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This is VAERS ID 176444

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 176444
VAERS Form:
Age:5.0
Sex:Male
Location:Unknown
Vaccinated:2000-08-07
Onset:2000-08-10
Submitted:2001-10-17
Entered:2001-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE 956A2 / 0 LA / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD R1346 / 0 LL / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MSD 0401K / 1 RA / SC
VARCEL: VARICELLA (VARIVAX) / MSD 1349J / 0 LA / SC

Administered by: Other      Purchased by: Unknown
Symptoms: EDEMA, GAIT ABNORM, PAIN, ORCHITIS, EDEMA SCROTUM

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Ultrasound-test results not provided
CDC 'Split Type':

Write-up: On 8/7/00, the child received his 1st injection of Infanrix. On that date, he also received his 2nd injection of MMRII and his 1st injections of varicella and IPOL. On 8/10/00, the pt experienced left testicular swelling, mild erythema of the left scrotum"with generalized tenderness and swelling. The pt walks with legs slightly abducted. The pt''s dx was orchitis. The pt''s mother stated that ""we can only conclude that it was a reaction to the vaccine"". He was seen by a pediatric urologist who reported ""t


Changed on 12/30/2006

VAERS ID: 176444 Before After
VAERS Form:
Age:5.0
Sex:Male
Location:Unknown
Vaccinated:2000-08-07
Onset:2000-08-10
Submitted:2001-10-17
Entered:2001-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE 956A2 / 0 LA / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD R1346 / 0 LL / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MSD 0401K / 1 RA / SC
VARCEL: VARICELLA (VARIVAX) / MSD 1349J / 0 LA / SC

Administered by: Other      Purchased by: Unknown
Symptoms: EDEMA, GAIT ABNORM, PAIN, ORCHITIS, EDEMA SCROTUM

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Ultrasound-test results not provided
CDC 'Split Type':

Write-up: On 8/7/00, the child received his 1st injection of Infanrix. On that date, he also received his 2nd injection of MMRII and his 1st injections of varicella and IPOL. On 8/10/00, the pt experienced left testicular swelling, mild erythema of the left scrotum"with generalized tenderness and swelling. The pt walks with legs slightly abducted. The pt''s pt''''s dx was orchitis. The pt''s pt''''s mother stated that ""we /"we can only conclude that it was a reaction to the vaccine"". vaccine/". He was seen by a pediatric urologist who reported ""t /


Changed on 12/8/2009

VAERS ID: 176444 Before After
VAERS Form:
Age:5.0
Sex:Male
Location:Unknown
Vaccinated:2000-08-07
Onset:2000-08-10
Submitted:2001-10-17
Entered:2001-10-19 2001-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE SMITHKLINE BEECHAM 956A2 / 0 LA / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. R1346 / 0 LL / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 0401K / 1 RA / SC
VARCEL: VARICELLA (VARIVAX) VARICELLA (VARIVAX) / MSD MERCK & CO. INC. 1349J / 0 LA / SC

Administered by: Other      Purchased by: Unknown Other
Symptoms: Difficulty in walking, Erythema, Orchitis, Pain, Scrotal oedema, Swelling, EDEMA, GAIT ABNORM, PAIN, ORCHITIS, EDEMA SCROTUM

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Ultrasound-test results not provided
CDC 'Split Type': (blank) 20010241221

Write-up: On 8/7/00, the child received his 1st injection of Infanrix. On that date, he also received his 2nd injection of MMRII and his 1st injections of varicella and IPOL. On 8/10/00, the pt experienced left testicular swelling, mild erythema of the left scrotum"with scrotum with generalized tenderness and swelling. The pt walks with legs slightly abducted. The pt''''s pt''s dx was orchitis. The pt''''s pt''s mother stated that /"we "we can only conclude that it was a reaction to the vaccine/". vaccine". He was seen by a pediatric urologist who reported / "that there had not been a documented case of this type of reaction in a juvenile in over 17 years". The reporter considered the pt''s experience to have resulted in a significant disability. Follow-up information from a nurse, stated "she vaguely recalled this child''s experience and believed he had seen a pediatric urologist who was not the primary physician treating the pt for this experience". The nurse also stated "she thought it was the urologist who felt the child''s orchitis was related to MMRII vaccination, though she was not certain of this". She also stated "that she believed the child walked with his legs abducted due to the testicular swelling and orchitis and this was not a separate experience but again she could not definitively state this without checking the pt''s chart". Outcome of the orchitis was not provided.


