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This is VAERS ID 29797

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History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 29797
VAERS Form:
Age:0.6
Sex:Male
Location:Georgia
Vaccinated:1991-02-22
Onset:1991-03-04
Submitted:1991-03-05
Entered:1991-04-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 271965 / 1 RL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M210EP / 0 LL / IM
IPV: POLIOVAX / CONNAUGHT LTD 841024 / 1 RA / SC

Administered by: Public      Purchased by: Unknown
Symptoms: AGITATION, COUGH INC, 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:
Other Medications: NONE
Current Illness: Well
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Immun given 22FEB91 infant well @ that time;4MAR91 AM when mom noted child became "croupy sounding & fussy" no fever to MD dx w/ear infect mom reported MD vs she remembered this from informal consent form;


Changed on 12/8/2009

VAERS ID: 29797 Before After
VAERS Form:
Age:0.6
Sex:Male
Location:Georgia
Vaccinated:1991-02-22
Onset:1991-03-04
Submitted:1991-03-05
Entered:1991-04-12 1991-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 271965 / 1 RL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M210EP / 0 LL / IM
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. 841024 / 1 RA / SC

Administered by: Public      Purchased by: Unknown Public
Symptoms: Agitation, Cough, Otitis media, AGITATION, COUGH INC, 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:
Other Medications: NONE
Current Illness: Well
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) GA9137

Write-up: Immun given 22FEB91 infant well @ that time;4MAR91 AM when mom noted child became "croupy sounding & fussy" no fever to MD dx w/ear infect mom reported MD vs she remembered this from informal consent form;


Changed on 5/14/2017

VAERS ID: 29797 Before After
VAERS Form:
Age:0.6
Sex:Male
Location:Georgia
Vaccinated:1991-02-22
Onset:1991-03-04
Submitted:1991-03-05
Entered:1991-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271965 / 1 RL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M210EP / 0 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841024 / 1 RA / SC

Administered by: Public      Purchased by: Public
Symptoms: Agitation, Cough, Otitis media

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: NONE
Current Illness: Well
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA9137

Write-up: Immun given 22FEB91 infant well @ that time;4MAR91 AM when mom noted child became "croupy sounding & fussy" no fever to MD dx w/ear infect mom reported MD vs she remembered this from informal consent form;


Changed on 9/14/2017

VAERS ID: 29797 Before After
VAERS Form:(blank) 1
Age:0.6
Sex:Male
Location:Georgia
Vaccinated:1991-02-22
Onset:1991-03-04
Submitted:1991-03-05
Entered:1991-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271965 / 1 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M210EP / 0 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841024 / 1 2 RA / SC

Administered by: Public      Purchased by: Public
Symptoms: Agitation, Cough, Otitis media

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: NONE
Current Illness: Well
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA9137

Write-up: Immun given 22FEB91 infant well @ that time;4MAR91 AM when mom noted child became "croupy sounding & fussy" no fever to MD dx w/ear infect mom reported MD vs she remembered this from informal consent form;


Changed on 2/14/2018

VAERS ID: 29797 Before After
VAERS Form:1
Age:0.6
Sex:Male
Location:Georgia
Vaccinated:1991-02-22
Onset:1991-03-04
Submitted:1991-03-05
Entered:1991-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271965 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M210EP / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841024 / 2 RA / SC

Administered by: Public      Purchased by: Public
Symptoms: Agitation, Cough, Otitis media

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: NONE
Current Illness: Well
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA9137

Write-up: Immun given 22FEB91 infant well @ that time;4MAR91 AM when mom noted child became "croupy sounding & fussy" no fever to MD dx w/ear infect mom reported MD vs she remembered this from informal consent form;


Changed on 6/14/2018

VAERS ID: 29797 Before After
VAERS Form:1
Age:0.6
Sex:Male
Location:Georgia
Vaccinated:1991-02-22
Onset:1991-03-04
Submitted:1991-03-05
Entered:1991-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271965 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M210EP / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841024 / 2 RA / SC

Administered by: Public      Purchased by: Public
Symptoms: Agitation, Cough, Otitis media

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: NONE
Current Illness: Well
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA9137

Write-up: Immun given 22FEB91 infant well @ that time;4MAR91 AM when mom noted child became "croupy sounding & fussy" no fever to MD dx w/ear infect mom reported MD vs she remembered this from informal consent form;


Changed on 8/14/2018

VAERS ID: 29797 Before After
VAERS Form:1
Age:0.6
Sex:Male
Location:Georgia
Vaccinated:1991-02-22
Onset:1991-03-04
Submitted:1991-03-05
Entered:1991-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271965 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M210EP / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841024 / 2 RA / SC

