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This is VAERS ID 27794

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 27794
VAERS Form:
Age:1.3
Sex:Male
Location:Illinois
Vaccinated:1991-01-22
Onset:1991-01-30
Submitted:1991-02-02
Entered:1991-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIBTITER / LEDERLE(PRAXIS) M090FF / - LA / IM
MMR: MMR II / MSD 1901S / - - / SC

Administered by: Private      Purchased by: Unknown
Symptoms: CONVULS, FEVER

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: URI
Preexisting Conditions: recurrent otitis media
Allergies:
Diagnostic Lab Data: CSF - no growth; EEG - pending
CDC 'Split Type':

Write-up: 8 days p/immun pt had fever of 105.6 & generalized sz of 1 1/2 hr duration.


Changed on 12/8/2009

VAERS ID: 27794 Before After
VAERS Form:
Age:1.3
Sex:Male
Location:Illinois
Vaccinated:1991-01-22
Onset:1991-01-30
Submitted:1991-02-02
Entered:1991-02-09 1991-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M090FF / - LA / IM
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 1901S / - - / SC

Administered by: Private      Purchased by: Unknown
Symptoms: Convulsion, Pyrexia, CONVULS, FEVER

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: URI
Preexisting Conditions: recurrent otitis media
Allergies:
Diagnostic Lab Data: CSF - no growth; EEG - pending
CDC 'Split Type':

Write-up: 8 days p/immun pt had fever of 105.6 & generalized sz of 1 1/2 hr duration.


Changed on 5/14/2017

VAERS ID: 27794 Before After
VAERS Form:
Age:1.3
Sex:Male
Location:Illinois
Vaccinated:1991-01-22
Onset:1991-01-30
Submitted:1991-02-02
Entered:1991-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M090FF / - LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1901S / - - / SC

Administered by: Private      Purchased by: Unknown
Symptoms: Convulsion, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: URI
Preexisting Conditions: recurrent otitis media
Allergies:
Diagnostic Lab Data: CSF - no growth; EEG - pending
CDC 'Split Type':

Write-up: 8 days p/immun pt had fever of 105.6 & generalized sz of 1 1/2 hr duration.


Changed on 9/14/2017

VAERS ID: 27794 Before After
VAERS Form:(blank) 1
Age:1.3
Sex:Male
Location:Illinois
Vaccinated:1991-01-22
Onset:1991-01-30
Submitted:1991-02-02
Entered:1991-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M090FF / - UNK LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1901S / - UNK - / SC

Administered by: Private      Purchased by: Unknown
Symptoms: Convulsion, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: URI
Preexisting Conditions: recurrent otitis media
Allergies:
Diagnostic Lab Data: CSF - no growth; EEG - pending
CDC 'Split Type':

Write-up: 8 days p/immun pt had fever of 105.6 & generalized sz of 1 1/2 hr duration.


Changed on 2/14/2018

VAERS ID: 27794 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Illinois
Vaccinated:1991-01-22
Onset:1991-01-30
Submitted:1991-02-02
Entered:1991-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M090FF / UNK LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1901S / UNK - / SC

Administered by: Private      Purchased by: Unknown
Symptoms: Convulsion, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: URI
Preexisting Conditions: recurrent otitis media
Allergies:
Diagnostic Lab Data: CSF - no growth; EEG - pending
CDC 'Split Type':

Write-up: 8 days p/immun pt had fever of 105.6 & generalized sz of 1 1/2 hr duration.


Changed on 6/14/2018

VAERS ID: 27794 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Illinois
Vaccinated:1991-01-22
Onset:1991-01-30
Submitted:1991-02-02
Entered:1991-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M090FF / UNK LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1901S / UNK - / SC

Administered by: Private      Purchased by: Unknown
Symptoms: Convulsion, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: URI
Preexisting Conditions: recurrent otitis media
Allergies:
Diagnostic Lab Data: CSF - no growth; EEG - pending
CDC 'Split Type':

Write-up: 8 days p/immun pt had fever of 105.6 & generalized sz of 1 1/2 hr duration.


Changed on 8/14/2018

VAERS ID: 27794 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Illinois
Vaccinated:1991-01-22
Onset:1991-01-30
Submitted:1991-02-02
Entered:1991-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M090FF / UNK LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1901S / UNK - / SC

Administered by: Private      Purchased by: Unknown
Symptoms: Convulsion, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: URI
Preexisting Conditions: recurrent otitis media
Allergies:
Diagnostic Lab Data: CSF - no growth; EEG - pending
CDC 'Split Type':

Write-up: 8 days p/immun pt had fever of 105.6 & generalized sz of 1 1/2 hr duration.


Changed on 9/14/2018

VAERS ID: 27794 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Illinois
Vaccinated:1991-01-22
Onset:1991-01-30
Submitted:1991-02-02
Entered:1991-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M090FF / UNK LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1901S / UNK - / SC

Administered by: Private      Purchased by: Unknown
Symptoms: Convulsion, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: URI
Preexisting Conditions: recurrent otitis media
Allergies:
Diagnostic Lab Data: CSF - no growth; EEG - pending
CDC 'Split Type':

Write-up: 8 days p/immun pt had fever of 105.6 & generalized sz of 1 1/2 hr duration.


Changed on 10/14/2018

VAERS ID: 27794 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Illinois
Vaccinated:1991-01-22
Onset:1991-01-30
Submitted:1991-02-02
Entered:1991-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M090FF / UNK LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1901S / UNK - / SC

Administered by: Private      Purchased by: Unknown
Symptoms: Convulsion, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: URI
Preexisting Conditions: recurrent otitis media
Allergies:
Diagnostic Lab Data: CSF - no growth; EEG - pending
CDC 'Split Type':

Write-up: 8 days p/immun pt had fever of 105.6 & generalized sz of 1 1/2 hr duration.

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