Changed on 9/14/2017

VAERS ID: 176444 Before After
VAERS Form:(blank) 1
Age:5.0
Sex:Male
Location:Unknown
Vaccinated:2000-08-07
Onset:2000-08-10
Submitted:2001-10-17
Entered:2001-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 956A2 / 0 1 LA / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R1346 / 0 1 LL / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0401K / 1 2 RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1349J / 0 1 LA / SC

Administered by: Other      Purchased by: Other
Symptoms: Difficulty in walking, Erythema, Orchitis, Pain, Scrotal oedema, Swelling

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Ultrasound-test results not provided
CDC 'Split Type': 20010241221

Write-up: On 8/7/00, the child received his 1st injection of Infanrix. On that date, he also received his 2nd injection of MMRII and his 1st injections of varicella and IPOL. On 8/10/00, the pt experienced left testicular swelling, mild erythema of the left scrotum with generalized tenderness and swelling. The pt walks with legs slightly abducted. The pt''s dx was orchitis. The pt''s mother stated that "we can only conclude that it was a reaction to the vaccine". He was seen by a pediatric urologist who reported "that there had not been a documented case of this type of reaction in a juvenile in over 17 years". The reporter considered the pt''s experience to have resulted in a significant disability. Follow-up information from a nurse, stated "she vaguely recalled this child''s experience and believed he had seen a pediatric urologist who was not the primary physician treating the pt for this experience". The nurse also stated "she thought it was the urologist who felt the child''s orchitis was related to MMRII vaccination, though she was not certain of this". She also stated "that she believed the child walked with his legs abducted due to the testicular swelling and orchitis and this was not a separate experience but again she could not definitively state this without checking the pt''s chart". Outcome of the orchitis was not provided.


Changed on 2/14/2018

VAERS ID: 176444 Before After
VAERS Form:1
Age:5.0
Sex:Male
Location:Unknown
Vaccinated:2000-08-07
Onset:2000-08-10
Submitted:2001-10-17
Entered:2001-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 956A2 / 1 LA / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R1346 / 1 LL / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0401K / 2 RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1349J / 1 LA / SC

Administered by: Other      Purchased by: Other
Symptoms: Difficulty in walking, Erythema, Orchitis, Pain, Scrotal oedema, Swelling

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Ultrasound-test results not provided
CDC 'Split Type': 20010241221

Write-up: On 8/7/00, the child received his 1st injection of Infanrix. On that date, he also received his 2nd injection of MMRII and his 1st injections of varicella and IPOL. On 8/10/00, the pt experienced left testicular swelling, mild erythema of the left scrotum with generalized tenderness and swelling. The pt walks with legs slightly abducted. The pt''s dx was orchitis. The pt''s mother stated that "we can only conclude that it was a reaction to the vaccine". He was seen by a pediatric urologist who reported "that there had not been a documented case of this type of reaction in a juvenile in over 17 years". The reporter considered the pt''s experience to have resulted in a significant disability. Follow-up information from a nurse, stated "she vaguely recalled this child''s experience and believed he had seen a pediatric urologist who was not the primary physician treating the pt for this experience". The nurse also stated "she thought it was the urologist who felt the child''s orchitis was related to MMRII vaccination, though she was not certain of this". She also stated "that she believed the child walked with his legs abducted due to the testicular swelling and orchitis and this was not a separate experience but again she could not definitively state this without checking the pt''s chart". Outcome of the orchitis was not provided.


Changed on 6/14/2018

VAERS ID: 176444 Before After
VAERS Form:1
Age:5.0
Sex:Male
Location:Unknown
Vaccinated:2000-08-07
Onset:2000-08-10
Submitted:2001-10-17
Entered:2001-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 956A2 / 1 LA / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R1346 / 1 LL / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0401K / 2 RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1349J / 1 LA / SC

Administered by: Other      Purchased by: Other
Symptoms: Difficulty in walking, Erythema, Orchitis, Pain, Scrotal oedema, Swelling

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Ultrasound-test results not provided
CDC 'Split Type': 20010241221

