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This is VAERS ID 27114

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History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 27114
VAERS Form:
Age:0.7
Sex:Male
Location:Wisconsin
Vaccinated:1990-10-24
Onset:1990-10-24
Submitted:1990-10-31
Entered:1990-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 268912 / 1 LL / IM
IPV: POLIOVAX / CONNAUGHT LTD 841022 / 1 RL / SC

Administered by: Public      Purchased by: Unknown
Symptoms: AGITATION, FEVER, PAIN, PNEUMONIA, BRONCHITIS

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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: very mild cold symptoms
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated w/DTP/IPV developed temp 100, cried 45 min constantly after receiving inject continued crying at intervals until afternoon especially when moved. Lt leg pain. Also, developed cold symptoms, possible bronchitis or pneumonia.


Changed on 12/8/2009

VAERS ID: 27114 Before After
VAERS Form:
Age:0.7
Sex:Male
Location:Wisconsin
Vaccinated:1990-10-24
Onset:1990-10-24
Submitted:1990-10-31
Entered:1990-12-20 1990-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 268912 / 1 LL / IM
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. 841022 / 1 RL / SC

Administered by: Public      Purchased by: Unknown Public
Symptoms: Agitation, Bronchitis, Pain, Pneumonia, Pyrexia, Rhinitis, AGITATION, FEVER, PAIN, PNEUMONIA, BRONCHITIS

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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: very mild cold symptoms
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) WI90042

Write-up: Pt vaccinated w/DTP/IPV developed temp 100, cried 45 min constantly after receiving inject continued crying at intervals until afternoon especially when moved. Lt leg pain. Also, developed cold symptoms, possible bronchitis or pneumonia.


Changed on 5/14/2017

VAERS ID: 27114 Before After
VAERS Form:
Age:0.7
Sex:Male
Location:Wisconsin
Vaccinated:1990-10-24
Onset:1990-10-24
Submitted:1990-10-31
Entered:1990-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 268912 / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841022 / 1 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Agitation, Bronchitis, Pain, Pneumonia, Pyrexia, Rhinitis

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: very mild cold symptoms
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WI90042

Write-up: Pt vaccinated w/DTP/IPV developed temp 100, cried 45 min constantly after receiving inject continued crying at intervals until afternoon especially when moved. Lt leg pain. Also, developed cold symptoms, possible bronchitis or pneumonia.


Changed on 9/14/2017

VAERS ID: 27114 Before After
VAERS Form:(blank) 1
Age:0.7
Sex:Male
Location:Wisconsin
Vaccinated:1990-10-24
Onset:1990-10-24
Submitted:1990-10-31
Entered:1990-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 268912 / 1 2 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841022 / 1 2 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Agitation, Bronchitis, Pain, Pneumonia, Pyrexia, Rhinitis

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: very mild cold symptoms
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WI90042

Write-up: Pt vaccinated w/DTP/IPV developed temp 100, cried 45 min constantly after receiving inject continued crying at intervals until afternoon especially when moved. Lt leg pain. Also, developed cold symptoms, possible bronchitis or pneumonia.


Changed on 2/14/2018

VAERS ID: 27114 Before After
VAERS Form:1
Age:0.7
Sex:Male
Location:Wisconsin
Vaccinated:1990-10-24
Onset:1990-10-24
Submitted:1990-10-31
Entered:1990-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 268912 / 2 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841022 / 2 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Agitation, Bronchitis, Pain, Pneumonia, Pyrexia, Rhinitis

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: very mild cold symptoms
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WI90042

Write-up: Pt vaccinated w/DTP/IPV developed temp 100, cried 45 min constantly after receiving inject continued crying at intervals until afternoon especially when moved. Lt leg pain. Also, developed cold symptoms, possible bronchitis or pneumonia.


Changed on 6/14/2018

VAERS ID: 27114 Before After
VAERS Form:1
Age:0.7
Sex:Male
Location:Wisconsin
Vaccinated:1990-10-24
Onset:1990-10-24
Submitted:1990-10-31
Entered:1990-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 268912 / 2 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841022 / 2 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Agitation, Bronchitis, Pain, Pneumonia, Pyrexia, Rhinitis

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: very mild cold symptoms
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WI90042

Write-up: Pt vaccinated w/DTP/IPV developed temp 100, cried 45 min constantly after receiving inject continued crying at intervals until afternoon especially when moved. Lt leg pain. Also, developed cold symptoms, possible bronchitis or pneumonia.


