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This is VAERS ID 29941

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 29941
VAERS Form:
Age:1.3
Sex:Male
Location:Georgia
Vaccinated:1991-01-28
Onset:1991-01-28
Submitted:1991-02-14
Entered:1991-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 271965 / 3 RA / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M650FB / 0 LA / IM
MMR: MMR II / MSD 1229S / 0 LL / SC
OPV: ORIMUNE / LEDERLE 0619E / 2 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: FEVER, VOMIT, 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:     Extended hospital stay? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NONE

Write-up: Developed fever immediately p/getting vax; Seen by MD states ear infect; Still fever & vomiting;


Changed on 12/8/2009

VAERS ID: 29941 Before After
VAERS Form:
Age:1.3
Sex:Male
Location:Georgia
Vaccinated:1991-01-28
Onset:1991-01-28
Submitted:1991-02-14
Entered:1991-04-19 1991-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 271965 / 3 RA / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M650FB / 0 LA / IM
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 1229S / 0 LL / SC
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 0619E / 2 - / PO

Administered by: Public      Purchased by: Unknown Public
Symptoms: Otitis media, Pyrexia, Vomiting, FEVER, VOMIT, 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:     Extended hospital stay? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NONE GA9156

Write-up: Developed fever immediately p/getting vax; Seen by MD states ear infect; Still fever & vomiting;


Changed on 5/14/2017

VAERS ID: 29941 Before After
VAERS Form:
Age:1.3
Sex:Male
Location:Georgia
Vaccinated:1991-01-28
Onset:1991-01-28
Submitted:1991-02-14
Entered:1991-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271965 / 3 RA / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M650FB / 0 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1229S / 0 LL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 0619E / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Otitis media, Pyrexia, Vomiting

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: NONE NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': GA9156

Write-up: Developed fever immediately p/getting vax; Seen by MD states ear infect; Still fever & vomiting;


Changed on 9/14/2017

VAERS ID: 29941 Before After
VAERS Form:(blank) 1
Age:1.3
Sex:Male
Location:Georgia
Vaccinated:1991-01-28
Onset:1991-01-28
Submitted:1991-02-14
Entered:1991-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271965 / 3 4 RA / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M650FB / 0 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1229S / 0 1 LL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0619E / 2 3 - MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Otitis media, Pyrexia, Vomiting

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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': GA9156

Write-up: Developed fever immediately p/getting vax; Seen by MD states ear infect; Still fever & vomiting;


Changed on 2/14/2018

VAERS ID: 29941 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Georgia
Vaccinated:1991-01-28
Onset:1991-01-28
Submitted:1991-02-14
Entered:1991-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271965 / 4 RA / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M650FB / 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1229S / 1 LL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0619E / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Otitis media, Pyrexia, Vomiting

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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': GA9156

Write-up: Developed fever immediately p/getting vax; Seen by MD states ear infect; Still fever & vomiting;


Changed on 6/14/2018

VAERS ID: 29941 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Georgia
Vaccinated:1991-01-28
Onset:1991-01-28
Submitted:1991-02-14
Entered:1991-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271965 / 4 RA / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M650FB / 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1229S / 1 LL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0619E / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Otitis media, Pyrexia, Vomiting

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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': GA9156

Write-up: Developed fever immediately p/getting vax; Seen by MD states ear infect; Still fever & vomiting;


Changed on 8/14/2018

VAERS ID: 29941 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Georgia
Vaccinated:1991-01-28
Onset:1991-01-28
Submitted:1991-02-14
Entered:1991-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271965 / 4 RA / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M650FB / 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1229S / 1 LL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0619E / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Otitis media, Pyrexia, Vomiting

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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': GA9156

Write-up: Developed fever immediately p/getting vax; Seen by MD states ear infect; Still fever & vomiting;


Changed on 9/14/2018

VAERS ID: 29941 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Georgia
Vaccinated:1991-01-28
Onset:1991-01-28
Submitted:1991-02-14
Entered:1991-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271965 / 4 RA / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M650FB / 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1229S / 1 LL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0619E / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Otitis media, Pyrexia, Vomiting

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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': GA9156

Write-up: Developed fever immediately p/getting vax; Seen by MD states ear infect; Still fever & vomiting;


Changed on 10/14/2018

VAERS ID: 29941 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Georgia
Vaccinated:1991-01-28
Onset:1991-01-28
Submitted:1991-02-14
Entered:1991-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271965 / 4 RA / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M650FB / 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1229S / 1 LL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0619E / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Otitis media, Pyrexia, Vomiting

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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': GA9156

Write-up: Developed fever immediately p/getting vax; Seen by MD states ear infect; Still fever & vomiting;

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