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This is VAERS ID 26603

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 26603
VAERS Form:
Age:1.0
Sex:Male
Location:Colorado
Vaccinated:1990-10-24
Onset:1990-10-29
Submitted:1990-11-05
Entered:1990-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP / CONNAUGHT LABS 0A21149 / 1 LL / IM
OPV: ORIMUNE / LEDERLE 0611B / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-29
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Proventil Syrup, Terbutaline
Current Illness: BPD, Oxygen Dependency
Preexisting Conditions: Premature Infant 31 wks Gest; Severe Bronchopulmonary Dysplasia; Growth retardation
Allergies:
Diagnostic Lab Data: Autopsy pending
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV found in bed about 10AM after put down for morning nap on 29OCT90. took to Hosp ER & unable to revive. Sudden Infant Death Syndrome.


Changed on 12/8/2009

VAERS ID: 26603 Before After
VAERS Form:
Age:1.0
Sex:Male
Location:Colorado
Vaccinated:1990-10-24
Onset:1990-10-29
Submitted:1990-11-05
Entered:1990-11-13 1990-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP DTP (NO BRAND NAME) / CONNAUGHT LABS CONNAUGHT LABORATORIES 0A21149 / 1 LL / IM
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 0611B / 1 - / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-29
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Proventil Syrup, Terbutaline
Current Illness: BPD, Oxygen Dependency
Preexisting Conditions: Premature Infant 31 wks Gest; Severe Bronchopulmonary Dysplasia; Growth retardation
Allergies:
Diagnostic Lab Data: Autopsy pending
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV found in bed about 10AM after put down for morning nap on 29OCT90. took to Hosp ER & unable to revive. Sudden Infant Death Syndrome.


Changed on 5/14/2017

VAERS ID: 26603 Before After
VAERS Form:
Age:1.0
Sex:Male
Location:Colorado
Vaccinated:1990-10-24
Onset:1990-10-29
Submitted:1990-11-05
Entered:1990-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0A21149 / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 0611B / 1 - / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-29
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Proventil Syrup, Terbutaline
Current Illness: BPD, Oxygen Dependency
Preexisting Conditions: Premature Infant 31 wks Gest; Severe Bronchopulmonary Dysplasia; Growth retardation
Allergies:
Diagnostic Lab Data: Autopsy pending
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV found in bed about 10AM after put down for morning nap on 29OCT90. took to Hosp ER & unable to revive. Sudden Infant Death Syndrome.


Changed on 9/14/2017

VAERS ID: 26603 Before After
VAERS Form:(blank) 1
Age:1.0
Sex:Male
Location:Colorado
Vaccinated:1990-10-24
Onset:1990-10-29
Submitted:1990-11-05
Entered:1990-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0A21149 / 1 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0611B / 1 2 - MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-29
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Proventil Syrup, Terbutaline
Current Illness: BPD, Oxygen Dependency
Preexisting Conditions: Premature Infant 31 wks Gest; Severe Bronchopulmonary Dysplasia; Growth retardation
Allergies:
Diagnostic Lab Data: Autopsy pending
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV found in bed about 10AM after put down for morning nap on 29OCT90. took to Hosp ER & unable to revive. Sudden Infant Death Syndrome.


Changed on 2/14/2018

VAERS ID: 26603 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Colorado
Vaccinated:1990-10-24
Onset:1990-10-29
Submitted:1990-11-05
Entered:1990-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0A21149 / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0611B / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-29
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Proventil Syrup, Terbutaline
Current Illness: BPD, Oxygen Dependency
Preexisting Conditions: Premature Infant 31 wks Gest; Severe Bronchopulmonary Dysplasia; Growth retardation
Allergies:
Diagnostic Lab Data: Autopsy pending
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV found in bed about 10AM after put down for morning nap on 29OCT90. took to Hosp ER & unable to revive. Sudden Infant Death Syndrome.


Changed on 6/14/2018

VAERS ID: 26603 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Colorado
Vaccinated:1990-10-24
Onset:1990-10-29
Submitted:1990-11-05
Entered:1990-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0A21149 / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0611B / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-29
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Proventil Syrup, Terbutaline
Current Illness: BPD, Oxygen Dependency
Preexisting Conditions: Premature Infant 31 wks Gest; Severe Bronchopulmonary Dysplasia; Growth retardation
Allergies:
Diagnostic Lab Data: Autopsy pending
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV found in bed about 10AM after put down for morning nap on 29OCT90. took to Hosp ER & unable to revive. Sudden Infant Death Syndrome.


Changed on 8/14/2018

VAERS ID: 26603 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Colorado
Vaccinated:1990-10-24
Onset:1990-10-29
Submitted:1990-11-05
Entered:1990-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0A21149 / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0611B / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-29
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Proventil Syrup, Terbutaline
Current Illness: BPD, Oxygen Dependency
Preexisting Conditions: Premature Infant 31 wks Gest; Severe Bronchopulmonary Dysplasia; Growth retardation
Allergies:
Diagnostic Lab Data: Autopsy pending
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV found in bed about 10AM after put down for morning nap on 29OCT90. took to Hosp ER & unable to revive. Sudden Infant Death Syndrome.


Changed on 9/14/2018

VAERS ID: 26603 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Colorado
Vaccinated:1990-10-24
Onset:1990-10-29
Submitted:1990-11-05
Entered:1990-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0A21149 / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0611B / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-29
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Proventil Syrup, Terbutaline
Current Illness: BPD, Oxygen Dependency
Preexisting Conditions: Premature Infant 31 wks Gest; Severe Bronchopulmonary Dysplasia; Growth retardation
Allergies:
Diagnostic Lab Data: Autopsy pending
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV found in bed about 10AM after put down for morning nap on 29OCT90. took to Hosp ER & unable to revive. Sudden Infant Death Syndrome.


Changed on 10/14/2018

VAERS ID: 26603 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Colorado
Vaccinated:1990-10-24
Onset:1990-10-29
Submitted:1990-11-05
Entered:1990-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0A21149 / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0611B / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-29
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Proventil Syrup, Terbutaline
Current Illness: BPD, Oxygen Dependency
Preexisting Conditions: Premature Infant 31 wks Gest; Severe Bronchopulmonary Dysplasia; Growth retardation
Allergies:
Diagnostic Lab Data: Autopsy pending
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV found in bed about 10AM after put down for morning nap on 29OCT90. took to Hosp ER & unable to revive. Sudden Infant Death Syndrome.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=26603&WAYBACKHISTORY=ON


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