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This is VAERS ID 39056

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 39056
VAERS Form:
Age:1.3
Sex:Male
Location:North Carolina
Vaccinated:1991-09-06
Onset:1991-09-12
Submitted:1992-01-17
Entered:1992-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 295975 / 3 RA / -
HIBV: HIBTITER / LEDERLE(PRAXIS) M145HA / 0 LA / -
MMR: MMR II / MSD 0575T / 0 RA / SC
OPV: ORIMUNE / LEDERLE 0630A / 2 - / PO

Administered by: Public      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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: premature 37 wks gestation
Allergies:
Diagnostic Lab Data: blood tests & LP;
CDC 'Split Type':

Write-up: Fever & sz devel 6 days p/immun wen to hosp where blood work & lumbar puncture was done;


Changed on 12/8/2009

VAERS ID: 39056 Before After
VAERS Form:
Age:1.3
Sex:Male
Location:North Carolina
Vaccinated:1991-09-06
Onset:1991-09-12
Submitted:1992-01-17
Entered:1992-01-29 1992-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 295975 / 3 RA / -
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M145HA / 0 LA / -
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 0575T / 0 RA / SC
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 0630A / 2 - / PO

Administered by: Public      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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: premature 37 wks gestation
Allergies:
Diagnostic Lab Data: blood tests & LP;
CDC 'Split Type': (blank) NC92004

Write-up: Fever & sz devel 6 days p/immun wen to hosp where blood work & lumbar puncture was done;


Changed on 5/14/2017

VAERS ID: 39056 Before After
VAERS Form:
Age:1.3
Sex:Male
Location:North Carolina
Vaccinated:1991-09-06
Onset:1991-09-12
Submitted:1992-01-17
Entered:1992-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 295975 / 3 RA / -
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M145HA / 0 LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0575T / 0 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 0630A / 2 - / PO

Administered by: Public      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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: premature 37 wks gestation
Allergies:
Diagnostic Lab Data: blood tests & LP;
CDC 'Split Type': NC92004

Write-up: Fever & sz devel 6 days p/immun wen to hosp where blood work & lumbar puncture was done;


Changed on 9/14/2017

VAERS ID: 39056 Before After
VAERS Form:(blank) 1
Age:1.3
Sex:Male
Location:North Carolina
Vaccinated:1991-09-06
Onset:1991-09-12
Submitted:1992-01-17
Entered:1992-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 295975 / 3 4 RA / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M145HA / 0 1 LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0575T / 0 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0630A / 2 3 - MO / PO

Administered by: Public      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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: premature 37 wks gestation
Allergies:
Diagnostic Lab Data: blood tests & LP;
CDC 'Split Type': NC92004

Write-up: Fever & sz devel 6 days p/immun wen to hosp where blood work & lumbar puncture was done;


Changed on 2/14/2018

VAERS ID: 39056 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:North Carolina
Vaccinated:1991-09-06
Onset:1991-09-12
Submitted:1992-01-17
Entered:1992-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 295975 / 4 RA / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M145HA / 1 LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0575T / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0630A / 3 MO / PO

Administered by: Public      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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: premature 37 wks gestation
Allergies:
Diagnostic Lab Data: blood tests & LP;
CDC 'Split Type': NC92004

Write-up: Fever & sz devel 6 days p/immun wen to hosp where blood work & lumbar puncture was done;


Changed on 6/14/2018

VAERS ID: 39056 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:North Carolina
Vaccinated:1991-09-06
Onset:1991-09-12
Submitted:1992-01-17
Entered:1992-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 295975 / 4 RA / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M145HA / 1 LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0575T / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0630A / 3 MO / PO

Administered by: Public      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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: premature 37 wks gestation
Allergies:
Diagnostic Lab Data: blood tests & LP;
CDC 'Split Type': NC92004

Write-up: Fever & sz devel 6 days p/immun wen to hosp where blood work & lumbar puncture was done;


Changed on 8/14/2018

VAERS ID: 39056 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:North Carolina
Vaccinated:1991-09-06
Onset:1991-09-12
Submitted:1992-01-17
Entered:1992-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 295975 / 4 RA / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M145HA / 1 LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0575T / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0630A / 3 MO / PO

Administered by: Public      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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: premature 37 wks gestation
Allergies:
Diagnostic Lab Data: blood tests & LP;
CDC 'Split Type': NC92004

Write-up: Fever & sz devel 6 days p/immun wen to hosp where blood work & lumbar puncture was done;


Changed on 9/14/2018

VAERS ID: 39056 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:North Carolina
Vaccinated:1991-09-06
Onset:1991-09-12
Submitted:1992-01-17
Entered:1992-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 295975 / 4 RA / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M145HA / 1 LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0575T / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0630A / 3 MO / PO

Administered by: Public      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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: premature 37 wks gestation
Allergies:
Diagnostic Lab Data: blood tests & LP;
CDC 'Split Type': NC92004

Write-up: Fever & sz devel 6 days p/immun wen to hosp where blood work & lumbar puncture was done;


Changed on 10/14/2018

VAERS ID: 39056 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:North Carolina
Vaccinated:1991-09-06
Onset:1991-09-12
Submitted:1992-01-17
Entered:1992-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 295975 / 4 RA / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M145HA / 1 LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0575T / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0630A / 3 MO / PO

Administered by: Public      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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: premature 37 wks gestation
Allergies:
Diagnostic Lab Data: blood tests & LP;
CDC 'Split Type': NC92004

Write-up: Fever & sz devel 6 days p/immun wen to hosp where blood work & lumbar puncture was done;

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