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This is VAERS ID 133814

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 133814
VAERS Form:
Age:0.3
Sex:Male
Location:Florida
Vaccinated:2000-01-04
Onset:2000-01-05
Submitted:2000-01-05
Entered:2000-02-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA / CONNAUGHT LABS 7172DA / 2 LL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) 460103A / 2 RL / IM
IPV: IPV / MERIEUX INST N0956 / 2 LL / SC

Administered by: Private      Purchased by: Unknown
Symptoms: AGITATION, ASTHENIA, OTITIS MED, LARYNGITIS, CRY ABNORMAL

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: Mylicon drops
Current Illness: Colic
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Temp 102-103, inconsolable crying, intermittently calms down, resumes crying, high pitch approx exhausted & falls asleep 2 1/2 hrs later. Left clinic asleep. 1/6, re-evaluated, sx''s now like croup & bilateral OM. Admitted, dx: croup.


Changed on 12/30/2006

VAERS ID: 133814 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Florida
Vaccinated:2000-01-04
Onset:2000-01-05
Submitted:2000-01-05
Entered:2000-02-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA / CONNAUGHT LABS 7172DA / 2 LL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) 460103A / 2 RL / IM
IPV: IPV / MERIEUX INST N0956 / 2 LL / SC

Administered by: Private      Purchased by: Unknown
Symptoms: AGITATION, ASTHENIA, OTITIS MED, LARYNGITIS, CRY ABNORMAL

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: Mylicon drops
Current Illness: Colic
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Temp 102-103, inconsolable crying, intermittently calms down, resumes crying, high pitch approx exhausted & falls asleep 2 1/2 hrs later. Left clinic asleep. 1/6, re-evaluated, sx''s sx''''s now like croup & bilateral OM. Admitted, dx: croup.


Changed on 12/8/2009

VAERS ID: 133814 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Florida
Vaccinated:2000-01-04
Onset:2000-01-05
Submitted:2000-01-05
Entered:2000-02-29 2000-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA DTAP (TRIPEDIA) / CONNAUGHT LABS CONNAUGHT LABORATORIES 7172DA / 2 LL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS 460103A / 2 RL / IM
IPV: IPV POLIO VIRUS, INACT. (NO BRAND NAME) / MERIEUX INST PASTEUR MERIEUX INST. N0956 / 2 LL / SC

Administered by: Private      Purchased by: Unknown Private
Symptoms: Agitation, Asthenia, Crying, Laryngitis, Otitis media, AGITATION, ASTHENIA, OTITIS MED, LARYNGITIS, CRY ABNORMAL

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: Mylicon drops
Current Illness: Colic
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Temp 102-103, inconsolable crying, intermittently calms down, resumes crying, high pitch approx exhausted & falls asleep 2 1/2 hrs later. Left clinic asleep. 1/6, re-evaluated, sx''''s sx''s now like croup & bilateral OM. Admitted, dx: croup.


Changed on 5/14/2017

VAERS ID: 133814 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Florida
Vaccinated:2000-01-04
Onset:2000-01-05
Submitted:2000-01-05
Entered:2000-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7172DA / 2 LL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH 460103A / 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. N0956 / 2 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Asthenia, Crying, Laryngitis, 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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Mylicon drops
Current Illness: Colic
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Temp 102-103, inconsolable crying, intermittently calms down, resumes crying, high pitch approx exhausted & falls asleep 2 1/2 hrs later. Left clinic asleep. 1/6, re-evaluated, sx''s now like croup & bilateral OM. Admitted, dx: croup.


Changed on 9/14/2017

VAERS ID: 133814 Before After
VAERS Form:(blank) 1
Age:0.3
Sex:Male
Location:Florida
Vaccinated:2000-01-04
Onset:2000-01-05
Submitted:2000-01-05
Entered:2000-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7172DA / 2 3 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 460103A / 2 3 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. N0956 / 2 3 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Asthenia, Crying, Laryngitis, 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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Mylicon drops
Current Illness: Colic
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Temp 102-103, inconsolable crying, intermittently calms down, resumes crying, high pitch approx exhausted & falls asleep 2 1/2 hrs later. Left clinic asleep. 1/6, re-evaluated, sx''s now like croup & bilateral OM. Admitted, dx: croup.


