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This is VAERS ID 175835

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 175835
VAERS Form:
Age:1.3
Sex:Male
Location:Minnesota
Vaccinated:1998-09-02
Onset:1998-09-03
Submitted:2001-09-13
Entered:2001-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABS U0932710 / 3 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABS U0950670 / 2 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MSD 0787H / 0 LL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE 793E2 / 1 - / PO
VARCEL: VARICELLA (VARIVAX) / MSD 0610H / 0 RL / IM

Administered by: ??      Purchased by: Unknown
Symptoms: DEAF, GAIT ABNORM, DIARRHEA, EYE DIS, INFECT FUNG

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: ;UNK. MEASLES, MUMPS & RUBELLA VIRUS LIVE;2;5.00;In Sibling
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NONE

Write-up: The pt experienced chronic permanent diarrhea, chronic ""yeast infection"" type rashes, change in hearing, loss of eye contact, started to walk on tip toes and spin allot.


Changed on 12/30/2006

VAERS ID: 175835 Before After
VAERS Form:
Age:1.3
Sex:Male
Location:Minnesota
Vaccinated:1998-09-02
Onset:1998-09-03
Submitted:2001-09-13
Entered:2001-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABS U0932710 / 3 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABS U0950670 / 2 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MSD 0787H / 0 LL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE 793E2 / 1 - / PO
VARCEL: VARICELLA (VARIVAX) / MSD 0610H / 0 RL / IM

Administered by: ??      Purchased by: Unknown
Symptoms: DEAF, GAIT ABNORM, DIARRHEA, EYE DIS, INFECT FUNG

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: ;UNK. MEASLES, MUMPS & RUBELLA VIRUS LIVE;2;5.00;In Sibling
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NONE

Write-up: The pt experienced chronic permanent diarrhea, chronic ""yeast infection"" /"yeast infection/" type rashes, change in hearing, loss of eye contact, started to walk on tip toes and spin allot.


Changed on 12/8/2009

VAERS ID: 175835 Before After
VAERS Form:
Age:1.3
Sex:Male
Location:Minnesota
Vaccinated:1998-09-02
Onset:1998-09-03
Submitted:2001-09-13
Entered:2001-10-02 2001-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABS CONNAUGHT LABORATORIES U0932710 / 3 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABS CONNAUGHT LABORATORIES U0950670 / 2 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 0787H / 0 LL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 793E2 / 1 - / PO
VARCEL: VARICELLA (VARIVAX) VARICELLA (VARIVAX) / MSD MERCK & CO. INC. 0610H / 0 RL / IM

Administered by: ??      Purchased by: Unknown (blank)
Symptoms: Diarrhoea, Eye disorder, Fungal infection, Gait disturbance, Rash, Hypoacusis, DEAF, GAIT ABNORM, DIARRHEA, EYE DIS, INFECT FUNG

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: ;UNK. MEASLES, MUMPS & RUBELLA VIRUS LIVE;2;5.00;In Sibling
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NONE

Write-up: The pt experienced chronic permanent diarrhea, chronic /"yeast infection/" "yeast infection" type rashes, change in hearing, loss of eye contact, started to walk on tip toes and spin allot.


Changed on 10/14/2012

VAERS ID: 175835 Before After
VAERS Form:
Age:1.3
Sex:Male
Location:Minnesota
Vaccinated:1998-09-02
Onset:1998-09-03
Submitted:2001-09-13
Entered:2001-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES U0932710 / 3 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES U0950670 / 2 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0787H / 0 LL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES 793E2 / 1 - / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0610H / 0 RL / IM

Administered by: ??      Purchased by: ??
Symptoms: Diarrhoea, Eye disorder, Fungal infection, Gait disturbance, Rash, Hypoacusis

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: ;UNK. MEASLES, MUMPS & RUBELLA VIRUS LIVE;2;5.00;In Sibling
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NONE (blank)

Write-up: The pt experienced chronic permanent diarrhea, chronic "yeast infection" type rashes, change in hearing, loss of eye contact, started to walk on tip toes and spin allot.


