National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts.org
Search Results

This is VAERS ID 87194

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 87194
VAERS Form:
Age:2.1
Sex:Male
Location:Alaska
Vaccinated:1996-05-14
Onset:1996-06-02
Submitted:1996-06-14
Entered:1996-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HAVRIX / SMITHKLINE 178A2 / 0 LL / -
VARCEL: VARIVAX / MSD 0390B / 0 RL / -

Administered by: Private      Purchased by: Unknown
Symptoms: AGITATION, FEVER, COORDINAT ABNORM, CSF ABNORM, ATAXIA

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: 3     Extended hospital stay? No
Previous Vaccinations: NA
Other Medications: Pedicare
Current Illness: sl cough & runny nose
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CSF 30WBC, 70% LM; 10% P;20% oth;4JUN-7JUn gluc 49;prot 84;ESR;WBC 22.4-13.3;PTT 628-480;180-78-115;chem pretty nl;MRI nl;
CDC 'Split Type': NONE

Write-up: tremor, ataxia, fever, cranky;adm to hosp 4JUN;sx abated by 7JUN;temp nl;tremor/dysmetria;ataxic gait; better 7JUN;14JUN still unsteady on rising;


Changed on 12/8/2009

VAERS ID: 87194 Before After
VAERS Form:
Age:2.1
Sex:Male
Location:Alaska
Vaccinated:1996-05-14
Onset:1996-06-02
Submitted:1996-06-14
Entered:1996-06-25 1996-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HAVRIX HEP A (HAVRIX) / SMITHKLINE SMITHKLINE BEECHAM 178A2 / 0 LL / -
VARCEL: VARIVAX VARICELLA (VARIVAX) / MSD MERCK & CO. INC. 0390B / 0 RL / -

Administered by: Private      Purchased by: Unknown Private
Symptoms: Agitation, Coordination abnormal, Gait disturbance, Pyrexia, Tremor, CSF test abnormal, AGITATION, FEVER, COORDINAT ABNORM, CSF ABNORM, ATAXIA

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: 3     Extended hospital stay? No
Previous Vaccinations: NA
Other Medications: Pedicare
Current Illness: sl cough & runny nose
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CSF 30WBC, 70% LM; 10% P;20% oth;4JUN-7JUn gluc 49;prot 84;ESR;WBC 22.4-13.3;PTT 628-480;180-78-115;chem pretty nl;MRI nl;
CDC 'Split Type': NONE (blank)

Write-up: tremor, ataxia, fever, cranky;adm to hosp 4JUN;sx abated by 7JUN;temp nl;tremor/dysmetria;ataxic gait; better 7JUN;14JUN still unsteady on rising;


Changed on 2/14/2017

VAERS ID: 87194 Before After
VAERS Form:
Age:2.1 2.0
Sex:Male
Location:Alaska
Vaccinated:1996-05-14
Onset:1996-06-02
Submitted:1996-06-14
Entered:1996-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 178A2 / 0 LL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0390B / 0 RL / -

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Coordination abnormal, Gait disturbance, Pyrexia, Tremor, CSF test abnormal

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: 3     Extended hospital stay? No
Previous Vaccinations: NA
Other Medications: Pedicare
Current Illness: sl cough & runny nose
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CSF 30WBC, 70% LM; 10% P;20% oth;4JUN-7JUn gluc 49;prot 84;ESR;WBC 22.4-13.3;PTT 628-480;180-78-115;chem pretty nl;MRI nl;
CDC 'Split Type':

Write-up: tremor, ataxia, fever, cranky;adm to hosp 4JUN;sx abated by 7JUN;temp nl;tremor/dysmetria;ataxic gait; better 7JUN;14JUN still unsteady on rising;


Changed on 5/14/2017

VAERS ID: 87194 Before After
VAERS Form:
Age:2.0
Sex:Male
Location:Alaska
Vaccinated:1996-05-14
Onset:1996-06-02
Submitted:1996-06-14
Entered:1996-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 178A2 / 0 LL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0390B / 0 RL / -

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Coordination abnormal, Gait disturbance, Pyrexia, Tremor, CSF test abnormal

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: 3     Extended hospital stay? No
Previous Vaccinations: NA NA~ ()~~~In patient
Other Medications: Pedicare
Current Illness: sl cough & runny nose
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CSF 30WBC, 70% LM; 10% P;20% oth;4JUN-7JUn gluc 49;prot 84;ESR;WBC 22.4-13.3;PTT 628-480;180-78-115;chem pretty nl;MRI nl;
CDC 'Split Type':

Write-up: tremor, ataxia, fever, cranky;adm to hosp 4JUN;sx abated by 7JUN;temp nl;tremor/dysmetria;ataxic gait; better 7JUN;14JUN still unsteady on rising;