Changed on 8/14/2018

VAERS ID: 27114 Before After
VAERS Form:1
Age:0.7
Sex:Male
Location:Wisconsin
Vaccinated:1990-10-24
Onset:1990-10-24
Submitted:1990-10-31
Entered:1990-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 268912 / 2 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841022 / 2 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Agitation, Bronchitis, Pain, Pneumonia, Pyrexia, Rhinitis

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: very mild cold symptoms
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WI90042

Write-up: Pt vaccinated w/DTP/IPV developed temp 100, cried 45 min constantly after receiving inject continued crying at intervals until afternoon especially when moved. Lt leg pain. Also, developed cold symptoms, possible bronchitis or pneumonia.


Changed on 9/14/2018

VAERS ID: 27114 Before After
VAERS Form:1
Age:0.7
Sex:Male
Location:Wisconsin
Vaccinated:1990-10-24
Onset:1990-10-24
Submitted:1990-10-31
Entered:1990-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 268912 / 2 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841022 / 2 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Agitation, Bronchitis, Pain, Pneumonia, Pyrexia, Rhinitis

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: very mild cold symptoms
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WI90042

Write-up: Pt vaccinated w/DTP/IPV developed temp 100, cried 45 min constantly after receiving inject continued crying at intervals until afternoon especially when moved. Lt leg pain. Also, developed cold symptoms, possible bronchitis or pneumonia.


Changed on 10/14/2018

VAERS ID: 27114 Before After
VAERS Form:1
Age:0.7
Sex:Male
Location:Wisconsin
Vaccinated:1990-10-24
Onset:1990-10-24
Submitted:1990-10-31
Entered:1990-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 268912 / 2 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841022 / 2 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Agitation, Bronchitis, Pain, Pneumonia, Pyrexia, Rhinitis

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: very mild cold symptoms
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WI90042

Write-up: Pt vaccinated w/DTP/IPV developed temp 100, cried 45 min constantly after receiving inject continued crying at intervals until afternoon especially when moved. Lt leg pain. Also, developed cold symptoms, possible bronchitis or pneumonia.


Changed on 12/24/2020

VAERS ID: 27114 Before After
VAERS Form:1
Age:0.7
Sex:Male
Location:Wisconsin
Vaccinated:1990-10-24
Onset:1990-10-24
Submitted:1990-10-31
Entered:1990-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 268912 / 2 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841022 / 2 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Agitation, Bronchitis, Pain, Pneumonia, Pyrexia, Rhinitis

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: very mild cold symptoms
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WI90042

Write-up: Pt vaccinated w/DTP/IPV developed temp 100, cried 45 min constantly after receiving inject continued crying at intervals until afternoon especially when moved. Lt leg pain. Also, developed cold symptoms, possible bronchitis or pneumonia.


Changed on 12/30/2020

VAERS ID: 27114 Before After
VAERS Form:1
Age:0.7
Sex:Male
Location:Wisconsin
Vaccinated:1990-10-24
Onset:1990-10-24
Submitted:1990-10-31
Entered:1990-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 268912 / 2 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841022 / 2 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Agitation, Bronchitis, Pain, Pneumonia, Pyrexia, Rhinitis

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: very mild cold symptoms
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WI90042

Write-up: Pt vaccinated w/DTP/IPV developed temp 100, cried 45 min constantly after receiving inject continued crying at intervals until afternoon especially when moved. Lt leg pain. Also, developed cold symptoms, possible bronchitis or pneumonia.


Changed on 5/7/2021

VAERS ID: 27114 Before After
VAERS Form:1
Age:0.7
Sex:Male
Location:Wisconsin
Vaccinated:1990-10-24
Onset:1990-10-24
Submitted:1990-10-31
Entered:1990-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 268912 / 2 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841022 / 2 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Agitation, Bronchitis, Pain, Pneumonia, Pyrexia, Rhinitis

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: very mild cold symptoms
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WI90042

Write-up: Pt vaccinated w/DTP/IPV developed temp 100, cried 45 min constantly after receiving inject continued crying at intervals until afternoon especially when moved. Lt leg pain. Also, developed cold symptoms, possible bronchitis or pneumonia.


Changed on 5/14/2021

VAERS ID: 27114 Before After
VAERS Form:1
Age:0.7
Sex:Male
Location:Wisconsin
Vaccinated:1990-10-24
Onset:1990-10-24
Submitted:1990-10-31
Entered:1990-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 268912 / 2 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841022 / 2 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Agitation, Bronchitis, Pain, Pneumonia, Pyrexia, Rhinitis

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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: very mild cold symptoms
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WI90042

Write-up: Pt vaccinated w/DTP/IPV developed temp 100, cried 45 min constantly after receiving inject continued crying at intervals until afternoon especially when moved. Lt leg pain. Also, developed cold symptoms, possible bronchitis or pneumonia.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=27114&WAYBACKHISTORY=ON


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