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This is VAERS ID 42794

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 42794
VAERS Form:
Age:1.3
Sex:Male
Location:Pennsylvania
Vaccinated:1992-05-29
Onset:1992-06-04
Submitted:1992-06-08
Entered:1992-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIBTITER / LEDERLE(PRAXIS) M070HP / 3 RA / IM
MMR: MMR II / MSD 1941T / 0 LA / SC

Administered by: Private      Purchased by: Unknown
Symptoms: CONVULS, FEVER, CYANOSIS, APNEA, HEART ARREST

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: heart murmur
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Began 29MAY w/elevated temp; 30MAY & 31MAY t101.6 & above; 01JUN afebrile; 4JUN had sz (extremity upper) & facial twitching x 1 1/2min @ 810AM; gave CPR as pt lips cyanotic & apneic spell;


Changed on 12/8/2009

VAERS ID: 42794 Before After
VAERS Form:
Age:1.3
Sex:Male
Location:Pennsylvania
Vaccinated:1992-05-29
Onset:1992-06-04
Submitted:1992-06-08
Entered:1992-06-18 1992-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M070HP / 3 RA / IM
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 1941T / 0 LA / SC

Administered by: Private      Purchased by: Unknown Private
Symptoms: Apnoea, Cardiac arrest, Convulsion, Cyanosis, Muscle twitching, Pyrexia, CONVULS, FEVER, CYANOSIS, APNEA, HEART ARREST

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: heart murmur
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Began 29MAY w/elevated temp; 30MAY & 31MAY t101.6 & above; 01JUN afebrile; 4JUN had sz (extremity upper) & facial twitching x 1 1/2min @ 810AM; gave CPR as pt lips cyanotic & apneic spell;


Changed on 5/14/2017

VAERS ID: 42794 Before After
VAERS Form:
Age:1.3
Sex:Male
Location:Pennsylvania
Vaccinated:1992-05-29
Onset:1992-06-04
Submitted:1992-06-08
Entered:1992-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M070HP / 3 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1941T / 0 LA / SC

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Convulsion, Cyanosis, Muscle twitching, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: heart murmur
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Began 29MAY w/elevated temp; 30MAY & 31MAY t101.6 & above; 01JUN afebrile; 4JUN had sz (extremity upper) & facial twitching x 1 1/2min @ 810AM; gave CPR as pt lips cyanotic & apneic spell;


Changed on 9/14/2017

VAERS ID: 42794 Before After
VAERS Form:(blank) 1
Age:1.3
Sex:Male
Location:Pennsylvania
Vaccinated:1992-05-29
Onset:1992-06-04
Submitted:1992-06-08
Entered:1992-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M070HP / 3 4 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1941T / 0 1 LA / SC

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Convulsion, Cyanosis, Muscle twitching, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: heart murmur
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Began 29MAY w/elevated temp; 30MAY & 31MAY t101.6 & above; 01JUN afebrile; 4JUN had sz (extremity upper) & facial twitching x 1 1/2min @ 810AM; gave CPR as pt lips cyanotic & apneic spell;


Changed on 2/14/2018

VAERS ID: 42794 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Pennsylvania
Vaccinated:1992-05-29
Onset:1992-06-04
Submitted:1992-06-08
Entered:1992-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M070HP / 4 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1941T / 1 LA / SC

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Convulsion, Cyanosis, Muscle twitching, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: heart murmur
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Began 29MAY w/elevated temp; 30MAY & 31MAY t101.6 & above; 01JUN afebrile; 4JUN had sz (extremity upper) & facial twitching x 1 1/2min @ 810AM; gave CPR as pt lips cyanotic & apneic spell;


Changed on 6/14/2018

VAERS ID: 42794 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Pennsylvania
Vaccinated:1992-05-29
Onset:1992-06-04
Submitted:1992-06-08
Entered:1992-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M070HP / 4 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1941T / 1 LA / SC

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Convulsion, Cyanosis, Muscle twitching, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: heart murmur
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Began 29MAY w/elevated temp; 30MAY & 31MAY t101.6 & above; 01JUN afebrile; 4JUN had sz (extremity upper) & facial twitching x 1 1/2min @ 810AM; gave CPR as pt lips cyanotic & apneic spell;


Changed on 8/14/2018

VAERS ID: 42794 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Pennsylvania
Vaccinated:1992-05-29
Onset:1992-06-04
Submitted:1992-06-08
Entered:1992-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M070HP / 4 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1941T / 1 LA / SC

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Convulsion, Cyanosis, Muscle twitching, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: heart murmur
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Began 29MAY w/elevated temp; 30MAY & 31MAY t101.6 & above; 01JUN afebrile; 4JUN had sz (extremity upper) & facial twitching x 1 1/2min @ 810AM; gave CPR as pt lips cyanotic & apneic spell;


Changed on 9/14/2018

VAERS ID: 42794 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Pennsylvania
Vaccinated:1992-05-29
Onset:1992-06-04
Submitted:1992-06-08
Entered:1992-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M070HP / 4 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1941T / 1 LA / SC

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Convulsion, Cyanosis, Muscle twitching, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: heart murmur
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Began 29MAY w/elevated temp; 30MAY & 31MAY t101.6 & above; 01JUN afebrile; 4JUN had sz (extremity upper) & facial twitching x 1 1/2min @ 810AM; gave CPR as pt lips cyanotic & apneic spell;


Changed on 10/14/2018

VAERS ID: 42794 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Pennsylvania
Vaccinated:1992-05-29
Onset:1992-06-04
Submitted:1992-06-08
Entered:1992-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M070HP / 4 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1941T / 1 LA / SC

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Convulsion, Cyanosis, Muscle twitching, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: heart murmur
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Began 29MAY w/elevated temp; 30MAY & 31MAY t101.6 & above; 01JUN afebrile; 4JUN had sz (extremity upper) & facial twitching x 1 1/2min @ 810AM; gave CPR as pt lips cyanotic & apneic spell;

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=42794&WAYBACKHISTORY=ON


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