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This is VAERS ID 30055

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 30055
VAERS Form:
Age:1.8
Sex:Male
Location:Ohio
Vaccinated:1991-04-17
Onset:1991-04-17
Submitted:1991-04-18
Entered:1991-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 285917 / 1 RL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M160FH / 0 LL / IM
MMR: MMR II / MSD 1483S / 0 LA / SC

Administered by: Public      Purchased by: Unknown
Symptoms: AGITATION, CHILLS, FEVER, TREMOR

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:
Current Illness: Cold-no fever
Preexisting Conditions: p/vax developed severe bronchitis;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': p/vax developed severe bronchitis;

Write-up: Crying, felt cold, & was shaking, temp to 105; Hospitalized for observation for 2 days; Tx APAP & hypothermia blanket;


Changed on 12/8/2009

VAERS ID: 30055 Before After
VAERS Form:
Age:1.8
Sex:Male
Location:Ohio
Vaccinated:1991-04-17
Onset:1991-04-17
Submitted:1991-04-18
Entered:1991-04-26 1991-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 285917 / 1 RL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M160FH / 0 LL / IM
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 1483S / 0 LA / SC

Administered by: Public      Purchased by: Unknown Public
Symptoms: Agitation, Chills, Pyrexia, Tremor, AGITATION, CHILLS, FEVER, TREMOR

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:
Current Illness: Cold-no fever
Preexisting Conditions: p/vax developed severe bronchitis;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': p/vax developed severe bronchitis; (blank)

Write-up: Crying, felt cold, & was shaking, temp to 105; Hospitalized for observation for 2 days; Tx APAP & hypothermia blanket;


Changed on 5/14/2017

VAERS ID: 30055 Before After
VAERS Form:
Age:1.8
Sex:Male
Location:Ohio
Vaccinated:1991-04-17
Onset:1991-04-17
Submitted:1991-04-18
Entered:1991-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285917 / 1 RL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M160FH / 0 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1483S / 0 LA / SC

Administered by: Public      Purchased by: Public
Symptoms: Agitation, Chills, Pyrexia, Tremor

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:
Current Illness: Cold-no fever
Preexisting Conditions: p/vax developed severe bronchitis;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Crying, felt cold, & was shaking, temp to 105; Hospitalized for observation for 2 days; Tx APAP & hypothermia blanket;


Changed on 9/14/2017

VAERS ID: 30055 Before After
VAERS Form:(blank) 1
Age:1.8
Sex:Male
Location:Ohio
Vaccinated:1991-04-17
Onset:1991-04-17
Submitted:1991-04-18
Entered:1991-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285917 / 1 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M160FH / 0 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1483S / 0 1 LA / SC

Administered by: Public      Purchased by: Public
Symptoms: Agitation, Chills, Pyrexia, Tremor

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:
Current Illness: Cold-no fever
Preexisting Conditions: p/vax developed severe bronchitis;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Crying, felt cold, & was shaking, temp to 105; Hospitalized for observation for 2 days; Tx APAP & hypothermia blanket;


Changed on 2/14/2018

VAERS ID: 30055 Before After
VAERS Form:1
Age:1.8
Sex:Male
Location:Ohio
Vaccinated:1991-04-17
Onset:1991-04-17
Submitted:1991-04-18
Entered:1991-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285917 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M160FH / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1483S / 1 LA / SC

Administered by: Public      Purchased by: Public
Symptoms: Agitation, Chills, Pyrexia, Tremor

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:
Current Illness: Cold-no fever
Preexisting Conditions: p/vax developed severe bronchitis;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Crying, felt cold, & was shaking, temp to 105; Hospitalized for observation for 2 days; Tx APAP & hypothermia blanket;


Changed on 6/14/2018

VAERS ID: 30055 Before After
VAERS Form:1
Age:1.8
Sex:Male
Location:Ohio
Vaccinated:1991-04-17
Onset:1991-04-17
Submitted:1991-04-18
Entered:1991-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285917 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M160FH / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1483S / 1 LA / SC

Administered by: Public      Purchased by: Public
Symptoms: Agitation, Chills, Pyrexia, Tremor

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:
Current Illness: Cold-no fever
Preexisting Conditions: p/vax developed severe bronchitis;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Crying, felt cold, & was shaking, temp to 105; Hospitalized for observation for 2 days; Tx APAP & hypothermia blanket;


Changed on 8/14/2018

VAERS ID: 30055 Before After
VAERS Form:1
Age:1.8
Sex:Male
Location:Ohio
Vaccinated:1991-04-17
Onset:1991-04-17
Submitted:1991-04-18
Entered:1991-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285917 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M160FH / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1483S / 1 LA / SC

Administered by: Public      Purchased by: Public
Symptoms: Agitation, Chills, Pyrexia, Tremor

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:
Current Illness: Cold-no fever
Preexisting Conditions: p/vax developed severe bronchitis;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Crying, felt cold, & was shaking, temp to 105; Hospitalized for observation for 2 days; Tx APAP & hypothermia blanket;


Changed on 9/14/2018

VAERS ID: 30055 Before After
VAERS Form:1
Age:1.8
Sex:Male
Location:Ohio
Vaccinated:1991-04-17
Onset:1991-04-17
Submitted:1991-04-18
Entered:1991-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285917 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M160FH / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1483S / 1 LA / SC

Administered by: Public      Purchased by: Public
Symptoms: Agitation, Chills, Pyrexia, Tremor

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:
Current Illness: Cold-no fever
Preexisting Conditions: p/vax developed severe bronchitis;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Crying, felt cold, & was shaking, temp to 105; Hospitalized for observation for 2 days; Tx APAP & hypothermia blanket;


Changed on 10/14/2018

VAERS ID: 30055 Before After
VAERS Form:1
Age:1.8
Sex:Male
Location:Ohio
Vaccinated:1991-04-17
Onset:1991-04-17
Submitted:1991-04-18
Entered:1991-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285917 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M160FH / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1483S / 1 LA / SC

Administered by: Public      Purchased by: Public
Symptoms: Agitation, Chills, Pyrexia, Tremor

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:
Current Illness: Cold-no fever
Preexisting Conditions: p/vax developed severe bronchitis;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Crying, felt cold, & was shaking, temp to 105; Hospitalized for observation for 2 days; Tx APAP & hypothermia blanket;

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