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This is VAERS ID 27246

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 27246
VAERS Form:
Age:0.3
Sex:Male
Location:Washington
Vaccinated:1990-12-14
Onset:1990-12-15
Submitted:1990-12-17
Entered:1991-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 271916 / 1 RL / -
OPV: ORIMUNE / LEDERLE 287951 / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS, HYPOTONIA, CYANOSIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-15
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: This was an adopted infant born at Tacoma General Hosp
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vac w/ DTP/OPV had norm 4 mo well baby exam; Next day found limp & cyanotic. Brought to ER by paramedics, no signs of life after usual resuscitation measures. Possible SIDS. 06FEB91: AUTOPSY REPORT RECEIVED FROM SHC; DX = SIDS


Changed on 12/8/2009

VAERS ID: 27246 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Washington
Vaccinated:1990-12-14
Onset:1990-12-15
Submitted:1990-12-17
Entered:1991-01-04 1990-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 271916 / 1 RL / -
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 287951 / 1 - / PO

Administered by: Private      Purchased by: Unknown Other
Symptoms: Cyanosis, Hypotonia, SIDS, Sudden infant death syndrome, HYPOTONIA, CYANOSIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-15
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: This was an adopted infant born at Tacoma General Hosp
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) WA90499

Write-up: Pt vac w/ DTP/OPV had norm 4 mo well baby exam; Next day found limp & cyanotic. Brought to ER by paramedics, no signs of life after usual resuscitation measures. Possible SIDS. 06FEB91: AUTOPSY REPORT RECEIVED FROM SHC; DX = SIDS


Changed on 5/14/2017

VAERS ID: 27246 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Washington
Vaccinated:1990-12-14
Onset:1990-12-15
Submitted:1990-12-17
Entered:1990-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271916 / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 287951 / 1 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Cyanosis, Hypotonia, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-15
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: This was an adopted infant born at Tacoma General Hosp
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WA90499

Write-up: Pt vac w/ DTP/OPV had norm 4 mo well baby exam; Next day found limp & cyanotic. Brought to ER by paramedics, no signs of life after usual resuscitation measures. Possible SIDS. 06FEB91: AUTOPSY REPORT RECEIVED FROM SHC; DX = SIDS


Changed on 9/14/2017

VAERS ID: 27246 Before After
VAERS Form:(blank) 1
Age:0.3
Sex:Male
Location:Washington
Vaccinated:1990-12-14
Onset:1990-12-15
Submitted:1990-12-17
Entered:1990-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271916 / 1 2 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 287951 / 1 2 - MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Cyanosis, Hypotonia, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-15
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: This was an adopted infant born at Tacoma General Hosp
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WA90499

Write-up: Pt vac w/ DTP/OPV had norm 4 mo well baby exam; Next day found limp & cyanotic. Brought to ER by paramedics, no signs of life after usual resuscitation measures. Possible SIDS. 06FEB91: AUTOPSY REPORT RECEIVED FROM SHC; DX = SIDS


Changed on 2/14/2018

VAERS ID: 27246 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Washington
Vaccinated:1990-12-14
Onset:1990-12-15
Submitted:1990-12-17
Entered:1990-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271916 / 2 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 287951 / 2 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Cyanosis, Hypotonia, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-15
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: This was an adopted infant born at Tacoma General Hosp
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WA90499

Write-up: Pt vac w/ DTP/OPV had norm 4 mo well baby exam; Next day found limp & cyanotic. Brought to ER by paramedics, no signs of life after usual resuscitation measures. Possible SIDS. 06FEB91: AUTOPSY REPORT RECEIVED FROM SHC; DX = SIDS


Changed on 6/14/2018

VAERS ID: 27246 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Washington
Vaccinated:1990-12-14
Onset:1990-12-15
Submitted:1990-12-17
Entered:1990-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271916 / 2 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 287951 / 2 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Cyanosis, Hypotonia, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-15
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: This was an adopted infant born at Tacoma General Hosp
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WA90499

Write-up: Pt vac w/ DTP/OPV had norm 4 mo well baby exam; Next day found limp & cyanotic. Brought to ER by paramedics, no signs of life after usual resuscitation measures. Possible SIDS. 06FEB91: AUTOPSY REPORT RECEIVED FROM SHC; DX = SIDS


Changed on 8/14/2018

VAERS ID: 27246 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Washington
Vaccinated:1990-12-14
Onset:1990-12-15
Submitted:1990-12-17
Entered:1990-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271916 / 2 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 287951 / 2 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Cyanosis, Hypotonia, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-15
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: This was an adopted infant born at Tacoma General Hosp
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WA90499

Write-up: Pt vac w/ DTP/OPV had norm 4 mo well baby exam; Next day found limp & cyanotic. Brought to ER by paramedics, no signs of life after usual resuscitation measures. Possible SIDS. 06FEB91: AUTOPSY REPORT RECEIVED FROM SHC; DX = SIDS


Changed on 9/14/2018

VAERS ID: 27246 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Washington
Vaccinated:1990-12-14
Onset:1990-12-15
Submitted:1990-12-17
Entered:1990-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271916 / 2 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 287951 / 2 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Cyanosis, Hypotonia, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-15
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: This was an adopted infant born at Tacoma General Hosp
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WA90499

Write-up: Pt vac w/ DTP/OPV had norm 4 mo well baby exam; Next day found limp & cyanotic. Brought to ER by paramedics, no signs of life after usual resuscitation measures. Possible SIDS. 06FEB91: AUTOPSY REPORT RECEIVED FROM SHC; DX = SIDS


Changed on 10/14/2018

VAERS ID: 27246 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Washington
Vaccinated:1990-12-14
Onset:1990-12-15
Submitted:1990-12-17
Entered:1990-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271916 / 2 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 287951 / 2 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Cyanosis, Hypotonia, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-15
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: This was an adopted infant born at Tacoma General Hosp
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WA90499

Write-up: Pt vac w/ DTP/OPV had norm 4 mo well baby exam; Next day found limp & cyanotic. Brought to ER by paramedics, no signs of life after usual resuscitation measures. Possible SIDS. 06FEB91: AUTOPSY REPORT RECEIVED FROM SHC; DX = SIDS

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