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This is VAERS ID 29348

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 29348
VAERS Form:
Age:0.4
Sex:Male
Location:New Jersey
Vaccinated:1991-03-08
Onset:1991-03-10
Submitted:1991-03-21
Entered:1991-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP / CONNAUGHT LABS 0C21045 / 0 LL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M085FP / 0 RL / IM
OPV: ORIMUNE / LEDERLE 295950 / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: HYPOTONIA, CYANOSIS, HEART ARREST

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1991-03-12
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: NA
Other Medications: Amoxil, Ventolin
Current Illness: Resolving otitis & bronchiolitis;
Preexisting Conditions: Clinically well by hx of Physical exam
Allergies:
Diagnostic Lab Data: Pt to Bridgeton ER & Transferred to Children''s Hosp of Phila
CDC 'Split Type': Clinically well by hx of Physical exam

Write-up: 10MAR91 child found by aunt cyanotic & "still" in crib rushed to ER Cardiac arrest-intubated & resuscitated-transferred to Hosp.


Changed on 12/8/2009

VAERS ID: 29348 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:New Jersey
Vaccinated:1991-03-08
Onset:1991-03-10
Submitted:1991-03-21
Entered:1991-03-29 1991-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP DTP (NO BRAND NAME) / CONNAUGHT LABS CONNAUGHT LABORATORIES 0C21045 / 0 LL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M085FP / 0 RL / IM
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 295950 / 0 - / PO

Administered by: Private      Purchased by: Unknown Private
Symptoms: Cardiac arrest, Cyanosis, Hypotonia, HYPOTONIA, CYANOSIS, HEART ARREST

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1991-03-12
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: NA
Other Medications: Amoxil, Ventolin
Current Illness: Resolving otitis & bronchiolitis;
Preexisting Conditions: Clinically well by hx of Physical exam
Allergies:
Diagnostic Lab Data: Pt to Bridgeton ER & Transferred to Children''s Hosp of Phila
CDC 'Split Type': Clinically well by hx of Physical exam (blank)

Write-up: 10MAR91 child found by aunt cyanotic & "still" in crib rushed to ER Cardiac arrest-intubated & resuscitated-transferred to Hosp.


Changed on 2/13/2013

VAERS ID: 29348 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:New Jersey
Vaccinated:1991-03-08
Onset:1991-03-10
Submitted:1991-03-21
Entered:1991-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0C21045 / 0 LL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M085FP / 0 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 295950 / 0 - / PO

Administered by: Private Unknown      Purchased by: Private Unknown
Symptoms: Cardiac arrest, Cyanosis, Hypotonia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1991-03-12
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: NA NA~ ()~~0.00~Patient
Other Medications: Amoxil, Ventolin
Current Illness: Resolving otitis & bronchiolitis;
Preexisting Conditions: Clinically well by hx of Physical exam
Allergies:
Diagnostic Lab Data: Pt to Bridgeton ER & Transferred to Children''s Hosp of Phila another hospital
CDC 'Split Type':

Write-up: 10MAR91 child found by aunt cyanotic & "still" in crib rushed to ER Cardiac arrest-intubated & resuscitated-transferred to Hosp.


Changed on 6/14/2014

VAERS ID: 29348 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:New Jersey
Vaccinated:1991-03-08
Onset:1991-03-10
Submitted:1991-03-21
Entered:1991-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0C21045 / 0 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M085FP / 0 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 295950 / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cardiac arrest, Cyanosis, Hypotonia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1991-03-12
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: NA~ ()~~0.00~Patient
Other Medications: Amoxil, Ventolin
Current Illness: Resolving otitis & bronchiolitis;
Preexisting Conditions: Clinically well by hx of Physical exam
Allergies:
Diagnostic Lab Data: Pt to ER & Transferred to another hospital
CDC 'Split Type':

Write-up: 10MAR91 child found by aunt cyanotic & "still" in crib rushed to ER Cardiac arrest-intubated & resuscitated-transferred to Hosp.


Changed on 3/14/2015

VAERS ID: 29348 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:New Jersey
Vaccinated:1991-03-08
Onset:1991-03-10
Submitted:1991-03-21
Entered:1991-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0C21045 / 0 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M085FP / 0 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 295950 / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cardiac arrest, Cyanosis, Hypotonia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1991-03-12
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: NA~ ()~~0.00~Patient
Other Medications: Amoxil, Ventolin
Current Illness: Resolving otitis & bronchiolitis;
Preexisting Conditions: Clinically well by hx of Physical exam
Allergies:
Diagnostic Lab Data: Pt to ER & Transferred to another hospital
CDC 'Split Type':

Write-up: 10MAR91 child found by aunt cyanotic & "still" in crib rushed to ER Cardiac arrest-intubated & resuscitated-transferred to Hosp.


Changed on 2/14/2017

VAERS ID: 29348 Before After
VAERS Form:
Age:0.4 0.38
Sex:Male
Location:New Jersey
Vaccinated:1991-03-08
Onset:1991-03-10
Submitted:1991-03-21
Entered:1991-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0C21045 / 0 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M085FP / 0 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 295950 / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cardiac arrest, Cyanosis, Hypotonia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1991-03-12
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: NA~ ()~~0.00~Patient
Other Medications: Amoxil, Ventolin
Current Illness: Resolving otitis & bronchiolitis;
Preexisting Conditions: Clinically well by hx of Physical exam
Allergies:
Diagnostic Lab Data: Pt to ER & Transferred to another hospital
CDC 'Split Type':

Write-up: 10MAR91 child found by aunt cyanotic & "still" in crib rushed to ER Cardiac arrest-intubated & resuscitated-transferred to Hosp.


