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This is VAERS ID 78939

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 78939
VAERS Form:
Age:11.6
Sex:Female
Location:Kansas
Vaccinated:1995-05-12
Onset:1995-05-19
Submitted:1995-11-07
Entered:1995-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MMR II / MSD 1052A / 1 LL / -

Administered by: Public      Purchased by: Unknown
Symptoms: AGITATION, CONVULS, ANOREXIA, LEUKOCYTOSIS, PNEUMONIA

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1995-05-22
Permanent Disability? No
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: pt severely disabled @ 6wks w/DTP dose 1
Other Medications: Depakote, Lamictal
Current Illness: NONE
Preexisting Conditions: severely mentally & physically disabled-uncontrolled sz disorder
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': severely mentally & physically disabled-uncontrolled sz disorder

Write-up: pneumonia w/inc szs, 19MAY95 restless, poor appetite, 22MAY95 afeb elevated WBC, prolonged szs just prior to code (epileptic status) lasted $g30mins


Changed on 12/8/2009

VAERS ID: 78939 Before After
VAERS Form:
Age:11.6
Sex:Female
Location:Kansas
Vaccinated:1995-05-12
Onset:1995-05-19
Submitted:1995-11-07
Entered:1995-11-17 1995-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 1052A / 1 LL / -

Administered by: Public      Purchased by: Unknown Other
Symptoms: Agitation, Anorexia, Convulsion, Leukocytosis, Pneumonia, AGITATION, CONVULS, ANOREXIA, LEUKOCYTOSIS, PNEUMONIA

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1995-05-22
Permanent Disability? No
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: pt severely disabled @ 6wks w/DTP dose 1
Other Medications: Depakote, Lamictal
Current Illness: NONE
Preexisting Conditions: severely mentally & physically disabled-uncontrolled sz disorder
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': severely mentally & physically disabled-uncontrolled sz disorder (blank)

Write-up: pneumonia w/inc szs, 19MAY95 restless, poor appetite, 22MAY95 afeb elevated WBC, prolonged szs just prior to code (epileptic status) lasted $g30mins


Changed on 2/14/2017

VAERS ID: 78939 Before After
VAERS Form:
Age:11.6 11.0
Sex:Female
Location:Kansas
Vaccinated:1995-05-12
Onset:1995-05-19
Submitted:1995-11-07
Entered:1995-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1052A / 1 LL / -

Administered by: Public      Purchased by: Other
Symptoms: Agitation, Anorexia, Convulsion, Leukocytosis, Pneumonia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1995-05-22
Permanent Disability? No
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: pt severely disabled @ 6wks w/DTP dose 1
Other Medications: Depakote, Lamictal
Current Illness: NONE
Preexisting Conditions: severely mentally & physically disabled-uncontrolled sz disorder
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pneumonia w/inc szs, 19MAY95 restless, poor appetite, 22MAY95 afeb elevated WBC, prolonged szs just prior to code (epileptic status) lasted $g30mins


Changed on 5/14/2017

VAERS ID: 78939 Before After
VAERS Form:
Age:11.0
Sex:Female
Location:Kansas
Vaccinated:1995-05-12
Onset:1995-05-19
Submitted:1995-11-07
Entered:1995-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1052A / 1 LL / -

Administered by: Public      Purchased by: Other
Symptoms: Agitation, Anorexia, Convulsion, Leukocytosis, Pneumonia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1995-05-22
Permanent Disability? No
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: pt severely disabled @ 6wks w/DTP dose 1 1~ ()~~~In patient
Other Medications: Depakote, Lamictal
Current Illness: NONE
Preexisting Conditions: severely mentally & physically disabled-uncontrolled sz disorder
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pneumonia w/inc szs, 19MAY95 restless, poor appetite, 22MAY95 afeb elevated WBC, prolonged szs just prior to code (epileptic status) lasted $g30mins


Changed on 9/14/2017

VAERS ID: 78939 Before After
VAERS Form:(blank) 1
Age:11.0
Sex:Female
Location:Kansas
Vaccinated:1995-05-12
Onset:1995-05-19
Submitted:1995-11-07
Entered:1995-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1052A / 1 2 LL / -

Administered by: Public      Purchased by: Other
Symptoms: Agitation, Anorexia, Convulsion, Leukocytosis, Pneumonia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1995-05-22
Permanent Disability? No
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: pt severely disabled @ 6wks w/DTP dose 1~ ()~~~In patient
Other Medications: Depakote, Lamictal
Current Illness: NONE
Preexisting Conditions: severely mentally & physically disabled-uncontrolled sz disorder
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pneumonia w/inc szs, 19MAY95 restless, poor appetite, 22MAY95 afeb elevated WBC, prolonged szs just prior to code (epileptic status) lasted $g30mins


