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This is VAERS ID 61525

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 61525
VAERS Form:
Age:11.3
Sex:Female
Location:Texas
Vaccinated:1993-06-08
Onset:1993-06-10
Submitted:1994-03-30
Entered:1994-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED, PEDIATRIC / CONNAUGHT LABS 3C51048 / - - / IM
MMR: MMR II / MSD 1503V / 1 - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: INFECT, HEADACHE, ASTHENIA, DEPRESSION, ANXIETY

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? No
Previous Vaccinations:
Other Medications: Lorabid
Current Illness:
Preexisting Conditions: Thoracic outlet synd; UTI, recurrent; Rhinitis, allergic; chickenpox; strep throat; reglan allergy;
Allergies:
Diagnostic Lab Data: 16JUN93 Serum alk phos 217; Phosphate 4.9; WBC Count 5.6; Neutrophils 40%; Lymphocytes 51%; Monocytes 6%; EOS 2%; Basophils 1%; ESR 18%; Epstein-barr antibody 69%; Lymphocytes 50%; 25AUG93 Epstein-barr 96%; IGA 45%;
CDC 'Split Type':

Write-up: Pt recvd vax & devel lightheadedness, n&v, h/a, light sensitivity; episode of diarrhea & dec appetite; fever 101, alk phos 217; culture of sinuses revealed 4+ staphylococcus aureus; migraine h/a w/tension component; depressed; hypoglycemia;


Changed on 12/8/2009

VAERS ID: 61525 Before After
VAERS Form:
Age:11.3
Sex:Female
Location:Texas
Vaccinated:1993-06-08
Onset:1993-06-10
Submitted:1994-03-30
Entered:1994-04-08 1994-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED, PEDIATRIC DT ADSORBED (NO BRAND NAME) / CONNAUGHT LABS CONNAUGHT LABORATORIES 3C51048 / - - / IM
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 1503V / 1 - / IM

Administered by: Private      Purchased by: Unknown Other
Symptoms: Abdominal pain, Anxiety, Asthenia, Depression, Headache, Infection, Migraine, Photosensitivity reaction, INFECT, HEADACHE, ASTHENIA, DEPRESSION, ANXIETY

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? No
Previous Vaccinations:
Other Medications: Lorabid
Current Illness:
Preexisting Conditions: Thoracic outlet synd; UTI, recurrent; Rhinitis, allergic; chickenpox; strep throat; reglan allergy;
Allergies:
Diagnostic Lab Data: 16JUN93 Serum alk phos 217; Phosphate 4.9; WBC Count 5.6; Neutrophils 40%; Lymphocytes 51%; Monocytes 6%; EOS 2%; Basophils 1%; ESR 18%; Epstein-barr antibody 69%; Lymphocytes 50%; 25AUG93 Epstein-barr 96%; IGA 45%;
CDC 'Split Type': (blank) WAES93090874

Write-up: Pt recvd vax & devel lightheadedness, n&v, h/a, light sensitivity; episode of diarrhea & dec appetite; fever 101, alk phos 217; culture of sinuses revealed 4+ staphylococcus aureus; migraine h/a w/tension component; depressed; hypoglycemia;


Changed on 2/14/2017

VAERS ID: 61525 Before After
VAERS Form:
Age:11.3 11.0
Sex:Female
Location:Texas
Vaccinated:1993-06-08
Onset:1993-06-10
Submitted:1994-03-30
Entered:1994-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 3C51048 / - - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1503V / 1 - / IM

Administered by: Private      Purchased by: Other
Symptoms: Abdominal pain, Anxiety, Asthenia, Depression, Headache, Infection, Migraine, Photosensitivity reaction

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? No
Previous Vaccinations:
Other Medications: Lorabid
Current Illness:
Preexisting Conditions: Thoracic outlet synd; UTI, recurrent; Rhinitis, allergic; chickenpox; strep throat; reglan allergy;
Allergies:
Diagnostic Lab Data: 16JUN93 Serum alk phos 217; Phosphate 4.9; WBC Count 5.6; Neutrophils 40%; Lymphocytes 51%; Monocytes 6%; EOS 2%; Basophils 1%; ESR 18%; Epstein-barr antibody 69%; Lymphocytes 50%; 25AUG93 Epstein-barr 96%; IGA 45%;
CDC 'Split Type': WAES93090874

Write-up: Pt recvd vax & devel lightheadedness, n&v, h/a, light sensitivity; episode of diarrhea & dec appetite; fever 101, alk phos 217; culture of sinuses revealed 4+ staphylococcus aureus; migraine h/a w/tension component; depressed; hypoglycemia;


Changed on 5/14/2017

VAERS ID: 61525 Before After
VAERS Form:
Age:11.0
Sex:Female
Location:Texas
Vaccinated:1993-06-08
Onset:1993-06-10
Submitted:1994-03-30
Entered:1994-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 3C51048 / - - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1503V / 1 - / IM

