This is VAERS ID 25137

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID:	25137
VAERS Form:
Age:	5.0
Gender:	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: Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: PT HAD INTERMITTENT BRADYCARDIA, LOW BP AND ALTERED CONSCIOUSNESS.

Changed on 12/8/2009

VAERS ID:	25137 Before After
VAERS Form:
Age:	5.0
Gender:	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 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

Write-up: PT HAD INTERMITTENT BRADYCARDIA, LOW BP AND ALTERED CONSCIOUSNESS.

Changed on 5/14/2017

VAERS ID:	25137 Before After
VAERS Form:
Age:	5.0
Gender:	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: 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: Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: PT HAD INTERMITTENT BRADYCARDIA, LOW BP AND ALTERED CONSCIOUSNESS.

Changed on 9/14/2017

VAERS ID:	25137 Before After
VAERS Form:	(blank) 1
Age:	5.0
Gender:	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: 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: Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: PT HAD INTERMITTENT BRADYCARDIA, LOW BP AND ALTERED CONSCIOUSNESS.

Changed on 2/14/2018

VAERS ID:	25137 Before After
VAERS Form:	1
Age:	5.0
Gender:	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: 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: Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: PT HAD INTERMITTENT BRADYCARDIA, LOW BP AND ALTERED CONSCIOUSNESS.

Changed on 6/14/2018

VAERS ID:	25137 Before After
VAERS Form:	1
Age:	5.0
Gender:	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: 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: Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: PT HAD INTERMITTENT BRADYCARDIA, LOW BP AND ALTERED CONSCIOUSNESS.

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