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This is VAERS ID 59878

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 59878
VAERS Form:
Age:1.3
Sex:Female
Location:Texas
Vaccinated:1990-10-12
Onset:1990-10-13
Submitted:1994-02-01
Entered:1994-02-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: PROHIBIT / CONNAUGHT LABS 0J11070 / 0 L / IM
MMR: MMR II / MSD 0895F / - RL / SC

Administered by: Public      Purchased by: Unknown
Symptoms: FEVER, MENTAL RETARD

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NONE

Write-up: pt recvd vax & exp fever & was dx as developmentally delayed;


Changed on 12/8/2009

VAERS ID: 59878 Before After
VAERS Form:
Age:1.3
Sex:Female
Location:Texas
Vaccinated:1990-10-12
Onset:1990-10-13
Submitted:1994-02-01
Entered:1994-02-19 1994-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: PROHIBIT HIB (PROHIBIT) / CONNAUGHT LABS CONNAUGHT LABORATORIES 0J11070 / 0 L / IM
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 0895F / - RL / SC

Administered by: Public      Purchased by: Unknown Public
Symptoms: Mental retardation severity unspecified, Pyrexia, FEVER, MENTAL RETARD

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NONE TX9420

Write-up: pt recvd vax & exp fever & was dx as developmentally delayed;


Changed on 5/14/2017

VAERS ID: 59878 Before After
VAERS Form:
Age:1.3
Sex:Female
Location:Texas
Vaccinated:1990-10-12
Onset:1990-10-13
Submitted:1994-02-01
Entered:1994-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0J11070 / 0 L - / IM IM L
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0895F / - RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Mental retardation severity unspecified, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: NONE NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': TX9420

Write-up: pt recvd vax & exp fever & was dx as developmentally delayed;


Changed on 9/14/2017

VAERS ID: 59878 Before After
VAERS Form:(blank) 1
Age:1.3
Sex:Female
Location:Texas
Vaccinated:1990-10-12
Onset:1990-10-13
Submitted:1994-02-01
Entered:1994-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0J11070 / 0 1 - / IM L
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0895F / - UNK RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Mental retardation severity unspecified, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': TX9420

Write-up: pt recvd vax & exp fever & was dx as developmentally delayed;


Changed on 2/14/2018

VAERS ID: 59878 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:Texas
Vaccinated:1990-10-12
Onset:1990-10-13
Submitted:1994-02-01
Entered:1994-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0J11070 / 1 - / IM L
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0895F / UNK RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Mental retardation severity unspecified, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': TX9420

Write-up: pt recvd vax & exp fever & was dx as developmentally delayed;


Changed on 6/14/2018

VAERS ID: 59878 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:Texas
Vaccinated:1990-10-12
Onset:1990-10-13
Submitted:1994-02-01
Entered:1994-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0J11070 / 1 - / IM L
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0895F / UNK RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Mental retardation severity unspecified, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': TX9420

Write-up: pt recvd vax & exp fever & was dx as developmentally delayed;


Changed on 8/14/2018

VAERS ID: 59878 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:Texas
Vaccinated:1990-10-12
Onset:1990-10-13
Submitted:1994-02-01
Entered:1994-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0J11070 / 1 - / IM L
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0895F / UNK RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Mental retardation severity unspecified, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': TX9420

Write-up: pt recvd vax & exp fever & was dx as developmentally delayed;


Changed on 9/14/2018

VAERS ID: 59878 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:Texas
Vaccinated:1990-10-12
Onset:1990-10-13
Submitted:1994-02-01
Entered:1994-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0J11070 / 1 - / IM L
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0895F / UNK RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Mental retardation severity unspecified, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': TX9420

Write-up: pt recvd vax & exp fever & was dx as developmentally delayed;


Changed on 10/14/2018

VAERS ID: 59878 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:Texas
Vaccinated:1990-10-12
Onset:1990-10-13
Submitted:1994-02-01
Entered:1994-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0J11070 / 1 - / IM L
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0895F / UNK RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Mental retardation severity unspecified, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': TX9420

Write-up: pt recvd vax & exp fever & was dx as developmentally delayed;

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