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This is VAERS ID 26626

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 26626
VAERS Form:
Age:1.4
Sex:Female
Location:Pennsylvania
Vaccinated:1990-11-07
Onset:1990-11-07
Submitted:1990-11-08
Entered:1990-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 259959 / 2 LL / IM
HIBV: PROHIBIT / CONNAUGHT LABS 0A21133 / 0 RL / -
MMR: MMR II / MSD 1703S / 0 RA / -
OPV: ORIMUNE / LEDERLE 0618A / 2 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: PHARYNGITIS, OTITIS MED, FEBRILE SEIZURE

Life Threatening? No
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Dimetapp, Septra
Current Illness: Mild URI/BOME
Preexisting Conditions: pt had LOM 9OCT90
Allergies:
Diagnostic Lab Data: WBC 7.1, VA = normal, urine callas=negative,blood culture
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV/MMR/PROHIBIT mild URI for 1 wk otitis one month ago otitis w/effusion at exam 7NOV developed Febrile seizure, temp 41, fluid in middle ear.


Changed on 12/8/2009

VAERS ID: 26626 Before After
VAERS Form:
Age:1.4
Sex:Female
Location:Pennsylvania
Vaccinated:1990-11-07
Onset:1990-11-07
Submitted:1990-11-08
Entered:1990-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 259959 / 2 LL / IM
HIBV: PROHIBIT HIB (PROHIBIT) / CONNAUGHT LABS CONNAUGHT LABORATORIES 0A21133 / 0 RL / -
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 1703S / 0 RA / -
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 0618A / 2 - / PO

Administered by: Private      Purchased by: Unknown Private
Symptoms: Febrile convulsion, Otitis media, Pharyngitis, PHARYNGITIS, OTITIS MED, FEBRILE SEIZURE

Life Threatening? No
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Dimetapp, Septra
Current Illness: Mild URI/BOME
Preexisting Conditions: pt had LOM 9OCT90
Allergies:
Diagnostic Lab Data: WBC 7.1, VA = normal, urine callas=negative,blood culture
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV/MMR/PROHIBIT mild URI for 1 wk otitis one month ago otitis w/effusion at exam 7NOV developed Febrile seizure, temp 41, fluid in middle ear.


Changed on 5/14/2017

VAERS ID: 26626 Before After
VAERS Form:
Age:1.4
Sex:Female
Location:Pennsylvania
Vaccinated:1990-11-07
Onset:1990-11-07
Submitted:1990-11-08
Entered:1990-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 259959 / 2 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0A21133 / 0 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1703S / 0 RA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 0618A / 2 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Febrile convulsion, Otitis media, Pharyngitis

Life Threatening? No
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: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Dimetapp, Septra
Current Illness: Mild URI/BOME
Preexisting Conditions: pt had LOM 9OCT90
Allergies:
Diagnostic Lab Data: WBC 7.1, VA = normal, urine callas=negative,blood culture
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV/MMR/PROHIBIT mild URI for 1 wk otitis one month ago otitis w/effusion at exam 7NOV developed Febrile seizure, temp 41, fluid in middle ear.


Changed on 9/14/2017

VAERS ID: 26626 Before After
VAERS Form:(blank) 1
Age:1.4
Sex:Female
Location:Pennsylvania
Vaccinated:1990-11-07
Onset:1990-11-07
Submitted:1990-11-08
Entered:1990-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 259959 / 2 3 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0A21133 / 0 1 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1703S / 0 1 RA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0618A / 2 3 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Febrile convulsion, Otitis media, Pharyngitis

Life Threatening? No
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: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Dimetapp, Septra
Current Illness: Mild URI/BOME
Preexisting Conditions: pt had LOM 9OCT90
Allergies:
Diagnostic Lab Data: WBC 7.1, VA = normal, urine callas=negative,blood culture
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV/MMR/PROHIBIT mild URI for 1 wk otitis one month ago otitis w/effusion at exam 7NOV developed Febrile seizure, temp 41, fluid in middle ear.


