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This is VAERS ID 25913

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 25913
VAERS Form:
Age:0.3
Sex:Male
Location:Unknown
Vaccinated:1990-01-24
Onset:1990-01-25
Submitted:0000-00-00
Entered:1990-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 256960 / - - / -

Administered by: Private      Purchased by: Unknown
Symptoms: INFECT, APNEA, LYMPHADENO, EDEMA LUNG, ENCEPHALOPATHY

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-01-25
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: See WORM for autopsy report, emergency room reports
CDC 'Split Type':

Write-up: Pt received DPT vacc. @ 11 a.m. 24Jan90, 25Jan90 child discovered not breathing & CPR was administered. MEDEVACed to Stormont-Vail Medical Ctr, Tokepa, pronounced dead, only symptom noted periods of ""blank staring"" exhibited by the child.


Changed on 12/30/2006

VAERS ID: 25913 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Unknown
Vaccinated:1990-01-24
Onset:1990-01-25
Submitted:0000-00-00
Entered:1990-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 256960 / - - / -

Administered by: Private      Purchased by: Unknown
Symptoms: INFECT, APNEA, LYMPHADENO, EDEMA LUNG, ENCEPHALOPATHY

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-01-25
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: See WORM for autopsy report, emergency room reports
CDC 'Split Type':

Write-up: Pt received DPT vacc. @ 11 a.m. 24Jan90, 25Jan90 child discovered not breathing & CPR was administered. MEDEVACed to Stormont-Vail Medical Ctr, Tokepa, pronounced dead, only symptom noted periods of ""blank staring"" /"blank staring/" exhibited by the child.


Changed on 12/8/2009

VAERS ID: 25913 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Unknown
Vaccinated:1990-01-24
Onset:1990-01-25
Submitted:0000-00-00
Entered:1990-09-18 1990-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 256960 / - - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Apnoea, Encephalopathy, Infection, Lymphadenopathy, Pulmonary oedema, INFECT, APNEA, LYMPHADENO, EDEMA LUNG, ENCEPHALOPATHY

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-01-25
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: See WORM for autopsy report, emergency room reports
CDC 'Split Type':

Write-up: Pt received DPT vacc. @ 11 a.m. 24Jan90, 25Jan90 child discovered not breathing & CPR was administered. MEDEVACed to Stormont-Vail Medical Ctr, Tokepa, pronounced dead, only symptom noted periods of /"blank staring/" "blank staring" exhibited by the child.


Changed on 5/14/2017

VAERS ID: 25913 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Unknown
Vaccinated:1990-01-24
Onset:1990-01-25
Submitted:0000-00-00
Entered:1990-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 256960 / - - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Apnoea, Encephalopathy, Infection, Lymphadenopathy, Pulmonary oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-01-25
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: See WORM for autopsy report, emergency room reports
CDC 'Split Type':

Write-up: Pt received DPT vacc. @ 11 a.m. 24Jan90, 25Jan90 child discovered not breathing & CPR was administered. MEDEVACed to Stormont-Vail Medical Ctr, Tokepa, pronounced dead, only symptom noted periods of "blank staring" exhibited by the child.


Changed on 9/14/2017

VAERS ID: 25913 Before After
VAERS Form:(blank) 1
Age:0.3
Sex:Male
Location:Unknown
Vaccinated:1990-01-24
Onset:1990-01-25
Submitted:0000-00-00
Entered:1990-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 256960 / - UNK - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Apnoea, Encephalopathy, Infection, Lymphadenopathy, Pulmonary oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-01-25
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: See WORM for autopsy report, emergency room reports
CDC 'Split Type':

Write-up: Pt received DPT vacc. @ 11 a.m. 24Jan90, 25Jan90 child discovered not breathing & CPR was administered. MEDEVACed to Stormont-Vail Medical Ctr, Tokepa, pronounced dead, only symptom noted periods of "blank staring" exhibited by the child.


Changed on 2/14/2018

VAERS ID: 25913 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Unknown
Vaccinated:1990-01-24
Onset:1990-01-25
Submitted:0000-00-00
Entered:1990-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 256960 / UNK - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Apnoea, Encephalopathy, Infection, Lymphadenopathy, Pulmonary oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-01-25
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: See WORM for autopsy report, emergency room reports
CDC 'Split Type':

Write-up: Pt received DPT vacc. @ 11 a.m. 24Jan90, 25Jan90 child discovered not breathing & CPR was administered. MEDEVACed to Stormont-Vail Medical Ctr, Tokepa, pronounced dead, only symptom noted periods of "blank staring" exhibited by the child.


Changed on 6/14/2018

VAERS ID: 25913 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Unknown
Vaccinated:1990-01-24
Onset:1990-01-25
Submitted:0000-00-00
Entered:1990-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 256960 / UNK - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Apnoea, Encephalopathy, Infection, Lymphadenopathy, Pulmonary oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-01-25
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: See WORM for autopsy report, emergency room reports
CDC 'Split Type':

Write-up: Pt received DPT vacc. @ 11 a.m. 24Jan90, 25Jan90 child discovered not breathing & CPR was administered. MEDEVACed to Stormont-Vail Medical Ctr, Tokepa, pronounced dead, only symptom noted periods of "blank staring" exhibited by the child.


Changed on 8/14/2018

VAERS ID: 25913 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Unknown
Vaccinated:1990-01-24
Onset:1990-01-25
Submitted:0000-00-00
Entered:1990-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 256960 / UNK - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Apnoea, Encephalopathy, Infection, Lymphadenopathy, Pulmonary oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-01-25
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: See WORM for autopsy report, emergency room reports
CDC 'Split Type':

Write-up: Pt received DPT vacc. @ 11 a.m. 24Jan90, 25Jan90 child discovered not breathing & CPR was administered. MEDEVACed to Stormont-Vail Medical Ctr, Tokepa, pronounced dead, only symptom noted periods of "blank staring" exhibited by the child.


Changed on 9/14/2018

VAERS ID: 25913 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Unknown
Vaccinated:1990-01-24
Onset:1990-01-25
Submitted:0000-00-00
Entered:1990-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 256960 / UNK - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Apnoea, Encephalopathy, Infection, Lymphadenopathy, Pulmonary oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-01-25
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: See WORM for autopsy report, emergency room reports
CDC 'Split Type':

Write-up: Pt received DPT vacc. @ 11 a.m. 24Jan90, 25Jan90 child discovered not breathing & CPR was administered. MEDEVACed to Stormont-Vail Medical Ctr, Tokepa, pronounced dead, only symptom noted periods of "blank staring" exhibited by the child.


Changed on 10/14/2018

VAERS ID: 25913 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Unknown
Vaccinated:1990-01-24
Onset:1990-01-25
Submitted:0000-00-00
Entered:1990-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 256960 / UNK - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Apnoea, Encephalopathy, Infection, Lymphadenopathy, Pulmonary oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-01-25
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: See WORM for autopsy report, emergency room reports
CDC 'Split Type':

Write-up: Pt received DPT vacc. @ 11 a.m. 24Jan90, 25Jan90 child discovered not breathing & CPR was administered. MEDEVACed to Stormont-Vail Medical Ctr, Tokepa, pronounced dead, only symptom noted periods of "blank staring" exhibited by the child.

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