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This is VAERS ID 46017

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 46017
VAERS Form:
Age:1.5
Sex:Female
Location:South Carolina
Vaccinated:1992-03-17
Onset:1992-03-17
Submitted:1992-09-21
Entered:1992-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 320905 / 3 LL / -
HIBV: HIBTITER / LEDERLE(PRAXIS) M695HL / 2 RL / -
MMR: MMR II / MSD 1987T / 0 RL / -
OPV: ORIMUNE / LEDERLE 314934 / 2 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE x/sl cold no fever
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': NONE

Write-up: pt had elevated temp p/last vax; hospitalized x 5 days; mom states temp went as high as 114; MD said hospitalization could be related to vax reaction;


Changed on 12/8/2009

VAERS ID: 46017 Before After
VAERS Form:
Age:1.5
Sex:Female
Location:South Carolina
Vaccinated:1992-03-17
Onset:1992-03-17
Submitted:1992-09-21
Entered:1992-10-08 1992-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 320905 / 3 LL / -
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M695HL / 2 RL / -
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 1987T / 0 RL / -
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 314934 / 2 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: Pyrexia, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE x/sl cold no fever
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': NONE SC92121

Write-up: pt had elevated temp p/last vax; hospitalized x 5 days; mom states temp went as high as 114; MD said hospitalization could be related to vax reaction;


Changed on 5/14/2017

VAERS ID: 46017 Before After
VAERS Form:
Age:1.5
Sex:Female
Location:South Carolina
Vaccinated:1992-03-17
Onset:1992-03-17
Submitted:1992-09-21
Entered:1992-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 320905 / 3 LL / -
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M695HL / 2 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1987T / 0 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 314934 / 2 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: 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: 5     Extended hospital stay? No
Previous Vaccinations: NONE NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE x/sl cold no fever
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': SC92121

Write-up: pt had elevated temp p/last vax; hospitalized x 5 days; mom states temp went as high as 114; MD said hospitalization could be related to vax reaction;


Changed on 9/14/2017

VAERS ID: 46017 Before After
VAERS Form:(blank) 1
Age:1.5
Sex:Female
Location:South Carolina
Vaccinated:1992-03-17
Onset:1992-03-17
Submitted:1992-09-21
Entered:1992-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 320905 / 3 4 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M695HL / 2 3 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1987T / 0 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 314934 / 2 3 - MO / PO

Administered by: Public      Purchased by: Unknown
Symptoms: 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: 5     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE x/sl cold no fever
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': SC92121

Write-up: pt had elevated temp p/last vax; hospitalized x 5 days; mom states temp went as high as 114; MD said hospitalization could be related to vax reaction;


Changed on 2/14/2018

VAERS ID: 46017 Before After
VAERS Form:1
Age:1.5
Sex:Female
Location:South Carolina
Vaccinated:1992-03-17
Onset:1992-03-17
Submitted:1992-09-21
Entered:1992-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 320905 / 4 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M695HL / 3 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1987T / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 314934 / 3 MO / PO

Administered by: Public      Purchased by: Unknown
Symptoms: 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: 5     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE x/sl cold no fever
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': SC92121

Write-up: pt had elevated temp p/last vax; hospitalized x 5 days; mom states temp went as high as 114; MD said hospitalization could be related to vax reaction;


Changed on 6/14/2018

VAERS ID: 46017 Before After
VAERS Form:1
Age:1.5
Sex:Female
Location:South Carolina
Vaccinated:1992-03-17
Onset:1992-03-17
Submitted:1992-09-21
Entered:1992-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 320905 / 4 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M695HL / 3 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1987T / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 314934 / 3 MO / PO

Administered by: Public      Purchased by: Unknown
Symptoms: 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: 5     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE x/sl cold no fever
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': SC92121

Write-up: pt had elevated temp p/last vax; hospitalized x 5 days; mom states temp went as high as 114; MD said hospitalization could be related to vax reaction;


Changed on 8/14/2018

VAERS ID: 46017 Before After
VAERS Form:1
Age:1.5
Sex:Female
Location:South Carolina
Vaccinated:1992-03-17
Onset:1992-03-17
Submitted:1992-09-21
Entered:1992-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 320905 / 4 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M695HL / 3 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1987T / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 314934 / 3 MO / PO

Administered by: Public      Purchased by: Unknown
Symptoms: 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: 5     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE x/sl cold no fever
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': SC92121

Write-up: pt had elevated temp p/last vax; hospitalized x 5 days; mom states temp went as high as 114; MD said hospitalization could be related to vax reaction;


Changed on 9/14/2018

VAERS ID: 46017 Before After
VAERS Form:1
Age:1.5
Sex:Female
Location:South Carolina
Vaccinated:1992-03-17
Onset:1992-03-17
Submitted:1992-09-21
Entered:1992-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 320905 / 4 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M695HL / 3 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1987T / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 314934 / 3 MO / PO

Administered by: Public      Purchased by: Unknown
Symptoms: 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: 5     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE x/sl cold no fever
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': SC92121

Write-up: pt had elevated temp p/last vax; hospitalized x 5 days; mom states temp went as high as 114; MD said hospitalization could be related to vax reaction;


Changed on 10/14/2018

VAERS ID: 46017 Before After
VAERS Form:1
Age:1.5
Sex:Female
Location:South Carolina
Vaccinated:1992-03-17
Onset:1992-03-17
Submitted:1992-09-21
Entered:1992-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 320905 / 4 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M695HL / 3 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1987T / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 314934 / 3 MO / PO

Administered by: Public      Purchased by: Unknown
Symptoms: 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: 5     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE x/sl cold no fever
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': SC92121

Write-up: pt had elevated temp p/last vax; hospitalized x 5 days; mom states temp went as high as 114; MD said hospitalization could be related to vax reaction;

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