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This is VAERS ID 29978

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 29978
VAERS Form:
Age:1.3
Sex:Male
Location:Pennsylvania
Vaccinated:1991-02-14
Onset:1991-03-10
Submitted:1991-04-16
Entered:1991-04-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIBTITER / LEDERLE(PRAXIS) M200FD / 0 RA / IM
MMR: MMR II / MSD 1880S / 0 LA / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-10
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 pt; pale, listless; 2mos, DTP, 1st dose;
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy negative; DX SIDS; No evidence of viral or bacterial infect;
CDC 'Split Type': NONE

Write-up: Seen on 7MAR91 as mom requested to have TM''s checked; child active & normal 9MAR91 developed sl. fever & rhinorrhea was well except for fever @ 0222 10MAR91 parents heard him in crib 0730 10MAR91; Found dead @ 11AM 10MAR91;


Changed on 12/8/2009

VAERS ID: 29978 Before After
VAERS Form:
Age:1.3
Sex:Male
Location:Pennsylvania
Vaccinated:1991-02-14
Onset:1991-03-10
Submitted:1991-04-16
Entered:1991-04-24 1991-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M200FD / 0 RA / IM
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 1880S / 0 LA / SC

Administered by: Private      Purchased by: Unknown Private
Symptoms: Pyrexia, Rhinitis, SIDS, Sudden infant death syndrome, FEVER, RHINITIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-10
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 pt; pale, listless; 2mos, DTP, 1st dose;
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy negative; DX SIDS; No evidence of viral or bacterial infect;
CDC 'Split Type': NONE WAES91040942

Write-up: Seen on 7MAR91 as mom requested to have TM''s checked; child active & normal 9MAR91 developed sl. fever & rhinorrhea was well except for fever @ 0222 10MAR91 parents heard him in crib 0730 10MAR91; Found dead @ 11AM 10MAR91;


Changed on 5/14/2017

VAERS ID: 29978 Before After
VAERS Form:
Age:1.3
Sex:Male
Location:Pennsylvania
Vaccinated:1991-02-14
Onset:1991-03-10
Submitted:1991-04-16
Entered:1991-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M200FD / 0 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1880S / 0 LA / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-10
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 pt; pale, listless; 2mos, DTP, 1st dose; dose;~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy negative; DX SIDS; No evidence of viral or bacterial infect;
CDC 'Split Type': WAES91040942 (blank)

Write-up: Seen on 7MAR91 as mom requested to have TM''s checked; child active & normal 9MAR91 developed sl. fever & rhinorrhea was well except for fever @ 0222 10MAR91 parents heard him in crib 0730 10MAR91; Found dead @ 11AM 10MAR91;


Changed on 9/14/2017

VAERS ID: 29978 Before After
VAERS Form:(blank) 1
Age:1.3
Sex:Male
Location:Pennsylvania
Vaccinated:1991-02-14
Onset:1991-03-10
Submitted:1991-04-16
Entered:1991-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200FD / 0 1 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1880S / 0 1 LA / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-10
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 pt; pale, listless; 2mos, DTP, 1st dose;~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy negative; DX SIDS; No evidence of viral or bacterial infect;
CDC 'Split Type':

Write-up: Seen on 7MAR91 as mom requested to have TM''s checked; child active & normal 9MAR91 developed sl. fever & rhinorrhea was well except for fever @ 0222 10MAR91 parents heard him in crib 0730 10MAR91; Found dead @ 11AM 10MAR91;


Changed on 2/14/2018

VAERS ID: 29978 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Pennsylvania
Vaccinated:1991-02-14
Onset:1991-03-10
Submitted:1991-04-16
Entered:1991-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200FD / 1 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1880S / 1 LA / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-10
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 pt; pale, listless; 2mos, DTP, 1st dose;~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy negative; DX SIDS; No evidence of viral or bacterial infect;
CDC 'Split Type':

Write-up: Seen on 7MAR91 as mom requested to have TM''s checked; child active & normal 9MAR91 developed sl. fever & rhinorrhea was well except for fever @ 0222 10MAR91 parents heard him in crib 0730 10MAR91; Found dead @ 11AM 10MAR91;


Changed on 6/14/2018

VAERS ID: 29978 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Pennsylvania
Vaccinated:1991-02-14
Onset:1991-03-10
Submitted:1991-04-16
Entered:1991-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200FD / 1 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1880S / 1 LA / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-10
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 pt; pale, listless; 2mos, DTP, 1st dose;~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy negative; DX SIDS; No evidence of viral or bacterial infect;
CDC 'Split Type':

Write-up: Seen on 7MAR91 as mom requested to have TM''s checked; child active & normal 9MAR91 developed sl. fever & rhinorrhea was well except for fever @ 0222 10MAR91 parents heard him in crib 0730 10MAR91; Found dead @ 11AM 10MAR91;


Changed on 8/14/2018

VAERS ID: 29978 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Pennsylvania
Vaccinated:1991-02-14
Onset:1991-03-10
Submitted:1991-04-16
Entered:1991-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200FD / 1 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1880S / 1 LA / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-10
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 pt; pale, listless; 2mos, DTP, 1st dose;~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy negative; DX SIDS; No evidence of viral or bacterial infect;
CDC 'Split Type':

Write-up: Seen on 7MAR91 as mom requested to have TM''s checked; child active & normal 9MAR91 developed sl. fever & rhinorrhea was well except for fever @ 0222 10MAR91 parents heard him in crib 0730 10MAR91; Found dead @ 11AM 10MAR91;


Changed on 9/14/2018

VAERS ID: 29978 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Pennsylvania
Vaccinated:1991-02-14
Onset:1991-03-10
Submitted:1991-04-16
Entered:1991-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200FD / 1 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1880S / 1 LA / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-10
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 pt; pale, listless; 2mos, DTP, 1st dose;~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy negative; DX SIDS; No evidence of viral or bacterial infect;
CDC 'Split Type':

Write-up: Seen on 7MAR91 as mom requested to have TM''s checked; child active & normal 9MAR91 developed sl. fever & rhinorrhea was well except for fever @ 0222 10MAR91 parents heard him in crib 0730 10MAR91; Found dead @ 11AM 10MAR91;


Changed on 10/14/2018

VAERS ID: 29978 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:Pennsylvania
Vaccinated:1991-02-14
Onset:1991-03-10
Submitted:1991-04-16
Entered:1991-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200FD / 1 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1880S / 1 LA / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-10
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 pt; pale, listless; 2mos, DTP, 1st dose;~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy negative; DX SIDS; No evidence of viral or bacterial infect;
CDC 'Split Type':

Write-up: Seen on 7MAR91 as mom requested to have TM''s checked; child active & normal 9MAR91 developed sl. fever & rhinorrhea was well except for fever @ 0222 10MAR91 parents heard him in crib 0730 10MAR91; Found dead @ 11AM 10MAR91;

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=29978&WAYBACKHISTORY=ON


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