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This is VAERS ID 28130

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History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 28130
VAERS Form:
Age:3.6
Sex:Male
Location:Georgia
Vaccinated:1990-04-10
Onset:1990-04-10
Submitted:0000-00-00
Entered:1991-02-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 256962 / - - / -
IPV: POLIOVAX / CONNAUGHT LTD 841012 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: FEVER, VOMIT, RASH, MALAISE, DIARRHEA

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: No illness following 2 previous immunizations
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: CDC reports: 4 yo child developed fever 103, rash, diarrhea, vomiting & malaise following DTP/EIPV immun. Duration of illness 2 days.


Changed on 12/8/2009

VAERS ID: 28130 Before After
VAERS Form:
Age:3.6
Sex:Male
Location:Georgia
Vaccinated:1990-04-10
Onset:1990-04-10
Submitted:0000-00-00
Entered:1991-02-19 1991-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 256962 / - - / -
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. 841012 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diarrhoea, Malaise, Pyrexia, Rash, Vomiting, FEVER, VOMIT, RASH, MALAISE, DIARRHEA

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: No illness following 2 previous immunizations
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) 900162810

Write-up: CDC reports: 4 yo child developed fever 103, rash, diarrhea, vomiting & malaise following DTP/EIPV immun. Duration of illness 2 days.


Changed on 2/14/2017

VAERS ID: 28130 Before After
VAERS Form:
Age:3.6 3.0
Sex:Male
Location:Georgia
Vaccinated:1990-04-10
Onset:1990-04-10
Submitted:0000-00-00
Entered:1991-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 256962 / - - / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841012 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diarrhoea, Malaise, Pyrexia, Rash, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: No illness following 2 previous immunizations
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 900162810

Write-up: CDC reports: 4 yo child developed fever 103, rash, diarrhea, vomiting & malaise following DTP/EIPV immun. Duration of illness 2 days.


Changed on 5/14/2017

VAERS ID: 28130 Before After
VAERS Form:
Age:3.0
Sex:Male
Location:Georgia
Vaccinated:1990-04-10
Onset:1990-04-10
Submitted:0000-00-00
Entered:1991-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 256962 / - - / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841012 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diarrhoea, Malaise, Pyrexia, Rash, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: No illness following 2 previous immunizations
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 900162810

Write-up: CDC reports: 4 yo child developed fever 103, rash, diarrhea, vomiting & malaise following DTP/EIPV immun. Duration of illness 2 days.


Changed on 9/14/2017

VAERS ID: 28130 Before After
VAERS Form:(blank) 1
Age:3.0
Sex:Male
Location:Georgia
Vaccinated:1990-04-10
Onset:1990-04-10
Submitted:0000-00-00
Entered:1991-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 256962 / - UNK - / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841012 / - UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diarrhoea, Malaise, Pyrexia, Rash, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: No illness following 2 previous immunizations
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 900162810

Write-up: CDC reports: 4 yo child developed fever 103, rash, diarrhea, vomiting & malaise following DTP/EIPV immun. Duration of illness 2 days.


Changed on 2/14/2018

VAERS ID: 28130 Before After
VAERS Form:1
Age:3.0
Sex:Male
Location:Georgia
Vaccinated:1990-04-10
Onset:1990-04-10
Submitted:0000-00-00
Entered:1991-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 256962 / UNK - / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841012 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diarrhoea, Malaise, Pyrexia, Rash, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: No illness following 2 previous immunizations
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 900162810

Write-up: CDC reports: 4 yo child developed fever 103, rash, diarrhea, vomiting & malaise following DTP/EIPV immun. Duration of illness 2 days.


Changed on 6/14/2018

VAERS ID: 28130 Before After
VAERS Form:1
Age:3.0
Sex:Male
Location:Georgia
Vaccinated:1990-04-10
Onset:1990-04-10
Submitted:0000-00-00
Entered:1991-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 256962 / UNK - / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841012 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diarrhoea, Malaise, Pyrexia, Rash, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: No illness following 2 previous immunizations
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 900162810

Write-up: CDC reports: 4 yo child developed fever 103, rash, diarrhea, vomiting & malaise following DTP/EIPV immun. Duration of illness 2 days.


