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This is VAERS ID 28357

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 28357
VAERS Form:
Age:0.5
Sex:Male
Location:California
Vaccinated:1991-01-28
Onset:1991-01-31
Submitted:1991-02-13
Entered:1991-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 291931 / 2 RL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M085FF / 1 LL / IM

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS, EDEMA LUNG, LUNG DIS, PETECHIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-01-31
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: none
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: autopsy underway- preliminary Dx- Sids
CDC 'Split Type': none

Write-up: Pt found dead in crib am 31Jan91, pt asymptomatic prior to death.


Changed on 12/8/2009

VAERS ID: 28357 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:California
Vaccinated:1991-01-28
Onset:1991-01-31
Submitted:1991-02-13
Entered:1991-02-26 1991-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 291931 / 2 RL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M085FF / 1 LL / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Lung disorder, Petechiae, Pulmonary oedema, SIDS, Sudden infant death syndrome, EDEMA LUNG, LUNG DIS, PETECHIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-01-31
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: none
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: autopsy underway- preliminary Dx- Sids
CDC 'Split Type': none (blank)

Write-up: Pt found dead in crib am 31Jan91, pt asymptomatic prior to death.


Changed on 5/14/2017

VAERS ID: 28357 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:California
Vaccinated:1991-01-28
Onset:1991-01-31
Submitted:1991-02-13
Entered:1991-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291931 / 2 RL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M085FF / 1 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Lung disorder, Petechiae, Pulmonary oedema, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-01-31
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: none none~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: autopsy underway- preliminary Dx- Sids
CDC 'Split Type':

Write-up: Pt found dead in crib am 31Jan91, pt asymptomatic prior to death.


Changed on 9/14/2017

VAERS ID: 28357 Before After
VAERS Form:(blank) 1
Age:0.5
Sex:Male
Location:California
Vaccinated:1991-01-28
Onset:1991-01-31
Submitted:1991-02-13
Entered:1991-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291931 / 2 3 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M085FF / 1 2 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Lung disorder, Petechiae, Pulmonary oedema, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-01-31
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: none~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: autopsy underway- preliminary Dx- Sids
CDC 'Split Type':

Write-up: Pt found dead in crib am 31Jan91, pt asymptomatic prior to death.


Changed on 2/14/2018

VAERS ID: 28357 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:California
Vaccinated:1991-01-28
Onset:1991-01-31
Submitted:1991-02-13
Entered:1991-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291931 / 3 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M085FF / 2 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Lung disorder, Petechiae, Pulmonary oedema, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-01-31
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: none~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: autopsy underway- preliminary Dx- Sids
CDC 'Split Type':

Write-up: Pt found dead in crib am 31Jan91, pt asymptomatic prior to death.


Changed on 6/14/2018

VAERS ID: 28357 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:California
Vaccinated:1991-01-28
Onset:1991-01-31
Submitted:1991-02-13
Entered:1991-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291931 / 3 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M085FF / 2 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Lung disorder, Petechiae, Pulmonary oedema, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-01-31
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: none~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: autopsy underway- preliminary Dx- Sids
CDC 'Split Type':

Write-up: Pt found dead in crib am 31Jan91, pt asymptomatic prior to death.


Changed on 8/14/2018

VAERS ID: 28357 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:California
Vaccinated:1991-01-28
Onset:1991-01-31
Submitted:1991-02-13
Entered:1991-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291931 / 3 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M085FF / 2 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Lung disorder, Petechiae, Pulmonary oedema, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-01-31
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: none~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: autopsy underway- preliminary Dx- Sids
CDC 'Split Type':

Write-up: Pt found dead in crib am 31Jan91, pt asymptomatic prior to death.


Changed on 9/14/2018

VAERS ID: 28357 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:California
Vaccinated:1991-01-28
Onset:1991-01-31
Submitted:1991-02-13
Entered:1991-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291931 / 3 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M085FF / 2 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Lung disorder, Petechiae, Pulmonary oedema, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-01-31
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: none~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: autopsy underway- preliminary Dx- Sids
CDC 'Split Type':

Write-up: Pt found dead in crib am 31Jan91, pt asymptomatic prior to death.


Changed on 10/14/2018

VAERS ID: 28357 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:California
Vaccinated:1991-01-28
Onset:1991-01-31
Submitted:1991-02-13
Entered:1991-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291931 / 3 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M085FF / 2 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Lung disorder, Petechiae, Pulmonary oedema, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-01-31
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: none~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: autopsy underway- preliminary Dx- Sids
CDC 'Split Type':

Write-up: Pt found dead in crib am 31Jan91, pt asymptomatic prior to death.

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