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This is VAERS ID 28903

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History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 28903
VAERS Form:
Age:1.4
Sex:Male
Location:Pennsylvania
Vaccinated:1991-02-05
Onset:1991-02-05
Submitted:1991-02-06
Entered:1991-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 293948 / 3 RL / IM
IPV: POLIOVAX / CONNAUGHT LTD 841028 / 2 LL / SC

Administered by: Public      Purchased by: Unknown
Symptoms: FEVER, URTICARIA, PRURITUS, ASTHENIA, OTITIS MED

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: NONE
Other Medications:
Current Illness: runny nose from teething
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 7FEB91 @ ER second visit - XRAY & Blood Work
CDC 'Split Type': NONE

Write-up: 5FEB91 rash described as hives developed. To ER - Benedryl; had elevated temp during day - not measured; responded to Tylenol; 6FEb91 Benedryl stopped itching-rash con''t-temp up & down all day - 103R. Weak; OM dx.


Changed on 12/8/2009

VAERS ID: 28903 Before After
VAERS Form:
Age:1.4
Sex:Male
Location:Pennsylvania
Vaccinated:1991-02-05
Onset:1991-02-05
Submitted:1991-02-06
Entered:1991-03-15 1991-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 293948 / 3 RL / IM
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. 841028 / 2 LL / SC

Administered by: Public      Purchased by: Unknown Public
Symptoms: Asthenia, Otitis media, Pruritus, Pyrexia, Urticaria, FEVER, URTICARIA, PRURITUS, ASTHENIA, OTITIS MED

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: NONE
Other Medications:
Current Illness: runny "runny nose from teething teething"
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 7FEB91 @ ER second visit - XRAY & Blood Work
CDC 'Split Type': NONE PA9160

Write-up: 5FEB91 rash described as hives developed. To ER - Benedryl; had elevated temp during day - not measured; responded to Tylenol; 6FEb91 Benedryl stopped itching-rash con''t-temp up & down all day - 103R. Weak; OM dx.


Changed on 5/14/2017

VAERS ID: 28903 Before After
VAERS Form:
Age:1.4
Sex:Male
Location:Pennsylvania
Vaccinated:1991-02-05
Onset:1991-02-05
Submitted:1991-02-06
Entered:1991-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 293948 / 3 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841028 / 2 LL / SC

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, Otitis media, Pruritus, Pyrexia, Urticaria

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: NONE NONE~ ()~~~In patient
Other Medications:
Current Illness: "runny nose from teething"
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 7FEB91 @ ER second visit - XRAY & Blood Work
CDC 'Split Type': PA9160

Write-up: 5FEB91 rash described as hives developed. To ER - Benedryl; had elevated temp during day - not measured; responded to Tylenol; 6FEb91 Benedryl stopped itching-rash con''t-temp up & down all day - 103R. Weak; OM dx.


Changed on 9/14/2017

VAERS ID: 28903 Before After
VAERS Form:(blank) 1
Age:1.4
Sex:Male
Location:Pennsylvania
Vaccinated:1991-02-05
Onset:1991-02-05
Submitted:1991-02-06
Entered:1991-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 293948 / 3 4 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841028 / 2 3 LL / SC

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, Otitis media, Pruritus, Pyrexia, Urticaria

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: NONE~ ()~~~In patient
Other Medications:
Current Illness: "runny nose from teething"
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 7FEB91 @ ER second visit - XRAY & Blood Work
CDC 'Split Type': PA9160

Write-up: 5FEB91 rash described as hives developed. To ER - Benedryl; had elevated temp during day - not measured; responded to Tylenol; 6FEb91 Benedryl stopped itching-rash con''t-temp up & down all day - 103R. Weak; OM dx.


Changed on 2/14/2018

VAERS ID: 28903 Before After
VAERS Form:1
Age:1.4
Sex:Male
Location:Pennsylvania
Vaccinated:1991-02-05
Onset:1991-02-05
Submitted:1991-02-06
Entered:1991-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 293948 / 4 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841028 / 3 LL / SC

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, Otitis media, Pruritus, Pyrexia, Urticaria

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: NONE~ ()~~~In patient
Other Medications:
Current Illness: "runny nose from teething"
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 7FEB91 @ ER second visit - XRAY & Blood Work
CDC 'Split Type': PA9160

Write-up: 5FEB91 rash described as hives developed. To ER - Benedryl; had elevated temp during day - not measured; responded to Tylenol; 6FEb91 Benedryl stopped itching-rash con''t-temp up & down all day - 103R. Weak; OM dx.


Changed on 6/14/2018

VAERS ID: 28903 Before After
VAERS Form:1
Age:1.4
Sex:Male
Location:Pennsylvania
Vaccinated:1991-02-05
Onset:1991-02-05
Submitted:1991-02-06
Entered:1991-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 293948 / 4 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841028 / 3 LL / SC

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, Otitis media, Pruritus, Pyrexia, Urticaria

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: NONE~ ()~~~In patient
Other Medications:
Current Illness: "runny nose from teething"
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 7FEB91 @ ER second visit - XRAY & Blood Work
CDC 'Split Type': PA9160

Write-up: 5FEB91 rash described as hives developed. To ER - Benedryl; had elevated temp during day - not measured; responded to Tylenol; 6FEb91 Benedryl stopped itching-rash con''t-temp up & down all day - 103R. Weak; OM dx.