Changed on 9/14/2017

VAERS ID: 87194 Before After
VAERS Form:(blank) 1
Age:2.0
Sex:Male
Location:Alaska
Vaccinated:1996-05-14
Onset:1996-06-02
Submitted:1996-06-14
Entered:1996-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 178A2 / 0 1 LL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0390B / 0 1 RL / -

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Coordination abnormal, Gait disturbance, Pyrexia, Tremor, CSF test abnormal

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: 3     Extended hospital stay? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: Pedicare
Current Illness: sl cough & runny nose
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CSF 30WBC, 70% LM; 10% P;20% oth;4JUN-7JUn gluc 49;prot 84;ESR;WBC 22.4-13.3;PTT 628-480;180-78-115;chem pretty nl;MRI nl;
CDC 'Split Type':

Write-up: tremor, ataxia, fever, cranky;adm to hosp 4JUN;sx abated by 7JUN;temp nl;tremor/dysmetria;ataxic gait; better 7JUN;14JUN still unsteady on rising;


Changed on 2/14/2018

VAERS ID: 87194 Before After
VAERS Form:1
Age:2.0
Sex:Male
Location:Alaska
Vaccinated:1996-05-14
Onset:1996-06-02
Submitted:1996-06-14
Entered:1996-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 178A2 / 1 LL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0390B / 1 RL / -

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Coordination abnormal, Gait disturbance, Pyrexia, Tremor, CSF test abnormal

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: 3     Extended hospital stay? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: Pedicare
Current Illness: sl cough & runny nose
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CSF 30WBC, 70% LM; 10% P;20% oth;4JUN-7JUn gluc 49;prot 84;ESR;WBC 22.4-13.3;PTT 628-480;180-78-115;chem pretty nl;MRI nl;
CDC 'Split Type':

Write-up: tremor, ataxia, fever, cranky;adm to hosp 4JUN;sx abated by 7JUN;temp nl;tremor/dysmetria;ataxic gait; better 7JUN;14JUN still unsteady on rising;


Changed on 6/14/2018

VAERS ID: 87194 Before After
VAERS Form:1
Age:2.0
Sex:Male
Location:Alaska
Vaccinated:1996-05-14
Onset:1996-06-02
Submitted:1996-06-14
Entered:1996-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 178A2 / 1 LL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0390B / 1 RL / -

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Coordination abnormal, Gait disturbance, Pyrexia, Tremor, CSF test abnormal

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: 3     Extended hospital stay? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: Pedicare
Current Illness: sl cough & runny nose
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CSF 30WBC, 70% LM; 10% P;20% oth;4JUN-7JUn gluc 49;prot 84;ESR;WBC 22.4-13.3;PTT 628-480;180-78-115;chem pretty nl;MRI nl;
CDC 'Split Type':

Write-up: tremor, ataxia, fever, cranky;adm to hosp 4JUN;sx abated by 7JUN;temp nl;tremor/dysmetria;ataxic gait; better 7JUN;14JUN still unsteady on rising;


Changed on 8/14/2018

VAERS ID: 87194 Before After
VAERS Form:1
Age:2.0
Sex:Male
Location:Alaska
Vaccinated:1996-05-14
Onset:1996-06-02
Submitted:1996-06-14
Entered:1996-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 178A2 / 1 LL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0390B / 1 RL / -

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Coordination abnormal, Gait disturbance, Pyrexia, Tremor, CSF test abnormal

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: 3     Extended hospital stay? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: Pedicare
Current Illness: sl cough & runny nose
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CSF 30WBC, 70% LM; 10% P;20% oth;4JUN-7JUn gluc 49;prot 84;ESR;WBC 22.4-13.3;PTT 628-480;180-78-115;chem pretty nl;MRI nl;
CDC 'Split Type':

Write-up: tremor, ataxia, fever, cranky;adm to hosp 4JUN;sx abated by 7JUN;temp nl;tremor/dysmetria;ataxic gait; better 7JUN;14JUN still unsteady on rising;


Changed on 9/14/2018

VAERS ID: 87194 Before After
VAERS Form:1
Age:2.0
Sex:Male
Location:Alaska
Vaccinated:1996-05-14
Onset:1996-06-02
Submitted:1996-06-14
Entered:1996-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 178A2 / 1 LL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0390B / 1 RL / -

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Coordination abnormal, Gait disturbance, Pyrexia, Tremor, CSF test abnormal

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: 3     Extended hospital stay? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: Pedicare
Current Illness: sl cough & runny nose
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CSF 30WBC, 70% LM; 10% P;20% oth;4JUN-7JUn gluc 49;prot 84;ESR;WBC 22.4-13.3;PTT 628-480;180-78-115;chem pretty nl;MRI nl;
CDC 'Split Type':

Write-up: tremor, ataxia, fever, cranky;adm to hosp 4JUN;sx abated by 7JUN;temp nl;tremor/dysmetria;ataxic gait; better 7JUN;14JUN still unsteady on rising;


