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This is VAERS ID 27169

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 27169
VAERS Form:
Age:2.0
Sex:Female
Location:Rhode Island
Vaccinated:1990-12-10
Onset:1990-12-11
Submitted:1990-12-14
Entered:1991-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIBTITER / LEDERLE(PRAXIS) M025FC / 0 - / IM
MMR: MMR II / MSD 1879S / 0 - / IM

Administered by: Public      Purchased by: Unknown
Symptoms: CONVULS, FEVER, MENINGITIS, CSF ABNORM

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Ceclor
Current Illness: Mild serious otitis
Preexisting Conditions: partially resolved otitis media
Allergies:
Diagnostic Lab Data: CSF Culture positive - H. Influenza
CDC 'Split Type':

Write-up: Pt vaccinated with MMR/HIB developed fever, possible convulsion, bacterial meningitis.


Changed on 12/8/2009

VAERS ID: 27169 Before After
VAERS Form:
Age:2.0
Sex:Female
Location:Rhode Island
Vaccinated:1990-12-10
Onset:1990-12-11
Submitted:1990-12-14
Entered:1991-01-02 1990-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M025FC / 0 - / IM
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 1879S / 0 - / IM

Administered by: Public      Purchased by: Unknown Public
Symptoms: Convulsion, Meningitis, Pyrexia, CSF test abnormal, CONVULS, FEVER, MENINGITIS, CSF ABNORM

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Ceclor
Current Illness: Mild serious otitis
Preexisting Conditions: partially resolved otitis media
Allergies:
Diagnostic Lab Data: CSF Culture positive - H. Influenza
CDC 'Split Type':

Write-up: Pt vaccinated with MMR/HIB developed fever, possible convulsion, bacterial meningitis.


Changed on 5/14/2017

VAERS ID: 27169 Before After
VAERS Form:
Age:2.0
Sex:Female
Location:Rhode Island
Vaccinated:1990-12-10
Onset:1990-12-11
Submitted:1990-12-14
Entered:1990-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M025FC / 0 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1879S / 0 - / IM

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Meningitis, Pyrexia, CSF test abnormal

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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Ceclor
Current Illness: Mild serious otitis
Preexisting Conditions: partially resolved otitis media
Allergies:
Diagnostic Lab Data: CSF Culture positive - H. Influenza
CDC 'Split Type':

Write-up: Pt vaccinated with MMR/HIB developed fever, possible convulsion, bacterial meningitis.


Changed on 9/14/2017

VAERS ID: 27169 Before After
VAERS Form:(blank) 1
Age:2.0
Sex:Female
Location:Rhode Island
Vaccinated:1990-12-10
Onset:1990-12-11
Submitted:1990-12-14
Entered:1990-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M025FC / 0 1 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1879S / 0 1 - / IM

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Meningitis, Pyrexia, CSF test abnormal

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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Ceclor
Current Illness: Mild serious otitis
Preexisting Conditions: partially resolved otitis media
Allergies:
Diagnostic Lab Data: CSF Culture positive - H. Influenza
CDC 'Split Type':

Write-up: Pt vaccinated with MMR/HIB developed fever, possible convulsion, bacterial meningitis.


Changed on 2/14/2018

VAERS ID: 27169 Before After
VAERS Form:1
Age:2.0
Sex:Female
Location:Rhode Island
Vaccinated:1990-12-10
Onset:1990-12-11
Submitted:1990-12-14
Entered:1990-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M025FC / 1 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1879S / 1 - / IM

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Meningitis, Pyrexia, CSF test abnormal

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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Ceclor
Current Illness: Mild serious otitis
Preexisting Conditions: partially resolved otitis media
Allergies:
Diagnostic Lab Data: CSF Culture positive - H. Influenza
CDC 'Split Type':

Write-up: Pt vaccinated with MMR/HIB developed fever, possible convulsion, bacterial meningitis.


Changed on 6/14/2018

VAERS ID: 27169 Before After
VAERS Form:1
Age:2.0
Sex:Female
Location:Rhode Island
Vaccinated:1990-12-10
Onset:1990-12-11
Submitted:1990-12-14
Entered:1990-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M025FC / 1 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1879S / 1 - / IM

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Meningitis, Pyrexia, CSF test abnormal

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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Ceclor
Current Illness: Mild serious otitis
Preexisting Conditions: partially resolved otitis media
Allergies:
Diagnostic Lab Data: CSF Culture positive - H. Influenza
CDC 'Split Type':

Write-up: Pt vaccinated with MMR/HIB developed fever, possible convulsion, bacterial meningitis.


Changed on 8/14/2018

VAERS ID: 27169 Before After
VAERS Form:1
Age:2.0
Sex:Female
Location:Rhode Island
Vaccinated:1990-12-10
Onset:1990-12-11
Submitted:1990-12-14
Entered:1990-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M025FC / 1 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1879S / 1 - / IM

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Meningitis, Pyrexia, CSF test abnormal

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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Ceclor
Current Illness: Mild serious otitis
Preexisting Conditions: partially resolved otitis media
Allergies:
Diagnostic Lab Data: CSF Culture positive - H. Influenza
CDC 'Split Type':

Write-up: Pt vaccinated with MMR/HIB developed fever, possible convulsion, bacterial meningitis.


Changed on 9/14/2018

VAERS ID: 27169 Before After
VAERS Form:1
Age:2.0
Sex:Female
Location:Rhode Island
Vaccinated:1990-12-10
Onset:1990-12-11
Submitted:1990-12-14
Entered:1990-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M025FC / 1 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1879S / 1 - / IM

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Meningitis, Pyrexia, CSF test abnormal

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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Ceclor
Current Illness: Mild serious otitis
Preexisting Conditions: partially resolved otitis media
Allergies:
Diagnostic Lab Data: CSF Culture positive - H. Influenza
CDC 'Split Type':

Write-up: Pt vaccinated with MMR/HIB developed fever, possible convulsion, bacterial meningitis.


Changed on 10/14/2018

VAERS ID: 27169 Before After
VAERS Form:1
Age:2.0
Sex:Female
Location:Rhode Island
Vaccinated:1990-12-10
Onset:1990-12-11
Submitted:1990-12-14
Entered:1990-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M025FC / 1 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1879S / 1 - / IM

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Meningitis, Pyrexia, CSF test abnormal

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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Ceclor
Current Illness: Mild serious otitis
Preexisting Conditions: partially resolved otitis media
Allergies:
Diagnostic Lab Data: CSF Culture positive - H. Influenza
CDC 'Split Type':

Write-up: Pt vaccinated with MMR/HIB developed fever, possible convulsion, bacterial meningitis.

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