National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 25163

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 25163
VAERS Form:
Age:0.0
Sex:Male
Location:Illinois
Vaccinated:1990-01-03
Onset:1990-01-03
Submitted:0000-00-00
Entered:1990-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 262912 / - NA / IM
OPV: ORIMUNE / LEDERLE 256923(0598E) / - - / -

Administered by: Private      Purchased by: Unknown
Symptoms: VOMIT, SOMNOLENCE

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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: PT APPEARED LETHARGIC APPROX. 8 HRS AFTER DTP/OPV IMMUN, CHILD HAD SEVERE LETHARGY AND GAGGING EPISODES AND WAS HOSP. FOR OBSERVATION


Changed on 12/8/2009

VAERS ID: 25163 Before After
VAERS Form:
Age:0.0
Sex:Male
Location:Illinois
Vaccinated:1990-01-03
Onset:1990-01-03
Submitted:0000-00-00
Entered:1990-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 262912 / - NA / IM
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 256923(0598E) / - - / -

Administered by: Private      Purchased by: Unknown Private
Symptoms: Somnolence, Vomiting, VOMIT, SOMNOLENCE

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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) 9000092.01

Write-up: PT APPEARED LETHARGIC APPROX. 8 HRS AFTER DTP/OPV IMMUN, CHILD HAD SEVERE LETHARGY AND GAGGING EPISODES AND WAS HOSP. FOR OBSERVATION


Changed on 2/4/2011

VAERS ID: 25163 Before After
VAERS Form:
Age:0.0 (blank)
Sex:Male
Location:Illinois
Vaccinated:1990-01-03
Onset:1990-01-03
Submitted:0000-00-00
Entered:1990-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 262912 / - NA / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES 256923(0598E) / - - / -

Administered by: Private      Purchased by: Private
Symptoms: Somnolence, Vomiting

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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 9000092.01

Write-up: PT APPEARED LETHARGIC APPROX. 8 HRS AFTER DTP/OPV IMMUN, CHILD HAD SEVERE LETHARGY AND GAGGING EPISODES AND WAS HOSP. FOR OBSERVATION


Changed on 2/14/2017

VAERS ID: 25163 Before After
VAERS Form:
Age:(blank) 0.0
Sex:Male
Location:Illinois
Vaccinated:1990-01-03
Onset:1990-01-03
Submitted:0000-00-00
Entered:1990-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 262912 / - NA / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES 256923(0598E) / - - / -

Administered by: Private      Purchased by: Private
Symptoms: Somnolence, Vomiting

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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 9000092.01

Write-up: PT APPEARED LETHARGIC APPROX. 8 HRS AFTER DTP/OPV IMMUN, CHILD HAD SEVERE LETHARGY AND GAGGING EPISODES AND WAS HOSP. FOR OBSERVATION


Changed on 5/14/2017

VAERS ID: 25163 Before After
VAERS Form:
Age:0.0
Sex:Male
Location:Illinois
Vaccinated:1990-01-03
Onset:1990-01-03
Submitted:0000-00-00
Entered:1990-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 262912 / - NA - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 256923(0598E) / - - / -

Administered by: Private      Purchased by: Private
Symptoms: Somnolence, Vomiting

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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 9000092.01

Write-up: PT APPEARED LETHARGIC APPROX. 8 HRS AFTER DTP/OPV IMMUN, CHILD HAD SEVERE LETHARGY AND GAGGING EPISODES AND WAS HOSP. FOR OBSERVATION


Changed on 9/14/2017

VAERS ID: 25163 Before After
VAERS Form:(blank) 1
Age:0.0
Sex:Male
Location:Illinois
Vaccinated:1990-01-03
Onset:1990-01-03
Submitted:0000-00-00
Entered:1990-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 262912 / - UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 256923(0598E) / - UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Somnolence, Vomiting

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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 9000092.01

