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This is VAERS ID 25016

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 25016
VAERS Form:
Age:0.3
Sex:Female
Location:Georgia
Vaccinated:1986-02-09
Onset:1986-02-09
Submitted:0000-00-00
Entered:1990-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE - / - - / -

Administered by: Private      Purchased by: Unknown
Symptoms: FEVER, MENTAL RETARD, CONVULS GRAND MAL, EEG ABNORM

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: initially all lab data WNL; EEG normal, however over period 1986-1988 EEG has turned markedly abnormal, all lab studies WNL
CDC 'Split Type':

Write-up: 4 mon. infant given DTP 6Feb86- no problems until 9FEB86 awoke w/ fever 103F seen by MD normal exam. 18 hrs later generalized tonic-clonic seizure thought to be febrile, 2nd seizure 17Mar86, 3rd 3Apr86, child has developmental delay.

Changed on 12/8/2009

VAERS ID: 25016 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:Georgia
Vaccinated:1986-02-09
Onset:1986-02-09
Submitted:0000-00-00
Entered:1990-07-10 1990-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES - / - - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Electroencephalogram abnormal, Grand mal convulsion, Mental retardation severity unspecified, Pyrexia, FEVER, MENTAL RETARD, CONVULS GRAND MAL, EEG ABNORM

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: initially all lab data WNL; EEG normal, however over period 1986-1988 EEG has turned markedly abnormal, all lab studies WNL
CDC 'Split Type': (blank) 8902823.01

Write-up: 4 mon. infant given DTP 6Feb86- no problems until 9FEB86 awoke w/ fever 103F seen by MD normal exam. 18 hrs later generalized tonic-clonic seizure thought to be febrile, 2nd seizure 17Mar86, 3rd 3Apr86, child has developmental delay.

Changed on 2/13/2013

VAERS ID: 25016 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:Georgia
Vaccinated:1986-02-09
Onset:1986-02-09
Submitted:0000-00-00
Entered:1990-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES - / - - / -

Administered by: Private Unknown      Purchased by: Unknown
Symptoms: Electroencephalogram abnormal, Grand mal convulsion, Mental retardation severity unspecified, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: initially all lab data WNL; EEG normal, however over period 1986-1988 EEG has turned markedly abnormal, all lab studies WNL
CDC 'Split Type': 8902823.01 890282301

Write-up: 4 mon. infant given DTP 6Feb86- no problems until 9FEB86 awoke w/ fever 103F seen by MD normal exam. 18 hrs later generalized tonic-clonic seizure thought to be febrile, 2nd seizure 17Mar86, 3rd 3Apr86, child has developmental delay.

Changed on 9/14/2017

VAERS ID: 25016 Before After
VAERS Form:(blank) 1
Age:0.3
Sex:Female
Location:Georgia
Vaccinated:1986-02-09
Onset:1986-02-09
Submitted:0000-00-00
Entered:1990-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES - / - UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Electroencephalogram abnormal, Grand mal convulsion, Mental retardation severity unspecified, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: initially all lab data WNL; EEG normal, however over period 1986-1988 EEG has turned markedly abnormal, all lab studies WNL
CDC 'Split Type': 890282301

Write-up: 4 mon. infant given DTP 6Feb86- no problems until 9FEB86 awoke w/ fever 103F seen by MD normal exam. 18 hrs later generalized tonic-clonic seizure thought to be febrile, 2nd seizure 17Mar86, 3rd 3Apr86, child has developmental delay.

Changed on 2/14/2018

VAERS ID: 25016 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:Georgia
Vaccinated:1986-02-09
Onset:1986-02-09
Submitted:0000-00-00
Entered:1990-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES - / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Electroencephalogram abnormal, Grand mal convulsion, Mental retardation severity unspecified, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: initially all lab data WNL; EEG normal, however over period 1986-1988 EEG has turned markedly abnormal, all lab studies WNL
CDC 'Split Type': 890282301

Write-up: 4 mon. infant given DTP 6Feb86- no problems until 9FEB86 awoke w/ fever 103F seen by MD normal exam. 18 hrs later generalized tonic-clonic seizure thought to be febrile, 2nd seizure 17Mar86, 3rd 3Apr86, child has developmental delay.

