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This is VAERS ID 25961

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 25961
VAERS Form:
Age:5.0
Sex:Male
Location:New York
Vaccinated:1990-08-18
Onset:1990-08-23
Submitted:1990-09-06
Entered:1990-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MMR II / MSD 2074R / 1 A / SC

Administered by: Private      Purchased by: Unknown
Symptoms: APNEA, PAIN, HEART ARREST, LAB TEST ABNORM

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Sickle Cell Disease/Anemia
Allergies:
Diagnostic Lab Data: WBC - 8,000 on admission
CDC 'Split Type':

Write-up: Pt vaccinated with MMR, experienced Leg pains, ileus 25AUG90, HSP 25AUG, Hgb decreased 3gm%, 29AUG resp & cardiac crisis reversed w/transfusion. D/C asympotomatic 5SEP90 disch asymptomatic 5SEP90.


Changed on 12/8/2009

VAERS ID: 25961 Before After
VAERS Form:
Age:5.0
Sex:Male
Location:New York
Vaccinated:1990-08-18
Onset:1990-08-23
Submitted:1990-09-06
Entered:1990-09-20 1990-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 2074R / 1 A / SC

Administered by: Private      Purchased by: Unknown Private
Symptoms: Apnoea, Cardiac arrest, Laboratory test abnormal, Pain, APNEA, PAIN, HEART ARREST, LAB TEST ABNORM

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Sickle Cell Disease/Anemia
Allergies:
Diagnostic Lab Data: WBC - 8,000 on admission
CDC 'Split Type':

Write-up: Pt vaccinated with MMR, experienced Leg pains, ileus 25AUG90, HSP 25AUG, Hgb decreased 3gm%, 29AUG resp & cardiac crisis reversed w/transfusion. D/C asympotomatic 5SEP90 disch asymptomatic 5SEP90.


Changed on 5/14/2017

VAERS ID: 25961 Before After
VAERS Form:
Age:5.0
Sex:Male
Location:New York
Vaccinated:1990-08-18
Onset:1990-08-23
Submitted:1990-09-06
Entered:1990-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2074R / 1 A - / SC SC A

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Laboratory test abnormal, Pain

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Sickle Cell Disease/Anemia
Allergies:
Diagnostic Lab Data: WBC - 8,000 on admission
CDC 'Split Type':

Write-up: Pt vaccinated with MMR, experienced Leg pains, ileus 25AUG90, HSP 25AUG, Hgb decreased 3gm%, 29AUG resp & cardiac crisis reversed w/transfusion. D/C asympotomatic 5SEP90 disch asymptomatic 5SEP90.


Changed on 9/14/2017

VAERS ID: 25961 Before After
VAERS Form:(blank) 1
Age:5.0
Sex:Male
Location:New York
Vaccinated:1990-08-18
Onset:1990-08-23
Submitted:1990-09-06
Entered:1990-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2074R / 1 2 - / SC A

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Laboratory test abnormal, Pain

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Sickle Cell Disease/Anemia
Allergies:
Diagnostic Lab Data: WBC - 8,000 on admission
CDC 'Split Type':

Write-up: Pt vaccinated with MMR, experienced Leg pains, ileus 25AUG90, HSP 25AUG, Hgb decreased 3gm%, 29AUG resp & cardiac crisis reversed w/transfusion. D/C asympotomatic 5SEP90 disch asymptomatic 5SEP90.


Changed on 2/14/2018

VAERS ID: 25961 Before After
VAERS Form:1
Age:5.0
Sex:Male
Location:New York
Vaccinated:1990-08-18
Onset:1990-08-23
Submitted:1990-09-06
Entered:1990-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2074R / 2 - / SC A

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Laboratory test abnormal, Pain

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Sickle Cell Disease/Anemia
Allergies:
Diagnostic Lab Data: WBC - 8,000 on admission
CDC 'Split Type':

Write-up: Pt vaccinated with MMR, experienced Leg pains, ileus 25AUG90, HSP 25AUG, Hgb decreased 3gm%, 29AUG resp & cardiac crisis reversed w/transfusion. D/C asympotomatic 5SEP90 disch asymptomatic 5SEP90.


Changed on 6/14/2018

VAERS ID: 25961 Before After
VAERS Form:1
Age:5.0
Sex:Male
Location:New York
Vaccinated:1990-08-18
Onset:1990-08-23
Submitted:1990-09-06
Entered:1990-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2074R / 2 - / SC A

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Laboratory test abnormal, Pain

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Sickle Cell Disease/Anemia
Allergies:
Diagnostic Lab Data: WBC - 8,000 on admission
CDC 'Split Type':

Write-up: Pt vaccinated with MMR, experienced Leg pains, ileus 25AUG90, HSP 25AUG, Hgb decreased 3gm%, 29AUG resp & cardiac crisis reversed w/transfusion. D/C asympotomatic 5SEP90 disch asymptomatic 5SEP90.


Changed on 8/14/2018

VAERS ID: 25961 Before After
VAERS Form:1
Age:5.0
Sex:Male
Location:New York
Vaccinated:1990-08-18
Onset:1990-08-23
Submitted:1990-09-06
Entered:1990-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2074R / 2 - / SC A

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Laboratory test abnormal, Pain

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Sickle Cell Disease/Anemia
Allergies:
Diagnostic Lab Data: WBC - 8,000 on admission
CDC 'Split Type':

Write-up: Pt vaccinated with MMR, experienced Leg pains, ileus 25AUG90, HSP 25AUG, Hgb decreased 3gm%, 29AUG resp & cardiac crisis reversed w/transfusion. D/C asympotomatic 5SEP90 disch asymptomatic 5SEP90.


Changed on 9/14/2018

VAERS ID: 25961 Before After
VAERS Form:1
Age:5.0
Sex:Male
Location:New York
Vaccinated:1990-08-18
Onset:1990-08-23
Submitted:1990-09-06
Entered:1990-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2074R / 2 - / SC A

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Laboratory test abnormal, Pain

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Sickle Cell Disease/Anemia
Allergies:
Diagnostic Lab Data: WBC - 8,000 on admission
CDC 'Split Type':

Write-up: Pt vaccinated with MMR, experienced Leg pains, ileus 25AUG90, HSP 25AUG, Hgb decreased 3gm%, 29AUG resp & cardiac crisis reversed w/transfusion. D/C asympotomatic 5SEP90 disch asymptomatic 5SEP90.


Changed on 10/14/2018

VAERS ID: 25961 Before After
VAERS Form:1
Age:5.0
Sex:Male
Location:New York
Vaccinated:1990-08-18
Onset:1990-08-23
Submitted:1990-09-06
Entered:1990-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2074R / 2 - / SC A

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Laboratory test abnormal, Pain

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Sickle Cell Disease/Anemia
Allergies:
Diagnostic Lab Data: WBC - 8,000 on admission
CDC 'Split Type':

Write-up: Pt vaccinated with MMR, experienced Leg pains, ileus 25AUG90, HSP 25AUG, Hgb decreased 3gm%, 29AUG resp & cardiac crisis reversed w/transfusion. D/C asympotomatic 5SEP90 disch asymptomatic 5SEP90.

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