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This is VAERS ID 25003

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History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

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.

Changed on 12/8/2009

VAERS ID: 25003 Before After
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 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.

Changed on 5/14/2017

VAERS ID: 25003 Before After
VAERS Form:
Age:0.8
Sex:Male
Location:Texas
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.

Changed on 9/14/2017

VAERS ID: 25003 Before After
VAERS Form:(blank) 1
Age:0.8
Sex:Male
Location:Texas
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.

Changed on 2/14/2018

VAERS ID: 25003 Before After
VAERS Form:1
Age:0.8
Sex:Male
Location:Texas
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.

Changed on 6/14/2018

VAERS ID: 25003 Before After
VAERS Form:1
Age:0.8
Sex:Male
Location:Texas
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.

Changed on 8/14/2018

VAERS ID: 25003 Before After
VAERS Form:1
Age:0.8
Sex:Male
Location:Texas
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.

Changed on 9/14/2018

VAERS ID: 25003 Before After
VAERS Form:1
Age:0.8
Sex:Male
Location:Texas
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.

Changed on 10/14/2018

VAERS ID: 25003 Before After
VAERS Form:1
Age:0.8
Sex:Male
Location:Texas
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.

Changed on 12/24/2020

VAERS ID: 25003 Before After
VAERS Form:1
Age:0.8
Sex:Male
Location:Texas
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.

Changed on 12/30/2020

VAERS ID: 25003 Before After
VAERS Form:1
Age:0.8
Sex:Male
Location:Texas
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.

Changed on 5/7/2021

VAERS ID: 25003 Before After
VAERS Form:1
Age:0.8
Sex:Male
Location:Texas
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.

Changed on 5/21/2021

VAERS ID: 25003 Before After
VAERS Form:1
Age:0.8
Sex:Male
Location:Texas
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.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=25003&WAYBACKHISTORY=ON


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