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This is VAERS ID 85024

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 85024
VAERS Form:
Age:1.2
Sex:Male
Location:Texas
Vaccinated:1996-03-21
Onset:1996-03-22
Submitted:1996-03-25
Entered:1996-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIBTITER / LEDERLE(PRAXIS) M010LL / 3 LL / IM
MMR: MMR II / MSD 1179B / 0 - / -

Administered by: Private      Purchased by: Unknown
Symptoms: CONVULS, CYANOSIS, HYPERTONIA, APNEA, HEART ARREST

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: unk
Current Illness: unk
Preexisting Conditions: it is noted that the pt''s home was fumigated before 24hrs this event occured;
Allergies:
Diagnostic Lab Data: WBC 13,700;segs 20%; lymphs 77%;monos 1%;eos 1%; UA neg;
CDC 'Split Type':

Write-up: pt recv vax 21MAR96 & the next day while mom was bathing pt-pt stopped breathing;CPR was administered & pt responded;pt exp a full sz w/jaw clenching;pt was taken to ER;on arrival in ER pt was in o distress & not exhibiting an sz activity;


Changed on 12/8/2009

VAERS ID: 85024 Before After
VAERS Form:
Age:1.2
Sex:Male
Location:Texas
Vaccinated:1996-03-21
Onset:1996-03-22
Submitted:1996-03-25
Entered:1996-04-23 1996-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M010LL / 3 LL / IM
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 1179B / 0 - / -

Administered by: Private      Purchased by: Unknown Private
Symptoms: Apnoea, Cardiac arrest, Convulsion, Cyanosis, Hypertonia, Respiratory disorder, CONVULS, CYANOSIS, HYPERTONIA, APNEA, HEART ARREST

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: unk
Current Illness: unk
Preexisting Conditions: it is noted that the pt''s home was fumigated before 24hrs this event occured;
Allergies:
Diagnostic Lab Data: WBC 13,700;segs 20%; lymphs 77%;monos 1%;eos 1%; UA neg;
CDC 'Split Type': (blank) 896088003L

Write-up: pt recv vax 21MAR96 & the next day while mom was bathing pt-pt stopped breathing;CPR was administered & pt responded;pt exp a full sz w/jaw clenching;pt was taken to ER;on arrival in ER pt was in o distress & not exhibiting an sz activity;


Changed on 5/14/2017

VAERS ID: 85024 Before After
VAERS Form:
Age:1.2
Sex:Male
Location:Texas
Vaccinated:1996-03-21
Onset:1996-03-22
Submitted:1996-03-25
Entered:1996-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M010LL / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1179B / 0 - / -

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Convulsion, Cyanosis, Hypertonia, Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: it is noted that the pt''s home was fumigated before 24hrs this event occured;
Allergies:
Diagnostic Lab Data: WBC 13,700;segs 20%; lymphs 77%;monos 1%;eos 1%; UA neg;
CDC 'Split Type': 896088003L

Write-up: pt recv vax 21MAR96 & the next day while mom was bathing pt-pt stopped breathing;CPR was administered & pt responded;pt exp a full sz w/jaw clenching;pt was taken to ER;on arrival in ER pt was in o distress & not exhibiting an sz activity;


Changed on 9/14/2017

VAERS ID: 85024 Before After
VAERS Form:(blank) 1
Age:1.2
Sex:Male
Location:Texas
Vaccinated:1996-03-21
Onset:1996-03-22
Submitted:1996-03-25
Entered:1996-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M010LL / 3 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1179B / 0 1 - / -

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Convulsion, Cyanosis, Hypertonia, Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: it is noted that the pt''s home was fumigated before 24hrs this event occured;
Allergies:
Diagnostic Lab Data: WBC 13,700;segs 20%; lymphs 77%;monos 1%;eos 1%; UA neg;
CDC 'Split Type': 896088003L

Write-up: pt recv vax 21MAR96 & the next day while mom was bathing pt-pt stopped breathing;CPR was administered & pt responded;pt exp a full sz w/jaw clenching;pt was taken to ER;on arrival in ER pt was in o distress & not exhibiting an sz activity;


Changed on 2/14/2018

VAERS ID: 85024 Before After
VAERS Form:1
Age:1.2
Sex:Male
Location:Texas
Vaccinated:1996-03-21
Onset:1996-03-22
Submitted:1996-03-25
Entered:1996-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M010LL / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1179B / 1 - / -

