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This is VAERS ID 26799

Case Details

VAERS ID: 26799 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: New Jersey  
Vaccinated:1990-09-24
Onset:1990-09-26
   Days after vaccination:2
Submitted: 1990-11-20
   Days after onset:55
Entered: 1990-11-27
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 281946 / 1 - / L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Hydronephrosis
SMQs:, Retroperitoneal fibrosis (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-09-26
   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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated with DTP/OPV child died. Autopsy showed baby had one kidney with chronic type changes, damage, hydronephrosis.


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