Changed on 2/14/2018

VAERS ID: 26626 Before After
VAERS Form:1
Age:1.4
Sex:Female
Location:Pennsylvania
Vaccinated:1990-11-07
Onset:1990-11-07
Submitted:1990-11-08
Entered:1990-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 259959 / 3 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0A21133 / 1 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1703S / 1 RA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0618A / 3 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Febrile convulsion, Otitis media, Pharyngitis

Life Threatening? No
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: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Dimetapp, Septra
Current Illness: Mild URI/BOME
Preexisting Conditions: pt had LOM 9OCT90
Allergies:
Diagnostic Lab Data: WBC 7.1, VA = normal, urine callas=negative,blood culture
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV/MMR/PROHIBIT mild URI for 1 wk otitis one month ago otitis w/effusion at exam 7NOV developed Febrile seizure, temp 41, fluid in middle ear.


Changed on 6/14/2018

VAERS ID: 26626 Before After
VAERS Form:1
Age:1.4
Sex:Female
Location:Pennsylvania
Vaccinated:1990-11-07
Onset:1990-11-07
Submitted:1990-11-08
Entered:1990-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 259959 / 3 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0A21133 / 1 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1703S / 1 RA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0618A / 3 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Febrile convulsion, Otitis media, Pharyngitis

Life Threatening? No
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: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Dimetapp, Septra
Current Illness: Mild URI/BOME
Preexisting Conditions: pt had LOM 9OCT90
Allergies:
Diagnostic Lab Data: WBC 7.1, VA = normal, urine callas=negative,blood culture
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV/MMR/PROHIBIT mild URI for 1 wk otitis one month ago otitis w/effusion at exam 7NOV developed Febrile seizure, temp 41, fluid in middle ear.


Changed on 8/14/2018

VAERS ID: 26626 Before After
VAERS Form:1
Age:1.4
Sex:Female
Location:Pennsylvania
Vaccinated:1990-11-07
Onset:1990-11-07
Submitted:1990-11-08
Entered:1990-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 259959 / 3 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0A21133 / 1 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1703S / 1 RA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0618A / 3 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Febrile convulsion, Otitis media, Pharyngitis

Life Threatening? No
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: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Dimetapp, Septra
Current Illness: Mild URI/BOME
Preexisting Conditions: pt had LOM 9OCT90
Allergies:
Diagnostic Lab Data: WBC 7.1, VA = normal, urine callas=negative,blood culture
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV/MMR/PROHIBIT mild URI for 1 wk otitis one month ago otitis w/effusion at exam 7NOV developed Febrile seizure, temp 41, fluid in middle ear.


Changed on 9/14/2018

VAERS ID: 26626 Before After
VAERS Form:1
Age:1.4
Sex:Female
Location:Pennsylvania
Vaccinated:1990-11-07
Onset:1990-11-07
Submitted:1990-11-08
Entered:1990-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 259959 / 3 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0A21133 / 1 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1703S / 1 RA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0618A / 3 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Febrile convulsion, Otitis media, Pharyngitis

Life Threatening? No
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: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Dimetapp, Septra
Current Illness: Mild URI/BOME
Preexisting Conditions: pt had LOM 9OCT90
Allergies:
Diagnostic Lab Data: WBC 7.1, VA = normal, urine callas=negative,blood culture
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV/MMR/PROHIBIT mild URI for 1 wk otitis one month ago otitis w/effusion at exam 7NOV developed Febrile seizure, temp 41, fluid in middle ear.


Changed on 10/14/2018

VAERS ID: 26626 Before After
VAERS Form:1
Age:1.4
Sex:Female
Location:Pennsylvania
Vaccinated:1990-11-07
Onset:1990-11-07
Submitted:1990-11-08
Entered:1990-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 259959 / 3 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0A21133 / 1 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1703S / 1 RA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0618A / 3 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Febrile convulsion, Otitis media, Pharyngitis

Life Threatening? No
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: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Dimetapp, Septra
Current Illness: Mild URI/BOME
Preexisting Conditions: pt had LOM 9OCT90
Allergies:
Diagnostic Lab Data: WBC 7.1, VA = normal, urine callas=negative,blood culture
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV/MMR/PROHIBIT mild URI for 1 wk otitis one month ago otitis w/effusion at exam 7NOV developed Febrile seizure, temp 41, fluid in middle ear.

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