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This is VAERS ID 26835

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 26835
VAERS Form:
Age:1.3
Sex:Male
Location:Texas
Vaccinated:1990-11-15
Onset:1990-11-16
Submitted:1990-11-20
Entered:1990-12-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIBTITER / LEDERLE(PRAXIS) M635FC / 0 RA / IM
MMR: MMR II / MSD 17055 / 0 RA / SC

Administered by: Private      Purchased by: Unknown
Symptoms: CONVULS

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Viscous Xylocaine 2%
Current Illness: Herpes stomatitis
Preexisting Conditions: Hypotonia, SIADH laryngotracheomalacia, GE reflux, ferrke serure
Allergies:
Diagnostic Lab Data: EEG-Seizure focus in the rt occpital - temporal region; CT Scan - Otitis Media Mastoid Effusion only
CDC 'Split Type':

Write-up: Pt vaccinated with MMR/HIB Grand Mal Seizure approx 12 hrs after the administration of vaccines. Admitted to hosp for 3 days of testing & observation. Placed on phenobarbital and seizure did not recur.


Changed on 12/8/2009

VAERS ID: 26835 Before After
VAERS Form:
Age:1.3
Sex:Male
Location:Texas
Vaccinated:1990-11-15
Onset:1990-11-16
Submitted:1990-11-20
Entered:1990-12-04 1990-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M635FC / 0 RA / IM
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 17055 / 0 RA / SC

Administered by: Private      Purchased by: Unknown Private
Symptoms: Convulsion, CONVULS

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Viscous Xylocaine 2%
Current Illness: Herpes stomatitis
Preexisting Conditions: Hypotonia, SIADH laryngotracheomalacia, GE reflux, ferrke serure
Allergies:
Diagnostic Lab Data: EEG-Seizure focus in the rt occpital - temporal region; CT Scan - Otitis Media Mastoid Effusion only
CDC 'Split Type':

Write-up: Pt vaccinated with MMR/HIB Grand Mal Seizure approx 12 hrs after the administration of vaccines. Admitted to hosp for 3 days of testing & observation. Placed on phenobarbital and seizure did not recur.


Changed on 5/14/2017

VAERS ID: 26835 Before After
VAERS Form:
Age:1.3
Sex:Male
Location:Texas
Vaccinated:1990-11-15
Onset:1990-11-16
Submitted:1990-11-20
Entered:1990-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M635FC / 0 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 17055 / 0 RA / SC

Administered by: Private      Purchased by: Private
Symptoms: Convulsion

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Viscous Xylocaine 2%
Current Illness: Herpes stomatitis
Preexisting Conditions: Hypotonia, SIADH laryngotracheomalacia, GE reflux, ferrke serure
Allergies:
Diagnostic Lab Data: EEG-Seizure focus in the rt occpital - temporal region; CT Scan - Otitis Media Mastoid Effusion only
CDC 'Split Type':

Write-up: Pt vaccinated with MMR/HIB Grand Mal Seizure approx 12 hrs after the administration of vaccines. Admitted to hosp for 3 days of testing & observation. Placed on phenobarbital and seizure did not recur.


Changed on 9/14/2017

VAERS ID: 26835 Before After
VAERS Form:(blank) 1
Age:1.3
Sex:Male
Location:Texas
Vaccinated:1990-11-15
Onset:1990-11-16
Submitted:1990-11-20
Entered:1990-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M635FC / 0 1 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 17055 / 0 1 RA / SC

Administered by: Private      Purchased by: Private
Symptoms: Convulsion

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Viscous Xylocaine 2%
Current Illness: Herpes stomatitis
Preexisting Conditions: Hypotonia, SIADH laryngotracheomalacia, GE reflux, ferrke serure
Allergies:
Diagnostic Lab Data: EEG-Seizure focus in the rt occpital - temporal region; CT Scan - Otitis Media Mastoid Effusion only
CDC 'Split Type':

Write-up: Pt vaccinated with MMR/HIB Grand Mal Seizure approx 12 hrs after the administration of vaccines. Admitted to hosp for 3 days of testing & observation. Placed on phenobarbital and seizure did not recur.


