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This is VAERS ID 28073

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 28073
VAERS Form:
Age:0.2
Sex:Female
Location:Arizona
Vaccinated:1990-12-19
Onset:1990-12-22
Submitted:1990-12-26
Entered:1991-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP / CONNAUGHT LABS 0F11081 / 0 LL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M190FO / 0 RL / IM
OPV: ORIMUNE / LEDERLE 291938 / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-22
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 sister; high fever; DTP/OPV; 1 dose.
Other Medications: None
Current Illness: None
Preexisting Conditions: Resolved otitis media
Allergies:
Diagnostic Lab Data: Autopsy consistent with SIDS.
CDC 'Split Type': Resolved otitis media

Write-up: Baby found dead in crib early in tha AM on 22DEC90; Sudden Infant Death Syndrome.


Changed on 12/8/2009

VAERS ID: 28073 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Arizona
Vaccinated:1990-12-19
Onset:1990-12-22
Submitted:1990-12-26
Entered:1991-02-14 1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP DTP (NO BRAND NAME) / CONNAUGHT LABS CONNAUGHT LABORATORIES 0F11081 / 0 LL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M190FO / 0 RL / IM
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 291938 / 0 - / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-22
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 sister; high fever; DTP/OPV; 1 dose.
Other Medications: None
Current Illness: None
Preexisting Conditions: Resolved otitis media
Allergies:
Diagnostic Lab Data: Autopsy consistent with SIDS.
CDC 'Split Type': Resolved otitis media (blank)

Write-up: Baby found dead in crib early in tha AM on 22DEC90; Sudden Infant Death Syndrome.


Changed on 5/14/2017

VAERS ID: 28073 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Arizona
Vaccinated:1990-12-19
Onset:1990-12-22
Submitted:1990-12-26
Entered:1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0F11081 / 0 LL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M190FO / 0 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 291938 / 0 - / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-22
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 sister; high fever; DTP/OPV; 1 dose. dose.~ ()~~~In Sibling
Other Medications: None
Current Illness: None
Preexisting Conditions: Resolved otitis media
Allergies:
Diagnostic Lab Data: Autopsy consistent with SIDS.
CDC 'Split Type':

Write-up: Baby found dead in crib early in tha AM on 22DEC90; Sudden Infant Death Syndrome.


Changed on 9/14/2017

VAERS ID: 28073 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Female
Location:Arizona
Vaccinated:1990-12-19
Onset:1990-12-22
Submitted:1990-12-26
Entered:1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0F11081 / 0 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M190FO / 0 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 291938 / 0 1 - MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-22
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 sister; high fever; DTP/OPV; 1 dose.~ ()~~~In Sibling
Other Medications: None
Current Illness: None
Preexisting Conditions: Resolved otitis media
Allergies:
Diagnostic Lab Data: Autopsy consistent with SIDS.
CDC 'Split Type':

Write-up: Baby found dead in crib early in tha AM on 22DEC90; Sudden Infant Death Syndrome.


Changed on 2/14/2018

VAERS ID: 28073 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Arizona
Vaccinated:1990-12-19
Onset:1990-12-22
Submitted:1990-12-26
Entered:1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0F11081 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M190FO / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 291938 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-22
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 sister; high fever; DTP/OPV; 1 dose.~ ()~~~In Sibling
Other Medications: None
Current Illness: None
Preexisting Conditions: Resolved otitis media
Allergies:
Diagnostic Lab Data: Autopsy consistent with SIDS.
CDC 'Split Type':

Write-up: Baby found dead in crib early in tha AM on 22DEC90; Sudden Infant Death Syndrome.


Changed on 6/14/2018

VAERS ID: 28073 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Arizona
Vaccinated:1990-12-19
Onset:1990-12-22
Submitted:1990-12-26
Entered:1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0F11081 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M190FO / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 291938 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-22
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 sister; high fever; DTP/OPV; 1 dose.~ ()~~~In Sibling
Other Medications: None
Current Illness: None
Preexisting Conditions: Resolved otitis media
Allergies:
Diagnostic Lab Data: Autopsy consistent with SIDS.
CDC 'Split Type':

Write-up: Baby found dead in crib early in tha AM on 22DEC90; Sudden Infant Death Syndrome.


Changed on 8/14/2018

VAERS ID: 28073 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Arizona
Vaccinated:1990-12-19
Onset:1990-12-22
Submitted:1990-12-26
Entered:1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0F11081 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M190FO / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 291938 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-22
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 sister; high fever; DTP/OPV; 1 dose.~ ()~~~In Sibling
Other Medications: None
Current Illness: None
Preexisting Conditions: Resolved otitis media
Allergies:
Diagnostic Lab Data: Autopsy consistent with SIDS.
CDC 'Split Type':

Write-up: Baby found dead in crib early in tha AM on 22DEC90; Sudden Infant Death Syndrome.


Changed on 9/14/2018

VAERS ID: 28073 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Arizona
Vaccinated:1990-12-19
Onset:1990-12-22
Submitted:1990-12-26
Entered:1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0F11081 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M190FO / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 291938 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-22
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 sister; high fever; DTP/OPV; 1 dose.~ ()~~~In Sibling
Other Medications: None
Current Illness: None
Preexisting Conditions: Resolved otitis media
Allergies:
Diagnostic Lab Data: Autopsy consistent with SIDS.
CDC 'Split Type':

Write-up: Baby found dead in crib early in tha AM on 22DEC90; Sudden Infant Death Syndrome.


Changed on 10/14/2018

VAERS ID: 28073 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Arizona
Vaccinated:1990-12-19
Onset:1990-12-22
Submitted:1990-12-26
Entered:1991-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0F11081 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M190FO / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 291938 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-12-22
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 sister; high fever; DTP/OPV; 1 dose.~ ()~~~In Sibling
Other Medications: None
Current Illness: None
Preexisting Conditions: Resolved otitis media
Allergies:
Diagnostic Lab Data: Autopsy consistent with SIDS.
CDC 'Split Type':

Write-up: Baby found dead in crib early in tha AM on 22DEC90; Sudden Infant Death Syndrome.

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