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This is VAERS ID 27506

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 27506
VAERS Form:
Age:0.3
Sex:Male
Location:Virginia
Vaccinated:1991-01-08
Onset:1991-01-09
Submitted:1991-01-10
Entered:1991-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 293947 / 1 LL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M705FE / 0 RL / IM
OPV: ORIMUNE / LEDERLE 291964 / 1 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: SIDS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-01-09
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: Tylenol drops PRN
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: other pending autopsy at hospital. No lab work done 8JAN91
CDC 'Split Type':

Write-up: Pt vaccinated with DTP/OPV/HIB phone call from ER 9JAN91 at 1210PM requesting info re: child''s status on visit 8JAN91. Informed ER child well-given 2nd DTP, OPV & 1st HBCV - ER stated child ""SIDS"" found by mother - brought to ER via rescue.


Changed on 12/8/2009

VAERS ID: 27506 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Virginia
Vaccinated:1991-01-08
Onset:1991-01-09
Submitted:1991-01-10
Entered:1991-01-24 1991-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 293947 / 1 LL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M705FE / 0 RL / IM
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 291964 / 1 - / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-01-09
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: Tylenol drops PRN
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: other pending autopsy at hospital. No lab work done 8JAN91
CDC 'Split Type': (blank) VA91001

Write-up: Pt vaccinated with DTP/OPV/HIB phone call from ER 9JAN91 at 1210PM requesting info re: child''s status on visit 8JAN91. Informed ER child well-given 2nd DTP, OPV & 1st HBCV - ER stated child ""SIDS"" "SIDS" found by mother - brought to ER via rescue.


Changed on 5/14/2017

VAERS ID: 27506 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Virginia
Vaccinated:1991-01-08
Onset:1991-01-09
Submitted:1991-01-10
Entered:1991-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 293947 / 1 LL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M705FE / 0 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 291964 / 1 - / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-01-09
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: Tylenol drops PRN
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: other pending autopsy at hospital. No lab work done 8JAN91
CDC 'Split Type': VA91001

Write-up: Pt vaccinated with DTP/OPV/HIB phone call from ER 9JAN91 at 1210PM requesting info re: child''s status on visit 8JAN91. Informed ER child well-given 2nd DTP, OPV & 1st HBCV - ER stated child "SIDS" found by mother - brought to ER via rescue.


Changed on 9/14/2017

VAERS ID: 27506 Before After
VAERS Form:(blank) 1
Age:0.3
Sex:Male
Location:Virginia
Vaccinated:1991-01-08
Onset:1991-01-09
Submitted:1991-01-10
Entered:1991-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 293947 / 1 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M705FE / 0 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 291964 / 1 2 - MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-01-09
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: Tylenol drops PRN
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: other pending autopsy at hospital. No lab work done 8JAN91
CDC 'Split Type': VA91001

Write-up: Pt vaccinated with DTP/OPV/HIB phone call from ER 9JAN91 at 1210PM requesting info re: child''s status on visit 8JAN91. Informed ER child well-given 2nd DTP, OPV & 1st HBCV - ER stated child "SIDS" found by mother - brought to ER via rescue.


Changed on 2/14/2018

VAERS ID: 27506 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Virginia
Vaccinated:1991-01-08
Onset:1991-01-09
Submitted:1991-01-10
Entered:1991-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 293947 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M705FE / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 291964 / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-01-09
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: Tylenol drops PRN
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: other pending autopsy at hospital. No lab work done 8JAN91
CDC 'Split Type': VA91001

Write-up: Pt vaccinated with DTP/OPV/HIB phone call from ER 9JAN91 at 1210PM requesting info re: child''s status on visit 8JAN91. Informed ER child well-given 2nd DTP, OPV & 1st HBCV - ER stated child "SIDS" found by mother - brought to ER via rescue.


Changed on 6/14/2018

VAERS ID: 27506 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Virginia
Vaccinated:1991-01-08
Onset:1991-01-09
Submitted:1991-01-10
Entered:1991-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 293947 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M705FE / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 291964 / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-01-09
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: Tylenol drops PRN
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: other pending autopsy at hospital. No lab work done 8JAN91
CDC 'Split Type': VA91001

Write-up: Pt vaccinated with DTP/OPV/HIB phone call from ER 9JAN91 at 1210PM requesting info re: child''s status on visit 8JAN91. Informed ER child well-given 2nd DTP, OPV & 1st HBCV - ER stated child "SIDS" found by mother - brought to ER via rescue.


Changed on 8/14/2018

VAERS ID: 27506 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Virginia
Vaccinated:1991-01-08
Onset:1991-01-09
Submitted:1991-01-10
Entered:1991-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 293947 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M705FE / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 291964 / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-01-09
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: Tylenol drops PRN
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: other pending autopsy at hospital. No lab work done 8JAN91
CDC 'Split Type': VA91001

Write-up: Pt vaccinated with DTP/OPV/HIB phone call from ER 9JAN91 at 1210PM requesting info re: child''s status on visit 8JAN91. Informed ER child well-given 2nd DTP, OPV & 1st HBCV - ER stated child "SIDS" found by mother - brought to ER via rescue.


Changed on 9/14/2018

VAERS ID: 27506 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Virginia
Vaccinated:1991-01-08
Onset:1991-01-09
Submitted:1991-01-10
Entered:1991-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 293947 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M705FE / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 291964 / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-01-09
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: Tylenol drops PRN
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: other pending autopsy at hospital. No lab work done 8JAN91
CDC 'Split Type': VA91001

Write-up: Pt vaccinated with DTP/OPV/HIB phone call from ER 9JAN91 at 1210PM requesting info re: child''s status on visit 8JAN91. Informed ER child well-given 2nd DTP, OPV & 1st HBCV - ER stated child "SIDS" found by mother - brought to ER via rescue.


Changed on 10/14/2018

VAERS ID: 27506 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Virginia
Vaccinated:1991-01-08
Onset:1991-01-09
Submitted:1991-01-10
Entered:1991-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 293947 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M705FE / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 291964 / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-01-09
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: Tylenol drops PRN
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: other pending autopsy at hospital. No lab work done 8JAN91
CDC 'Split Type': VA91001

Write-up: Pt vaccinated with DTP/OPV/HIB phone call from ER 9JAN91 at 1210PM requesting info re: child''s status on visit 8JAN91. Informed ER child well-given 2nd DTP, OPV & 1st HBCV - ER stated child "SIDS" found by mother - brought to ER via rescue.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=27506&WAYBACKHISTORY=ON


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