Administered by: Private      Purchased by: Other
Symptoms: Abdominal pain, Anxiety, Asthenia, Depression, Headache, Infection, Migraine, Photosensitivity reaction

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Lorabid
Current Illness:
Preexisting Conditions: Thoracic outlet synd; UTI, recurrent; Rhinitis, allergic; chickenpox; strep throat; reglan allergy;
Allergies:
Diagnostic Lab Data: 16JUN93 Serum alk phos 217; Phosphate 4.9; WBC Count 5.6; Neutrophils 40%; Lymphocytes 51%; Monocytes 6%; EOS 2%; Basophils 1%; ESR 18%; Epstein-barr antibody 69%; Lymphocytes 50%; 25AUG93 Epstein-barr 96%; IGA 45%;
CDC 'Split Type': WAES93090874

Write-up: Pt recvd vax & devel lightheadedness, n&v, h/a, light sensitivity; episode of diarrhea & dec appetite; fever 101, alk phos 217; culture of sinuses revealed 4+ staphylococcus aureus; migraine h/a w/tension component; depressed; hypoglycemia;


Changed on 9/14/2017

VAERS ID: 61525 Before After
VAERS Form:(blank) 1
Age:11.0
Sex:Female
Location:Texas
Vaccinated:1993-06-08
Onset:1993-06-10
Submitted:1994-03-30
Entered:1994-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 3C51048 / - UNK - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1503V / 1 2 - / IM

Administered by: Private      Purchased by: Other
Symptoms: Abdominal pain, Anxiety, Asthenia, Depression, Headache, Infection, Migraine, Photosensitivity reaction

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Lorabid
Current Illness:
Preexisting Conditions: Thoracic outlet synd; UTI, recurrent; Rhinitis, allergic; chickenpox; strep throat; reglan allergy;
Allergies:
Diagnostic Lab Data: 16JUN93 Serum alk phos 217; Phosphate 4.9; WBC Count 5.6; Neutrophils 40%; Lymphocytes 51%; Monocytes 6%; EOS 2%; Basophils 1%; ESR 18%; Epstein-barr antibody 69%; Lymphocytes 50%; 25AUG93 Epstein-barr 96%; IGA 45%;
CDC 'Split Type': WAES93090874

Write-up: Pt recvd vax & devel lightheadedness, n&v, h/a, light sensitivity; episode of diarrhea & dec appetite; fever 101, alk phos 217; culture of sinuses revealed 4+ staphylococcus aureus; migraine h/a w/tension component; depressed; hypoglycemia;


Changed on 2/14/2018

VAERS ID: 61525 Before After
VAERS Form:1
Age:11.0
Sex:Female
Location:Texas
Vaccinated:1993-06-08
Onset:1993-06-10
Submitted:1994-03-30
Entered:1994-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 3C51048 / UNK - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1503V / 2 - / IM

Administered by: Private      Purchased by: Other
Symptoms: Abdominal pain, Anxiety, Asthenia, Depression, Headache, Infection, Migraine, Photosensitivity reaction

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Lorabid
Current Illness:
Preexisting Conditions: Thoracic outlet synd; UTI, recurrent; Rhinitis, allergic; chickenpox; strep throat; reglan allergy;
Allergies:
Diagnostic Lab Data: 16JUN93 Serum alk phos 217; Phosphate 4.9; WBC Count 5.6; Neutrophils 40%; Lymphocytes 51%; Monocytes 6%; EOS 2%; Basophils 1%; ESR 18%; Epstein-barr antibody 69%; Lymphocytes 50%; 25AUG93 Epstein-barr 96%; IGA 45%;
CDC 'Split Type': WAES93090874

Write-up: Pt recvd vax & devel lightheadedness, n&v, h/a, light sensitivity; episode of diarrhea & dec appetite; fever 101, alk phos 217; culture of sinuses revealed 4+ staphylococcus aureus; migraine h/a w/tension component; depressed; hypoglycemia;


Changed on 6/14/2018

VAERS ID: 61525 Before After
VAERS Form:1
Age:11.0
Sex:Female
Location:Texas
Vaccinated:1993-06-08
Onset:1993-06-10
Submitted:1994-03-30
Entered:1994-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 3C51048 / UNK - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1503V / 2 - / IM

Administered by: Private      Purchased by: Other
Symptoms: Abdominal pain, Anxiety, Asthenia, Depression, Headache, Infection, Migraine, Photosensitivity reaction

