National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 28321

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 28321
VAERS Form:
Age:0.3
Sex:Male
Location:Oregon
Vaccinated:1991-02-05
Onset:1991-02-06
Submitted:1991-02-07
Entered:1991-02-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 285918 / 0 LL / -
HIBV: HIBTITER / LEDERLE(PRAXIS) M200FE / 0 LL / -
OPV: ORIMUNE / LEDERLE 291938 / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-02-06
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 poss.
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Autopsy-$g no cause found
CDC 'Split Type':

Write-up: sids death 16-24 hrs /p administration of imm.


Changed on 12/8/2009

VAERS ID: 28321 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Oregon
Vaccinated:1991-02-05
Onset:1991-02-06
Submitted:1991-02-07
Entered:1991-02-20 1991-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 285918 / 0 LL / -
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M200FE / 0 LL / -
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:1991-02-06
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 poss.
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Autopsy-$g no cause found
CDC 'Split Type':

Write-up: sids death 16-24 hrs /p administration of imm.


Changed on 5/14/2017

VAERS ID: 28321 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Oregon
Vaccinated:1991-02-05
Onset:1991-02-06
Submitted:1991-02-07
Entered:1991-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285918 / 0 LL / -
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M200FE / 0 LL / -
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:1991-02-06
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 poss.
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Autopsy-$g no cause found
CDC 'Split Type':

Write-up: sids death 16-24 hrs /p administration of imm.


Changed on 9/14/2017

VAERS ID: 28321 Before After
VAERS Form:(blank) 1
Age:0.3
Sex:Male
Location:Oregon
Vaccinated:1991-02-05
Onset:1991-02-06
Submitted:1991-02-07
Entered:1991-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285918 / 0 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200FE / 0 1 LL / -
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:1991-02-06
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 poss.
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Autopsy-$g no cause found
CDC 'Split Type':

Write-up: sids death 16-24 hrs /p administration of imm.


Changed on 2/14/2018

VAERS ID: 28321 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Oregon
Vaccinated:1991-02-05
Onset:1991-02-06
Submitted:1991-02-07
Entered:1991-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285918 / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200FE / 1 LL / -
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:1991-02-06
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 poss.
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Autopsy-$g no cause found
CDC 'Split Type':

Write-up: sids death 16-24 hrs /p administration of imm.


Changed on 6/14/2018

VAERS ID: 28321 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Oregon
Vaccinated:1991-02-05
Onset:1991-02-06
Submitted:1991-02-07
Entered:1991-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285918 / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200FE / 1 LL / -
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:1991-02-06
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 poss.
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Autopsy-$g no cause found
CDC 'Split Type':

Write-up: sids death 16-24 hrs /p administration of imm.


Changed on 8/14/2018

VAERS ID: 28321 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Oregon
Vaccinated:1991-02-05
Onset:1991-02-06
Submitted:1991-02-07
Entered:1991-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285918 / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200FE / 1 LL / -
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:1991-02-06
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 poss.
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Autopsy-$g no cause found
CDC 'Split Type':

Write-up: sids death 16-24 hrs /p administration of imm.


Changed on 9/14/2018

VAERS ID: 28321 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Oregon
Vaccinated:1991-02-05
Onset:1991-02-06
Submitted:1991-02-07
Entered:1991-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285918 / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200FE / 1 LL / -
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:1991-02-06
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 poss.
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Autopsy-$g no cause found
CDC 'Split Type':

Write-up: sids death 16-24 hrs /p administration of imm.


Changed on 10/14/2018

VAERS ID: 28321 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Oregon
Vaccinated:1991-02-05
Onset:1991-02-06
Submitted:1991-02-07
Entered:1991-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285918 / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200FE / 1 LL / -
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:1991-02-06
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 poss.
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Autopsy-$g no cause found
CDC 'Split Type':

Write-up: sids death 16-24 hrs /p administration of imm.

New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=28321&WAYBACKHISTORY=ON


Copyright © 2019 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166