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This is VAERS ID 25039

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 25039
VAERS Form:
Age:0.2
Sex:Female
Location:Indiana
Vaccinated:1990-06-14
Onset:1990-06-15
Submitted:0000-00-00
Entered:1990-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP / CONNAUGHT LABS 9B11033 / - - / -

Administered by: Private      Purchased by: Unknown
Symptoms: HYPOTONIA, STUPOR

Life Threatening? No
Birth Defect? No
Died? No
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Prematurity 27w on monitor for Hx apnea/bradycardia
Allergies:
Diagnostic Lab Data: HCT stable; Blood, Urine, CSF Cultures Neg
CDC 'Split Type':

Write-up: Hypotonia, Hyporesponsive reaction.


Changed on 12/8/2009

VAERS ID: 25039 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Indiana
Vaccinated:1990-06-14
Onset:1990-06-15
Submitted:0000-00-00
Entered:1990-07-11 1990-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP DTP (NO BRAND NAME) / CONNAUGHT LABS CONNAUGHT LABORATORIES 9B11033 / - - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Hypotonia, Stupor, HYPOTONIA, STUPOR

Life Threatening? No
Birth Defect? No
Died? No
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Prematurity 27w on monitor for Hx apnea/bradycardia
Allergies:
Diagnostic Lab Data: HCT stable; Blood, Urine, CSF Cultures Neg
CDC 'Split Type':

Write-up: Hypotonia, Hyporesponsive reaction.


Changed on 5/14/2017

VAERS ID: 25039 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Indiana
Vaccinated:1990-06-14
Onset:1990-06-15
Submitted:0000-00-00
Entered:1990-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 9B11033 / - - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Hypotonia, Stupor

Life Threatening? No
Birth Defect? No
Died? No
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Prematurity 27w on monitor for Hx apnea/bradycardia
Allergies:
Diagnostic Lab Data: HCT stable; Blood, Urine, CSF Cultures Neg
CDC 'Split Type':

Write-up: Hypotonia, Hyporesponsive reaction.


Changed on 9/14/2017

VAERS ID: 25039 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Female
Location:Indiana
Vaccinated:1990-06-14
Onset:1990-06-15
Submitted:0000-00-00
Entered:1990-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 9B11033 / - UNK - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Hypotonia, Stupor

Life Threatening? No
Birth Defect? No
Died? No
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Prematurity 27w on monitor for Hx apnea/bradycardia
Allergies:
Diagnostic Lab Data: HCT stable; Blood, Urine, CSF Cultures Neg
CDC 'Split Type':

Write-up: Hypotonia, Hyporesponsive reaction.


Changed on 2/14/2018

VAERS ID: 25039 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Indiana
Vaccinated:1990-06-14
Onset:1990-06-15
Submitted:0000-00-00
Entered:1990-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 9B11033 / UNK - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Hypotonia, Stupor

Life Threatening? No
Birth Defect? No
Died? No
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Prematurity 27w on monitor for Hx apnea/bradycardia
Allergies:
Diagnostic Lab Data: HCT stable; Blood, Urine, CSF Cultures Neg
CDC 'Split Type':

Write-up: Hypotonia, Hyporesponsive reaction.


Changed on 6/14/2018

VAERS ID: 25039 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Indiana
Vaccinated:1990-06-14
Onset:1990-06-15
Submitted:0000-00-00
Entered:1990-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 9B11033 / UNK - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Hypotonia, Stupor

Life Threatening? No
Birth Defect? No
Died? No
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Prematurity 27w on monitor for Hx apnea/bradycardia
Allergies:
Diagnostic Lab Data: HCT stable; Blood, Urine, CSF Cultures Neg
CDC 'Split Type':

Write-up: Hypotonia, Hyporesponsive reaction.


Changed on 8/14/2018

VAERS ID: 25039 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Indiana
Vaccinated:1990-06-14
Onset:1990-06-15
Submitted:0000-00-00
Entered:1990-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 9B11033 / UNK - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Hypotonia, Stupor

Life Threatening? No
Birth Defect? No
Died? No
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Prematurity 27w on monitor for Hx apnea/bradycardia
Allergies:
Diagnostic Lab Data: HCT stable; Blood, Urine, CSF Cultures Neg
CDC 'Split Type':

Write-up: Hypotonia, Hyporesponsive reaction.


Changed on 9/14/2018

VAERS ID: 25039 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Indiana
Vaccinated:1990-06-14
Onset:1990-06-15
Submitted:0000-00-00
Entered:1990-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 9B11033 / UNK - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Hypotonia, Stupor

Life Threatening? No
Birth Defect? No
Died? No
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Prematurity 27w on monitor for Hx apnea/bradycardia
Allergies:
Diagnostic Lab Data: HCT stable; Blood, Urine, CSF Cultures Neg
CDC 'Split Type':

Write-up: Hypotonia, Hyporesponsive reaction.


Changed on 10/14/2018

VAERS ID: 25039 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Indiana
Vaccinated:1990-06-14
Onset:1990-06-15
Submitted:0000-00-00
Entered:1990-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 9B11033 / UNK - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Hypotonia, Stupor

Life Threatening? No
Birth Defect? No
Died? No
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Prematurity 27w on monitor for Hx apnea/bradycardia
Allergies:
Diagnostic Lab Data: HCT stable; Blood, Urine, CSF Cultures Neg
CDC 'Split Type':

Write-up: Hypotonia, Hyporesponsive reaction.

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