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History of Changes from the VAERS Wayback Machine |
VAERS ID: | 25003 |
VAERS Form: | |
Age: | 0.8 |
Sex: | Male |
Location: | Texas |
Vaccinated: | 1990-01-29 |
Onset: | 1990-02-04 |
Submitted: | 0000-00-00 |
Entered: | 1990-07-05 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTP: TRI-IMMUNOL / LEDERLE | 259962 / 3 | - / IM |
OPV: ORIMUNE / LEDERLE | 241950 / 3 | - / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: BRAIN SYND ACUTE, HYPOKINESIA, HYPOTONIA
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:0000-00-00
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: Hypotonic, Hyporesponsive episode, Infant died: Reyes text Syndrome. Vaccine given for routine immunizations.
Vaccinated: | 1990-01-29 |
Onset: | 1990-02-04 |
Submitted: | 0000-00-00 |
Entered: | 1990-07-05 1990-07-02 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES | 259962 / 3 | - / IM |
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES | 241950 / 3 | - / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Delirium, Hypokinesia, Hypotonia, BRAIN SYND ACUTE, HYPOKINESIA, HYPOTONIA
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:0000-00-00
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: Hypotonic, Hyporesponsive episode, Infant died: Reyes text Syndrome. Vaccine given for routine immunizations.
Vaccinated: | 1990-01-29 |
Onset: | 1990-02-04 |
Submitted: | 0000-00-00 |
Entered: | 1990-07-02 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES | 259962 / 3 | - / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH | 241950 / 3 | - / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Delirium, Hypokinesia, Hypotonia
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:0000-00-00
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: Hypotonic, Hyporesponsive episode, Infant died: Reyes text Syndrome. Vaccine given for routine immunizations.
Vaccinated: | 1990-01-29 |
Onset: | 1990-02-04 |
Submitted: | 0000-00-00 |
Entered: | 1990-07-02 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES | 259962 / 3 4 | - / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH | 241950 / 3 4 | - MO / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Delirium, Hypokinesia, Hypotonia
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:0000-00-00
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: Hypotonic, Hyporesponsive episode, Infant died: Reyes text Syndrome. Vaccine given for routine immunizations.
Vaccinated: | 1990-01-29 |
Onset: | 1990-02-04 |
Submitted: | 0000-00-00 |
Entered: | 1990-07-02 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES | 259962 / 4 | - / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH | 241950 / 4 | MO / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Delirium, Hypokinesia, Hypotonia
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:0000-00-00
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: Hypotonic, Hyporesponsive episode, Infant died: Reyes text Syndrome. Vaccine given for routine immunizations.
Vaccinated: | 1990-01-29 |
Onset: | 1990-02-04 |
Submitted: | 0000-00-00 |
Entered: | 1990-07-02 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES | 259962 / 4 | - / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH | 241950 / 4 | MO / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Delirium, Hypokinesia, Hypotonia
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:0000-00-00
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: Hypotonic, Hyporesponsive episode, Infant died: Reyes text Syndrome. Vaccine given for routine immunizations.
Vaccinated: | 1990-01-29 |
Onset: | 1990-02-04 |
Submitted: | 0000-00-00 |
Entered: | 1990-07-02 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES | 259962 / 4 | - / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH | 241950 / 4 | MO / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Delirium, Hypokinesia, Hypotonia
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:0000-00-00
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: Hypotonic, Hyporesponsive episode, Infant died: Reyes text Syndrome. Vaccine given for routine immunizations.
Vaccinated: | 1990-01-29 |
Onset: | 1990-02-04 |
Submitted: | 0000-00-00 |
Entered: | 1990-07-02 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES | 259962 / 4 | - / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH | 241950 / 4 | MO / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Delirium, Hypokinesia, Hypotonia
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:0000-00-00
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: Hypotonic, Hyporesponsive episode, Infant died: Reyes text Syndrome. Vaccine given for routine immunizations.
Vaccinated: | 1990-01-29 |
Onset: | 1990-02-04 |
Submitted: | 0000-00-00 |
Entered: | 1990-07-02 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES | 259962 / 4 | - / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH | 241950 / 4 | MO / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Delirium, Hypokinesia, Hypotonia
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:0000-00-00
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: Hypotonic, Hyporesponsive episode, Infant died: Reyes text Syndrome. Vaccine given for routine immunizations.
Vaccinated: | 1990-01-29 |
Onset: | 1990-02-04 |
Submitted: | 0000-00-00 |
Entered: | 1990-07-02 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES | 259962 / 4 | - / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH | 241950 / 4 | MO / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Delirium, Hypokinesia, Hypotonia
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:0000-00-00
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: Hypotonic, Hyporesponsive episode, Infant died: Reyes text Syndrome. Vaccine given for routine immunizations.
Vaccinated: | 1990-01-29 |
Onset: | 1990-02-04 |
Submitted: | 0000-00-00 |
Entered: | 1990-07-02 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES | 259962 / 4 | - / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH | 241950 / 4 | MO / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Delirium, Hypokinesia, Hypotonia
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:0000-00-00
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: Hypotonic, Hyporesponsive episode, Infant died: Reyes text Syndrome. Vaccine given for routine immunizations.
Link To This Search Result:
https://medalerts.org/vaersdb/findfield.php?IDNUMBER=25003&WAYBACKHISTORY=ON
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