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This is VAERS ID 26209

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 26209
VAERS Form:
Age:0.7
Sex:Unknown
Location:North Carolina
Vaccinated:1990-09-11
Onset:1990-09-11
Submitted:0000-00-00
Entered:1990-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 268910 / 1 - / -
OPV: ORIMUNE / LEDERLE 0608E / - - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: SIDS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-09-13
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: Autopsy pending - copy of report requested
CDC 'Split Type':

Write-up: Pt vaccinated /w DTP/OPV & died same evening. Prior to death, infant was alone & had been drinking from a bottle of milk, found non-responsive. Taken to ER- pronounced dead on arrival. There was some possible aspiration.


Changed on 12/8/2009

VAERS ID: 26209 Before After
VAERS Form:
Age:0.7
Sex:Unknown
Location:North Carolina
Vaccinated:1990-09-11
Onset:1990-09-11
Submitted:0000-00-00
Entered:1990-10-12 1990-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 268910 / 1 - / -
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 0608E / - - / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-09-13
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: Autopsy pending - copy of report requested
CDC 'Split Type': (blank) 9001603.01

Write-up: Pt vaccinated /w DTP/OPV & died same evening. Prior to death, infant was alone & had been drinking from a bottle of milk, found non-responsive. Taken to ER- pronounced dead on arrival. There was some possible aspiration.


Changed on 5/14/2017

VAERS ID: 26209 Before After
VAERS Form:
Age:0.7
Sex:Unknown
Location:North Carolina
Vaccinated:1990-09-11
Onset:1990-09-11
Submitted:0000-00-00
Entered:1990-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 268910 / 1 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 0608E / - - / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-09-13
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: Autopsy pending - copy of report requested
CDC 'Split Type': 9001603.01

Write-up: Pt vaccinated /w DTP/OPV & died same evening. Prior to death, infant was alone & had been drinking from a bottle of milk, found non-responsive. Taken to ER- pronounced dead on arrival. There was some possible aspiration.


Changed on 9/14/2017

VAERS ID: 26209 Before After
VAERS Form:(blank) 1
Age:0.7
Sex:Unknown
Location:North Carolina
Vaccinated:1990-09-11
Onset:1990-09-11
Submitted:0000-00-00
Entered:1990-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 268910 / 1 2 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0608E / - UNK - MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-09-13
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: Autopsy pending - copy of report requested
CDC 'Split Type': 9001603.01

Write-up: Pt vaccinated /w DTP/OPV & died same evening. Prior to death, infant was alone & had been drinking from a bottle of milk, found non-responsive. Taken to ER- pronounced dead on arrival. There was some possible aspiration.


Changed on 2/14/2018

VAERS ID: 26209 Before After
VAERS Form:1
Age:0.7
Sex:Unknown
Location:North Carolina
Vaccinated:1990-09-11
Onset:1990-09-11
Submitted:0000-00-00
Entered:1990-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 268910 / 2 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0608E / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-09-13
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: Autopsy pending - copy of report requested
CDC 'Split Type': 9001603.01

Write-up: Pt vaccinated /w DTP/OPV & died same evening. Prior to death, infant was alone & had been drinking from a bottle of milk, found non-responsive. Taken to ER- pronounced dead on arrival. There was some possible aspiration.


Changed on 6/14/2018

VAERS ID: 26209 Before After
VAERS Form:1
Age:0.7
Sex:Unknown
Location:North Carolina
Vaccinated:1990-09-11
Onset:1990-09-11
Submitted:0000-00-00
Entered:1990-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 268910 / 2 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0608E / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-09-13
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: Autopsy pending - copy of report requested
CDC 'Split Type': 9001603.01

Write-up: Pt vaccinated /w DTP/OPV & died same evening. Prior to death, infant was alone & had been drinking from a bottle of milk, found non-responsive. Taken to ER- pronounced dead on arrival. There was some possible aspiration.


Changed on 8/14/2018

VAERS ID: 26209 Before After
VAERS Form:1
Age:0.7
Sex:Unknown
Location:North Carolina
Vaccinated:1990-09-11
Onset:1990-09-11
Submitted:0000-00-00
Entered:1990-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 268910 / 2 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0608E / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-09-13
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: Autopsy pending - copy of report requested
CDC 'Split Type': 9001603.01

Write-up: Pt vaccinated /w DTP/OPV & died same evening. Prior to death, infant was alone & had been drinking from a bottle of milk, found non-responsive. Taken to ER- pronounced dead on arrival. There was some possible aspiration.


Changed on 9/14/2018

VAERS ID: 26209 Before After
VAERS Form:1
Age:0.7
Sex:Unknown
Location:North Carolina
Vaccinated:1990-09-11
Onset:1990-09-11
Submitted:0000-00-00
Entered:1990-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 268910 / 2 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0608E / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-09-13
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: Autopsy pending - copy of report requested
CDC 'Split Type': 9001603.01

Write-up: Pt vaccinated /w DTP/OPV & died same evening. Prior to death, infant was alone & had been drinking from a bottle of milk, found non-responsive. Taken to ER- pronounced dead on arrival. There was some possible aspiration.


Changed on 10/14/2018

VAERS ID: 26209 Before After
VAERS Form:1
Age:0.7
Sex:Unknown
Location:North Carolina
Vaccinated:1990-09-11
Onset:1990-09-11
Submitted:0000-00-00
Entered:1990-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 268910 / 2 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0608E / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-09-13
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: Autopsy pending - copy of report requested
CDC 'Split Type': 9001603.01

Write-up: Pt vaccinated /w DTP/OPV & died same evening. Prior to death, infant was alone & had been drinking from a bottle of milk, found non-responsive. Taken to ER- pronounced dead on arrival. There was some possible aspiration.

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