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This is VAERS ID 26196

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 26196
VAERS Form:
Age:0.5
Sex:Female
Location:Michigan
Vaccinated:1990-08-20
Onset:1990-08-22
Submitted:1990-10-02
Entered:1990-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP MICH. PHD. / MICHIGAN DPH 1211A / 1 LL / IM
OPV: ORIMUNE / LEDERLE 0611E / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS, GI DIS, WEIGHT INC

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-08-22
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: None w/exception of Regurgitation
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Autopsy reported as SIDS w/ cardiomyopathy per Dr Ron Graeser, ME.
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV child presented for well child exam 20Aug90. Only concerns noted were precipitous weight gain & intermittant regurgitation of Prosobee.


Changed on 12/8/2009

VAERS ID: 26196 Before After
VAERS Form:
Age:0.5
Sex:Female
Location:Michigan
Vaccinated:1990-08-20
Onset:1990-08-22
Submitted:1990-10-02
Entered:1990-10-12 1990-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP MICH. PHD. DTP (NO BRAND NAME) / MICHIGAN DPH MICHIGAN DEPT PUB HLTH 1211A / 1 LL / IM
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 0611E / 1 - / PO

Administered by: Private      Purchased by: Unknown Public
Symptoms: Gastrointestinal disorder, SIDS, Sudden infant death syndrome, Weight increased, GI DIS, WEIGHT INC

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-08-22
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: None w/exception of Regurgitation
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Autopsy reported as SIDS w/ cardiomyopathy per Dr Ron Graeser, ME.
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV child presented for well child exam 20Aug90. Only concerns noted were precipitous weight gain & intermittant regurgitation of Prosobee.


Changed on 2/13/2013

VAERS ID: 26196 Before After
VAERS Form:
Age:0.5
Sex:Female
Location:Michigan
Vaccinated:1990-08-20
Onset:1990-08-22
Submitted:1990-10-02
Entered:1990-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH 1211A / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 0611E / 1 - / PO

Administered by: Private Unknown      Purchased by: Public Unknown
Symptoms: Gastrointestinal disorder, Sudden infant death syndrome, Weight increased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-08-22
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: None w/exception of Regurgitation
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Autopsy reported as SIDS w/ cardiomyopathy per Dr Ron Graeser, ME. Dr.
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV child presented for well child exam 20Aug90. Only concerns noted were precipitous weight gain & intermittant regurgitation of Prosobee.


Changed on 2/14/2017

VAERS ID: 26196 Before After
VAERS Form:
Age:0.5 0.51
Sex:Female
Location:Michigan
Vaccinated:1990-08-20
Onset:1990-08-22
Submitted:1990-10-02
Entered:1990-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH 1211A / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0611E / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Gastrointestinal disorder, Sudden infant death syndrome, Weight increased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-08-22
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: None w/exception of Regurgitation
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Autopsy reported as SIDS w/ cardiomyopathy per Dr.
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV child presented for well child exam 20Aug90. Only concerns noted were precipitous weight gain & intermittant regurgitation of Prosobee.


Changed on 9/14/2017

VAERS ID: 26196 Before After
VAERS Form:(blank) 1
Age:0.51
Sex:Female
Location:Michigan
Vaccinated:1990-08-20
Onset:1990-08-22
Submitted:1990-10-02
Entered:1990-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH 1211A / 1 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0611E / 1 2 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Gastrointestinal disorder, Sudden infant death syndrome, Weight increased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-08-22
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: None w/exception of Regurgitation
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Autopsy reported as SIDS w/ cardiomyopathy per Dr.
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV child presented for well child exam 20Aug90. Only concerns noted were precipitous weight gain & intermittant regurgitation of Prosobee.


Changed on 2/14/2018

VAERS ID: 26196 Before After
VAERS Form:1
Age:0.51
Sex:Female
Location:Michigan
Vaccinated:1990-08-20
Onset:1990-08-22
Submitted:1990-10-02
Entered:1990-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH 1211A / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0611E / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Gastrointestinal disorder, Sudden infant death syndrome, Weight increased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-08-22
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: None w/exception of Regurgitation
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Autopsy reported as SIDS w/ cardiomyopathy per Dr.
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV child presented for well child exam 20Aug90. Only concerns noted were precipitous weight gain & intermittant regurgitation of Prosobee.


Changed on 6/14/2018

VAERS ID: 26196 Before After
VAERS Form:1
Age:0.51
Sex:Female
Location:Michigan
Vaccinated:1990-08-20
Onset:1990-08-22
Submitted:1990-10-02
Entered:1990-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH 1211A / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0611E / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Gastrointestinal disorder, Sudden infant death syndrome, Weight increased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-08-22
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: None w/exception of Regurgitation
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Autopsy reported as SIDS w/ cardiomyopathy per Dr.
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV child presented for well child exam 20Aug90. Only concerns noted were precipitous weight gain & intermittant regurgitation of Prosobee.


Changed on 8/14/2018

VAERS ID: 26196 Before After
VAERS Form:1
Age:0.51
Sex:Female
Location:Michigan
Vaccinated:1990-08-20
Onset:1990-08-22
Submitted:1990-10-02
Entered:1990-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH 1211A / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0611E / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Gastrointestinal disorder, Sudden infant death syndrome, Weight increased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-08-22
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: None w/exception of Regurgitation
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Autopsy reported as SIDS w/ cardiomyopathy per Dr.
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV child presented for well child exam 20Aug90. Only concerns noted were precipitous weight gain & intermittant regurgitation of Prosobee.


Changed on 9/14/2018

VAERS ID: 26196 Before After
VAERS Form:1
Age:0.51
Sex:Female
Location:Michigan
Vaccinated:1990-08-20
Onset:1990-08-22
Submitted:1990-10-02
Entered:1990-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH 1211A / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0611E / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Gastrointestinal disorder, Sudden infant death syndrome, Weight increased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-08-22
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: None w/exception of Regurgitation
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Autopsy reported as SIDS w/ cardiomyopathy per Dr.
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV child presented for well child exam 20Aug90. Only concerns noted were precipitous weight gain & intermittant regurgitation of Prosobee.


Changed on 10/14/2018

VAERS ID: 26196 Before After
VAERS Form:1
Age:0.51
Sex:Female
Location:Michigan
Vaccinated:1990-08-20
Onset:1990-08-22
Submitted:1990-10-02
Entered:1990-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH 1211A / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0611E / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Gastrointestinal disorder, Sudden infant death syndrome, Weight increased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-08-22
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: None w/exception of Regurgitation
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Autopsy reported as SIDS w/ cardiomyopathy per Dr.
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV child presented for well child exam 20Aug90. Only concerns noted were precipitous weight gain & intermittant regurgitation of Prosobee.

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