Write-up: On 8/7/00, the child received his 1st injection of Infanrix. On that date, he also received his 2nd injection of MMRII and his 1st injections of varicella and IPOL. On 8/10/00, the pt experienced left testicular swelling, mild erythema of the left scrotum with generalized tenderness and swelling. The pt walks with legs slightly abducted. The pt''s dx was orchitis. The pt''s mother stated that "we can only conclude that it was a reaction to the vaccine". He was seen by a pediatric urologist who reported "that there had not been a documented case of this type of reaction in a juvenile in over 17 years". The reporter considered the pt''s experience to have resulted in a significant disability. Follow-up information from a nurse, stated "she vaguely recalled this child''s experience and believed he had seen a pediatric urologist who was not the primary physician treating the pt for this experience". The nurse also stated "she thought it was the urologist who felt the child''s orchitis was related to MMRII vaccination, though she was not certain of this". She also stated "that she believed the child walked with his legs abducted due to the testicular swelling and orchitis and this was not a separate experience but again she could not definitively state this without checking the pt''s chart". Outcome of the orchitis was not provided.


Changed on 8/14/2018

VAERS ID: 176444 Before After
VAERS Form:1
Age:5.0
Sex:Male
Location:Unknown
Vaccinated:2000-08-07
Onset:2000-08-10
Submitted:2001-10-17
Entered:2001-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 956A2 / 1 LA / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R1346 / 1 LL / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0401K / 2 RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1349J / 1 LA / SC

Administered by: Other      Purchased by: Other
Symptoms: Difficulty in walking, Erythema, Orchitis, Pain, Scrotal oedema, Swelling

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Ultrasound-test results not provided
CDC 'Split Type': 20010241221

Write-up: On 8/7/00, the child received his 1st injection of Infanrix. On that date, he also received his 2nd injection of MMRII and his 1st injections of varicella and IPOL. On 8/10/00, the pt experienced left testicular swelling, mild erythema of the left scrotum with generalized tenderness and swelling. The pt walks with legs slightly abducted. The pt''s dx was orchitis. The pt''s mother stated that "we can only conclude that it was a reaction to the vaccine". He was seen by a pediatric urologist who reported "that there had not been a documented case of this type of reaction in a juvenile in over 17 years". The reporter considered the pt''s experience to have resulted in a significant disability. Follow-up information from a nurse, stated "she vaguely recalled this child''s experience and believed he had seen a pediatric urologist who was not the primary physician treating the pt for this experience". The nurse also stated "she thought it was the urologist who felt the child''s orchitis was related to MMRII vaccination, though she was not certain of this". She also stated "that she believed the child walked with his legs abducted due to the testicular swelling and orchitis and this was not a separate experience but again she could not definitively state this without checking the pt''s chart". Outcome of the orchitis was not provided.


Changed on 9/14/2018

VAERS ID: 176444 Before After
VAERS Form:1
Age:5.0
Sex:Male
Location:Unknown
Vaccinated:2000-08-07
Onset:2000-08-10
Submitted:2001-10-17
Entered:2001-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 956A2 / 1 LA / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R1346 / 1 LL / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0401K / 2 RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1349J / 1 LA / SC

Administered by: Other      Purchased by: Other
Symptoms: Difficulty in walking, Erythema, Orchitis, Pain, Scrotal oedema, Swelling

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Ultrasound-test results not provided
CDC 'Split Type': 20010241221

Write-up: On 8/7/00, the child received his 1st injection of Infanrix. On that date, he also received his 2nd injection of MMRII and his 1st injections of varicella and IPOL. On 8/10/00, the pt experienced left testicular swelling, mild erythema of the left scrotum with generalized tenderness and swelling. The pt walks with legs slightly abducted. The pt''s dx was orchitis. The pt''s mother stated that "we can only conclude that it was a reaction to the vaccine". He was seen by a pediatric urologist who reported "that there had not been a documented case of this type of reaction in a juvenile in over 17 years". The reporter considered the pt''s experience to have resulted in a significant disability. Follow-up information from a nurse, stated "she vaguely recalled this child''s experience and believed he had seen a pediatric urologist who was not the primary physician treating the pt for this experience". The nurse also stated "she thought it was the urologist who felt the child''s orchitis was related to MMRII vaccination, though she was not certain of this". She also stated "that she believed the child walked with his legs abducted due to the testicular swelling and orchitis and this was not a separate experience but again she could not definitively state this without checking the pt''s chart". Outcome of the orchitis was not provided.