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Convulsion, Cyanosis, Hypertonia, Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: it is noted that the pt''s home was fumigated before 24hrs this event occured;
Allergies:
Diagnostic Lab Data: WBC 13,700;segs 20%; lymphs 77%;monos 1%;eos 1%; UA neg;
CDC 'Split Type': 896088003L

Write-up: pt recv vax 21MAR96 & the next day while mom was bathing pt-pt stopped breathing;CPR was administered & pt responded;pt exp a full sz w/jaw clenching;pt was taken to ER;on arrival in ER pt was in o distress & not exhibiting an sz activity;


Changed on 6/14/2018

VAERS ID: 85024 Before After
VAERS Form:1
Age:1.2
Sex:Male
Location:Texas
Vaccinated:1996-03-21
Onset:1996-03-22
Submitted:1996-03-25
Entered:1996-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M010LL / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1179B / 1 - / -

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Convulsion, Cyanosis, Hypertonia, Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: it is noted that the pt''s home was fumigated before 24hrs this event occured;
Allergies:
Diagnostic Lab Data: WBC 13,700;segs 20%; lymphs 77%;monos 1%;eos 1%; UA neg;
CDC 'Split Type': 896088003L

Write-up: pt recv vax 21MAR96 & the next day while mom was bathing pt-pt stopped breathing;CPR was administered & pt responded;pt exp a full sz w/jaw clenching;pt was taken to ER;on arrival in ER pt was in o distress & not exhibiting an sz activity;


Changed on 8/14/2018

VAERS ID: 85024 Before After
VAERS Form:1
Age:1.2
Sex:Male
Location:Texas
Vaccinated:1996-03-21
Onset:1996-03-22
Submitted:1996-03-25
Entered:1996-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M010LL / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1179B / 1 - / -

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Convulsion, Cyanosis, Hypertonia, Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: it is noted that the pt''s home was fumigated before 24hrs this event occured;
Allergies:
Diagnostic Lab Data: WBC 13,700;segs 20%; lymphs 77%;monos 1%;eos 1%; UA neg;
CDC 'Split Type': 896088003L

Write-up: pt recv vax 21MAR96 & the next day while mom was bathing pt-pt stopped breathing;CPR was administered & pt responded;pt exp a full sz w/jaw clenching;pt was taken to ER;on arrival in ER pt was in o distress & not exhibiting an sz activity;


Changed on 9/14/2018

VAERS ID: 85024 Before After
VAERS Form:1
Age:1.2
Sex:Male
Location:Texas
Vaccinated:1996-03-21
Onset:1996-03-22
Submitted:1996-03-25
Entered:1996-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M010LL / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1179B / 1 - / -

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Convulsion, Cyanosis, Hypertonia, Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: it is noted that the pt''s home was fumigated before 24hrs this event occured;
Allergies:
Diagnostic Lab Data: WBC 13,700;segs 20%; lymphs 77%;monos 1%;eos 1%; UA neg;
CDC 'Split Type': 896088003L

Write-up: pt recv vax 21MAR96 & the next day while mom was bathing pt-pt stopped breathing;CPR was administered & pt responded;pt exp a full sz w/jaw clenching;pt was taken to ER;on arrival in ER pt was in o distress & not exhibiting an sz activity;


Changed on 10/14/2018

VAERS ID: 85024 Before After
VAERS Form:1
Age:1.2
Sex:Male
Location:Texas
Vaccinated:1996-03-21
Onset:1996-03-22
Submitted:1996-03-25
Entered:1996-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M010LL / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1179B / 1 - / -

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Convulsion, Cyanosis, Hypertonia, Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: it is noted that the pt''s home was fumigated before 24hrs this event occured;
Allergies:
Diagnostic Lab Data: WBC 13,700;segs 20%; lymphs 77%;monos 1%;eos 1%; UA neg;
CDC 'Split Type': 896088003L

Write-up: pt recv vax 21MAR96 & the next day while mom was bathing pt-pt stopped breathing;CPR was administered & pt responded;pt exp a full sz w/jaw clenching;pt was taken to ER;on arrival in ER pt was in o distress & not exhibiting an sz activity;

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=85024&WAYBACKHISTORY=ON


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