National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 39160

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 39160
VAERS Form:
Age:1.3
Sex:Female
Location:California
Vaccinated:1991-04-11
Onset:1991-04-21
Submitted:1992-01-20
Entered:1992-01-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP / CONNAUGHT LABS 0B21044 / 2 A / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M105HA / 2 L / IM
MMR: MMR II / MSD 2236S / 0 A / SC

Administered by: Private      Purchased by: Unknown
Symptoms: CONVULS, MENTAL RETARD, CONVULS GRAND MAL, ENCEPHALITIS, OTITIS MED

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? Yes
Previous Vaccinations: NONE
Other Medications: Amoxicillin
Current Illness: minimum serous otitis med
Preexisting Conditions: febrile seizure 14MAR91;
Allergies:
Diagnostic Lab Data: @ hosp Sp tap, CT or MRI scan;
CDC 'Split Type': febrile seizure 14MAR91;

Write-up: Status epilepticus, ear infect seen by MD taken to hosp pt is apparently retarded; prolonged sz & encephalitis;


Changed on 12/8/2009

VAERS ID: 39160 Before After
VAERS Form:
Age:1.3
Sex:Female
Location:California
Vaccinated:1991-04-11
Onset:1991-04-21
Submitted:1992-01-20
Entered:1992-01-31 1992-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP DTP (NO BRAND NAME) / CONNAUGHT LABS CONNAUGHT LABORATORIES 0B21044 / 2 A / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M105HA / 2 L / IM
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 2236S / 0 A / SC

Administered by: Private      Purchased by: Unknown Private
Symptoms: Convulsion, Encephalitis, Grand mal convulsion, Mental retardation severity unspecified, Otitis media, CONVULS, MENTAL RETARD, CONVULS GRAND MAL, ENCEPHALITIS, OTITIS MED

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? Yes
Previous Vaccinations: NONE
Other Medications: Amoxicillin
Current Illness: minimum serous otitis med
Preexisting Conditions: febrile seizure 14MAR91;
Allergies:
Diagnostic Lab Data: @ hosp Sp tap, CT or MRI scan;
CDC 'Split Type': febrile seizure 14MAR91; (blank)

Write-up: Status epilepticus, ear infect seen by MD taken to hosp pt is apparently retarded; prolonged sz & encephalitis;


Changed on 5/14/2017

VAERS ID: 39160 Before After
VAERS Form:
Age:1.3
Sex:Female
Location:California
Vaccinated:1991-04-11
Onset:1991-04-21
Submitted:1992-01-20
Entered:1992-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0B21044 / 2 A - / IM IM A
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M105HA / 2 L - / IM IM L
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2236S / 0 A - / SC SC A

Administered by: Private      Purchased by: Private
Symptoms: Convulsion, Encephalitis, Grand mal convulsion, Mental retardation severity unspecified, Otitis media

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? Yes
Previous Vaccinations: NONE NONE~ ()~~~In patient
Other Medications: Amoxicillin
Current Illness: minimum serous otitis med
Preexisting Conditions: febrile seizure 14MAR91;
Allergies:
Diagnostic Lab Data: @ hosp Sp tap, CT or MRI scan;
CDC 'Split Type':

Write-up: Status epilepticus, ear infect seen by MD taken to hosp pt is apparently retarded; prolonged sz & encephalitis;


Changed on 9/14/2017

VAERS ID: 39160 Before After
VAERS Form:(blank) 1
Age:1.3
Sex:Female
Location:California
Vaccinated:1991-04-11
Onset:1991-04-21
Submitted:1992-01-20
Entered:1992-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0B21044 / 2 3 - / IM A
HIBV: HIB (HIBTITER) / PFIZER/WYETH M105HA / 2 3 - / IM L
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2236S / 0 1 - / SC A

Administered by: Private      Purchased by: Private
Symptoms: Convulsion, Encephalitis, Grand mal convulsion, Mental retardation severity unspecified, Otitis media

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? Yes
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Amoxicillin
Current Illness: minimum serous otitis med
Preexisting Conditions: febrile seizure 14MAR91;
Allergies:
Diagnostic Lab Data: @ hosp Sp tap, CT or MRI scan;
CDC 'Split Type':

Write-up: Status epilepticus, ear infect seen by MD taken to hosp pt is apparently retarded; prolonged sz & encephalitis;