Changed on 2/14/2018

VAERS ID: 133814 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Florida
Vaccinated:2000-01-04
Onset:2000-01-05
Submitted:2000-01-05
Entered:2000-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7172DA / 3 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 460103A / 3 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. N0956 / 3 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Asthenia, Crying, Laryngitis, 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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Mylicon drops
Current Illness: Colic
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Temp 102-103, inconsolable crying, intermittently calms down, resumes crying, high pitch approx exhausted & falls asleep 2 1/2 hrs later. Left clinic asleep. 1/6, re-evaluated, sx''s now like croup & bilateral OM. Admitted, dx: croup.


Changed on 6/14/2018

VAERS ID: 133814 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Florida
Vaccinated:2000-01-04
Onset:2000-01-05
Submitted:2000-01-05
Entered:2000-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7172DA / 3 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 460103A / 3 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. N0956 / 3 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Asthenia, Crying, Laryngitis, 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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Mylicon drops
Current Illness: Colic
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Temp 102-103, inconsolable crying, intermittently calms down, resumes crying, high pitch approx exhausted & falls asleep 2 1/2 hrs later. Left clinic asleep. 1/6, re-evaluated, sx''s now like croup & bilateral OM. Admitted, dx: croup.


Changed on 8/14/2018

VAERS ID: 133814 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Florida
Vaccinated:2000-01-04
Onset:2000-01-05
Submitted:2000-01-05
Entered:2000-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7172DA / 3 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 460103A / 3 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. N0956 / 3 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Asthenia, Crying, Laryngitis, 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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Mylicon drops
Current Illness: Colic
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Temp 102-103, inconsolable crying, intermittently calms down, resumes crying, high pitch approx exhausted & falls asleep 2 1/2 hrs later. Left clinic asleep. 1/6, re-evaluated, sx''s now like croup & bilateral OM. Admitted, dx: croup.


Changed on 9/14/2018

VAERS ID: 133814 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Florida
Vaccinated:2000-01-04
Onset:2000-01-05
Submitted:2000-01-05
Entered:2000-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7172DA / 3 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 460103A / 3 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. N0956 / 3 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Asthenia, Crying, Laryngitis, 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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Mylicon drops
Current Illness: Colic
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Temp 102-103, inconsolable crying, intermittently calms down, resumes crying, high pitch approx exhausted & falls asleep 2 1/2 hrs later. Left clinic asleep. 1/6, re-evaluated, sx''s now like croup & bilateral OM. Admitted, dx: croup.


Changed on 10/14/2018

VAERS ID: 133814 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Florida
Vaccinated:2000-01-04
Onset:2000-01-05
Submitted:2000-01-05
Entered:2000-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7172DA / 3 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 460103A / 3 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. N0956 / 3 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Asthenia, Crying, Laryngitis, 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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Mylicon drops
Current Illness: Colic
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Temp 102-103, inconsolable crying, intermittently calms down, resumes crying, high pitch approx exhausted & falls asleep 2 1/2 hrs later. Left clinic asleep. 1/6, re-evaluated, sx''s now like croup & bilateral OM. Admitted, dx: croup.


Changed on 12/24/2020

VAERS ID: 133814 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Florida
Vaccinated:2000-01-04
Onset:2000-01-05
Submitted:2000-01-05
Entered:2000-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7172DA / 3 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 460103A / 3 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. N0956 / 3 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Asthenia, Crying, Laryngitis, 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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Mylicon drops
Current Illness: Colic
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Temp 102-103, inconsolable crying, intermittently calms down, resumes crying, high pitch approx exhausted & falls asleep 2 1/2 hrs later. Left clinic asleep. 1/6, re-evaluated, sx''s now like croup & bilateral OM. Admitted, dx: croup.


Changed on 12/30/2020

VAERS ID: 133814 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Florida
Vaccinated:2000-01-04
Onset:2000-01-05
Submitted:2000-01-05
Entered:2000-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7172DA / 3 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 460103A / 3 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. N0956 / 3 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Asthenia, Crying, Laryngitis, 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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Mylicon drops
Current Illness: Colic
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Temp 102-103, inconsolable crying, intermittently calms down, resumes crying, high pitch approx exhausted & falls asleep 2 1/2 hrs later. Left clinic asleep. 1/6, re-evaluated, sx''s now like croup & bilateral OM. Admitted, dx: croup.

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