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This is VAERS ID 28070

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 28070
VAERS Form:
Age:0.2
Sex:Male
Location:South Dakota
Vaccinated:1990-10-12
Onset:1990-10-15
Submitted:1991-01-10
Entered:1991-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 285920 / 0 LL / -
OPV: ORIMUNE / LEDERLE 0614E / 0 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: SIDS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-15
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: None
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Autopsy report- Mild inflammatory change w/in liver, Mild nonspecific respiratory or gastrointestinal infect; No evidence of underlying trauma. No evidence to suggest any element of abuse and/or neglect.
CDC 'Split Type':

Write-up: SIDS.


Changed on 12/8/2009

VAERS ID: 28070 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:South Dakota
Vaccinated:1990-10-12
Onset:1990-10-15
Submitted:1991-01-10
Entered:1991-02-14 1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 285920 / 0 LL / -
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 0614E / 0 - / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-15
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: None
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Autopsy report- Mild inflammatory change w/in liver, Mild nonspecific respiratory or gastrointestinal infect; No evidence of underlying trauma. No evidence to suggest any element of abuse and/or neglect.
CDC 'Split Type': (blank) SD91002

Write-up: SIDS.


Changed on 5/14/2017

VAERS ID: 28070 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:South Dakota
Vaccinated:1990-10-12
Onset:1990-10-15
Submitted:1991-01-10
Entered:1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285920 / 0 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 0614E / 0 - / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-15
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: None
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Autopsy report- Mild inflammatory change w/in liver, Mild nonspecific respiratory or gastrointestinal infect; No evidence of underlying trauma. No evidence to suggest any element of abuse and/or neglect.
CDC 'Split Type': SD91002

Write-up: SIDS.


Changed on 9/14/2017

VAERS ID: 28070 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:South Dakota
Vaccinated:1990-10-12
Onset:1990-10-15
Submitted:1991-01-10
Entered:1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285920 / 0 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0614E / 0 1 - MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-15
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: None
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Autopsy report- Mild inflammatory change w/in liver, Mild nonspecific respiratory or gastrointestinal infect; No evidence of underlying trauma. No evidence to suggest any element of abuse and/or neglect.
CDC 'Split Type': SD91002

Write-up: SIDS.


Changed on 2/14/2018

VAERS ID: 28070 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:South Dakota
Vaccinated:1990-10-12
Onset:1990-10-15
Submitted:1991-01-10
Entered:1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285920 / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0614E / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-15
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: None
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Autopsy report- Mild inflammatory change w/in liver, Mild nonspecific respiratory or gastrointestinal infect; No evidence of underlying trauma. No evidence to suggest any element of abuse and/or neglect.
CDC 'Split Type': SD91002

Write-up: SIDS.


Changed on 6/14/2018

VAERS ID: 28070 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:South Dakota
Vaccinated:1990-10-12
Onset:1990-10-15
Submitted:1991-01-10
Entered:1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285920 / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0614E / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-15
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: None
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Autopsy report- Mild inflammatory change w/in liver, Mild nonspecific respiratory or gastrointestinal infect; No evidence of underlying trauma. No evidence to suggest any element of abuse and/or neglect.
CDC 'Split Type': SD91002

Write-up: SIDS.


Changed on 8/14/2018

VAERS ID: 28070 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:South Dakota
Vaccinated:1990-10-12
Onset:1990-10-15
Submitted:1991-01-10
Entered:1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285920 / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0614E / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-15
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: None
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Autopsy report- Mild inflammatory change w/in liver, Mild nonspecific respiratory or gastrointestinal infect; No evidence of underlying trauma. No evidence to suggest any element of abuse and/or neglect.
CDC 'Split Type': SD91002

Write-up: SIDS.


Changed on 9/14/2018

VAERS ID: 28070 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:South Dakota
Vaccinated:1990-10-12
Onset:1990-10-15
Submitted:1991-01-10
Entered:1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285920 / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0614E / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-15
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: None
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Autopsy report- Mild inflammatory change w/in liver, Mild nonspecific respiratory or gastrointestinal infect; No evidence of underlying trauma. No evidence to suggest any element of abuse and/or neglect.
CDC 'Split Type': SD91002

Write-up: SIDS.


Changed on 10/14/2018

VAERS ID: 28070 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:South Dakota
Vaccinated:1990-10-12
Onset:1990-10-15
Submitted:1991-01-10
Entered:1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285920 / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0614E / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-15
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: None
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Autopsy report- Mild inflammatory change w/in liver, Mild nonspecific respiratory or gastrointestinal infect; No evidence of underlying trauma. No evidence to suggest any element of abuse and/or neglect.
CDC 'Split Type': SD91002

Write-up: SIDS.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=28070&WAYBACKHISTORY=ON


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