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This is VAERS ID 28826

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 28826
VAERS Form:
Age:0.3
Sex:Male
Location:Oregon
Vaccinated:1991-01-16
Onset:1991-02-09
Submitted:1991-02-15
Entered:1991-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 271916 / 0 RL / -
HIBV: HIBTITER / LEDERLE(PRAXIS) M705EF / 0 LL / -
OPV: ORIMUNE / LEDERLE 0614A / 0 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: SIDS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-02-09
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: NONE
Current Illness: NONE
Preexisting Conditions: 2 wks premie/C-section for mom''s eclampsia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS.


Changed on 12/8/2009

VAERS ID: 28826 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Oregon
Vaccinated:1991-01-16
Onset:1991-02-09
Submitted:1991-02-15
Entered:1991-03-13 1991-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 271916 / 0 RL / -
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M705EF / 0 LL / -
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 0614A / 0 - / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-02-09
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: NONE
Current Illness: NONE
Preexisting Conditions: 2 wks premie/C-section for mom''s eclampsia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) OR913

Write-up: SIDS.


Changed on 5/14/2017

VAERS ID: 28826 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Oregon
Vaccinated:1991-01-16
Onset:1991-02-09
Submitted:1991-02-15
Entered:1991-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271916 / 0 RL / -
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M705EF / 0 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 0614A / 0 - / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-02-09
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: NONE
Current Illness: NONE
Preexisting Conditions: 2 wks premie/C-section for mom''s eclampsia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': OR913

Write-up: SIDS.


Changed on 9/14/2017

VAERS ID: 28826 Before After
VAERS Form:(blank) 1
Age:0.3
Sex:Male
Location:Oregon
Vaccinated:1991-01-16
Onset:1991-02-09
Submitted:1991-02-15
Entered:1991-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271916 / 0 1 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M705EF / 0 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0614A / 0 1 - MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-02-09
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: NONE
Current Illness: NONE
Preexisting Conditions: 2 wks premie/C-section for mom''s eclampsia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': OR913

Write-up: SIDS.


Changed on 2/14/2018

VAERS ID: 28826 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Oregon
Vaccinated:1991-01-16
Onset:1991-02-09
Submitted:1991-02-15
Entered:1991-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271916 / 1 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M705EF / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0614A / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-02-09
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: NONE
Current Illness: NONE
Preexisting Conditions: 2 wks premie/C-section for mom''s eclampsia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': OR913

Write-up: SIDS.


Changed on 6/14/2018

VAERS ID: 28826 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Oregon
Vaccinated:1991-01-16
Onset:1991-02-09
Submitted:1991-02-15
Entered:1991-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271916 / 1 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M705EF / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0614A / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-02-09
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: NONE
Current Illness: NONE
Preexisting Conditions: 2 wks premie/C-section for mom''s eclampsia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': OR913

Write-up: SIDS.


Changed on 8/14/2018

VAERS ID: 28826 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Oregon
Vaccinated:1991-01-16
Onset:1991-02-09
Submitted:1991-02-15
Entered:1991-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271916 / 1 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M705EF / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0614A / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-02-09
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: NONE
Current Illness: NONE
Preexisting Conditions: 2 wks premie/C-section for mom''s eclampsia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': OR913

Write-up: SIDS.


Changed on 9/14/2018

VAERS ID: 28826 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Oregon
Vaccinated:1991-01-16
Onset:1991-02-09
Submitted:1991-02-15
Entered:1991-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271916 / 1 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M705EF / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0614A / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-02-09
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: NONE
Current Illness: NONE
Preexisting Conditions: 2 wks premie/C-section for mom''s eclampsia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': OR913

Write-up: SIDS.


Changed on 10/14/2018

VAERS ID: 28826 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Oregon
Vaccinated:1991-01-16
Onset:1991-02-09
Submitted:1991-02-15
Entered:1991-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271916 / 1 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M705EF / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0614A / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-02-09
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: NONE
Current Illness: NONE
Preexisting Conditions: 2 wks premie/C-section for mom''s eclampsia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': OR913

Write-up: SIDS.

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