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This is VAERS ID 28501

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 28501
VAERS Form:
Age:2.6
Sex:Male
Location:New York
Vaccinated:1990-10-29
Onset:1990-11-03
Submitted:1991-02-13
Entered:1991-03-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP / CONNAUGHT LABS 0M11148 / 3 LL / IM
HIBV: PROHIBIT / CONNAUGHT LABS 0I11070 / 0 RL / -
MMR: MMR II / MSD 15685 / 0 LA / -
OPV: ORIMUNE / LEDERLE 0620C / 2 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: DYSPNEA, CONVULS GRAND MAL

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: had c/o headache since fall on 5OCT
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CT & MRI Scans- normal. Spinal Fluid - normal; EEG - abnormal.
CDC 'Split Type':

Write-up: Presented to ER just a/MN on 3NOV90 w/focal status epilepticus required large dose of anticonvulsants intubation & mechanical ventilation a/sz stopped. Pt continues to require anticonvulsants.


Changed on 12/8/2009

VAERS ID: 28501 Before After
VAERS Form:
Age:2.6
Sex:Male
Location:New York
Vaccinated:1990-10-29
Onset:1990-11-03
Submitted:1991-02-13
Entered:1991-03-06 1991-02-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP DTP (NO BRAND NAME) / CONNAUGHT LABS CONNAUGHT LABORATORIES 0M11148 / 3 LL / IM
HIBV: PROHIBIT HIB (PROHIBIT) / CONNAUGHT LABS CONNAUGHT LABORATORIES 0I11070 / 0 RL / -
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 15685 / 0 LA / -
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 0620C / 2 - / PO

Administered by: Private      Purchased by: Unknown Private
Symptoms: Dyspnoea, Grand mal convulsion, DYSPNEA, CONVULS GRAND MAL

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: had c/o headache since fall on 5OCT
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CT & MRI Scans- normal. Spinal Fluid - normal; EEG - abnormal.
CDC 'Split Type':

Write-up: Presented to ER just a/MN on 3NOV90 w/focal status epilepticus required large dose of anticonvulsants intubation & mechanical ventilation a/sz stopped. Pt continues to require anticonvulsants.


Changed on 2/14/2017

VAERS ID: 28501 Before After
VAERS Form:
Age:2.6 2.0
Sex:Male
Location:New York
Vaccinated:1990-10-29
Onset:1990-11-03
Submitted:1991-02-13
Entered:1991-02-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0M11148 / 3 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0I11070 / 0 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 15685 / 0 LA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES 0620C / 2 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Dyspnoea, Grand mal 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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: had c/o headache since fall on 5OCT
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CT & MRI Scans- normal. Spinal Fluid - normal; EEG - abnormal.
CDC 'Split Type':

Write-up: Presented to ER just a/MN on 3NOV90 w/focal status epilepticus required large dose of anticonvulsants intubation & mechanical ventilation a/sz stopped. Pt continues to require anticonvulsants.


Changed on 5/14/2017

VAERS ID: 28501 Before After
VAERS Form:
Age:2.0
Sex:Male
Location:New York
Vaccinated:1990-10-29
Onset:1990-11-03
Submitted:1991-02-13
Entered:1991-02-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0M11148 / 3 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0I11070 / 0 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 15685 / 0 LA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 0620C / 2 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Dyspnoea, Grand mal 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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: had c/o headache since fall on 5OCT
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CT & MRI Scans- normal. Spinal Fluid - normal; EEG - abnormal.
CDC 'Split Type':

Write-up: Presented to ER just a/MN on 3NOV90 w/focal status epilepticus required large dose of anticonvulsants intubation & mechanical ventilation a/sz stopped. Pt continues to require anticonvulsants.


Changed on 9/14/2017

VAERS ID: 28501 Before After
VAERS Form:(blank) 1
Age:2.0
Sex:Male
Location:New York
Vaccinated:1990-10-29
Onset:1990-11-03
Submitted:1991-02-13
Entered:1991-02-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0M11148 / 3 4 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0I11070 / 0 1 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 15685 / 0 1 LA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0620C / 2 3 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Dyspnoea, Grand mal 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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: had c/o headache since fall on 5OCT
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CT & MRI Scans- normal. Spinal Fluid - normal; EEG - abnormal.
CDC 'Split Type':

Write-up: Presented to ER just a/MN on 3NOV90 w/focal status epilepticus required large dose of anticonvulsants intubation & mechanical ventilation a/sz stopped. Pt continues to require anticonvulsants.


