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This is VAERS ID 26931

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 26931
VAERS Form:
Age:6.0
Sex:Female
Location:Missouri
Vaccinated:1990-09-28
Onset:1990-09-29
Submitted:0000-00-00
Entered:1990-12-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MMR II / MSD 11495 / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: RASH, ARTHRALGIA, ECCHYMOSIS

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: Amoxil for poss sinus infection & local skin infection.
Current Illness:
Preexisting Conditions: Hx of allergy to Phenobarbital - unknown reaction
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with MMR developed joint stiffness & soreness, slight bruising at inject site, rash which was described as itchy, no redness or swelling.


Changed on 12/8/2009

VAERS ID: 26931 Before After
VAERS Form:
Age:6.0
Sex:Female
Location:Missouri
Vaccinated:1990-09-28
Onset:1990-09-29
Submitted:0000-00-00
Entered:1990-12-12 1990-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 11495 / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Arthralgia, Ecchymosis, Rash, RASH, ARTHRALGIA, ECCHYMOSIS

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: Amoxil for poss sinus infection & local skin infection.
Current Illness:
Preexisting Conditions: Hx of allergy to Phenobarbital - unknown reaction
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with MMR developed joint stiffness & soreness, slight bruising at inject site, rash which was described as itchy, no redness or swelling.


Changed on 5/14/2017

VAERS ID: 26931 Before After
VAERS Form:
Age:6.0
Sex:Female
Location:Missouri
Vaccinated:1990-09-28
Onset:1990-09-29
Submitted:0000-00-00
Entered:1990-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 11495 / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Arthralgia, Ecchymosis, Rash

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: Amoxil for poss sinus infection & local skin infection.
Current Illness:
Preexisting Conditions: Hx of allergy to Phenobarbital - unknown reaction
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with MMR developed joint stiffness & soreness, slight bruising at inject site, rash which was described as itchy, no redness or swelling.


Changed on 9/14/2017

VAERS ID: 26931 Before After
VAERS Form:(blank) 1
Age:6.0
Sex:Female
Location:Missouri
Vaccinated:1990-09-28
Onset:1990-09-29
Submitted:0000-00-00
Entered:1990-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 11495 / - UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Arthralgia, Ecchymosis, Rash

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: Amoxil for poss sinus infection & local skin infection.
Current Illness:
Preexisting Conditions: Hx of allergy to Phenobarbital - unknown reaction
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with MMR developed joint stiffness & soreness, slight bruising at inject site, rash which was described as itchy, no redness or swelling.


Changed on 2/14/2018

VAERS ID: 26931 Before After
VAERS Form:1
Age:6.0
Sex:Female
Location:Missouri
Vaccinated:1990-09-28
Onset:1990-09-29
Submitted:0000-00-00
Entered:1990-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 11495 / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Arthralgia, Ecchymosis, Rash

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: Amoxil for poss sinus infection & local skin infection.
Current Illness:
Preexisting Conditions: Hx of allergy to Phenobarbital - unknown reaction
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with MMR developed joint stiffness & soreness, slight bruising at inject site, rash which was described as itchy, no redness or swelling.


Changed on 6/14/2018

VAERS ID: 26931 Before After
VAERS Form:1
Age:6.0
Sex:Female
Location:Missouri
Vaccinated:1990-09-28
Onset:1990-09-29
Submitted:0000-00-00
Entered:1990-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 11495 / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Arthralgia, Ecchymosis, Rash

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: Amoxil for poss sinus infection & local skin infection.
Current Illness:
Preexisting Conditions: Hx of allergy to Phenobarbital - unknown reaction
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with MMR developed joint stiffness & soreness, slight bruising at inject site, rash which was described as itchy, no redness or swelling.


Changed on 8/14/2018

VAERS ID: 26931 Before After
VAERS Form:1
Age:6.0
Sex:Female
Location:Missouri
Vaccinated:1990-09-28
Onset:1990-09-29
Submitted:0000-00-00
Entered:1990-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 11495 / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Arthralgia, Ecchymosis, Rash

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: Amoxil for poss sinus infection & local skin infection.
Current Illness:
Preexisting Conditions: Hx of allergy to Phenobarbital - unknown reaction
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with MMR developed joint stiffness & soreness, slight bruising at inject site, rash which was described as itchy, no redness or swelling.


Changed on 9/14/2018

VAERS ID: 26931 Before After
VAERS Form:1
Age:6.0
Sex:Female
Location:Missouri
Vaccinated:1990-09-28
Onset:1990-09-29
Submitted:0000-00-00
Entered:1990-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 11495 / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Arthralgia, Ecchymosis, Rash

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: Amoxil for poss sinus infection & local skin infection.
Current Illness:
Preexisting Conditions: Hx of allergy to Phenobarbital - unknown reaction
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with MMR developed joint stiffness & soreness, slight bruising at inject site, rash which was described as itchy, no redness or swelling.


Changed on 10/14/2018

VAERS ID: 26931 Before After
VAERS Form:1
Age:6.0
Sex:Female
Location:Missouri
Vaccinated:1990-09-28
Onset:1990-09-29
Submitted:0000-00-00
Entered:1990-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 11495 / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Arthralgia, Ecchymosis, Rash

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: Amoxil for poss sinus infection & local skin infection.
Current Illness:
Preexisting Conditions: Hx of allergy to Phenobarbital - unknown reaction
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with MMR developed joint stiffness & soreness, slight bruising at inject site, rash which was described as itchy, no redness or swelling.


Changed on 12/24/2020

VAERS ID: 26931 Before After
VAERS Form:1
Age:6.0
Sex:Female
Location:Missouri
Vaccinated:1990-09-28
Onset:1990-09-29
Submitted:0000-00-00
Entered:1990-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 11495 / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Arthralgia, Ecchymosis, Rash

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: Amoxil for poss sinus infection & local skin infection.
Current Illness:
Preexisting Conditions: Hx of allergy to Phenobarbital - unknown reaction
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with MMR developed joint stiffness & soreness, slight bruising at inject site, rash which was described as itchy, no redness or swelling.


Changed on 12/30/2020

VAERS ID: 26931 Before After
VAERS Form:1
Age:6.0
Sex:Female
Location:Missouri
Vaccinated:1990-09-28
Onset:1990-09-29
Submitted:0000-00-00
Entered:1990-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 11495 / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Arthralgia, Ecchymosis, Rash

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: Amoxil for poss sinus infection & local skin infection.
Current Illness:
Preexisting Conditions: Hx of allergy to Phenobarbital - unknown reaction
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with MMR developed joint stiffness & soreness, slight bruising at inject site, rash which was described as itchy, no redness or swelling.

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