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This is VAERS ID 29507

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 29507
VAERS Form:
Age:1.7
Sex:Male
Location:Oregon
Vaccinated:1991-03-12
Onset:1991-03-13
Submitted:1991-03-20
Entered:1991-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 297908 / 3 - / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M636FN / 0 - / IM
MMR: MMR II / MSD 2258F / 0 - / IM
OPV: ORIMUNE / LEDERLE 0626F / 2 - / PO

Administered by: Private      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: 2     Extended hospital stay? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NONE

Write-up: Admitted to hosp w/in 24 hrs of receiving immun w/temp 104 & sz;


Changed on 12/8/2009

VAERS ID: 29507 Before After
VAERS Form:
Age:1.7
Sex:Male
Location:Oregon
Vaccinated:1991-03-12
Onset:1991-03-13
Submitted:1991-03-20
Entered:1991-04-05 1991-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 297908 / 3 - / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M636FN / 0 - / IM
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 2258F / 0 - / IM
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 0626F / 2 - / PO

Administered by: Private      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: 2     Extended hospital stay? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NONE (blank)

Write-up: Admitted to hosp w/in 24 hrs of receiving immun w/temp 104 & sz;


Changed on 5/14/2017

VAERS ID: 29507 Before After
VAERS Form:
Age:1.7
Sex:Male
Location:Oregon
Vaccinated:1991-03-12
Onset:1991-03-13
Submitted:1991-03-20
Entered:1991-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 297908 / 3 - / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M636FN / 0 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2258F / 0 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 0626F / 2 - / PO

Administered by: Private      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: 2     Extended hospital stay? No
Previous Vaccinations: NONE NONE~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Admitted to hosp w/in 24 hrs of receiving immun w/temp 104 & sz;


Changed on 9/14/2017

VAERS ID: 29507 Before After
VAERS Form:(blank) 1
Age:1.7
Sex:Male
Location:Oregon
Vaccinated:1991-03-12
Onset:1991-03-13
Submitted:1991-03-20
Entered:1991-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 297908 / 3 4 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M636FN / 0 1 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2258F / 0 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0626F / 2 3 - MO / PO

Administered by: Private      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: 2     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Admitted to hosp w/in 24 hrs of receiving immun w/temp 104 & sz;


Changed on 2/14/2018

VAERS ID: 29507 Before After
VAERS Form:1
Age:1.7
Sex:Male
Location:Oregon
Vaccinated:1991-03-12
Onset:1991-03-13
Submitted:1991-03-20
Entered:1991-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 297908 / 4 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M636FN / 1 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2258F / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0626F / 3 MO / PO

Administered by: Private      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: 2     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Admitted to hosp w/in 24 hrs of receiving immun w/temp 104 & sz;


Changed on 6/14/2018

VAERS ID: 29507 Before After
VAERS Form:1
Age:1.7
Sex:Male
Location:Oregon
Vaccinated:1991-03-12
Onset:1991-03-13
Submitted:1991-03-20
Entered:1991-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 297908 / 4 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M636FN / 1 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2258F / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0626F / 3 MO / PO

Administered by: Private      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: 2     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Admitted to hosp w/in 24 hrs of receiving immun w/temp 104 & sz;


Changed on 8/14/2018

VAERS ID: 29507 Before After
VAERS Form:1
Age:1.7
Sex:Male
Location:Oregon
Vaccinated:1991-03-12
Onset:1991-03-13
Submitted:1991-03-20
Entered:1991-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 297908 / 4 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M636FN / 1 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2258F / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0626F / 3 MO / PO

Administered by: Private      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: 2     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Admitted to hosp w/in 24 hrs of receiving immun w/temp 104 & sz;


Changed on 9/14/2018

VAERS ID: 29507 Before After
VAERS Form:1
Age:1.7
Sex:Male
Location:Oregon
Vaccinated:1991-03-12
Onset:1991-03-13
Submitted:1991-03-20
Entered:1991-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 297908 / 4 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M636FN / 1 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2258F / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0626F / 3 MO / PO

Administered by: Private      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: 2     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Admitted to hosp w/in 24 hrs of receiving immun w/temp 104 & sz;


Changed on 10/14/2018

VAERS ID: 29507 Before After
VAERS Form:1
Age:1.7
Sex:Male
Location:Oregon
Vaccinated:1991-03-12
Onset:1991-03-13
Submitted:1991-03-20
Entered:1991-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 297908 / 4 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M636FN / 1 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2258F / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0626F / 3 MO / PO

Administered by: Private      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: 2     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Admitted to hosp w/in 24 hrs of receiving immun w/temp 104 & sz;

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