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This is VAERS ID 25780

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 25780
VAERS Form:
Age:0.2
Sex:Male
Location:Maryland
Vaccinated:1990-07-26
Onset:1990-07-28
Submitted:0000-00-00
Entered:1990-08-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 271967 / - - / -
OPV: ORIMUNE / LEDERLE - / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: FEVER

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-07-29
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: No previous seizures in pt. No hx of seizures in parents and/or siblings.
Allergies:
Diagnostic Lab Data: Autopsy performed 30JUL90. Copy of report requested
CDC 'Split Type':

Write-up: On 28JUL90 (48 hrs aftr DTP/OPV immunization), the infant experienced a fever of 104, the following day, infant was fed 8 oz of formula and 2 hrs later expired. Taken to ER was pronounced dead on arrival.


Changed on 12/8/2009

VAERS ID: 25780 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Maryland
Vaccinated:1990-07-26
Onset:1990-07-28
Submitted:0000-00-00
Entered:1990-08-29 1990-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 271967 / - - / -
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES - / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Pyrexia, FEVER

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-07-29
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: No previous seizures in pt. No hx of seizures in parents and/or siblings.
Allergies:
Diagnostic Lab Data: Autopsy performed 30JUL90. Copy of report requested
CDC 'Split Type': (blank) 9001336.01

Write-up: On 28JUL90 (48 hrs aftr DTP/OPV immunization), the infant experienced a fever of 104, the following day, infant was fed 8 oz of formula and 2 hrs later expired. Taken to ER was pronounced dead on arrival.


Changed on 5/14/2017

VAERS ID: 25780 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Maryland
Vaccinated:1990-07-26
Onset:1990-07-28
Submitted:0000-00-00
Entered:1990-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271967 / - - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH - / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-07-29
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: No previous seizures in pt. No hx of seizures in parents and/or siblings.
Allergies:
Diagnostic Lab Data: Autopsy performed 30JUL90. Copy of report requested
CDC 'Split Type': 9001336.01

Write-up: On 28JUL90 (48 hrs aftr DTP/OPV immunization), the infant experienced a fever of 104, the following day, infant was fed 8 oz of formula and 2 hrs later expired. Taken to ER was pronounced dead on arrival.


Changed on 9/14/2017

VAERS ID: 25780 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:Maryland
Vaccinated:1990-07-26
Onset:1990-07-28
Submitted:0000-00-00
Entered:1990-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271967 / - UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / - UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-07-29
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: No previous seizures in pt. No hx of seizures in parents and/or siblings.
Allergies:
Diagnostic Lab Data: Autopsy performed 30JUL90. Copy of report requested
CDC 'Split Type': 9001336.01

Write-up: On 28JUL90 (48 hrs aftr DTP/OPV immunization), the infant experienced a fever of 104, the following day, infant was fed 8 oz of formula and 2 hrs later expired. Taken to ER was pronounced dead on arrival.


Changed on 2/14/2018

VAERS ID: 25780 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Maryland
Vaccinated:1990-07-26
Onset:1990-07-28
Submitted:0000-00-00
Entered:1990-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271967 / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-07-29
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: No previous seizures in pt. No hx of seizures in parents and/or siblings.
Allergies:
Diagnostic Lab Data: Autopsy performed 30JUL90. Copy of report requested
CDC 'Split Type': 9001336.01

Write-up: On 28JUL90 (48 hrs aftr DTP/OPV immunization), the infant experienced a fever of 104, the following day, infant was fed 8 oz of formula and 2 hrs later expired. Taken to ER was pronounced dead on arrival.


Changed on 6/14/2018

VAERS ID: 25780 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Maryland
Vaccinated:1990-07-26
Onset:1990-07-28
Submitted:0000-00-00
Entered:1990-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271967 / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-07-29
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: No previous seizures in pt. No hx of seizures in parents and/or siblings.
Allergies:
Diagnostic Lab Data: Autopsy performed 30JUL90. Copy of report requested
CDC 'Split Type': 9001336.01

Write-up: On 28JUL90 (48 hrs aftr DTP/OPV immunization), the infant experienced a fever of 104, the following day, infant was fed 8 oz of formula and 2 hrs later expired. Taken to ER was pronounced dead on arrival.


Changed on 8/14/2018

VAERS ID: 25780 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Maryland
Vaccinated:1990-07-26
Onset:1990-07-28
Submitted:0000-00-00
Entered:1990-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271967 / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-07-29
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: No previous seizures in pt. No hx of seizures in parents and/or siblings.
Allergies:
Diagnostic Lab Data: Autopsy performed 30JUL90. Copy of report requested
CDC 'Split Type': 9001336.01

Write-up: On 28JUL90 (48 hrs aftr DTP/OPV immunization), the infant experienced a fever of 104, the following day, infant was fed 8 oz of formula and 2 hrs later expired. Taken to ER was pronounced dead on arrival.


Changed on 9/14/2018

VAERS ID: 25780 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Maryland
Vaccinated:1990-07-26
Onset:1990-07-28
Submitted:0000-00-00
Entered:1990-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271967 / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-07-29
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: No previous seizures in pt. No hx of seizures in parents and/or siblings.
Allergies:
Diagnostic Lab Data: Autopsy performed 30JUL90. Copy of report requested
CDC 'Split Type': 9001336.01

Write-up: On 28JUL90 (48 hrs aftr DTP/OPV immunization), the infant experienced a fever of 104, the following day, infant was fed 8 oz of formula and 2 hrs later expired. Taken to ER was pronounced dead on arrival.


Changed on 10/14/2018

VAERS ID: 25780 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Maryland
Vaccinated:1990-07-26
Onset:1990-07-28
Submitted:0000-00-00
Entered:1990-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271967 / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-07-29
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: No previous seizures in pt. No hx of seizures in parents and/or siblings.
Allergies:
Diagnostic Lab Data: Autopsy performed 30JUL90. Copy of report requested
CDC 'Split Type': 9001336.01

Write-up: On 28JUL90 (48 hrs aftr DTP/OPV immunization), the infant experienced a fever of 104, the following day, infant was fed 8 oz of formula and 2 hrs later expired. Taken to ER was pronounced dead on arrival.

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