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This is VAERS ID 33051

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 33051
VAERS Form:
Age:1.4
Sex:Male
Location:California
Vaccinated:1990-08-16
Onset:1990-08-16
Submitted:1991-07-24
Entered:1991-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 279947 / 2 LL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) 6FD340 / 2 RL / IM
OPV: ORIMUNE / LEDERLE 271958 / 2 - / PO

Administered by: Military      Purchased by: Unknown
Symptoms: FEVER, MENTAL RETARD, CONVULS GRAND MAL

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Diagnostic workup for seizures-neg
CDC 'Split Type': NONE

Write-up: Pt recvd 3rd DTP on 16AUG90 later that day high temp & grand mal seizure, first seizure, since then recurrent grand mal seizures; nonfebrile & developmental arrest; work-up negative; Dx by MD as seizure disorder secondary to DTP;


Changed on 12/8/2009

VAERS ID: 33051 Before After
VAERS Form:
Age:1.4
Sex:Male
Location:California
Vaccinated:1990-08-16
Onset:1990-08-16
Submitted:1991-07-24
Entered:1991-08-02 1991-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 279947 / 2 LL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS 6FD340 / 2 RL / IM
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 271958 / 2 - / PO

Administered by: Military      Purchased by: Unknown Private
Symptoms: Grand mal convulsion, Mental retardation severity unspecified, Pyrexia, FEVER, MENTAL RETARD, CONVULS GRAND MAL

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Diagnostic workup for seizures-neg
CDC 'Split Type': NONE (blank)

Write-up: Pt recvd 3rd DTP on 16AUG90 later that day high temp & grand mal seizure, first seizure, since then recurrent grand mal seizures; nonfebrile & developmental arrest; work-up negative; Dx by MD as seizure disorder secondary to DTP;


Changed on 5/14/2017

VAERS ID: 33051 Before After
VAERS Form:
Age:1.4
Sex:Male
Location:California
Vaccinated:1990-08-16
Onset:1990-08-16
Submitted:1991-07-24
Entered:1991-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 279947 / 2 LL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH 6FD340 / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 271958 / 2 - / PO

Administered by: Military      Purchased by: Private
Symptoms: Grand mal convulsion, Mental retardation severity unspecified, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: NONE NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Diagnostic workup for seizures-neg
CDC 'Split Type':

Write-up: Pt recvd 3rd DTP on 16AUG90 later that day high temp & grand mal seizure, first seizure, since then recurrent grand mal seizures; nonfebrile & developmental arrest; work-up negative; Dx by MD as seizure disorder secondary to DTP;


Changed on 9/14/2017

VAERS ID: 33051 Before After
VAERS Form:(blank) 1
Age:1.4
Sex:Male
Location:California
Vaccinated:1990-08-16
Onset:1990-08-16
Submitted:1991-07-24
Entered:1991-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 279947 / 2 3 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 6FD340 / 2 3 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 271958 / 2 3 - MO / PO

Administered by: Military      Purchased by: Private
Symptoms: Grand mal convulsion, Mental retardation severity unspecified, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Diagnostic workup for seizures-neg
CDC 'Split Type':

Write-up: Pt recvd 3rd DTP on 16AUG90 later that day high temp & grand mal seizure, first seizure, since then recurrent grand mal seizures; nonfebrile & developmental arrest; work-up negative; Dx by MD as seizure disorder secondary to DTP;


Changed on 2/14/2018

VAERS ID: 33051 Before After
VAERS Form:1
Age:1.4
Sex:Male
Location:California
Vaccinated:1990-08-16
Onset:1990-08-16
Submitted:1991-07-24
Entered:1991-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 279947 / 3 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 6FD340 / 3 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 271958 / 3 MO / PO

Administered by: Military      Purchased by: Private
Symptoms: Grand mal convulsion, Mental retardation severity unspecified, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Diagnostic workup for seizures-neg
CDC 'Split Type':

Write-up: Pt recvd 3rd DTP on 16AUG90 later that day high temp & grand mal seizure, first seizure, since then recurrent grand mal seizures; nonfebrile & developmental arrest; work-up negative; Dx by MD as seizure disorder secondary to DTP;


Changed on 6/14/2018

VAERS ID: 33051 Before After
VAERS Form:1
Age:1.4
Sex:Male
Location:California
Vaccinated:1990-08-16
Onset:1990-08-16
Submitted:1991-07-24
Entered:1991-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 279947 / 3 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 6FD340 / 3 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 271958 / 3 MO / PO

Administered by: Military      Purchased by: Private
Symptoms: Grand mal convulsion, Mental retardation severity unspecified, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Diagnostic workup for seizures-neg
CDC 'Split Type':

Write-up: Pt recvd 3rd DTP on 16AUG90 later that day high temp & grand mal seizure, first seizure, since then recurrent grand mal seizures; nonfebrile & developmental arrest; work-up negative; Dx by MD as seizure disorder secondary to DTP;


Changed on 8/14/2018

VAERS ID: 33051 Before After
VAERS Form:1
Age:1.4
Sex:Male
Location:California
Vaccinated:1990-08-16
Onset:1990-08-16
Submitted:1991-07-24
Entered:1991-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 279947 / 3 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 6FD340 / 3 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 271958 / 3 MO / PO

Administered by: Military      Purchased by: Private
Symptoms: Grand mal convulsion, Mental retardation severity unspecified, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Diagnostic workup for seizures-neg
CDC 'Split Type':

Write-up: Pt recvd 3rd DTP on 16AUG90 later that day high temp & grand mal seizure, first seizure, since then recurrent grand mal seizures; nonfebrile & developmental arrest; work-up negative; Dx by MD as seizure disorder secondary to DTP;


Changed on 9/14/2018

VAERS ID: 33051 Before After
VAERS Form:1
Age:1.4
Sex:Male
Location:California
Vaccinated:1990-08-16
Onset:1990-08-16
Submitted:1991-07-24
Entered:1991-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 279947 / 3 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 6FD340 / 3 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 271958 / 3 MO / PO

Administered by: Military      Purchased by: Private
Symptoms: Grand mal convulsion, Mental retardation severity unspecified, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Diagnostic workup for seizures-neg
CDC 'Split Type':

Write-up: Pt recvd 3rd DTP on 16AUG90 later that day high temp & grand mal seizure, first seizure, since then recurrent grand mal seizures; nonfebrile & developmental arrest; work-up negative; Dx by MD as seizure disorder secondary to DTP;


Changed on 10/14/2018

VAERS ID: 33051 Before After
VAERS Form:1
Age:1.4
Sex:Male
Location:California
Vaccinated:1990-08-16
Onset:1990-08-16
Submitted:1991-07-24
Entered:1991-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 279947 / 3 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 6FD340 / 3 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 271958 / 3 MO / PO

Administered by: Military      Purchased by: Private
Symptoms: Grand mal convulsion, Mental retardation severity unspecified, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Diagnostic workup for seizures-neg
CDC 'Split Type':

Write-up: Pt recvd 3rd DTP on 16AUG90 later that day high temp & grand mal seizure, first seizure, since then recurrent grand mal seizures; nonfebrile & developmental arrest; work-up negative; Dx by MD as seizure disorder secondary to DTP;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=33051&WAYBACKHISTORY=ON


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