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This is VAERS ID 28827

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 28827
VAERS Form:
Age:0.7
Sex:Female
Location:Oregon
Vaccinated:1991-02-07
Onset:1991-02-09
Submitted:1991-02-21
Entered:1991-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP / CONNAUGHT LABS 283914 / 1 RL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M670FC / 0 LL / IM
OPV: ORIMUNE / LEDERLE 0619B / 1 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: SIDS, AGITATION, VASODILAT

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-02-10
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 report documented SIDS as cause of death
CDC 'Split Type': NONE

Write-up: 9FEB91 @ 8P parents remembered that Pt. was fussy & felt hot. Continued to feel hot & wake up every hr through the night.


Changed on 12/8/2009

VAERS ID: 28827 Before After
VAERS Form:
Age:0.7
Sex:Female
Location:Oregon
Vaccinated:1991-02-07
Onset:1991-02-09
Submitted:1991-02-21
Entered:1991-03-13 1991-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP DTP (NO BRAND NAME) / CONNAUGHT LABS CONNAUGHT LABORATORIES 283914 / 1 RL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M670FC / 0 LL / IM
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 0619B / 1 - / PO

Administered by: Public      Purchased by: Unknown Public
Symptoms: Agitation, SIDS, Sudden infant death syndrome, Vasodilatation, AGITATION, VASODILAT

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-02-10
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 report documented SIDS as cause of death
CDC 'Split Type': NONE OR915

Write-up: 9FEB91 @ 8P parents remembered that Pt. was fussy & felt hot. Continued to feel hot & wake up every hr through the night.


Changed on 5/14/2017

VAERS ID: 28827 Before After
VAERS Form:
Age:0.7
Sex:Female
Location:Oregon
Vaccinated:1991-02-07
Onset:1991-02-09
Submitted:1991-02-21
Entered:1991-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 283914 / 1 RL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M670FC / 0 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 0619B / 1 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Agitation, Sudden infant death syndrome, Vasodilatation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-02-10
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 report documented SIDS as cause of death
CDC 'Split Type': OR915

Write-up: 9FEB91 @ 8P parents remembered that Pt. was fussy & felt hot. Continued to feel hot & wake up every hr through the night.


Changed on 9/14/2017

VAERS ID: 28827 Before After
VAERS Form:(blank) 1
Age:0.7
Sex:Female
Location:Oregon
Vaccinated:1991-02-07
Onset:1991-02-09
Submitted:1991-02-21
Entered:1991-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 283914 / 1 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M670FC / 0 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0619B / 1 2 - MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Agitation, Sudden infant death syndrome, Vasodilatation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-02-10
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 report documented SIDS as cause of death
CDC 'Split Type': OR915

Write-up: 9FEB91 @ 8P parents remembered that Pt. was fussy & felt hot. Continued to feel hot & wake up every hr through the night.


Changed on 2/14/2018

VAERS ID: 28827 Before After
VAERS Form:1
Age:0.7
Sex:Female
Location:Oregon
Vaccinated:1991-02-07
Onset:1991-02-09
Submitted:1991-02-21
Entered:1991-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 283914 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M670FC / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0619B / 2 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Agitation, Sudden infant death syndrome, Vasodilatation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-02-10
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 report documented SIDS as cause of death
CDC 'Split Type': OR915

Write-up: 9FEB91 @ 8P parents remembered that Pt. was fussy & felt hot. Continued to feel hot & wake up every hr through the night.


Changed on 6/14/2018

VAERS ID: 28827 Before After
VAERS Form:1
Age:0.7
Sex:Female
Location:Oregon
Vaccinated:1991-02-07
Onset:1991-02-09
Submitted:1991-02-21
Entered:1991-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 283914 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M670FC / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0619B / 2 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Agitation, Sudden infant death syndrome, Vasodilatation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-02-10
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 report documented SIDS as cause of death
CDC 'Split Type': OR915

Write-up: 9FEB91 @ 8P parents remembered that Pt. was fussy & felt hot. Continued to feel hot & wake up every hr through the night.


Changed on 8/14/2018

VAERS ID: 28827 Before After
VAERS Form:1
Age:0.7
Sex:Female
Location:Oregon
Vaccinated:1991-02-07
Onset:1991-02-09
Submitted:1991-02-21
Entered:1991-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 283914 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M670FC / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0619B / 2 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Agitation, Sudden infant death syndrome, Vasodilatation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-02-10
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 report documented SIDS as cause of death
CDC 'Split Type': OR915

Write-up: 9FEB91 @ 8P parents remembered that Pt. was fussy & felt hot. Continued to feel hot & wake up every hr through the night.


Changed on 9/14/2018

VAERS ID: 28827 Before After
VAERS Form:1
Age:0.7
Sex:Female
Location:Oregon
Vaccinated:1991-02-07
Onset:1991-02-09
Submitted:1991-02-21
Entered:1991-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 283914 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M670FC / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0619B / 2 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Agitation, Sudden infant death syndrome, Vasodilatation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-02-10
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 report documented SIDS as cause of death
CDC 'Split Type': OR915

Write-up: 9FEB91 @ 8P parents remembered that Pt. was fussy & felt hot. Continued to feel hot & wake up every hr through the night.


Changed on 10/14/2018

VAERS ID: 28827 Before After
VAERS Form:1
Age:0.7
Sex:Female
Location:Oregon
Vaccinated:1991-02-07
Onset:1991-02-09
Submitted:1991-02-21
Entered:1991-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 283914 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M670FC / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0619B / 2 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Agitation, Sudden infant death syndrome, Vasodilatation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-02-10
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 report documented SIDS as cause of death
CDC 'Split Type': OR915

Write-up: 9FEB91 @ 8P parents remembered that Pt. was fussy & felt hot. Continued to feel hot & wake up every hr through the night.

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