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This is VAERS ID 25617

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 25617
VAERS Form:
Age:1.3
Sex:Female
Location:Texas
Vaccinated:1990-06-11
Onset:1990-06-11
Submitted:0000-00-00
Entered:1990-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP / CONNAUGHT LABS 9B11033 / - - / IM
MMR: MMR II / MSD 00655 / - - / IM
OPV: ORIMUNE / LEDERLE 259941 / - - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: CHILLS, FEVER, SWEAT, CYANOSIS

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
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:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: increased temp 102.4 F oral approx. 1 hr /p inject. Cyanotic face, hands & lower extremitites. Cold clamy feeling /w body shaking. No seizures. Rxn last approx. 15 min. No med intravention required.


Changed on 12/8/2009

VAERS ID: 25617 Before After
VAERS Form:
Age:1.3
Sex:Female
Location:Texas
Vaccinated:1990-06-11
Onset:1990-06-11
Submitted:0000-00-00
Entered:1990-07-31 1990-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP DTP (NO BRAND NAME) / CONNAUGHT LABS CONNAUGHT LABORATORIES 9B11033 / - - / IM
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 00655 / - - / IM
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 259941 / - - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Chills, Cyanosis, Hyperhidrosis, Pyrexia, CHILLS, FEVER, SWEAT, CYANOSIS

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
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:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: increased temp 102.4 F oral approx. 1 hr /p inject. Cyanotic face, hands & lower extremitites. Cold clamy feeling /w body shaking. No seizures. Rxn last approx. 15 min. No med intravention required.


Changed on 5/14/2017

VAERS ID: 25617 Before After
VAERS Form:
Age:1.3
Sex:Female
Location:Texas
Vaccinated:1990-06-11
Onset:1990-06-11
Submitted:0000-00-00
Entered:1990-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 9B11033 / - - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 00655 / - - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 259941 / - - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Chills, Cyanosis, Hyperhidrosis, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: increased temp 102.4 F oral approx. 1 hr /p inject. Cyanotic face, hands & lower extremitites. Cold clamy feeling /w body shaking. No seizures. Rxn last approx. 15 min. No med intravention required.


Changed on 9/14/2017

VAERS ID: 25617 Before After
VAERS Form:(blank) 1
Age:1.3
Sex:Female
Location:Texas
Vaccinated:1990-06-11
Onset:1990-06-11
Submitted:0000-00-00
Entered:1990-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 9B11033 / - UNK - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 00655 / - UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 259941 / - UNK - MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Chills, Cyanosis, Hyperhidrosis, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: increased temp 102.4 F oral approx. 1 hr /p inject. Cyanotic face, hands & lower extremitites. Cold clamy feeling /w body shaking. No seizures. Rxn last approx. 15 min. No med intravention required.


Changed on 2/14/2018

VAERS ID: 25617 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:Texas
Vaccinated:1990-06-11
Onset:1990-06-11
Submitted:0000-00-00
Entered:1990-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 9B11033 / UNK - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 00655 / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 259941 / UNK MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Chills, Cyanosis, Hyperhidrosis, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: increased temp 102.4 F oral approx. 1 hr /p inject. Cyanotic face, hands & lower extremitites. Cold clamy feeling /w body shaking. No seizures. Rxn last approx. 15 min. No med intravention required.


Changed on 6/14/2018

VAERS ID: 25617 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:Texas
Vaccinated:1990-06-11
Onset:1990-06-11
Submitted:0000-00-00
Entered:1990-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 9B11033 / UNK - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 00655 / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 259941 / UNK MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Chills, Cyanosis, Hyperhidrosis, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: increased temp 102.4 F oral approx. 1 hr /p inject. Cyanotic face, hands & lower extremitites. Cold clamy feeling /w body shaking. No seizures. Rxn last approx. 15 min. No med intravention required.


Changed on 8/14/2018

VAERS ID: 25617 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:Texas
Vaccinated:1990-06-11
Onset:1990-06-11
Submitted:0000-00-00
Entered:1990-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 9B11033 / UNK - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 00655 / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 259941 / UNK MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Chills, Cyanosis, Hyperhidrosis, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: increased temp 102.4 F oral approx. 1 hr /p inject. Cyanotic face, hands & lower extremitites. Cold clamy feeling /w body shaking. No seizures. Rxn last approx. 15 min. No med intravention required.


Changed on 9/14/2018

VAERS ID: 25617 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:Texas
Vaccinated:1990-06-11
Onset:1990-06-11
Submitted:0000-00-00
Entered:1990-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 9B11033 / UNK - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 00655 / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 259941 / UNK MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Chills, Cyanosis, Hyperhidrosis, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: increased temp 102.4 F oral approx. 1 hr /p inject. Cyanotic face, hands & lower extremitites. Cold clamy feeling /w body shaking. No seizures. Rxn last approx. 15 min. No med intravention required.


Changed on 10/14/2018

VAERS ID: 25617 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:Texas
Vaccinated:1990-06-11
Onset:1990-06-11
Submitted:0000-00-00
Entered:1990-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 9B11033 / UNK - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 00655 / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 259941 / UNK MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Chills, Cyanosis, Hyperhidrosis, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: increased temp 102.4 F oral approx. 1 hr /p inject. Cyanotic face, hands & lower extremitites. Cold clamy feeling /w body shaking. No seizures. Rxn last approx. 15 min. No med intravention required.

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