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This is VAERS ID 77317

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 77317
VAERS Form:
Age:1.3
Sex:Female
Location:Florida
Vaccinated:1995-08-09
Onset:1995-08-09
Submitted:1995-08-30
Entered:1995-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE / LEDERLE 378907 / 0 L / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) A7D05LK / 0 L / IM
VARCEL: VARIVAX / MSD 0400B / 0 L / SC

Administered by: Private      Purchased by: Unknown
Symptoms: BRAIN SYND ACUTE, FEVER, ANOREXIA, GAIT ABNORM, EDEMA BRAIN

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: mild diarrhea
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: abn MRI-edema of lt basal ganglia
CDC 'Split Type':

Write-up: t101; rt hemiparesis


Changed on 12/8/2009

VAERS ID: 77317 Before After
VAERS Form:
Age:1.3
Sex:Female
Location:Florida
Vaccinated:1995-08-09
Onset:1995-08-09
Submitted:1995-08-30
Entered:1995-09-19 1995-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE DTAP (ACEL-IMUNE) / LEDERLE LEDERLE LABORATORIES 378907 / 0 L / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS A7D05LK / 0 L / IM
VARCEL: VARIVAX VARICELLA (VARIVAX) / MSD MERCK & CO. INC. 0400B / 0 L / SC

Administered by: Private      Purchased by: Unknown Private
Symptoms: Anorexia, Delirium, Gait disturbance, Hemiplegia, Hypertonia, Hypokinesia, Pyrexia, Brain oedema, BRAIN SYND ACUTE, FEVER, ANOREXIA, GAIT ABNORM, EDEMA BRAIN

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: mild diarrhea
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: abn MRI-edema of lt basal ganglia
CDC 'Split Type': (blank) WAES95090139

Write-up: t101; rt hemiparesis


Changed on 5/14/2017

VAERS ID: 77317 Before After
VAERS Form:
Age:1.3
Sex:Female
Location:Florida
Vaccinated:1995-08-09
Onset:1995-08-09
Submitted:1995-08-30
Entered:1995-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 378907 / 0 L - / IM IM L
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH A7D05LK / 0 L - / IM IM L
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0400B / 0 L - / SC SC L

Administered by: Private      Purchased by: Private
Symptoms: Anorexia, Delirium, Gait disturbance, Hemiplegia, Hypertonia, Hypokinesia, Pyrexia, Brain oedema

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: mild diarrhea
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: abn MRI-edema of lt basal ganglia
CDC 'Split Type': WAES95090139

Write-up: t101; rt hemiparesis


Changed on 9/14/2017

VAERS ID: 77317 Before After
VAERS Form:(blank) 1
Age:1.3
Sex:Female
Location:Florida
Vaccinated:1995-08-09
Onset:1995-08-09
Submitted:1995-08-30
Entered:1995-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 378907 / 0 1 - / IM L
HIBV: HIB (HIBTITER) / PFIZER/WYETH A7D05LK / 0 1 - / IM L
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0400B / 0 1 - / SC L

Administered by: Private      Purchased by: Private
Symptoms: Anorexia, Delirium, Gait disturbance, Hemiplegia, Hypertonia, Hypokinesia, Pyrexia, Brain oedema

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: mild diarrhea
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: abn MRI-edema of lt basal ganglia
CDC 'Split Type': WAES95090139

Write-up: t101; rt hemiparesis


Changed on 2/14/2018

VAERS ID: 77317 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:Florida
Vaccinated:1995-08-09
Onset:1995-08-09
Submitted:1995-08-30
Entered:1995-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 378907 / 1 - / IM L
HIBV: HIB (HIBTITER) / PFIZER/WYETH A7D05LK / 1 - / IM L
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0400B / 1 - / SC L

Administered by: Private      Purchased by: Private
Symptoms: Anorexia, Delirium, Gait disturbance, Hemiplegia, Hypertonia, Hypokinesia, Pyrexia, Brain oedema

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: mild diarrhea
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: abn MRI-edema of lt basal ganglia
CDC 'Split Type': WAES95090139

Write-up: t101; rt hemiparesis


Changed on 6/14/2018

VAERS ID: 77317 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:Florida
Vaccinated:1995-08-09
Onset:1995-08-09
Submitted:1995-08-30
Entered:1995-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 378907 / 1 - / IM L
HIBV: HIB (HIBTITER) / PFIZER/WYETH A7D05LK / 1 - / IM L
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0400B / 1 - / SC L

Administered by: Private      Purchased by: Private
Symptoms: Anorexia, Delirium, Gait disturbance, Hemiplegia, Hypertonia, Hypokinesia, Pyrexia, Brain oedema

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: mild diarrhea
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: abn MRI-edema of lt basal ganglia
CDC 'Split Type': WAES95090139

