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This is VAERS ID 26294

Case Details

VAERS ID: 26294 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Tennessee  
Vaccinated:1990-01-23
Onset:1990-01-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1990-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 256959 / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0594F / UNK MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-01-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: No illness following previous immunization.
Allergies:
Diagnostic Lab Data:
CDC Split Type: 9001633.02

Write-up: CDC Reports: 5 mo infant receivd DTP/OPV on 23JAN90 and died 24JAN90.


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