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This is VAERS ID 27394

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 27394
VAERS Form:
Age:1.6
Sex:Female
Location:Missouri
Vaccinated:1990-11-29
Onset:1990-12-04
Submitted:1990-12-18
Entered:1991-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED, PEDIATRIC / WYETH 4908019 / - LA / IM
HIBV: PROHIBIT / CONNAUGHT LABS 01920168 / 0 RA / IM
MMR: MMR II / MSD 1414S / 0 RA / SC
OPV: ORIMUNE / LEDERLE 281925 / 2 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: In pt; 7mo; DTP;3
Other Medications:
Current Illness:
Preexisting Conditions: Febrile seizure after 3 DTP on 6NOV89.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': Febrile seizure after 3 DTP on 6NOV89.

Write-up: 5 days after vaccination, dev temp 103+ for 48 hrs - 2 seizures related to temp elevation. Treated for otitis media at Hospital 2 days later


Changed on 12/8/2009

VAERS ID: 27394 Before After
VAERS Form:
Age:1.6
Sex:Female
Location:Missouri
Vaccinated:1990-11-29
Onset:1990-12-04
Submitted:1990-12-18
Entered:1991-01-16 1991-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED, PEDIATRIC DT ADSORBED (NO BRAND NAME) / WYETH WYETH PHARMACEUTICALS, INC 4908019 / - LA / IM
HIBV: PROHIBIT HIB (PROHIBIT) / CONNAUGHT LABS CONNAUGHT LABORATORIES 01920168 / 0 RA / IM
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 1414S / 0 RA / SC
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 281925 / 2 - / PO

Administered by: Public      Purchased by: Unknown Public
Symptoms: Febrile convulsion, Otitis media, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: In pt; 7mo; DTP;3
Other Medications:
Current Illness:
Preexisting Conditions: Febrile seizure after 3 DTP on 6NOV89.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': Febrile seizure after 3 DTP on 6NOV89. MO903

Write-up: 5 days after vaccination, dev temp 103+ for 48 hrs - 2 seizures related to temp elevation. Treated for otitis media at Hospital 2 days later


Changed on 8/31/2010

VAERS ID: 27394 Before After
VAERS Form:
Age:1.6
Sex:Female
Location:Missouri
Vaccinated:1990-11-29
Onset:1990-12-04
Submitted:1990-12-18
Entered:1991-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4908019 / - LA / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 01920168 / 0 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1414S / 0 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES 281925 / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Febrile convulsion, Otitis media

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:     Extended hospital stay? No
Previous Vaccinations: In pt; 7mo; DTP;3
Other Medications:
Current Illness:
Preexisting Conditions: Febrile seizure after 3 DTP on 6NOV89.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MO903

Write-up: 5 days after vaccination, dev temp 103+ for 48 hrs - 2 seizures related to temp elevation. Treated for otitis media at Hospital 2 days later


Changed on 5/14/2017

VAERS ID: 27394 Before After
VAERS Form:
Age:1.6
Sex:Female
Location:Missouri
Vaccinated:1990-11-29
Onset:1990-12-04
Submitted:1990-12-18
Entered:1991-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / PFIZER/WYETH 4908019 / - LA / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 01920168 / 0 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1414S / 0 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 281925 / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Febrile convulsion, Otitis media

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:     Extended hospital stay? No
Previous Vaccinations: In pt; 7mo; DTP;3 DTP;3~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Febrile seizure after 3 DTP on 6NOV89.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MO903

Write-up: 5 days after vaccination, dev temp 103+ for 48 hrs - 2 seizures related to temp elevation. Treated for otitis media at Hospital 2 days later


Changed on 9/14/2017

VAERS ID: 27394 Before After
VAERS Form:(blank) 1
Age:1.6
Sex:Female
Location:Missouri
Vaccinated:1990-11-29
Onset:1990-12-04
Submitted:1990-12-18
Entered:1991-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / PFIZER/WYETH 4908019 / - UNK LA / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 01920168 / 0 1 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1414S / 0 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 281925 / 2 3 - MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Febrile convulsion, Otitis media

