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History of Changes from the VAERS Wayback Machine |
VAERS ID: | 25553 |
VAERS Form: | |
Age: | 0.2 |
Sex: | Male |
Location: | Tennessee |
Vaccinated: | 1990-06-25 |
Onset: | 1990-06-27 |
Submitted: | 0000-00-00 |
Entered: | 1990-07-24 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTP: DTP / CONNAUGHT LABS | 9J01114 / - | - / - |
OPV: UNK. POLIOVIRUS LIVE ORAL TRIVALENT / UNCLASSIFIED | - / - | - / - |
Administered by: Private Purchased by: Unknown
Symptoms: EDEMA LUNG, FIBRILLAT VENT, HEM ADREN, LUNG DIS, NECRO ADREN
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:0000-00-00
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: none
Current Illness: routine well baby checkup given
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: Pt found in crib unresponsive at 09:00 6-27-90; DTP & OPV given on 06-25-90 at 15:00. Pt to ER via ambo, no spontaneous heartbeat, pulse or resp. CPR and defib attempted, could not convert v-fib to NSR. Pupils fixed & unresp. See WORM.
Vaccinated: | 1990-06-25 |
Onset: | 1990-06-27 |
Submitted: | 0000-00-00 |
Entered: | 1990-07-24 1990-07-23 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTP: DTP DTP (NO BRAND NAME) / CONNAUGHT LABS CONNAUGHT LABORATORIES | 9J01114 / - | - / - |
OPV: UNK. POLIOVIRUS LIVE ORAL TRIVALENT POLIO VIRUS, ORAL (NO BRAND NAME) / UNCLASSIFIED UNKNOWN MANUFACTURER | - / - | - / - |
Administered by: Private Purchased by: Unknown Private
Symptoms: Adrenal cortex necrosis, Adrenal haemorrhage, Lung disorder, Neoplasm, Petechiae, Pulmonary oedema, Stupor, Ventricular fibrillation, EDEMA LUNG, FIBRILLAT VENT, HEM ADREN, LUNG DIS, NECRO ADREN
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:0000-00-00
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: none
Current Illness: routine well baby checkup given
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: Pt found in crib unresponsive at 09:00 6-27-90; DTP & OPV given on 06-25-90 at 15:00. Pt to ER via ambo, no spontaneous heartbeat, pulse or resp. CPR and defib attempted, could not convert v-fib to NSR. Pupils fixed & unresp. See WORM.
Vaccinated: | 1990-06-25 |
Onset: | 1990-06-27 |
Submitted: | 0000-00-00 |
Entered: | 1990-07-23 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES | 9J01114 / - | - / - |
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER | - / - | - / - |
Administered by: Private Purchased by: Private
Symptoms: Adrenal cortex necrosis, Adrenal haemorrhage, Lung disorder, Neoplasm, Petechiae, Pulmonary oedema, Stupor, Ventricular fibrillation
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:0000-00-00
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: none
Current Illness: routine well baby checkup given
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: Pt found in crib unresponsive at 09:00 6-27-90; DTP & OPV given on 06-25-90 at 15:00. Pt to ER via ambo, no spontaneous heartbeat, pulse or resp. CPR and defib attempted, could not convert v-fib to NSR. Pupils fixed & unresp. See WORM.
Vaccinated: | 1990-06-25 |
Onset: | 1990-06-27 |
Submitted: | 0000-00-00 |
Entered: | 1990-07-23 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES | 9J01114 / - UNK | - / - |
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER | - / - UNK | - / - |
Administered by: Private Purchased by: Private
Symptoms: Adrenal cortex necrosis, Adrenal haemorrhage, Lung disorder, Neoplasm, Petechiae, Pulmonary oedema, Stupor, Ventricular fibrillation
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:0000-00-00
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: none
Current Illness: routine well baby checkup given
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: Pt found in crib unresponsive at 09:00 6-27-90; DTP & OPV given on 06-25-90 at 15:00. Pt to ER via ambo, no spontaneous heartbeat, pulse or resp. CPR and defib attempted, could not convert v-fib to NSR. Pupils fixed & unresp. See WORM.
Vaccinated: | 1990-06-25 |
Onset: | 1990-06-27 |
Submitted: | 0000-00-00 |
Entered: | 1990-07-23 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES | 9J01114 / UNK | - / - |
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER | - / UNK | - / - |
Administered by: Private Purchased by: Private
Symptoms: Adrenal cortex necrosis, Adrenal haemorrhage, Lung disorder, Neoplasm, Petechiae, Pulmonary oedema, Stupor, Ventricular fibrillation
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:0000-00-00
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: none
Current Illness: routine well baby checkup given
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: Pt found in crib unresponsive at 09:00 6-27-90; DTP & OPV given on 06-25-90 at 15:00. Pt to ER via ambo, no spontaneous heartbeat, pulse or resp. CPR and defib attempted, could not convert v-fib to NSR. Pupils fixed & unresp. See WORM.