Changed on 8/14/2018

VAERS ID: 28903 Before After
VAERS Form:1
Age:1.4
Sex:Male
Location:Pennsylvania
Vaccinated:1991-02-05
Onset:1991-02-05
Submitted:1991-02-06
Entered:1991-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 293948 / 4 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841028 / 3 LL / SC

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, Otitis media, Pruritus, Pyrexia, Urticaria

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: NONE~ ()~~~In patient
Other Medications:
Current Illness: "runny nose from teething"
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 7FEB91 @ ER second visit - XRAY & Blood Work
CDC 'Split Type': PA9160

Write-up: 5FEB91 rash described as hives developed. To ER - Benedryl; had elevated temp during day - not measured; responded to Tylenol; 6FEb91 Benedryl stopped itching-rash con''t-temp up & down all day - 103R. Weak; OM dx.


Changed on 9/14/2018

VAERS ID: 28903 Before After
VAERS Form:1
Age:1.4
Sex:Male
Location:Pennsylvania
Vaccinated:1991-02-05
Onset:1991-02-05
Submitted:1991-02-06
Entered:1991-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 293948 / 4 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841028 / 3 LL / SC

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, Otitis media, Pruritus, Pyrexia, Urticaria

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: NONE~ ()~~~In patient
Other Medications:
Current Illness: "runny nose from teething"
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 7FEB91 @ ER second visit - XRAY & Blood Work
CDC 'Split Type': PA9160

Write-up: 5FEB91 rash described as hives developed. To ER - Benedryl; had elevated temp during day - not measured; responded to Tylenol; 6FEb91 Benedryl stopped itching-rash con''t-temp up & down all day - 103R. Weak; OM dx.


Changed on 10/14/2018

VAERS ID: 28903 Before After
VAERS Form:1
Age:1.4
Sex:Male
Location:Pennsylvania
Vaccinated:1991-02-05
Onset:1991-02-05
Submitted:1991-02-06
Entered:1991-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 293948 / 4 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841028 / 3 LL / SC

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, Otitis media, Pruritus, Pyrexia, Urticaria

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: NONE~ ()~~~In patient
Other Medications:
Current Illness: "runny nose from teething"
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 7FEB91 @ ER second visit - XRAY & Blood Work
CDC 'Split Type': PA9160

Write-up: 5FEB91 rash described as hives developed. To ER - Benedryl; had elevated temp during day - not measured; responded to Tylenol; 6FEb91 Benedryl stopped itching-rash con''t-temp up & down all day - 103R. Weak; OM dx.


Changed on 12/24/2020

VAERS ID: 28903 Before After
VAERS Form:1
Age:1.4
Sex:Male
Location:Pennsylvania
Vaccinated:1991-02-05
Onset:1991-02-05
Submitted:1991-02-06
Entered:1991-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 293948 / 4 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841028 / 3 LL / SC

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, Otitis media, Pruritus, Pyrexia, Urticaria

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: NONE~ ()~~~In patient
Other Medications:
Current Illness: "runny nose from teething"
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 7FEB91 @ ER second visit - XRAY & Blood Work
CDC 'Split Type': PA9160

Write-up: 5FEB91 rash described as hives developed. To ER - Benedryl; had elevated temp during day - not measured; responded to Tylenol; 6FEb91 Benedryl stopped itching-rash con''t-temp up & down all day - 103R. Weak; OM dx.


Changed on 12/30/2020

VAERS ID: 28903 Before After
VAERS Form:1
Age:1.4
Sex:Male
Location:Pennsylvania
Vaccinated:1991-02-05
Onset:1991-02-05
Submitted:1991-02-06
Entered:1991-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 293948 / 4 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841028 / 3 LL / SC

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, Otitis media, Pruritus, Pyrexia, Urticaria

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: NONE~ ()~~~In patient
Other Medications:
Current Illness: "runny nose from teething"
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 7FEB91 @ ER second visit - XRAY & Blood Work
CDC 'Split Type': PA9160

Write-up: 5FEB91 rash described as hives developed. To ER - Benedryl; had elevated temp during day - not measured; responded to Tylenol; 6FEb91 Benedryl stopped itching-rash con''t-temp up & down all day - 103R. Weak; OM dx.


Changed on 5/7/2021

VAERS ID: 28903 Before After
VAERS Form:1
Age:1.4
Sex:Male
Location:Pennsylvania
Vaccinated:1991-02-05
Onset:1991-02-05
Submitted:1991-02-06
Entered:1991-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 293948 / 4 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841028 / 3 LL / SC

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, Otitis media, Pruritus, Pyrexia, Urticaria

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: NONE~ ()~~~In patient
Other Medications:
Current Illness: "runny nose from teething"
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 7FEB91 @ ER second visit - XRAY & Blood Work
CDC 'Split Type': PA9160

Write-up: 5FEB91 rash described as hives developed. To ER - Benedryl; had elevated temp during day - not measured; responded to Tylenol; 6FEb91 Benedryl stopped itching-rash con''t-temp up & down all day - 103R. Weak; OM dx.


Changed on 5/14/2021

VAERS ID: 28903 Before After
VAERS Form:1
Age:1.4
Sex:Male
Location:Pennsylvania
Vaccinated:1991-02-05
Onset:1991-02-05
Submitted:1991-02-06
Entered:1991-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 293948 / 4 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841028 / 3 LL / SC

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, Otitis media, Pruritus, Pyrexia, Urticaria

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: NONE~ ()~~~In patient
Other Medications:
Current Illness: "runny nose from teething"
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 7FEB91 @ ER second visit - XRAY & Blood Work
CDC 'Split Type': PA9160

Write-up: 5FEB91 rash described as hives developed. To ER - Benedryl; had elevated temp during day - not measured; responded to Tylenol; 6FEb91 Benedryl stopped itching-rash con''t-temp up & down all day - 103R. Weak; OM dx.

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