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This is VAERS ID 39042

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 39042
VAERS Form:
Age:1.3
Sex:Female
Location:North Carolina
Vaccinated:1991-07-02
Onset:1992-01-06
Submitted:1992-01-15
Entered:1992-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIBTITER / LEDERLE(PRAXIS) M660HC / 1 RL / IM
MMR: MMR II / MSD 0885T / 0 - / SC

Administered by: Private      Purchased by: Unknown
Symptoms: FEVER, SOMNOLENCE, INFECT, MENINGITIS, NO DRUG EFFECT

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations: NA
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: HEALTHY
Allergies:
Diagnostic Lab Data: LP-3000 WBC H. flu; BC positive for H. Flu
CDC 'Split Type': HEALTHY

Write-up: Pt was vaxed w/HIBTITTER @ 9mos of age & given 2nd dose @ 15mos of age; approx 6 mos later, exp high fever, vomiting & lethargy; hospitalized; dx H. Flu Meningitis; tx included IV Rocephin & Steroids x 10 days;


Changed on 12/8/2009

VAERS ID: 39042 Before After
VAERS Form:
Age:1.3
Sex:Female
Location:North Carolina
Vaccinated:1991-07-02
Onset:1992-01-06
Submitted:1992-01-15
Entered:1992-01-29 1992-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M660HC / 1 RL / IM
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 0885T / 0 - / SC

Administered by: Private      Purchased by: Unknown Private
Symptoms: Drug ineffective, Infection, Meningitis, Pyrexia, Somnolence, Vomiting, FEVER, SOMNOLENCE, INFECT, MENINGITIS, NO DRUG EFFECT

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations: NA
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: HEALTHY
Allergies:
Diagnostic Lab Data: LP-3000 WBC H. flu; BC positive for H. Flu
CDC 'Split Type': HEALTHY 920010301

Write-up: Pt was vaxed w/HIBTITTER @ 9mos of age & given 2nd dose @ 15mos of age; approx 6 mos later, exp high fever, vomiting & lethargy; hospitalized; dx H. Flu Meningitis; tx included IV Rocephin & Steroids x 10 days;


Changed on 5/14/2017

VAERS ID: 39042 Before After
VAERS Form:
Age:1.3
Sex:Female
Location:North Carolina
Vaccinated:1991-07-02
Onset:1992-01-06
Submitted:1992-01-15
Entered:1992-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M660HC / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0885T / 0 - / SC

Administered by: Private      Purchased by: Private
Symptoms: Drug ineffective, Infection, Meningitis, Pyrexia, Somnolence, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations: NA NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: HEALTHY
Allergies:
Diagnostic Lab Data: LP-3000 WBC H. flu; BC positive for H. Flu
CDC 'Split Type': 920010301

Write-up: Pt was vaxed w/HIBTITTER @ 9mos of age & given 2nd dose @ 15mos of age; approx 6 mos later, exp high fever, vomiting & lethargy; hospitalized; dx H. Flu Meningitis; tx included IV Rocephin & Steroids x 10 days;


Changed on 9/14/2017

VAERS ID: 39042 Before After
VAERS Form:(blank) 1
Age:1.3
Sex:Female
Location:North Carolina
Vaccinated:1991-07-02
Onset:1992-01-06
Submitted:1992-01-15
Entered:1992-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M660HC / 1 2 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0885T / 0 1 - / SC

Administered by: Private      Purchased by: Private
Symptoms: Drug ineffective, Infection, Meningitis, Pyrexia, Somnolence, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: HEALTHY
Allergies:
Diagnostic Lab Data: LP-3000 WBC H. flu; BC positive for H. Flu
CDC 'Split Type': 920010301

Write-up: Pt was vaxed w/HIBTITTER @ 9mos of age & given 2nd dose @ 15mos of age; approx 6 mos later, exp high fever, vomiting & lethargy; hospitalized; dx H. Flu Meningitis; tx included IV Rocephin & Steroids x 10 days;


Changed on 2/14/2018

VAERS ID: 39042 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:North Carolina
Vaccinated:1991-07-02
Onset:1992-01-06
Submitted:1992-01-15
Entered:1992-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M660HC / 2 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0885T / 1 - / SC

