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This is VAERS ID 25491

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 25491
VAERS Form:
Age:0.3
Sex:Male
Location:Iowa
Vaccinated:1990-06-15
Onset:1990-06-15
Submitted:0000-00-00
Entered:1990-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 279947 / - - / IM
OPV: ORIMUNE / LEDERLE 275933 / - - / -

Administered by: Private      Purchased by: Unknown
Symptoms: AGITATION, HYPOTONIA, PALLOR

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? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Preemie- twin
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: LIMP, PALE, EXCESSIVE IRRITABILITY, HYPOTONIC


Changed on 12/8/2009

VAERS ID: 25491 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Iowa
Vaccinated:1990-06-15
Onset:1990-06-15
Submitted:0000-00-00
Entered:1990-07-18 1990-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 279947 / - - / IM
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 275933 / - - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Agitation, Hypotonia, Pallor, AGITATION, HYPOTONIA, PALLOR

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? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Preemie- twin
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: LIMP, PALE, EXCESSIVE IRRITABILITY, HYPOTONIC


Changed on 5/14/2017

VAERS ID: 25491 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Iowa
Vaccinated:1990-06-15
Onset:1990-06-15
Submitted:0000-00-00
Entered:1990-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 279947 / - - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 275933 / - - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Agitation, Hypotonia, Pallor

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? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Preemie- twin
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: LIMP, PALE, EXCESSIVE IRRITABILITY, HYPOTONIC


Changed on 9/14/2017

VAERS ID: 25491 Before After
VAERS Form:(blank) 1
Age:0.3
Sex:Male
Location:Iowa
Vaccinated:1990-06-15
Onset:1990-06-15
Submitted:0000-00-00
Entered:1990-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 279947 / - UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 275933 / - UNK - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Agitation, Hypotonia, Pallor

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? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Preemie- twin
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: LIMP, PALE, EXCESSIVE IRRITABILITY, HYPOTONIC


Changed on 2/14/2018

VAERS ID: 25491 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Iowa
Vaccinated:1990-06-15
Onset:1990-06-15
Submitted:0000-00-00
Entered:1990-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 279947 / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 275933 / UNK - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Agitation, Hypotonia, Pallor

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? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Preemie- twin
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: LIMP, PALE, EXCESSIVE IRRITABILITY, HYPOTONIC


Changed on 6/14/2018

VAERS ID: 25491 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Iowa
Vaccinated:1990-06-15
Onset:1990-06-15
Submitted:0000-00-00
Entered:1990-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 279947 / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 275933 / UNK - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Agitation, Hypotonia, Pallor

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? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Preemie- twin
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: LIMP, PALE, EXCESSIVE IRRITABILITY, HYPOTONIC


Changed on 8/14/2018

VAERS ID: 25491 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Iowa
Vaccinated:1990-06-15
Onset:1990-06-15
Submitted:0000-00-00
Entered:1990-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 279947 / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 275933 / UNK - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Agitation, Hypotonia, Pallor

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? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Preemie- twin
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: LIMP, PALE, EXCESSIVE IRRITABILITY, HYPOTONIC


Changed on 9/14/2018

VAERS ID: 25491 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Iowa
Vaccinated:1990-06-15
Onset:1990-06-15
Submitted:0000-00-00
Entered:1990-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 279947 / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 275933 / UNK - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Agitation, Hypotonia, Pallor

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? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Preemie- twin
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: LIMP, PALE, EXCESSIVE IRRITABILITY, HYPOTONIC


Changed on 10/14/2018

VAERS ID: 25491 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Iowa
Vaccinated:1990-06-15
Onset:1990-06-15
Submitted:0000-00-00
Entered:1990-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 279947 / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 275933 / UNK - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Agitation, Hypotonia, Pallor

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? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Preemie- twin
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: LIMP, PALE, EXCESSIVE IRRITABILITY, HYPOTONIC


Changed on 12/24/2020

VAERS ID: 25491 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Iowa
Vaccinated:1990-06-15
Onset:1990-06-15
Submitted:0000-00-00
Entered:1990-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 279947 / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 275933 / UNK - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Agitation, Hypotonia, Pallor

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? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Preemie- twin
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: LIMP, PALE, EXCESSIVE IRRITABILITY, HYPOTONIC


Changed on 12/30/2020

VAERS ID: 25491 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Iowa
Vaccinated:1990-06-15
Onset:1990-06-15
Submitted:0000-00-00
Entered:1990-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 279947 / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 275933 / UNK - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Agitation, Hypotonia, Pallor

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? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Preemie- twin
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: LIMP, PALE, EXCESSIVE IRRITABILITY, HYPOTONIC

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