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This is VAERS ID 30903

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History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 30903
VAERS Form:
Age:0.4
Sex:Male
Location:Michigan
Vaccinated:1991-05-06
Onset:1991-05-07
Submitted:1991-05-09
Entered:1991-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP MICH. PHD. / MICHIGAN DPH TR1212B / 0 LL / IM
IPV: POLIOVAX / CONNAUGHT LTD 841122 / 0 RL / SC

Administered by: Public      Purchased by: Unknown
Symptoms: AGITATION

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: Alupent 2cc (10mg/5ml) TID
Current Illness: NONE
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Day p/vax pt became extremely irritable, screaming & holding his head, finger nails digging into his face & eye where he attempted to hold his face; Was bothered by noise; Also could not be comforted;


Changed on 12/8/2009

VAERS ID: 30903 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:Michigan
Vaccinated:1991-05-06
Onset:1991-05-07
Submitted:1991-05-09
Entered:1991-06-04 1991-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP MICH. PHD. DTP (NO BRAND NAME) / MICHIGAN DPH MICHIGAN DEPT PUB HLTH TR1212B / 0 LL / IM
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. 841122 / 0 RL / SC

Administered by: Public      Purchased by: Unknown Public
Symptoms: Agitation, AGITATION

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: Alupent 2cc (10mg/5ml) TID
Current Illness: NONE
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) MI9135

Write-up: Day p/vax pt became extremely irritable, screaming & holding his head, finger nails digging into his face & eye where he attempted to hold his face; Was bothered by noise; Also could not be comforted;


Changed on 5/14/2017

VAERS ID: 30903 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:Michigan
Vaccinated:1991-05-06
Onset:1991-05-07
Submitted:1991-05-09
Entered:1991-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH TR1212B / 0 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841122 / 0 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Agitation

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: Alupent 2cc (10mg/5ml) TID
Current Illness: NONE
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MI9135

Write-up: Day p/vax pt became extremely irritable, screaming & holding his head, finger nails digging into his face & eye where he attempted to hold his face; Was bothered by noise; Also could not be comforted;


Changed on 9/14/2017

VAERS ID: 30903 Before After
VAERS Form:(blank) 1
Age:0.4
Sex:Male
Location:Michigan
Vaccinated:1991-05-06
Onset:1991-05-07
Submitted:1991-05-09
Entered:1991-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH TR1212B / 0 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841122 / 0 1 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Agitation

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: Alupent 2cc (10mg/5ml) TID
Current Illness: NONE
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MI9135

Write-up: Day p/vax pt became extremely irritable, screaming & holding his head, finger nails digging into his face & eye where he attempted to hold his face; Was bothered by noise; Also could not be comforted;


Changed on 2/14/2018

VAERS ID: 30903 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Michigan
Vaccinated:1991-05-06
Onset:1991-05-07
Submitted:1991-05-09
Entered:1991-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH TR1212B / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841122 / 1 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Agitation

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: Alupent 2cc (10mg/5ml) TID
Current Illness: NONE
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MI9135

Write-up: Day p/vax pt became extremely irritable, screaming & holding his head, finger nails digging into his face & eye where he attempted to hold his face; Was bothered by noise; Also could not be comforted;


Changed on 6/14/2018

VAERS ID: 30903 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Michigan
Vaccinated:1991-05-06
Onset:1991-05-07
Submitted:1991-05-09
Entered:1991-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH TR1212B / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841122 / 1 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Agitation

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: Alupent 2cc (10mg/5ml) TID
Current Illness: NONE
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MI9135

Write-up: Day p/vax pt became extremely irritable, screaming & holding his head, finger nails digging into his face & eye where he attempted to hold his face; Was bothered by noise; Also could not be comforted;


Changed on 8/14/2018

VAERS ID: 30903 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Michigan
Vaccinated:1991-05-06
Onset:1991-05-07
Submitted:1991-05-09
Entered:1991-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH TR1212B / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841122 / 1 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Agitation

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: Alupent 2cc (10mg/5ml) TID
Current Illness: NONE
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MI9135

Write-up: Day p/vax pt became extremely irritable, screaming & holding his head, finger nails digging into his face & eye where he attempted to hold his face; Was bothered by noise; Also could not be comforted;


Changed on 9/14/2018

VAERS ID: 30903 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Michigan
Vaccinated:1991-05-06
Onset:1991-05-07
Submitted:1991-05-09
Entered:1991-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH TR1212B / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841122 / 1 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Agitation

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: Alupent 2cc (10mg/5ml) TID
Current Illness: NONE
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MI9135

Write-up: Day p/vax pt became extremely irritable, screaming & holding his head, finger nails digging into his face & eye where he attempted to hold his face; Was bothered by noise; Also could not be comforted;


Changed on 10/14/2018

VAERS ID: 30903 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Michigan
Vaccinated:1991-05-06
Onset:1991-05-07
Submitted:1991-05-09
Entered:1991-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH TR1212B / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841122 / 1 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Agitation

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: Alupent 2cc (10mg/5ml) TID
Current Illness: NONE
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MI9135

Write-up: Day p/vax pt became extremely irritable, screaming & holding his head, finger nails digging into his face & eye where he attempted to hold his face; Was bothered by noise; Also could not be comforted;


Changed on 12/24/2020

VAERS ID: 30903 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Michigan
Vaccinated:1991-05-06
Onset:1991-05-07
Submitted:1991-05-09
Entered:1991-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH TR1212B / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841122 / 1 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Agitation

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: Alupent 2cc (10mg/5ml) TID
Current Illness: NONE
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MI9135

Write-up: Day p/vax pt became extremely irritable, screaming & holding his head, finger nails digging into his face & eye where he attempted to hold his face; Was bothered by noise; Also could not be comforted;


Changed on 12/30/2020

VAERS ID: 30903 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Michigan
Vaccinated:1991-05-06
Onset:1991-05-07
Submitted:1991-05-09
Entered:1991-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH TR1212B / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841122 / 1 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Agitation

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: Alupent 2cc (10mg/5ml) TID
Current Illness: NONE
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MI9135

Write-up: Day p/vax pt became extremely irritable, screaming & holding his head, finger nails digging into his face & eye where he attempted to hold his face; Was bothered by noise; Also could not be comforted;


Changed on 5/7/2021

VAERS ID: 30903 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Michigan
Vaccinated:1991-05-06
Onset:1991-05-07
Submitted:1991-05-09
Entered:1991-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH TR1212B / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841122 / 1 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Agitation

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: Alupent 2cc (10mg/5ml) TID
Current Illness: NONE
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MI9135

Write-up: Day p/vax pt became extremely irritable, screaming & holding his head, finger nails digging into his face & eye where he attempted to hold his face; Was bothered by noise; Also could not be comforted;


Changed on 5/14/2021

VAERS ID: 30903 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Michigan
Vaccinated:1991-05-06
Onset:1991-05-07
Submitted:1991-05-09
Entered:1991-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH TR1212B / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 841122 / 1 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Agitation

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: Alupent 2cc (10mg/5ml) TID
Current Illness: NONE
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MI9135

Write-up: Day p/vax pt became extremely irritable, screaming & holding his head, finger nails digging into his face & eye where he attempted to hold his face; Was bothered by noise; Also could not be comforted;

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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=30903&WAYBACKHISTORY=ON


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