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This is VAERS ID 264016

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 264016
VAERS Form:
Age:4.0
Gender:Female
Location:California
Vaccinated:2006-10-03
Onset:2006-10-04
Submitted:2006-10-04
Entered:2006-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE AC14B035AA / 4 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR, INC. Z0018 / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1069P / 1 RL / SC

Administered by: Public      Purchased by: Unknown
Symptoms: Injection site oedema, Pyrexia, Thrombocytopenic purpura

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations: cellulitis~~~0~In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NONE

Write-up:Significant local swelling, fever and ITP to Dtap #05


Changed on 12/8/2009

VAERS ID: 264016 Before After
VAERS Form:
Age:4.0
Gender:Female
Location:California
Vaccinated:2006-10-03
Onset:2006-10-04
Submitted:2006-10-04
Entered:2006-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE GLAXOSMITHKLINE BIOLOGICALS AC14B035AA / 4 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR, INC. AVENTIS PASTEUR Z0018 / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1069P / 1 RL / SC

Administered by: Public      Purchased by: Unknown Private
Symptoms: Injection site oedema, Pyrexia, Thrombocytopenic purpura

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations: cellulitis~~~0~In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NONE (blank)

Write-up:Significant local swelling, fever and ITP to Dtap #05


Changed on 5/14/2017

VAERS ID: 264016 Before After
VAERS Form:
Age:4.0
Gender:Female
Location:California
Vaccinated:2006-10-03
Onset:2006-10-04
Submitted:2006-10-04
Entered:2006-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B035AA / 4 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR SANOFI PASTEUR Z0018 / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1069P / 1 RL / SC

Administered by: Public      Purchased by: Private
Symptoms: Injection site oedema, Pyrexia, Thrombocytopenic purpura

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations: cellulitis~~~0~In cellulitis~ ()~~0.00~In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Significant local swelling, fever and ITP to Dtap #05


Changed on 9/14/2017

VAERS ID: 264016 Before After
VAERS Form:(blank) 1
Age:4.0
Gender:Female
Location:California
Vaccinated:2006-10-03
Onset:2006-10-04
Submitted:2006-10-04
Entered:2006-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B035AA / 4 5 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0018 / 3 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1069P / 1 2 RL / SC

Administered by: Public      Purchased by: Private
Symptoms: Injection site oedema, Pyrexia, Thrombocytopenic purpura

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations: cellulitis~ ()~~0.00~In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Significant local swelling, fever and ITP to Dtap #05


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