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This is VAERS ID 29256

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 29256
VAERS Form:
Age:0.2
Sex:Female
Location:Illinois
Vaccinated:1991-03-01
Onset:1991-03-02
Submitted:1991-03-05
Entered:1991-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 291928 / 0 L / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M670SH / 0 L / IM
OPV: ORIMUNE / LEDERLE 0624M / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-02
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: NA
Other Medications: NA
Current Illness: healthy
Preexisting Conditions: NA
Allergies:
Diagnostic Lab Data: Autopsy being performed. No report to date;
CDC 'Split Type': NA

Write-up: 3 mo infant rec''d DTP/HIBTITER/ORIMUNE 1MAR91; had no sx; Next morning 2MAR91 infant was found dead in crib by mom; autopsy is being performed;


Changed on 12/8/2009

VAERS ID: 29256 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Illinois
Vaccinated:1991-03-01
Onset:1991-03-02
Submitted:1991-03-05
Entered:1991-03-27 1991-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 291928 / 0 L / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M670SH / 0 L / IM
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 0624M / 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:1991-03-02
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: NA
Other Medications: NA
Current Illness: healthy
Preexisting Conditions: NA
Allergies:
Diagnostic Lab Data: Autopsy being performed. No report to date;
CDC 'Split Type': NA 910050501

Write-up: 3 mo infant rec''d DTP/HIBTITER/ORIMUNE 1MAR91; had no sx; Next morning 2MAR91 infant was found dead in crib by mom; autopsy is being performed;


Changed on 5/14/2017

VAERS ID: 29256 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Illinois
Vaccinated:1991-03-01
Onset:1991-03-02
Submitted:1991-03-05
Entered:1991-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291928 / 0 L - / IM IM L
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M670SH / 0 L - / IM IM L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 0624M / 0 - / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-02
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: NA NA~ ()~~~In patient
Other Medications: NA
Current Illness: healthy
Preexisting Conditions: NA
Allergies:
Diagnostic Lab Data: Autopsy being performed. No report to date;
CDC 'Split Type': 910050501

Write-up: 3 mo infant rec''d DTP/HIBTITER/ORIMUNE 1MAR91; had no sx; Next morning 2MAR91 infant was found dead in crib by mom; autopsy is being performed;


Changed on 9/14/2017

VAERS ID: 29256 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Female
Location:Illinois
Vaccinated:1991-03-01
Onset:1991-03-02
Submitted:1991-03-05
Entered:1991-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291928 / 0 1 - / IM L
HIBV: HIB (HIBTITER) / PFIZER/WYETH M670SH / 0 1 - / IM L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0624M / 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:1991-03-02
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: NA~ ()~~~In patient
Other Medications: NA
Current Illness: healthy
Preexisting Conditions: NA
Allergies:
Diagnostic Lab Data: Autopsy being performed. No report to date;
CDC 'Split Type': 910050501

Write-up: 3 mo infant rec''d DTP/HIBTITER/ORIMUNE 1MAR91; had no sx; Next morning 2MAR91 infant was found dead in crib by mom; autopsy is being performed;


Changed on 2/14/2018

VAERS ID: 29256 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Illinois
Vaccinated:1991-03-01
Onset:1991-03-02
Submitted:1991-03-05
Entered:1991-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291928 / 1 - / IM L
HIBV: HIB (HIBTITER) / PFIZER/WYETH M670SH / 1 - / IM L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0624M / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-02
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: NA~ ()~~~In patient
Other Medications: NA
Current Illness: healthy
Preexisting Conditions: NA
Allergies:
Diagnostic Lab Data: Autopsy being performed. No report to date;
CDC 'Split Type': 910050501

Write-up: 3 mo infant rec''d DTP/HIBTITER/ORIMUNE 1MAR91; had no sx; Next morning 2MAR91 infant was found dead in crib by mom; autopsy is being performed;


Changed on 6/14/2018

VAERS ID: 29256 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Illinois
Vaccinated:1991-03-01
Onset:1991-03-02
Submitted:1991-03-05
Entered:1991-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291928 / 1 - / IM L
HIBV: HIB (HIBTITER) / PFIZER/WYETH M670SH / 1 - / IM L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0624M / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-02
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: NA~ ()~~~In patient
Other Medications: NA
Current Illness: healthy
Preexisting Conditions: NA
Allergies:
Diagnostic Lab Data: Autopsy being performed. No report to date;
CDC 'Split Type': 910050501

Write-up: 3 mo infant rec''d DTP/HIBTITER/ORIMUNE 1MAR91; had no sx; Next morning 2MAR91 infant was found dead in crib by mom; autopsy is being performed;


Changed on 8/14/2018

VAERS ID: 29256 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Illinois
Vaccinated:1991-03-01
Onset:1991-03-02
Submitted:1991-03-05
Entered:1991-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291928 / 1 - / IM L
HIBV: HIB (HIBTITER) / PFIZER/WYETH M670SH / 1 - / IM L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0624M / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-02
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: NA~ ()~~~In patient
Other Medications: NA
Current Illness: healthy
Preexisting Conditions: NA
Allergies:
Diagnostic Lab Data: Autopsy being performed. No report to date;
CDC 'Split Type': 910050501

Write-up: 3 mo infant rec''d DTP/HIBTITER/ORIMUNE 1MAR91; had no sx; Next morning 2MAR91 infant was found dead in crib by mom; autopsy is being performed;


Changed on 9/14/2018

VAERS ID: 29256 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Illinois
Vaccinated:1991-03-01
Onset:1991-03-02
Submitted:1991-03-05
Entered:1991-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291928 / 1 - / IM L
HIBV: HIB (HIBTITER) / PFIZER/WYETH M670SH / 1 - / IM L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0624M / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-02
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: NA~ ()~~~In patient
Other Medications: NA
Current Illness: healthy
Preexisting Conditions: NA
Allergies:
Diagnostic Lab Data: Autopsy being performed. No report to date;
CDC 'Split Type': 910050501

Write-up: 3 mo infant rec''d DTP/HIBTITER/ORIMUNE 1MAR91; had no sx; Next morning 2MAR91 infant was found dead in crib by mom; autopsy is being performed;


Changed on 10/14/2018

VAERS ID: 29256 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Illinois
Vaccinated:1991-03-01
Onset:1991-03-02
Submitted:1991-03-05
Entered:1991-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291928 / 1 - / IM L
HIBV: HIB (HIBTITER) / PFIZER/WYETH M670SH / 1 - / IM L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0624M / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-02
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: NA~ ()~~~In patient
Other Medications: NA
Current Illness: healthy
Preexisting Conditions: NA
Allergies:
Diagnostic Lab Data: Autopsy being performed. No report to date;
CDC 'Split Type': 910050501

Write-up: 3 mo infant rec''d DTP/HIBTITER/ORIMUNE 1MAR91; had no sx; Next morning 2MAR91 infant was found dead in crib by mom; autopsy is being performed;

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=29256&WAYBACKHISTORY=ON


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