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This is VAERS ID 26694

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 26694
VAERS Form:
Age:0.2
Sex:Male
Location:Tennessee
Vaccinated:1990-09-10
Onset:0000-00-00
Submitted:1990-11-16
Entered:1990-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 285968 / 0 L / IM
OPV: ORIMUNE / LEDERLE 283949 / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: APNEA, ENCEPHALITIS, CNS DEPRESS, HEM SUBARACHNOID

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-13
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: Chronic CNS Disease
Preexisting Conditions: Subarachnoid hemorrhage & encephalomalacia
Allergies:
Diagnostic Lab Data: Prior CT scans showed subarachnoid hemorhage; encephalomalacia.
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV then died 13OCT90 from respiratory arrest secondary to severe central nervous system disease which antedated immunization. Immunizations not felt to be related to death.


Changed on 12/8/2009

VAERS ID: 26694 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Tennessee
Vaccinated:1990-09-10
Onset:0000-00-00
Submitted:1990-11-16
Entered:1990-11-26 1990-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 285968 / 0 L / IM
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 283949 / 0 - / PO

Administered by: Private      Purchased by: Unknown Private
Symptoms: Apnoea, Depressed level of consciousness, Encephalitis, Subarachnoid haemorrhage, APNEA, ENCEPHALITIS, CNS DEPRESS, HEM SUBARACHNOID

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-13
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: Chronic CNS Disease
Preexisting Conditions: Subarachnoid hemorrhage & encephalomalacia
Allergies:
Diagnostic Lab Data: Prior CT scans showed subarachnoid hemorhage; encephalomalacia.
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV then died 13OCT90 from respiratory arrest secondary to severe central nervous system disease which antedated immunization. Immunizations not felt to be related to death.


Changed on 8/31/2010

VAERS ID: 26694 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Tennessee
Vaccinated:1990-09-10
Onset:0000-00-00
Submitted:1990-11-16
Entered:1990-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285968 / 0 L / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES 283949 / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Depressed level of consciousness, Encephalitis, Subarachnoid haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-13
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: Chronic CNS Disease
Preexisting Conditions: Subarachnoid hemorrhage & encephalomalacia
Allergies:
Diagnostic Lab Data: Prior CT scans showed subarachnoid hemorhage; encephalomalacia.
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV then died 13OCT90 from respiratory arrest secondary to severe central nervous system disease which antedated immunization. Immunizations not felt to be related to death.


Changed on 4/13/2011

VAERS ID: 26694 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Tennessee
Vaccinated:1990-09-10
Onset:0000-00-00
Submitted:1990-11-16
Entered:1990-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285968 / 0 L / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES 283949 / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Depressed level of consciousness, Encephalitis, Subarachnoid haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-13
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: Chronic CNS Disease
Preexisting Conditions: Subarachnoid hemorrhage & encephalomalacia
Allergies:
Diagnostic Lab Data: Prior CT scans showed subarachnoid hemorhage; encephalomalacia.
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV then died 13OCT90 from respiratory arrest secondary to severe central nervous system disease which antedated immunization. Immunizations not felt to be related to death.


Changed on 5/13/2011

VAERS ID: 26694 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Tennessee
Vaccinated:1990-09-10
Onset:0000-00-00
Submitted:1990-11-16
Entered:1990-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285968 / 0 L / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES 283949 / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Depressed level of consciousness, Encephalitis, Subarachnoid haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-13
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: Chronic CNS Disease
Preexisting Conditions: Subarachnoid hemorrhage & encephalomalacia
Allergies:
Diagnostic Lab Data: Prior CT scans showed subarachnoid hemorhage; encephalomalacia.
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV then died 13OCT90 from respiratory arrest secondary to severe central nervous system disease which antedated immunization. Immunizations not felt to be related to death.


Changed on 6/11/2011

VAERS ID: 26694 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Tennessee
Vaccinated:1990-09-10
Onset:0000-00-00
Submitted:1990-11-16
Entered:1990-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285968 / 0 L / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES 283949 / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Depressed level of consciousness, Encephalitis, Subarachnoid haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-13
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: Chronic CNS Disease
Preexisting Conditions: Subarachnoid hemorrhage & encephalomalacia
Allergies:
Diagnostic Lab Data: Prior CT scans showed subarachnoid hemorhage; encephalomalacia.
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV then died 13OCT90 from respiratory arrest secondary to severe central nervous system disease which antedated immunization. Immunizations not felt to be related to death.