Administered by: Private      Purchased by: Private
Symptoms: Drug ineffective, Infection, Meningitis, Pyrexia, Somnolence, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: HEALTHY
Allergies:
Diagnostic Lab Data: LP-3000 WBC H. flu; BC positive for H. Flu
CDC 'Split Type': 920010301

Write-up: Pt was vaxed w/HIBTITTER @ 9mos of age & given 2nd dose @ 15mos of age; approx 6 mos later, exp high fever, vomiting & lethargy; hospitalized; dx H. Flu Meningitis; tx included IV Rocephin & Steroids x 10 days;


Changed on 6/14/2018

VAERS ID: 39042 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:North Carolina
Vaccinated:1991-07-02
Onset:1992-01-06
Submitted:1992-01-15
Entered:1992-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M660HC / 2 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0885T / 1 - / SC

Administered by: Private      Purchased by: Private
Symptoms: Drug ineffective, Infection, Meningitis, Pyrexia, Somnolence, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: HEALTHY
Allergies:
Diagnostic Lab Data: LP-3000 WBC H. flu; BC positive for H. Flu
CDC 'Split Type': 920010301

Write-up: Pt was vaxed w/HIBTITTER @ 9mos of age & given 2nd dose @ 15mos of age; approx 6 mos later, exp high fever, vomiting & lethargy; hospitalized; dx H. Flu Meningitis; tx included IV Rocephin & Steroids x 10 days;


Changed on 8/14/2018

VAERS ID: 39042 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:North Carolina
Vaccinated:1991-07-02
Onset:1992-01-06
Submitted:1992-01-15
Entered:1992-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M660HC / 2 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0885T / 1 - / SC

Administered by: Private      Purchased by: Private
Symptoms: Drug ineffective, Infection, Meningitis, Pyrexia, Somnolence, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: HEALTHY
Allergies:
Diagnostic Lab Data: LP-3000 WBC H. flu; BC positive for H. Flu
CDC 'Split Type': 920010301

Write-up: Pt was vaxed w/HIBTITTER @ 9mos of age & given 2nd dose @ 15mos of age; approx 6 mos later, exp high fever, vomiting & lethargy; hospitalized; dx H. Flu Meningitis; tx included IV Rocephin & Steroids x 10 days;


Changed on 9/14/2018

VAERS ID: 39042 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:North Carolina
Vaccinated:1991-07-02
Onset:1992-01-06
Submitted:1992-01-15
Entered:1992-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M660HC / 2 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0885T / 1 - / SC

Administered by: Private      Purchased by: Private
Symptoms: Drug ineffective, Infection, Meningitis, Pyrexia, Somnolence, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: HEALTHY
Allergies:
Diagnostic Lab Data: LP-3000 WBC H. flu; BC positive for H. Flu
CDC 'Split Type': 920010301

Write-up: Pt was vaxed w/HIBTITTER @ 9mos of age & given 2nd dose @ 15mos of age; approx 6 mos later, exp high fever, vomiting & lethargy; hospitalized; dx H. Flu Meningitis; tx included IV Rocephin & Steroids x 10 days;


Changed on 10/14/2018

VAERS ID: 39042 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:North Carolina
Vaccinated:1991-07-02
Onset:1992-01-06
Submitted:1992-01-15
Entered:1992-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M660HC / 2 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0885T / 1 - / SC

Administered by: Private      Purchased by: Private
Symptoms: Drug ineffective, Infection, Meningitis, Pyrexia, Somnolence, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: HEALTHY
Allergies:
Diagnostic Lab Data: LP-3000 WBC H. flu; BC positive for H. Flu
CDC 'Split Type': 920010301

Write-up: Pt was vaxed w/HIBTITTER @ 9mos of age & given 2nd dose @ 15mos of age; approx 6 mos later, exp high fever, vomiting & lethargy; hospitalized; dx H. Flu Meningitis; tx included IV Rocephin & Steroids x 10 days;

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=39042&WAYBACKHISTORY=ON


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