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This is VAERS ID 28514

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 28514
VAERS Form:
Age:0.2
Sex:Male
Location:Virginia
Vaccinated:1989-12-14
Onset:1989-12-15
Submitted:1991-02-25
Entered:1991-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 283914 / - - / -
OPV: UNK. POLIOVIRUS LIVE ORAL TRIVALENT / UNCLASSIFIED 253938 / - - / -

Administered by: Private      Purchased by: Unknown
Symptoms: AGITATION, FEVER, ANOREXIA, EDEMA, CRY ABNORMAL

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1989-12-23
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: NA
Other Medications: NA
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NONE

Write-up: Swelling on leg, fever, excessive sleeping, high pitched crying episodes lasting over 2 hrs @ a time reluctant feeding.


Changed on 12/8/2009

VAERS ID: 28514 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Virginia
Vaccinated:1989-12-14
Onset:1989-12-15
Submitted:1991-02-25
Entered:1991-03-07 1991-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 283914 / - - / -
OPV: UNK. POLIOVIRUS LIVE ORAL TRIVALENT POLIO VIRUS, ORAL (NO BRAND NAME) / UNCLASSIFIED UNKNOWN MANUFACTURER 253938 / - - / -

Administered by: Private      Purchased by: Unknown Other
Symptoms: Agitation, Anorexia, Crying, Oedema, Pyrexia, Somnolence, AGITATION, FEVER, ANOREXIA, EDEMA, CRY ABNORMAL

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1989-12-23
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: NA
Other Medications: NA
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NONE (blank)

Write-up: Swelling on leg, fever, excessive sleeping, high pitched crying episodes lasting over 2 hrs @ a time reluctant feeding.


Changed on 5/14/2017

VAERS ID: 28514 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Virginia
Vaccinated:1989-12-14
Onset:1989-12-15
Submitted:1991-02-25
Entered:1991-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283914 / - - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER 253938 / - - / -

Administered by: Private      Purchased by: Other
Symptoms: Agitation, Anorexia, Crying, Oedema, Pyrexia, Somnolence

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1989-12-23
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: NA NA~ ()~~~In patient
Other Medications: NA
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Swelling on leg, fever, excessive sleeping, high pitched crying episodes lasting over 2 hrs @ a time reluctant feeding.


Changed on 9/14/2017

VAERS ID: 28514 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:Virginia
Vaccinated:1989-12-14
Onset:1989-12-15
Submitted:1991-02-25
Entered:1991-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283914 / - UNK - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER 253938 / - UNK - / -

Administered by: Private      Purchased by: Other
Symptoms: Agitation, Anorexia, Crying, Oedema, Pyrexia, Somnolence

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1989-12-23
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: NA~ ()~~~In patient
Other Medications: NA
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Swelling on leg, fever, excessive sleeping, high pitched crying episodes lasting over 2 hrs @ a time reluctant feeding.


Changed on 2/14/2018

VAERS ID: 28514 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Virginia
Vaccinated:1989-12-14
Onset:1989-12-15
Submitted:1991-02-25
Entered:1991-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283914 / UNK - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER 253938 / UNK - / -

Administered by: Private      Purchased by: Other
Symptoms: Agitation, Anorexia, Crying, Oedema, Pyrexia, Somnolence

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1989-12-23
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: NA~ ()~~~In patient
Other Medications: NA
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Swelling on leg, fever, excessive sleeping, high pitched crying episodes lasting over 2 hrs @ a time reluctant feeding.


Changed on 6/14/2018

VAERS ID: 28514 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Virginia
Vaccinated:1989-12-14
Onset:1989-12-15
Submitted:1991-02-25
Entered:1991-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283914 / UNK - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER 253938 / UNK - / -

Administered by: Private      Purchased by: Other
Symptoms: Agitation, Anorexia, Crying, Oedema, Pyrexia, Somnolence

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1989-12-23
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: NA~ ()~~~In patient
Other Medications: NA
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Swelling on leg, fever, excessive sleeping, high pitched crying episodes lasting over 2 hrs @ a time reluctant feeding.


Changed on 8/14/2018

VAERS ID: 28514 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Virginia
Vaccinated:1989-12-14
Onset:1989-12-15
Submitted:1991-02-25
Entered:1991-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283914 / UNK - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER 253938 / UNK - / -

Administered by: Private      Purchased by: Other
Symptoms: Agitation, Anorexia, Crying, Oedema, Pyrexia, Somnolence

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1989-12-23
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: NA~ ()~~~In patient
Other Medications: NA
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Swelling on leg, fever, excessive sleeping, high pitched crying episodes lasting over 2 hrs @ a time reluctant feeding.


Changed on 9/14/2018

VAERS ID: 28514 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Virginia
Vaccinated:1989-12-14
Onset:1989-12-15
Submitted:1991-02-25
Entered:1991-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283914 / UNK - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER 253938 / UNK - / -

Administered by: Private      Purchased by: Other
Symptoms: Agitation, Anorexia, Crying, Oedema, Pyrexia, Somnolence

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1989-12-23
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: NA~ ()~~~In patient
Other Medications: NA
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Swelling on leg, fever, excessive sleeping, high pitched crying episodes lasting over 2 hrs @ a time reluctant feeding.


Changed on 10/14/2018

VAERS ID: 28514 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Virginia
Vaccinated:1989-12-14
Onset:1989-12-15
Submitted:1991-02-25
Entered:1991-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283914 / UNK - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER 253938 / UNK - / -

Administered by: Private      Purchased by: Other
Symptoms: Agitation, Anorexia, Crying, Oedema, Pyrexia, Somnolence

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1989-12-23
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: NA~ ()~~~In patient
Other Medications: NA
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Swelling on leg, fever, excessive sleeping, high pitched crying episodes lasting over 2 hrs @ a time reluctant feeding.

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