Write-up: t101; rt hemiparesis


Changed on 8/14/2018

VAERS ID: 77317 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:Florida
Vaccinated:1995-08-09
Onset:1995-08-09
Submitted:1995-08-30
Entered:1995-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 378907 / 1 - / IM L
HIBV: HIB (HIBTITER) / PFIZER/WYETH A7D05LK / 1 - / IM L
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0400B / 1 - / SC L

Administered by: Private      Purchased by: Private
Symptoms: Anorexia, Delirium, Gait disturbance, Hemiplegia, Hypertonia, Hypokinesia, Pyrexia, Brain oedema

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: mild diarrhea
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: abn MRI-edema of lt basal ganglia
CDC 'Split Type': WAES95090139

Write-up: t101; rt hemiparesis


Changed on 9/14/2018

VAERS ID: 77317 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:Florida
Vaccinated:1995-08-09
Onset:1995-08-09
Submitted:1995-08-30
Entered:1995-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 378907 / 1 - / IM L
HIBV: HIB (HIBTITER) / PFIZER/WYETH A7D05LK / 1 - / IM L
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0400B / 1 - / SC L

Administered by: Private      Purchased by: Private
Symptoms: Anorexia, Delirium, Gait disturbance, Hemiplegia, Hypertonia, Hypokinesia, Pyrexia, Brain oedema

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: mild diarrhea
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: abn MRI-edema of lt basal ganglia
CDC 'Split Type': WAES95090139

Write-up: t101; rt hemiparesis


Changed on 10/14/2018

VAERS ID: 77317 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:Florida
Vaccinated:1995-08-09
Onset:1995-08-09
Submitted:1995-08-30
Entered:1995-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 378907 / 1 - / IM L
HIBV: HIB (HIBTITER) / PFIZER/WYETH A7D05LK / 1 - / IM L
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0400B / 1 - / SC L

Administered by: Private      Purchased by: Private
Symptoms: Anorexia, Delirium, Gait disturbance, Hemiplegia, Hypertonia, Hypokinesia, Pyrexia, Brain oedema

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: mild diarrhea
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: abn MRI-edema of lt basal ganglia
CDC 'Split Type': WAES95090139

Write-up: t101; rt hemiparesis


Changed on 12/24/2020

VAERS ID: 77317 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:Florida
Vaccinated:1995-08-09
Onset:1995-08-09
Submitted:1995-08-30
Entered:1995-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 378907 / 1 - / IM L
HIBV: HIB (HIBTITER) / PFIZER/WYETH A7D05LK / 1 - / IM L
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0400B / 1 - / SC L

Administered by: Private      Purchased by: Private
Symptoms: Anorexia, Delirium, Gait disturbance, Hemiplegia, Hypertonia, Hypokinesia, Pyrexia, Brain oedema

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: mild diarrhea
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: abn MRI-edema of lt basal ganglia
CDC 'Split Type': WAES95090139

Write-up: t101; rt hemiparesis


Changed on 12/30/2020

VAERS ID: 77317 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:Florida
Vaccinated:1995-08-09
Onset:1995-08-09
Submitted:1995-08-30
Entered:1995-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 378907 / 1 - / IM L
HIBV: HIB (HIBTITER) / PFIZER/WYETH A7D05LK / 1 - / IM L
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0400B / 1 - / SC L

Administered by: Private      Purchased by: Private
Symptoms: Anorexia, Delirium, Gait disturbance, Hemiplegia, Hypertonia, Hypokinesia, Pyrexia, Brain oedema

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: mild diarrhea
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: abn MRI-edema of lt basal ganglia
CDC 'Split Type': WAES95090139

Write-up: t101; rt hemiparesis


Changed on 5/7/2021

VAERS ID: 77317 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:Florida
Vaccinated:1995-08-09
Onset:1995-08-09
Submitted:1995-08-30
Entered:1995-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 378907 / 1 - / IM L
HIBV: HIB (HIBTITER) / PFIZER/WYETH A7D05LK / 1 - / IM L
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0400B / 1 - / SC L

Administered by: Private      Purchased by: Private
Symptoms: Anorexia, Delirium, Gait disturbance, Hemiplegia, Hypertonia, Hypokinesia, Pyrexia, Brain oedema

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: mild diarrhea
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: abn MRI-edema of lt basal ganglia
CDC 'Split Type': WAES95090139

Write-up: t101; rt hemiparesis


Changed on 5/14/2021

VAERS ID: 77317 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:Florida
Vaccinated:1995-08-09
Onset:1995-08-09
Submitted:1995-08-30
Entered:1995-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 378907 / 1 - / IM L
HIBV: HIB (HIBTITER) / PFIZER/WYETH A7D05LK / 1 - / IM L
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0400B / 1 - / SC L

Administered by: Private      Purchased by: Private
Symptoms: Anorexia, Delirium, Gait disturbance, Hemiplegia, Hypertonia, Hypokinesia, Pyrexia, Brain oedema

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: mild diarrhea
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: abn MRI-edema of lt basal ganglia
CDC 'Split Type': WAES95090139

Write-up: t101; rt hemiparesis

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