![]() |
National Vaccine Information Center Your Health. Your Family. Your Choice. |
MedAlerts Home |
History of Changes from the VAERS Wayback Machine |
VAERS ID: | 25542 |
VAERS Form: | |
Age: | 22.0 |
Sex: | Female |
Location: | California |
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: | 0000-00-00 |
Entered: | 1990-07-20 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTP: TRI-IMMUNOL / LEDERLE | - / - | - / - |
Administered by: Private Purchased by: Unknown
Symptoms: MENTAL RETARD, ANOMALY HEART
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:
CDC 'Split Type':
Write-up: immunized 1968, experienced developmental delay, dysmorphism, hypertelorism, thick tongue, asymptomatic pulmonary stenosis, possible Turner''s Noonan''s syndrome & heart murmur, child last seen by reporter 1971
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: | 0000-00-00 |
Entered: | 1990-07-20 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTP: TRI-IMMUNOL / LEDERLE | - / - | - / - |
Administered by: Private Purchased by: Unknown
Symptoms: MENTAL RETARD, ANOMALY HEART
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:
CDC 'Split Type':
Write-up: immunized 1968, experienced developmental delay, dysmorphism, hypertelorism, thick tongue, asymptomatic pulmonary stenosis, possible Turner''s Noonan''s Turner''''s Noonan''''s syndrome & heart murmur, child last seen by reporter 1971
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: | 0000-00-00 |
Entered: | 1990-07-20 1990-07-18 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES | - / - | - / - |
Administered by: Private Purchased by: Unknown
Symptoms: Heart disease congenital, Mental retardation severity unspecified, MENTAL RETARD, ANOMALY HEART
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:
CDC 'Split Type': (blank) 9001111.01
Write-up: immunized 1968, experienced developmental delay, dysmorphism, hypertelorism, thick tongue, asymptomatic pulmonary stenosis, possible Turner''''s Noonan''''s Turner''s Noonan''s syndrome & heart murmur, child last seen by reporter 1971
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: | 0000-00-00 |
Entered: | 1990-07-18 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES | - / - | - / - |
Administered by: Private Purchased by: Unknown
Symptoms: Heart disease congenital, Mental retardation severity unspecified
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 9001111.01
Write-up: immunized 1968, experienced developmental delay, dysmorphism, hypertelorism, thick tongue, asymptomatic pulmonary stenosis, possible Turner''s Noonan''s syndrome & heart murmur, child last seen by reporter 1971
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: | 0000-00-00 |
Entered: | 1990-07-18 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES | - / - UNK | - / - |
Administered by: Private Purchased by: Unknown
Symptoms: Heart disease congenital, Mental retardation severity unspecified
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 9001111.01
Write-up: immunized 1968, experienced developmental delay, dysmorphism, hypertelorism, thick tongue, asymptomatic pulmonary stenosis, possible Turner''s Noonan''s syndrome & heart murmur, child last seen by reporter 1971
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: | 0000-00-00 |
Entered: | 1990-07-18 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES | - / UNK | - / - |
Administered by: Private Purchased by: Unknown
Symptoms: Heart disease congenital, Mental retardation severity unspecified
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 9001111.01
Write-up: immunized 1968, experienced developmental delay, dysmorphism, hypertelorism, thick tongue, asymptomatic pulmonary stenosis, possible Turner''s Noonan''s syndrome & heart murmur, child last seen by reporter 1971
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: | 0000-00-00 |
Entered: | 1990-07-18 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES | - / UNK | - / - |
Administered by: Private Purchased by: Unknown
Symptoms: Heart disease congenital, Mental retardation severity unspecified
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 9001111.01
Write-up: immunized 1968, experienced developmental delay, dysmorphism, hypertelorism, thick tongue, asymptomatic pulmonary stenosis, possible Turner''s Noonan''s syndrome & heart murmur, child last seen by reporter 1971
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: | 0000-00-00 |
Entered: | 1990-07-18 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES | - / UNK | - / - |
Administered by: Private Purchased by: Unknown
Symptoms: Heart disease congenital, Mental retardation severity unspecified
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 9001111.01
Write-up: immunized 1968, experienced developmental delay, dysmorphism, hypertelorism, thick tongue, asymptomatic pulmonary stenosis, possible Turner''s Noonan''s syndrome & heart murmur, child last seen by reporter 1971
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: | 0000-00-00 |
Entered: | 1990-07-18 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES | - / UNK | - / - |
Administered by: Private Purchased by: Unknown
Symptoms: Heart disease congenital, Mental retardation severity unspecified
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 9001111.01
Write-up: immunized 1968, experienced developmental delay, dysmorphism, hypertelorism, thick tongue, asymptomatic pulmonary stenosis, possible Turner''s Noonan''s syndrome & heart murmur, child last seen by reporter 1971
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: | 0000-00-00 |
Entered: | 1990-07-18 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES | - / UNK | - / - |
Administered by: Private Purchased by: Unknown
Symptoms: Heart disease congenital, Mental retardation severity unspecified
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 9001111.01
Write-up: immunized 1968, experienced developmental delay, dysmorphism, hypertelorism, thick tongue, asymptomatic pulmonary stenosis, possible Turner''s Noonan''s syndrome & heart murmur, child last seen by reporter 1971
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: | 0000-00-00 |
Entered: | 1990-07-18 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES | - / UNK | - / - |
Administered by: Private Purchased by: Unknown
Symptoms: Heart disease congenital, Mental retardation severity unspecified
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 9001111.01
Write-up: immunized 1968, experienced developmental delay, dysmorphism, hypertelorism, thick tongue, asymptomatic pulmonary stenosis, possible Turner''s Noonan''s syndrome & heart murmur, child last seen by reporter 1971
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: | 0000-00-00 |
Entered: | 1990-07-18 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES | - / UNK | - / - |
Administered by: Private Purchased by: Unknown
Symptoms: Heart disease congenital, Mental retardation severity unspecified
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 9001111.01
Write-up: immunized 1968, experienced developmental delay, dysmorphism, hypertelorism, thick tongue, asymptomatic pulmonary stenosis, possible Turner''s Noonan''s syndrome & heart murmur, child last seen by reporter 1971
Link To This Search Result:
https://medalerts.org/vaersdb/findfield.php?IDNUMBER=25542&WAYBACKHISTORY=ON
Copyright ©
2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166