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This is VAERS ID 26957

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 26957
VAERS Form:
Age:1.4
Sex:Male
Location:Washington
Vaccinated:1990-11-10
Onset:1990-11-19
Submitted:1990-12-01
Entered:1990-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: PEDVAXHIB / MSD 07415 / 0 A / IM
MMR: MMR II / MSD 1492S / 0 A / SC

Administered by: Private      Purchased by: Unknown
Symptoms: CONVULS, FEVER, EYES GAZE UPWARD, CYANOSIS

Life Threatening? No
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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with MMR/HIB developed temp $g104 & tonic seizure, w/eyes deviated to left & mild cyanosis - seizure duration less than 2 min - postictal 15-20min. initial eval by MEDICS at childs home. Seen in office within 1 hr of incident.


Changed on 12/8/2009

VAERS ID: 26957 Before After
VAERS Form:
Age:1.4
Sex:Male
Location:Washington
Vaccinated:1990-11-10
Onset:1990-11-19
Submitted:1990-12-01
Entered:1990-12-13 1990-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: PEDVAXHIB HIB (PEDVAXHIB) / MSD MERCK & CO. INC. 07415 / 0 A / IM
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 1492S / 0 A / SC

Administered by: Private      Purchased by: Unknown Public
Symptoms: Convulsion, Cyanosis, Pyrexia, Gaze palsy, CONVULS, FEVER, EYES GAZE UPWARD, CYANOSIS

Life Threatening? No
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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) WA90493

Write-up: Pt vaccinated with MMR/HIB developed temp $g104 & tonic seizure, w/eyes deviated to left & mild cyanosis - seizure duration less than 2 min - postictal 15-20min. initial eval by MEDICS at childs home. Seen in office within 1 hr of incident.


Changed on 5/14/2017

VAERS ID: 26957 Before After
VAERS Form:
Age:1.4
Sex:Male
Location:Washington
Vaccinated:1990-11-10
Onset:1990-11-19
Submitted:1990-12-01
Entered:1990-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 07415 / 0 A - / IM IM A
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1492S / 0 A - / SC SC A

Administered by: Private      Purchased by: Public
Symptoms: Convulsion, Cyanosis, Pyrexia, Gaze palsy

Life Threatening? No
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WA90493

Write-up: Pt vaccinated with MMR/HIB developed temp $g104 & tonic seizure, w/eyes deviated to left & mild cyanosis - seizure duration less than 2 min - postictal 15-20min. initial eval by MEDICS at childs home. Seen in office within 1 hr of incident.


Changed on 9/14/2017

VAERS ID: 26957 Before After
VAERS Form:(blank) 1
Age:1.4
Sex:Male
Location:Washington
Vaccinated:1990-11-10
Onset:1990-11-19
Submitted:1990-12-01
Entered:1990-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 07415 / 0 1 - / IM A
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1492S / 0 1 - / SC A

Administered by: Private      Purchased by: Public
Symptoms: Convulsion, Cyanosis, Pyrexia, Gaze palsy

Life Threatening? No
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WA90493

Write-up: Pt vaccinated with MMR/HIB developed temp $g104 & tonic seizure, w/eyes deviated to left & mild cyanosis - seizure duration less than 2 min - postictal 15-20min. initial eval by MEDICS at childs home. Seen in office within 1 hr of incident.


Changed on 2/14/2018

VAERS ID: 26957 Before After
VAERS Form:1
Age:1.4
Sex:Male
Location:Washington
Vaccinated:1990-11-10
Onset:1990-11-19
Submitted:1990-12-01
Entered:1990-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 07415 / 1 - / IM A
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1492S / 1 - / SC A

Administered by: Private      Purchased by: Public
Symptoms: Convulsion, Cyanosis, Pyrexia, Gaze palsy

Life Threatening? No
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WA90493

Write-up: Pt vaccinated with MMR/HIB developed temp $g104 & tonic seizure, w/eyes deviated to left & mild cyanosis - seizure duration less than 2 min - postictal 15-20min. initial eval by MEDICS at childs home. Seen in office within 1 hr of incident.


Changed on 6/14/2018

VAERS ID: 26957 Before After
VAERS Form:1
Age:1.4
Sex:Male
Location:Washington
Vaccinated:1990-11-10
Onset:1990-11-19
Submitted:1990-12-01
Entered:1990-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 07415 / 1 - / IM A
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1492S / 1 - / SC A

Administered by: Private      Purchased by: Public
Symptoms: Convulsion, Cyanosis, Pyrexia, Gaze palsy

Life Threatening? No
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WA90493

Write-up: Pt vaccinated with MMR/HIB developed temp $g104 & tonic seizure, w/eyes deviated to left & mild cyanosis - seizure duration less than 2 min - postictal 15-20min. initial eval by MEDICS at childs home. Seen in office within 1 hr of incident.


Changed on 8/14/2018

VAERS ID: 26957 Before After
VAERS Form:1
Age:1.4
Sex:Male
Location:Washington
Vaccinated:1990-11-10
Onset:1990-11-19
Submitted:1990-12-01
Entered:1990-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 07415 / 1 - / IM A
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1492S / 1 - / SC A

Administered by: Private      Purchased by: Public
Symptoms: Convulsion, Cyanosis, Pyrexia, Gaze palsy

Life Threatening? No
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WA90493

Write-up: Pt vaccinated with MMR/HIB developed temp $g104 & tonic seizure, w/eyes deviated to left & mild cyanosis - seizure duration less than 2 min - postictal 15-20min. initial eval by MEDICS at childs home. Seen in office within 1 hr of incident.


Changed on 9/14/2018

VAERS ID: 26957 Before After
VAERS Form:1
Age:1.4
Sex:Male
Location:Washington
Vaccinated:1990-11-10
Onset:1990-11-19
Submitted:1990-12-01
Entered:1990-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 07415 / 1 - / IM A
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1492S / 1 - / SC A

Administered by: Private      Purchased by: Public
Symptoms: Convulsion, Cyanosis, Pyrexia, Gaze palsy

Life Threatening? No
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WA90493

Write-up: Pt vaccinated with MMR/HIB developed temp $g104 & tonic seizure, w/eyes deviated to left & mild cyanosis - seizure duration less than 2 min - postictal 15-20min. initial eval by MEDICS at childs home. Seen in office within 1 hr of incident.


Changed on 10/14/2018

VAERS ID: 26957 Before After
VAERS Form:1
Age:1.4
Sex:Male
Location:Washington
Vaccinated:1990-11-10
Onset:1990-11-19
Submitted:1990-12-01
Entered:1990-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 07415 / 1 - / IM A
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1492S / 1 - / SC A

Administered by: Private      Purchased by: Public
Symptoms: Convulsion, Cyanosis, Pyrexia, Gaze palsy

Life Threatening? No
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WA90493

Write-up: Pt vaccinated with MMR/HIB developed temp $g104 & tonic seizure, w/eyes deviated to left & mild cyanosis - seizure duration less than 2 min - postictal 15-20min. initial eval by MEDICS at childs home. Seen in office within 1 hr of incident.

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