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This is VAERS ID 28820

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 28820
VAERS Form:
Age:5.4
Sex:Female
Location:Oregon
Vaccinated:1991-01-30
Onset:1991-01-31
Submitted:0000-00-00
Entered:1991-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 291931 / 4 RL / -
MMR: UNK. MEASLES, MUMPS & RUBELLA VIRUS LIVE / UNCLASSIFIED - / - - / -

Administered by: Private      Purchased by: Unknown
Symptoms: FEVER, ANOREXIA, EDEMA, ARTHROSIS, FIBRO TENDON

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:     Extended hospital stay? No
Previous Vaccinations: NO INFO
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Culture - negative
CDC 'Split Type': NONE

Write-up: Local rxn w/massive swelling - Hospitalized & operated to relieve pressure -myositis or fascititis. Fever of 102; decreased po intake. Thigh tense w/increased warmth, tender to palpation, knee effusion;Probable cellulitis w/sympathetic KE.


Changed on 12/8/2009

VAERS ID: 28820 Before After
VAERS Form:
Age:5.4
Sex:Female
Location:Oregon
Vaccinated:1991-01-30
Onset:1991-01-31
Submitted:0000-00-00
Entered:1991-03-08 1991-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 291931 / 4 RL / -
MMR: UNK. MEASLES, MUMPS & RUBELLA VIRUS LIVE MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNCLASSIFIED UNKNOWN MANUFACTURER - / - - / -

Administered by: Private      Purchased by: Unknown Private
Symptoms: Anorexia, Fibrosis tendinous, Myositis, Oedema, Osteoarthritis, Pyrexia, Vasodilatation, FEVER, ANOREXIA, EDEMA, ARTHROSIS, FIBRO TENDON

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:     Extended hospital stay? No
Previous Vaccinations: NO INFO
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Culture - negative
CDC 'Split Type': NONE (blank)

Write-up: Local rxn w/massive swelling - Hospitalized & operated to relieve pressure -myositis or fascititis. Fever of 102; decreased po intake. Thigh tense w/increased warmth, tender to palpation, knee effusion;Probable cellulitis w/sympathetic KE.


Changed on 2/14/2017

VAERS ID: 28820 Before After
VAERS Form:
Age:5.4 5.0
Sex:Female
Location:Oregon
Vaccinated:1991-01-30
Onset:1991-01-31
Submitted:0000-00-00
Entered:1991-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291931 / 4 RL / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Private      Purchased by: Private
Symptoms: Anorexia, Fibrosis tendinous, Myositis, Oedema, Osteoarthritis, Pyrexia, Vasodilatation

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:     Extended hospital stay? No
Previous Vaccinations: NO INFO
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Culture - negative
CDC 'Split Type':

Write-up: Local rxn w/massive swelling - Hospitalized & operated to relieve pressure -myositis or fascititis. Fever of 102; decreased po intake. Thigh tense w/increased warmth, tender to palpation, knee effusion;Probable cellulitis w/sympathetic KE.


Changed on 5/14/2017

VAERS ID: 28820 Before After
VAERS Form:
Age:5.0
Sex:Female
Location:Oregon
Vaccinated:1991-01-30
Onset:1991-01-31
Submitted:0000-00-00
Entered:1991-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291931 / 4 RL / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Private      Purchased by: Private
Symptoms: Anorexia, Fibrosis tendinous, Myositis, Oedema, Osteoarthritis, Pyrexia, Vasodilatation

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:     Extended hospital stay? No
Previous Vaccinations: NO INFO INFO~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Culture - negative
CDC 'Split Type':

Write-up: Local rxn w/massive swelling - Hospitalized & operated to relieve pressure -myositis or fascititis. Fever of 102; decreased po intake. Thigh tense w/increased warmth, tender to palpation, knee effusion;Probable cellulitis w/sympathetic KE.


Changed on 9/14/2017

VAERS ID: 28820 Before After
VAERS Form:(blank) 1
Age:5.0
Sex:Female
Location:Oregon
Vaccinated:1991-01-30
Onset:1991-01-31
Submitted:0000-00-00
Entered:1991-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291931 / 4 5 RL / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Anorexia, Fibrosis tendinous, Myositis, Oedema, Osteoarthritis, Pyrexia, Vasodilatation

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:     Extended hospital stay? No
Previous Vaccinations: NO INFO~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Culture - negative
CDC 'Split Type':

Write-up: Local rxn w/massive swelling - Hospitalized & operated to relieve pressure -myositis or fascititis. Fever of 102; decreased po intake. Thigh tense w/increased warmth, tender to palpation, knee effusion;Probable cellulitis w/sympathetic KE.


