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This is VAERS ID 27309

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 27309
VAERS Form:
Age:0.2
Sex:Female
Location:California
Vaccinated:1990-12-06
Onset:1990-12-12
Submitted:1990-12-21
Entered:1991-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 291930 / 0 LL / IM
OPV: ORIMUNE / LEDERLE 285951 / - - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: SIDS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-12
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: Pathology report by High Dessert Hosp. Lancaster
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV sudden infant death.


Changed on 12/8/2009

VAERS ID: 27309 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:California
Vaccinated:1990-12-06
Onset:1990-12-12
Submitted:1990-12-21
Entered:1991-01-08 1991-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 291930 / 0 LL / IM
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 285951 / - - / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-12
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: Pathology report by High Dessert Hosp. Lancaster
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV sudden infant death.


Changed on 2/13/2013

VAERS ID: 27309 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:California
Vaccinated:1990-12-06
Onset:1990-12-12
Submitted:1990-12-21
Entered:1991-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291930 / 0 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 285951 / - - / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-12
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: Pathology report by High Dessert Hosp. Lancaster
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV sudden infant death.


Changed on 2/14/2017

VAERS ID: 27309 Before After
VAERS Form:
Age:0.2 0.18
Sex:Female
Location:California
Vaccinated:1990-12-06
Onset:1990-12-12
Submitted:1990-12-21
Entered:1991-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291930 / 0 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 285951 / - - / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-12
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: Pathology report by Hosp.
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV sudden infant death.


Changed on 9/14/2017

VAERS ID: 27309 Before After
VAERS Form:(blank) 1
Age:0.18
Sex:Female
Location:California
Vaccinated:1990-12-06
Onset:1990-12-12
Submitted:1990-12-21
Entered:1991-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291930 / 0 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 285951 / - UNK - MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-12
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: Pathology report by Hosp.
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV sudden infant death.


Changed on 2/14/2018

VAERS ID: 27309 Before After
VAERS Form:1
Age:0.18
Sex:Female
Location:California
Vaccinated:1990-12-06
Onset:1990-12-12
Submitted:1990-12-21
Entered:1991-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291930 / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 285951 / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-12
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: Pathology report by Hosp.
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV sudden infant death.


Changed on 6/14/2018

VAERS ID: 27309 Before After
VAERS Form:1
Age:0.18
Sex:Female
Location:California
Vaccinated:1990-12-06
Onset:1990-12-12
Submitted:1990-12-21
Entered:1991-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291930 / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 285951 / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-12
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: Pathology report by Hosp.
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV sudden infant death.


Changed on 8/14/2018

VAERS ID: 27309 Before After
VAERS Form:1
Age:0.18
Sex:Female
Location:California
Vaccinated:1990-12-06
Onset:1990-12-12
Submitted:1990-12-21
Entered:1991-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291930 / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 285951 / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-12
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: Pathology report by Hosp.
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV sudden infant death.


Changed on 9/14/2018

VAERS ID: 27309 Before After
VAERS Form:1
Age:0.18
Sex:Female
Location:California
Vaccinated:1990-12-06
Onset:1990-12-12
Submitted:1990-12-21
Entered:1991-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291930 / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 285951 / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-12
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: Pathology report by Hosp.
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV sudden infant death.


Changed on 10/14/2018

VAERS ID: 27309 Before After
VAERS Form:1
Age:0.18
Sex:Female
Location:California
Vaccinated:1990-12-06
Onset:1990-12-12
Submitted:1990-12-21
Entered:1991-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291930 / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 285951 / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-12
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: Pathology report by Hosp.
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV sudden infant death.

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