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This is VAERS ID 28763

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 28763
VAERS Form:
Age:1.3
Sex:Male
Location:Nebraska
Vaccinated:1991-02-19
Onset:1991-02-20
Submitted:1991-02-21
Entered:1991-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 283926 / 3 LL / IM
MMR: MMR II / MSD 0896S / 0 RL / SC
OPV: ORIMUNE / LEDERLE 291944 / 2 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: CONVULS, FEVER, EYES GAZE UPWARD, SOMNOLENCE, OTITIS MED

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: NA
Other Medications: NONE
Current Illness: no fever--up/about/active playing
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Spinal Tap - normal; CBC - WNL; Chest & Sinus x-rays - normal
CDC 'Split Type': NONE

Write-up: 2AM elev T 102.6 (ax) sponge bath & tylenol given; 330AM T 102.8 (ax) sponge bath given; 930AM mom took child shopping noted groggy & sleepy while riding in cart; Developed sz & eyes rolling back in head; Temp 105.7; Dx ear infect


Changed on 12/8/2009

VAERS ID: 28763 Before After
VAERS Form:
Age:1.3
Sex:Male
Location:Nebraska
Vaccinated:1991-02-19
Onset:1991-02-20
Submitted:1991-02-21
Entered:1991-03-08 1991-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 283926 / 3 LL / IM
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 0896S / 0 RL / SC
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 291944 / 2 - / PO

Administered by: Public      Purchased by: Unknown Public
Symptoms: Convulsion, Otitis media, Pyrexia, Somnolence, Gaze palsy, CONVULS, FEVER, EYES GAZE UPWARD, SOMNOLENCE, OTITIS MED

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: NA
Other Medications: NONE
Current Illness: no fever--up/about/active playing
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Spinal Tap - normal; CBC - WNL; Chest & Sinus x-rays - normal
CDC 'Split Type': NONE NE911

Write-up: 2AM elev T 102.6 (ax) sponge bath & tylenol given; 330AM T 102.8 (ax) sponge bath given; 930AM mom took child shopping noted groggy & sleepy while riding in cart; Developed sz & eyes rolling back in head; Temp 105.7; Dx ear infect


Changed on 5/14/2017

VAERS ID: 28763 Before After
VAERS Form:
Age:1.3
Sex:Male
Location:Nebraska
Vaccinated:1991-02-19
Onset:1991-02-20
Submitted:1991-02-21
Entered:1991-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283926 / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0896S / 0 RL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 291944 / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Otitis media, Pyrexia, Somnolence, Gaze palsy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: NA NA~ ()~~~In patient
Other Medications: NONE
Current Illness: no fever--up/about/active playing
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Spinal Tap - normal; CBC - WNL; Chest & Sinus x-rays - normal
CDC 'Split Type': NE911

Write-up: 2AM elev T 102.6 (ax) sponge bath & tylenol given; 330AM T 102.8 (ax) sponge bath given; 930AM mom took child shopping noted groggy & sleepy while riding in cart; Developed sz & eyes rolling back in head; Temp 105.7; Dx ear infect


Changed on 9/14/2017

VAERS ID: 28763 Before After
VAERS Form:(blank) 1
Age:1.3
Sex:Male
Location:Nebraska
Vaccinated:1991-02-19
Onset:1991-02-20
Submitted:1991-02-21
Entered:1991-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283926 / 3 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0896S / 0 1 RL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 291944 / 2 3 - MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Otitis media, Pyrexia, Somnolence, Gaze palsy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: no fever--up/about/active playing
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Spinal Tap - normal; CBC - WNL; Chest & Sinus x-rays - normal
CDC 'Split Type': NE911

Write-up: 2AM elev T 102.6 (ax) sponge bath & tylenol given; 330AM T 102.8 (ax) sponge bath given; 930AM mom took child shopping noted groggy & sleepy while riding in cart; Developed sz & eyes rolling back in head; Temp 105.7; Dx ear infect


Changed on 2/14/2018

VAERS ID: 28763 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Nebraska
Vaccinated:1991-02-19
Onset:1991-02-20
Submitted:1991-02-21
Entered:1991-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283926 / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0896S / 1 RL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 291944 / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Otitis media, Pyrexia, Somnolence, Gaze palsy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: no fever--up/about/active playing
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Spinal Tap - normal; CBC - WNL; Chest & Sinus x-rays - normal
CDC 'Split Type': NE911

Write-up: 2AM elev T 102.6 (ax) sponge bath & tylenol given; 330AM T 102.8 (ax) sponge bath given; 930AM mom took child shopping noted groggy & sleepy while riding in cart; Developed sz & eyes rolling back in head; Temp 105.7; Dx ear infect


Changed on 6/14/2018

VAERS ID: 28763 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Nebraska
Vaccinated:1991-02-19
Onset:1991-02-20
Submitted:1991-02-21
Entered:1991-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283926 / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0896S / 1 RL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 291944 / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Otitis media, Pyrexia, Somnolence, Gaze palsy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: no fever--up/about/active playing
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Spinal Tap - normal; CBC - WNL; Chest & Sinus x-rays - normal
CDC 'Split Type': NE911

Write-up: 2AM elev T 102.6 (ax) sponge bath & tylenol given; 330AM T 102.8 (ax) sponge bath given; 930AM mom took child shopping noted groggy & sleepy while riding in cart; Developed sz & eyes rolling back in head; Temp 105.7; Dx ear infect


Changed on 8/14/2018

VAERS ID: 28763 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Nebraska
Vaccinated:1991-02-19
Onset:1991-02-20
Submitted:1991-02-21
Entered:1991-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283926 / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0896S / 1 RL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 291944 / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Otitis media, Pyrexia, Somnolence, Gaze palsy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: no fever--up/about/active playing
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Spinal Tap - normal; CBC - WNL; Chest & Sinus x-rays - normal
CDC 'Split Type': NE911

Write-up: 2AM elev T 102.6 (ax) sponge bath & tylenol given; 330AM T 102.8 (ax) sponge bath given; 930AM mom took child shopping noted groggy & sleepy while riding in cart; Developed sz & eyes rolling back in head; Temp 105.7; Dx ear infect


Changed on 9/14/2018

VAERS ID: 28763 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Nebraska
Vaccinated:1991-02-19
Onset:1991-02-20
Submitted:1991-02-21
Entered:1991-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283926 / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0896S / 1 RL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 291944 / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Otitis media, Pyrexia, Somnolence, Gaze palsy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: no fever--up/about/active playing
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Spinal Tap - normal; CBC - WNL; Chest & Sinus x-rays - normal
CDC 'Split Type': NE911

Write-up: 2AM elev T 102.6 (ax) sponge bath & tylenol given; 330AM T 102.8 (ax) sponge bath given; 930AM mom took child shopping noted groggy & sleepy while riding in cart; Developed sz & eyes rolling back in head; Temp 105.7; Dx ear infect


Changed on 10/14/2018

VAERS ID: 28763 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Nebraska
Vaccinated:1991-02-19
Onset:1991-02-20
Submitted:1991-02-21
Entered:1991-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283926 / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0896S / 1 RL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 291944 / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Otitis media, Pyrexia, Somnolence, Gaze palsy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: no fever--up/about/active playing
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Spinal Tap - normal; CBC - WNL; Chest & Sinus x-rays - normal
CDC 'Split Type': NE911

Write-up: 2AM elev T 102.6 (ax) sponge bath & tylenol given; 330AM T 102.8 (ax) sponge bath given; 930AM mom took child shopping noted groggy & sleepy while riding in cart; Developed sz & eyes rolling back in head; Temp 105.7; Dx ear infect

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