Changed on 10/14/2018

VAERS ID: 176444 Before After
VAERS Form:1
Age:5.0
Sex:Male
Location:Unknown
Vaccinated:2000-08-07
Onset:2000-08-10
Submitted:2001-10-17
Entered:2001-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 956A2 / 1 LA / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R1346 / 1 LL / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0401K / 2 RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1349J / 1 LA / SC

Administered by: Other      Purchased by: Other
Symptoms: Difficulty in walking, Erythema, Orchitis, Pain, Scrotal oedema, Swelling

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Ultrasound-test results not provided
CDC 'Split Type': 20010241221

Write-up: On 8/7/00, the child received his 1st injection of Infanrix. On that date, he also received his 2nd injection of MMRII and his 1st injections of varicella and IPOL. On 8/10/00, the pt experienced left testicular swelling, mild erythema of the left scrotum with generalized tenderness and swelling. The pt walks with legs slightly abducted. The pt''s dx was orchitis. The pt''s mother stated that "we can only conclude that it was a reaction to the vaccine". He was seen by a pediatric urologist who reported "that there had not been a documented case of this type of reaction in a juvenile in over 17 years". The reporter considered the pt''s experience to have resulted in a significant disability. Follow-up information from a nurse, stated "she vaguely recalled this child''s experience and believed he had seen a pediatric urologist who was not the primary physician treating the pt for this experience". The nurse also stated "she thought it was the urologist who felt the child''s orchitis was related to MMRII vaccination, though she was not certain of this". She also stated "that she believed the child walked with his legs abducted due to the testicular swelling and orchitis and this was not a separate experience but again she could not definitively state this without checking the pt''s chart". Outcome of the orchitis was not provided.


Changed on 12/24/2020

VAERS ID: 176444 Before After
VAERS Form:1
Age:5.0
Sex:Male
Location:Unknown
Vaccinated:2000-08-07
Onset:2000-08-10
Submitted:2001-10-17
Entered:2001-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 956A2 / 1 LA / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R1346 / 1 LL / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0401K / 2 RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1349J / 1 LA / SC

Administered by: Other      Purchased by: Other
Symptoms: Difficulty in walking, Erythema, Orchitis, Pain, Scrotal oedema, Swelling

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Ultrasound-test results not provided
CDC 'Split Type': 20010241221

Write-up: On 8/7/00, the child received his 1st injection of Infanrix. On that date, he also received his 2nd injection of MMRII and his 1st injections of varicella and IPOL. On 8/10/00, the pt experienced left testicular swelling, mild erythema of the left scrotum with generalized tenderness and swelling. The pt walks with legs slightly abducted. The pt''s dx was orchitis. The pt''s mother stated that "we can only conclude that it was a reaction to the vaccine". He was seen by a pediatric urologist who reported "that there had not been a documented case of this type of reaction in a juvenile in over 17 years". The reporter considered the pt''s experience to have resulted in a significant disability. Follow-up information from a nurse, stated "she vaguely recalled this child''s experience and believed he had seen a pediatric urologist who was not the primary physician treating the pt for this experience". The nurse also stated "she thought it was the urologist who felt the child''s orchitis was related to MMRII vaccination, though she was not certain of this". She also stated "that she believed the child walked with his legs abducted due to the testicular swelling and orchitis and this was not a separate experience but again she could not definitively state this without checking the pt''s chart". Outcome of the orchitis was not provided.


Changed on 12/30/2020

VAERS ID: 176444 Before After
VAERS Form:1
Age:5.0
Sex:Male
Location:Unknown
Vaccinated:2000-08-07
Onset:2000-08-10
Submitted:2001-10-17
Entered:2001-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 956A2 / 1 LA / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R1346 / 1 LL / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0401K / 2 RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1349J / 1 LA / SC

Administered by: Other      Purchased by: Other
Symptoms: Difficulty in walking, Erythema, Orchitis, Pain, Scrotal oedema, Swelling

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Ultrasound-test results not provided
CDC 'Split Type': 20010241221