Changed on 5/14/2017

VAERS ID: 175835 Before After
VAERS Form:
Age:1.3
Sex:Male
Location:Minnesota
Vaccinated:1998-09-02
Onset:1998-09-03
Submitted:2001-09-13
Entered:2001-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES U0932710 / 3 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES U0950670 / 2 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0787H / 0 LL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 793E2 / 1 - / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0610H / 0 RL / IM

Administered by: (blank) Unknown      Purchased by: (blank) Unknown
Symptoms: Diarrhoea, Eye disorder, Fungal infection, Gait disturbance, Rash, Hypoacusis

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: ;UNK. MEASLES, MUMPS & RUBELLA VIRUS LIVE;2;5.00;In ~Measles + Mumps + Rubella (no brand name)~2~5.00~In Sibling
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: The pt experienced chronic permanent diarrhea, chronic "yeast infection" type rashes, change in hearing, loss of eye contact, started to walk on tip toes and spin allot.


Changed on 9/14/2017

VAERS ID: 175835 Before After
VAERS Form:(blank) 1
Age:1.3
Sex:Male
Location:Minnesota
Vaccinated:1998-09-02
Onset:1998-09-03
Submitted:2001-09-13
Entered:2001-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES U0932710 / 3 4 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES U0950670 / 2 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0787H / 0 1 LL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 793E2 / 1 2 - MO / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0610H / 0 1 RL / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diarrhoea, Eye disorder, Fungal infection, Gait disturbance, Rash, Hypoacusis

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: ~Measles + Mumps + Rubella (no brand name)~2~5.00~In Sibling
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: The pt experienced chronic permanent diarrhea, chronic "yeast infection" type rashes, change in hearing, loss of eye contact, started to walk on tip toes and spin allot.


Changed on 2/14/2018

VAERS ID: 175835 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Minnesota
Vaccinated:1998-09-02
Onset:1998-09-03
Submitted:2001-09-13
Entered:2001-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES U0932710 / 4 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES U0950670 / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0787H / 1 LL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 793E2 / 2 MO / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0610H / 1 RL / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diarrhoea, Eye disorder, Fungal infection, Gait disturbance, Rash, Hypoacusis

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: ~Measles + Mumps + Rubella (no brand name)~2~5.00~In Sibling
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: The pt experienced chronic permanent diarrhea, chronic "yeast infection" type rashes, change in hearing, loss of eye contact, started to walk on tip toes and spin allot.


Changed on 6/14/2018

VAERS ID: 175835 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Minnesota
Vaccinated:1998-09-02
Onset:1998-09-03
Submitted:2001-09-13
Entered:2001-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES U0932710 / 4 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES U0950670 / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0787H / 1 LL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 793E2 / 2 MO / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0610H / 1 RL / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diarrhoea, Eye disorder, Fungal infection, Gait disturbance, Rash, Hypoacusis

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: ~Measles + Mumps + Rubella (no brand name)~2~5.00~In Sibling
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: The pt experienced chronic permanent diarrhea, chronic "yeast infection" type rashes, change in hearing, loss of eye contact, started to walk on tip toes and spin allot.


Changed on 8/14/2018

VAERS ID: 175835 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Minnesota
Vaccinated:1998-09-02
Onset:1998-09-03
Submitted:2001-09-13
Entered:2001-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES U0932710 / 4 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES U0950670 / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0787H / 1 LL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 793E2 / 2 MO / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0610H / 1 RL / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diarrhoea, Eye disorder, Fungal infection, Gait disturbance, Rash, Hypoacusis

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: ~Measles + Mumps + Rubella (no brand name)~2~5.00~In Sibling
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: The pt experienced chronic permanent diarrhea, chronic "yeast infection" type rashes, change in hearing, loss of eye contact, started to walk on tip toes and spin allot.


