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This is VAERS ID 58900

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History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 58900
VAERS Form:
Age:0.1
Sex:Male
Location:New Hampshire
Vaccinated:1993-10-13
Onset:1993-10-21
Submitted:1993-12-20
Entered:1994-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 355901 / 0 LL / IM
HEP: RECOMBIVAX HB / MSD 0460W / 1 RL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M110KA / 0 RL / IM
IPV: POLIOVAX / CONNAUGHT LTD G0489 / 0 LL / IM

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-21
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: SIDS 21OCT93;


Changed on 12/8/2009

VAERS ID: 58900 Before After
VAERS Form:
Age:0.1
Sex:Male
Location:New Hampshire
Vaccinated:1993-10-13
Onset:1993-10-21
Submitted:1993-12-20
Entered:1994-01-12 1994-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 355901 / 0 LL / IM
HEP: RECOMBIVAX HB HEP B (RECOMBIVAX HB) / MSD MERCK & CO. INC. 0460W / 1 RL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M110KA / 0 RL / IM
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. G0489 / 0 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-21
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': (blank) NH93028

Write-up: SIDS 21OCT93;


Changed on 5/14/2017

VAERS ID: 58900 Before After
VAERS Form:
Age:0.1
Sex:Male
Location:New Hampshire
Vaccinated:1993-10-13
Onset:1993-10-21
Submitted:1993-12-20
Entered:1994-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 355901 / 0 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0460W / 1 RL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M110KA / 0 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. G0489 / 0 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-21
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NH93028

Write-up: SIDS 21OCT93;


Changed on 9/14/2017

VAERS ID: 58900 Before After
VAERS Form:(blank) 1
Age:0.1
Sex:Male
Location:New Hampshire
Vaccinated:1993-10-13
Onset:1993-10-21
Submitted:1993-12-20
Entered:1994-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 355901 / 0 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0460W / 1 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M110KA / 0 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. G0489 / 0 1 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-21
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NH93028

Write-up: SIDS 21OCT93;


Changed on 2/14/2018

VAERS ID: 58900 Before After
VAERS Form:1
Age:0.1
Sex:Male
Location:New Hampshire
Vaccinated:1993-10-13
Onset:1993-10-21
Submitted:1993-12-20
Entered:1994-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 355901 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0460W / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M110KA / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. G0489 / 1 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-21
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NH93028

Write-up: SIDS 21OCT93;


Changed on 6/14/2018

VAERS ID: 58900 Before After
VAERS Form:1
Age:0.1
Sex:Male
Location:New Hampshire
Vaccinated:1993-10-13
Onset:1993-10-21
Submitted:1993-12-20
Entered:1994-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 355901 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0460W / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M110KA / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. G0489 / 1 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-21
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NH93028

Write-up: SIDS 21OCT93;


Changed on 8/14/2018

VAERS ID: 58900 Before After
VAERS Form:1
Age:0.1
Sex:Male
Location:New Hampshire
Vaccinated:1993-10-13
Onset:1993-10-21
Submitted:1993-12-20
Entered:1994-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 355901 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0460W / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M110KA / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. G0489 / 1 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-21
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NH93028

Write-up: SIDS 21OCT93;


Changed on 9/14/2018

VAERS ID: 58900 Before After
VAERS Form:1
Age:0.1
Sex:Male
Location:New Hampshire
Vaccinated:1993-10-13
Onset:1993-10-21
Submitted:1993-12-20
Entered:1994-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 355901 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0460W / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M110KA / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. G0489 / 1 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-21
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NH93028

Write-up: SIDS 21OCT93;


Changed on 10/14/2018

VAERS ID: 58900 Before After
VAERS Form:1
Age:0.1
Sex:Male
Location:New Hampshire
Vaccinated:1993-10-13
Onset:1993-10-21
Submitted:1993-12-20
Entered:1994-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 355901 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0460W / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M110KA / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. G0489 / 1 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-21
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NH93028

Write-up: SIDS 21OCT93;


Changed on 12/24/2020

VAERS ID: 58900 Before After
VAERS Form:1
Age:0.1
Sex:Male
Location:New Hampshire
Vaccinated:1993-10-13
Onset:1993-10-21
Submitted:1993-12-20
Entered:1994-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 355901 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0460W / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M110KA / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. G0489 / 1 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-21
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NH93028

Write-up: SIDS 21OCT93;


Changed on 12/30/2020

VAERS ID: 58900 Before After
VAERS Form:1
Age:0.1
Sex:Male
Location:New Hampshire
Vaccinated:1993-10-13
Onset:1993-10-21
Submitted:1993-12-20
Entered:1994-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 355901 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0460W / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M110KA / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. G0489 / 1 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-21
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NH93028

Write-up: SIDS 21OCT93;


Changed on 5/7/2021

VAERS ID: 58900 Before After
VAERS Form:1
Age:0.1
Sex:Male
Location:New Hampshire
Vaccinated:1993-10-13
Onset:1993-10-21
Submitted:1993-12-20
Entered:1994-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 355901 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0460W / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M110KA / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. G0489 / 1 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-21
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NH93028

Write-up: SIDS 21OCT93;


Changed on 5/14/2021

VAERS ID: 58900 Before After
VAERS Form:1
Age:0.1
Sex:Male
Location:New Hampshire
Vaccinated:1993-10-13
Onset:1993-10-21
Submitted:1993-12-20
Entered:1994-01-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 355901 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0460W / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M110KA / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. G0489 / 1 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-10-21
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NH93028

Write-up: SIDS 21OCT93;

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