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This is VAERS ID 25703

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 25703
VAERS Form:
Age:0.3
Sex:Female
Location:Virginia
Vaccinated:1990-06-26
Onset:1990-06-26
Submitted:0000-00-00
Entered:1990-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 235944 / - - / IM
OPV: UNK. POLIOVIRUS LIVE ORAL TRIVALENT / UNCLASSIFIED - / - - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-06-26
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: Pt vaccinated with DTP/OPV (1st set) 6 hrs ltr 20 mins and a feeding found dead. Autopsy report SIDS


Changed on 12/8/2009

VAERS ID: 25703 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:Virginia
Vaccinated:1990-06-26
Onset:1990-06-26
Submitted:0000-00-00
Entered:1990-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 235944 / - - / IM
OPV: UNK. POLIOVIRUS LIVE ORAL TRIVALENT POLIO VIRUS, ORAL (NO BRAND NAME) / UNCLASSIFIED UNKNOWN MANUFACTURER - / - - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-06-26
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: Pt vaccinated with DTP/OPV (1st set) 6 hrs ltr 20 mins and a feeding found dead. Autopsy report SIDS


Changed on 5/14/2017

VAERS ID: 25703 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:Virginia
Vaccinated:1990-06-26
Onset:1990-06-26
Submitted:0000-00-00
Entered:1990-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 235944 / - - / IM
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-06-26
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: Pt vaccinated with DTP/OPV (1st set) 6 hrs ltr 20 mins and a feeding found dead. Autopsy report SIDS


Changed on 9/14/2017

VAERS ID: 25703 Before After
VAERS Form:(blank) 1
Age:0.3
Sex:Female
Location:Virginia
Vaccinated:1990-06-26
Onset:1990-06-26
Submitted:0000-00-00
Entered:1990-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 235944 / - UNK - / IM
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK - MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-06-26
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: Pt vaccinated with DTP/OPV (1st set) 6 hrs ltr 20 mins and a feeding found dead. Autopsy report SIDS


Changed on 2/14/2018

VAERS ID: 25703 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:Virginia
Vaccinated:1990-06-26
Onset:1990-06-26
Submitted:0000-00-00
Entered:1990-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 235944 / UNK - / IM
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-06-26
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: Pt vaccinated with DTP/OPV (1st set) 6 hrs ltr 20 mins and a feeding found dead. Autopsy report SIDS


Changed on 6/14/2018

VAERS ID: 25703 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:Virginia
Vaccinated:1990-06-26
Onset:1990-06-26
Submitted:0000-00-00
Entered:1990-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 235944 / UNK - / IM
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-06-26
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: Pt vaccinated with DTP/OPV (1st set) 6 hrs ltr 20 mins and a feeding found dead. Autopsy report SIDS


Changed on 8/14/2018

VAERS ID: 25703 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:Virginia
Vaccinated:1990-06-26
Onset:1990-06-26
Submitted:0000-00-00
Entered:1990-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 235944 / UNK - / IM
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-06-26
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: Pt vaccinated with DTP/OPV (1st set) 6 hrs ltr 20 mins and a feeding found dead. Autopsy report SIDS


Changed on 9/14/2018

VAERS ID: 25703 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:Virginia
Vaccinated:1990-06-26
Onset:1990-06-26
Submitted:0000-00-00
Entered:1990-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 235944 / UNK - / IM
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-06-26
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: Pt vaccinated with DTP/OPV (1st set) 6 hrs ltr 20 mins and a feeding found dead. Autopsy report SIDS


Changed on 10/14/2018

VAERS ID: 25703 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:Virginia
Vaccinated:1990-06-26
Onset:1990-06-26
Submitted:0000-00-00
Entered:1990-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 235944 / UNK - / IM
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-06-26
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: Pt vaccinated with DTP/OPV (1st set) 6 hrs ltr 20 mins and a feeding found dead. Autopsy report SIDS

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