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This is VAERS ID 26102

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 26102
VAERS Form:
Age:0.2
Sex:Male
Location:Oklahoma
Vaccinated:1990-08-21
Onset:1990-09-03
Submitted:0000-00-00
Entered:1990-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 283913 / 2 RL / IM
HIBV: UNK. HAEMOPHILUS B / UNCLASSIFIED M66FB / 0 LL / IM
MMR: MMR II / MSD 12925 / 0 RA / SC
OPV: ORIMUNE / LEDERLE 277942 / 2 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: AGITATION, SOMNOLENCE, GAIT ABNORM, CONFUS, SKIN DISCOLOR

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 12     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Ceftriaxone 500 mg IV, Augmentin 250 Mgn tid X 1 wk
Current Illness: none WIC recert.
Preexisting Conditions: 10/89 Sizemore, PA no known allergies
Allergies:
Diagnostic Lab Data: CSF & Blood Cultures - Haemophilus Influenza done 7SEP90
CDC 'Split Type':

Write-up: vomiting, lethargy, restless, disoriented, can''t walk, stiff discoloration of feet & hands


Changed on 12/30/2006

VAERS ID: 26102 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Oklahoma
Vaccinated:1990-08-21
Onset:1990-09-03
Submitted:0000-00-00
Entered:1990-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 283913 / 2 RL / IM
HIBV: UNK. HAEMOPHILUS B / UNCLASSIFIED M66FB / 0 LL / IM
MMR: MMR II / MSD 12925 / 0 RA / SC
OPV: ORIMUNE / LEDERLE 277942 / 2 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: AGITATION, SOMNOLENCE, GAIT ABNORM, CONFUS, SKIN DISCOLOR

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 12     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Ceftriaxone 500 mg IV, Augmentin 250 Mgn tid X 1 wk
Current Illness: none WIC recert.
Preexisting Conditions: 10/89 Sizemore, PA no known allergies
Allergies:
Diagnostic Lab Data: CSF & Blood Cultures - Haemophilus Influenza done 7SEP90
CDC 'Split Type':

Write-up: vomiting, lethargy, restless, disoriented, can''t can''''t walk, stiff discoloration of feet & hands


Changed on 12/8/2009

VAERS ID: 26102 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Oklahoma
Vaccinated:1990-08-21
Onset:1990-09-03
Submitted:0000-00-00
Entered:1990-09-26 1990-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 283913 / 2 RL / IM
HIBV: UNK. HAEMOPHILUS B HIB (NO BRAND NAME) / UNCLASSIFIED UNKNOWN MANUFACTURER M66FB / 0 LL / IM
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 12925 / 0 RA / SC
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 277942 / 2 - / PO

Administered by: Public Unknown      Purchased by: Unknown
Symptoms: Agitation, Confusional state, Gait disturbance, Skin discolouration, Somnolence, Vomiting, AGITATION, SOMNOLENCE, GAIT ABNORM, CONFUS, SKIN DISCOLOR

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 12     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Ceftriaxone 500 mg IV, Augmentin 250 Mgn tid X 1 wk
Current Illness: none WIC recert.
Preexisting Conditions: 10/89 Sizemore, PA no known allergies
Allergies:
Diagnostic Lab Data: CSF & Blood Cultures - Haemophilus Influenza done 7SEP90
CDC 'Split Type':

Write-up: vomiting, lethargy, restless, disoriented, can''''t can''t walk, stiff discoloration of feet & hands


Changed on 5/14/2017

VAERS ID: 26102 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Oklahoma
Vaccinated:1990-08-21
Onset:1990-09-03
Submitted:0000-00-00
Entered:1990-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283913 / 2 RL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER M66FB / 0 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 12925 / 0 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 277942 / 2 - / PO

Administered by: Unknown Public      Purchased by: Unknown Public
Symptoms: Agitation, Confusional state, Gait disturbance, Skin discolouration, Somnolence, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 12     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Ceftriaxone 500 mg IV, Augmentin 250 Mgn tid X 1 wk
Current Illness: none WIC recert.
Preexisting Conditions: 10/89 Sizemore, PA no known allergies
Allergies:
Diagnostic Lab Data: CSF & Blood Cultures - Haemophilus Influenza done 7SEP90
CDC 'Split Type':

Write-up: vomiting, lethargy, restless, disoriented, can''t walk, stiff discoloration of feet & hands


