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This is VAERS ID 28173

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 28173
VAERS Form:
Age:1.8
Sex:Female
Location:Alabama
Vaccinated:1989-10-23
Onset:1989-10-23
Submitted:0000-00-00
Entered:1991-02-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 256962 / - - / -
MMR: MMR II / MSD 1661R / - - / -
OPV: ORIMUNE / LEDERLE 253944 / - - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: CONVULS

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: No hx of convuls in pt, hx of convuls in siblings & parents unknown.
Allergies:
Diagnostic Lab Data: EEG; Brain Scan: Lumbar Puncture - Normal
CDC 'Split Type':

Write-up: CDC reports: 21 mo child had convuls following DTP/OPV/MMR. Hospitalized 2 days. EEG, Brain Scan, Lumbar Puncture - normal.


Changed on 12/8/2009

VAERS ID: 28173 Before After
VAERS Form:
Age:1.8
Sex:Female
Location:Alabama
Vaccinated:1989-10-23
Onset:1989-10-23
Submitted:0000-00-00
Entered:1991-02-21 1991-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 256962 / - - / -
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 1661R / - - / -
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 253944 / - - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Convulsion, CONVULS

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: No hx of convuls in pt, hx of convuls in siblings & parents unknown.
Allergies:
Diagnostic Lab Data: EEG; Brain Scan: Lumbar Puncture - Normal
CDC 'Split Type': (blank) 900165901

Write-up: CDC reports: 21 mo child had convuls following DTP/OPV/MMR. Hospitalized 2 days. EEG, Brain Scan, Lumbar Puncture - normal.


Changed on 5/14/2017

VAERS ID: 28173 Before After
VAERS Form:
Age:1.8
Sex:Female
Location:Alabama
Vaccinated:1989-10-23
Onset:1989-10-23
Submitted:0000-00-00
Entered:1991-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 256962 / - - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1661R / - - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 253944 / - - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Convulsion

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: No hx of convuls in pt, hx of convuls in siblings & parents unknown.
Allergies:
Diagnostic Lab Data: EEG; Brain Scan: Lumbar Puncture - Normal
CDC 'Split Type': 900165901

Write-up: CDC reports: 21 mo child had convuls following DTP/OPV/MMR. Hospitalized 2 days. EEG, Brain Scan, Lumbar Puncture - normal.


Changed on 9/14/2017

VAERS ID: 28173 Before After
VAERS Form:(blank) 1
Age:1.8
Sex:Female
Location:Alabama
Vaccinated:1989-10-23
Onset:1989-10-23
Submitted:0000-00-00
Entered:1991-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 256962 / - UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1661R / - UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 253944 / - UNK - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Convulsion

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: No hx of convuls in pt, hx of convuls in siblings & parents unknown.
Allergies:
Diagnostic Lab Data: EEG; Brain Scan: Lumbar Puncture - Normal
CDC 'Split Type': 900165901

Write-up: CDC reports: 21 mo child had convuls following DTP/OPV/MMR. Hospitalized 2 days. EEG, Brain Scan, Lumbar Puncture - normal.


Changed on 2/14/2018

VAERS ID: 28173 Before After
VAERS Form:1
Age:1.8
Sex:Female
Location:Alabama
Vaccinated:1989-10-23
Onset:1989-10-23
Submitted:0000-00-00
Entered:1991-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 256962 / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1661R / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 253944 / UNK MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Convulsion

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: No hx of convuls in pt, hx of convuls in siblings & parents unknown.
Allergies:
Diagnostic Lab Data: EEG; Brain Scan: Lumbar Puncture - Normal
CDC 'Split Type': 900165901

Write-up: CDC reports: 21 mo child had convuls following DTP/OPV/MMR. Hospitalized 2 days. EEG, Brain Scan, Lumbar Puncture - normal.


Changed on 6/14/2018

VAERS ID: 28173 Before After
VAERS Form:1
Age:1.8
Sex:Female
Location:Alabama
Vaccinated:1989-10-23
Onset:1989-10-23
Submitted:0000-00-00
Entered:1991-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 256962 / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1661R / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 253944 / UNK MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Convulsion

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: No hx of convuls in pt, hx of convuls in siblings & parents unknown.
Allergies:
Diagnostic Lab Data: EEG; Brain Scan: Lumbar Puncture - Normal
CDC 'Split Type': 900165901

Write-up: CDC reports: 21 mo child had convuls following DTP/OPV/MMR. Hospitalized 2 days. EEG, Brain Scan, Lumbar Puncture - normal.


Changed on 8/14/2018

VAERS ID: 28173 Before After
VAERS Form:1
Age:1.8
Sex:Female
Location:Alabama
Vaccinated:1989-10-23
Onset:1989-10-23
Submitted:0000-00-00
Entered:1991-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 256962 / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1661R / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 253944 / UNK MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Convulsion

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: No hx of convuls in pt, hx of convuls in siblings & parents unknown.
Allergies:
Diagnostic Lab Data: EEG; Brain Scan: Lumbar Puncture - Normal
CDC 'Split Type': 900165901

Write-up: CDC reports: 21 mo child had convuls following DTP/OPV/MMR. Hospitalized 2 days. EEG, Brain Scan, Lumbar Puncture - normal.


Changed on 9/14/2018

VAERS ID: 28173 Before After
VAERS Form:1
Age:1.8
Sex:Female
Location:Alabama
Vaccinated:1989-10-23
Onset:1989-10-23
Submitted:0000-00-00
Entered:1991-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 256962 / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1661R / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 253944 / UNK MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Convulsion

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: No hx of convuls in pt, hx of convuls in siblings & parents unknown.
Allergies:
Diagnostic Lab Data: EEG; Brain Scan: Lumbar Puncture - Normal
CDC 'Split Type': 900165901

Write-up: CDC reports: 21 mo child had convuls following DTP/OPV/MMR. Hospitalized 2 days. EEG, Brain Scan, Lumbar Puncture - normal.


Changed on 10/14/2018

VAERS ID: 28173 Before After
VAERS Form:1
Age:1.8
Sex:Female
Location:Alabama
Vaccinated:1989-10-23
Onset:1989-10-23
Submitted:0000-00-00
Entered:1991-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 256962 / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1661R / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 253944 / UNK MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Convulsion

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: No hx of convuls in pt, hx of convuls in siblings & parents unknown.
Allergies:
Diagnostic Lab Data: EEG; Brain Scan: Lumbar Puncture - Normal
CDC 'Split Type': 900165901

Write-up: CDC reports: 21 mo child had convuls following DTP/OPV/MMR. Hospitalized 2 days. EEG, Brain Scan, Lumbar Puncture - normal.

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