Changed on 5/14/2017

VAERS ID: 26694 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Tennessee
Vaccinated:1990-09-10
Onset:0000-00-00
Submitted:1990-11-16
Entered:1990-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285968 / 0 L - / IM IM L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 283949 / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Depressed level of consciousness, Encephalitis, Subarachnoid haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-13
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: Chronic CNS Disease
Preexisting Conditions: Subarachnoid hemorrhage & encephalomalacia
Allergies:
Diagnostic Lab Data: Prior CT scans showed subarachnoid hemorhage; encephalomalacia.
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV then died 13OCT90 from respiratory arrest secondary to severe central nervous system disease which antedated immunization. Immunizations not felt to be related to death.


Changed on 9/14/2017

VAERS ID: 26694 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:Tennessee
Vaccinated:1990-09-10
Onset:0000-00-00
Submitted:1990-11-16
Entered:1990-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285968 / 0 1 - / IM L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 283949 / 0 1 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Depressed level of consciousness, Encephalitis, Subarachnoid haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-13
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: Chronic CNS Disease
Preexisting Conditions: Subarachnoid hemorrhage & encephalomalacia
Allergies:
Diagnostic Lab Data: Prior CT scans showed subarachnoid hemorhage; encephalomalacia.
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV then died 13OCT90 from respiratory arrest secondary to severe central nervous system disease which antedated immunization. Immunizations not felt to be related to death.


Changed on 2/14/2018

VAERS ID: 26694 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Tennessee
Vaccinated:1990-09-10
Onset:0000-00-00
Submitted:1990-11-16
Entered:1990-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285968 / 1 - / IM L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 283949 / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Depressed level of consciousness, Encephalitis, Subarachnoid haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-13
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: Chronic CNS Disease
Preexisting Conditions: Subarachnoid hemorrhage & encephalomalacia
Allergies:
Diagnostic Lab Data: Prior CT scans showed subarachnoid hemorhage; encephalomalacia.
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV then died 13OCT90 from respiratory arrest secondary to severe central nervous system disease which antedated immunization. Immunizations not felt to be related to death.


Changed on 6/14/2018

VAERS ID: 26694 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Tennessee
Vaccinated:1990-09-10
Onset:0000-00-00
Submitted:1990-11-16
Entered:1990-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285968 / 1 - / IM L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 283949 / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Depressed level of consciousness, Encephalitis, Subarachnoid haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-13
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: Chronic CNS Disease
Preexisting Conditions: Subarachnoid hemorrhage & encephalomalacia
Allergies:
Diagnostic Lab Data: Prior CT scans showed subarachnoid hemorhage; encephalomalacia.
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV then died 13OCT90 from respiratory arrest secondary to severe central nervous system disease which antedated immunization. Immunizations not felt to be related to death.


Changed on 8/14/2018

VAERS ID: 26694 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Tennessee
Vaccinated:1990-09-10
Onset:0000-00-00
Submitted:1990-11-16
Entered:1990-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285968 / 1 - / IM L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 283949 / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Depressed level of consciousness, Encephalitis, Subarachnoid haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-13
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: Chronic CNS Disease
Preexisting Conditions: Subarachnoid hemorrhage & encephalomalacia
Allergies:
Diagnostic Lab Data: Prior CT scans showed subarachnoid hemorhage; encephalomalacia.
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV then died 13OCT90 from respiratory arrest secondary to severe central nervous system disease which antedated immunization. Immunizations not felt to be related to death.


Changed on 9/14/2018

VAERS ID: 26694 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Tennessee
Vaccinated:1990-09-10
Onset:0000-00-00
Submitted:1990-11-16
Entered:1990-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285968 / 1 - / IM L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 283949 / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Depressed level of consciousness, Encephalitis, Subarachnoid haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-13
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: Chronic CNS Disease
Preexisting Conditions: Subarachnoid hemorrhage & encephalomalacia
Allergies:
Diagnostic Lab Data: Prior CT scans showed subarachnoid hemorhage; encephalomalacia.
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV then died 13OCT90 from respiratory arrest secondary to severe central nervous system disease which antedated immunization. Immunizations not felt to be related to death.


Changed on 10/14/2018

VAERS ID: 26694 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Tennessee
Vaccinated:1990-09-10
Onset:0000-00-00
Submitted:1990-11-16
Entered:1990-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285968 / 1 - / IM L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 283949 / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Depressed level of consciousness, Encephalitis, Subarachnoid haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-13
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: Chronic CNS Disease
Preexisting Conditions: Subarachnoid hemorrhage & encephalomalacia
Allergies:
Diagnostic Lab Data: Prior CT scans showed subarachnoid hemorhage; encephalomalacia.
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV then died 13OCT90 from respiratory arrest secondary to severe central nervous system disease which antedated immunization. Immunizations not felt to be related to death.

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