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This is VAERS ID 133481

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 133481
VAERS Form:
Age:1.7
Sex:Female
Location:Arizona
Vaccinated:2000-01-13
Onset:2000-01-14
Submitted:2000-01-18
Entered:2000-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA / CONNAUGHT LABS 7172DA / 1 L / IM
HBHEPB: COMVAX / MSD 0611J / 1 - / IM
IPV: POLIOVAX / CONNAUGHT LTD P0552 / 1 A / IM
MMR: MMR II / MSD 0130J / 0 - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: OTITIS MED, FEBRILE SEIZURE, HYPOXIA

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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amoxil
Current Illness: Ear infection
Preexisting Conditions: Hx of febrile seizures, BOM
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt has known hx of febrile seizures. She developed fever and seizure. Pt was intubated and admitted in ICU. Pt was hospitalized for 5 days.


Changed on 12/8/2009

VAERS ID: 133481 Before After
VAERS Form:
Age:1.7
Sex:Female
Location:Arizona
Vaccinated:2000-01-13
Onset:2000-01-14
Submitted:2000-01-18
Entered:2000-01-28 2000-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA DTAP (TRIPEDIA) / CONNAUGHT LABS CONNAUGHT LABORATORIES 7172DA / 1 L / IM
HBHEPB: COMVAX HIB + HEP B (COMVAX) / MSD MERCK & CO. INC. 0611J / 1 - / IM
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. P0552 / 1 A / IM
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 0130J / 0 - / IM

Administered by: Private      Purchased by: Unknown Public
Symptoms: Febrile convulsion, Hypoxia, Otitis media, OTITIS MED, FEBRILE SEIZURE, HYPOXIA

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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amoxil
Current Illness: Ear infection
Preexisting Conditions: Hx of febrile seizures, BOM
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt has known hx of febrile seizures. She developed fever and seizure. Pt was intubated and admitted in ICU. Pt was hospitalized for 5 days.


Changed on 5/14/2017

VAERS ID: 133481 Before After
VAERS Form:
Age:1.7
Sex:Female
Location:Arizona
Vaccinated:2000-01-13
Onset:2000-01-14
Submitted:2000-01-18
Entered:2000-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7172DA / 1 L - / IM IM L
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0611J / 1 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P0552 / 1 A - / IM IM A
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0130J / 0 - / IM

Administered by: Private      Purchased by: Public
Symptoms: Febrile convulsion, Hypoxia, Otitis media

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: 5     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Amoxil
Current Illness: Ear infection
Preexisting Conditions: Hx of febrile seizures, BOM
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt has known hx of febrile seizures. She developed fever and seizure. Pt was intubated and admitted in ICU. Pt was hospitalized for 5 days.


Changed on 9/14/2017

VAERS ID: 133481 Before After
VAERS Form:(blank) 1
Age:1.7
Sex:Female
Location:Arizona
Vaccinated:2000-01-13
Onset:2000-01-14
Submitted:2000-01-18
Entered:2000-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7172DA / 1 2 - / IM L
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0611J / 1 2 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P0552 / 1 2 - / IM A
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0130J / 0 1 - / IM

Administered by: Private      Purchased by: Public
Symptoms: Febrile convulsion, Hypoxia, Otitis media

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: 5     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Amoxil
Current Illness: Ear infection
Preexisting Conditions: Hx of febrile seizures, BOM
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt has known hx of febrile seizures. She developed fever and seizure. Pt was intubated and admitted in ICU. Pt was hospitalized for 5 days.


Changed on 2/14/2018

VAERS ID: 133481 Before After
VAERS Form:1
Age:1.7
Sex:Female
Location:Arizona
Vaccinated:2000-01-13
Onset:2000-01-14
Submitted:2000-01-18
Entered:2000-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7172DA / 2 - / IM L
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0611J / 2 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P0552 / 2 - / IM A
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0130J / 1 - / IM

Administered by: Private      Purchased by: Public
Symptoms: Febrile convulsion, Hypoxia, Otitis media

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: 5     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Amoxil
Current Illness: Ear infection
Preexisting Conditions: Hx of febrile seizures, BOM
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt has known hx of febrile seizures. She developed fever and seizure. Pt was intubated and admitted in ICU. Pt was hospitalized for 5 days.


