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This is VAERS ID 31372

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 31372
VAERS Form:
Age:0.2
Sex:Female
Location:South Carolina
Vaccinated:1990-07-19
Onset:1990-07-19
Submitted:1991-06-04
Entered:1991-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 283911 / 0 LL / IM
OPV: ORIMUNE / LEDERLE 279937 / 0 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: CONVULS, FEVER, MENTAL RETARD, HYPERTONIA

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 14     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Recvd vax in am,developed T in pm,mom gave APAP.Pt started""jerking"".Mom PC MD gave APAP.TO MD in am R/T ""jerky movements"" MD states pt was having sz.Pt has cont to have sz.Mom states""developmentally delayed"" R/T sz per MD.


Changed on 12/8/2009

VAERS ID: 31372 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:South Carolina
Vaccinated:1990-07-19
Onset:1990-07-19
Submitted:1991-06-04
Entered:1991-06-21 1991-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 283911 / 0 LL / IM
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 279937 / 0 - / PO

Administered by: Public      Purchased by: Unknown Public
Symptoms: Convulsion, Hypertonia, Mental retardation severity unspecified, Pyrexia, CONVULS, FEVER, MENTAL RETARD, HYPERTONIA

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 14     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) SC91074

Write-up: Recvd vax in am,developed T in pm,mom gave APAP.Pt started""jerking"".Mom started"jerking".Mom PC MD gave APAP.TO MD in am R/T ""jerky movements"" "jerky movements" MD states pt was having sz.Pt has cont to have sz.Mom states""developmentally delayed"" states"developmentally delayed" R/T sz per MD.


Changed on 5/14/2017

VAERS ID: 31372 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:South Carolina
Vaccinated:1990-07-19
Onset:1990-07-19
Submitted:1991-06-04
Entered:1991-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283911 / 0 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 279937 / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Hypertonia, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 14     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': SC91074

Write-up: Recvd vax in am,developed T in pm,mom gave APAP.Pt started"jerking".Mom PC MD gave APAP.TO MD in am R/T "jerky movements" MD states pt was having sz.Pt has cont to have sz.Mom states"developmentally delayed" R/T sz per MD.


Changed on 9/14/2017

VAERS ID: 31372 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Female
Location:South Carolina
Vaccinated:1990-07-19
Onset:1990-07-19
Submitted:1991-06-04
Entered:1991-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283911 / 0 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 279937 / 0 1 - MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Hypertonia, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 14     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': SC91074

Write-up: Recvd vax in am,developed T in pm,mom gave APAP.Pt started"jerking".Mom PC MD gave APAP.TO MD in am R/T "jerky movements" MD states pt was having sz.Pt has cont to have sz.Mom states"developmentally delayed" R/T sz per MD.


Changed on 2/14/2018

VAERS ID: 31372 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:South Carolina
Vaccinated:1990-07-19
Onset:1990-07-19
Submitted:1991-06-04
Entered:1991-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283911 / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 279937 / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Hypertonia, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 14     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': SC91074

Write-up: Recvd vax in am,developed T in pm,mom gave APAP.Pt started"jerking".Mom PC MD gave APAP.TO MD in am R/T "jerky movements" MD states pt was having sz.Pt has cont to have sz.Mom states"developmentally delayed" R/T sz per MD.


Changed on 6/14/2018

VAERS ID: 31372 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:South Carolina
Vaccinated:1990-07-19
Onset:1990-07-19
Submitted:1991-06-04
Entered:1991-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283911 / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 279937 / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Hypertonia, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 14     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': SC91074

Write-up: Recvd vax in am,developed T in pm,mom gave APAP.Pt started"jerking".Mom PC MD gave APAP.TO MD in am R/T "jerky movements" MD states pt was having sz.Pt has cont to have sz.Mom states"developmentally delayed" R/T sz per MD.


Changed on 8/14/2018

VAERS ID: 31372 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:South Carolina
Vaccinated:1990-07-19
Onset:1990-07-19
Submitted:1991-06-04
Entered:1991-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283911 / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 279937 / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Hypertonia, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 14     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': SC91074

Write-up: Recvd vax in am,developed T in pm,mom gave APAP.Pt started"jerking".Mom PC MD gave APAP.TO MD in am R/T "jerky movements" MD states pt was having sz.Pt has cont to have sz.Mom states"developmentally delayed" R/T sz per MD.


Changed on 9/14/2018

VAERS ID: 31372 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:South Carolina
Vaccinated:1990-07-19
Onset:1990-07-19
Submitted:1991-06-04
Entered:1991-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283911 / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 279937 / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Hypertonia, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 14     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': SC91074

Write-up: Recvd vax in am,developed T in pm,mom gave APAP.Pt started"jerking".Mom PC MD gave APAP.TO MD in am R/T "jerky movements" MD states pt was having sz.Pt has cont to have sz.Mom states"developmentally delayed" R/T sz per MD.


Changed on 10/14/2018

VAERS ID: 31372 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:South Carolina
Vaccinated:1990-07-19
Onset:1990-07-19
Submitted:1991-06-04
Entered:1991-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283911 / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 279937 / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Convulsion, Hypertonia, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 14     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': SC91074

Write-up: Recvd vax in am,developed T in pm,mom gave APAP.Pt started"jerking".Mom PC MD gave APAP.TO MD in am R/T "jerky movements" MD states pt was having sz.Pt has cont to have sz.Mom states"developmentally delayed" R/T sz per MD.

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