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This is VAERS ID 59212

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 59212
VAERS Form:
Age:2.4
Sex:Male
Location:Illinois
Vaccinated:1993-05-20
Onset:1993-05-30
Submitted:1993-11-29
Entered:1994-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP / CONNAUGHT LABS 352914 / 2 LL / -
HIBV: HIBTITER / LEDERLE(PRAXIS) M630JK / 2 RL / -
MMR: MMR II / MSD 1110 / 0 RL / -
OPV: ORIMUNE / LEDERLE 346940 / 1 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: CONVULS, MENTAL RETARD, PERSON DIS, APNEA, SEPSIS

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CSF-no dx; blood tests showed infection; EEG-MRI-szs, syrinx on spine (abnl);
CDC 'Split Type':

Write-up: 6PM 1JUN fast breathing, clenched fists locked jaw, eyes rolled, shaking/stiff body then stopped breathing per mom; has had 5 other sz since then; no hx of sz a/; mom says pt has t99-100 during sz;


Changed on 12/8/2009

VAERS ID: 59212 Before After
VAERS Form:
Age:2.4
Sex:Male
Location:Illinois
Vaccinated:1993-05-20
Onset:1993-05-30
Submitted:1993-11-29
Entered:1994-01-26 1994-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP DTP (NO BRAND NAME) / CONNAUGHT LABS CONNAUGHT LABORATORIES 352914 / 2 LL / -
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M630JK / 2 RL / -
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 1110 / 0 RL / -
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 346940 / 1 - / PO

Administered by: Public      Purchased by: Unknown Public
Symptoms: Apnoea, Convulsion, Mental retardation severity unspecified, Personality disorder, Sepsis, Somnolence, Thinking abnormal, CONVULS, MENTAL RETARD, PERSON DIS, APNEA, SEPSIS

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CSF-no dx; blood tests showed infection; EEG-MRI-szs, syrinx on spine (abnl);
CDC 'Split Type': (blank) IL93134

Write-up: 6PM 1JUN fast breathing, clenched fists locked jaw, eyes rolled, shaking/stiff body then stopped breathing per mom; has had 5 other sz since then; no hx of sz a/; mom says pt has t99-100 during sz;


Changed on 2/14/2017

VAERS ID: 59212 Before After
VAERS Form:
Age:2.4 2.0
Sex:Male
Location:Illinois
Vaccinated:1993-05-20
Onset:1993-05-30
Submitted:1993-11-29
Entered:1994-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 352914 / 2 LL / -
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS M630JK / 2 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1110 / 0 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES 346940 / 1 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Convulsion, Mental retardation severity unspecified, Personality disorder, Sepsis, Somnolence, Thinking abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CSF-no dx; blood tests showed infection; EEG-MRI-szs, syrinx on spine (abnl);
CDC 'Split Type': IL93134

Write-up: 6PM 1JUN fast breathing, clenched fists locked jaw, eyes rolled, shaking/stiff body then stopped breathing per mom; has had 5 other sz since then; no hx of sz a/; mom says pt has t99-100 during sz;


Changed on 5/14/2017

VAERS ID: 59212 Before After
VAERS Form:
Age:2.0
Sex:Male
Location:Illinois
Vaccinated:1993-05-20
Onset:1993-05-30
Submitted:1993-11-29
Entered:1994-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 352914 / 2 LL / -
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M630JK / 2 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1110 / 0 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 346940 / 1 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Convulsion, Mental retardation severity unspecified, Personality disorder, Sepsis, Somnolence, Thinking abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CSF-no dx; blood tests showed infection; EEG-MRI-szs, syrinx on spine (abnl);
CDC 'Split Type': IL93134

Write-up: 6PM 1JUN fast breathing, clenched fists locked jaw, eyes rolled, shaking/stiff body then stopped breathing per mom; has had 5 other sz since then; no hx of sz a/; mom says pt has t99-100 during sz;


Changed on 9/14/2017

VAERS ID: 59212 Before After
VAERS Form:(blank) 1
Age:2.0
Sex:Male
Location:Illinois
Vaccinated:1993-05-20
Onset:1993-05-30
Submitted:1993-11-29
Entered:1994-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 352914 / 2 3 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M630JK / 2 3 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1110 / 0 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 346940 / 1 2 - MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Convulsion, Mental retardation severity unspecified, Personality disorder, Sepsis, Somnolence, Thinking abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CSF-no dx; blood tests showed infection; EEG-MRI-szs, syrinx on spine (abnl);
CDC 'Split Type': IL93134

