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This is VAERS ID 53484

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History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 53484
VAERS Form:
Age:0.4
Sex:Male
Location:Illinois
Vaccinated:1993-05-19
Onset:0000-00-00
Submitted:1993-05-20
Entered:1993-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP / CONNAUGHT LABS 2H31039 / 1 LL / IM
HEP: UNK. HEPATITIS B / UNCLASSIFIED 68515OK / 1 RL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M100HP / 1 RL / IM
IPV: IPV / MERIEUX INST G0210 / 1 LL / IM

Administered by: Public      Purchased by: Unknown
Symptoms: APNEA, ANOREXIA, HEART ARREST, COUGH INC, PETECHIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-05-20
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: most likely unrelated but pt died of SIDS; pt exposed to HIV; born premature 30 wks gestation;


Changed on 12/8/2009

VAERS ID: 53484 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:Illinois
Vaccinated:1993-05-19
Onset:0000-00-00
Submitted:1993-05-20
Entered:1993-06-04 1993-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP DTP (NO BRAND NAME) / CONNAUGHT LABS CONNAUGHT LABORATORIES 2H31039 / 1 LL / IM
HEP: UNK. HEPATITIS B HEP B (NO BRAND NAME) / UNCLASSIFIED UNKNOWN MANUFACTURER 68515OK / 1 RL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M100HP / 1 RL / IM
IPV: IPV POLIO VIRUS, INACT. (NO BRAND NAME) / MERIEUX INST PASTEUR MERIEUX INST. G0210 / 1 LL / IM

Administered by: Public      Purchased by: Unknown Public
Symptoms: Anorexia, Apnoea, Cardiac arrest, Cough, Petechiae, Rhinitis, Sudden infant death syndrome, APNEA, ANOREXIA, HEART ARREST, COUGH INC, PETECHIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-05-20
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': (blank) IL93082

Write-up: most likely unrelated but pt died of SIDS; pt exposed to HIV; born premature 30 wks gestation;


Changed on 5/14/2017

VAERS ID: 53484 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:Illinois
Vaccinated:1993-05-19
Onset:0000-00-00
Submitted:1993-05-20
Entered:1993-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2H31039 / 1 LL / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER 68515OK / 1 RL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M100HP / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. G0210 / 1 LL / IM

Administered by: Public      Purchased by: Public
Symptoms: Anorexia, Apnoea, Cardiac arrest, Cough, Petechiae, Rhinitis, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-05-20
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': IL93082

Write-up: most likely unrelated but pt died of SIDS; pt exposed to HIV; born premature 30 wks gestation;


Changed on 9/14/2017

VAERS ID: 53484 Before After
VAERS Form:(blank) 1
Age:0.4
Sex:Male
Location:Illinois
Vaccinated:1993-05-19
Onset:0000-00-00
Submitted:1993-05-20
Entered:1993-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2H31039 / 1 2 LL / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER 68515OK / 1 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M100HP / 1 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. G0210 / 1 2 LL / IM

Administered by: Public      Purchased by: Public
Symptoms: Anorexia, Apnoea, Cardiac arrest, Cough, Petechiae, Rhinitis, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-05-20
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': IL93082

Write-up: most likely unrelated but pt died of SIDS; pt exposed to HIV; born premature 30 wks gestation;


Changed on 2/14/2018

VAERS ID: 53484 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Illinois
Vaccinated:1993-05-19
Onset:0000-00-00
Submitted:1993-05-20
Entered:1993-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2H31039 / 2 LL / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER 68515OK / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M100HP / 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. G0210 / 2 LL / IM

Administered by: Public      Purchased by: Public
Symptoms: Anorexia, Apnoea, Cardiac arrest, Cough, Petechiae, Rhinitis, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-05-20
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': IL93082

Write-up: most likely unrelated but pt died of SIDS; pt exposed to HIV; born premature 30 wks gestation;


Changed on 6/14/2018

VAERS ID: 53484 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Illinois
Vaccinated:1993-05-19
Onset:0000-00-00
Submitted:1993-05-20
Entered:1993-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2H31039 / 2 LL / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER 68515OK / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M100HP / 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. G0210 / 2 LL / IM

Administered by: Public      Purchased by: Public
Symptoms: Anorexia, Apnoea, Cardiac arrest, Cough, Petechiae, Rhinitis, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-05-20
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': IL93082