Changed on 9/14/2017

VAERS ID: 26102 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:Oklahoma
Vaccinated:1990-08-21
Onset:1990-09-03
Submitted:0000-00-00
Entered:1990-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283913 / 2 3 RL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER M66FB / 0 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 12925 / 0 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 277942 / 2 3 - MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Agitation, Confusional state, Gait disturbance, Skin discolouration, Somnolence, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 12     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Ceftriaxone 500 mg IV, Augmentin 250 Mgn tid X 1 wk
Current Illness: none WIC recert.
Preexisting Conditions: 10/89 Sizemore, PA no known allergies
Allergies:
Diagnostic Lab Data: CSF & Blood Cultures - Haemophilus Influenza done 7SEP90
CDC 'Split Type':

Write-up: vomiting, lethargy, restless, disoriented, can''t walk, stiff discoloration of feet & hands


Changed on 2/14/2018

VAERS ID: 26102 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Oklahoma
Vaccinated:1990-08-21
Onset:1990-09-03
Submitted:0000-00-00
Entered:1990-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283913 / 3 RL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER M66FB / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 12925 / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 277942 / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Agitation, Confusional state, Gait disturbance, Skin discolouration, Somnolence, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 12     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Ceftriaxone 500 mg IV, Augmentin 250 Mgn tid X 1 wk
Current Illness: none WIC recert.
Preexisting Conditions: 10/89 Sizemore, PA no known allergies
Allergies:
Diagnostic Lab Data: CSF & Blood Cultures - Haemophilus Influenza done 7SEP90
CDC 'Split Type':

Write-up: vomiting, lethargy, restless, disoriented, can''t walk, stiff discoloration of feet & hands


Changed on 6/14/2018

VAERS ID: 26102 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Oklahoma
Vaccinated:1990-08-21
Onset:1990-09-03
Submitted:0000-00-00
Entered:1990-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283913 / 3 RL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER M66FB / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 12925 / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 277942 / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Agitation, Confusional state, Gait disturbance, Skin discolouration, Somnolence, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 12     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Ceftriaxone 500 mg IV, Augmentin 250 Mgn tid X 1 wk
Current Illness: none WIC recert.
Preexisting Conditions: 10/89 Sizemore, PA no known allergies
Allergies:
Diagnostic Lab Data: CSF & Blood Cultures - Haemophilus Influenza done 7SEP90
CDC 'Split Type':

Write-up: vomiting, lethargy, restless, disoriented, can''t walk, stiff discoloration of feet & hands


Changed on 8/14/2018

VAERS ID: 26102 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Oklahoma
Vaccinated:1990-08-21
Onset:1990-09-03
Submitted:0000-00-00
Entered:1990-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283913 / 3 RL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER M66FB / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 12925 / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 277942 / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Agitation, Confusional state, Gait disturbance, Skin discolouration, Somnolence, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 12     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Ceftriaxone 500 mg IV, Augmentin 250 Mgn tid X 1 wk
Current Illness: none WIC recert.
Preexisting Conditions: 10/89 Sizemore, PA no known allergies
Allergies:
Diagnostic Lab Data: CSF & Blood Cultures - Haemophilus Influenza done 7SEP90
CDC 'Split Type':

Write-up: vomiting, lethargy, restless, disoriented, can''t walk, stiff discoloration of feet & hands


Changed on 9/14/2018

VAERS ID: 26102 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Oklahoma
Vaccinated:1990-08-21
Onset:1990-09-03
Submitted:0000-00-00
Entered:1990-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283913 / 3 RL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER M66FB / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 12925 / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 277942 / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Agitation, Confusional state, Gait disturbance, Skin discolouration, Somnolence, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 12     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Ceftriaxone 500 mg IV, Augmentin 250 Mgn tid X 1 wk
Current Illness: none WIC recert.
Preexisting Conditions: 10/89 Sizemore, PA no known allergies
Allergies:
Diagnostic Lab Data: CSF & Blood Cultures - Haemophilus Influenza done 7SEP90
CDC 'Split Type':

Write-up: vomiting, lethargy, restless, disoriented, can''t walk, stiff discoloration of feet & hands


Changed on 10/14/2018

VAERS ID: 26102 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Oklahoma
Vaccinated:1990-08-21
Onset:1990-09-03
Submitted:0000-00-00
Entered:1990-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283913 / 3 RL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER M66FB / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 12925 / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 277942 / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Agitation, Confusional state, Gait disturbance, Skin discolouration, Somnolence, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 12     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Ceftriaxone 500 mg IV, Augmentin 250 Mgn tid X 1 wk
Current Illness: none WIC recert.
Preexisting Conditions: 10/89 Sizemore, PA no known allergies
Allergies:
Diagnostic Lab Data: CSF & Blood Cultures - Haemophilus Influenza done 7SEP90
CDC 'Split Type':

Write-up: vomiting, lethargy, restless, disoriented, can''t walk, stiff discoloration of feet & hands

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