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This is VAERS ID 27153

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 27153
VAERS Form:
Age:0.3
Sex:Unknown
Location:Ohio
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1990-12-05
Entered:1991-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP / CONNAUGHT LABS 0B21173 / - - / -
HIBV: UNK. HAEMOPHILUS B / UNCLASSIFIED - / - - / -
OPV: ORIMUNE / LEDERLE - / - - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: SIDS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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; SIDS death 1 day post injection.


Changed on 12/8/2009

VAERS ID: 27153 Before After
VAERS Form:
Age:0.3
Sex:Unknown
Location:Ohio
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1990-12-05
Entered:1991-01-02 1990-12-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP DTP (NO BRAND NAME) / CONNAUGHT LABS CONNAUGHT LABORATORIES 0B21173 / - - / -
HIBV: UNK. HAEMOPHILUS B HIB (NO BRAND NAME) / UNCLASSIFIED UNKNOWN MANUFACTURER - / - - / -
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES - / - - / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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) CO3729

Write-up: Pt vaccinated with DTP/OPV/HIB; SIDS death 1 day post injection.


Changed on 5/14/2017

VAERS ID: 27153 Before After
VAERS Form:
Age:0.3
Sex:Unknown
Location:Ohio
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1990-12-05
Entered:1990-12-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0B21173 / - - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH - / - - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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': CO3729

Write-up: Pt vaccinated with DTP/OPV/HIB; SIDS death 1 day post injection.


Changed on 9/14/2017

VAERS ID: 27153 Before After
VAERS Form:(blank) 1
Age:0.3
Sex:Unknown
Location:Ohio
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1990-12-05
Entered:1990-12-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0B21173 / - UNK - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / - UNK - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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': CO3729

Write-up: Pt vaccinated with DTP/OPV/HIB; SIDS death 1 day post injection.


Changed on 2/14/2018

VAERS ID: 27153 Before After
VAERS Form:1
Age:0.3
Sex:Unknown
Location:Ohio
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1990-12-05
Entered:1990-12-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0B21173 / UNK - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / UNK MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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': CO3729

Write-up: Pt vaccinated with DTP/OPV/HIB; SIDS death 1 day post injection.


Changed on 6/14/2018

VAERS ID: 27153 Before After
VAERS Form:1
Age:0.3
Sex:Unknown
Location:Ohio
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1990-12-05
Entered:1990-12-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0B21173 / UNK - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / UNK MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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': CO3729

Write-up: Pt vaccinated with DTP/OPV/HIB; SIDS death 1 day post injection.


Changed on 8/14/2018

VAERS ID: 27153 Before After
VAERS Form:1
Age:0.3
Sex:Unknown
Location:Ohio
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1990-12-05
Entered:1990-12-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0B21173 / UNK - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / UNK MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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': CO3729

Write-up: Pt vaccinated with DTP/OPV/HIB; SIDS death 1 day post injection.


Changed on 9/14/2018

VAERS ID: 27153 Before After
VAERS Form:1
Age:0.3
Sex:Unknown
Location:Ohio
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1990-12-05
Entered:1990-12-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0B21173 / UNK - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / UNK MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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': CO3729

Write-up: Pt vaccinated with DTP/OPV/HIB; SIDS death 1 day post injection.


Changed on 10/14/2018

VAERS ID: 27153 Before After
VAERS Form:1
Age:0.3
Sex:Unknown
Location:Ohio
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1990-12-05
Entered:1990-12-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0B21173 / UNK - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / UNK MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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': CO3729

Write-up: Pt vaccinated with DTP/OPV/HIB; SIDS death 1 day post injection.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=27153&WAYBACKHISTORY=ON


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