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:     Extended hospital stay? No
Previous Vaccinations: In pt; 7mo; DTP;3~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Febrile seizure after 3 DTP on 6NOV89.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MO903

Write-up: 5 days after vaccination, dev temp 103+ for 48 hrs - 2 seizures related to temp elevation. Treated for otitis media at Hospital 2 days later


Changed on 2/14/2018

VAERS ID: 27394 Before After
VAERS Form:1
Age:1.6
Sex:Female
Location:Missouri
Vaccinated:1990-11-29
Onset:1990-12-04
Submitted:1990-12-18
Entered:1991-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / PFIZER/WYETH 4908019 / UNK LA / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 01920168 / 1 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1414S / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 281925 / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Febrile convulsion, Otitis media

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:     Extended hospital stay? No
Previous Vaccinations: In pt; 7mo; DTP;3~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Febrile seizure after 3 DTP on 6NOV89.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MO903

Write-up: 5 days after vaccination, dev temp 103+ for 48 hrs - 2 seizures related to temp elevation. Treated for otitis media at Hospital 2 days later


Changed on 6/14/2018

VAERS ID: 27394 Before After
VAERS Form:1
Age:1.6
Sex:Female
Location:Missouri
Vaccinated:1990-11-29
Onset:1990-12-04
Submitted:1990-12-18
Entered:1991-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / PFIZER/WYETH 4908019 / UNK LA / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 01920168 / 1 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1414S / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 281925 / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Febrile convulsion, Otitis media

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:     Extended hospital stay? No
Previous Vaccinations: In pt; 7mo; DTP;3~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Febrile seizure after 3 DTP on 6NOV89.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MO903

Write-up: 5 days after vaccination, dev temp 103+ for 48 hrs - 2 seizures related to temp elevation. Treated for otitis media at Hospital 2 days later


Changed on 8/14/2018

VAERS ID: 27394 Before After
VAERS Form:1
Age:1.6
Sex:Female
Location:Missouri
Vaccinated:1990-11-29
Onset:1990-12-04
Submitted:1990-12-18
Entered:1991-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / PFIZER/WYETH 4908019 / UNK LA / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 01920168 / 1 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1414S / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 281925 / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Febrile convulsion, Otitis media

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:     Extended hospital stay? No
Previous Vaccinations: In pt; 7mo; DTP;3~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Febrile seizure after 3 DTP on 6NOV89.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MO903

Write-up: 5 days after vaccination, dev temp 103+ for 48 hrs - 2 seizures related to temp elevation. Treated for otitis media at Hospital 2 days later


Changed on 9/14/2018

VAERS ID: 27394 Before After
VAERS Form:1
Age:1.6
Sex:Female
Location:Missouri
Vaccinated:1990-11-29
Onset:1990-12-04
Submitted:1990-12-18
Entered:1991-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / PFIZER/WYETH 4908019 / UNK LA / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 01920168 / 1 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1414S / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 281925 / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Febrile convulsion, Otitis media

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:     Extended hospital stay? No
Previous Vaccinations: In pt; 7mo; DTP;3~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Febrile seizure after 3 DTP on 6NOV89.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MO903

Write-up: 5 days after vaccination, dev temp 103+ for 48 hrs - 2 seizures related to temp elevation. Treated for otitis media at Hospital 2 days later


Changed on 10/14/2018

VAERS ID: 27394 Before After
VAERS Form:1
Age:1.6
Sex:Female
Location:Missouri
Vaccinated:1990-11-29
Onset:1990-12-04
Submitted:1990-12-18
Entered:1991-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / PFIZER/WYETH 4908019 / UNK LA / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 01920168 / 1 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1414S / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 281925 / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Febrile convulsion, Otitis media

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:     Extended hospital stay? No
Previous Vaccinations: In pt; 7mo; DTP;3~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Febrile seizure after 3 DTP on 6NOV89.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MO903

Write-up: 5 days after vaccination, dev temp 103+ for 48 hrs - 2 seizures related to temp elevation. Treated for otitis media at Hospital 2 days later

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