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This is VAERS ID 25683

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 25683
VAERS Form:
Age:0.4
Sex:Female
Location:Missouri
Vaccinated:1990-06-29
Onset:1990-07-02
Submitted:0000-00-00
Entered:1990-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 271911 / - - / IM
OPV: ORIMUNE / LEDERLE 0603F / - - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-07-02
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: hx of infantile apnea syndrome
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV found dead 4 days after receiving vac. Infant apnea syndrome on monitor.

Changed on 12/8/2009

VAERS ID: 25683 Before After
VAERS Form:
Age:0.4
Sex:Female
Location:Missouri
Vaccinated:1990-06-29
Onset:1990-07-02
Submitted:0000-00-00
Entered:1990-08-22 1990-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 271911 / - - / IM
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 0603F / - - / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-07-02
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: hx of infantile apnea syndrome
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV found dead 4 days after receiving vac. Infant apnea syndrome on monitor.

Changed on 5/14/2017

VAERS ID: 25683 Before After
VAERS Form:
Age:0.4
Sex:Female
Location:Missouri
Vaccinated:1990-06-29
Onset:1990-07-02
Submitted:0000-00-00
Entered:1990-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271911 / - - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 0603F / - - / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-07-02
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: hx of infantile apnea syndrome
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV found dead 4 days after receiving vac. Infant apnea syndrome on monitor.

Changed on 9/14/2017

VAERS ID: 25683 Before After
VAERS Form:(blank) 1
Age:0.4
Sex:Female
Location:Missouri
Vaccinated:1990-06-29
Onset:1990-07-02
Submitted:0000-00-00
Entered:1990-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271911 / - UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0603F / - UNK - MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-07-02
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: hx of infantile apnea syndrome
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV found dead 4 days after receiving vac. Infant apnea syndrome on monitor.

Changed on 2/14/2018

VAERS ID: 25683 Before After
VAERS Form:1
Age:0.4
Sex:Female
Location:Missouri
Vaccinated:1990-06-29
Onset:1990-07-02
Submitted:0000-00-00
Entered:1990-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271911 / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0603F / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-07-02
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: hx of infantile apnea syndrome
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV found dead 4 days after receiving vac. Infant apnea syndrome on monitor.

Changed on 6/14/2018

VAERS ID: 25683 Before After
VAERS Form:1
Age:0.4
Sex:Female
Location:Missouri
Vaccinated:1990-06-29
Onset:1990-07-02
Submitted:0000-00-00
Entered:1990-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271911 / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0603F / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-07-02
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: hx of infantile apnea syndrome
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV found dead 4 days after receiving vac. Infant apnea syndrome on monitor.

Changed on 8/14/2018

VAERS ID: 25683 Before After
VAERS Form:1
Age:0.4
Sex:Female
Location:Missouri
Vaccinated:1990-06-29
Onset:1990-07-02
Submitted:0000-00-00
Entered:1990-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271911 / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0603F / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-07-02
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: hx of infantile apnea syndrome
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV found dead 4 days after receiving vac. Infant apnea syndrome on monitor.

Changed on 9/14/2018

VAERS ID: 25683 Before After
VAERS Form:1
Age:0.4
Sex:Female
Location:Missouri
Vaccinated:1990-06-29
Onset:1990-07-02
Submitted:0000-00-00
Entered:1990-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271911 / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0603F / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-07-02
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: hx of infantile apnea syndrome
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV found dead 4 days after receiving vac. Infant apnea syndrome on monitor.

Changed on 10/14/2018

VAERS ID: 25683 Before After
VAERS Form:1
Age:0.4
Sex:Female
Location:Missouri
Vaccinated:1990-06-29
Onset:1990-07-02
Submitted:0000-00-00
Entered:1990-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271911 / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0603F / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-07-02
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: hx of infantile apnea syndrome
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV found dead 4 days after receiving vac. Infant apnea syndrome on monitor.

Changed on 12/24/2020

VAERS ID: 25683 Before After
VAERS Form:1
Age:0.4
Sex:Female
Location:Missouri
Vaccinated:1990-06-29
Onset:1990-07-02
Submitted:0000-00-00
Entered:1990-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271911 / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0603F / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-07-02
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: hx of infantile apnea syndrome
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV found dead 4 days after receiving vac. Infant apnea syndrome on monitor.

Changed on 12/30/2020

VAERS ID: 25683 Before After
VAERS Form:1
Age:0.4
Sex:Female
Location:Missouri
Vaccinated:1990-06-29
Onset:1990-07-02
Submitted:0000-00-00
Entered:1990-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271911 / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0603F / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-07-02
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: hx of infantile apnea syndrome
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV found dead 4 days after receiving vac. Infant apnea syndrome on monitor.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=25683&WAYBACKHISTORY=ON


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