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This is VAERS ID 25930

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 25930
VAERS Form:
Age:6.0
Sex:Female
Location:Missouri
Vaccinated:1990-08-21
Onset:1990-08-21
Submitted:0000-00-00
Entered:1990-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 281944 / - RA / IM
MMR: MMR II / MSD 1414S / - LA / IM
OPV: ORIMUNE / LEDERLE 281924 / - - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: CONVULS, EYES GAZE UPWARD, TREMOR, COMA

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: SMA -7, Ca, sleep EEG
CDC 'Split Type':

Write-up: child received DPT & MMR & OPV at 9:30 am @ CO. Health Dept. @ 1:00pm child''s eyes rolled back, ""shook"", became unconscious, suspect seizure. Had similar episode last summer not assoc. /w immunization.


Changed on 12/30/2006

VAERS ID: 25930 Before After
VAERS Form:
Age:6.0
Sex:Female
Location:Missouri
Vaccinated:1990-08-21
Onset:1990-08-21
Submitted:0000-00-00
Entered:1990-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 281944 / - RA / IM
MMR: MMR II / MSD 1414S / - LA / IM
OPV: ORIMUNE / LEDERLE 281924 / - - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: CONVULS, EYES GAZE UPWARD, TREMOR, COMA

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: SMA -7, Ca, sleep EEG
CDC 'Split Type':

Write-up: child received DPT & MMR & OPV at 9:30 am @ CO. Health Dept. @ 1:00pm child''s child''''s eyes rolled back, ""shook"", /"shook/", became unconscious, suspect seizure. Had similar episode last summer not assoc. /w immunization.


Changed on 12/8/2009

VAERS ID: 25930 Before After
VAERS Form:
Age:6.0
Sex:Female
Location:Missouri
Vaccinated:1990-08-21
Onset:1990-08-21
Submitted:0000-00-00
Entered:1990-09-19 1990-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 281944 / - RA / IM
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 1414S / - LA / IM
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 281924 / - - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Coma, Convulsion, Tremor, Gaze palsy, CONVULS, EYES GAZE UPWARD, TREMOR, COMA

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: SMA -7, Ca, sleep EEG
CDC 'Split Type':

Write-up: child received DPT & MMR & OPV at 9:30 am @ CO. Health Dept. @ 1:00pm child''''s child''s eyes rolled back, /"shook/", "shook", became unconscious, suspect seizure. Had similar episode last summer not assoc. /w immunization.


Changed on 2/13/2013

VAERS ID: 25930 Before After
VAERS Form:
Age:6.0
Sex:Female
Location:Missouri
Vaccinated:1990-08-21
Onset:1990-08-21
Submitted:0000-00-00
Entered:1990-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 281944 / - RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1414S / - LA / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 281924 / - - / PO

Administered by: Private Unknown      Purchased by: Unknown
Symptoms: Coma, Convulsion, Tremor, Gaze palsy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: SMA -7, Ca, sleep EEG
CDC 'Split Type':

Write-up: child Child received DPT & MMR & OPV at 9:30 am @ CO. at Co. Health Dept. @ at 1:00pm child''s eyes rolled back, "shook", became unconscious, suspect seizure. Had similar episode last summer not assoc. /w immunization.


Changed on 9/14/2017

VAERS ID: 25930 Before After
VAERS Form:(blank) 1
Age:6.0
Sex:Female
Location:Missouri
Vaccinated:1990-08-21
Onset:1990-08-21
Submitted:0000-00-00
Entered:1990-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 281944 / - UNK RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1414S / - UNK LA / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 281924 / - UNK - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Coma, Convulsion, Tremor, Gaze palsy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: SMA -7, Ca, sleep EEG
CDC 'Split Type':

Write-up: Child received DPT & MMR & OPV at 9:30 am at Co. Health Dept. at 1:00pm child''s eyes rolled back, "shook", became unconscious, suspect seizure. Had similar episode last summer not assoc. /w immunization.


Changed on 2/14/2018

VAERS ID: 25930 Before After
VAERS Form:1
Age:6.0
Sex:Female
Location:Missouri
Vaccinated:1990-08-21
Onset:1990-08-21
Submitted:0000-00-00
Entered:1990-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 281944 / UNK RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1414S / UNK LA / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 281924 / UNK MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Coma, Convulsion, Tremor, Gaze palsy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: SMA -7, Ca, sleep EEG
CDC 'Split Type':

Write-up: Child received DPT & MMR & OPV at 9:30 am at Co. Health Dept. at 1:00pm child''s eyes rolled back, "shook", became unconscious, suspect seizure. Had similar episode last summer not assoc. /w immunization.


Changed on 6/14/2018

VAERS ID: 25930 Before After
VAERS Form:1
Age:6.0
Sex:Female
Location:Missouri
Vaccinated:1990-08-21
Onset:1990-08-21
Submitted:0000-00-00
Entered:1990-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 281944 / UNK RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1414S / UNK LA / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 281924 / UNK MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Coma, Convulsion, Tremor, Gaze palsy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: SMA -7, Ca, sleep EEG
CDC 'Split Type':

Write-up: Child received DPT & MMR & OPV at 9:30 am at Co. Health Dept. at 1:00pm child''s eyes rolled back, "shook", became unconscious, suspect seizure. Had similar episode last summer not assoc. /w immunization.


Changed on 8/14/2018

VAERS ID: 25930 Before After
VAERS Form:1
Age:6.0
Sex:Female
Location:Missouri
Vaccinated:1990-08-21
Onset:1990-08-21
Submitted:0000-00-00
Entered:1990-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 281944 / UNK RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1414S / UNK LA / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 281924 / UNK MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Coma, Convulsion, Tremor, Gaze palsy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: SMA -7, Ca, sleep EEG
CDC 'Split Type':

Write-up: Child received DPT & MMR & OPV at 9:30 am at Co. Health Dept. at 1:00pm child''s eyes rolled back, "shook", became unconscious, suspect seizure. Had similar episode last summer not assoc. /w immunization.


Changed on 9/14/2018

VAERS ID: 25930 Before After
VAERS Form:1
Age:6.0
Sex:Female
Location:Missouri
Vaccinated:1990-08-21
Onset:1990-08-21
Submitted:0000-00-00
Entered:1990-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 281944 / UNK RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1414S / UNK LA / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 281924 / UNK MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Coma, Convulsion, Tremor, Gaze palsy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: SMA -7, Ca, sleep EEG
CDC 'Split Type':

Write-up: Child received DPT & MMR & OPV at 9:30 am at Co. Health Dept. at 1:00pm child''s eyes rolled back, "shook", became unconscious, suspect seizure. Had similar episode last summer not assoc. /w immunization.


Changed on 10/14/2018

VAERS ID: 25930 Before After
VAERS Form:1
Age:6.0
Sex:Female
Location:Missouri
Vaccinated:1990-08-21
Onset:1990-08-21
Submitted:0000-00-00
Entered:1990-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 281944 / UNK RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1414S / UNK LA / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 281924 / UNK MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Coma, Convulsion, Tremor, Gaze palsy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: SMA -7, Ca, sleep EEG
CDC 'Split Type':

Write-up: Child received DPT & MMR & OPV at 9:30 am at Co. Health Dept. at 1:00pm child''s eyes rolled back, "shook", became unconscious, suspect seizure. Had similar episode last summer not assoc. /w immunization.

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