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This is VAERS ID 27648

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 27648
VAERS Form:
Age:1.3
Sex:Female
Location:New York
Vaccinated:1990-11-05
Onset:1990-11-12
Submitted:1991-01-25
Entered:1991-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIBTITER / LEDERLE(PRAXIS) M030FC / 0 LA / SC
MMR: MMR II / MSD 1707S / 0 RA / SC

Administered by: Private      Purchased by: Unknown
Symptoms: CONVULS, FEVER, APNEA, TREMOR, COMA

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: WBC 17,400, NOSC CX PIII, TC PIII
CDC 'Split Type':

Write-up: Temp 105 onset 1 wk after MMR vaccine; Pt had episode of shaking, LOC, ?apnea/vs seizure observed 48 hrs in hosp, Recovered completely.


Changed on 12/8/2009

VAERS ID: 27648 Before After
VAERS Form:
Age:1.3
Sex:Female
Location:New York
Vaccinated:1990-11-05
Onset:1990-11-12
Submitted:1991-01-25
Entered:1991-02-01 1991-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M030FC / 0 LA / SC
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 1707S / 0 RA / SC

Administered by: Private      Purchased by: Unknown Private
Symptoms: Apnoea, Coma, Convulsion, Pyrexia, Tremor, CONVULS, FEVER, APNEA, TREMOR, COMA

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: WBC 17,400, NOSC CX PIII, TC PIII
CDC 'Split Type':

Write-up: Temp 105 onset 1 wk after MMR vaccine; Pt had episode of shaking, LOC, ?apnea/vs seizure observed 48 hrs in hosp, Recovered completely.


Changed on 5/14/2017

VAERS ID: 27648 Before After
VAERS Form:
Age:1.3
Sex:Female
Location:New York
Vaccinated:1990-11-05
Onset:1990-11-12
Submitted:1991-01-25
Entered:1991-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M030FC / 0 LA / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1707S / 0 RA / SC

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Coma, Convulsion, Pyrexia, Tremor

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: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: WBC 17,400, NOSC CX PIII, TC PIII
CDC 'Split Type':

Write-up: Temp 105 onset 1 wk after MMR vaccine; Pt had episode of shaking, LOC, ?apnea/vs seizure observed 48 hrs in hosp, Recovered completely.


Changed on 9/14/2017

VAERS ID: 27648 Before After
VAERS Form:(blank) 1
Age:1.3
Sex:Female
Location:New York
Vaccinated:1990-11-05
Onset:1990-11-12
Submitted:1991-01-25
Entered:1991-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M030FC / 0 1 LA / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1707S / 0 1 RA / SC

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Coma, Convulsion, Pyrexia, Tremor

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: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: WBC 17,400, NOSC CX PIII, TC PIII
CDC 'Split Type':

Write-up: Temp 105 onset 1 wk after MMR vaccine; Pt had episode of shaking, LOC, ?apnea/vs seizure observed 48 hrs in hosp, Recovered completely.


Changed on 2/14/2018

VAERS ID: 27648 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:New York
Vaccinated:1990-11-05
Onset:1990-11-12
Submitted:1991-01-25
Entered:1991-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M030FC / 1 LA / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1707S / 1 RA / SC

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Coma, Convulsion, Pyrexia, Tremor

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: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: WBC 17,400, NOSC CX PIII, TC PIII
CDC 'Split Type':

Write-up: Temp 105 onset 1 wk after MMR vaccine; Pt had episode of shaking, LOC, ?apnea/vs seizure observed 48 hrs in hosp, Recovered completely.


Changed on 6/14/2018

VAERS ID: 27648 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:New York
Vaccinated:1990-11-05
Onset:1990-11-12
Submitted:1991-01-25
Entered:1991-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M030FC / 1 LA / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1707S / 1 RA / SC

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Coma, Convulsion, Pyrexia, Tremor

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: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: WBC 17,400, NOSC CX PIII, TC PIII
CDC 'Split Type':

Write-up: Temp 105 onset 1 wk after MMR vaccine; Pt had episode of shaking, LOC, ?apnea/vs seizure observed 48 hrs in hosp, Recovered completely.


Changed on 8/14/2018

VAERS ID: 27648 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:New York
Vaccinated:1990-11-05
Onset:1990-11-12
Submitted:1991-01-25
Entered:1991-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M030FC / 1 LA / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1707S / 1 RA / SC

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Coma, Convulsion, Pyrexia, Tremor

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: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: WBC 17,400, NOSC CX PIII, TC PIII
CDC 'Split Type':

Write-up: Temp 105 onset 1 wk after MMR vaccine; Pt had episode of shaking, LOC, ?apnea/vs seizure observed 48 hrs in hosp, Recovered completely.


Changed on 9/14/2018

VAERS ID: 27648 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:New York
Vaccinated:1990-11-05
Onset:1990-11-12
Submitted:1991-01-25
Entered:1991-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M030FC / 1 LA / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1707S / 1 RA / SC

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Coma, Convulsion, Pyrexia, Tremor

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: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: WBC 17,400, NOSC CX PIII, TC PIII
CDC 'Split Type':

Write-up: Temp 105 onset 1 wk after MMR vaccine; Pt had episode of shaking, LOC, ?apnea/vs seizure observed 48 hrs in hosp, Recovered completely.


Changed on 10/14/2018

VAERS ID: 27648 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:New York
Vaccinated:1990-11-05
Onset:1990-11-12
Submitted:1991-01-25
Entered:1991-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M030FC / 1 LA / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1707S / 1 RA / SC

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Coma, Convulsion, Pyrexia, Tremor

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: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: WBC 17,400, NOSC CX PIII, TC PIII
CDC 'Split Type':

Write-up: Temp 105 onset 1 wk after MMR vaccine; Pt had episode of shaking, LOC, ?apnea/vs seizure observed 48 hrs in hosp, Recovered completely.

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