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This is VAERS ID 25691

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 25691
VAERS Form:
Age:0.3
Sex:Male
Location:Colorado
Vaccinated:1990-06-04
Onset:1990-06-05
Submitted:0000-00-00
Entered:1990-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 259958 / - L / -
OPV: ORIMUNE / LEDERLE 598E3936 / - - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: EDEMA INJECT SITE, FEVER, HYSN INJECT SITE

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: Lumbar puncture WNL
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV developed fever of 104 and site swelling, rash. MD reported mild fever following DTP on 9-APR-90


Changed on 12/8/2009

VAERS ID: 25691 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Colorado
Vaccinated:1990-06-04
Onset:1990-06-05
Submitted:0000-00-00
Entered:1990-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 259958 / - L / -
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 598E3936 / - - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site oedema, Pyrexia, EDEMA INJECT SITE, FEVER, HYSN INJECT SITE

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: Lumbar puncture WNL
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV developed fever of 104 and site swelling, rash. MD reported mild fever following DTP on 9-APR-90


Changed on 5/14/2017

VAERS ID: 25691 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Colorado
Vaccinated:1990-06-04
Onset:1990-06-05
Submitted:0000-00-00
Entered:1990-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 259958 / - L - / - L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 598E3936 / - - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site oedema, Pyrexia

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: Lumbar puncture WNL
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV developed fever of 104 and site swelling, rash. MD reported mild fever following DTP on 9-APR-90


Changed on 9/14/2017

VAERS ID: 25691 Before After
VAERS Form:(blank) 1
Age:0.3
Sex:Male
Location:Colorado
Vaccinated:1990-06-04
Onset:1990-06-05
Submitted:0000-00-00
Entered:1990-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 259958 / - UNK - / L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 598E3936 / - UNK - MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site oedema, Pyrexia

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: Lumbar puncture WNL
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV developed fever of 104 and site swelling, rash. MD reported mild fever following DTP on 9-APR-90


Changed on 2/14/2018

VAERS ID: 25691 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Colorado
Vaccinated:1990-06-04
Onset:1990-06-05
Submitted:0000-00-00
Entered:1990-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 259958 / UNK - / L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 598E3936 / UNK MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site oedema, Pyrexia

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: Lumbar puncture WNL
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV developed fever of 104 and site swelling, rash. MD reported mild fever following DTP on 9-APR-90


Changed on 6/14/2018

VAERS ID: 25691 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Colorado
Vaccinated:1990-06-04
Onset:1990-06-05
Submitted:0000-00-00
Entered:1990-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 259958 / UNK - / L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 598E3936 / UNK MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site oedema, Pyrexia

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: Lumbar puncture WNL
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV developed fever of 104 and site swelling, rash. MD reported mild fever following DTP on 9-APR-90


Changed on 8/14/2018

VAERS ID: 25691 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Colorado
Vaccinated:1990-06-04
Onset:1990-06-05
Submitted:0000-00-00
Entered:1990-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 259958 / UNK - / L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 598E3936 / UNK MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site oedema, Pyrexia

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: Lumbar puncture WNL
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV developed fever of 104 and site swelling, rash. MD reported mild fever following DTP on 9-APR-90


Changed on 9/14/2018

VAERS ID: 25691 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Colorado
Vaccinated:1990-06-04
Onset:1990-06-05
Submitted:0000-00-00
Entered:1990-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 259958 / UNK - / L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 598E3936 / UNK MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site oedema, Pyrexia

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: Lumbar puncture WNL
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV developed fever of 104 and site swelling, rash. MD reported mild fever following DTP on 9-APR-90


Changed on 10/14/2018

VAERS ID: 25691 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Colorado
Vaccinated:1990-06-04
Onset:1990-06-05
Submitted:0000-00-00
Entered:1990-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 259958 / UNK - / L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 598E3936 / UNK MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site oedema, Pyrexia

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: Lumbar puncture WNL
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV developed fever of 104 and site swelling, rash. MD reported mild fever following DTP on 9-APR-90


Changed on 12/24/2020

VAERS ID: 25691 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Colorado
Vaccinated:1990-06-04
Onset:1990-06-05
Submitted:0000-00-00
Entered:1990-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 259958 / UNK - / L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 598E3936 / UNK MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site oedema, Pyrexia

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: Lumbar puncture WNL
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV developed fever of 104 and site swelling, rash. MD reported mild fever following DTP on 9-APR-90


Changed on 12/30/2020

VAERS ID: 25691 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Colorado
Vaccinated:1990-06-04
Onset:1990-06-05
Submitted:0000-00-00
Entered:1990-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 259958 / UNK - / L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 598E3936 / UNK MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site oedema, Pyrexia

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: Lumbar puncture WNL
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV developed fever of 104 and site swelling, rash. MD reported mild fever following DTP on 9-APR-90

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