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This is VAERS ID 27661

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 27661
VAERS Form:
Age:1.3
Sex:Male
Location:Georgia
Vaccinated:1990-12-10
Onset:1990-12-19
Submitted:1990-12-31
Entered:1991-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 281945 / 3 LA / IM
MMR: MMR II / MSD 1229S / 0 RA / SC
OPV: ORIMUNE / LEDERLE 0619D / 2 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: FEVER, EYES GAZE UPWARD, RASH, TREMOR, DYSPNEA

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: pt vaccinated w/HBCV, PRAXIS, M670FC, IM, LA, 0, 12DEC90. Also tempra
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 19DEC90 approx 415PM grunting, eyes rolled back, trembling all over, difficulty breathing, hot. Lasted approx 8 min. White blood count -good, temp 104, lt ear red.


Changed on 12/8/2009

VAERS ID: 27661 Before After
VAERS Form:
Age:1.3
Sex:Male
Location:Georgia
Vaccinated:1990-12-10
Onset:1990-12-19
Submitted:1990-12-31
Entered:1991-02-05 1991-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 281945 / 3 LA / IM
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 1229S / 0 RA / SC
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 0619D / 2 - / PO

Administered by: Public      Purchased by: Unknown Public
Symptoms: Dyspnoea, Pyrexia, Rash, Tremor, Vasodilatation, Gaze palsy, FEVER, EYES GAZE UPWARD, RASH, TREMOR, DYSPNEA

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: pt vaccinated w/HBCV, PRAXIS, M670FC, IM, LA, 0, 12DEC90. Also tempra
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) GA9026

Write-up: 19DEC90 approx 415PM grunting, eyes rolled back, trembling all over, difficulty breathing, hot. Lasted approx 8 min. White blood count -good, temp 104, lt ear red.


Changed on 5/14/2017

VAERS ID: 27661 Before After
VAERS Form:
Age:1.3
Sex:Male
Location:Georgia
Vaccinated:1990-12-10
Onset:1990-12-19
Submitted:1990-12-31
Entered:1991-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 281945 / 3 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1229S / 0 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 0619D / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Dyspnoea, Pyrexia, Rash, Tremor, Vasodilatation, Gaze palsy

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: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: pt vaccinated w/HBCV, PRAXIS, M670FC, IM, LA, 0, 12DEC90. Also tempra
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA9026

Write-up: 19DEC90 approx 415PM grunting, eyes rolled back, trembling all over, difficulty breathing, hot. Lasted approx 8 min. White blood count -good, temp 104, lt ear red.


Changed on 9/14/2017

VAERS ID: 27661 Before After
VAERS Form:(blank) 1
Age:1.3
Sex:Male
Location:Georgia
Vaccinated:1990-12-10
Onset:1990-12-19
Submitted:1990-12-31
Entered:1991-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 281945 / 3 4 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1229S / 0 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0619D / 2 3 - MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Dyspnoea, Pyrexia, Rash, Tremor, Vasodilatation, Gaze palsy

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: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: pt vaccinated w/HBCV, PRAXIS, M670FC, IM, LA, 0, 12DEC90. Also tempra
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA9026

Write-up: 19DEC90 approx 415PM grunting, eyes rolled back, trembling all over, difficulty breathing, hot. Lasted approx 8 min. White blood count -good, temp 104, lt ear red.


Changed on 2/14/2018

VAERS ID: 27661 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Georgia
Vaccinated:1990-12-10
Onset:1990-12-19
Submitted:1990-12-31
Entered:1991-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 281945 / 4 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1229S / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0619D / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Dyspnoea, Pyrexia, Rash, Tremor, Vasodilatation, Gaze palsy

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: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: pt vaccinated w/HBCV, PRAXIS, M670FC, IM, LA, 0, 12DEC90. Also tempra
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA9026

Write-up: 19DEC90 approx 415PM grunting, eyes rolled back, trembling all over, difficulty breathing, hot. Lasted approx 8 min. White blood count -good, temp 104, lt ear red.


Changed on 6/14/2018

VAERS ID: 27661 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Georgia
Vaccinated:1990-12-10
Onset:1990-12-19
Submitted:1990-12-31
Entered:1991-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 281945 / 4 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1229S / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0619D / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Dyspnoea, Pyrexia, Rash, Tremor, Vasodilatation, Gaze palsy

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: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: pt vaccinated w/HBCV, PRAXIS, M670FC, IM, LA, 0, 12DEC90. Also tempra
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA9026

Write-up: 19DEC90 approx 415PM grunting, eyes rolled back, trembling all over, difficulty breathing, hot. Lasted approx 8 min. White blood count -good, temp 104, lt ear red.


Changed on 8/14/2018

VAERS ID: 27661 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Georgia
Vaccinated:1990-12-10
Onset:1990-12-19
Submitted:1990-12-31
Entered:1991-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 281945 / 4 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1229S / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0619D / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Dyspnoea, Pyrexia, Rash, Tremor, Vasodilatation, Gaze palsy

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: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: pt vaccinated w/HBCV, PRAXIS, M670FC, IM, LA, 0, 12DEC90. Also tempra
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA9026

Write-up: 19DEC90 approx 415PM grunting, eyes rolled back, trembling all over, difficulty breathing, hot. Lasted approx 8 min. White blood count -good, temp 104, lt ear red.


Changed on 9/14/2018

VAERS ID: 27661 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Georgia
Vaccinated:1990-12-10
Onset:1990-12-19
Submitted:1990-12-31
Entered:1991-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 281945 / 4 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1229S / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0619D / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Dyspnoea, Pyrexia, Rash, Tremor, Vasodilatation, Gaze palsy

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: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: pt vaccinated w/HBCV, PRAXIS, M670FC, IM, LA, 0, 12DEC90. Also tempra
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA9026

Write-up: 19DEC90 approx 415PM grunting, eyes rolled back, trembling all over, difficulty breathing, hot. Lasted approx 8 min. White blood count -good, temp 104, lt ear red.


Changed on 10/14/2018

VAERS ID: 27661 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Georgia
Vaccinated:1990-12-10
Onset:1990-12-19
Submitted:1990-12-31
Entered:1991-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 281945 / 4 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1229S / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0619D / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Dyspnoea, Pyrexia, Rash, Tremor, Vasodilatation, Gaze palsy

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: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: pt vaccinated w/HBCV, PRAXIS, M670FC, IM, LA, 0, 12DEC90. Also tempra
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA9026

Write-up: 19DEC90 approx 415PM grunting, eyes rolled back, trembling all over, difficulty breathing, hot. Lasted approx 8 min. White blood count -good, temp 104, lt ear red.

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