Changed on 10/14/2018

VAERS ID: 87194 Before After
VAERS Form:1
Age:2.0
Sex:Male
Location:Alaska
Vaccinated:1996-05-14
Onset:1996-06-02
Submitted:1996-06-14
Entered:1996-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 178A2 / 1 LL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0390B / 1 RL / -

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Coordination abnormal, Gait disturbance, Pyrexia, Tremor, CSF test abnormal

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: 3     Extended hospital stay? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: Pedicare
Current Illness: sl cough & runny nose
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CSF 30WBC, 70% LM; 10% P;20% oth;4JUN-7JUn gluc 49;prot 84;ESR;WBC 22.4-13.3;PTT 628-480;180-78-115;chem pretty nl;MRI nl;
CDC 'Split Type':

Write-up: tremor, ataxia, fever, cranky;adm to hosp 4JUN;sx abated by 7JUN;temp nl;tremor/dysmetria;ataxic gait; better 7JUN;14JUN still unsteady on rising;


Changed on 12/24/2020

VAERS ID: 87194 Before After
VAERS Form:1
Age:2.0
Sex:Male
Location:Alaska
Vaccinated:1996-05-14
Onset:1996-06-02
Submitted:1996-06-14
Entered:1996-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 178A2 / 1 LL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0390B / 1 RL / -

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Coordination abnormal, Gait disturbance, Pyrexia, Tremor, CSF test abnormal

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: 3     Extended hospital stay? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: Pedicare
Current Illness: sl cough & runny nose
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CSF 30WBC, 70% LM; 10% P;20% oth;4JUN-7JUn gluc 49;prot 84;ESR;WBC 22.4-13.3;PTT 628-480;180-78-115;chem pretty nl;MRI nl;
CDC 'Split Type':

Write-up: tremor, ataxia, fever, cranky;adm to hosp 4JUN;sx abated by 7JUN;temp nl;tremor/dysmetria;ataxic gait; better 7JUN;14JUN still unsteady on rising;


Changed on 12/30/2020

VAERS ID: 87194 Before After
VAERS Form:1
Age:2.0
Sex:Male
Location:Alaska
Vaccinated:1996-05-14
Onset:1996-06-02
Submitted:1996-06-14
Entered:1996-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 178A2 / 1 LL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0390B / 1 RL / -

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Coordination abnormal, Gait disturbance, Pyrexia, Tremor, CSF test abnormal

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: 3     Extended hospital stay? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: Pedicare
Current Illness: sl cough & runny nose
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CSF 30WBC, 70% LM; 10% P;20% oth;4JUN-7JUn gluc 49;prot 84;ESR;WBC 22.4-13.3;PTT 628-480;180-78-115;chem pretty nl;MRI nl;
CDC 'Split Type':

Write-up: tremor, ataxia, fever, cranky;adm to hosp 4JUN;sx abated by 7JUN;temp nl;tremor/dysmetria;ataxic gait; better 7JUN;14JUN still unsteady on rising;


Changed on 5/7/2021

VAERS ID: 87194 Before After
VAERS Form:1
Age:2.0
Sex:Male
Location:Alaska
Vaccinated:1996-05-14
Onset:1996-06-02
Submitted:1996-06-14
Entered:1996-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 178A2 / 1 LL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0390B / 1 RL / -

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Coordination abnormal, Gait disturbance, Pyrexia, Tremor, CSF test abnormal

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: 3     Extended hospital stay? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: Pedicare
Current Illness: sl cough & runny nose
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CSF 30WBC, 70% LM; 10% P;20% oth;4JUN-7JUn gluc 49;prot 84;ESR;WBC 22.4-13.3;PTT 628-480;180-78-115;chem pretty nl;MRI nl;
CDC 'Split Type':

Write-up: tremor, ataxia, fever, cranky;adm to hosp 4JUN;sx abated by 7JUN;temp nl;tremor/dysmetria;ataxic gait; better 7JUN;14JUN still unsteady on rising;


Changed on 5/21/2021

VAERS ID: 87194 Before After
VAERS Form:1
Age:2.0
Sex:Male
Location:Alaska
Vaccinated:1996-05-14
Onset:1996-06-02
Submitted:1996-06-14
Entered:1996-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 178A2 / 1 LL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0390B / 1 RL / -

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Coordination abnormal, Gait disturbance, Pyrexia, Tremor, CSF test abnormal

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: 3     Extended hospital stay? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: Pedicare
Current Illness: sl cough & runny nose
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CSF 30WBC, 70% LM; 10% P;20% oth;4JUN-7JUn gluc 49;prot 84;ESR;WBC 22.4-13.3;PTT 628-480;180-78-115;chem pretty nl;MRI nl;
CDC 'Split Type':

Write-up: tremor, ataxia, fever, cranky;adm to hosp 4JUN;sx abated by 7JUN;temp nl;tremor/dysmetria;ataxic gait; better 7JUN;14JUN still unsteady on rising;

New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=87194&WAYBACKHISTORY=ON


Copyright © 2022 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166