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This is VAERS ID 27161

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 27161
VAERS Form:
Age:0.2
Sex:Male
Location:Massachusetts
Vaccinated:1990-12-11
Onset:1990-12-12
Submitted:1990-12-17
Entered:1991-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP MASS. PHD. / MASS. DPH DTP272 / - LL / -
HIBV: HIBTITER / LEDERLE(PRAXIS) M190FD / - RL / -
OPV: ORIMUNE / LEDERLE 287952 / - - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-12
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 died approx 24 hrs later. preliminary dx SIDS.


Changed on 12/8/2009

VAERS ID: 27161 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Massachusetts
Vaccinated:1990-12-11
Onset:1990-12-12
Submitted:1990-12-17
Entered:1991-01-02 1990-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP MASS. PHD. DTP (NO BRAND NAME) / MASS. DPH MASS. PUB HLTH BIOL LAB DTP272 / - LL / -
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M190FD / - RL / -
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 287952 / - - / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-12
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 died approx 24 hrs later. preliminary dx SIDS.


Changed on 5/14/2017

VAERS ID: 27161 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Massachusetts
Vaccinated:1990-12-11
Onset:1990-12-12
Submitted:1990-12-17
Entered:1990-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MASS. PUB HLTH BIOL LAB DTP272 / - LL / -
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M190FD / - RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 287952 / - - / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-12
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':

Write-up: Pt vaccinated with DTP/OPV/HIB died approx 24 hrs later. preliminary dx SIDS.


Changed on 9/14/2017

VAERS ID: 27161 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:Massachusetts
Vaccinated:1990-12-11
Onset:1990-12-12
Submitted:1990-12-17
Entered:1990-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MASS. PUB HLTH BIOL LAB DTP272 / - UNK LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M190FD / - UNK RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 287952 / - UNK - MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-12
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':

Write-up: Pt vaccinated with DTP/OPV/HIB died approx 24 hrs later. preliminary dx SIDS.


Changed on 2/14/2018

VAERS ID: 27161 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Massachusetts
Vaccinated:1990-12-11
Onset:1990-12-12
Submitted:1990-12-17
Entered:1990-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MASS. PUB HLTH BIOL LAB DTP272 / UNK LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M190FD / UNK RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 287952 / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-12
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':

Write-up: Pt vaccinated with DTP/OPV/HIB died approx 24 hrs later. preliminary dx SIDS.


Changed on 6/14/2018

VAERS ID: 27161 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Massachusetts
Vaccinated:1990-12-11
Onset:1990-12-12
Submitted:1990-12-17
Entered:1990-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MASS. PUB HLTH BIOL LAB DTP272 / UNK LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M190FD / UNK RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 287952 / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-12
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':

Write-up: Pt vaccinated with DTP/OPV/HIB died approx 24 hrs later. preliminary dx SIDS.


Changed on 8/14/2018

VAERS ID: 27161 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Massachusetts
Vaccinated:1990-12-11
Onset:1990-12-12
Submitted:1990-12-17
Entered:1990-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MASS. PUB HLTH BIOL LAB DTP272 / UNK LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M190FD / UNK RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 287952 / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-12
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':

Write-up: Pt vaccinated with DTP/OPV/HIB died approx 24 hrs later. preliminary dx SIDS.


Changed on 9/14/2018

VAERS ID: 27161 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Massachusetts
Vaccinated:1990-12-11
Onset:1990-12-12
Submitted:1990-12-17
Entered:1990-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MASS. PUB HLTH BIOL LAB DTP272 / UNK LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M190FD / UNK RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 287952 / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-12
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':

Write-up: Pt vaccinated with DTP/OPV/HIB died approx 24 hrs later. preliminary dx SIDS.


Changed on 10/14/2018

VAERS ID: 27161 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Massachusetts
Vaccinated:1990-12-11
Onset:1990-12-12
Submitted:1990-12-17
Entered:1990-12-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MASS. PUB HLTH BIOL LAB DTP272 / UNK LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M190FD / UNK RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 287952 / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-12
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':

Write-up: Pt vaccinated with DTP/OPV/HIB died approx 24 hrs later. preliminary dx SIDS.

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