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Lorabid
Current Illness:
Preexisting Conditions: Thoracic outlet synd; UTI, recurrent; Rhinitis, allergic; chickenpox; strep throat; reglan allergy;
Allergies:
Diagnostic Lab Data: 16JUN93 Serum alk phos 217; Phosphate 4.9; WBC Count 5.6; Neutrophils 40%; Lymphocytes 51%; Monocytes 6%; EOS 2%; Basophils 1%; ESR 18%; Epstein-barr antibody 69%; Lymphocytes 50%; 25AUG93 Epstein-barr 96%; IGA 45%;
CDC 'Split Type': WAES93090874

Write-up: Pt recvd vax & devel lightheadedness, n&v, h/a, light sensitivity; episode of diarrhea & dec appetite; fever 101, alk phos 217; culture of sinuses revealed 4+ staphylococcus aureus; migraine h/a w/tension component; depressed; hypoglycemia;


Changed on 8/14/2018

VAERS ID: 61525 Before After
VAERS Form:1
Age:11.0
Sex:Female
Location:Texas
Vaccinated:1993-06-08
Onset:1993-06-10
Submitted:1994-03-30
Entered:1994-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 3C51048 / UNK - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1503V / 2 - / IM

Administered by: Private      Purchased by: Other
Symptoms: Abdominal pain, Anxiety, Asthenia, Depression, Headache, Infection, Migraine, Photosensitivity reaction

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Lorabid
Current Illness:
Preexisting Conditions: Thoracic outlet synd; UTI, recurrent; Rhinitis, allergic; chickenpox; strep throat; reglan allergy;
Allergies:
Diagnostic Lab Data: 16JUN93 Serum alk phos 217; Phosphate 4.9; WBC Count 5.6; Neutrophils 40%; Lymphocytes 51%; Monocytes 6%; EOS 2%; Basophils 1%; ESR 18%; Epstein-barr antibody 69%; Lymphocytes 50%; 25AUG93 Epstein-barr 96%; IGA 45%;
CDC 'Split Type': WAES93090874

Write-up: Pt recvd vax & devel lightheadedness, n&v, h/a, light sensitivity; episode of diarrhea & dec appetite; fever 101, alk phos 217; culture of sinuses revealed 4+ staphylococcus aureus; migraine h/a w/tension component; depressed; hypoglycemia;


Changed on 9/14/2018

VAERS ID: 61525 Before After
VAERS Form:1
Age:11.0
Sex:Female
Location:Texas
Vaccinated:1993-06-08
Onset:1993-06-10
Submitted:1994-03-30
Entered:1994-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 3C51048 / UNK - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1503V / 2 - / IM

Administered by: Private      Purchased by: Other
Symptoms: Abdominal pain, Anxiety, Asthenia, Depression, Headache, Infection, Migraine, Photosensitivity reaction

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Lorabid
Current Illness:
Preexisting Conditions: Thoracic outlet synd; UTI, recurrent; Rhinitis, allergic; chickenpox; strep throat; reglan allergy;
Allergies:
Diagnostic Lab Data: 16JUN93 Serum alk phos 217; Phosphate 4.9; WBC Count 5.6; Neutrophils 40%; Lymphocytes 51%; Monocytes 6%; EOS 2%; Basophils 1%; ESR 18%; Epstein-barr antibody 69%; Lymphocytes 50%; 25AUG93 Epstein-barr 96%; IGA 45%;
CDC 'Split Type': WAES93090874

Write-up: Pt recvd vax & devel lightheadedness, n&v, h/a, light sensitivity; episode of diarrhea & dec appetite; fever 101, alk phos 217; culture of sinuses revealed 4+ staphylococcus aureus; migraine h/a w/tension component; depressed; hypoglycemia;


Changed on 10/14/2018

VAERS ID: 61525 Before After
VAERS Form:1
Age:11.0
Sex:Female
Location:Texas
Vaccinated:1993-06-08
Onset:1993-06-10
Submitted:1994-03-30
Entered:1994-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 3C51048 / UNK - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1503V / 2 - / IM

Administered by: Private      Purchased by: Other
Symptoms: Abdominal pain, Anxiety, Asthenia, Depression, Headache, Infection, Migraine, Photosensitivity reaction

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Lorabid
Current Illness:
Preexisting Conditions: Thoracic outlet synd; UTI, recurrent; Rhinitis, allergic; chickenpox; strep throat; reglan allergy;
Allergies:
Diagnostic Lab Data: 16JUN93 Serum alk phos 217; Phosphate 4.9; WBC Count 5.6; Neutrophils 40%; Lymphocytes 51%; Monocytes 6%; EOS 2%; Basophils 1%; ESR 18%; Epstein-barr antibody 69%; Lymphocytes 50%; 25AUG93 Epstein-barr 96%; IGA 45%;
CDC 'Split Type': WAES93090874

Write-up: Pt recvd vax & devel lightheadedness, n&v, h/a, light sensitivity; episode of diarrhea & dec appetite; fever 101, alk phos 217; culture of sinuses revealed 4+ staphylococcus aureus; migraine h/a w/tension component; depressed; hypoglycemia;

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