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This is VAERS ID 26336

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 26336
VAERS Form:
Age:0.2
Sex:Male
Location:Maryland
Vaccinated:1990-07-26
Onset:1990-07-29
Submitted:1990-10-23
Entered:1990-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 271967 / 0 LL / IM
OPV: ORIMUNE / LEDERLE 0603D / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS, AGITATION, 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:
Allergies:
Diagnostic Lab Data: Post mortem exam nonspecific. Parents advised by medical examiner that child died of SIDS.
CDC 'Split Type':

Write-up: Pt vacc. /w DTP/OPV developed fever to maximum 100, mild irritability x3d. Pt then found dead in crib on day 3.


Changed on 12/8/2009

VAERS ID: 26336 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Maryland
Vaccinated:1990-07-26
Onset:1990-07-29
Submitted:1990-10-23
Entered:1990-10-31 1990-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 271967 / 0 LL / IM
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 0603D / 0 - / PO

Administered by: Private      Purchased by: Unknown Private
Symptoms: Agitation, Pyrexia, SIDS, Sudden infant death syndrome, AGITATION, 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:
Allergies:
Diagnostic Lab Data: Post mortem exam nonspecific. Parents advised by medical examiner that child died of SIDS.
CDC 'Split Type':

Write-up: Pt vacc. /w DTP/OPV developed fever to maximum 100, mild irritability x3d. Pt then found dead in crib on day 3.


Changed on 5/14/2017

VAERS ID: 26336 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Maryland
Vaccinated:1990-07-26
Onset:1990-07-29
Submitted:1990-10-23
Entered:1990-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271967 / 0 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 0603D / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Pyrexia, Sudden infant death syndrome

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:
Allergies:
Diagnostic Lab Data: Post mortem exam nonspecific. Parents advised by medical examiner that child died of SIDS.
CDC 'Split Type':

Write-up: Pt vacc. /w DTP/OPV developed fever to maximum 100, mild irritability x3d. Pt then found dead in crib on day 3.


Changed on 9/14/2017

VAERS ID: 26336 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:Maryland
Vaccinated:1990-07-26
Onset:1990-07-29
Submitted:1990-10-23
Entered:1990-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271967 / 0 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0603D / 0 1 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Pyrexia, Sudden infant death syndrome

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:
Allergies:
Diagnostic Lab Data: Post mortem exam nonspecific. Parents advised by medical examiner that child died of SIDS.
CDC 'Split Type':

Write-up: Pt vacc. /w DTP/OPV developed fever to maximum 100, mild irritability x3d. Pt then found dead in crib on day 3.


Changed on 2/14/2018

VAERS ID: 26336 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Maryland
Vaccinated:1990-07-26
Onset:1990-07-29
Submitted:1990-10-23
Entered:1990-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271967 / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0603D / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Pyrexia, Sudden infant death syndrome

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:
Allergies:
Diagnostic Lab Data: Post mortem exam nonspecific. Parents advised by medical examiner that child died of SIDS.
CDC 'Split Type':

Write-up: Pt vacc. /w DTP/OPV developed fever to maximum 100, mild irritability x3d. Pt then found dead in crib on day 3.


Changed on 6/14/2018

VAERS ID: 26336 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Maryland
Vaccinated:1990-07-26
Onset:1990-07-29
Submitted:1990-10-23
Entered:1990-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271967 / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0603D / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Pyrexia, Sudden infant death syndrome

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:
Allergies:
Diagnostic Lab Data: Post mortem exam nonspecific. Parents advised by medical examiner that child died of SIDS.
CDC 'Split Type':

Write-up: Pt vacc. /w DTP/OPV developed fever to maximum 100, mild irritability x3d. Pt then found dead in crib on day 3.


Changed on 8/14/2018

VAERS ID: 26336 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Maryland
Vaccinated:1990-07-26
Onset:1990-07-29
Submitted:1990-10-23
Entered:1990-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271967 / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0603D / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Pyrexia, Sudden infant death syndrome

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:
Allergies:
Diagnostic Lab Data: Post mortem exam nonspecific. Parents advised by medical examiner that child died of SIDS.
CDC 'Split Type':

Write-up: Pt vacc. /w DTP/OPV developed fever to maximum 100, mild irritability x3d. Pt then found dead in crib on day 3.


Changed on 9/14/2018

VAERS ID: 26336 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Maryland
Vaccinated:1990-07-26
Onset:1990-07-29
Submitted:1990-10-23
Entered:1990-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271967 / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0603D / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Pyrexia, Sudden infant death syndrome

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:
Allergies:
Diagnostic Lab Data: Post mortem exam nonspecific. Parents advised by medical examiner that child died of SIDS.
CDC 'Split Type':

Write-up: Pt vacc. /w DTP/OPV developed fever to maximum 100, mild irritability x3d. Pt then found dead in crib on day 3.


Changed on 10/14/2018

VAERS ID: 26336 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Maryland
Vaccinated:1990-07-26
Onset:1990-07-29
Submitted:1990-10-23
Entered:1990-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271967 / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0603D / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Pyrexia, Sudden infant death syndrome

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:
Allergies:
Diagnostic Lab Data: Post mortem exam nonspecific. Parents advised by medical examiner that child died of SIDS.
CDC 'Split Type':

Write-up: Pt vacc. /w DTP/OPV developed fever to maximum 100, mild irritability x3d. Pt then found dead in crib on day 3.

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