Changed on 2/14/2018

VAERS ID: 26835 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Texas
Vaccinated:1990-11-15
Onset:1990-11-16
Submitted:1990-11-20
Entered:1990-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M635FC / 1 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 17055 / 1 RA / SC

Administered by: Private      Purchased by: Private
Symptoms: Convulsion

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Viscous Xylocaine 2%
Current Illness: Herpes stomatitis
Preexisting Conditions: Hypotonia, SIADH laryngotracheomalacia, GE reflux, ferrke serure
Allergies:
Diagnostic Lab Data: EEG-Seizure focus in the rt occpital - temporal region; CT Scan - Otitis Media Mastoid Effusion only
CDC 'Split Type':

Write-up: Pt vaccinated with MMR/HIB Grand Mal Seizure approx 12 hrs after the administration of vaccines. Admitted to hosp for 3 days of testing & observation. Placed on phenobarbital and seizure did not recur.


Changed on 6/14/2018

VAERS ID: 26835 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Texas
Vaccinated:1990-11-15
Onset:1990-11-16
Submitted:1990-11-20
Entered:1990-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M635FC / 1 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 17055 / 1 RA / SC

Administered by: Private      Purchased by: Private
Symptoms: Convulsion

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Viscous Xylocaine 2%
Current Illness: Herpes stomatitis
Preexisting Conditions: Hypotonia, SIADH laryngotracheomalacia, GE reflux, ferrke serure
Allergies:
Diagnostic Lab Data: EEG-Seizure focus in the rt occpital - temporal region; CT Scan - Otitis Media Mastoid Effusion only
CDC 'Split Type':

Write-up: Pt vaccinated with MMR/HIB Grand Mal Seizure approx 12 hrs after the administration of vaccines. Admitted to hosp for 3 days of testing & observation. Placed on phenobarbital and seizure did not recur.


Changed on 8/14/2018

VAERS ID: 26835 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Texas
Vaccinated:1990-11-15
Onset:1990-11-16
Submitted:1990-11-20
Entered:1990-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M635FC / 1 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 17055 / 1 RA / SC

Administered by: Private      Purchased by: Private
Symptoms: Convulsion

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Viscous Xylocaine 2%
Current Illness: Herpes stomatitis
Preexisting Conditions: Hypotonia, SIADH laryngotracheomalacia, GE reflux, ferrke serure
Allergies:
Diagnostic Lab Data: EEG-Seizure focus in the rt occpital - temporal region; CT Scan - Otitis Media Mastoid Effusion only
CDC 'Split Type':

Write-up: Pt vaccinated with MMR/HIB Grand Mal Seizure approx 12 hrs after the administration of vaccines. Admitted to hosp for 3 days of testing & observation. Placed on phenobarbital and seizure did not recur.


Changed on 9/14/2018

VAERS ID: 26835 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Texas
Vaccinated:1990-11-15
Onset:1990-11-16
Submitted:1990-11-20
Entered:1990-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M635FC / 1 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 17055 / 1 RA / SC

Administered by: Private      Purchased by: Private
Symptoms: Convulsion

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Viscous Xylocaine 2%
Current Illness: Herpes stomatitis
Preexisting Conditions: Hypotonia, SIADH laryngotracheomalacia, GE reflux, ferrke serure
Allergies:
Diagnostic Lab Data: EEG-Seizure focus in the rt occpital - temporal region; CT Scan - Otitis Media Mastoid Effusion only
CDC 'Split Type':

Write-up: Pt vaccinated with MMR/HIB Grand Mal Seizure approx 12 hrs after the administration of vaccines. Admitted to hosp for 3 days of testing & observation. Placed on phenobarbital and seizure did not recur.


Changed on 10/14/2018

VAERS ID: 26835 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Texas
Vaccinated:1990-11-15
Onset:1990-11-16
Submitted:1990-11-20
Entered:1990-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M635FC / 1 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 17055 / 1 RA / SC

Administered by: Private      Purchased by: Private
Symptoms: Convulsion

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Viscous Xylocaine 2%
Current Illness: Herpes stomatitis
Preexisting Conditions: Hypotonia, SIADH laryngotracheomalacia, GE reflux, ferrke serure
Allergies:
Diagnostic Lab Data: EEG-Seizure focus in the rt occpital - temporal region; CT Scan - Otitis Media Mastoid Effusion only
CDC 'Split Type':

Write-up: Pt vaccinated with MMR/HIB Grand Mal Seizure approx 12 hrs after the administration of vaccines. Admitted to hosp for 3 days of testing & observation. Placed on phenobarbital and seizure did not recur.

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