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This is VAERS ID 27096

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 27096
VAERS Form:
Age:5.2
Sex:Female
Location:Montana
Vaccinated:1990-11-14
Onset:1990-11-28
Submitted:1990-12-10
Entered:1991-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 271961 / 0 LA / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) - / 0 - / -
MMR: MMR II / MSD 0217S / 0 RA / IM
OPV: ORIMUNE / LEDERLE 275925 / 0 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: GUILLAIN BARRE SYND, ASTHENIA

Life Threatening? Yes
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: had EMG consistant /w Guillain Barre, Had negative spinal tap , CAT scan
CDC 'Split Type':

Write-up: Guillian Barre Syndrome requiring intubation. Pt is still in hosp as of 10Dec90, Developed weakness on 28Nov90


Changed on 12/8/2009

VAERS ID: 27096 Before After
VAERS Form:
Age:5.2
Sex:Female
Location:Montana
Vaccinated:1990-11-14
Onset:1990-11-28
Submitted:1990-12-10
Entered:1991-01-10 1990-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 271961 / 0 LA / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS - / 0 - / -
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 0217S / 0 RA / IM
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 275925 / 0 - / PO

Administered by: Public      Purchased by: Unknown Public
Symptoms: Asthenia, Guillain-Barre syndrome, GUILLAIN BARRE SYND, ASTHENIA

Life Threatening? Yes
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: had EMG consistant /w Guillain Barre, Had negative spinal tap , CAT scan
CDC 'Split Type':

Write-up: Guillian Barre Syndrome requiring intubation. Pt is still in hosp as of 10Dec90, Developed weakness on 28Nov90


Changed on 2/14/2017

VAERS ID: 27096 Before After
VAERS Form:
Age:5.2 5.0
Sex:Female
Location:Montana
Vaccinated:1990-11-14
Onset:1990-11-28
Submitted:1990-12-10
Entered:1990-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271961 / 0 LA / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS - / 0 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0217S / 0 RA / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES 275925 / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, Guillain-Barre syndrome

Life Threatening? Yes
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: had EMG consistant /w Guillain Barre, Had negative spinal tap , CAT scan
CDC 'Split Type':

Write-up: Guillian Barre Syndrome requiring intubation. Pt is still in hosp as of 10Dec90, Developed weakness on 28Nov90


Changed on 5/14/2017

VAERS ID: 27096 Before After
VAERS Form:
Age:5.0
Sex:Female
Location:Montana
Vaccinated:1990-11-14
Onset:1990-11-28
Submitted:1990-12-10
Entered:1990-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271961 / 0 LA / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH - / 0 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0217S / 0 RA / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 275925 / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, Guillain-Barre syndrome

Life Threatening? Yes
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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: had EMG consistant /w Guillain Barre, Had negative spinal tap , CAT scan
CDC 'Split Type':

Write-up: Guillian Barre Syndrome requiring intubation. Pt is still in hosp as of 10Dec90, Developed weakness on 28Nov90


Changed on 9/14/2017

VAERS ID: 27096 Before After
VAERS Form:(blank) 1
Age:5.0
Sex:Female
Location:Montana
Vaccinated:1990-11-14
Onset:1990-11-28
Submitted:1990-12-10
Entered:1990-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271961 / 0 1 LA / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / 0 1 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0217S / 0 1 RA / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 275925 / 0 1 - MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, Guillain-Barre syndrome

Life Threatening? Yes
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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: had EMG consistant /w Guillain Barre, Had negative spinal tap , CAT scan
CDC 'Split Type':

Write-up: Guillian Barre Syndrome requiring intubation. Pt is still in hosp as of 10Dec90, Developed weakness on 28Nov90


Changed on 2/14/2018

VAERS ID: 27096 Before After
VAERS Form:1
Age:5.0
Sex:Female
Location:Montana
Vaccinated:1990-11-14
Onset:1990-11-28
Submitted:1990-12-10
Entered:1990-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271961 / 1 LA / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / 1 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0217S / 1 RA / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 275925 / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, Guillain-Barre syndrome

Life Threatening? Yes
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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: had EMG consistant /w Guillain Barre, Had negative spinal tap , CAT scan
CDC 'Split Type':

Write-up: Guillian Barre Syndrome requiring intubation. Pt is still in hosp as of 10Dec90, Developed weakness on 28Nov90


Changed on 6/14/2018

VAERS ID: 27096 Before After
VAERS Form:1
Age:5.0
Sex:Female
Location:Montana
Vaccinated:1990-11-14
Onset:1990-11-28
Submitted:1990-12-10
Entered:1990-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271961 / 1 LA / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / 1 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0217S / 1 RA / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 275925 / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, Guillain-Barre syndrome

Life Threatening? Yes
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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: had EMG consistant /w Guillain Barre, Had negative spinal tap , CAT scan
CDC 'Split Type':

Write-up: Guillian Barre Syndrome requiring intubation. Pt is still in hosp as of 10Dec90, Developed weakness on 28Nov90


Changed on 8/14/2018

VAERS ID: 27096 Before After
VAERS Form:1
Age:5.0
Sex:Female
Location:Montana
Vaccinated:1990-11-14
Onset:1990-11-28
Submitted:1990-12-10
Entered:1990-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271961 / 1 LA / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / 1 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0217S / 1 RA / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 275925 / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, Guillain-Barre syndrome

Life Threatening? Yes
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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: had EMG consistant /w Guillain Barre, Had negative spinal tap , CAT scan
CDC 'Split Type':

Write-up: Guillian Barre Syndrome requiring intubation. Pt is still in hosp as of 10Dec90, Developed weakness on 28Nov90


Changed on 9/14/2018

VAERS ID: 27096 Before After
VAERS Form:1
Age:5.0
Sex:Female
Location:Montana
Vaccinated:1990-11-14
Onset:1990-11-28
Submitted:1990-12-10
Entered:1990-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271961 / 1 LA / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / 1 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0217S / 1 RA / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 275925 / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, Guillain-Barre syndrome

Life Threatening? Yes
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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: had EMG consistant /w Guillain Barre, Had negative spinal tap , CAT scan
CDC 'Split Type':

Write-up: Guillian Barre Syndrome requiring intubation. Pt is still in hosp as of 10Dec90, Developed weakness on 28Nov90


Changed on 10/14/2018

VAERS ID: 27096 Before After
VAERS Form:1
Age:5.0
Sex:Female
Location:Montana
Vaccinated:1990-11-14
Onset:1990-11-28
Submitted:1990-12-10
Entered:1990-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271961 / 1 LA / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / 1 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0217S / 1 RA / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 275925 / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, Guillain-Barre syndrome

Life Threatening? Yes
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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: had EMG consistant /w Guillain Barre, Had negative spinal tap , CAT scan
CDC 'Split Type':

Write-up: Guillian Barre Syndrome requiring intubation. Pt is still in hosp as of 10Dec90, Developed weakness on 28Nov90

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