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This is VAERS ID 30008

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History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 30008
VAERS Form:
Age:1.3
Sex:Female
Location:Idaho
Vaccinated:1991-01-17
Onset:1991-01-24
Submitted:1991-02-06
Entered:1991-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 289901 / 3 LL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M660FB / 0 LA / IM
MMR: MMR II / MSD 0895S / 0 RA / SC
OPV: ORIMUNE / LEDERLE 0622D / 2 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: CONVULS, SOMNOLENCE, STUPOR, HYPERTONIA, HEM

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? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: nONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Found bleeding from mouth; warm to touch, lethargic, not stiff, unresponsive, limp, poss sz activity;


Changed on 12/8/2009

VAERS ID: 30008 Before After
VAERS Form:
Age:1.3
Sex:Female
Location:Idaho
Vaccinated:1991-01-17
Onset:1991-01-24
Submitted:1991-02-06
Entered:1991-04-25 1991-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 289901 / 3 LL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M660FB / 0 LA / IM
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 0895S / 0 RA / SC
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 0622D / 2 - / PO

Administered by: Public      Purchased by: Unknown Public
Symptoms: Convulsion, Hypertonia, Somnolence, Stupor, Vasodilatation, Haemorrhage, CONVULS, SOMNOLENCE, STUPOR, HYPERTONIA, HEM

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? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: nONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': (blank) ID91011

Write-up: Found bleeding from mouth; warm to touch, lethargic, not stiff, unresponsive, limp, poss sz activity;


Changed on 5/14/2017

VAERS ID: 30008 Before After
VAERS Form:
Age:1.3
Sex:Female
Location:Idaho
Vaccinated:1991-01-17
Onset:1991-01-24
Submitted:1991-02-06
Entered:1991-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289901 / 3 LL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M660FB / 0 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0895S / 0 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 0622D / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Hypertonia, Somnolence, Stupor, Vasodilatation, Haemorrhage

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: nONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': ID91011

Write-up: Found bleeding from mouth; warm to touch, lethargic, not stiff, unresponsive, limp, poss sz activity;


Changed on 9/14/2017

VAERS ID: 30008 Before After
VAERS Form:(blank) 1
Age:1.3
Sex:Female
Location:Idaho
Vaccinated:1991-01-17
Onset:1991-01-24
Submitted:1991-02-06
Entered:1991-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289901 / 3 4 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M660FB / 0 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0895S / 0 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0622D / 2 3 - MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Hypertonia, Somnolence, Stupor, Vasodilatation, Haemorrhage

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: nONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': ID91011

Write-up: Found bleeding from mouth; warm to touch, lethargic, not stiff, unresponsive, limp, poss sz activity;


Changed on 2/14/2018

VAERS ID: 30008 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:Idaho
Vaccinated:1991-01-17
Onset:1991-01-24
Submitted:1991-02-06
Entered:1991-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289901 / 4 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M660FB / 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0895S / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0622D / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Hypertonia, Somnolence, Stupor, Vasodilatation, Haemorrhage

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: nONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': ID91011

Write-up: Found bleeding from mouth; warm to touch, lethargic, not stiff, unresponsive, limp, poss sz activity;


Changed on 6/14/2018

VAERS ID: 30008 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:Idaho
Vaccinated:1991-01-17
Onset:1991-01-24
Submitted:1991-02-06
Entered:1991-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289901 / 4 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M660FB / 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0895S / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0622D / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Hypertonia, Somnolence, Stupor, Vasodilatation, Haemorrhage

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: nONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': ID91011

Write-up: Found bleeding from mouth; warm to touch, lethargic, not stiff, unresponsive, limp, poss sz activity;


Changed on 8/14/2018

VAERS ID: 30008 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:Idaho
Vaccinated:1991-01-17
Onset:1991-01-24
Submitted:1991-02-06
Entered:1991-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289901 / 4 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M660FB / 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0895S / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0622D / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Hypertonia, Somnolence, Stupor, Vasodilatation, Haemorrhage

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: nONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': ID91011

Write-up: Found bleeding from mouth; warm to touch, lethargic, not stiff, unresponsive, limp, poss sz activity;


Changed on 9/14/2018

VAERS ID: 30008 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:Idaho
Vaccinated:1991-01-17
Onset:1991-01-24
Submitted:1991-02-06
Entered:1991-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289901 / 4 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M660FB / 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0895S / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0622D / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Hypertonia, Somnolence, Stupor, Vasodilatation, Haemorrhage

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: nONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': ID91011

Write-up: Found bleeding from mouth; warm to touch, lethargic, not stiff, unresponsive, limp, poss sz activity;


Changed on 10/14/2018

VAERS ID: 30008 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:Idaho
Vaccinated:1991-01-17
Onset:1991-01-24
Submitted:1991-02-06
Entered:1991-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289901 / 4 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M660FB / 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0895S / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0622D / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Hypertonia, Somnolence, Stupor, Vasodilatation, Haemorrhage

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: nONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': ID91011

Write-up: Found bleeding from mouth; warm to touch, lethargic, not stiff, unresponsive, limp, poss sz activity;


Changed on 12/24/2020

VAERS ID: 30008 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:Idaho
Vaccinated:1991-01-17
Onset:1991-01-24
Submitted:1991-02-06
Entered:1991-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289901 / 4 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M660FB / 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0895S / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0622D / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Hypertonia, Somnolence, Stupor, Vasodilatation, Haemorrhage

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: nONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': ID91011

Write-up: Found bleeding from mouth; warm to touch, lethargic, not stiff, unresponsive, limp, poss sz activity;


Changed on 12/30/2020

VAERS ID: 30008 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:Idaho
Vaccinated:1991-01-17
Onset:1991-01-24
Submitted:1991-02-06
Entered:1991-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289901 / 4 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M660FB / 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0895S / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0622D / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Hypertonia, Somnolence, Stupor, Vasodilatation, Haemorrhage

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: nONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': ID91011

Write-up: Found bleeding from mouth; warm to touch, lethargic, not stiff, unresponsive, limp, poss sz activity;


Changed on 5/7/2021

VAERS ID: 30008 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:Idaho
Vaccinated:1991-01-17
Onset:1991-01-24
Submitted:1991-02-06
Entered:1991-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289901 / 4 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M660FB / 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0895S / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0622D / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Hypertonia, Somnolence, Stupor, Vasodilatation, Haemorrhage

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: nONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': ID91011

Write-up: Found bleeding from mouth; warm to touch, lethargic, not stiff, unresponsive, limp, poss sz activity;


Changed on 5/21/2021

VAERS ID: 30008 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:Idaho
Vaccinated:1991-01-17
Onset:1991-01-24
Submitted:1991-02-06
Entered:1991-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289901 / 4 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M660FB / 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0895S / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0622D / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Hypertonia, Somnolence, Stupor, Vasodilatation, Haemorrhage

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: nONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': ID91011

Write-up: Found bleeding from mouth; warm to touch, lethargic, not stiff, unresponsive, limp, poss sz activity;

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