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This is VAERS ID 28873

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 28873
VAERS Form:
Age:0.2
Sex:Female
Location:New York
Vaccinated:1991-01-28
Onset:1991-01-30
Submitted:1991-02-12
Entered:1991-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 289962 / - - / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M740EN / - - / IM
OPV: ORIMUNE / LEDERLE 283946 / - - / PO

Administered by: Other      Purchased by: Unknown
Symptoms: REACT UNEVAL

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Preexisting Conditions: birthweight 6 lbs, full term pregnancy; uncomplicated spontaneous delivery. Family hx of astham.
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: 2 mo infant rec''d DTP/OPV/HIB TITER on 28JAN91. Pt died (DATE & TIME UNKNOWN).


Changed on 12/8/2009

VAERS ID: 28873 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:New York
Vaccinated:1991-01-28
Onset:1991-01-30
Submitted:1991-02-12
Entered:1991-03-13 1991-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 289962 / - - / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M740EN / - - / IM
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 283946 / - - / PO

Administered by: Other      Purchased by: Unknown Other
Symptoms: Unevaluable event, REACT UNEVAL

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Preexisting Conditions: birthweight 6 lbs, full term pregnancy; uncomplicated spontaneous delivery. Family hx of astham.
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': (blank) 910032401

Write-up: 2 mo infant rec''d DTP/OPV/HIB TITER on 28JAN91. Pt died (DATE & TIME UNKNOWN).


Changed on 5/14/2017

VAERS ID: 28873 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:New York
Vaccinated:1991-01-28
Onset:1991-01-30
Submitted:1991-02-12
Entered:1991-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289962 / - - / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M740EN / - - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 283946 / - - / PO

Administered by: Other      Purchased by: Other
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Preexisting Conditions: birthweight 6 lbs, full term pregnancy; uncomplicated spontaneous delivery. Family hx of astham.
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': 910032401

Write-up: 2 mo infant rec''d DTP/OPV/HIB TITER on 28JAN91. Pt died (DATE & TIME UNKNOWN).


Changed on 9/14/2017

VAERS ID: 28873 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Female
Location:New York
Vaccinated:1991-01-28
Onset:1991-01-30
Submitted:1991-02-12
Entered:1991-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289962 / - UNK - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M740EN / - UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 283946 / - UNK - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Preexisting Conditions: birthweight 6 lbs, full term pregnancy; uncomplicated spontaneous delivery. Family hx of astham.
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': 910032401

Write-up: 2 mo infant rec''d DTP/OPV/HIB TITER on 28JAN91. Pt died (DATE & TIME UNKNOWN).


Changed on 2/14/2018

VAERS ID: 28873 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:New York
Vaccinated:1991-01-28
Onset:1991-01-30
Submitted:1991-02-12
Entered:1991-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289962 / UNK - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M740EN / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 283946 / UNK MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Preexisting Conditions: birthweight 6 lbs, full term pregnancy; uncomplicated spontaneous delivery. Family hx of astham.
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': 910032401

Write-up: 2 mo infant rec''d DTP/OPV/HIB TITER on 28JAN91. Pt died (DATE & TIME UNKNOWN).


Changed on 6/14/2018

VAERS ID: 28873 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:New York
Vaccinated:1991-01-28
Onset:1991-01-30
Submitted:1991-02-12
Entered:1991-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289962 / UNK - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M740EN / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 283946 / UNK MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Preexisting Conditions: birthweight 6 lbs, full term pregnancy; uncomplicated spontaneous delivery. Family hx of astham.
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': 910032401

Write-up: 2 mo infant rec''d DTP/OPV/HIB TITER on 28JAN91. Pt died (DATE & TIME UNKNOWN).


Changed on 8/14/2018

VAERS ID: 28873 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:New York
Vaccinated:1991-01-28
Onset:1991-01-30
Submitted:1991-02-12
Entered:1991-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289962 / UNK - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M740EN / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 283946 / UNK MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Preexisting Conditions: birthweight 6 lbs, full term pregnancy; uncomplicated spontaneous delivery. Family hx of astham.
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': 910032401

Write-up: 2 mo infant rec''d DTP/OPV/HIB TITER on 28JAN91. Pt died (DATE & TIME UNKNOWN).


Changed on 9/14/2018

VAERS ID: 28873 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:New York
Vaccinated:1991-01-28
Onset:1991-01-30
Submitted:1991-02-12
Entered:1991-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289962 / UNK - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M740EN / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 283946 / UNK MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Preexisting Conditions: birthweight 6 lbs, full term pregnancy; uncomplicated spontaneous delivery. Family hx of astham.
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': 910032401

Write-up: 2 mo infant rec''d DTP/OPV/HIB TITER on 28JAN91. Pt died (DATE & TIME UNKNOWN).


Changed on 10/14/2018

VAERS ID: 28873 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:New York
Vaccinated:1991-01-28
Onset:1991-01-30
Submitted:1991-02-12
Entered:1991-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289962 / UNK - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M740EN / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 283946 / UNK MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Preexisting Conditions: birthweight 6 lbs, full term pregnancy; uncomplicated spontaneous delivery. Family hx of astham.
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': 910032401

Write-up: 2 mo infant rec''d DTP/OPV/HIB TITER on 28JAN91. Pt died (DATE & TIME UNKNOWN).

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