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History of Changes from the VAERS Wayback Machine |
VAERS ID: | 25137 |
VAERS Form: | |
Age: | 5.0 |
Sex: | Female |
Location: | Virginia |
Vaccinated: | 1990-05-28 |
Onset: | 1990-05-28 |
Submitted: | 0000-00-00 |
Entered: | 1990-07-09 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTP: TRI-IMMUNOL / LEDERLE | 262913 / - | - / IM |
MMR: MMR II / MSD | 05595/2414R / - | - / - |
OPV: ORIMUNE / LEDERLE | 277943 / - | - / - |
Administered by: Private Purchased by: Unknown
Symptoms: HYPOTENS, BRADYCARDIA, STUPOR
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:
Write-up: PT HAD INTERMITTENT BRADYCARDIA, LOW BP AND ALTERED CONSCIOUSNESS.
Vaccinated: | 1990-05-28 |
Onset: | 1990-05-28 |
Submitted: | 0000-00-00 |
Entered: | 1990-07-09 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES | 262913 / - | - / IM |
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. | 05595/2414R / - | - / - |
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES | 277943 / - | - / - |
Administered by: Private Purchased by: Unknown
Symptoms: Bradycardia, Hypotension, Stupor, HYPOTENS, BRADYCARDIA, STUPOR
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:
Write-up: PT HAD INTERMITTENT BRADYCARDIA, LOW BP AND ALTERED CONSCIOUSNESS.
Vaccinated: | 1990-05-28 |
Onset: | 1990-05-28 |
Submitted: | 0000-00-00 |
Entered: | 1990-07-09 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES | 262913 / - | - / IM |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. | 05595/2414R / - | - / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH | 277943 / - | - / - |
Administered by: Private Purchased by: Unknown
Symptoms: Bradycardia, Hypotension, Stupor
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:
Write-up: PT HAD INTERMITTENT BRADYCARDIA, LOW BP AND ALTERED CONSCIOUSNESS.
Vaccinated: | 1990-05-28 |
Onset: | 1990-05-28 |
Submitted: | 0000-00-00 |
Entered: | 1990-07-09 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES | 262913 / - UNK | - / IM |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. | 05595/2414R / - UNK | - / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH | 277943 / - UNK | - / - |
Administered by: Private Purchased by: Unknown
Symptoms: Bradycardia, Hypotension, Stupor
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:
Write-up: PT HAD INTERMITTENT BRADYCARDIA, LOW BP AND ALTERED CONSCIOUSNESS.
Vaccinated: | 1990-05-28 |
Onset: | 1990-05-28 |
Submitted: | 0000-00-00 |
Entered: | 1990-07-09 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES | 262913 / UNK | - / IM |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. | 05595/2414R / UNK | - / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH | 277943 / UNK | - / - |
Administered by: Private Purchased by: Unknown
Symptoms: Bradycardia, Hypotension, Stupor
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:
Write-up: PT HAD INTERMITTENT BRADYCARDIA, LOW BP AND ALTERED CONSCIOUSNESS.
Vaccinated: | 1990-05-28 |
Onset: | 1990-05-28 |
Submitted: | 0000-00-00 |
Entered: | 1990-07-09 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES | 262913 / UNK | - / IM |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. | 05595/2414R / UNK | - / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH | 277943 / UNK | - / - |
Administered by: Private Purchased by: Unknown
Symptoms: Bradycardia, Hypotension, Stupor
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:
Write-up: PT HAD INTERMITTENT BRADYCARDIA, LOW BP AND ALTERED CONSCIOUSNESS.
Vaccinated: | 1990-05-28 |
Onset: | 1990-05-28 |
Submitted: | 0000-00-00 |
Entered: | 1990-07-09 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES | 262913 / UNK | - / IM |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. | 05595/2414R / UNK | - / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH | 277943 / UNK | - / - |
Administered by: Private Purchased by: Unknown
Symptoms: Bradycardia, Hypotension, Stupor
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:
Write-up: PT HAD INTERMITTENT BRADYCARDIA, LOW BP AND ALTERED CONSCIOUSNESS.
Vaccinated: | 1990-05-28 |
Onset: | 1990-05-28 |
Submitted: | 0000-00-00 |
Entered: | 1990-07-09 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES | 262913 / UNK | - / IM |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. | 05595/2414R / UNK | - / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH | 277943 / UNK | - / - |
Administered by: Private Purchased by: Unknown
Symptoms: Bradycardia, Hypotension, Stupor
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:
Write-up: PT HAD INTERMITTENT BRADYCARDIA, LOW BP AND ALTERED CONSCIOUSNESS.
Vaccinated: | 1990-05-28 |
Onset: | 1990-05-28 |
Submitted: | 0000-00-00 |
Entered: | 1990-07-09 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES | 262913 / UNK | - / IM |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. | 05595/2414R / UNK | - / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH | 277943 / UNK | - / - |
Administered by: Private Purchased by: Unknown
Symptoms: Bradycardia, Hypotension, Stupor
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:
Write-up: PT HAD INTERMITTENT BRADYCARDIA, LOW BP AND ALTERED CONSCIOUSNESS.
Vaccinated: | 1990-05-28 |
Onset: | 1990-05-28 |
Submitted: | 0000-00-00 |
Entered: | 1990-07-09 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES | 262913 / UNK | - / IM |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. | 05595/2414R / UNK | - / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH | 277943 / UNK | - / - |
Administered by: Private Purchased by: Unknown
Symptoms: Bradycardia, Hypotension, Stupor
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:
Write-up: PT HAD INTERMITTENT BRADYCARDIA, LOW BP AND ALTERED CONSCIOUSNESS.
Vaccinated: | 1990-05-28 |
Onset: | 1990-05-28 |
Submitted: | 0000-00-00 |
Entered: | 1990-07-09 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES | 262913 / UNK | - / IM |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. | 05595/2414R / UNK | - / - |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH | 277943 / UNK | - / - |
Administered by: Private Purchased by: Unknown
Symptoms: Bradycardia, Hypotension, Stupor
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:
Write-up: PT HAD INTERMITTENT BRADYCARDIA, LOW BP AND ALTERED CONSCIOUSNESS.
Link To This Search Result:
https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=25137&WAYBACKHISTORY=ON
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