on 10/14/2018

VAERS ID: 25922 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Ohio
Vaccinated:1990-08-14
Onset:1990-08-24
Submitted:1990-09-08
Entered:1990-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M205EP / UNK - / SC A
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1494S / UNK - / SC A

Administered by: Private      Purchased by: Private
Symptoms: Convulsion, Pallor, Pyrexia, Rash, Rash maculo-papular, Stupor

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? Yes, days: 9     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Hearing loss - Rx PET - Chronic ear infection; premature 3 wks early, developmental delay, febrile seizure MAR 90.
Allergies:
Diagnostic Lab Data: EEG 21AUG showed seizure activity w/slowing background - CT & MRI scan normal - Metabolic tests done w/elevated pyruvate & _____ still in progress. Hx of prior developemental delay prior to vaccine.
CDC 'Split Type':

Write-up: Pt vaccinated with MMR/HIB developed fever X 24hrs w/mild erythema rash upper trunk - Macular papular on 27AUG90; Reevaluated- fever, fading of rash. Short periods of starring, face color changed & dazed state seizure were short. See WORM.

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