Changed on 9/14/2017

VAERS ID: 29348 Before After
VAERS Form:(blank) 1
Age:0.38
Sex:Male
Location:New Jersey
Vaccinated:1991-03-08
Onset:1991-03-10
Submitted:1991-03-21
Entered:1991-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0C21045 / 0 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M085FP / 0 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 295950 / 0 1 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cardiac arrest, Cyanosis, Hypotonia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1991-03-12
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: NA~ ()~~0.00~Patient
Other Medications: Amoxil, Ventolin
Current Illness: Resolving otitis & bronchiolitis;
Preexisting Conditions: Clinically well by hx of Physical exam
Allergies:
Diagnostic Lab Data: Pt to ER & Transferred to another hospital
CDC 'Split Type':

Write-up: 10MAR91 child found by aunt cyanotic & "still" in crib rushed to ER Cardiac arrest-intubated & resuscitated-transferred to Hosp.


Changed on 2/14/2018

VAERS ID: 29348 Before After
VAERS Form:1
Age:0.38
Sex:Male
Location:New Jersey
Vaccinated:1991-03-08
Onset:1991-03-10
Submitted:1991-03-21
Entered:1991-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0C21045 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M085FP / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 295950 / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cardiac arrest, Cyanosis, Hypotonia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1991-03-12
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: NA~ ()~~0.00~Patient
Other Medications: Amoxil, Ventolin
Current Illness: Resolving otitis & bronchiolitis;
Preexisting Conditions: Clinically well by hx of Physical exam
Allergies:
Diagnostic Lab Data: Pt to ER & Transferred to another hospital
CDC 'Split Type':

Write-up: 10MAR91 child found by aunt cyanotic & "still" in crib rushed to ER Cardiac arrest-intubated & resuscitated-transferred to Hosp.


Changed on 6/14/2018

VAERS ID: 29348 Before After
VAERS Form:1
Age:0.38
Sex:Male
Location:New Jersey
Vaccinated:1991-03-08
Onset:1991-03-10
Submitted:1991-03-21
Entered:1991-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0C21045 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M085FP / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 295950 / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cardiac arrest, Cyanosis, Hypotonia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1991-03-12
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: NA~ ()~~0.00~Patient
Other Medications: Amoxil, Ventolin
Current Illness: Resolving otitis & bronchiolitis;
Preexisting Conditions: Clinically well by hx of Physical exam
Allergies:
Diagnostic Lab Data: Pt to ER & Transferred to another hospital
CDC 'Split Type':

Write-up: 10MAR91 child found by aunt cyanotic & "still" in crib rushed to ER Cardiac arrest-intubated & resuscitated-transferred to Hosp.


Changed on 8/14/2018

VAERS ID: 29348 Before After
VAERS Form:1
Age:0.38
Sex:Male
Location:New Jersey
Vaccinated:1991-03-08
Onset:1991-03-10
Submitted:1991-03-21
Entered:1991-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0C21045 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M085FP / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 295950 / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cardiac arrest, Cyanosis, Hypotonia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1991-03-12
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: NA~ ()~~0.00~Patient
Other Medications: Amoxil, Ventolin
Current Illness: Resolving otitis & bronchiolitis;
Preexisting Conditions: Clinically well by hx of Physical exam
Allergies:
Diagnostic Lab Data: Pt to ER & Transferred to another hospital
CDC 'Split Type':

Write-up: 10MAR91 child found by aunt cyanotic & "still" in crib rushed to ER Cardiac arrest-intubated & resuscitated-transferred to Hosp.


Changed on 9/14/2018

VAERS ID: 29348 Before After
VAERS Form:1
Age:0.38
Sex:Male
Location:New Jersey
Vaccinated:1991-03-08
Onset:1991-03-10
Submitted:1991-03-21
Entered:1991-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0C21045 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M085FP / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 295950 / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cardiac arrest, Cyanosis, Hypotonia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1991-03-12
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: NA~ ()~~0.00~Patient
Other Medications: Amoxil, Ventolin
Current Illness: Resolving otitis & bronchiolitis;
Preexisting Conditions: Clinically well by hx of Physical exam
Allergies:
Diagnostic Lab Data: Pt to ER & Transferred to another hospital
CDC 'Split Type':

Write-up: 10MAR91 child found by aunt cyanotic & "still" in crib rushed to ER Cardiac arrest-intubated & resuscitated-transferred to Hosp.


Changed on 10/14/2018

VAERS ID: 29348 Before After
VAERS Form:1
Age:0.38
Sex:Male
Location:New Jersey
Vaccinated:1991-03-08
Onset:1991-03-10
Submitted:1991-03-21
Entered:1991-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0C21045 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M085FP / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 295950 / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cardiac arrest, Cyanosis, Hypotonia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1991-03-12
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: NA~ ()~~0.00~Patient
Other Medications: Amoxil, Ventolin
Current Illness: Resolving otitis & bronchiolitis;
Preexisting Conditions: Clinically well by hx of Physical exam
Allergies:
Diagnostic Lab Data: Pt to ER & Transferred to another hospital
CDC 'Split Type':

Write-up: 10MAR91 child found by aunt cyanotic & "still" in crib rushed to ER Cardiac arrest-intubated & resuscitated-transferred to Hosp.

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