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This is VAERS ID 26963

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 26963
VAERS Form:
Age:1.3
Sex:Female
Location:Indiana
Vaccinated:1990-09-25
Onset:1990-10-05
Submitted:1990-12-06
Entered:1990-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: PROHIBIT / CONNAUGHT LABS 9B11106 / 0 LL / -
MMR: MMR II / MSD 1485S / 0 RL / -

Administered by: Private      Purchased by: Unknown
Symptoms: FEVER, RASH

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 mother - SAME EVENT - Rubella - Didn''t give.
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with MMR/HIB 10 days post immunization developed temp 103- trunk rash after fever broke. Father is MD - looked like mass of small lesion.


Changed on 12/8/2009

VAERS ID: 26963 Before After
VAERS Form:
Age:1.3
Sex:Female
Location:Indiana
Vaccinated:1990-09-25
Onset:1990-10-05
Submitted:1990-12-06
Entered:1990-12-13 1990-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: PROHIBIT HIB (PROHIBIT) / CONNAUGHT LABS CONNAUGHT LABORATORIES 9B11106 / 0 LL / -
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 1485S / 0 RL / -

Administered by: Private      Purchased by: Unknown Private
Symptoms: Pyrexia, Rash, FEVER, RASH

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 mother - SAME EVENT - Rubella - Didn''t give.
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with MMR/HIB 10 days post immunization developed temp 103- trunk rash after fever broke. Father is MD - looked like mass of small lesion.


Changed on 5/14/2017

VAERS ID: 26963 Before After
VAERS Form:
Age:1.3
Sex:Female
Location:Indiana
Vaccinated:1990-09-25
Onset:1990-10-05
Submitted:1990-12-06
Entered:1990-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 9B11106 / 0 LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1485S / 0 RL / -

Administered by: Private      Purchased by: Private
Symptoms: Pyrexia, Rash

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 mother - SAME EVENT - Rubella - Didn''t give. give.~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with MMR/HIB 10 days post immunization developed temp 103- trunk rash after fever broke. Father is MD - looked like mass of small lesion.


Changed on 9/14/2017

VAERS ID: 26963 Before After
VAERS Form:(blank) 1
Age:1.3
Sex:Female
Location:Indiana
Vaccinated:1990-09-25
Onset:1990-10-05
Submitted:1990-12-06
Entered:1990-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 9B11106 / 0 1 LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1485S / 0 1 RL / -

Administered by: Private      Purchased by: Private
Symptoms: Pyrexia, Rash

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 mother - SAME EVENT - Rubella - Didn''t give.~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with MMR/HIB 10 days post immunization developed temp 103- trunk rash after fever broke. Father is MD - looked like mass of small lesion.


Changed on 2/14/2018

VAERS ID: 26963 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:Indiana
Vaccinated:1990-09-25
Onset:1990-10-05
Submitted:1990-12-06
Entered:1990-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 9B11106 / 1 LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1485S / 1 RL / -

Administered by: Private      Purchased by: Private
Symptoms: Pyrexia, Rash

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 mother - SAME EVENT - Rubella - Didn''t give.~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with MMR/HIB 10 days post immunization developed temp 103- trunk rash after fever broke. Father is MD - looked like mass of small lesion.


Changed on 6/14/2018

VAERS ID: 26963 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:Indiana
Vaccinated:1990-09-25
Onset:1990-10-05
Submitted:1990-12-06
Entered:1990-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 9B11106 / 1 LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1485S / 1 RL / -

Administered by: Private      Purchased by: Private
Symptoms: Pyrexia, Rash

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 mother - SAME EVENT - Rubella - Didn''t give.~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with MMR/HIB 10 days post immunization developed temp 103- trunk rash after fever broke. Father is MD - looked like mass of small lesion.


Changed on 8/14/2018

VAERS ID: 26963 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:Indiana
Vaccinated:1990-09-25
Onset:1990-10-05
Submitted:1990-12-06
Entered:1990-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 9B11106 / 1 LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1485S / 1 RL / -

Administered by: Private      Purchased by: Private
Symptoms: Pyrexia, Rash

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 mother - SAME EVENT - Rubella - Didn''t give.~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with MMR/HIB 10 days post immunization developed temp 103- trunk rash after fever broke. Father is MD - looked like mass of small lesion.


Changed on 9/14/2018

VAERS ID: 26963 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:Indiana
Vaccinated:1990-09-25
Onset:1990-10-05
Submitted:1990-12-06
Entered:1990-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 9B11106 / 1 LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1485S / 1 RL / -

Administered by: Private      Purchased by: Private
Symptoms: Pyrexia, Rash

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 mother - SAME EVENT - Rubella - Didn''t give.~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with MMR/HIB 10 days post immunization developed temp 103- trunk rash after fever broke. Father is MD - looked like mass of small lesion.


Changed on 10/14/2018

VAERS ID: 26963 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:Indiana
Vaccinated:1990-09-25
Onset:1990-10-05
Submitted:1990-12-06
Entered:1990-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 9B11106 / 1 LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1485S / 1 RL / -

Administered by: Private      Purchased by: Private
Symptoms: Pyrexia, Rash

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 mother - SAME EVENT - Rubella - Didn''t give.~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with MMR/HIB 10 days post immunization developed temp 103- trunk rash after fever broke. Father is MD - looked like mass of small lesion.

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