National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 27726

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 27726
VAERS Form:
Age:1.5
Sex:Female
Location:Wisconsin
Vaccinated:1991-01-21
Onset:1991-01-21
Submitted:1991-01-22
Entered:1991-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 283913 / 0 RL / IM
MMR: MMR II / MSD 1471S / 0 - / SC
OPV: ORIMUNE / LEDERLE 0615D / 0 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: CONVULS, SOMNOLENCE, STUPOR

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:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: EEG-neg; Electrolytes-normal; Chempand-essentially negative; CBC-sl lympocytosis
CDC 'Split Type':

Write-up: Pt drinking milk & began choking head tipped back eyes rolled back,sucking noises w/mouth & tongue gurgling sounds from milk from bottle& mucus. Unresponsive,color pink lower extrem cool to touch,barefoot,lasted 2 min.;Responded-sleep-to ER


Changed on 12/8/2009

VAERS ID: 27726 Before After
VAERS Form:
Age:1.5
Sex:Female
Location:Wisconsin
Vaccinated:1991-01-21
Onset:1991-01-21
Submitted:1991-01-22
Entered:1991-02-07 1991-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 283913 / 0 RL / IM
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 1471S / 0 - / SC
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 0615D / 0 - / PO

Administered by: Public      Purchased by: Unknown Public
Symptoms: Convulsion, Somnolence, Stupor, CONVULS, SOMNOLENCE, STUPOR

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:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: EEG-neg; Electrolytes-normal; Chempand-essentially negative; CBC-sl lympocytosis
CDC 'Split Type': (blank) WI91006

Write-up: Pt drinking milk & began choking head tipped back eyes rolled back,sucking noises w/mouth & tongue gurgling sounds from milk from bottle& mucus. Unresponsive,color pink lower extrem cool to touch,barefoot,lasted 2 min.;Responded-sleep-to ER


Changed on 5/14/2017

VAERS ID: 27726 Before After
VAERS Form:
Age:1.5
Sex:Female
Location:Wisconsin
Vaccinated:1991-01-21
Onset:1991-01-21
Submitted:1991-01-22
Entered:1991-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283913 / 0 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1471S / 0 - / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 0615D / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Somnolence, Stupor

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 patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: EEG-neg; Electrolytes-normal; Chempand-essentially negative; CBC-sl lympocytosis
CDC 'Split Type': WI91006

Write-up: Pt drinking milk & began choking head tipped back eyes rolled back,sucking noises w/mouth & tongue gurgling sounds from milk from bottle& mucus. Unresponsive,color pink lower extrem cool to touch,barefoot,lasted 2 min.;Responded-sleep-to ER


Changed on 9/14/2017

VAERS ID: 27726 Before After
VAERS Form:(blank) 1
Age:1.5
Sex:Female
Location:Wisconsin
Vaccinated:1991-01-21
Onset:1991-01-21
Submitted:1991-01-22
Entered:1991-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283913 / 0 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1471S / 0 1 - / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0615D / 0 1 - MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Somnolence, Stupor

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 patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: EEG-neg; Electrolytes-normal; Chempand-essentially negative; CBC-sl lympocytosis
CDC 'Split Type': WI91006

Write-up: Pt drinking milk & began choking head tipped back eyes rolled back,sucking noises w/mouth & tongue gurgling sounds from milk from bottle& mucus. Unresponsive,color pink lower extrem cool to touch,barefoot,lasted 2 min.;Responded-sleep-to ER


Changed on 2/14/2018

VAERS ID: 27726 Before After
VAERS Form:1
Age:1.5
Sex:Female
Location:Wisconsin
Vaccinated:1991-01-21
Onset:1991-01-21
Submitted:1991-01-22
Entered:1991-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283913 / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1471S / 1 - / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0615D / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Somnolence, Stupor

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 patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: EEG-neg; Electrolytes-normal; Chempand-essentially negative; CBC-sl lympocytosis
CDC 'Split Type': WI91006

Write-up: Pt drinking milk & began choking head tipped back eyes rolled back,sucking noises w/mouth & tongue gurgling sounds from milk from bottle& mucus. Unresponsive,color pink lower extrem cool to touch,barefoot,lasted 2 min.;Responded-sleep-to ER


Changed on 6/14/2018

VAERS ID: 27726 Before After
VAERS Form:1
Age:1.5
Sex:Female
Location:Wisconsin
Vaccinated:1991-01-21
Onset:1991-01-21
Submitted:1991-01-22
Entered:1991-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283913 / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1471S / 1 - / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0615D / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Somnolence, Stupor

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 patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: EEG-neg; Electrolytes-normal; Chempand-essentially negative; CBC-sl lympocytosis
CDC 'Split Type': WI91006

Write-up: Pt drinking milk & began choking head tipped back eyes rolled back,sucking noises w/mouth & tongue gurgling sounds from milk from bottle& mucus. Unresponsive,color pink lower extrem cool to touch,barefoot,lasted 2 min.;Responded-sleep-to ER


Changed on 8/14/2018

VAERS ID: 27726 Before After
VAERS Form:1
Age:1.5
Sex:Female
Location:Wisconsin
Vaccinated:1991-01-21
Onset:1991-01-21
Submitted:1991-01-22
Entered:1991-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283913 / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1471S / 1 - / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0615D / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Somnolence, Stupor

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 patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: EEG-neg; Electrolytes-normal; Chempand-essentially negative; CBC-sl lympocytosis
CDC 'Split Type': WI91006

Write-up: Pt drinking milk & began choking head tipped back eyes rolled back,sucking noises w/mouth & tongue gurgling sounds from milk from bottle& mucus. Unresponsive,color pink lower extrem cool to touch,barefoot,lasted 2 min.;Responded-sleep-to ER


Changed on 9/14/2018

VAERS ID: 27726 Before After
VAERS Form:1
Age:1.5
Sex:Female
Location:Wisconsin
Vaccinated:1991-01-21
Onset:1991-01-21
Submitted:1991-01-22
Entered:1991-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283913 / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1471S / 1 - / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0615D / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Somnolence, Stupor

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 patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: EEG-neg; Electrolytes-normal; Chempand-essentially negative; CBC-sl lympocytosis
CDC 'Split Type': WI91006

Write-up: Pt drinking milk & began choking head tipped back eyes rolled back,sucking noises w/mouth & tongue gurgling sounds from milk from bottle& mucus. Unresponsive,color pink lower extrem cool to touch,barefoot,lasted 2 min.;Responded-sleep-to ER


Changed on 10/14/2018

VAERS ID: 27726 Before After
VAERS Form:1
Age:1.5
Sex:Female
Location:Wisconsin
Vaccinated:1991-01-21
Onset:1991-01-21
Submitted:1991-01-22
Entered:1991-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283913 / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1471S / 1 - / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0615D / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Somnolence, Stupor

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 patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: EEG-neg; Electrolytes-normal; Chempand-essentially negative; CBC-sl lympocytosis
CDC 'Split Type': WI91006

Write-up: Pt drinking milk & began choking head tipped back eyes rolled back,sucking noises w/mouth & tongue gurgling sounds from milk from bottle& mucus. Unresponsive,color pink lower extrem cool to touch,barefoot,lasted 2 min.;Responded-sleep-to ER

New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=27726&WAYBACKHISTORY=ON


Copyright © 2019 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166