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This is VAERS ID 27341

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 27341
VAERS Form:
Age:0.2
Sex:Male
Location:California
Vaccinated:1990-12-27
Onset:1990-12-29
Submitted:1991-01-03
Entered:1991-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 283910 / - - / -
HIBV: HIBTITER / LEDERLE(PRAXIS) M6507B / - - / -
OPV: ORIMUNE / LEDERLE 06137 / - - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: CYANOSIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-29
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:
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV/HIB Titer found blue in crib.


Changed on 12/8/2009

VAERS ID: 27341 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:California
Vaccinated:1990-12-27
Onset:1990-12-29
Submitted:1991-01-03
Entered:1991-01-10 1991-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 283910 / - - / -
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M6507B / - - / -
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 06137 / - - / PO

Administered by: Private      Purchased by: Unknown Private
Symptoms: Cyanosis, CYANOSIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-29
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:
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV/HIB Titer found blue in crib.


Changed on 5/14/2017

VAERS ID: 27341 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:California
Vaccinated:1990-12-27
Onset:1990-12-29
Submitted:1991-01-03
Entered:1991-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283910 / - - / -
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M6507B / - - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 06137 / - - / PO

Administered by: Private      Purchased by: Private
Symptoms: Cyanosis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-29
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV/HIB Titer found blue in crib.


Changed on 9/14/2017

VAERS ID: 27341 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:California
Vaccinated:1990-12-27
Onset:1990-12-29
Submitted:1991-01-03
Entered:1991-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283910 / - UNK - / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M6507B / - UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 06137 / - UNK - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Cyanosis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-29
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV/HIB Titer found blue in crib.


Changed on 2/14/2018

VAERS ID: 27341 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:California
Vaccinated:1990-12-27
Onset:1990-12-29
Submitted:1991-01-03
Entered:1991-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283910 / UNK - / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M6507B / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 06137 / UNK MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Cyanosis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-29
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV/HIB Titer found blue in crib.


Changed on 6/14/2018

VAERS ID: 27341 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:California
Vaccinated:1990-12-27
Onset:1990-12-29
Submitted:1991-01-03
Entered:1991-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283910 / UNK - / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M6507B / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 06137 / UNK MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Cyanosis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-29
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV/HIB Titer found blue in crib.


Changed on 8/14/2018

VAERS ID: 27341 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:California
Vaccinated:1990-12-27
Onset:1990-12-29
Submitted:1991-01-03
Entered:1991-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283910 / UNK - / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M6507B / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 06137 / UNK MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Cyanosis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-29
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV/HIB Titer found blue in crib.


Changed on 9/14/2018

VAERS ID: 27341 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:California
Vaccinated:1990-12-27
Onset:1990-12-29
Submitted:1991-01-03
Entered:1991-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283910 / UNK - / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M6507B / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 06137 / UNK MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Cyanosis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-29
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV/HIB Titer found blue in crib.


Changed on 10/14/2018

VAERS ID: 27341 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:California
Vaccinated:1990-12-27
Onset:1990-12-29
Submitted:1991-01-03
Entered:1991-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283910 / UNK - / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M6507B / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 06137 / UNK MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Cyanosis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-29
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV/HIB Titer found blue in crib.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=27341&WAYBACKHISTORY=ON


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