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This is VAERS ID 39375

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 39375
VAERS Form:
Age:1.5
Sex:Male
Location:Oregon
Vaccinated:1991-12-31
Onset:1992-01-16
Submitted:1992-01-22
Entered:1992-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 293948 / 3 LL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M575HC / 2 LA / IM
MMR: MMR II / MSD 0862T / - RL / SC
OPV: ORIMUNE / LEDERLE 0641M / 2 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: CONVULS, FEVER, COUGH INC, OTITIS MED

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:     Extended hospital stay? No
Previous Vaccinations: pt exp prolonged crying
Other Medications: NONE
Current Illness: sz @ that ear infect 6 wks prior
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NONE

Write-up: 1 wk p/shots devel cough no other sx; dad states had ear infect & fever 6 wks earlier had small sz; 16JAN devel fever 103.6 & sz that eve; To ER per ambulance sent home that eve; had 2nd sz @ home returned to hosp given ATB for ear infect;


Changed on 12/8/2009

VAERS ID: 39375 Before After
VAERS Form:
Age:1.5
Sex:Male
Location:Oregon
Vaccinated:1991-12-31
Onset:1992-01-16
Submitted:1992-01-22
Entered:1992-02-12 1992-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 293948 / 3 LL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M575HC / 2 LA / IM
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 0862T / - RL / SC
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 0641M / 2 - / PO

Administered by: Public      Purchased by: Unknown Public
Symptoms: Convulsion, Cough, Otitis media, Pyrexia, CONVULS, FEVER, COUGH INC, OTITIS MED

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:     Extended hospital stay? No
Previous Vaccinations: pt exp prolonged crying
Other Medications: NONE
Current Illness: sz @ that ear infect 6 wks prior
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NONE OR927

Write-up: 1 wk p/shots devel cough no other sx; dad states had ear infect & fever 6 wks earlier had small sz; 16JAN devel fever 103.6 & sz that eve; To ER per ambulance sent home that eve; had 2nd sz @ home returned to hosp given ATB for ear infect;


Changed on 5/14/2017

VAERS ID: 39375 Before After
VAERS Form:
Age:1.5
Sex:Male
Location:Oregon
Vaccinated:1991-12-31
Onset:1992-01-16
Submitted:1992-01-22
Entered:1992-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 293948 / 3 LL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M575HC / 2 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0862T / - RL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 0641M / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Cough, 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:     Extended hospital stay? No
Previous Vaccinations: pt exp prolonged crying crying~ ()~~~In patient
Other Medications: NONE
Current Illness: sz @ that ear infect 6 wks prior
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': OR927

Write-up: 1 wk p/shots devel cough no other sx; dad states had ear infect & fever 6 wks earlier had small sz; 16JAN devel fever 103.6 & sz that eve; To ER per ambulance sent home that eve; had 2nd sz @ home returned to hosp given ATB for ear infect;


Changed on 9/14/2017

VAERS ID: 39375 Before After
VAERS Form:(blank) 1
Age:1.5
Sex:Male
Location:Oregon
Vaccinated:1991-12-31
Onset:1992-01-16
Submitted:1992-01-22
Entered:1992-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 293948 / 3 4 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M575HC / 2 3 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0862T / - UNK RL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0641M / 2 3 - MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Cough, 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:     Extended hospital stay? No
Previous Vaccinations: pt exp prolonged crying~ ()~~~In patient
Other Medications: NONE
Current Illness: sz @ that ear infect 6 wks prior
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': OR927

Write-up: 1 wk p/shots devel cough no other sx; dad states had ear infect & fever 6 wks earlier had small sz; 16JAN devel fever 103.6 & sz that eve; To ER per ambulance sent home that eve; had 2nd sz @ home returned to hosp given ATB for ear infect;


