National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 27690

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 27690
VAERS Form:
Age:
Sex:Unknown
Location:Florida
Vaccinated:1991-01-18
Onset:1991-01-25
Submitted:0000-00-00
Entered:1991-02-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP / CONNAUGHT LABS 0B21173 / 0 LL / -
HIBV: HIBTITER / LEDERLE(PRAXIS) M190FD / 0 RL / -
OPV: ORIMUNE / LEDERLE 0623A / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: REACT UNEVAL

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-01-25
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: High T-4 lst PKU - Normal testing results rec.
Allergies:
Diagnostic Lab Data: Autopsy Done-no results at this time
CDC 'Split Type':

Write-up: Child rec 1st DTP shot OPV & HIBtiter vax on 18JAN91, child expired on 25JAN91 cause of death unknown at this point autopsy done - no results at this time 30JAN91


Changed on 12/8/2009

VAERS ID: 27690 Before After
VAERS Form:
Age:
Sex:Unknown
Location:Florida
Vaccinated:1991-01-18
Onset:1991-01-25
Submitted:0000-00-00
Entered:1991-02-06 1991-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP DTP (NO BRAND NAME) / CONNAUGHT LABS CONNAUGHT LABORATORIES 0B21173 / 0 LL / -
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M190FD / 0 RL / -
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 0623A / 0 - / PO

Administered by: Private      Purchased by: Unknown Public
Symptoms: Unevaluable event, REACT UNEVAL

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-01-25
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: High T-4 lst PKU - Normal testing results rec.
Allergies:
Diagnostic Lab Data: Autopsy Done-no results at this time
CDC 'Split Type':

Write-up: Child rec 1st DTP shot OPV & HIBtiter vax on 18JAN91, child expired on 25JAN91 cause of death unknown at this point autopsy done - no results at this time 30JAN91


Changed on 5/14/2017

VAERS ID: 27690 Before After
VAERS Form:
Age:
Sex:Unknown
Location:Florida
Vaccinated:1991-01-18
Onset:1991-01-25
Submitted:0000-00-00
Entered:1991-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0B21173 / 0 LL / -
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M190FD / 0 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 0623A / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-01-25
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: High T-4 lst PKU - Normal testing results rec.
Allergies:
Diagnostic Lab Data: Autopsy Done-no results at this time
CDC 'Split Type':

Write-up: Child rec 1st DTP shot OPV & HIBtiter vax on 18JAN91, child expired on 25JAN91 cause of death unknown at this point autopsy done - no results at this time 30JAN91


Changed on 9/14/2017

VAERS ID: 27690 Before After
VAERS Form:(blank) 1
Age:
Sex:Unknown
Location:Florida
Vaccinated:1991-01-18
Onset:1991-01-25
Submitted:0000-00-00
Entered:1991-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0B21173 / 0 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M190FD / 0 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0623A / 0 1 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-01-25
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: High T-4 lst PKU - Normal testing results rec.
Allergies:
Diagnostic Lab Data: Autopsy Done-no results at this time
CDC 'Split Type':

Write-up: Child rec 1st DTP shot OPV & HIBtiter vax on 18JAN91, child expired on 25JAN91 cause of death unknown at this point autopsy done - no results at this time 30JAN91


Changed on 2/14/2018

VAERS ID: 27690 Before After
VAERS Form:1
Age:
Sex:Unknown
Location:Florida
Vaccinated:1991-01-18
Onset:1991-01-25
Submitted:0000-00-00
Entered:1991-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0B21173 / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M190FD / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0623A / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-01-25
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: High T-4 lst PKU - Normal testing results rec.
Allergies:
Diagnostic Lab Data: Autopsy Done-no results at this time
CDC 'Split Type':

Write-up: Child rec 1st DTP shot OPV & HIBtiter vax on 18JAN91, child expired on 25JAN91 cause of death unknown at this point autopsy done - no results at this time 30JAN91


Changed on 6/14/2018

VAERS ID: 27690 Before After
VAERS Form:1
Age:
Sex:Unknown
Location:Florida
Vaccinated:1991-01-18
Onset:1991-01-25
Submitted:0000-00-00
Entered:1991-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0B21173 / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M190FD / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0623A / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-01-25
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: High T-4 lst PKU - Normal testing results rec.
Allergies:
Diagnostic Lab Data: Autopsy Done-no results at this time
CDC 'Split Type':

Write-up: Child rec 1st DTP shot OPV & HIBtiter vax on 18JAN91, child expired on 25JAN91 cause of death unknown at this point autopsy done - no results at this time 30JAN91


Changed on 8/14/2018

VAERS ID: 27690 Before After
VAERS Form:1
Age:
Sex:Unknown
Location:Florida
Vaccinated:1991-01-18
Onset:1991-01-25
Submitted:0000-00-00
Entered:1991-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0B21173 / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M190FD / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0623A / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-01-25
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: High T-4 lst PKU - Normal testing results rec.
Allergies:
Diagnostic Lab Data: Autopsy Done-no results at this time
CDC 'Split Type':

Write-up: Child rec 1st DTP shot OPV & HIBtiter vax on 18JAN91, child expired on 25JAN91 cause of death unknown at this point autopsy done - no results at this time 30JAN91


Changed on 9/14/2018

VAERS ID: 27690 Before After
VAERS Form:1
Age:
Sex:Unknown
Location:Florida
Vaccinated:1991-01-18
Onset:1991-01-25
Submitted:0000-00-00
Entered:1991-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0B21173 / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M190FD / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0623A / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-01-25
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: High T-4 lst PKU - Normal testing results rec.
Allergies:
Diagnostic Lab Data: Autopsy Done-no results at this time
CDC 'Split Type':

Write-up: Child rec 1st DTP shot OPV & HIBtiter vax on 18JAN91, child expired on 25JAN91 cause of death unknown at this point autopsy done - no results at this time 30JAN91


Changed on 10/14/2018

VAERS ID: 27690 Before After
VAERS Form:1
Age:
Sex:Unknown
Location:Florida
Vaccinated:1991-01-18
Onset:1991-01-25
Submitted:0000-00-00
Entered:1991-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0B21173 / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M190FD / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0623A / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-01-25
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: High T-4 lst PKU - Normal testing results rec.
Allergies:
Diagnostic Lab Data: Autopsy Done-no results at this time
CDC 'Split Type':

Write-up: Child rec 1st DTP shot OPV & HIBtiter vax on 18JAN91, child expired on 25JAN91 cause of death unknown at this point autopsy done - no results at this time 30JAN91

New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=27690&WAYBACKHISTORY=ON


Copyright © 2019 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166