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This is VAERS ID 28091

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 28091
VAERS Form:
Age:0.2
Sex:Male
Location:Virginia
Vaccinated:1990-10-09
Onset:1990-10-09
Submitted:1991-02-07
Entered:1991-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 283914 / 0 RL / -

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS, VOMIT

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-14
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: Tylenol
Current Illness: None
Preexisting Conditions: lt congenital hip dysplasia
Allergies:
Diagnostic Lab Data: Cause of death SIDS - no autopsy performed.
CDC 'Split Type':

Write-up: Died 5 days p/1st DTP vax; Noticed spitting-up increased p/vax.


Changed on 12/8/2009

VAERS ID: 28091 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Virginia
Vaccinated:1990-10-09
Onset:1990-10-09
Submitted:1991-02-07
Entered:1991-02-15 1991-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 283914 / 0 RL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-14
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: Tylenol
Current Illness: None
Preexisting Conditions: lt congenital hip dysplasia
Allergies:
Diagnostic Lab Data: Cause of death SIDS - no autopsy performed.
CDC 'Split Type':

Write-up: Died 5 days p/1st DTP vax; Noticed spitting-up increased p/vax.


Changed on 5/14/2017

VAERS ID: 28091 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Virginia
Vaccinated:1990-10-09
Onset:1990-10-09
Submitted:1991-02-07
Entered:1991-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283914 / 0 RL / -

Administered by: Private      Purchased by: Private
Symptoms: Sudden infant death syndrome, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-14
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: Tylenol
Current Illness: None
Preexisting Conditions: lt congenital hip dysplasia
Allergies:
Diagnostic Lab Data: Cause of death SIDS - no autopsy performed.
CDC 'Split Type':

Write-up: Died 5 days p/1st DTP vax; Noticed spitting-up increased p/vax.


Changed on 9/14/2017

VAERS ID: 28091 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:Virginia
Vaccinated:1990-10-09
Onset:1990-10-09
Submitted:1991-02-07
Entered:1991-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283914 / 0 1 RL / -

Administered by: Private      Purchased by: Private
Symptoms: Sudden infant death syndrome, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-14
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: Tylenol
Current Illness: None
Preexisting Conditions: lt congenital hip dysplasia
Allergies:
Diagnostic Lab Data: Cause of death SIDS - no autopsy performed.
CDC 'Split Type':

Write-up: Died 5 days p/1st DTP vax; Noticed spitting-up increased p/vax.


Changed on 2/14/2018

VAERS ID: 28091 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Virginia
Vaccinated:1990-10-09
Onset:1990-10-09
Submitted:1991-02-07
Entered:1991-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283914 / 1 RL / -

Administered by: Private      Purchased by: Private
Symptoms: Sudden infant death syndrome, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-14
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: Tylenol
Current Illness: None
Preexisting Conditions: lt congenital hip dysplasia
Allergies:
Diagnostic Lab Data: Cause of death SIDS - no autopsy performed.
CDC 'Split Type':

Write-up: Died 5 days p/1st DTP vax; Noticed spitting-up increased p/vax.


Changed on 6/14/2018

VAERS ID: 28091 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Virginia
Vaccinated:1990-10-09
Onset:1990-10-09
Submitted:1991-02-07
Entered:1991-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283914 / 1 RL / -

Administered by: Private      Purchased by: Private
Symptoms: Sudden infant death syndrome, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-14
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: Tylenol
Current Illness: None
Preexisting Conditions: lt congenital hip dysplasia
Allergies:
Diagnostic Lab Data: Cause of death SIDS - no autopsy performed.
CDC 'Split Type':

Write-up: Died 5 days p/1st DTP vax; Noticed spitting-up increased p/vax.


Changed on 8/14/2018

VAERS ID: 28091 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Virginia
Vaccinated:1990-10-09
Onset:1990-10-09
Submitted:1991-02-07
Entered:1991-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283914 / 1 RL / -

Administered by: Private      Purchased by: Private
Symptoms: Sudden infant death syndrome, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-14
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: Tylenol
Current Illness: None
Preexisting Conditions: lt congenital hip dysplasia
Allergies:
Diagnostic Lab Data: Cause of death SIDS - no autopsy performed.
CDC 'Split Type':

Write-up: Died 5 days p/1st DTP vax; Noticed spitting-up increased p/vax.


Changed on 9/14/2018

VAERS ID: 28091 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Virginia
Vaccinated:1990-10-09
Onset:1990-10-09
Submitted:1991-02-07
Entered:1991-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283914 / 1 RL / -

Administered by: Private      Purchased by: Private
Symptoms: Sudden infant death syndrome, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-14
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: Tylenol
Current Illness: None
Preexisting Conditions: lt congenital hip dysplasia
Allergies:
Diagnostic Lab Data: Cause of death SIDS - no autopsy performed.
CDC 'Split Type':

Write-up: Died 5 days p/1st DTP vax; Noticed spitting-up increased p/vax.


Changed on 10/14/2018

VAERS ID: 28091 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Virginia
Vaccinated:1990-10-09
Onset:1990-10-09
Submitted:1991-02-07
Entered:1991-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283914 / 1 RL / -

Administered by: Private      Purchased by: Private
Symptoms: Sudden infant death syndrome, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-10-14
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: Tylenol
Current Illness: None
Preexisting Conditions: lt congenital hip dysplasia
Allergies:
Diagnostic Lab Data: Cause of death SIDS - no autopsy performed.
CDC 'Split Type':

Write-up: Died 5 days p/1st DTP vax; Noticed spitting-up increased p/vax.

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