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This is VAERS ID 27691

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 27691
VAERS Form:
Age:0.5
Sex:Male
Location:Minnesota
Vaccinated:1991-01-17
Onset:1991-01-23
Submitted:1991-01-24
Entered:1991-02-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP / CONNAUGHT LABS 0A21149 / 2 LL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M090FF / 1 RL / IM

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-01-23
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: Septra
Current Illness: otitis media
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Autopsy - no evidence for abnormalities.
CDC 'Split Type':

Write-up: Crib Death; Felt to be sids.


Changed on 12/8/2009

VAERS ID: 27691 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Minnesota
Vaccinated:1991-01-17
Onset:1991-01-23
Submitted:1991-01-24
Entered:1991-02-06 1991-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP DTP (NO BRAND NAME) / CONNAUGHT LABS CONNAUGHT LABORATORIES 0A21149 / 2 LL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M090FF / 1 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-01-23
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: Septra
Current Illness: otitis media
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Autopsy - no evidence for abnormalities.
CDC 'Split Type':

Write-up: Crib Death; Felt to be sids.


Changed on 5/14/2017

VAERS ID: 27691 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Minnesota
Vaccinated:1991-01-17
Onset:1991-01-23
Submitted:1991-01-24
Entered:1991-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0A21149 / 2 LL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M090FF / 1 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-01-23
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: Septra
Current Illness: otitis media
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Autopsy - no evidence for abnormalities.
CDC 'Split Type':

Write-up: Crib Death; Felt to be sids.


Changed on 9/14/2017

VAERS ID: 27691 Before After
VAERS Form:(blank) 1
Age:0.5
Sex:Male
Location:Minnesota
Vaccinated:1991-01-17
Onset:1991-01-23
Submitted:1991-01-24
Entered:1991-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0A21149 / 2 3 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M090FF / 1 2 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-01-23
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: Septra
Current Illness: otitis media
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Autopsy - no evidence for abnormalities.
CDC 'Split Type':

Write-up: Crib Death; Felt to be sids.


Changed on 2/14/2018

VAERS ID: 27691 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:Minnesota
Vaccinated:1991-01-17
Onset:1991-01-23
Submitted:1991-01-24
Entered:1991-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0A21149 / 3 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M090FF / 2 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-01-23
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: Septra
Current Illness: otitis media
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Autopsy - no evidence for abnormalities.
CDC 'Split Type':

Write-up: Crib Death; Felt to be sids.


Changed on 6/14/2018

VAERS ID: 27691 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:Minnesota
Vaccinated:1991-01-17
Onset:1991-01-23
Submitted:1991-01-24
Entered:1991-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0A21149 / 3 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M090FF / 2 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-01-23
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: Septra
Current Illness: otitis media
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Autopsy - no evidence for abnormalities.
CDC 'Split Type':

Write-up: Crib Death; Felt to be sids.


Changed on 8/14/2018

VAERS ID: 27691 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:Minnesota
Vaccinated:1991-01-17
Onset:1991-01-23
Submitted:1991-01-24
Entered:1991-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0A21149 / 3 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M090FF / 2 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-01-23
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: Septra
Current Illness: otitis media
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Autopsy - no evidence for abnormalities.
CDC 'Split Type':

Write-up: Crib Death; Felt to be sids.


Changed on 9/14/2018

VAERS ID: 27691 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:Minnesota
Vaccinated:1991-01-17
Onset:1991-01-23
Submitted:1991-01-24
Entered:1991-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0A21149 / 3 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M090FF / 2 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-01-23
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: Septra
Current Illness: otitis media
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Autopsy - no evidence for abnormalities.
CDC 'Split Type':

Write-up: Crib Death; Felt to be sids.


Changed on 10/14/2018

VAERS ID: 27691 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:Minnesota
Vaccinated:1991-01-17
Onset:1991-01-23
Submitted:1991-01-24
Entered:1991-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0A21149 / 3 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M090FF / 2 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-01-23
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: Septra
Current Illness: otitis media
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Autopsy - no evidence for abnormalities.
CDC 'Split Type':

Write-up: Crib Death; Felt to be sids.

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