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This is VAERS ID 25530

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 25530
VAERS Form:
Age:0.3
Sex:Male
Location:Indiana
Vaccinated:1990-06-04
Onset:1990-06-04
Submitted:0000-00-00
Entered:1990-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 262913 / - - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS, AGITATION, FEVER

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-06-05
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: no relevant hx, no siblings
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt had low grade fever & fussiness within 12 hrs /p vaccination, slept well that evenig. Following moring infant was fine; taken to babysitter and was placed in crib for nap. Infant was found dead ar 1:00 pm. Autospy report list SIDS

Changed on 12/8/2009

VAERS ID: 25530 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Indiana
Vaccinated:1990-06-04
Onset:1990-06-04
Submitted:0000-00-00
Entered:1990-07-19 1990-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 262913 / - - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Agitation, Pyrexia, SIDS, Sudden infant death syndrome, AGITATION, FEVER

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-06-05
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: no relevant hx, no siblings
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) 9001011.01

Write-up: Pt had low grade fever & fussiness within 12 hrs /p vaccination, slept well that evenig. Following moring infant was fine; taken to babysitter and was placed in crib for nap. Infant was found dead ar 1:00 pm. Autospy report list SIDS

Changed on 5/14/2017

VAERS ID: 25530 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Indiana
Vaccinated:1990-06-04
Onset:1990-06-04
Submitted:0000-00-00
Entered:1990-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 262913 / - - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Agitation, Pyrexia, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-06-05
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: no relevant hx, no siblings
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 9001011.01

Write-up: Pt had low grade fever & fussiness within 12 hrs /p vaccination, slept well that evenig. Following moring infant was fine; taken to babysitter and was placed in crib for nap. Infant was found dead ar 1:00 pm. Autospy report list SIDS

Changed on 9/14/2017

VAERS ID: 25530 Before After
VAERS Form:(blank) 1
Age:0.3
Sex:Male
Location:Indiana
Vaccinated:1990-06-04
Onset:1990-06-04
Submitted:0000-00-00
Entered:1990-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 262913 / - UNK - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Agitation, Pyrexia, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-06-05
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: no relevant hx, no siblings
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 9001011.01

Write-up: Pt had low grade fever & fussiness within 12 hrs /p vaccination, slept well that evenig. Following moring infant was fine; taken to babysitter and was placed in crib for nap. Infant was found dead ar 1:00 pm. Autospy report list SIDS

Changed on 2/14/2018

VAERS ID: 25530 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Indiana
Vaccinated:1990-06-04
Onset:1990-06-04
Submitted:0000-00-00
Entered:1990-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 262913 / UNK - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Agitation, Pyrexia, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-06-05
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: no relevant hx, no siblings
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 9001011.01

Write-up: Pt had low grade fever & fussiness within 12 hrs /p vaccination, slept well that evenig. Following moring infant was fine; taken to babysitter and was placed in crib for nap. Infant was found dead ar 1:00 pm. Autospy report list SIDS

Changed on 6/14/2018

VAERS ID: 25530 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Indiana
Vaccinated:1990-06-04
Onset:1990-06-04
Submitted:0000-00-00
Entered:1990-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 262913 / UNK - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Agitation, Pyrexia, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-06-05
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: no relevant hx, no siblings
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 9001011.01

Write-up: Pt had low grade fever & fussiness within 12 hrs /p vaccination, slept well that evenig. Following moring infant was fine; taken to babysitter and was placed in crib for nap. Infant was found dead ar 1:00 pm. Autospy report list SIDS

Changed on 8/14/2018

VAERS ID: 25530 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Indiana
Vaccinated:1990-06-04
Onset:1990-06-04
Submitted:0000-00-00
Entered:1990-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 262913 / UNK - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Agitation, Pyrexia, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-06-05
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: no relevant hx, no siblings
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 9001011.01

Write-up: Pt had low grade fever & fussiness within 12 hrs /p vaccination, slept well that evenig. Following moring infant was fine; taken to babysitter and was placed in crib for nap. Infant was found dead ar 1:00 pm. Autospy report list SIDS

Changed on 9/14/2018

VAERS ID: 25530 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Indiana
Vaccinated:1990-06-04
Onset:1990-06-04
Submitted:0000-00-00
Entered:1990-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 262913 / UNK - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Agitation, Pyrexia, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-06-05
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: no relevant hx, no siblings
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 9001011.01

Write-up: Pt had low grade fever & fussiness within 12 hrs /p vaccination, slept well that evenig. Following moring infant was fine; taken to babysitter and was placed in crib for nap. Infant was found dead ar 1:00 pm. Autospy report list SIDS

Changed on 10/14/2018

VAERS ID: 25530 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Indiana
Vaccinated:1990-06-04
Onset:1990-06-04
Submitted:0000-00-00
Entered:1990-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 262913 / UNK - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Agitation, Pyrexia, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-06-05
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: no relevant hx, no siblings
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 9001011.01

Write-up: Pt had low grade fever & fussiness within 12 hrs /p vaccination, slept well that evenig. Following moring infant was fine; taken to babysitter and was placed in crib for nap. Infant was found dead ar 1:00 pm. Autospy report list SIDS

Changed on 12/24/2020

VAERS ID: 25530 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Indiana
Vaccinated:1990-06-04
Onset:1990-06-04
Submitted:0000-00-00
Entered:1990-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 262913 / UNK - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Agitation, Pyrexia, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-06-05
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: no relevant hx, no siblings
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 9001011.01

Write-up: Pt had low grade fever & fussiness within 12 hrs /p vaccination, slept well that evenig. Following moring infant was fine; taken to babysitter and was placed in crib for nap. Infant was found dead ar 1:00 pm. Autospy report list SIDS

Changed on 12/30/2020

VAERS ID: 25530 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Indiana
Vaccinated:1990-06-04
Onset:1990-06-04
Submitted:0000-00-00
Entered:1990-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 262913 / UNK - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Agitation, Pyrexia, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-06-05
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: no relevant hx, no siblings
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 9001011.01

Write-up: Pt had low grade fever & fussiness within 12 hrs /p vaccination, slept well that evenig. Following moring infant was fine; taken to babysitter and was placed in crib for nap. Infant was found dead ar 1:00 pm. Autospy report list SIDS

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