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This is VAERS ID 29272

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 29272
VAERS Form:
Age:0.4
Sex:Male
Location:Oregon
Vaccinated:1991-01-30
Onset:1991-02-25
Submitted:1991-03-08
Entered:1991-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP / CONNAUGHT LABS 0B21044 / 1 RL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M085FF / 1 LL / IM
OPV: ORIMUNE / LEDERLE 0626F / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-02-25
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: Pierre/Robin synd; Cerebral Palsy
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS Death;


Changed on 12/8/2009

VAERS ID: 29272 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:Oregon
Vaccinated:1991-01-30
Onset:1991-02-25
Submitted:1991-03-08
Entered:1991-03-27 1991-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP DTP (NO BRAND NAME) / CONNAUGHT LABS CONNAUGHT LABORATORIES 0B21044 / 1 RL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M085FF / 1 LL / IM
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 0626F / 1 - / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-02-25
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: Pierre/Robin synd; Cerebral Palsy
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS Death;


Changed on 5/14/2017

VAERS ID: 29272 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:Oregon
Vaccinated:1991-01-30
Onset:1991-02-25
Submitted:1991-03-08
Entered:1991-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0B21044 / 1 RL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M085FF / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 0626F / 1 - / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-02-25
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: Pierre/Robin synd; Cerebral Palsy
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS Death;


Changed on 9/14/2017

VAERS ID: 29272 Before After
VAERS Form:(blank) 1
Age:0.4
Sex:Male
Location:Oregon
Vaccinated:1991-01-30
Onset:1991-02-25
Submitted:1991-03-08
Entered:1991-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0B21044 / 1 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M085FF / 1 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0626F / 1 2 - MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-02-25
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: Pierre/Robin synd; Cerebral Palsy
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS Death;


Changed on 2/14/2018

VAERS ID: 29272 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Oregon
Vaccinated:1991-01-30
Onset:1991-02-25
Submitted:1991-03-08
Entered:1991-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0B21044 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M085FF / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0626F / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-02-25
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: Pierre/Robin synd; Cerebral Palsy
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS Death;


Changed on 6/14/2018

VAERS ID: 29272 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Oregon
Vaccinated:1991-01-30
Onset:1991-02-25
Submitted:1991-03-08
Entered:1991-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0B21044 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M085FF / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0626F / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-02-25
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: Pierre/Robin synd; Cerebral Palsy
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS Death;


Changed on 8/14/2018

VAERS ID: 29272 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Oregon
Vaccinated:1991-01-30
Onset:1991-02-25
Submitted:1991-03-08
Entered:1991-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0B21044 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M085FF / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0626F / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-02-25
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: Pierre/Robin synd; Cerebral Palsy
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS Death;


Changed on 9/14/2018

VAERS ID: 29272 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Oregon
Vaccinated:1991-01-30
Onset:1991-02-25
Submitted:1991-03-08
Entered:1991-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0B21044 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M085FF / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0626F / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-02-25
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: Pierre/Robin synd; Cerebral Palsy
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS Death;


Changed on 10/14/2018

VAERS ID: 29272 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Oregon
Vaccinated:1991-01-30
Onset:1991-02-25
Submitted:1991-03-08
Entered:1991-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0B21044 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M085FF / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0626F / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-02-25
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: Pierre/Robin synd; Cerebral Palsy
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS Death;

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