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This is VAERS ID 28355

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 28355
VAERS Form:
Age:1.4
Sex:Male
Location:Florida
Vaccinated:1991-01-21
Onset:1991-01-29
Submitted:1991-02-15
Entered:1991-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MMR II / MSD 22345 / 0 - / SC

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

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: unknown
Other Medications: none
Current Illness: none
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data: Unknown-in patient record not available to me.
CDC 'Split Type': unknown

Write-up: pt had fever to 106.1 & seizure. May have had lumbar puncture.


Changed on 12/8/2009

VAERS ID: 28355 Before After
VAERS Form:
Age:1.4
Sex:Male
Location:Florida
Vaccinated:1991-01-21
Onset:1991-01-29
Submitted:1991-02-15
Entered:1991-02-26 1991-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 22345 / 0 - / SC

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

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: unknown
Other Medications: none
Current Illness: none
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data: Unknown-in patient record not available to me.
CDC 'Split Type': unknown (blank)

Write-up: pt had fever to 106.1 & seizure. May have had lumbar puncture.


Changed on 5/14/2017

VAERS ID: 28355 Before After
VAERS Form:
Age:1.4
Sex:Male
Location:Florida
Vaccinated:1991-01-21
Onset:1991-01-29
Submitted:1991-02-15
Entered:1991-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 22345 / 0 - / SC

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

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: unknown unknown~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data: Unknown-in patient record not available to me.
CDC 'Split Type':

Write-up: pt had fever to 106.1 & seizure. May have had lumbar puncture.


Changed on 9/14/2017

VAERS ID: 28355 Before After
VAERS Form:(blank) 1
Age:1.4
Sex:Male
Location:Florida
Vaccinated:1991-01-21
Onset:1991-01-29
Submitted:1991-02-15
Entered:1991-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 22345 / 0 1 - / SC

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

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: unknown~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data: Unknown-in patient record not available to me.
CDC 'Split Type':

Write-up: pt had fever to 106.1 & seizure. May have had lumbar puncture.


Changed on 2/14/2018

VAERS ID: 28355 Before After
VAERS Form:1
Age:1.4
Sex:Male
Location:Florida
Vaccinated:1991-01-21
Onset:1991-01-29
Submitted:1991-02-15
Entered:1991-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 22345 / 1 - / SC

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

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: unknown~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data: Unknown-in patient record not available to me.
CDC 'Split Type':

Write-up: pt had fever to 106.1 & seizure. May have had lumbar puncture.


Changed on 6/14/2018

VAERS ID: 28355 Before After
VAERS Form:1
Age:1.4
Sex:Male
Location:Florida
Vaccinated:1991-01-21
Onset:1991-01-29
Submitted:1991-02-15
Entered:1991-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 22345 / 1 - / SC

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

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: unknown~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data: Unknown-in patient record not available to me.
CDC 'Split Type':

Write-up: pt had fever to 106.1 & seizure. May have had lumbar puncture.


Changed on 8/14/2018

VAERS ID: 28355 Before After
VAERS Form:1
Age:1.4
Sex:Male
Location:Florida
Vaccinated:1991-01-21
Onset:1991-01-29
Submitted:1991-02-15
Entered:1991-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 22345 / 1 - / SC

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

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: unknown~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data: Unknown-in patient record not available to me.
CDC 'Split Type':

Write-up: pt had fever to 106.1 & seizure. May have had lumbar puncture.


Changed on 9/14/2018

VAERS ID: 28355 Before After
VAERS Form:1
Age:1.4
Sex:Male
Location:Florida
Vaccinated:1991-01-21
Onset:1991-01-29
Submitted:1991-02-15
Entered:1991-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 22345 / 1 - / SC

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

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: unknown~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data: Unknown-in patient record not available to me.
CDC 'Split Type':

Write-up: pt had fever to 106.1 & seizure. May have had lumbar puncture.


Changed on 10/14/2018

VAERS ID: 28355 Before After
VAERS Form:1
Age:1.4
Sex:Male
Location:Florida
Vaccinated:1991-01-21
Onset:1991-01-29
Submitted:1991-02-15
Entered:1991-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 22345 / 1 - / SC

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

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: unknown~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data: Unknown-in patient record not available to me.
CDC 'Split Type':

Write-up: pt had fever to 106.1 & seizure. May have had lumbar puncture.

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