Changed on 2/14/2018

VAERS ID: 39375 Before After
VAERS Form:1
Age:1.5
Sex:Male
Location:Oregon
Vaccinated:1991-12-31
Onset:1992-01-16
Submitted:1992-01-22
Entered:1992-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 293948 / 4 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M575HC / 3 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0862T / UNK RL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0641M / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Cough, 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:     Extended hospital stay? No
Previous Vaccinations: pt exp prolonged crying~ ()~~~In patient
Other Medications: NONE
Current Illness: sz @ that ear infect 6 wks prior
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': OR927

Write-up: 1 wk p/shots devel cough no other sx; dad states had ear infect & fever 6 wks earlier had small sz; 16JAN devel fever 103.6 & sz that eve; To ER per ambulance sent home that eve; had 2nd sz @ home returned to hosp given ATB for ear infect;


Changed on 6/14/2018

VAERS ID: 39375 Before After
VAERS Form:1
Age:1.5
Sex:Male
Location:Oregon
Vaccinated:1991-12-31
Onset:1992-01-16
Submitted:1992-01-22
Entered:1992-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 293948 / 4 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M575HC / 3 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0862T / UNK RL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0641M / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Cough, 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:     Extended hospital stay? No
Previous Vaccinations: pt exp prolonged crying~ ()~~~In patient
Other Medications: NONE
Current Illness: sz @ that ear infect 6 wks prior
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': OR927

Write-up: 1 wk p/shots devel cough no other sx; dad states had ear infect & fever 6 wks earlier had small sz; 16JAN devel fever 103.6 & sz that eve; To ER per ambulance sent home that eve; had 2nd sz @ home returned to hosp given ATB for ear infect;


Changed on 8/14/2018

VAERS ID: 39375 Before After
VAERS Form:1
Age:1.5
Sex:Male
Location:Oregon
Vaccinated:1991-12-31
Onset:1992-01-16
Submitted:1992-01-22
Entered:1992-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 293948 / 4 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M575HC / 3 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0862T / UNK RL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0641M / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Cough, 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:     Extended hospital stay? No
Previous Vaccinations: pt exp prolonged crying~ ()~~~In patient
Other Medications: NONE
Current Illness: sz @ that ear infect 6 wks prior
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': OR927

Write-up: 1 wk p/shots devel cough no other sx; dad states had ear infect & fever 6 wks earlier had small sz; 16JAN devel fever 103.6 & sz that eve; To ER per ambulance sent home that eve; had 2nd sz @ home returned to hosp given ATB for ear infect;


Changed on 9/14/2018

VAERS ID: 39375 Before After
VAERS Form:1
Age:1.5
Sex:Male
Location:Oregon
Vaccinated:1991-12-31
Onset:1992-01-16
Submitted:1992-01-22
Entered:1992-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 293948 / 4 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M575HC / 3 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0862T / UNK RL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0641M / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Cough, 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:     Extended hospital stay? No
Previous Vaccinations: pt exp prolonged crying~ ()~~~In patient
Other Medications: NONE
Current Illness: sz @ that ear infect 6 wks prior
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': OR927

Write-up: 1 wk p/shots devel cough no other sx; dad states had ear infect & fever 6 wks earlier had small sz; 16JAN devel fever 103.6 & sz that eve; To ER per ambulance sent home that eve; had 2nd sz @ home returned to hosp given ATB for ear infect;


Changed on 10/14/2018

VAERS ID: 39375 Before After
VAERS Form:1
Age:1.5
Sex:Male
Location:Oregon
Vaccinated:1991-12-31
Onset:1992-01-16
Submitted:1992-01-22
Entered:1992-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 293948 / 4 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M575HC / 3 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0862T / UNK RL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0641M / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Cough, 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:     Extended hospital stay? No
Previous Vaccinations: pt exp prolonged crying~ ()~~~In patient
Other Medications: NONE
Current Illness: sz @ that ear infect 6 wks prior
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': OR927

Write-up: 1 wk p/shots devel cough no other sx; dad states had ear infect & fever 6 wks earlier had small sz; 16JAN devel fever 103.6 & sz that eve; To ER per ambulance sent home that eve; had 2nd sz @ home returned to hosp given ATB for ear infect;

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