Changed on 2/14/2018

VAERS ID: 28501 Before After
VAERS Form:1
Age:2.0
Sex:Male
Location:New York
Vaccinated:1990-10-29
Onset:1990-11-03
Submitted:1991-02-13
Entered:1991-02-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0M11148 / 4 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0I11070 / 1 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 15685 / 1 LA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0620C / 3 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Dyspnoea, Grand mal 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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: had c/o headache since fall on 5OCT
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CT & MRI Scans- normal. Spinal Fluid - normal; EEG - abnormal.
CDC 'Split Type':

Write-up: Presented to ER just a/MN on 3NOV90 w/focal status epilepticus required large dose of anticonvulsants intubation & mechanical ventilation a/sz stopped. Pt continues to require anticonvulsants.


Changed on 6/14/2018

VAERS ID: 28501 Before After
VAERS Form:1
Age:2.0
Sex:Male
Location:New York
Vaccinated:1990-10-29
Onset:1990-11-03
Submitted:1991-02-13
Entered:1991-02-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0M11148 / 4 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0I11070 / 1 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 15685 / 1 LA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0620C / 3 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Dyspnoea, Grand mal 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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: had c/o headache since fall on 5OCT
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CT & MRI Scans- normal. Spinal Fluid - normal; EEG - abnormal.
CDC 'Split Type':

Write-up: Presented to ER just a/MN on 3NOV90 w/focal status epilepticus required large dose of anticonvulsants intubation & mechanical ventilation a/sz stopped. Pt continues to require anticonvulsants.


Changed on 8/14/2018

VAERS ID: 28501 Before After
VAERS Form:1
Age:2.0
Sex:Male
Location:New York
Vaccinated:1990-10-29
Onset:1990-11-03
Submitted:1991-02-13
Entered:1991-02-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0M11148 / 4 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0I11070 / 1 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 15685 / 1 LA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0620C / 3 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Dyspnoea, Grand mal 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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: had c/o headache since fall on 5OCT
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CT & MRI Scans- normal. Spinal Fluid - normal; EEG - abnormal.
CDC 'Split Type':

Write-up: Presented to ER just a/MN on 3NOV90 w/focal status epilepticus required large dose of anticonvulsants intubation & mechanical ventilation a/sz stopped. Pt continues to require anticonvulsants.


Changed on 9/14/2018

VAERS ID: 28501 Before After
VAERS Form:1
Age:2.0
Sex:Male
Location:New York
Vaccinated:1990-10-29
Onset:1990-11-03
Submitted:1991-02-13
Entered:1991-02-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0M11148 / 4 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0I11070 / 1 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 15685 / 1 LA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0620C / 3 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Dyspnoea, Grand mal 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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: had c/o headache since fall on 5OCT
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CT & MRI Scans- normal. Spinal Fluid - normal; EEG - abnormal.
CDC 'Split Type':

Write-up: Presented to ER just a/MN on 3NOV90 w/focal status epilepticus required large dose of anticonvulsants intubation & mechanical ventilation a/sz stopped. Pt continues to require anticonvulsants.


Changed on 10/14/2018

VAERS ID: 28501 Before After
VAERS Form:1
Age:2.0
Sex:Male
Location:New York
Vaccinated:1990-10-29
Onset:1990-11-03
Submitted:1991-02-13
Entered:1991-02-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0M11148 / 4 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0I11070 / 1 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 15685 / 1 LA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0620C / 3 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Dyspnoea, Grand mal 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:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: had c/o headache since fall on 5OCT
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CT & MRI Scans- normal. Spinal Fluid - normal; EEG - abnormal.
CDC 'Split Type':

Write-up: Presented to ER just a/MN on 3NOV90 w/focal status epilepticus required large dose of anticonvulsants intubation & mechanical ventilation a/sz stopped. Pt continues to require anticonvulsants.

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