National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 27604

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 27604
VAERS Form:
Age:0.5
Sex:Male
Location:California
Vaccinated:1991-01-07
Onset:1991-01-07
Submitted:1991-01-23
Entered:1991-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP / CONNAUGHT LABS 0G11097 / 1 RL / -
IPV: POLIOVAX / CONNAUGHT LTD 841122 / 0 LL / -

Administered by: Private      Purchased by: Unknown
Symptoms: INJECT SITE REACT, FEVER

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Recent DEC90 Bronchiolitis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vax w/DTP/IPV developed fever to 102 approx 12 hrs /p shot. Seen next day temp 99(ax). 3.5cm erythema, induration at inject site.


Changed on 12/8/2009

VAERS ID: 27604 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:California
Vaccinated:1991-01-07
Onset:1991-01-07
Submitted:1991-01-23
Entered:1991-01-30 1991-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP DTP (NO BRAND NAME) / CONNAUGHT LABS CONNAUGHT LABORATORIES 0G11097 / 1 RL / -
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. 841122 / 0 LL / -

Administered by: Private      Purchased by: Unknown Private
Symptoms: Injection site reaction, Pyrexia, INJECT SITE REACT, FEVER

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Recent DEC90 Bronchiolitis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vax w/DTP/IPV developed fever to 102 approx 12 hrs /p shot. Seen next day temp 99(ax). 3.5cm erythema, induration at inject site.


Changed on 5/14/2017

VAERS ID: 27604 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:California
Vaccinated:1991-01-07
Onset:1991-01-07
Submitted:1991-01-23
Entered:1991-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0G11097 / 1 RL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841122 / 0 LL / -

Administered by: Private      Purchased by: Private
Symptoms: Injection site reaction, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Recent DEC90 Bronchiolitis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vax w/DTP/IPV developed fever to 102 approx 12 hrs /p shot. Seen next day temp 99(ax). 3.5cm erythema, induration at inject site.


Changed on 9/14/2017

VAERS ID: 27604 Before After
VAERS Form:(blank) 1
Age:0.5
Sex:Male
Location:California
Vaccinated:1991-01-07
Onset:1991-01-07
Submitted:1991-01-23
Entered:1991-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0G11097 / 1 2 RL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841122 / 0 1 LL / -

Administered by: Private      Purchased by: Private
Symptoms: Injection site reaction, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Recent DEC90 Bronchiolitis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vax w/DTP/IPV developed fever to 102 approx 12 hrs /p shot. Seen next day temp 99(ax). 3.5cm erythema, induration at inject site.


Changed on 2/14/2018

VAERS ID: 27604 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:California
Vaccinated:1991-01-07
Onset:1991-01-07
Submitted:1991-01-23
Entered:1991-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0G11097 / 2 RL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841122 / 1 LL / -

Administered by: Private      Purchased by: Private
Symptoms: Injection site reaction, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Recent DEC90 Bronchiolitis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vax w/DTP/IPV developed fever to 102 approx 12 hrs /p shot. Seen next day temp 99(ax). 3.5cm erythema, induration at inject site.


Changed on 6/14/2018

VAERS ID: 27604 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:California
Vaccinated:1991-01-07
Onset:1991-01-07
Submitted:1991-01-23
Entered:1991-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0G11097 / 2 RL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841122 / 1 LL / -

Administered by: Private      Purchased by: Private
Symptoms: Injection site reaction, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Recent DEC90 Bronchiolitis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vax w/DTP/IPV developed fever to 102 approx 12 hrs /p shot. Seen next day temp 99(ax). 3.5cm erythema, induration at inject site.


Changed on 8/14/2018

VAERS ID: 27604 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:California
Vaccinated:1991-01-07
Onset:1991-01-07
Submitted:1991-01-23
Entered:1991-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0G11097 / 2 RL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841122 / 1 LL / -

Administered by: Private      Purchased by: Private
Symptoms: Injection site reaction, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Recent DEC90 Bronchiolitis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vax w/DTP/IPV developed fever to 102 approx 12 hrs /p shot. Seen next day temp 99(ax). 3.5cm erythema, induration at inject site.


Changed on 9/14/2018

VAERS ID: 27604 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:California
Vaccinated:1991-01-07
Onset:1991-01-07
Submitted:1991-01-23
Entered:1991-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0G11097 / 2 RL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841122 / 1 LL / -

Administered by: Private      Purchased by: Private
Symptoms: Injection site reaction, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Recent DEC90 Bronchiolitis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vax w/DTP/IPV developed fever to 102 approx 12 hrs /p shot. Seen next day temp 99(ax). 3.5cm erythema, induration at inject site.


Changed on 10/14/2018

VAERS ID: 27604 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:California
Vaccinated:1991-01-07
Onset:1991-01-07
Submitted:1991-01-23
Entered:1991-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0G11097 / 2 RL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841122 / 1 LL / -

Administered by: Private      Purchased by: Private
Symptoms: Injection site reaction, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Recent DEC90 Bronchiolitis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vax w/DTP/IPV developed fever to 102 approx 12 hrs /p shot. Seen next day temp 99(ax). 3.5cm erythema, induration at inject site.


Changed on 12/24/2020

VAERS ID: 27604 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:California
Vaccinated:1991-01-07
Onset:1991-01-07
Submitted:1991-01-23
Entered:1991-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0G11097 / 2 RL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841122 / 1 LL / -

Administered by: Private      Purchased by: Private
Symptoms: Injection site reaction, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Recent DEC90 Bronchiolitis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vax w/DTP/IPV developed fever to 102 approx 12 hrs /p shot. Seen next day temp 99(ax). 3.5cm erythema, induration at inject site.


Changed on 12/30/2020

VAERS ID: 27604 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:California
Vaccinated:1991-01-07
Onset:1991-01-07
Submitted:1991-01-23
Entered:1991-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0G11097 / 2 RL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841122 / 1 LL / -

Administered by: Private      Purchased by: Private
Symptoms: Injection site reaction, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Recent DEC90 Bronchiolitis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vax w/DTP/IPV developed fever to 102 approx 12 hrs /p shot. Seen next day temp 99(ax). 3.5cm erythema, induration at inject site.


Changed on 5/7/2021

VAERS ID: 27604 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:California
Vaccinated:1991-01-07
Onset:1991-01-07
Submitted:1991-01-23
Entered:1991-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0G11097 / 2 RL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841122 / 1 LL / -

Administered by: Private      Purchased by: Private
Symptoms: Injection site reaction, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Recent DEC90 Bronchiolitis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vax w/DTP/IPV developed fever to 102 approx 12 hrs /p shot. Seen next day temp 99(ax). 3.5cm erythema, induration at inject site.


Changed on 5/14/2021

VAERS ID: 27604 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:California
Vaccinated:1991-01-07
Onset:1991-01-07
Submitted:1991-01-23
Entered:1991-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0G11097 / 2 RL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841122 / 1 LL / -

Administered by: Private      Purchased by: Private
Symptoms: Injection site reaction, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Recent DEC90 Bronchiolitis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vax w/DTP/IPV developed fever to 102 approx 12 hrs /p shot. Seen next day temp 99(ax). 3.5cm erythema, induration at inject site.

New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=27604&WAYBACKHISTORY=ON


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166