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This is VAERS ID 68886

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 68886
VAERS Form:
Age:1.3
Sex:Male
Location:Illinois
Vaccinated:1993-01-06
Onset:1993-01-07
Submitted:1994-11-07
Entered:1994-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: UNK. HAEMOPHILUS B / UNCLASSIFIED M150JC / 3 L / -
MMR: MMR II / MSD 1110V / 0 L / -

Administered by: Public      Purchased by: Unknown
Symptoms: CONVULS, SOMNOLENCE, STUPOR, REACT AGGRAV

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-06-01
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: 3     Extended hospital stay? No
Previous Vaccinations: pt exp szs w/all doses of DTP
Other Medications: TB Shot, PB, Tegretol, Depakote, Vit B6
Current Illness: NONE
Preexisting Conditions: febrile seizure dx 28DEC91
Allergies:
Diagnostic Lab Data: EEG- some abnormalities beginning to show, CAT Scan, MRI, Spinal tap
CDC 'Split Type': febrile seizure dx 28DEC91

Write-up: 6JAN93 w/4th vax pt had sz-no temp; awake on & off all noc long; 1105AM had 10 mins staring sz; very sleepy afterwards; p/experiencing approx 60 szs until age of 20 months, pt exp a 3 hrs sz, shock & died; autopsy was inconclusive;


Changed on 12/8/2009

VAERS ID: 68886 Before After
VAERS Form:
Age:1.3
Sex:Male
Location:Illinois
Vaccinated:1993-01-06
Onset:1993-01-07
Submitted:1994-11-07
Entered:1994-11-29 1994-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: UNK. HAEMOPHILUS B HIB (NO BRAND NAME) / UNCLASSIFIED UNKNOWN MANUFACTURER M150JC / 3 L / -
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 1110V / 0 L / -

Administered by: Public      Purchased by: Unknown Other
Symptoms: Condition aggravated, Convulsion, Somnolence, Stupor, CONVULS, SOMNOLENCE, STUPOR, REACT AGGRAV

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-06-01
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: 3     Extended hospital stay? No
Previous Vaccinations: pt exp szs w/all doses of DTP
Other Medications: TB Shot, PB, Tegretol, Depakote, Vit B6
Current Illness: NONE
Preexisting Conditions: febrile seizure dx 28DEC91
Allergies:
Diagnostic Lab Data: EEG- some abnormalities beginning to show, CAT Scan, MRI, Spinal tap
CDC 'Split Type': febrile seizure dx 28DEC91 IL940125

Write-up: 6JAN93 w/4th vax pt had sz-no temp; awake on & off all noc long; 1105AM had 10 mins staring sz; very sleepy afterwards; p/experiencing approx 60 szs until age of 20 months, pt exp a 3 hrs sz, shock & died; autopsy was inconclusive;


Changed on 5/14/2017

VAERS ID: 68886 Before After
VAERS Form:
Age:1.3
Sex:Male
Location:Illinois
Vaccinated:1993-01-06
Onset:1993-01-07
Submitted:1994-11-07
Entered:1994-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER M150JC / 3 L - / - L
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1110V / 0 L - / - L

Administered by: Public      Purchased by: Other
Symptoms: Condition aggravated, Convulsion, Somnolence, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-06-01
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: 3     Extended hospital stay? No
Previous Vaccinations: pt exp szs w/all doses of DTP DTP~ ()~~~In patient
Other Medications: TB Shot, PB, Tegretol, Depakote, Vit B6
Current Illness: NONE
Preexisting Conditions: febrile seizure dx 28DEC91
Allergies:
Diagnostic Lab Data: EEG- some abnormalities beginning to show, CAT Scan, MRI, Spinal tap
CDC 'Split Type': IL940125

Write-up: 6JAN93 w/4th vax pt had sz-no temp; awake on & off all noc long; 1105AM had 10 mins staring sz; very sleepy afterwards; p/experiencing approx 60 szs until age of 20 months, pt exp a 3 hrs sz, shock & died; autopsy was inconclusive;


Changed on 9/14/2017

VAERS ID: 68886 Before After
VAERS Form:(blank) 1
Age:1.3
Sex:Male
Location:Illinois
Vaccinated:1993-01-06
Onset:1993-01-07
Submitted:1994-11-07
Entered:1994-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER M150JC / 3 4 - / L
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1110V / 0 1 - / L

Administered by: Public      Purchased by: Other
Symptoms: Condition aggravated, Convulsion, Somnolence, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-06-01
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: 3     Extended hospital stay? No
Previous Vaccinations: pt exp szs w/all doses of DTP~ ()~~~In patient
Other Medications: TB Shot, PB, Tegretol, Depakote, Vit B6
Current Illness: NONE
Preexisting Conditions: febrile seizure dx 28DEC91
Allergies:
Diagnostic Lab Data: EEG- some abnormalities beginning to show, CAT Scan, MRI, Spinal tap
CDC 'Split Type': IL940125

Write-up: 6JAN93 w/4th vax pt had sz-no temp; awake on & off all noc long; 1105AM had 10 mins staring sz; very sleepy afterwards; p/experiencing approx 60 szs until age of 20 months, pt exp a 3 hrs sz, shock & died; autopsy was inconclusive;


Changed on 2/14/2018

VAERS ID: 68886 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Illinois
Vaccinated:1993-01-06
Onset:1993-01-07
Submitted:1994-11-07
Entered:1994-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER M150JC / 4 - / L
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1110V / 1 - / L

