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This is VAERS ID 29769

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 29769
VAERS Form:
Age:0.7
Sex:Male
Location:South Carolina
Vaccinated:1991-03-04
Onset:0000-00-00
Submitted:1991-03-25
Entered:1991-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 289901 / 1 RL / IM
HIBV: PROHIBIT / CONNAUGHT LABS 0A21131 / 0 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-23
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:


Changed on 12/8/2009

VAERS ID: 29769 Before After
VAERS Form:
Age:0.7
Sex:Male
Location:South Carolina
Vaccinated:1991-03-04
Onset:0000-00-00
Submitted:1991-03-25
Entered:1991-04-10 1991-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 289901 / 1 RL / IM
HIBV: PROHIBIT HIB (PROHIBIT) / CONNAUGHT LABS CONNAUGHT LABORATORIES 0A21131 / 0 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-23
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) SC91032

Write-up:


Changed on 5/14/2017

VAERS ID: 29769 Before After
VAERS Form:
Age:0.7
Sex:Male
Location:South Carolina
Vaccinated:1991-03-04
Onset:0000-00-00
Submitted:1991-03-25
Entered:1991-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289901 / 1 RL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0A21131 / 0 LL / IM

Administered by: Public      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-23
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': SC91032

Write-up:


Changed on 9/14/2017

VAERS ID: 29769 Before After
VAERS Form:(blank) 1
Age:0.7
Sex:Male
Location:South Carolina
Vaccinated:1991-03-04
Onset:0000-00-00
Submitted:1991-03-25
Entered:1991-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289901 / 1 2 RL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0A21131 / 0 1 LL / IM

Administered by: Public      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-23
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': SC91032

Write-up:


Changed on 2/14/2018

VAERS ID: 29769 Before After
VAERS Form:1
Age:0.7
Sex:Male
Location:South Carolina
Vaccinated:1991-03-04
Onset:0000-00-00
Submitted:1991-03-25
Entered:1991-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289901 / 2 RL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0A21131 / 1 LL / IM

Administered by: Public      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-23
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': SC91032

Write-up:


Changed on 6/14/2018

VAERS ID: 29769 Before After
VAERS Form:1
Age:0.7
Sex:Male
Location:South Carolina
Vaccinated:1991-03-04
Onset:0000-00-00
Submitted:1991-03-25
Entered:1991-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289901 / 2 RL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0A21131 / 1 LL / IM

Administered by: Public      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-23
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': SC91032

Write-up:


Changed on 8/14/2018

VAERS ID: 29769 Before After
VAERS Form:1
Age:0.7
Sex:Male
Location:South Carolina
Vaccinated:1991-03-04
Onset:0000-00-00
Submitted:1991-03-25
Entered:1991-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289901 / 2 RL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0A21131 / 1 LL / IM

Administered by: Public      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-23
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': SC91032

Write-up:


Changed on 9/14/2018

VAERS ID: 29769 Before After
VAERS Form:1
Age:0.7
Sex:Male
Location:South Carolina
Vaccinated:1991-03-04
Onset:0000-00-00
Submitted:1991-03-25
Entered:1991-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289901 / 2 RL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0A21131 / 1 LL / IM

Administered by: Public      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-23
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': SC91032

Write-up:


Changed on 10/14/2018

VAERS ID: 29769 Before After
VAERS Form:1
Age:0.7
Sex:Male
Location:South Carolina
Vaccinated:1991-03-04
Onset:0000-00-00
Submitted:1991-03-25
Entered:1991-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289901 / 2 RL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0A21131 / 1 LL / IM

Administered by: Public      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-23
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': SC91032

Write-up:

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