Write-up: 6PM 1JUN fast breathing, clenched fists locked jaw, eyes rolled, shaking/stiff body then stopped breathing per mom; has had 5 other sz since then; no hx of sz a/; mom says pt has t99-100 during sz;


Changed on 2/14/2018

VAERS ID: 59212 Before After
VAERS Form:1
Age:2.0
Sex:Male
Location:Illinois
Vaccinated:1993-05-20
Onset:1993-05-30
Submitted:1993-11-29
Entered:1994-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 352914 / 3 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M630JK / 3 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1110 / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 346940 / 2 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Convulsion, Mental retardation severity unspecified, Personality disorder, Sepsis, Somnolence, Thinking abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CSF-no dx; blood tests showed infection; EEG-MRI-szs, syrinx on spine (abnl);
CDC 'Split Type': IL93134

Write-up: 6PM 1JUN fast breathing, clenched fists locked jaw, eyes rolled, shaking/stiff body then stopped breathing per mom; has had 5 other sz since then; no hx of sz a/; mom says pt has t99-100 during sz;


Changed on 6/14/2018

VAERS ID: 59212 Before After
VAERS Form:1
Age:2.0
Sex:Male
Location:Illinois
Vaccinated:1993-05-20
Onset:1993-05-30
Submitted:1993-11-29
Entered:1994-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 352914 / 3 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M630JK / 3 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1110 / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 346940 / 2 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Convulsion, Mental retardation severity unspecified, Personality disorder, Sepsis, Somnolence, Thinking abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CSF-no dx; blood tests showed infection; EEG-MRI-szs, syrinx on spine (abnl);
CDC 'Split Type': IL93134

Write-up: 6PM 1JUN fast breathing, clenched fists locked jaw, eyes rolled, shaking/stiff body then stopped breathing per mom; has had 5 other sz since then; no hx of sz a/; mom says pt has t99-100 during sz;


Changed on 8/14/2018

VAERS ID: 59212 Before After
VAERS Form:1
Age:2.0
Sex:Male
Location:Illinois
Vaccinated:1993-05-20
Onset:1993-05-30
Submitted:1993-11-29
Entered:1994-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 352914 / 3 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M630JK / 3 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1110 / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 346940 / 2 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Convulsion, Mental retardation severity unspecified, Personality disorder, Sepsis, Somnolence, Thinking abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CSF-no dx; blood tests showed infection; EEG-MRI-szs, syrinx on spine (abnl);
CDC 'Split Type': IL93134

Write-up: 6PM 1JUN fast breathing, clenched fists locked jaw, eyes rolled, shaking/stiff body then stopped breathing per mom; has had 5 other sz since then; no hx of sz a/; mom says pt has t99-100 during sz;


Changed on 9/14/2018

VAERS ID: 59212 Before After
VAERS Form:1
Age:2.0
Sex:Male
Location:Illinois
Vaccinated:1993-05-20
Onset:1993-05-30
Submitted:1993-11-29
Entered:1994-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 352914 / 3 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M630JK / 3 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1110 / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 346940 / 2 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Convulsion, Mental retardation severity unspecified, Personality disorder, Sepsis, Somnolence, Thinking abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CSF-no dx; blood tests showed infection; EEG-MRI-szs, syrinx on spine (abnl);
CDC 'Split Type': IL93134

Write-up: 6PM 1JUN fast breathing, clenched fists locked jaw, eyes rolled, shaking/stiff body then stopped breathing per mom; has had 5 other sz since then; no hx of sz a/; mom says pt has t99-100 during sz;


Changed on 10/14/2018

VAERS ID: 59212 Before After
VAERS Form:1
Age:2.0
Sex:Male
Location:Illinois
Vaccinated:1993-05-20
Onset:1993-05-30
Submitted:1993-11-29
Entered:1994-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 352914 / 3 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M630JK / 3 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1110 / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 346940 / 2 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Convulsion, Mental retardation severity unspecified, Personality disorder, Sepsis, Somnolence, Thinking abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CSF-no dx; blood tests showed infection; EEG-MRI-szs, syrinx on spine (abnl);
CDC 'Split Type': IL93134

Write-up: 6PM 1JUN fast breathing, clenched fists locked jaw, eyes rolled, shaking/stiff body then stopped breathing per mom; has had 5 other sz since then; no hx of sz a/; mom says pt has t99-100 during sz;

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