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This is VAERS ID 30930

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 30930
VAERS Form:
Age:1.5
Sex:Female
Location:Oregon
Vaccinated:1991-04-11
Onset:1991-04-11
Submitted:1991-04-17
Entered:1991-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 285915 / 3 RL / -
HIBV: HIBTITER / LEDERLE(PRAXIS) M160FT / 0 LL / -
MMR: MMR II / MSD 2119R / 0 LA / SC
OPV: ORIMUNE / LEDERLE 619B1 / 2 - / -

Administered by: Public      Purchased by: Unknown
Symptoms: CONVULS, FEVER, OTITIS MED, DELIRIUM

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: NONE
Other Medications: Vitamins, Fluoride
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Blod Cultures
CDC 'Split Type': NONE

Write-up: fever @ 1630 temp not taken, delirous gave APAP; 12APR91 convuls; given 02 by fire dept t105f; treated for OM;


Changed on 12/8/2009

VAERS ID: 30930 Before After
VAERS Form:
Age:1.5
Sex:Female
Location:Oregon
Vaccinated:1991-04-11
Onset:1991-04-11
Submitted:1991-04-17
Entered:1991-06-05 1991-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 285915 / 3 RL / -
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M160FT / 0 LL / -
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 2119R / 0 LA / SC
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 619B1 / 2 - / -

Administered by: Public      Purchased by: Unknown Public
Symptoms: Convulsion, Delirium, Otitis media, Pyrexia, CONVULS, FEVER, OTITIS MED, DELIRIUM

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: NONE
Other Medications: Vitamins, Fluoride
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Blod Cultures
CDC 'Split Type': NONE OR9117

Write-up: fever @ 1630 temp not taken, delirous gave APAP; 12APR91 convuls; given 02 by fire dept t105f; treated for OM;


Changed on 5/14/2017

VAERS ID: 30930 Before After
VAERS Form:
Age:1.5
Sex:Female
Location:Oregon
Vaccinated:1991-04-11
Onset:1991-04-11
Submitted:1991-04-17
Entered:1991-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285915 / 3 RL / -
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M160FT / 0 LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2119R / 0 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 619B1 / 2 - / -

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Delirium, Otitis media, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: NONE NONE~ ()~~~In patient
Other Medications: Vitamins, Fluoride
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Blod Cultures
CDC 'Split Type': OR9117

Write-up: fever @ 1630 temp not taken, delirous gave APAP; 12APR91 convuls; given 02 by fire dept t105f; treated for OM;


Changed on 9/14/2017

VAERS ID: 30930 Before After
VAERS Form:(blank) 1
Age:1.5
Sex:Female
Location:Oregon
Vaccinated:1991-04-11
Onset:1991-04-11
Submitted:1991-04-17
Entered:1991-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285915 / 3 4 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M160FT / 0 1 LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2119R / 0 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 619B1 / 2 3 - / -

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Delirium, Otitis media, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Vitamins, Fluoride
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Blod Cultures
CDC 'Split Type': OR9117

Write-up: fever @ 1630 temp not taken, delirous gave APAP; 12APR91 convuls; given 02 by fire dept t105f; treated for OM;


Changed on 2/14/2018

VAERS ID: 30930 Before After
VAERS Form:1
Age:1.5
Sex:Female
Location:Oregon
Vaccinated:1991-04-11
Onset:1991-04-11
Submitted:1991-04-17
Entered:1991-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285915 / 4 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M160FT / 1 LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2119R / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 619B1 / 3 - / -

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Delirium, Otitis media, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Vitamins, Fluoride
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Blod Cultures
CDC 'Split Type': OR9117

Write-up: fever @ 1630 temp not taken, delirous gave APAP; 12APR91 convuls; given 02 by fire dept t105f; treated for OM;


Changed on 6/14/2018

VAERS ID: 30930 Before After
VAERS Form:1
Age:1.5
Sex:Female
Location:Oregon
Vaccinated:1991-04-11
Onset:1991-04-11
Submitted:1991-04-17
Entered:1991-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285915 / 4 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M160FT / 1 LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2119R / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 619B1 / 3 - / -

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Delirium, Otitis media, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Vitamins, Fluoride
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Blod Cultures
CDC 'Split Type': OR9117

Write-up: fever @ 1630 temp not taken, delirous gave APAP; 12APR91 convuls; given 02 by fire dept t105f; treated for OM;


Changed on 8/14/2018

VAERS ID: 30930 Before After
VAERS Form:1
Age:1.5
Sex:Female
Location:Oregon
Vaccinated:1991-04-11
Onset:1991-04-11
Submitted:1991-04-17
Entered:1991-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285915 / 4 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M160FT / 1 LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2119R / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 619B1 / 3 - / -

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Delirium, Otitis media, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Vitamins, Fluoride
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Blod Cultures
CDC 'Split Type': OR9117

Write-up: fever @ 1630 temp not taken, delirous gave APAP; 12APR91 convuls; given 02 by fire dept t105f; treated for OM;


Changed on 9/14/2018

VAERS ID: 30930 Before After
VAERS Form:1
Age:1.5
Sex:Female
Location:Oregon
Vaccinated:1991-04-11
Onset:1991-04-11
Submitted:1991-04-17
Entered:1991-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285915 / 4 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M160FT / 1 LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2119R / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 619B1 / 3 - / -

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Delirium, Otitis media, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Vitamins, Fluoride
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Blod Cultures
CDC 'Split Type': OR9117

Write-up: fever @ 1630 temp not taken, delirous gave APAP; 12APR91 convuls; given 02 by fire dept t105f; treated for OM;


Changed on 10/14/2018

VAERS ID: 30930 Before After
VAERS Form:1
Age:1.5
Sex:Female
Location:Oregon
Vaccinated:1991-04-11
Onset:1991-04-11
Submitted:1991-04-17
Entered:1991-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285915 / 4 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M160FT / 1 LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2119R / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 619B1 / 3 - / -

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Delirium, Otitis media, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Vitamins, Fluoride
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Blod Cultures
CDC 'Split Type': OR9117

Write-up: fever @ 1630 temp not taken, delirous gave APAP; 12APR91 convuls; given 02 by fire dept t105f; treated for OM;

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