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This is VAERS ID 26408

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 26408
VAERS Form:
Age:0.2
Sex:Male
Location:New Jersey
Vaccinated:1990-10-15
Onset:1990-10-17
Submitted:1990-10-23
Entered:1990-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP / CONNAUGHT LABS 0L11101 / 0 LL / -
OPV: ORIMUNE / LEDERLE 0615K / 0 - / PO

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

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? Yes, days:     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Spinal tap, WBC 800, Lymphs 34, Polys 47, Mono 9, RBC 4, Protein 138.1, Glu 43, L acid 3.1
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV on 16OCT90 child admitted to hosp w/temp of 104, vomitting & lethargy.


Changed on 12/8/2009

VAERS ID: 26408 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:New Jersey
Vaccinated:1990-10-15
Onset:1990-10-17
Submitted:1990-10-23
Entered:1990-11-05 1990-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP DTP (NO BRAND NAME) / CONNAUGHT LABS CONNAUGHT LABORATORIES 0L11101 / 0 LL / -
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 0615K / 0 - / PO

Administered by: Private      Purchased by: Unknown Private
Symptoms: Pyrexia, Somnolence, Vomiting, FEVER, VOMIT, SOMNOLENCE

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? Yes, days:     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Spinal tap, WBC 800, Lymphs 34, Polys 47, Mono 9, RBC 4, Protein 138.1, Glu 43, L acid 3.1
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV on 16OCT90 child admitted to hosp w/temp of 104, vomitting & lethargy.


Changed on 5/14/2017

VAERS ID: 26408 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:New Jersey
Vaccinated:1990-10-15
Onset:1990-10-17
Submitted:1990-10-23
Entered:1990-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0L11101 / 0 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 0615K / 0 - / PO

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

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? Yes, days:     Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Spinal tap, WBC 800, Lymphs 34, Polys 47, Mono 9, RBC 4, Protein 138.1, Glu 43, L acid 3.1
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV on 16OCT90 child admitted to hosp w/temp of 104, vomitting & lethargy.


Changed on 9/14/2017

VAERS ID: 26408 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:New Jersey
Vaccinated:1990-10-15
Onset:1990-10-17
Submitted:1990-10-23
Entered:1990-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0L11101 / 0 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0615K / 0 1 - MO / PO

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

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? Yes, days:     Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Spinal tap, WBC 800, Lymphs 34, Polys 47, Mono 9, RBC 4, Protein 138.1, Glu 43, L acid 3.1
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV on 16OCT90 child admitted to hosp w/temp of 104, vomitting & lethargy.


Changed on 2/14/2018

VAERS ID: 26408 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:New Jersey
Vaccinated:1990-10-15
Onset:1990-10-17
Submitted:1990-10-23
Entered:1990-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0L11101 / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0615K / 1 MO / PO

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

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? Yes, days:     Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Spinal tap, WBC 800, Lymphs 34, Polys 47, Mono 9, RBC 4, Protein 138.1, Glu 43, L acid 3.1
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV on 16OCT90 child admitted to hosp w/temp of 104, vomitting & lethargy.


Changed on 6/14/2018

VAERS ID: 26408 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:New Jersey
Vaccinated:1990-10-15
Onset:1990-10-17
Submitted:1990-10-23
Entered:1990-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0L11101 / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0615K / 1 MO / PO

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

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? Yes, days:     Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Spinal tap, WBC 800, Lymphs 34, Polys 47, Mono 9, RBC 4, Protein 138.1, Glu 43, L acid 3.1
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV on 16OCT90 child admitted to hosp w/temp of 104, vomitting & lethargy.


Changed on 8/14/2018

VAERS ID: 26408 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:New Jersey
Vaccinated:1990-10-15
Onset:1990-10-17
Submitted:1990-10-23
Entered:1990-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0L11101 / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0615K / 1 MO / PO

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

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? Yes, days:     Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Spinal tap, WBC 800, Lymphs 34, Polys 47, Mono 9, RBC 4, Protein 138.1, Glu 43, L acid 3.1
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV on 16OCT90 child admitted to hosp w/temp of 104, vomitting & lethargy.


Changed on 9/14/2018

VAERS ID: 26408 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:New Jersey
Vaccinated:1990-10-15
Onset:1990-10-17
Submitted:1990-10-23
Entered:1990-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0L11101 / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0615K / 1 MO / PO

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

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? Yes, days:     Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Spinal tap, WBC 800, Lymphs 34, Polys 47, Mono 9, RBC 4, Protein 138.1, Glu 43, L acid 3.1
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV on 16OCT90 child admitted to hosp w/temp of 104, vomitting & lethargy.


Changed on 10/14/2018

VAERS ID: 26408 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:New Jersey
Vaccinated:1990-10-15
Onset:1990-10-17
Submitted:1990-10-23
Entered:1990-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0L11101 / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0615K / 1 MO / PO

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

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? Yes, days:     Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Spinal tap, WBC 800, Lymphs 34, Polys 47, Mono 9, RBC 4, Protein 138.1, Glu 43, L acid 3.1
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV on 16OCT90 child admitted to hosp w/temp of 104, vomitting & lethargy.


Changed on 12/24/2020

VAERS ID: 26408 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:New Jersey
Vaccinated:1990-10-15
Onset:1990-10-17
Submitted:1990-10-23
Entered:1990-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0L11101 / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0615K / 1 MO / PO

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

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? Yes, days:     Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Spinal tap, WBC 800, Lymphs 34, Polys 47, Mono 9, RBC 4, Protein 138.1, Glu 43, L acid 3.1
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV on 16OCT90 child admitted to hosp w/temp of 104, vomitting & lethargy.


Changed on 12/30/2020

VAERS ID: 26408 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:New Jersey
Vaccinated:1990-10-15
Onset:1990-10-17
Submitted:1990-10-23
Entered:1990-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0L11101 / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0615K / 1 MO / PO

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

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? Yes, days:     Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Spinal tap, WBC 800, Lymphs 34, Polys 47, Mono 9, RBC 4, Protein 138.1, Glu 43, L acid 3.1
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV on 16OCT90 child admitted to hosp w/temp of 104, vomitting & lethargy.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=26408&WAYBACKHISTORY=ON


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