Write-up: most likely unrelated but pt died of SIDS; pt exposed to HIV; born premature 30 wks gestation;


Changed on 8/14/2018

VAERS ID: 53484 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Illinois
Vaccinated:1993-05-19
Onset:0000-00-00
Submitted:1993-05-20
Entered:1993-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2H31039 / 2 LL / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER 68515OK / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M100HP / 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. G0210 / 2 LL / IM

Administered by: Public      Purchased by: Public
Symptoms: Anorexia, Apnoea, Cardiac arrest, Cough, Petechiae, Rhinitis, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-05-20
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': IL93082

Write-up: most likely unrelated but pt died of SIDS; pt exposed to HIV; born premature 30 wks gestation;


Changed on 9/14/2018

VAERS ID: 53484 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Illinois
Vaccinated:1993-05-19
Onset:0000-00-00
Submitted:1993-05-20
Entered:1993-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2H31039 / 2 LL / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER 68515OK / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M100HP / 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. G0210 / 2 LL / IM

Administered by: Public      Purchased by: Public
Symptoms: Anorexia, Apnoea, Cardiac arrest, Cough, Petechiae, Rhinitis, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-05-20
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': IL93082

Write-up: most likely unrelated but pt died of SIDS; pt exposed to HIV; born premature 30 wks gestation;


Changed on 10/14/2018

VAERS ID: 53484 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Illinois
Vaccinated:1993-05-19
Onset:0000-00-00
Submitted:1993-05-20
Entered:1993-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2H31039 / 2 LL / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER 68515OK / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M100HP / 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. G0210 / 2 LL / IM

Administered by: Public      Purchased by: Public
Symptoms: Anorexia, Apnoea, Cardiac arrest, Cough, Petechiae, Rhinitis, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-05-20
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': IL93082

Write-up: most likely unrelated but pt died of SIDS; pt exposed to HIV; born premature 30 wks gestation;


Changed on 12/24/2020

VAERS ID: 53484 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Illinois
Vaccinated:1993-05-19
Onset:0000-00-00
Submitted:1993-05-20
Entered:1993-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2H31039 / 2 LL / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER 68515OK / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M100HP / 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. G0210 / 2 LL / IM

Administered by: Public      Purchased by: Public
Symptoms: Anorexia, Apnoea, Cardiac arrest, Cough, Petechiae, Rhinitis, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-05-20
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': IL93082

Write-up: most likely unrelated but pt died of SIDS; pt exposed to HIV; born premature 30 wks gestation;


Changed on 12/30/2020

VAERS ID: 53484 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Illinois
Vaccinated:1993-05-19
Onset:0000-00-00
Submitted:1993-05-20
Entered:1993-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2H31039 / 2 LL / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER 68515OK / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M100HP / 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. G0210 / 2 LL / IM

Administered by: Public      Purchased by: Public
Symptoms: Anorexia, Apnoea, Cardiac arrest, Cough, Petechiae, Rhinitis, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-05-20
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': IL93082

Write-up: most likely unrelated but pt died of SIDS; pt exposed to HIV; born premature 30 wks gestation;


Changed on 5/7/2021

VAERS ID: 53484 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Illinois
Vaccinated:1993-05-19
Onset:0000-00-00
Submitted:1993-05-20
Entered:1993-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2H31039 / 2 LL / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER 68515OK / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M100HP / 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. G0210 / 2 LL / IM

Administered by: Public      Purchased by: Public
Symptoms: Anorexia, Apnoea, Cardiac arrest, Cough, Petechiae, Rhinitis, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-05-20
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': IL93082

Write-up: most likely unrelated but pt died of SIDS; pt exposed to HIV; born premature 30 wks gestation;


Changed on 5/14/2021

VAERS ID: 53484 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Illinois
Vaccinated:1993-05-19
Onset:0000-00-00
Submitted:1993-05-20
Entered:1993-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2H31039 / 2 LL / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER 68515OK / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M100HP / 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. G0210 / 2 LL / IM

Administered by: Public      Purchased by: Public
Symptoms: Anorexia, Apnoea, Cardiac arrest, Cough, Petechiae, Rhinitis, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-05-20
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': IL93082

Write-up: most likely unrelated but pt died of SIDS; pt exposed to HIV; born premature 30 wks gestation;

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=53484&WAYBACKHISTORY=ON


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