Changed on 6/14/2018

VAERS ID: 133481 Before After
VAERS Form:1
Age:1.7
Sex:Female
Location:Arizona
Vaccinated:2000-01-13
Onset:2000-01-14
Submitted:2000-01-18
Entered:2000-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7172DA / 2 - / IM L
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0611J / 2 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P0552 / 2 - / IM A
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0130J / 1 - / IM

Administered by: Private      Purchased by: Public
Symptoms: Febrile convulsion, Hypoxia, Otitis media

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: 5     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Amoxil
Current Illness: Ear infection
Preexisting Conditions: Hx of febrile seizures, BOM
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt has known hx of febrile seizures. She developed fever and seizure. Pt was intubated and admitted in ICU. Pt was hospitalized for 5 days.


Changed on 8/14/2018

VAERS ID: 133481 Before After
VAERS Form:1
Age:1.7
Sex:Female
Location:Arizona
Vaccinated:2000-01-13
Onset:2000-01-14
Submitted:2000-01-18
Entered:2000-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7172DA / 2 - / IM L
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0611J / 2 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P0552 / 2 - / IM A
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0130J / 1 - / IM

Administered by: Private      Purchased by: Public
Symptoms: Febrile convulsion, Hypoxia, Otitis media

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: 5     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Amoxil
Current Illness: Ear infection
Preexisting Conditions: Hx of febrile seizures, BOM
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt has known hx of febrile seizures. She developed fever and seizure. Pt was intubated and admitted in ICU. Pt was hospitalized for 5 days.


Changed on 9/14/2018

VAERS ID: 133481 Before After
VAERS Form:1
Age:1.7
Sex:Female
Location:Arizona
Vaccinated:2000-01-13
Onset:2000-01-14
Submitted:2000-01-18
Entered:2000-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7172DA / 2 - / IM L
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0611J / 2 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P0552 / 2 - / IM A
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0130J / 1 - / IM

Administered by: Private      Purchased by: Public
Symptoms: Febrile convulsion, Hypoxia, Otitis media

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: 5     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Amoxil
Current Illness: Ear infection
Preexisting Conditions: Hx of febrile seizures, BOM
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt has known hx of febrile seizures. She developed fever and seizure. Pt was intubated and admitted in ICU. Pt was hospitalized for 5 days.


Changed on 10/14/2018

VAERS ID: 133481 Before After
VAERS Form:1
Age:1.7
Sex:Female
Location:Arizona
Vaccinated:2000-01-13
Onset:2000-01-14
Submitted:2000-01-18
Entered:2000-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7172DA / 2 - / IM L
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0611J / 2 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P0552 / 2 - / IM A
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0130J / 1 - / IM

Administered by: Private      Purchased by: Public
Symptoms: Febrile convulsion, Hypoxia, Otitis media

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: 5     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Amoxil
Current Illness: Ear infection
Preexisting Conditions: Hx of febrile seizures, BOM
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt has known hx of febrile seizures. She developed fever and seizure. Pt was intubated and admitted in ICU. Pt was hospitalized for 5 days.


Changed on 12/24/2020

VAERS ID: 133481 Before After
VAERS Form:1
Age:1.7
Sex:Female
Location:Arizona
Vaccinated:2000-01-13
Onset:2000-01-14
Submitted:2000-01-18
Entered:2000-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7172DA / 2 - / IM L
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0611J / 2 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P0552 / 2 - / IM A
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0130J / 1 - / IM

Administered by: Private      Purchased by: Public
Symptoms: Febrile convulsion, Hypoxia, Otitis media

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: 5     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Amoxil
Current Illness: Ear infection
Preexisting Conditions: Hx of febrile seizures, BOM
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt has known hx of febrile seizures. She developed fever and seizure. Pt was intubated and admitted in ICU. Pt was hospitalized for 5 days.


Changed on 12/30/2020

VAERS ID: 133481 Before After
VAERS Form:1
Age:1.7
Sex:Female
Location:Arizona
Vaccinated:2000-01-13
Onset:2000-01-14
Submitted:2000-01-18
Entered:2000-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7172DA / 2 - / IM L
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0611J / 2 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P0552 / 2 - / IM A
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0130J / 1 - / IM

Administered by: Private      Purchased by: Public
Symptoms: Febrile convulsion, Hypoxia, Otitis media

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: 5     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Amoxil
Current Illness: Ear infection
Preexisting Conditions: Hx of febrile seizures, BOM
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt has known hx of febrile seizures. She developed fever and seizure. Pt was intubated and admitted in ICU. Pt was hospitalized for 5 days.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=133481&WAYBACKHISTORY=ON


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