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This is VAERS ID 26020

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 26020
VAERS Form:
Age:5.0
Sex:Female
Location:Illinois
Vaccinated:1990-09-04
Onset:1990-09-05
Submitted:1990-09-14
Entered:1990-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP / CONNAUGHT LABS 0F11081 / 3 RA / IM
MMR: MMR II / MSD - / 1 LA / SC
OPV: ORIMUNE / LEDERLE - / 3 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: INJECT SITE REACT, FEVER, SOMNOLENCE

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Tylenol given for T & discomfort
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt came into ofc 1 day /p vaccine given, c/o sleepy & T, red patch & tenderness at rt deltoid & axillary T 101.8 at 5:05 pm


Changed on 12/8/2009

VAERS ID: 26020 Before After
VAERS Form:
Age:5.0
Sex:Female
Location:Illinois
Vaccinated:1990-09-04
Onset:1990-09-05
Submitted:1990-09-14
Entered:1990-09-25 1990-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP DTP (NO BRAND NAME) / CONNAUGHT LABS CONNAUGHT LABORATORIES 0F11081 / 3 RA / IM
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. - / 1 LA / SC
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES - / 3 - / PO

Administered by: Private      Purchased by: Unknown Private
Symptoms: Injection site reaction, Pyrexia, Somnolence, INJECT SITE REACT, FEVER, SOMNOLENCE

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Tylenol given for T & discomfort
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt came into ofc 1 day /p vaccine given, c/o sleepy & T, red patch & tenderness at rt deltoid & axillary T 101.8 at 5:05 pm


Changed on 5/14/2017

VAERS ID: 26020 Before After
VAERS Form:
Age:5.0
Sex:Female
Location:Illinois
Vaccinated:1990-09-04
Onset:1990-09-05
Submitted:1990-09-14
Entered:1990-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0F11081 / 3 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH - / 3 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Injection site reaction, Pyrexia, Somnolence

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Tylenol given for T & discomfort
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt came into ofc 1 day /p vaccine given, c/o sleepy & T, red patch & tenderness at rt deltoid & axillary T 101.8 at 5:05 pm


Changed on 9/14/2017

VAERS ID: 26020 Before After
VAERS Form:(blank) 1
Age:5.0
Sex:Female
Location:Illinois
Vaccinated:1990-09-04
Onset:1990-09-05
Submitted:1990-09-14
Entered:1990-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0F11081 / 3 4 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 1 2 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / 3 4 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Injection site reaction, Pyrexia, Somnolence

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Tylenol given for T & discomfort
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt came into ofc 1 day /p vaccine given, c/o sleepy & T, red patch & tenderness at rt deltoid & axillary T 101.8 at 5:05 pm


Changed on 2/14/2018

VAERS ID: 26020 Before After
VAERS Form:1
Age:5.0
Sex:Female
Location:Illinois
Vaccinated:1990-09-04
Onset:1990-09-05
Submitted:1990-09-14
Entered:1990-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0F11081 / 4 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 2 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / 4 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Injection site reaction, Pyrexia, Somnolence

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Tylenol given for T & discomfort
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt came into ofc 1 day /p vaccine given, c/o sleepy & T, red patch & tenderness at rt deltoid & axillary T 101.8 at 5:05 pm


Changed on 6/14/2018

VAERS ID: 26020 Before After
VAERS Form:1
Age:5.0
Sex:Female
Location:Illinois
Vaccinated:1990-09-04
Onset:1990-09-05
Submitted:1990-09-14
Entered:1990-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0F11081 / 4 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 2 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / 4 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Injection site reaction, Pyrexia, Somnolence

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Tylenol given for T & discomfort
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt came into ofc 1 day /p vaccine given, c/o sleepy & T, red patch & tenderness at rt deltoid & axillary T 101.8 at 5:05 pm


Changed on 8/14/2018

VAERS ID: 26020 Before After
VAERS Form:1
Age:5.0
Sex:Female
Location:Illinois
Vaccinated:1990-09-04
Onset:1990-09-05
Submitted:1990-09-14
Entered:1990-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0F11081 / 4 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 2 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / 4 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Injection site reaction, Pyrexia, Somnolence

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Tylenol given for T & discomfort
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt came into ofc 1 day /p vaccine given, c/o sleepy & T, red patch & tenderness at rt deltoid & axillary T 101.8 at 5:05 pm


Changed on 9/14/2018

VAERS ID: 26020 Before After
VAERS Form:1
Age:5.0
Sex:Female
Location:Illinois
Vaccinated:1990-09-04
Onset:1990-09-05
Submitted:1990-09-14
Entered:1990-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0F11081 / 4 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 2 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / 4 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Injection site reaction, Pyrexia, Somnolence

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Tylenol given for T & discomfort
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt came into ofc 1 day /p vaccine given, c/o sleepy & T, red patch & tenderness at rt deltoid & axillary T 101.8 at 5:05 pm


Changed on 10/14/2018

VAERS ID: 26020 Before After
VAERS Form:1
Age:5.0
Sex:Female
Location:Illinois
Vaccinated:1990-09-04
Onset:1990-09-05
Submitted:1990-09-14
Entered:1990-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0F11081 / 4 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 2 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / 4 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Injection site reaction, Pyrexia, Somnolence

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Tylenol given for T & discomfort
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt came into ofc 1 day /p vaccine given, c/o sleepy & T, red patch & tenderness at rt deltoid & axillary T 101.8 at 5:05 pm

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=26020&WAYBACKHISTORY=ON


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