Changed on 6/14/2018

VAERS ID: 25016 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:Georgia
Vaccinated:1986-02-09
Onset:1986-02-09
Submitted:0000-00-00
Entered:1990-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES - / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Electroencephalogram abnormal, Grand mal convulsion, Mental retardation severity unspecified, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: initially all lab data WNL; EEG normal, however over period 1986-1988 EEG has turned markedly abnormal, all lab studies WNL
CDC 'Split Type': 890282301

Write-up: 4 mon. infant given DTP 6Feb86- no problems until 9FEB86 awoke w/ fever 103F seen by MD normal exam. 18 hrs later generalized tonic-clonic seizure thought to be febrile, 2nd seizure 17Mar86, 3rd 3Apr86, child has developmental delay.

Changed on 8/14/2018

VAERS ID: 25016 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:Georgia
Vaccinated:1986-02-09
Onset:1986-02-09
Submitted:0000-00-00
Entered:1990-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES - / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Electroencephalogram abnormal, Grand mal convulsion, Mental retardation severity unspecified, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: initially all lab data WNL; EEG normal, however over period 1986-1988 EEG has turned markedly abnormal, all lab studies WNL
CDC 'Split Type': 890282301

Write-up: 4 mon. infant given DTP 6Feb86- no problems until 9FEB86 awoke w/ fever 103F seen by MD normal exam. 18 hrs later generalized tonic-clonic seizure thought to be febrile, 2nd seizure 17Mar86, 3rd 3Apr86, child has developmental delay.

Changed on 9/14/2018

VAERS ID: 25016 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:Georgia
Vaccinated:1986-02-09
Onset:1986-02-09
Submitted:0000-00-00
Entered:1990-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES - / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Electroencephalogram abnormal, Grand mal convulsion, Mental retardation severity unspecified, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: initially all lab data WNL; EEG normal, however over period 1986-1988 EEG has turned markedly abnormal, all lab studies WNL
CDC 'Split Type': 890282301

Write-up: 4 mon. infant given DTP 6Feb86- no problems until 9FEB86 awoke w/ fever 103F seen by MD normal exam. 18 hrs later generalized tonic-clonic seizure thought to be febrile, 2nd seizure 17Mar86, 3rd 3Apr86, child has developmental delay.

Changed on 10/14/2018

VAERS ID: 25016 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:Georgia
Vaccinated:1986-02-09
Onset:1986-02-09
Submitted:0000-00-00
Entered:1990-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES - / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Electroencephalogram abnormal, Grand mal convulsion, Mental retardation severity unspecified, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: initially all lab data WNL; EEG normal, however over period 1986-1988 EEG has turned markedly abnormal, all lab studies WNL
CDC 'Split Type': 890282301

Write-up: 4 mon. infant given DTP 6Feb86- no problems until 9FEB86 awoke w/ fever 103F seen by MD normal exam. 18 hrs later generalized tonic-clonic seizure thought to be febrile, 2nd seizure 17Mar86, 3rd 3Apr86, child has developmental delay.

Changed on 12/24/2020

VAERS ID: 25016 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:Georgia
Vaccinated:1986-02-09
Onset:1986-02-09
Submitted:0000-00-00
Entered:1990-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES - / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Electroencephalogram abnormal, Grand mal convulsion, Mental retardation severity unspecified, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: initially all lab data WNL; EEG normal, however over period 1986-1988 EEG has turned markedly abnormal, all lab studies WNL
CDC 'Split Type': 890282301

Write-up: 4 mon. infant given DTP 6Feb86- no problems until 9FEB86 awoke w/ fever 103F seen by MD normal exam. 18 hrs later generalized tonic-clonic seizure thought to be febrile, 2nd seizure 17Mar86, 3rd 3Apr86, child has developmental delay.

Changed on 12/30/2020

VAERS ID: 25016 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:Georgia
Vaccinated:1986-02-09
Onset:1986-02-09
Submitted:0000-00-00
Entered:1990-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES - / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Electroencephalogram abnormal, Grand mal convulsion, Mental retardation severity unspecified, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: initially all lab data WNL; EEG normal, however over period 1986-1988 EEG has turned markedly abnormal, all lab studies WNL
CDC 'Split Type': 890282301

Write-up: 4 mon. infant given DTP 6Feb86- no problems until 9FEB86 awoke w/ fever 103F seen by MD normal exam. 18 hrs later generalized tonic-clonic seizure thought to be febrile, 2nd seizure 17Mar86, 3rd 3Apr86, child has developmental delay.

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