Vaccinated: | 1990-06-25 |
Onset: | 1990-06-27 |
Submitted: | 0000-00-00 |
Entered: | 1990-07-23 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES | 9J01114 / UNK | - / - |
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER | - / UNK | - / - |
Administered by: Private Purchased by: Private
Symptoms: Adrenal cortex necrosis, Adrenal haemorrhage, Lung disorder, Neoplasm, Petechiae, Pulmonary oedema, Stupor, Ventricular fibrillation
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:0000-00-00
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: none
Current Illness: routine well baby checkup given
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: Pt found in crib unresponsive at 09:00 6-27-90; DTP & OPV given on 06-25-90 at 15:00. Pt to ER via ambo, no spontaneous heartbeat, pulse or resp. CPR and defib attempted, could not convert v-fib to NSR. Pupils fixed & unresp. See WORM.
Vaccinated: | 1990-06-25 |
Onset: | 1990-06-27 |
Submitted: | 0000-00-00 |
Entered: | 1990-07-23 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES | 9J01114 / UNK | - / - |
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER | - / UNK | - / - |
Administered by: Private Purchased by: Private
Symptoms: Adrenal cortex necrosis, Adrenal haemorrhage, Lung disorder, Neoplasm, Petechiae, Pulmonary oedema, Stupor, Ventricular fibrillation
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:0000-00-00
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: none
Current Illness: routine well baby checkup given
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: Pt found in crib unresponsive at 09:00 6-27-90; DTP & OPV given on 06-25-90 at 15:00. Pt to ER via ambo, no spontaneous heartbeat, pulse or resp. CPR and defib attempted, could not convert v-fib to NSR. Pupils fixed & unresp. See WORM.
Vaccinated: | 1990-06-25 |
Onset: | 1990-06-27 |
Submitted: | 0000-00-00 |
Entered: | 1990-07-23 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES | 9J01114 / UNK | - / - |
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER | - / UNK | - / - |
Administered by: Private Purchased by: Private
Symptoms: Adrenal cortex necrosis, Adrenal haemorrhage, Lung disorder, Neoplasm, Petechiae, Pulmonary oedema, Stupor, Ventricular fibrillation
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:0000-00-00
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: none
Current Illness: routine well baby checkup given
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: Pt found in crib unresponsive at 09:00 6-27-90; DTP & OPV given on 06-25-90 at 15:00. Pt to ER via ambo, no spontaneous heartbeat, pulse or resp. CPR and defib attempted, could not convert v-fib to NSR. Pupils fixed & unresp. See WORM.
Vaccinated: | 1990-06-25 |
Onset: | 1990-06-27 |
Submitted: | 0000-00-00 |
Entered: | 1990-07-23 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES | 9J01114 / UNK | - / - |
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER | - / UNK | - / - |
Administered by: Private Purchased by: Private
Symptoms: Adrenal cortex necrosis, Adrenal haemorrhage, Lung disorder, Neoplasm, Petechiae, Pulmonary oedema, Stupor, Ventricular fibrillation
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:0000-00-00
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: none
Current Illness: routine well baby checkup given
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: Pt found in crib unresponsive at 09:00 6-27-90; DTP & OPV given on 06-25-90 at 15:00. Pt to ER via ambo, no spontaneous heartbeat, pulse or resp. CPR and defib attempted, could not convert v-fib to NSR. Pupils fixed & unresp. See WORM.
Vaccinated: | 1990-06-25 |
Onset: | 1990-06-27 |
Submitted: | 0000-00-00 |
Entered: | 1990-07-23 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES | 9J01114 / UNK | - / - |
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER | - / UNK | - / - |
Administered by: Private Purchased by: Private
Symptoms: Adrenal cortex necrosis, Adrenal haemorrhage, Lung disorder, Neoplasm, Petechiae, Pulmonary oedema, Stupor, Ventricular fibrillation
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:0000-00-00
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: none
Current Illness: routine well baby checkup given
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: Pt found in crib unresponsive at 09:00 6-27-90; DTP & OPV given on 06-25-90 at 15:00. Pt to ER via ambo, no spontaneous heartbeat, pulse or resp. CPR and defib attempted, could not convert v-fib to NSR. Pupils fixed & unresp. See WORM.
Vaccinated: | 1990-06-25 |
Onset: | 1990-06-27 |
Submitted: | 0000-00-00 |
Entered: | 1990-07-23 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES | 9J01114 / UNK | - / - |
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER | - / UNK | - / - |
Administered by: Private Purchased by: Private
Symptoms: Adrenal cortex necrosis, Adrenal haemorrhage, Lung disorder, Neoplasm, Petechiae, Pulmonary oedema, Stupor, Ventricular fibrillation
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:0000-00-00
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: none
Current Illness: routine well baby checkup given
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: Pt found in crib unresponsive at 09:00 6-27-90; DTP & OPV given on 06-25-90 at 15:00. Pt to ER via ambo, no spontaneous heartbeat, pulse or resp. CPR and defib attempted, could not convert v-fib to NSR. Pupils fixed & unresp. See WORM.
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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=25553&WAYBACKHISTORY=ON
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