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This is VAERS ID 43259

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 43259
VAERS Form:
Age:1.5
Sex:Male
Location:New York
Vaccinated:1992-06-22
Onset:1992-06-22
Submitted:1992-06-24
Entered:1992-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE / LEDERLE 320969 / 3 - / IM
OPV: ORIMUNE / LEDERLE 316959 / - - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: CONVULS, FEVER, SOMNOLENCE

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: ear slight infection
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt temp rose to over 105 became limp, eyes rolled back, body stiffened & began to shake & jerk (sz)-turned blue; had some blood from the mouth; pt was wrapped in tepid towels to reduce fever & bring back color; pt became limp & sleepy;


Changed on 12/8/2009

VAERS ID: 43259 Before After
VAERS Form:
Age:1.5
Sex:Male
Location:New York
Vaccinated:1992-06-22
Onset:1992-06-22
Submitted:1992-06-24
Entered:1992-07-02 1992-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE DTAP (ACEL-IMUNE) / LEDERLE LEDERLE LABORATORIES 320969 / 3 - / IM
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 316959 / - - / PO

Administered by: Private      Purchased by: Unknown Private
Symptoms: Convulsion, Pyrexia, Somnolence, CONVULS, FEVER, SOMNOLENCE

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: ear slight infection
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt temp rose to over 105 became limp, eyes rolled back, body stiffened & began to shake & jerk (sz)-turned blue; had some blood from the mouth; pt was wrapped in tepid towels to reduce fever & bring back color; pt became limp & sleepy;


Changed on 5/14/2017

VAERS ID: 43259 Before After
VAERS Form:
Age:1.5
Sex:Male
Location:New York
Vaccinated:1992-06-22
Onset:1992-06-22
Submitted:1992-06-24
Entered:1992-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 320969 / 3 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 316959 / - - / PO

Administered by: Private      Purchased by: Private
Symptoms: Convulsion, Pyrexia, Somnolence

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Amoxie
Current Illness: ear slight infection serous otitis media
Preexisting Conditions: recurrent otitis media
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt temp rose t105, lethargy, seizures admitted to over 105 became limp, eyes rolled back, body stiffened & began to shake & jerk (sz)-turned blue; had some blood from the mouth; pt was wrapped in tepid towels to reduce fever & bring back color; pt became limp & sleepy; hosp;


Changed on 9/14/2017

VAERS ID: 43259 Before After
VAERS Form:(blank) 1
Age:1.5
Sex:Male
Location:New York
Vaccinated:1992-06-22
Onset:1992-06-22
Submitted:1992-06-24
Entered:1992-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 320969 / 3 4 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 316959 / - UNK - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Convulsion, Pyrexia, Somnolence

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Amoxie
Current Illness: serous otitis media
Preexisting Conditions: recurrent otitis media
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: t105, lethargy, seizures admitted to hosp;


Changed on 2/14/2018

VAERS ID: 43259 Before After
VAERS Form:1
Age:1.5
Sex:Male
Location:New York
Vaccinated:1992-06-22
Onset:1992-06-22
Submitted:1992-06-24
Entered:1992-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 320969 / 4 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 316959 / UNK MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Convulsion, Pyrexia, Somnolence

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Amoxie
Current Illness: serous otitis media
Preexisting Conditions: recurrent otitis media
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: t105, lethargy, seizures admitted to hosp;


Changed on 6/14/2018

VAERS ID: 43259 Before After
VAERS Form:1
Age:1.5
Sex:Male
Location:New York
Vaccinated:1992-06-22
Onset:1992-06-22
Submitted:1992-06-24
Entered:1992-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 320969 / 4 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 316959 / UNK MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Convulsion, Pyrexia, Somnolence

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Amoxie
Current Illness: serous otitis media
Preexisting Conditions: recurrent otitis media
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: t105, lethargy, seizures admitted to hosp;


Changed on 8/14/2018

VAERS ID: 43259 Before After
VAERS Form:1
Age:1.5
Sex:Male
Location:New York
Vaccinated:1992-06-22
Onset:1992-06-22
Submitted:1992-06-24
Entered:1992-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 320969 / 4 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 316959 / UNK MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Convulsion, Pyrexia, Somnolence

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Amoxie
Current Illness: serous otitis media
Preexisting Conditions: recurrent otitis media
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: t105, lethargy, seizures admitted to hosp;


Changed on 9/14/2018

VAERS ID: 43259 Before After
VAERS Form:1
Age:1.5
Sex:Male
Location:New York
Vaccinated:1992-06-22
Onset:1992-06-22
Submitted:1992-06-24
Entered:1992-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 320969 / 4 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 316959 / UNK MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Convulsion, Pyrexia, Somnolence

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Amoxie
Current Illness: serous otitis media
Preexisting Conditions: recurrent otitis media
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: t105, lethargy, seizures admitted to hosp;


Changed on 10/14/2018

VAERS ID: 43259 Before After
VAERS Form:1
Age:1.5
Sex:Male
Location:New York
Vaccinated:1992-06-22
Onset:1992-06-22
Submitted:1992-06-24
Entered:1992-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 320969 / 4 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 316959 / UNK MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Convulsion, Pyrexia, Somnolence

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Amoxie
Current Illness: serous otitis media
Preexisting Conditions: recurrent otitis media
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: t105, lethargy, seizures admitted to hosp;

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