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This is VAERS ID 27548

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 27548
VAERS Form:
Age:1.4
Sex:Male
Location:Virginia
Vaccinated:1990-11-15
Onset:1990-11-25
Submitted:1991-01-08
Entered:1991-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 285965 / 3 LL / IM
HIBV: PROHIBIT / CONNAUGHT LABS 0A21133 / 0 RL / IM
MMR: MMR II / MSD 1487S / 0 LA / SC
OPV: ORIMUNE / LEDERLE 287939 / 2 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: HYPOTONIA, FEVER

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated w/DTP/OPV/MMR/HIB 10 days /p developed rash, fever 106.3, limp taken to ER hospitalized 3 days.


Changed on 12/8/2009

VAERS ID: 27548 Before After
VAERS Form:
Age:1.4
Sex:Male
Location:Virginia
Vaccinated:1990-11-15
Onset:1990-11-25
Submitted:1991-01-08
Entered:1991-01-29 1991-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 285965 / 3 LL / IM
HIBV: PROHIBIT HIB (PROHIBIT) / CONNAUGHT LABS CONNAUGHT LABORATORIES 0A21133 / 0 RL / IM
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 1487S / 0 LA / SC
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 287939 / 2 - / PO

Administered by: Public      Purchased by: Unknown Public
Symptoms: Hypotonia, Pyrexia, HYPOTONIA, FEVER

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) VA91004

Write-up: Pt vaccinated w/DTP/OPV/MMR/HIB 10 days /p developed rash, fever 106.3, limp taken to ER hospitalized 3 days.


Changed on 5/14/2017

VAERS ID: 27548 Before After
VAERS Form:
Age:1.4
Sex:Male
Location:Virginia
Vaccinated:1990-11-15
Onset:1990-11-25
Submitted:1991-01-08
Entered:1991-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285965 / 3 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0A21133 / 0 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1487S / 0 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 287939 / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Hypotonia, Pyrexia

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': VA91004

Write-up: Pt vaccinated w/DTP/OPV/MMR/HIB 10 days /p developed rash, fever 106.3, limp taken to ER hospitalized 3 days.


Changed on 9/14/2017

VAERS ID: 27548 Before After
VAERS Form:(blank) 1
Age:1.4
Sex:Male
Location:Virginia
Vaccinated:1990-11-15
Onset:1990-11-25
Submitted:1991-01-08
Entered:1991-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285965 / 3 4 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0A21133 / 0 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1487S / 0 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 287939 / 2 3 - MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Hypotonia, Pyrexia

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': VA91004

Write-up: Pt vaccinated w/DTP/OPV/MMR/HIB 10 days /p developed rash, fever 106.3, limp taken to ER hospitalized 3 days.


Changed on 2/14/2018

VAERS ID: 27548 Before After
VAERS Form:1
Age:1.4
Sex:Male
Location:Virginia
Vaccinated:1990-11-15
Onset:1990-11-25
Submitted:1991-01-08
Entered:1991-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285965 / 4 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0A21133 / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1487S / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 287939 / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Hypotonia, Pyrexia

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': VA91004

Write-up: Pt vaccinated w/DTP/OPV/MMR/HIB 10 days /p developed rash, fever 106.3, limp taken to ER hospitalized 3 days.


Changed on 6/14/2018

VAERS ID: 27548 Before After
VAERS Form:1
Age:1.4
Sex:Male
Location:Virginia
Vaccinated:1990-11-15
Onset:1990-11-25
Submitted:1991-01-08
Entered:1991-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285965 / 4 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0A21133 / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1487S / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 287939 / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Hypotonia, Pyrexia

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': VA91004

Write-up: Pt vaccinated w/DTP/OPV/MMR/HIB 10 days /p developed rash, fever 106.3, limp taken to ER hospitalized 3 days.


Changed on 8/14/2018

VAERS ID: 27548 Before After
VAERS Form:1
Age:1.4
Sex:Male
Location:Virginia
Vaccinated:1990-11-15
Onset:1990-11-25
Submitted:1991-01-08
Entered:1991-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285965 / 4 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0A21133 / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1487S / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 287939 / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Hypotonia, Pyrexia

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': VA91004

Write-up: Pt vaccinated w/DTP/OPV/MMR/HIB 10 days /p developed rash, fever 106.3, limp taken to ER hospitalized 3 days.


Changed on 9/14/2018

VAERS ID: 27548 Before After
VAERS Form:1
Age:1.4
Sex:Male
Location:Virginia
Vaccinated:1990-11-15
Onset:1990-11-25
Submitted:1991-01-08
Entered:1991-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285965 / 4 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0A21133 / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1487S / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 287939 / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Hypotonia, Pyrexia

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': VA91004

Write-up: Pt vaccinated w/DTP/OPV/MMR/HIB 10 days /p developed rash, fever 106.3, limp taken to ER hospitalized 3 days.


Changed on 10/14/2018

VAERS ID: 27548 Before After
VAERS Form:1
Age:1.4
Sex:Male
Location:Virginia
Vaccinated:1990-11-15
Onset:1990-11-25
Submitted:1991-01-08
Entered:1991-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285965 / 4 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0A21133 / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1487S / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 287939 / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Hypotonia, Pyrexia

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': VA91004

Write-up: Pt vaccinated w/DTP/OPV/MMR/HIB 10 days /p developed rash, fever 106.3, limp taken to ER hospitalized 3 days.

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