Changed on 9/14/2018

VAERS ID: 175835 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Minnesota
Vaccinated:1998-09-02
Onset:1998-09-03
Submitted:2001-09-13
Entered:2001-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES U0932710 / 4 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES U0950670 / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0787H / 1 LL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 793E2 / 2 MO / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0610H / 1 RL / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diarrhoea, Eye disorder, Fungal infection, Gait disturbance, Rash, Hypoacusis

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: ~Measles + Mumps + Rubella (no brand name)~2~5.00~In Sibling
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: The pt experienced chronic permanent diarrhea, chronic "yeast infection" type rashes, change in hearing, loss of eye contact, started to walk on tip toes and spin allot.


Changed on 10/14/2018

VAERS ID: 175835 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Minnesota
Vaccinated:1998-09-02
Onset:1998-09-03
Submitted:2001-09-13
Entered:2001-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES U0932710 / 4 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES U0950670 / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0787H / 1 LL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 793E2 / 2 MO / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0610H / 1 RL / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diarrhoea, Eye disorder, Fungal infection, Gait disturbance, Rash, Hypoacusis

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: ~Measles + Mumps + Rubella (no brand name)~2~5.00~In Sibling
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: The pt experienced chronic permanent diarrhea, chronic "yeast infection" type rashes, change in hearing, loss of eye contact, started to walk on tip toes and spin allot.


Changed on 12/24/2020

VAERS ID: 175835 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Minnesota
Vaccinated:1998-09-02
Onset:1998-09-03
Submitted:2001-09-13
Entered:2001-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES U0932710 / 4 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES U0950670 / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0787H / 1 LL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 793E2 / 2 MO / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0610H / 1 RL / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diarrhoea, Eye disorder, Fungal infection, Gait disturbance, Rash, Hypoacusis

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: ~Measles + Mumps + Rubella (no brand name)~2~5.00~In Sibling
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: The pt experienced chronic permanent diarrhea, chronic "yeast infection" type rashes, change in hearing, loss of eye contact, started to walk on tip toes and spin allot.


Changed on 12/30/2020

VAERS ID: 175835 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Minnesota
Vaccinated:1998-09-02
Onset:1998-09-03
Submitted:2001-09-13
Entered:2001-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES U0932710 / 4 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES U0950670 / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0787H / 1 LL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 793E2 / 2 MO / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0610H / 1 RL / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diarrhoea, Eye disorder, Fungal infection, Gait disturbance, Rash, Hypoacusis

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: ~Measles + Mumps + Rubella (no brand name)~2~5.00~In Sibling
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: The pt experienced chronic permanent diarrhea, chronic "yeast infection" type rashes, change in hearing, loss of eye contact, started to walk on tip toes and spin allot.


Changed on 5/7/2021

VAERS ID: 175835 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Minnesota
Vaccinated:1998-09-02
Onset:1998-09-03
Submitted:2001-09-13
Entered:2001-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES U0932710 / 4 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES U0950670 / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0787H / 1 LL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 793E2 / 2 MO / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0610H / 1 RL / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diarrhoea, Eye disorder, Fungal infection, Gait disturbance, Rash, Hypoacusis

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: ~Measles + Mumps + Rubella (no brand name)~2~5.00~In Sibling
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: The pt experienced chronic permanent diarrhea, chronic "yeast infection" type rashes, change in hearing, loss of eye contact, started to walk on tip toes and spin allot.


Changed on 5/14/2021

VAERS ID: 175835 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Minnesota
Vaccinated:1998-09-02
Onset:1998-09-03
Submitted:2001-09-13
Entered:2001-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES U0932710 / 4 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES U0950670 / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0787H / 1 LL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 793E2 / 2 MO / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0610H / 1 RL / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diarrhoea, Eye disorder, Fungal infection, Gait disturbance, Rash, Hypoacusis

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: ~Measles + Mumps + Rubella (no brand name)~2~5.00~In Sibling
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: The pt experienced chronic permanent diarrhea, chronic "yeast infection" type rashes, change in hearing, loss of eye contact, started to walk on tip toes and spin allot.

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