Changed on 2/14/2018

VAERS ID: 28820 Before After
VAERS Form:1
Age:5.0
Sex:Female
Location:Oregon
Vaccinated:1991-01-30
Onset:1991-01-31
Submitted:0000-00-00
Entered:1991-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291931 / 5 RL / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Anorexia, Fibrosis tendinous, Myositis, Oedema, Osteoarthritis, Pyrexia, Vasodilatation

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:     Extended hospital stay? No
Previous Vaccinations: NO INFO~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Culture - negative
CDC 'Split Type':

Write-up: Local rxn w/massive swelling - Hospitalized & operated to relieve pressure -myositis or fascititis. Fever of 102; decreased po intake. Thigh tense w/increased warmth, tender to palpation, knee effusion;Probable cellulitis w/sympathetic KE.


Changed on 6/14/2018

VAERS ID: 28820 Before After
VAERS Form:1
Age:5.0
Sex:Female
Location:Oregon
Vaccinated:1991-01-30
Onset:1991-01-31
Submitted:0000-00-00
Entered:1991-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291931 / 5 RL / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Anorexia, Fibrosis tendinous, Myositis, Oedema, Osteoarthritis, Pyrexia, Vasodilatation

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:     Extended hospital stay? No
Previous Vaccinations: NO INFO~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Culture - negative
CDC 'Split Type':

Write-up: Local rxn w/massive swelling - Hospitalized & operated to relieve pressure -myositis or fascititis. Fever of 102; decreased po intake. Thigh tense w/increased warmth, tender to palpation, knee effusion;Probable cellulitis w/sympathetic KE.


Changed on 8/14/2018

VAERS ID: 28820 Before After
VAERS Form:1
Age:5.0
Sex:Female
Location:Oregon
Vaccinated:1991-01-30
Onset:1991-01-31
Submitted:0000-00-00
Entered:1991-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291931 / 5 RL / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Anorexia, Fibrosis tendinous, Myositis, Oedema, Osteoarthritis, Pyrexia, Vasodilatation

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:     Extended hospital stay? No
Previous Vaccinations: NO INFO~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Culture - negative
CDC 'Split Type':

Write-up: Local rxn w/massive swelling - Hospitalized & operated to relieve pressure -myositis or fascititis. Fever of 102; decreased po intake. Thigh tense w/increased warmth, tender to palpation, knee effusion;Probable cellulitis w/sympathetic KE.


Changed on 9/14/2018

VAERS ID: 28820 Before After
VAERS Form:1
Age:5.0
Sex:Female
Location:Oregon
Vaccinated:1991-01-30
Onset:1991-01-31
Submitted:0000-00-00
Entered:1991-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291931 / 5 RL / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Anorexia, Fibrosis tendinous, Myositis, Oedema, Osteoarthritis, Pyrexia, Vasodilatation

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:     Extended hospital stay? No
Previous Vaccinations: NO INFO~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Culture - negative
CDC 'Split Type':

Write-up: Local rxn w/massive swelling - Hospitalized & operated to relieve pressure -myositis or fascititis. Fever of 102; decreased po intake. Thigh tense w/increased warmth, tender to palpation, knee effusion;Probable cellulitis w/sympathetic KE.


Changed on 10/14/2018

VAERS ID: 28820 Before After
VAERS Form:1
Age:5.0
Sex:Female
Location:Oregon
Vaccinated:1991-01-30
Onset:1991-01-31
Submitted:0000-00-00
Entered:1991-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291931 / 5 RL / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Anorexia, Fibrosis tendinous, Myositis, Oedema, Osteoarthritis, Pyrexia, Vasodilatation

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:     Extended hospital stay? No
Previous Vaccinations: NO INFO~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Culture - negative
CDC 'Split Type':

Write-up: Local rxn w/massive swelling - Hospitalized & operated to relieve pressure -myositis or fascititis. Fever of 102; decreased po intake. Thigh tense w/increased warmth, tender to palpation, knee effusion;Probable cellulitis w/sympathetic KE.

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