Changed on 2/14/2018

VAERS ID: 78939 Before After
VAERS Form:1
Age:11.0
Sex:Female
Location:Kansas
Vaccinated:1995-05-12
Onset:1995-05-19
Submitted:1995-11-07
Entered:1995-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1052A / 2 LL / -

Administered by: Public      Purchased by: Other
Symptoms: Agitation, Anorexia, Convulsion, Leukocytosis, Pneumonia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1995-05-22
Permanent Disability? No
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: pt severely disabled @ 6wks w/DTP dose 1~ ()~~~In patient
Other Medications: Depakote, Lamictal
Current Illness: NONE
Preexisting Conditions: severely mentally & physically disabled-uncontrolled sz disorder
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pneumonia w/inc szs, 19MAY95 restless, poor appetite, 22MAY95 afeb elevated WBC, prolonged szs just prior to code (epileptic status) lasted $g30mins


Changed on 6/14/2018

VAERS ID: 78939 Before After
VAERS Form:1
Age:11.0
Sex:Female
Location:Kansas
Vaccinated:1995-05-12
Onset:1995-05-19
Submitted:1995-11-07
Entered:1995-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1052A / 2 LL / -

Administered by: Public      Purchased by: Other
Symptoms: Agitation, Anorexia, Convulsion, Leukocytosis, Pneumonia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1995-05-22
Permanent Disability? No
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: pt severely disabled @ 6wks w/DTP dose 1~ ()~~~In patient
Other Medications: Depakote, Lamictal
Current Illness: NONE
Preexisting Conditions: severely mentally & physically disabled-uncontrolled sz disorder
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pneumonia w/inc szs, 19MAY95 restless, poor appetite, 22MAY95 afeb elevated WBC, prolonged szs just prior to code (epileptic status) lasted $g30mins


Changed on 8/14/2018

VAERS ID: 78939 Before After
VAERS Form:1
Age:11.0
Sex:Female
Location:Kansas
Vaccinated:1995-05-12
Onset:1995-05-19
Submitted:1995-11-07
Entered:1995-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1052A / 2 LL / -

Administered by: Public      Purchased by: Other
Symptoms: Agitation, Anorexia, Convulsion, Leukocytosis, Pneumonia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1995-05-22
Permanent Disability? No
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: pt severely disabled @ 6wks w/DTP dose 1~ ()~~~In patient
Other Medications: Depakote, Lamictal
Current Illness: NONE
Preexisting Conditions: severely mentally & physically disabled-uncontrolled sz disorder
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pneumonia w/inc szs, 19MAY95 restless, poor appetite, 22MAY95 afeb elevated WBC, prolonged szs just prior to code (epileptic status) lasted $g30mins


Changed on 9/14/2018

VAERS ID: 78939 Before After
VAERS Form:1
Age:11.0
Sex:Female
Location:Kansas
Vaccinated:1995-05-12
Onset:1995-05-19
Submitted:1995-11-07
Entered:1995-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1052A / 2 LL / -

Administered by: Public      Purchased by: Other
Symptoms: Agitation, Anorexia, Convulsion, Leukocytosis, Pneumonia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1995-05-22
Permanent Disability? No
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: pt severely disabled @ 6wks w/DTP dose 1~ ()~~~In patient
Other Medications: Depakote, Lamictal
Current Illness: NONE
Preexisting Conditions: severely mentally & physically disabled-uncontrolled sz disorder
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pneumonia w/inc szs, 19MAY95 restless, poor appetite, 22MAY95 afeb elevated WBC, prolonged szs just prior to code (epileptic status) lasted $g30mins


Changed on 10/14/2018

VAERS ID: 78939 Before After
VAERS Form:1
Age:11.0
Sex:Female
Location:Kansas
Vaccinated:1995-05-12
Onset:1995-05-19
Submitted:1995-11-07
Entered:1995-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1052A / 2 LL / -

Administered by: Public      Purchased by: Other
Symptoms: Agitation, Anorexia, Convulsion, Leukocytosis, Pneumonia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1995-05-22
Permanent Disability? No
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: pt severely disabled @ 6wks w/DTP dose 1~ ()~~~In patient
Other Medications: Depakote, Lamictal
Current Illness: NONE
Preexisting Conditions: severely mentally & physically disabled-uncontrolled sz disorder
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pneumonia w/inc szs, 19MAY95 restless, poor appetite, 22MAY95 afeb elevated WBC, prolonged szs just prior to code (epileptic status) lasted $g30mins

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