Changed on 8/14/2018

VAERS ID: 28130 Before After
VAERS Form:1
Age:3.0
Sex:Male
Location:Georgia
Vaccinated:1990-04-10
Onset:1990-04-10
Submitted:0000-00-00
Entered:1991-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 256962 / UNK - / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841012 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diarrhoea, Malaise, Pyrexia, Rash, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: No illness following 2 previous immunizations
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 900162810

Write-up: CDC reports: 4 yo child developed fever 103, rash, diarrhea, vomiting & malaise following DTP/EIPV immun. Duration of illness 2 days.


Changed on 9/14/2018

VAERS ID: 28130 Before After
VAERS Form:1
Age:3.0
Sex:Male
Location:Georgia
Vaccinated:1990-04-10
Onset:1990-04-10
Submitted:0000-00-00
Entered:1991-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 256962 / UNK - / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841012 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diarrhoea, Malaise, Pyrexia, Rash, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: No illness following 2 previous immunizations
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 900162810

Write-up: CDC reports: 4 yo child developed fever 103, rash, diarrhea, vomiting & malaise following DTP/EIPV immun. Duration of illness 2 days.


Changed on 10/14/2018

VAERS ID: 28130 Before After
VAERS Form:1
Age:3.0
Sex:Male
Location:Georgia
Vaccinated:1990-04-10
Onset:1990-04-10
Submitted:0000-00-00
Entered:1991-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 256962 / UNK - / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841012 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diarrhoea, Malaise, Pyrexia, Rash, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: No illness following 2 previous immunizations
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 900162810

Write-up: CDC reports: 4 yo child developed fever 103, rash, diarrhea, vomiting & malaise following DTP/EIPV immun. Duration of illness 2 days.


Changed on 12/24/2020

VAERS ID: 28130 Before After
VAERS Form:1
Age:3.0
Sex:Male
Location:Georgia
Vaccinated:1990-04-10
Onset:1990-04-10
Submitted:0000-00-00
Entered:1991-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 256962 / UNK - / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841012 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diarrhoea, Malaise, Pyrexia, Rash, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: No illness following 2 previous immunizations
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 900162810

Write-up: CDC reports: 4 yo child developed fever 103, rash, diarrhea, vomiting & malaise following DTP/EIPV immun. Duration of illness 2 days.


Changed on 12/30/2020

VAERS ID: 28130 Before After
VAERS Form:1
Age:3.0
Sex:Male
Location:Georgia
Vaccinated:1990-04-10
Onset:1990-04-10
Submitted:0000-00-00
Entered:1991-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 256962 / UNK - / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841012 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diarrhoea, Malaise, Pyrexia, Rash, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: No illness following 2 previous immunizations
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 900162810

Write-up: CDC reports: 4 yo child developed fever 103, rash, diarrhea, vomiting & malaise following DTP/EIPV immun. Duration of illness 2 days.


Changed on 5/7/2021

VAERS ID: 28130 Before After
VAERS Form:1
Age:3.0
Sex:Male
Location:Georgia
Vaccinated:1990-04-10
Onset:1990-04-10
Submitted:0000-00-00
Entered:1991-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 256962 / UNK - / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841012 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diarrhoea, Malaise, Pyrexia, Rash, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: No illness following 2 previous immunizations
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 900162810

Write-up: CDC reports: 4 yo child developed fever 103, rash, diarrhea, vomiting & malaise following DTP/EIPV immun. Duration of illness 2 days.


Changed on 5/14/2021

VAERS ID: 28130 Before After
VAERS Form:1
Age:3.0
Sex:Male
Location:Georgia
Vaccinated:1990-04-10
Onset:1990-04-10
Submitted:0000-00-00
Entered:1991-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 256962 / UNK - / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841012 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diarrhoea, Malaise, Pyrexia, Rash, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: No illness following 2 previous immunizations
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 900162810

Write-up: CDC reports: 4 yo child developed fever 103, rash, diarrhea, vomiting & malaise following DTP/EIPV immun. Duration of illness 2 days.

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