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History of Changes from the VAERS Wayback Machine |
VAERS ID: | 25026 |
VAERS Form: | |
Age: | 1.0 |
Sex: | Male |
Location: | Washington |
Vaccinated: | 1990-01-12 |
Onset: | 1990-01-14 |
Submitted: | 0000-00-00 |
Entered: | 1990-07-10 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DT: DT ADSORBED PEDIATRIC / LEDERLE | 229974 / - | - / IM |
HIBV: PROHIBIT / CONNAUGHT LABS | 9A11092 / - | - / IM |
OPV: ORIMUNE / LEDERLE | 244970 / - | - / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: REACT UNEVAL
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1990-01-14
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: child found dead in bed 14Jan90. Had full check up 12Jan90 with immunizations DPT/HIB/Oral Polio
Vaccinated: | 1990-01-12 |
Onset: | 1990-01-14 |
Submitted: | 0000-00-00 |
Entered: | 1990-07-10 1990-07-09 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DT: DT ADSORBED PEDIATRIC DT ADSORBED (NO BRAND NAME) / LEDERLE LEDERLE LABORATORIES | 229974 / - | - / IM |
HIBV: PROHIBIT HIB (PROHIBIT) / CONNAUGHT LABS CONNAUGHT LABORATORIES | 9A11092 / - | - / IM |
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES | 244970 / - | - / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Unevaluable event, REACT UNEVAL
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1990-01-14
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: child found dead in bed 14Jan90. Had full check up 12Jan90 with immunizations DPT/HIB/Oral Polio
Vaccinated: | 1990-01-12 |
Onset: | 1990-01-14 |
Submitted: | 0000-00-00 |
Entered: | 1990-07-09 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DT: DT ADSORBED (NO BRAND NAME) / LEDERLE LABORATORIES | 229974 / - | - / IM |
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES | 9A11092 / - | - / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH | 244970 / - | - / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Unevaluable event
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1990-01-14
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: child found dead in bed 14Jan90. Had full check up 12Jan90 with immunizations DPT/HIB/Oral Polio
Vaccinated: | 1990-01-12 |
Onset: | 1990-01-14 |
Submitted: | 0000-00-00 |
Entered: | 1990-07-09 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DT: DT ADSORBED (NO BRAND NAME) / LEDERLE LABORATORIES | 229974 / - UNK | - / IM |
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES | 9A11092 / - UNK | - / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH | 244970 / - UNK | - MO / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Unevaluable event
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1990-01-14
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: child found dead in bed 14Jan90. Had full check up 12Jan90 with immunizations DPT/HIB/Oral Polio
Vaccinated: | 1990-01-12 |
Onset: | 1990-01-14 |
Submitted: | 0000-00-00 |
Entered: | 1990-07-09 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DT: DT ADSORBED (NO BRAND NAME) / LEDERLE LABORATORIES | 229974 / UNK | - / IM |
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES | 9A11092 / UNK | - / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH | 244970 / UNK | MO / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Unevaluable event
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1990-01-14
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: child found dead in bed 14Jan90. Had full check up 12Jan90 with immunizations DPT/HIB/Oral Polio
Vaccinated: | 1990-01-12 |
Onset: | 1990-01-14 |
Submitted: | 0000-00-00 |
Entered: | 1990-07-09 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DT: DT ADSORBED (NO BRAND NAME) / LEDERLE LABORATORIES | 229974 / UNK | - / IM |
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES | 9A11092 / UNK | - / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH | 244970 / UNK | MO / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Unevaluable event
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1990-01-14
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: child found dead in bed 14Jan90. Had full check up 12Jan90 with immunizations DPT/HIB/Oral Polio
Vaccinated: | 1990-01-12 |
Onset: | 1990-01-14 |
Submitted: | 0000-00-00 |
Entered: | 1990-07-09 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DT: DT ADSORBED (NO BRAND NAME) / LEDERLE LABORATORIES | 229974 / UNK | - / IM |
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES | 9A11092 / UNK | - / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH | 244970 / UNK | MO / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Unevaluable event
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1990-01-14
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: child found dead in bed 14Jan90. Had full check up 12Jan90 with immunizations DPT/HIB/Oral Polio
Vaccinated: | 1990-01-12 |
Onset: | 1990-01-14 |
Submitted: | 0000-00-00 |
Entered: | 1990-07-09 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DT: DT ADSORBED (NO BRAND NAME) / LEDERLE LABORATORIES | 229974 / UNK | - / IM |
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES | 9A11092 / UNK | - / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH | 244970 / UNK | MO / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Unevaluable event
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1990-01-14
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: child found dead in bed 14Jan90. Had full check up 12Jan90 with immunizations DPT/HIB/Oral Polio
Vaccinated: | 1990-01-12 |
Onset: | 1990-01-14 |
Submitted: | 0000-00-00 |
Entered: | 1990-07-09 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DT: DT ADSORBED (NO BRAND NAME) / LEDERLE LABORATORIES | 229974 / UNK | - / IM |
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES | 9A11092 / UNK | - / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH | 244970 / UNK | MO / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Unevaluable event
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1990-01-14
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: child found dead in bed 14Jan90. Had full check up 12Jan90 with immunizations DPT/HIB/Oral Polio
Vaccinated: | 1990-01-12 |
Onset: | 1990-01-14 |
Submitted: | 0000-00-00 |
Entered: | 1990-07-09 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DT: DT ADSORBED (NO BRAND NAME) / LEDERLE LABORATORIES | 229974 / UNK | - / IM |
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES | 9A11092 / UNK | - / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH | 244970 / UNK | MO / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Unevaluable event
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1990-01-14
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: child found dead in bed 14Jan90. Had full check up 12Jan90 with immunizations DPT/HIB/Oral Polio
Vaccinated: | 1990-01-12 |
Onset: | 1990-01-14 |
Submitted: | 0000-00-00 |
Entered: | 1990-07-09 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DT: DT ADSORBED (NO BRAND NAME) / LEDERLE LABORATORIES | 229974 / UNK | - / IM |
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES | 9A11092 / UNK | - / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH | 244970 / UNK | MO / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Unevaluable event
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1990-01-14
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: child found dead in bed 14Jan90. Had full check up 12Jan90 with immunizations DPT/HIB/Oral Polio
Link To This Search Result:
https://medalerts.org/vaersdb/findfield.php?IDNUMBER=25026&WAYBACKHISTORY=ON
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