Changed on 2/14/2018

VAERS ID: 39160 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:California
Vaccinated:1991-04-11
Onset:1991-04-21
Submitted:1992-01-20
Entered:1992-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0B21044 / 3 - / IM A
HIBV: HIB (HIBTITER) / PFIZER/WYETH M105HA / 3 - / IM L
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2236S / 1 - / SC A

Administered by: Private      Purchased by: Private
Symptoms: Convulsion, Encephalitis, Grand mal convulsion, Mental retardation severity unspecified, Otitis media

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? Yes
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Amoxicillin
Current Illness: minimum serous otitis med
Preexisting Conditions: febrile seizure 14MAR91;
Allergies:
Diagnostic Lab Data: @ hosp Sp tap, CT or MRI scan;
CDC 'Split Type':

Write-up: Status epilepticus, ear infect seen by MD taken to hosp pt is apparently retarded; prolonged sz & encephalitis;


Changed on 6/14/2018

VAERS ID: 39160 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:California
Vaccinated:1991-04-11
Onset:1991-04-21
Submitted:1992-01-20
Entered:1992-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0B21044 / 3 - / IM A
HIBV: HIB (HIBTITER) / PFIZER/WYETH M105HA / 3 - / IM L
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2236S / 1 - / SC A

Administered by: Private      Purchased by: Private
Symptoms: Convulsion, Encephalitis, Grand mal convulsion, Mental retardation severity unspecified, Otitis media

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? Yes
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Amoxicillin
Current Illness: minimum serous otitis med
Preexisting Conditions: febrile seizure 14MAR91;
Allergies:
Diagnostic Lab Data: @ hosp Sp tap, CT or MRI scan;
CDC 'Split Type':

Write-up: Status epilepticus, ear infect seen by MD taken to hosp pt is apparently retarded; prolonged sz & encephalitis;


Changed on 8/14/2018

VAERS ID: 39160 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:California
Vaccinated:1991-04-11
Onset:1991-04-21
Submitted:1992-01-20
Entered:1992-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0B21044 / 3 - / IM A
HIBV: HIB (HIBTITER) / PFIZER/WYETH M105HA / 3 - / IM L
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2236S / 1 - / SC A

Administered by: Private      Purchased by: Private
Symptoms: Convulsion, Encephalitis, Grand mal convulsion, Mental retardation severity unspecified, Otitis media

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? Yes
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Amoxicillin
Current Illness: minimum serous otitis med
Preexisting Conditions: febrile seizure 14MAR91;
Allergies:
Diagnostic Lab Data: @ hosp Sp tap, CT or MRI scan;
CDC 'Split Type':

Write-up: Status epilepticus, ear infect seen by MD taken to hosp pt is apparently retarded; prolonged sz & encephalitis;


Changed on 9/14/2018

VAERS ID: 39160 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:California
Vaccinated:1991-04-11
Onset:1991-04-21
Submitted:1992-01-20
Entered:1992-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0B21044 / 3 - / IM A
HIBV: HIB (HIBTITER) / PFIZER/WYETH M105HA / 3 - / IM L
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2236S / 1 - / SC A

Administered by: Private      Purchased by: Private
Symptoms: Convulsion, Encephalitis, Grand mal convulsion, Mental retardation severity unspecified, Otitis media

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? Yes
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Amoxicillin
Current Illness: minimum serous otitis med
Preexisting Conditions: febrile seizure 14MAR91;
Allergies:
Diagnostic Lab Data: @ hosp Sp tap, CT or MRI scan;
CDC 'Split Type':

Write-up: Status epilepticus, ear infect seen by MD taken to hosp pt is apparently retarded; prolonged sz & encephalitis;


Changed on 10/14/2018

VAERS ID: 39160 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:California
Vaccinated:1991-04-11
Onset:1991-04-21
Submitted:1992-01-20
Entered:1992-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0B21044 / 3 - / IM A
HIBV: HIB (HIBTITER) / PFIZER/WYETH M105HA / 3 - / IM L
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2236S / 1 - / SC A

Administered by: Private      Purchased by: Private
Symptoms: Convulsion, Encephalitis, Grand mal convulsion, Mental retardation severity unspecified, Otitis media

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? Yes
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Amoxicillin
Current Illness: minimum serous otitis med
Preexisting Conditions: febrile seizure 14MAR91;
Allergies:
Diagnostic Lab Data: @ hosp Sp tap, CT or MRI scan;
CDC 'Split Type':

Write-up: Status epilepticus, ear infect seen by MD taken to hosp pt is apparently retarded; prolonged sz & encephalitis;

New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=39160&WAYBACKHISTORY=ON


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