Write-up: PT APPEARED LETHARGIC APPROX. 8 HRS AFTER DTP/OPV IMMUN, CHILD HAD SEVERE LETHARGY AND GAGGING EPISODES AND WAS HOSP. FOR OBSERVATION


Changed on 2/14/2018

VAERS ID: 25163 Before After
VAERS Form:1
Age:0.0
Sex:Male
Location:Illinois
Vaccinated:1990-01-03
Onset:1990-01-03
Submitted:0000-00-00
Entered:1990-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 262912 / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 256923(0598E) / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Somnolence, Vomiting

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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 9000092.01

Write-up: PT APPEARED LETHARGIC APPROX. 8 HRS AFTER DTP/OPV IMMUN, CHILD HAD SEVERE LETHARGY AND GAGGING EPISODES AND WAS HOSP. FOR OBSERVATION


Changed on 6/14/2018

VAERS ID: 25163 Before After
VAERS Form:1
Age:0.0
Sex:Male
Location:Illinois
Vaccinated:1990-01-03
Onset:1990-01-03
Submitted:0000-00-00
Entered:1990-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 262912 / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 256923(0598E) / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Somnolence, Vomiting

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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 9000092.01

Write-up: PT APPEARED LETHARGIC APPROX. 8 HRS AFTER DTP/OPV IMMUN, CHILD HAD SEVERE LETHARGY AND GAGGING EPISODES AND WAS HOSP. FOR OBSERVATION


Changed on 8/14/2018

VAERS ID: 25163 Before After
VAERS Form:1
Age:0.0
Sex:Male
Location:Illinois
Vaccinated:1990-01-03
Onset:1990-01-03
Submitted:0000-00-00
Entered:1990-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 262912 / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 256923(0598E) / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Somnolence, Vomiting

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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 9000092.01

Write-up: PT APPEARED LETHARGIC APPROX. 8 HRS AFTER DTP/OPV IMMUN, CHILD HAD SEVERE LETHARGY AND GAGGING EPISODES AND WAS HOSP. FOR OBSERVATION


Changed on 9/14/2018

VAERS ID: 25163 Before After
VAERS Form:1
Age:0.0
Sex:Male
Location:Illinois
Vaccinated:1990-01-03
Onset:1990-01-03
Submitted:0000-00-00
Entered:1990-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 262912 / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 256923(0598E) / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Somnolence, Vomiting

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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 9000092.01

Write-up: PT APPEARED LETHARGIC APPROX. 8 HRS AFTER DTP/OPV IMMUN, CHILD HAD SEVERE LETHARGY AND GAGGING EPISODES AND WAS HOSP. FOR OBSERVATION


Changed on 10/14/2018

VAERS ID: 25163 Before After
VAERS Form:1
Age:0.0
Sex:Male
Location:Illinois
Vaccinated:1990-01-03
Onset:1990-01-03
Submitted:0000-00-00
Entered:1990-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 262912 / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 256923(0598E) / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Somnolence, Vomiting

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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 9000092.01

Write-up: PT APPEARED LETHARGIC APPROX. 8 HRS AFTER DTP/OPV IMMUN, CHILD HAD SEVERE LETHARGY AND GAGGING EPISODES AND WAS HOSP. FOR OBSERVATION


Changed on 7/14/2019

VAERS ID: 25163 Before After
VAERS Form:1
Age:0.0 (blank)
Sex:Male
Location:Illinois
Vaccinated:1990-01-03
Onset:1990-01-03
Submitted:0000-00-00
Entered:1990-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 262912 / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 256923(0598E) / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Somnolence, Vomiting

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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 9000092.01

Write-up: PT APPEARED LETHARGIC APPROX. 8 HRS AFTER DTP/OPV IMMUN, CHILD HAD SEVERE LETHARGY AND GAGGING EPISODES AND WAS HOSP. FOR OBSERVATION

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=25163&WAYBACKHISTORY=ON


Copyright © 2020 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166