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This is VAERS ID 29463

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 29463
VAERS Form:
Age:0.3
Sex:Male
Location:Texas
Vaccinated:1991-01-17
Onset:1991-01-17
Submitted:0000-00-00
Entered:1991-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 289963 / 0 LL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M200FD / 0 RL / IM
OPV: ORIMUNE / LEDERLE 0622D / 0 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: AGITATION, CYANOSIS, APNEA, CARDIOMEGALY, HERNIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-02-02
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:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: cranial synostosis & choanal atresia, & heart murmur
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: P/immun given client started to cry & then became apneic; PR noted 126; Apnea lasted only 15-20sec- raised lt arm & client responded imm; color ashen; DX w/hyperplastic heart: prognosis poor;


Changed on 12/8/2009

VAERS ID: 29463 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Texas
Vaccinated:1991-01-17
Onset:1991-01-17
Submitted:0000-00-00
Entered:1991-04-04 1991-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 289963 / 0 LL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M200FD / 0 RL / IM
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 0622D / 0 - / PO

Administered by: Public      Purchased by: Unknown Public
Symptoms: Agitation, Apnoea, Cardiomegaly, Cyanosis, Hernia, Pallor, Tachycardia, AGITATION, CYANOSIS, APNEA, CARDIOMEGALY, HERNIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-02-02
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:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: cranial synostosis & choanal atresia, & heart murmur
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) TX9108

Write-up: P/immun given client started to cry & then became apneic; PR noted 126; Apnea lasted only 15-20sec- raised lt arm & client responded imm; color ashen; DX w/hyperplastic heart: prognosis poor;


Changed on 5/14/2017

VAERS ID: 29463 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Texas
Vaccinated:1991-01-17
Onset:1991-01-17
Submitted:0000-00-00
Entered:1991-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289963 / 0 LL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M200FD / 0 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 0622D / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Agitation, Apnoea, Cardiomegaly, Cyanosis, Hernia, Pallor, Tachycardia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-02-02
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: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: cranial synostosis & choanal atresia, & heart murmur
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': TX9108

Write-up: P/immun given client started to cry & then became apneic; PR noted 126; Apnea lasted only 15-20sec- raised lt arm & client responded imm; color ashen; DX w/hyperplastic heart: prognosis poor;


Changed on 9/14/2017

VAERS ID: 29463 Before After
VAERS Form:(blank) 1
Age:0.3
Sex:Male
Location:Texas
Vaccinated:1991-01-17
Onset:1991-01-17
Submitted:0000-00-00
Entered:1991-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289963 / 0 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200FD / 0 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0622D / 0 1 - MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Agitation, Apnoea, Cardiomegaly, Cyanosis, Hernia, Pallor, Tachycardia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-02-02
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: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: cranial synostosis & choanal atresia, & heart murmur
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': TX9108

Write-up: P/immun given client started to cry & then became apneic; PR noted 126; Apnea lasted only 15-20sec- raised lt arm & client responded imm; color ashen; DX w/hyperplastic heart: prognosis poor;


Changed on 2/14/2018

VAERS ID: 29463 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Texas
Vaccinated:1991-01-17
Onset:1991-01-17
Submitted:0000-00-00
Entered:1991-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289963 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200FD / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0622D / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Agitation, Apnoea, Cardiomegaly, Cyanosis, Hernia, Pallor, Tachycardia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-02-02
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: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: cranial synostosis & choanal atresia, & heart murmur
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': TX9108

Write-up: P/immun given client started to cry & then became apneic; PR noted 126; Apnea lasted only 15-20sec- raised lt arm & client responded imm; color ashen; DX w/hyperplastic heart: prognosis poor;


Changed on 6/14/2018

VAERS ID: 29463 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Texas
Vaccinated:1991-01-17
Onset:1991-01-17
Submitted:0000-00-00
Entered:1991-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289963 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200FD / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0622D / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Agitation, Apnoea, Cardiomegaly, Cyanosis, Hernia, Pallor, Tachycardia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-02-02
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: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: cranial synostosis & choanal atresia, & heart murmur
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': TX9108

Write-up: P/immun given client started to cry & then became apneic; PR noted 126; Apnea lasted only 15-20sec- raised lt arm & client responded imm; color ashen; DX w/hyperplastic heart: prognosis poor;


Changed on 8/14/2018

VAERS ID: 29463 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Texas
Vaccinated:1991-01-17
Onset:1991-01-17
Submitted:0000-00-00
Entered:1991-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289963 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200FD / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0622D / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Agitation, Apnoea, Cardiomegaly, Cyanosis, Hernia, Pallor, Tachycardia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-02-02
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: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: cranial synostosis & choanal atresia, & heart murmur
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': TX9108

Write-up: P/immun given client started to cry & then became apneic; PR noted 126; Apnea lasted only 15-20sec- raised lt arm & client responded imm; color ashen; DX w/hyperplastic heart: prognosis poor;


Changed on 9/14/2018

VAERS ID: 29463 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Texas
Vaccinated:1991-01-17
Onset:1991-01-17
Submitted:0000-00-00
Entered:1991-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289963 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200FD / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0622D / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Agitation, Apnoea, Cardiomegaly, Cyanosis, Hernia, Pallor, Tachycardia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-02-02
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: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: cranial synostosis & choanal atresia, & heart murmur
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': TX9108

Write-up: P/immun given client started to cry & then became apneic; PR noted 126; Apnea lasted only 15-20sec- raised lt arm & client responded imm; color ashen; DX w/hyperplastic heart: prognosis poor;


Changed on 10/14/2018

VAERS ID: 29463 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Texas
Vaccinated:1991-01-17
Onset:1991-01-17
Submitted:0000-00-00
Entered:1991-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289963 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200FD / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0622D / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Agitation, Apnoea, Cardiomegaly, Cyanosis, Hernia, Pallor, Tachycardia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-02-02
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: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: cranial synostosis & choanal atresia, & heart murmur
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': TX9108

Write-up: P/immun given client started to cry & then became apneic; PR noted 126; Apnea lasted only 15-20sec- raised lt arm & client responded imm; color ashen; DX w/hyperplastic heart: prognosis poor;

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=29463&WAYBACKHISTORY=ON


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