Administered by: Public      Purchased by: Other
Symptoms: Condition aggravated, Convulsion, Somnolence, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-06-01
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: 3     Extended hospital stay? No
Previous Vaccinations: pt exp szs w/all doses of DTP~ ()~~~In patient
Other Medications: TB Shot, PB, Tegretol, Depakote, Vit B6
Current Illness: NONE
Preexisting Conditions: febrile seizure dx 28DEC91
Allergies:
Diagnostic Lab Data: EEG- some abnormalities beginning to show, CAT Scan, MRI, Spinal tap
CDC 'Split Type': IL940125

Write-up: 6JAN93 w/4th vax pt had sz-no temp; awake on & off all noc long; 1105AM had 10 mins staring sz; very sleepy afterwards; p/experiencing approx 60 szs until age of 20 months, pt exp a 3 hrs sz, shock & died; autopsy was inconclusive;


Changed on 6/14/2018

VAERS ID: 68886 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Illinois
Vaccinated:1993-01-06
Onset:1993-01-07
Submitted:1994-11-07
Entered:1994-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER M150JC / 4 - / L
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1110V / 1 - / L

Administered by: Public      Purchased by: Other
Symptoms: Condition aggravated, Convulsion, Somnolence, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-06-01
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: 3     Extended hospital stay? No
Previous Vaccinations: pt exp szs w/all doses of DTP~ ()~~~In patient
Other Medications: TB Shot, PB, Tegretol, Depakote, Vit B6
Current Illness: NONE
Preexisting Conditions: febrile seizure dx 28DEC91
Allergies:
Diagnostic Lab Data: EEG- some abnormalities beginning to show, CAT Scan, MRI, Spinal tap
CDC 'Split Type': IL940125

Write-up: 6JAN93 w/4th vax pt had sz-no temp; awake on & off all noc long; 1105AM had 10 mins staring sz; very sleepy afterwards; p/experiencing approx 60 szs until age of 20 months, pt exp a 3 hrs sz, shock & died; autopsy was inconclusive;


Changed on 8/14/2018

VAERS ID: 68886 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Illinois
Vaccinated:1993-01-06
Onset:1993-01-07
Submitted:1994-11-07
Entered:1994-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER M150JC / 4 - / L
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1110V / 1 - / L

Administered by: Public      Purchased by: Other
Symptoms: Condition aggravated, Convulsion, Somnolence, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-06-01
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: 3     Extended hospital stay? No
Previous Vaccinations: pt exp szs w/all doses of DTP~ ()~~~In patient
Other Medications: TB Shot, PB, Tegretol, Depakote, Vit B6
Current Illness: NONE
Preexisting Conditions: febrile seizure dx 28DEC91
Allergies:
Diagnostic Lab Data: EEG- some abnormalities beginning to show, CAT Scan, MRI, Spinal tap
CDC 'Split Type': IL940125

Write-up: 6JAN93 w/4th vax pt had sz-no temp; awake on & off all noc long; 1105AM had 10 mins staring sz; very sleepy afterwards; p/experiencing approx 60 szs until age of 20 months, pt exp a 3 hrs sz, shock & died; autopsy was inconclusive;


Changed on 9/14/2018

VAERS ID: 68886 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Illinois
Vaccinated:1993-01-06
Onset:1993-01-07
Submitted:1994-11-07
Entered:1994-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER M150JC / 4 - / L
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1110V / 1 - / L

Administered by: Public      Purchased by: Other
Symptoms: Condition aggravated, Convulsion, Somnolence, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-06-01
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: 3     Extended hospital stay? No
Previous Vaccinations: pt exp szs w/all doses of DTP~ ()~~~In patient
Other Medications: TB Shot, PB, Tegretol, Depakote, Vit B6
Current Illness: NONE
Preexisting Conditions: febrile seizure dx 28DEC91
Allergies:
Diagnostic Lab Data: EEG- some abnormalities beginning to show, CAT Scan, MRI, Spinal tap
CDC 'Split Type': IL940125

Write-up: 6JAN93 w/4th vax pt had sz-no temp; awake on & off all noc long; 1105AM had 10 mins staring sz; very sleepy afterwards; p/experiencing approx 60 szs until age of 20 months, pt exp a 3 hrs sz, shock & died; autopsy was inconclusive;


Changed on 10/14/2018

VAERS ID: 68886 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Illinois
Vaccinated:1993-01-06
Onset:1993-01-07
Submitted:1994-11-07
Entered:1994-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER M150JC / 4 - / L
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1110V / 1 - / L

Administered by: Public      Purchased by: Other
Symptoms: Condition aggravated, Convulsion, Somnolence, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-06-01
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: 3     Extended hospital stay? No
Previous Vaccinations: pt exp szs w/all doses of DTP~ ()~~~In patient
Other Medications: TB Shot, PB, Tegretol, Depakote, Vit B6
Current Illness: NONE
Preexisting Conditions: febrile seizure dx 28DEC91
Allergies:
Diagnostic Lab Data: EEG- some abnormalities beginning to show, CAT Scan, MRI, Spinal tap
CDC 'Split Type': IL940125

Write-up: 6JAN93 w/4th vax pt had sz-no temp; awake on & off all noc long; 1105AM had 10 mins staring sz; very sleepy afterwards; p/experiencing approx 60 szs until age of 20 months, pt exp a 3 hrs sz, shock & died; autopsy was inconclusive;

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