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This is VAERS ID 39564

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 39564
VAERS Form:
Age:1.4
Sex:Male
Location:Arizona
Vaccinated:1992-01-10
Onset:1992-01-21
Submitted:1992-01-31
Entered:1992-02-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: PEDVAXHIB / MSD 0887T / 2 - / IM
MMR: MMR II / MSD H56T / 1 - / IM

Administered by: Public      Purchased by: Unknown
Symptoms: CONVULS, FEVER, RHINITIS, DIARRHEA, 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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CBC-WNL;
CDC 'Split Type':

Write-up: Pt recvd MMR/HIB on 10JAN92 & on 20JAN92 devel rhinorrhea & fever; On 21JAN temp rose to 104 @ 4AM had a generalized sz x 3 mins; then @ 1145AM had another generalized sz lasting 2 mins; pt also had some loose stools; pt had no further sz;


Changed on 12/8/2009

VAERS ID: 39564 Before After
VAERS Form:
Age:1.4
Sex:Male
Location:Arizona
Vaccinated:1992-01-10
Onset:1992-01-21
Submitted:1992-01-31
Entered:1992-02-21 1992-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: PEDVAXHIB HIB (PEDVAXHIB) / MSD MERCK & CO. INC. 0887T / 2 - / IM
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. H56T / 1 - / IM

Administered by: Public      Purchased by: Unknown Public
Symptoms: Convulsion, Diarrhoea, Otitis media, Pyrexia, Rhinitis, CONVULS, FEVER, RHINITIS, DIARRHEA, 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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CBC-WNL;
CDC 'Split Type': (blank) AZ9209

Write-up: Pt recvd MMR/HIB on 10JAN92 & on 20JAN92 devel rhinorrhea & fever; On 21JAN temp rose to 104 @ 4AM had a generalized sz x 3 mins; then @ 1145AM had another generalized sz lasting 2 mins; pt also had some loose stools; pt had no further sz;


Changed on 5/14/2017

VAERS ID: 39564 Before After
VAERS Form:
Age:1.4
Sex:Male
Location:Arizona
Vaccinated:1992-01-10
Onset:1992-01-21
Submitted:1992-01-31
Entered:1992-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0887T / 2 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H56T / 1 - / IM

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Diarrhoea, Otitis media, Pyrexia, Rhinitis

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: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CBC-WNL;
CDC 'Split Type': AZ9209

Write-up: Pt recvd MMR/HIB on 10JAN92 & on 20JAN92 devel rhinorrhea & fever; On 21JAN temp rose to 104 @ 4AM had a generalized sz x 3 mins; then @ 1145AM had another generalized sz lasting 2 mins; pt also had some loose stools; pt had no further sz;


Changed on 9/14/2017

VAERS ID: 39564 Before After
VAERS Form:(blank) 1
Age:1.4
Sex:Male
Location:Arizona
Vaccinated:1992-01-10
Onset:1992-01-21
Submitted:1992-01-31
Entered:1992-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0887T / 2 3 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H56T / 1 2 - / IM

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Diarrhoea, Otitis media, Pyrexia, Rhinitis

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: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CBC-WNL;
CDC 'Split Type': AZ9209

Write-up: Pt recvd MMR/HIB on 10JAN92 & on 20JAN92 devel rhinorrhea & fever; On 21JAN temp rose to 104 @ 4AM had a generalized sz x 3 mins; then @ 1145AM had another generalized sz lasting 2 mins; pt also had some loose stools; pt had no further sz;


Changed on 2/14/2018

VAERS ID: 39564 Before After
VAERS Form:1
Age:1.4
Sex:Male
Location:Arizona
Vaccinated:1992-01-10
Onset:1992-01-21
Submitted:1992-01-31
Entered:1992-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0887T / 3 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H56T / 2 - / IM

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Diarrhoea, Otitis media, Pyrexia, Rhinitis

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: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CBC-WNL;
CDC 'Split Type': AZ9209

Write-up: Pt recvd MMR/HIB on 10JAN92 & on 20JAN92 devel rhinorrhea & fever; On 21JAN temp rose to 104 @ 4AM had a generalized sz x 3 mins; then @ 1145AM had another generalized sz lasting 2 mins; pt also had some loose stools; pt had no further sz;


Changed on 6/14/2018

VAERS ID: 39564 Before After
VAERS Form:1
Age:1.4
Sex:Male
Location:Arizona
Vaccinated:1992-01-10
Onset:1992-01-21
Submitted:1992-01-31
Entered:1992-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0887T / 3 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H56T / 2 - / IM

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Diarrhoea, Otitis media, Pyrexia, Rhinitis

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: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CBC-WNL;
CDC 'Split Type': AZ9209

Write-up: Pt recvd MMR/HIB on 10JAN92 & on 20JAN92 devel rhinorrhea & fever; On 21JAN temp rose to 104 @ 4AM had a generalized sz x 3 mins; then @ 1145AM had another generalized sz lasting 2 mins; pt also had some loose stools; pt had no further sz;


Changed on 8/14/2018

VAERS ID: 39564 Before After
VAERS Form:1
Age:1.4
Sex:Male
Location:Arizona
Vaccinated:1992-01-10
Onset:1992-01-21
Submitted:1992-01-31
Entered:1992-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0887T / 3 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H56T / 2 - / IM

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Diarrhoea, Otitis media, Pyrexia, Rhinitis

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: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CBC-WNL;
CDC 'Split Type': AZ9209

Write-up: Pt recvd MMR/HIB on 10JAN92 & on 20JAN92 devel rhinorrhea & fever; On 21JAN temp rose to 104 @ 4AM had a generalized sz x 3 mins; then @ 1145AM had another generalized sz lasting 2 mins; pt also had some loose stools; pt had no further sz;


Changed on 9/14/2018

VAERS ID: 39564 Before After
VAERS Form:1
Age:1.4
Sex:Male
Location:Arizona
Vaccinated:1992-01-10
Onset:1992-01-21
Submitted:1992-01-31
Entered:1992-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0887T / 3 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H56T / 2 - / IM

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Diarrhoea, Otitis media, Pyrexia, Rhinitis

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: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CBC-WNL;
CDC 'Split Type': AZ9209

Write-up: Pt recvd MMR/HIB on 10JAN92 & on 20JAN92 devel rhinorrhea & fever; On 21JAN temp rose to 104 @ 4AM had a generalized sz x 3 mins; then @ 1145AM had another generalized sz lasting 2 mins; pt also had some loose stools; pt had no further sz;


Changed on 10/14/2018

VAERS ID: 39564 Before After
VAERS Form:1
Age:1.4
Sex:Male
Location:Arizona
Vaccinated:1992-01-10
Onset:1992-01-21
Submitted:1992-01-31
Entered:1992-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0887T / 3 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H56T / 2 - / IM

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Diarrhoea, Otitis media, Pyrexia, Rhinitis

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: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CBC-WNL;
CDC 'Split Type': AZ9209

Write-up: Pt recvd MMR/HIB on 10JAN92 & on 20JAN92 devel rhinorrhea & fever; On 21JAN temp rose to 104 @ 4AM had a generalized sz x 3 mins; then @ 1145AM had another generalized sz lasting 2 mins; pt also had some loose stools; pt had no further sz;

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