Administered by: Public      Purchased by: Public
Symptoms: Agitation, Cough, Otitis media

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: NONE
Current Illness: Well
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA9137

Write-up: Immun given 22FEB91 infant well @ that time;4MAR91 AM when mom noted child became "croupy sounding & fussy" no fever to MD dx w/ear infect mom reported MD vs she remembered this from informal consent form;


Changed on 9/14/2018

VAERS ID: 29797 Before After
VAERS Form:1
Age:0.6
Sex:Male
Location:Georgia
Vaccinated:1991-02-22
Onset:1991-03-04
Submitted:1991-03-05
Entered:1991-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271965 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M210EP / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841024 / 2 RA / SC

Administered by: Public      Purchased by: Public
Symptoms: Agitation, Cough, Otitis media

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: NONE
Current Illness: Well
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA9137

Write-up: Immun given 22FEB91 infant well @ that time;4MAR91 AM when mom noted child became "croupy sounding & fussy" no fever to MD dx w/ear infect mom reported MD vs she remembered this from informal consent form;


Changed on 10/14/2018

VAERS ID: 29797 Before After
VAERS Form:1
Age:0.6
Sex:Male
Location:Georgia
Vaccinated:1991-02-22
Onset:1991-03-04
Submitted:1991-03-05
Entered:1991-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271965 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M210EP / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841024 / 2 RA / SC

Administered by: Public      Purchased by: Public
Symptoms: Agitation, Cough, Otitis media

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: NONE
Current Illness: Well
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA9137

Write-up: Immun given 22FEB91 infant well @ that time;4MAR91 AM when mom noted child became "croupy sounding & fussy" no fever to MD dx w/ear infect mom reported MD vs she remembered this from informal consent form;


Changed on 12/24/2020

VAERS ID: 29797 Before After
VAERS Form:1
Age:0.6
Sex:Male
Location:Georgia
Vaccinated:1991-02-22
Onset:1991-03-04
Submitted:1991-03-05
Entered:1991-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271965 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M210EP / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841024 / 2 RA / SC

Administered by: Public      Purchased by: Public
Symptoms: Agitation, Cough, Otitis media

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: NONE
Current Illness: Well
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA9137

Write-up: Immun given 22FEB91 infant well @ that time;4MAR91 AM when mom noted child became "croupy sounding & fussy" no fever to MD dx w/ear infect mom reported MD vs she remembered this from informal consent form;


Changed on 12/30/2020

VAERS ID: 29797 Before After
VAERS Form:1
Age:0.6
Sex:Male
Location:Georgia
Vaccinated:1991-02-22
Onset:1991-03-04
Submitted:1991-03-05
Entered:1991-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271965 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M210EP / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841024 / 2 RA / SC

Administered by: Public      Purchased by: Public
Symptoms: Agitation, Cough, Otitis media

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: NONE
Current Illness: Well
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA9137

Write-up: Immun given 22FEB91 infant well @ that time;4MAR91 AM when mom noted child became "croupy sounding & fussy" no fever to MD dx w/ear infect mom reported MD vs she remembered this from informal consent form;


Changed on 5/7/2021

VAERS ID: 29797 Before After
VAERS Form:1
Age:0.6
Sex:Male
Location:Georgia
Vaccinated:1991-02-22
Onset:1991-03-04
Submitted:1991-03-05
Entered:1991-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271965 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M210EP / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841024 / 2 RA / SC

Administered by: Public      Purchased by: Public
Symptoms: Agitation, Cough, Otitis media

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: NONE
Current Illness: Well
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA9137

Write-up: Immun given 22FEB91 infant well @ that time;4MAR91 AM when mom noted child became "croupy sounding & fussy" no fever to MD dx w/ear infect mom reported MD vs she remembered this from informal consent form;


Changed on 5/14/2021

VAERS ID: 29797 Before After
VAERS Form:1
Age:0.6
Sex:Male
Location:Georgia
Vaccinated:1991-02-22
Onset:1991-03-04
Submitted:1991-03-05
Entered:1991-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271965 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M210EP / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841024 / 2 RA / SC

Administered by: Public      Purchased by: Public
Symptoms: Agitation, Cough, Otitis media

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: NONE
Current Illness: Well
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA9137

Write-up: Immun given 22FEB91 infant well @ that time;4MAR91 AM when mom noted child became "croupy sounding & fussy" no fever to MD dx w/ear infect mom reported MD vs she remembered this from informal consent form;

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=29797&WAYBACKHISTORY=ON


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