Write-up: On 8/7/00, the child received his 1st injection of Infanrix. On that date, he also received his 2nd injection of MMRII and his 1st injections of varicella and IPOL. On 8/10/00, the pt experienced left testicular swelling, mild erythema of the left scrotum with generalized tenderness and swelling. The pt walks with legs slightly abducted. The pt''s dx was orchitis. The pt''s mother stated that "we can only conclude that it was a reaction to the vaccine". He was seen by a pediatric urologist who reported "that there had not been a documented case of this type of reaction in a juvenile in over 17 years". The reporter considered the pt''s experience to have resulted in a significant disability. Follow-up information from a nurse, stated "she vaguely recalled this child''s experience and believed he had seen a pediatric urologist who was not the primary physician treating the pt for this experience". The nurse also stated "she thought it was the urologist who felt the child''s orchitis was related to MMRII vaccination, though she was not certain of this". She also stated "that she believed the child walked with his legs abducted due to the testicular swelling and orchitis and this was not a separate experience but again she could not definitively state this without checking the pt''s chart". Outcome of the orchitis was not provided.


Changed on 5/7/2021

VAERS ID: 176444 Before After
VAERS Form:1
Age:5.0
Sex:Male
Location:Unknown
Vaccinated:2000-08-07
Onset:2000-08-10
Submitted:2001-10-17
Entered:2001-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 956A2 / 1 LA / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R1346 / 1 LL / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0401K / 2 RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1349J / 1 LA / SC

Administered by: Other      Purchased by: Other
Symptoms: Difficulty in walking, Erythema, Orchitis, Pain, Scrotal oedema, Swelling

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Ultrasound-test results not provided
CDC 'Split Type': 20010241221

Write-up: On 8/7/00, the child received his 1st injection of Infanrix. On that date, he also received his 2nd injection of MMRII and his 1st injections of varicella and IPOL. On 8/10/00, the pt experienced left testicular swelling, mild erythema of the left scrotum with generalized tenderness and swelling. The pt walks with legs slightly abducted. The pt''s dx was orchitis. The pt''s mother stated that "we can only conclude that it was a reaction to the vaccine". He was seen by a pediatric urologist who reported "that there had not been a documented case of this type of reaction in a juvenile in over 17 years". The reporter considered the pt''s experience to have resulted in a significant disability. Follow-up information from a nurse, stated "she vaguely recalled this child''s experience and believed he had seen a pediatric urologist who was not the primary physician treating the pt for this experience". The nurse also stated "she thought it was the urologist who felt the child''s orchitis was related to MMRII vaccination, though she was not certain of this". She also stated "that she believed the child walked with his legs abducted due to the testicular swelling and orchitis and this was not a separate experience but again she could not definitively state this without checking the pt''s chart". Outcome of the orchitis was not provided.


Changed on 5/14/2021

VAERS ID: 176444 Before After
VAERS Form:1
Age:5.0
Sex:Male
Location:Unknown
Vaccinated:2000-08-07
Onset:2000-08-10
Submitted:2001-10-17
Entered:2001-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 956A2 / 1 LA / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R1346 / 1 LL / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0401K / 2 RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1349J / 1 LA / SC

Administered by: Other      Purchased by: Other
Symptoms: Difficulty in walking, Erythema, Orchitis, Pain, Scrotal oedema, Swelling

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Ultrasound-test results not provided
CDC 'Split Type': 20010241221

Write-up: On 8/7/00, the child received his 1st injection of Infanrix. On that date, he also received his 2nd injection of MMRII and his 1st injections of varicella and IPOL. On 8/10/00, the pt experienced left testicular swelling, mild erythema of the left scrotum with generalized tenderness and swelling. The pt walks with legs slightly abducted. The pt''s dx was orchitis. The pt''s mother stated that "we can only conclude that it was a reaction to the vaccine". He was seen by a pediatric urologist who reported "that there had not been a documented case of this type of reaction in a juvenile in over 17 years". The reporter considered the pt''s experience to have resulted in a significant disability. Follow-up information from a nurse, stated "she vaguely recalled this child''s experience and believed he had seen a pediatric urologist who was not the primary physician treating the pt for this experience". The nurse also stated "she thought it was the urologist who felt the child''s orchitis was related to MMRII vaccination, though she was not certain of this". She also stated "that she believed the child walked with his legs abducted due to the testicular swelling and orchitis and this was not a separate experience but again she could not definitively state this without checking the pt''s chart". Outcome of the orchitis was not provided.

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