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This is VAERS ID 25104

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 25104
VAERS Form:
Age:0.7
Sex:Female
Location:Nebraska
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:0000-00-00
Entered:1990-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 259966 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: HYPOTONIA, EYES GAZE UPWARD, INJURY ACCID

Life Threatening? No
Birth Defect? No
Died? No
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Child given DTP on 11-DEC-89. Four Hrs later at home turned pale, eyes rolled back, became limp, bumped chin on high chair. No seizure activity. Examined in office; temp 102, otherwise fine. Child hospitalized and place on monitor.

Changed on 12/8/2009

VAERS ID: 25104 Before After
VAERS Form:
Age:0.7
Sex:Female
Location:Nebraska
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:0000-00-00
Entered:1990-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 259966 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Hypotonia, Injury, Gaze palsy, HYPOTONIA, EYES GAZE UPWARD, INJURY ACCID

Life Threatening? No
Birth Defect? No
Died? No
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) 8902951.01

Write-up: Child given DTP on 11-DEC-89. Four Hrs later at home turned pale, eyes rolled back, became limp, bumped chin on high chair. No seizure activity. Examined in office; temp 102, otherwise fine. Child hospitalized and place on monitor.

Changed on 9/14/2017

VAERS ID: 25104 Before After
VAERS Form:(blank) 1
Age:0.7
Sex:Female
Location:Nebraska
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:0000-00-00
Entered:1990-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 259966 / - UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Hypotonia, Injury, Gaze palsy

Life Threatening? No
Birth Defect? No
Died? No
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 8902951.01

Write-up: Child given DTP on 11-DEC-89. Four Hrs later at home turned pale, eyes rolled back, became limp, bumped chin on high chair. No seizure activity. Examined in office; temp 102, otherwise fine. Child hospitalized and place on monitor.

Changed on 2/14/2018

VAERS ID: 25104 Before After
VAERS Form:1
Age:0.7
Sex:Female
Location:Nebraska
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:0000-00-00
Entered:1990-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 259966 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Hypotonia, Injury, Gaze palsy

Life Threatening? No
Birth Defect? No
Died? No
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 8902951.01

Write-up: Child given DTP on 11-DEC-89. Four Hrs later at home turned pale, eyes rolled back, became limp, bumped chin on high chair. No seizure activity. Examined in office; temp 102, otherwise fine. Child hospitalized and place on monitor.

Changed on 6/14/2018

VAERS ID: 25104 Before After
VAERS Form:1
Age:0.7
Sex:Female
Location:Nebraska
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:0000-00-00
Entered:1990-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 259966 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Hypotonia, Injury, Gaze palsy

Life Threatening? No
Birth Defect? No
Died? No
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 8902951.01

Write-up: Child given DTP on 11-DEC-89. Four Hrs later at home turned pale, eyes rolled back, became limp, bumped chin on high chair. No seizure activity. Examined in office; temp 102, otherwise fine. Child hospitalized and place on monitor.

Changed on 8/14/2018

VAERS ID: 25104 Before After
VAERS Form:1
Age:0.7
Sex:Female
Location:Nebraska
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:0000-00-00
Entered:1990-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 259966 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Hypotonia, Injury, Gaze palsy

Life Threatening? No
Birth Defect? No
Died? No
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 8902951.01

Write-up: Child given DTP on 11-DEC-89. Four Hrs later at home turned pale, eyes rolled back, became limp, bumped chin on high chair. No seizure activity. Examined in office; temp 102, otherwise fine. Child hospitalized and place on monitor.

Changed on 9/14/2018

VAERS ID: 25104 Before After
VAERS Form:1
Age:0.7
Sex:Female
Location:Nebraska
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:0000-00-00
Entered:1990-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 259966 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Hypotonia, Injury, Gaze palsy

Life Threatening? No
Birth Defect? No
Died? No
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 8902951.01

Write-up: Child given DTP on 11-DEC-89. Four Hrs later at home turned pale, eyes rolled back, became limp, bumped chin on high chair. No seizure activity. Examined in office; temp 102, otherwise fine. Child hospitalized and place on monitor.

Changed on 10/14/2018

VAERS ID: 25104 Before After
VAERS Form:1
Age:0.7
Sex:Female
Location:Nebraska
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:0000-00-00
Entered:1990-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 259966 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Hypotonia, Injury, Gaze palsy

Life Threatening? No
Birth Defect? No
Died? No
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 8902951.01

Write-up: Child given DTP on 11-DEC-89. Four Hrs later at home turned pale, eyes rolled back, became limp, bumped chin on high chair. No seizure activity. Examined in office; temp 102, otherwise fine. Child hospitalized and place on monitor.

Changed on 12/24/2020

VAERS ID: 25104 Before After
VAERS Form:1
Age:0.7
Sex:Female
Location:Nebraska
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:0000-00-00
Entered:1990-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 259966 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Hypotonia, Injury, Gaze palsy

Life Threatening? No
Birth Defect? No
Died? No
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 8902951.01

Write-up: Child given DTP on 11-DEC-89. Four Hrs later at home turned pale, eyes rolled back, became limp, bumped chin on high chair. No seizure activity. Examined in office; temp 102, otherwise fine. Child hospitalized and place on monitor.

Changed on 12/30/2020

VAERS ID: 25104 Before After
VAERS Form:1
Age:0.7
Sex:Female
Location:Nebraska
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:0000-00-00
Entered:1990-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 259966 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Hypotonia, Injury, Gaze palsy

Life Threatening? No
Birth Defect? No
Died? No
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 8902951.01

Write-up: Child given DTP on 11-DEC-89. Four Hrs later at home turned pale, eyes rolled back, became limp, bumped chin on high chair. No seizure activity. Examined in office; temp 102, otherwise fine. Child hospitalized and place on monitor.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=25104&WAYBACKHISTORY=ON


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