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This is VAERS ID 31219

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 31219
VAERS Form:
Age:1.3
Sex:Male
Location:Washington
Vaccinated:1991-05-08
Onset:1991-05-15
Submitted:1991-05-31
Entered:1991-06-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIBTITER / LEDERLE(PRAXIS) M560FP / 1 RA / IM
MMR: MMR II / MSD 0572T / 0 LA / SC

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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Blood culture-Neg, Urine clear, CBC: 8,600WBC, 41 Poly, 22 Bands, 24 Lymphs, 13 Mono, CSF 4 Monocytes 0 RBC Culture neg
CDC 'Split Type':

Write-up: 7 days post vax pt devel fever to 105; Seen in Er had 30 second generalized tonic clonic sz; Subsequent septic workup was negative; Hospitalized x 2 days on ATB until cultures negative; tx Ceftriaxone;


Changed on 12/8/2009

VAERS ID: 31219 Before After
VAERS Form:
Age:1.3
Sex:Male
Location:Washington
Vaccinated:1991-05-08
Onset:1991-05-15
Submitted:1991-05-31
Entered:1991-06-13 1991-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M560FP / 1 RA / IM
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 0572T / 0 LA / SC

Administered by: Private      Purchased by: Unknown Public
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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Blood culture-Neg, Urine clear, CBC: 8,600WBC, 41 Poly, 22 Bands, 24 Lymphs, 13 Mono, CSF 4 Monocytes 0 RBC Culture neg
CDC 'Split Type': (blank) WA91565

Write-up: 7 days post vax pt devel fever to 105; Seen in Er had 30 second generalized tonic clonic sz; Subsequent septic workup was negative; Hospitalized x 2 days on ATB until cultures negative; tx Ceftriaxone;


Changed on 5/14/2017

VAERS ID: 31219 Before After
VAERS Form:
Age:1.3
Sex:Male
Location:Washington
Vaccinated:1991-05-08
Onset:1991-05-15
Submitted:1991-05-31
Entered:1991-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M560FP / 1 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0572T / 0 LA / SC

Administered by: Private      Purchased by: Public
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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Blood culture-Neg, Urine clear, CBC: 8,600WBC, 41 Poly, 22 Bands, 24 Lymphs, 13 Mono, CSF 4 Monocytes 0 RBC Culture neg LP - WNL
CDC 'Split Type': WA91565

Write-up: 7 days post vax pt devel fever to 105; Seen in Er had 30 second generalized tonic clonic sz; Subsequent septic workup was negative; Hospitalized x 2 days on ATB until cultures negative; tx Ceftriaxone; T40.5C, convuls, hospitalized;


Changed on 9/14/2017

VAERS ID: 31219 Before After
VAERS Form:(blank) 1
Age:1.3
Sex:Male
Location:Washington
Vaccinated:1991-05-08
Onset:1991-05-15
Submitted:1991-05-31
Entered:1991-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M560FP / 1 2 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0572T / 0 1 LA / SC

Administered by: Private      Purchased by: Public
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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: LP - WNL
CDC 'Split Type': WA91565

Write-up: T40.5C, convuls, hospitalized;


Changed on 2/14/2018

VAERS ID: 31219 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Washington
Vaccinated:1991-05-08
Onset:1991-05-15
Submitted:1991-05-31
Entered:1991-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M560FP / 2 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0572T / 1 LA / SC

Administered by: Private      Purchased by: Public
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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: LP - WNL
CDC 'Split Type': WA91565

Write-up: T40.5C, convuls, hospitalized;


Changed on 6/14/2018

VAERS ID: 31219 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Washington
Vaccinated:1991-05-08
Onset:1991-05-15
Submitted:1991-05-31
Entered:1991-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M560FP / 2 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0572T / 1 LA / SC

Administered by: Private      Purchased by: Public
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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: LP - WNL
CDC 'Split Type': WA91565

Write-up: T40.5C, convuls, hospitalized;


Changed on 8/14/2018

VAERS ID: 31219 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Washington
Vaccinated:1991-05-08
Onset:1991-05-15
Submitted:1991-05-31
Entered:1991-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M560FP / 2 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0572T / 1 LA / SC

Administered by: Private      Purchased by: Public
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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: LP - WNL
CDC 'Split Type': WA91565

Write-up: T40.5C, convuls, hospitalized;


Changed on 9/14/2018

VAERS ID: 31219 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Washington
Vaccinated:1991-05-08
Onset:1991-05-15
Submitted:1991-05-31
Entered:1991-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M560FP / 2 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0572T / 1 LA / SC

Administered by: Private      Purchased by: Public
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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: LP - WNL
CDC 'Split Type': WA91565

Write-up: T40.5C, convuls, hospitalized;


Changed on 10/14/2018

VAERS ID: 31219 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Washington
Vaccinated:1991-05-08
Onset:1991-05-15
Submitted:1991-05-31
Entered:1991-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M560FP / 2 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0572T / 1 LA / SC

Administered by: Private      Purchased by: Public
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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: LP - WNL
CDC 'Split Type': WA91565

Write-up: T40.5C, convuls, hospitalized;

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