National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 31639

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 31639
VAERS Form:
Age:1.3
Sex:Male
Location:North Carolina
Vaccinated:1991-06-10
Onset:1991-06-10
Submitted:1991-06-17
Entered:1991-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: PROHIBIT / CONNAUGHT LABS M560FP / 0 RL / -
MMR: MMR II / MSD 1658S / 0 LL / -

Administered by: Private      Purchased by: Unknown
Symptoms: AGITATION, FEVER, OTITIS MED, LEUKOPENIA

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: WBC-3900, 59-segs, 14-b
CDC 'Split Type':

Write-up: Developed febrile rxn 4-6 hrs p/ the immun. Assoc irritability. Symptoms persisted x 36 hrs-48 hrs. Concurrently DX: otitis media p/ 24 hrs of fever.


Changed on 12/8/2009

VAERS ID: 31639 Before After
VAERS Form:
Age:1.3
Sex:Male
Location:North Carolina
Vaccinated:1991-06-10
Onset:1991-06-10
Submitted:1991-06-17
Entered:1991-06-26 1991-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: PROHIBIT HIB (PROHIBIT) / CONNAUGHT LABS CONNAUGHT LABORATORIES M560FP / 0 RL / -
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 1658S / 0 LL / -

Administered by: Private      Purchased by: Unknown Private
Symptoms: Agitation, Leukopenia, Otitis media, Pyrexia, AGITATION, FEVER, OTITIS MED, LEUKOPENIA

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: WBC-3900, 59-segs, 14-b
CDC 'Split Type':

Write-up: Developed febrile rxn 4-6 hrs p/ the immun. Assoc irritability. Symptoms persisted x 36 hrs-48 hrs. Concurrently DX: otitis media p/ 24 hrs of fever.


Changed on 5/14/2017

VAERS ID: 31639 Before After
VAERS Form:
Age:1.3
Sex:Male
Location:North Carolina
Vaccinated:1991-06-10
Onset:1991-06-10
Submitted:1991-06-17
Entered:1991-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES M560FP / 0 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1658S / 0 LL / -

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Leukopenia, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: WBC-3900, 59-segs, 14-b
CDC 'Split Type':

Write-up: Developed febrile rxn 4-6 hrs p/ the immun. Assoc irritability. Symptoms persisted x 36 hrs-48 hrs. Concurrently DX: otitis media p/ 24 hrs of fever.


Changed on 9/14/2017

VAERS ID: 31639 Before After
VAERS Form:(blank) 1
Age:1.3
Sex:Male
Location:North Carolina
Vaccinated:1991-06-10
Onset:1991-06-10
Submitted:1991-06-17
Entered:1991-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES M560FP / 0 1 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1658S / 0 1 LL / -

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Leukopenia, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: WBC-3900, 59-segs, 14-b
CDC 'Split Type':

Write-up: Developed febrile rxn 4-6 hrs p/ the immun. Assoc irritability. Symptoms persisted x 36 hrs-48 hrs. Concurrently DX: otitis media p/ 24 hrs of fever.


Changed on 2/14/2018

VAERS ID: 31639 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:North Carolina
Vaccinated:1991-06-10
Onset:1991-06-10
Submitted:1991-06-17
Entered:1991-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES M560FP / 1 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1658S / 1 LL / -

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Leukopenia, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: WBC-3900, 59-segs, 14-b
CDC 'Split Type':

Write-up: Developed febrile rxn 4-6 hrs p/ the immun. Assoc irritability. Symptoms persisted x 36 hrs-48 hrs. Concurrently DX: otitis media p/ 24 hrs of fever.


Changed on 6/14/2018

VAERS ID: 31639 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:North Carolina
Vaccinated:1991-06-10
Onset:1991-06-10
Submitted:1991-06-17
Entered:1991-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES M560FP / 1 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1658S / 1 LL / -

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Leukopenia, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: WBC-3900, 59-segs, 14-b
CDC 'Split Type':

Write-up: Developed febrile rxn 4-6 hrs p/ the immun. Assoc irritability. Symptoms persisted x 36 hrs-48 hrs. Concurrently DX: otitis media p/ 24 hrs of fever.


Changed on 8/14/2018

VAERS ID: 31639 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:North Carolina
Vaccinated:1991-06-10
Onset:1991-06-10
Submitted:1991-06-17
Entered:1991-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES M560FP / 1 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1658S / 1 LL / -

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Leukopenia, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: WBC-3900, 59-segs, 14-b
CDC 'Split Type':

Write-up: Developed febrile rxn 4-6 hrs p/ the immun. Assoc irritability. Symptoms persisted x 36 hrs-48 hrs. Concurrently DX: otitis media p/ 24 hrs of fever.


Changed on 9/14/2018

VAERS ID: 31639 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:North Carolina
Vaccinated:1991-06-10
Onset:1991-06-10
Submitted:1991-06-17
Entered:1991-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES M560FP / 1 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1658S / 1 LL / -

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Leukopenia, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: WBC-3900, 59-segs, 14-b
CDC 'Split Type':

Write-up: Developed febrile rxn 4-6 hrs p/ the immun. Assoc irritability. Symptoms persisted x 36 hrs-48 hrs. Concurrently DX: otitis media p/ 24 hrs of fever.


Changed on 10/14/2018

VAERS ID: 31639 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:North Carolina
Vaccinated:1991-06-10
Onset:1991-06-10
Submitted:1991-06-17
Entered:1991-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES M560FP / 1 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1658S / 1 LL / -

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Leukopenia, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: WBC-3900, 59-segs, 14-b
CDC 'Split Type':

Write-up: Developed febrile rxn 4-6 hrs p/ the immun. Assoc irritability. Symptoms persisted x 36 hrs-48 hrs. Concurrently DX: otitis media p/ 24 hrs of fever.

New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=31639&WAYBACKHISTORY=ON


Copyright © 2019 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166