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This is VAERS ID 33136

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 33136
VAERS Form:
Age:0.2
Sex:Male
Location:Oklahoma
Vaccinated:1969-12-18
Onset:1969-12-18
Submitted:0000-00-00
Entered:1991-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: UNK. DTP / UNCLASSIFIED - / - - / -

Administered by: Private      Purchased by: Unknown
Symptoms: CONVULS, FEVER, CONVULS GRAND MAL

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: Pt exp sz w/DTP
Other Medications:
Current Illness: NONE
Preexisting Conditions: seizure disorder
Allergies:
Diagnostic Lab Data: Not available
CDC 'Split Type': seizure disorder

Write-up: P/each DTP shot pt had extreme fever of 104; Taken to MD then administered PCN shot;noticed pt lay in bed in trance;no sound could disturb;did not realize pt had petit mal until p/ grand mal.


Changed on 12/8/2009

VAERS ID: 33136 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Oklahoma
Vaccinated:1969-12-18
Onset:1969-12-18
Submitted:0000-00-00
Entered:1991-08-06 1991-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: UNK. DTP DTP (NO BRAND NAME) / UNCLASSIFIED UNKNOWN MANUFACTURER - / - - / -

Administered by: Private      Purchased by: Unknown Private
Symptoms: Convulsion, Grand mal convulsion, Pyrexia, CONVULS, FEVER, CONVULS GRAND MAL

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: Pt exp sz w/DTP
Other Medications:
Current Illness: NONE
Preexisting Conditions: seizure disorder
Allergies:
Diagnostic Lab Data: Not available
CDC 'Split Type': seizure disorder (blank)

Write-up: P/each DTP shot pt had extreme fever of 104; Taken to MD then administered PCN shot;noticed pt lay in bed in trance;no sound could disturb;did not realize pt had petit mal until p/ grand mal.


Changed on 5/14/2017

VAERS ID: 33136 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Oklahoma
Vaccinated:1969-12-18
Onset:1969-12-18
Submitted:0000-00-00
Entered:1991-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Private      Purchased by: Private
Symptoms: Convulsion, Grand mal convulsion, Pyrexia

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: Pt exp sz w/DTP w/DTP~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: seizure disorder
Allergies:
Diagnostic Lab Data: Not available
CDC 'Split Type':

Write-up: P/each DTP shot pt had extreme fever of 104; Taken to MD then administered PCN shot;noticed pt lay in bed in trance;no sound could disturb;did not realize pt had petit mal until p/ grand mal.


Changed on 9/14/2017

VAERS ID: 33136 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:Oklahoma
Vaccinated:1969-12-18
Onset:1969-12-18
Submitted:0000-00-00
Entered:1991-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Convulsion, Grand mal convulsion, Pyrexia

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: Pt exp sz w/DTP~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: seizure disorder
Allergies:
Diagnostic Lab Data: Not available
CDC 'Split Type':

Write-up: P/each DTP shot pt had extreme fever of 104; Taken to MD then administered PCN shot;noticed pt lay in bed in trance;no sound could disturb;did not realize pt had petit mal until p/ grand mal.


Changed on 2/14/2018

VAERS ID: 33136 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Oklahoma
Vaccinated:1969-12-18
Onset:1969-12-18
Submitted:0000-00-00
Entered:1991-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Convulsion, Grand mal convulsion, Pyrexia

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: Pt exp sz w/DTP~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: seizure disorder
Allergies:
Diagnostic Lab Data: Not available
CDC 'Split Type':

Write-up: P/each DTP shot pt had extreme fever of 104; Taken to MD then administered PCN shot;noticed pt lay in bed in trance;no sound could disturb;did not realize pt had petit mal until p/ grand mal.


Changed on 6/14/2018

VAERS ID: 33136 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Oklahoma
Vaccinated:1969-12-18
Onset:1969-12-18
Submitted:0000-00-00
Entered:1991-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Convulsion, Grand mal convulsion, Pyrexia

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: Pt exp sz w/DTP~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: seizure disorder
Allergies:
Diagnostic Lab Data: Not available
CDC 'Split Type':

Write-up: P/each DTP shot pt had extreme fever of 104; Taken to MD then administered PCN shot;noticed pt lay in bed in trance;no sound could disturb;did not realize pt had petit mal until p/ grand mal.


Changed on 8/14/2018

VAERS ID: 33136 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Oklahoma
Vaccinated:1969-12-18
Onset:1969-12-18
Submitted:0000-00-00
Entered:1991-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Convulsion, Grand mal convulsion, Pyrexia

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: Pt exp sz w/DTP~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: seizure disorder
Allergies:
Diagnostic Lab Data: Not available
CDC 'Split Type':

Write-up: P/each DTP shot pt had extreme fever of 104; Taken to MD then administered PCN shot;noticed pt lay in bed in trance;no sound could disturb;did not realize pt had petit mal until p/ grand mal.


Changed on 9/14/2018

VAERS ID: 33136 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Oklahoma
Vaccinated:1969-12-18
Onset:1969-12-18
Submitted:0000-00-00
Entered:1991-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Convulsion, Grand mal convulsion, Pyrexia

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: Pt exp sz w/DTP~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: seizure disorder
Allergies:
Diagnostic Lab Data: Not available
CDC 'Split Type':

Write-up: P/each DTP shot pt had extreme fever of 104; Taken to MD then administered PCN shot;noticed pt lay in bed in trance;no sound could disturb;did not realize pt had petit mal until p/ grand mal.


Changed on 10/14/2018

VAERS ID: 33136 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Oklahoma
Vaccinated:1969-12-18
Onset:1969-12-18
Submitted:0000-00-00
Entered:1991-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Convulsion, Grand mal convulsion, Pyrexia

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: Pt exp sz w/DTP~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: seizure disorder
Allergies:
Diagnostic Lab Data: Not available
CDC 'Split Type':

Write-up: P/each DTP shot pt had extreme fever of 104; Taken to MD then administered PCN shot;noticed pt lay in bed in trance;no sound could disturb;did not realize pt had petit mal until p/ grand mal.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=33136&WAYBACKHISTORY=ON


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