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This is VAERS ID 26078

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 26078
VAERS Form:
Age:18.7
Sex:Female
Location:New York
Vaccinated:1990-08-16
Onset:1990-08-16
Submitted:1990-09-17
Entered:1990-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MMR II / MSD 0692S / 0 - / SC
TD: UNK.TD ADSORBED, ADULTS / UNCLASSIFIED 287962 / - A / -

Administered by: Private      Purchased by: Unknown
Symptoms: SYNCOPE

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:
Current Illness:
Preexisting Conditions: Hx of prior syncope x2
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with MMR/TINE TEST 1 min later fainted sustained minor abrasions of face as result of syncope awoke spontaneously in 20 seconds after fainting.


Changed on 12/8/2009

VAERS ID: 26078 Before After
VAERS Form:
Age:18.7
Sex:Female
Location:New York
Vaccinated:1990-08-16
Onset:1990-08-16
Submitted:1990-09-17
Entered:1990-09-27 1990-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 0692S / 0 - / SC
TD: UNK.TD ADSORBED, ADULTS TD ADSORBED (NO BRAND NAME) / UNCLASSIFIED UNKNOWN MANUFACTURER 287962 / - A / -

Administered by: Private      Purchased by: Unknown Private
Symptoms: Syncope, SYNCOPE

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:
Current Illness:
Preexisting Conditions: Hx of prior syncope x2
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with MMR/TINE TEST 1 min later fainted sustained minor abrasions of face as result of syncope awoke spontaneously in 20 seconds after fainting.


Changed on 2/14/2017

VAERS ID: 26078 Before After
VAERS Form:
Age:18.7 18.0
Sex:Female
Location:New York
Vaccinated:1990-08-16
Onset:1990-08-16
Submitted:1990-09-17
Entered:1990-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0692S / 0 - / SC
TD: TD ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER 287962 / - A / -

Administered by: Private      Purchased by: Private
Symptoms: Syncope

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:
Current Illness:
Preexisting Conditions: Hx of prior syncope x2
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with MMR/TINE TEST 1 min later fainted sustained minor abrasions of face as result of syncope awoke spontaneously in 20 seconds after fainting.


Changed on 5/14/2017

VAERS ID: 26078 Before After
VAERS Form:
Age:18.0
Sex:Female
Location:New York
Vaccinated:1990-08-16
Onset:1990-08-16
Submitted:1990-09-17
Entered:1990-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0692S / 0 - / SC
TD: TD ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER 287962 / - A - / - A

Administered by: Private      Purchased by: Private
Symptoms: Syncope

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:
Current Illness:
Preexisting Conditions: Hx of prior syncope x2
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with MMR/TINE TEST 1 min later fainted sustained minor abrasions of face as result of syncope awoke spontaneously in 20 seconds after fainting.


Changed on 9/14/2017

VAERS ID: 26078 Before After
VAERS Form:(blank) 1
Age:18.0
Sex:Female
Location:New York
Vaccinated:1990-08-16
Onset:1990-08-16
Submitted:1990-09-17
Entered:1990-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0692S / 0 1 - / SC
TD: TD ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER 287962 / - UNK - / A

Administered by: Private      Purchased by: Private
Symptoms: Syncope

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:
Current Illness:
Preexisting Conditions: Hx of prior syncope x2
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with MMR/TINE TEST 1 min later fainted sustained minor abrasions of face as result of syncope awoke spontaneously in 20 seconds after fainting.


Changed on 2/14/2018

VAERS ID: 26078 Before After
VAERS Form:1
Age:18.0
Sex:Female
Location:New York
Vaccinated:1990-08-16
Onset:1990-08-16
Submitted:1990-09-17
Entered:1990-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0692S / 1 - / SC
TD: TD ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER 287962 / UNK - / A

Administered by: Private      Purchased by: Private
Symptoms: Syncope

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:
Current Illness:
Preexisting Conditions: Hx of prior syncope x2
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with MMR/TINE TEST 1 min later fainted sustained minor abrasions of face as result of syncope awoke spontaneously in 20 seconds after fainting.


Changed on 6/14/2018

VAERS ID: 26078 Before After
VAERS Form:1
Age:18.0
Sex:Female
Location:New York
Vaccinated:1990-08-16
Onset:1990-08-16
Submitted:1990-09-17
Entered:1990-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0692S / 1 - / SC
TD: TD ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER 287962 / UNK - / A

Administered by: Private      Purchased by: Private
Symptoms: Syncope

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:
Current Illness:
Preexisting Conditions: Hx of prior syncope x2
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with MMR/TINE TEST 1 min later fainted sustained minor abrasions of face as result of syncope awoke spontaneously in 20 seconds after fainting.


Changed on 8/14/2018

VAERS ID: 26078 Before After
VAERS Form:1
Age:18.0
Sex:Female
Location:New York
Vaccinated:1990-08-16
Onset:1990-08-16
Submitted:1990-09-17
Entered:1990-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0692S / 1 - / SC
TD: TD ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER 287962 / UNK - / A

Administered by: Private      Purchased by: Private
Symptoms: Syncope

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:
Current Illness:
Preexisting Conditions: Hx of prior syncope x2
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with MMR/TINE TEST 1 min later fainted sustained minor abrasions of face as result of syncope awoke spontaneously in 20 seconds after fainting.


Changed on 9/14/2018

VAERS ID: 26078 Before After
VAERS Form:1
Age:18.0
Sex:Female
Location:New York
Vaccinated:1990-08-16
Onset:1990-08-16
Submitted:1990-09-17
Entered:1990-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0692S / 1 - / SC
TD: TD ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER 287962 / UNK - / A

Administered by: Private      Purchased by: Private
Symptoms: Syncope

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:
Current Illness:
Preexisting Conditions: Hx of prior syncope x2
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with MMR/TINE TEST 1 min later fainted sustained minor abrasions of face as result of syncope awoke spontaneously in 20 seconds after fainting.


Changed on 10/14/2018

VAERS ID: 26078 Before After
VAERS Form:1
Age:18.0
Sex:Female
Location:New York
Vaccinated:1990-08-16
Onset:1990-08-16
Submitted:1990-09-17
Entered:1990-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0692S / 1 - / SC
TD: TD ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER 287962 / UNK - / A

Administered by: Private      Purchased by: Private
Symptoms: Syncope

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:
Current Illness:
Preexisting Conditions: Hx of prior syncope x2
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with MMR/TINE TEST 1 min later fainted sustained minor abrasions of face as result of syncope awoke spontaneously in 20 seconds after fainting.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=26078&WAYBACKHISTORY=ON


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