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This is VAERS ID 29812

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 29812
VAERS Form:
Age:0.2
Sex:Unknown
Location:Texas
Vaccinated:1991-03-06
Onset:1991-03-08
Submitted:1991-03-11
Entered:1991-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE - / 0 - / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) - / 0 - / IM
OPV: ORIMUNE / LEDERLE - / 0 - / PO

Administered by: Other      Purchased by: Unknown
Symptoms: SIDS, INFECT, MYOCARDITIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-08
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: PUB
Other Medications: NA
Current Illness: PUB
Preexisting Conditions: PUB
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': PUB

Write-up: 2 mo infant rec''d DTP/OPV/HIBTITER on 6MAR91; Died 8MAR91; Reported as SIDS; Autopsy is being performed;pt found to have generalized viremia & viral myocarditis.Reporter states that death was not in any way related to immun.


Changed on 12/8/2009

VAERS ID: 29812 Before After
VAERS Form:
Age:0.2
Sex:Unknown
Location:Texas
Vaccinated:1991-03-06
Onset:1991-03-08
Submitted:1991-03-11
Entered:1991-04-15 1991-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES - / 0 - / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS - / 0 - / IM
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES - / 0 - / PO

Administered by: Other      Purchased by: Unknown Other
Symptoms: Infection, Myocarditis, SIDS, Sudden infant death syndrome, INFECT, MYOCARDITIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-08
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: PUB
Other Medications: NA
Current Illness: PUB
Preexisting Conditions: PUB
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': PUB 910055001

Write-up: 2 mo infant rec''d DTP/OPV/HIBTITER on 6MAR91; Died 8MAR91; Reported as SIDS; Autopsy is being performed;pt found to have generalized viremia & viral myocarditis.Reporter states that death was not in any way related to immun.


Changed on 5/14/2017

VAERS ID: 29812 Before After
VAERS Form:
Age:0.2
Sex:Unknown
Location:Texas
Vaccinated:1991-03-06
Onset:1991-03-08
Submitted:1991-03-11
Entered:1991-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES - / 0 - / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH - / 0 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH - / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Infection, Myocarditis, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-08
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: PUB PUB~ ()~~~In patient
Other Medications: NA
Current Illness: PUB
Preexisting Conditions: PUB
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': 910055001

Write-up: 2 mo infant rec''d DTP/OPV/HIBTITER on 6MAR91; Died 8MAR91; Reported as SIDS; Autopsy is being performed;pt found to have generalized viremia & viral myocarditis.Reporter states that death was not in any way related to immun.


Changed on 9/14/2017

VAERS ID: 29812 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Unknown
Location:Texas
Vaccinated:1991-03-06
Onset:1991-03-08
Submitted:1991-03-11
Entered:1991-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES - / 0 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / 0 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / 0 1 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Infection, Myocarditis, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-08
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: PUB~ ()~~~In patient
Other Medications: NA
Current Illness: PUB
Preexisting Conditions: PUB
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': 910055001

Write-up: 2 mo infant rec''d DTP/OPV/HIBTITER on 6MAR91; Died 8MAR91; Reported as SIDS; Autopsy is being performed;pt found to have generalized viremia & viral myocarditis.Reporter states that death was not in any way related to immun.


Changed on 2/14/2018

VAERS ID: 29812 Before After
VAERS Form:1
Age:0.2
Sex:Unknown
Location:Texas
Vaccinated:1991-03-06
Onset:1991-03-08
Submitted:1991-03-11
Entered:1991-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES - / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Infection, Myocarditis, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-08
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: PUB~ ()~~~In patient
Other Medications: NA
Current Illness: PUB
Preexisting Conditions: PUB
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': 910055001

Write-up: 2 mo infant rec''d DTP/OPV/HIBTITER on 6MAR91; Died 8MAR91; Reported as SIDS; Autopsy is being performed;pt found to have generalized viremia & viral myocarditis.Reporter states that death was not in any way related to immun.


Changed on 6/14/2018

VAERS ID: 29812 Before After
VAERS Form:1
Age:0.2
Sex:Unknown
Location:Texas
Vaccinated:1991-03-06
Onset:1991-03-08
Submitted:1991-03-11
Entered:1991-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES - / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Infection, Myocarditis, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-08
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: PUB~ ()~~~In patient
Other Medications: NA
Current Illness: PUB
Preexisting Conditions: PUB
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': 910055001

Write-up: 2 mo infant rec''d DTP/OPV/HIBTITER on 6MAR91; Died 8MAR91; Reported as SIDS; Autopsy is being performed;pt found to have generalized viremia & viral myocarditis.Reporter states that death was not in any way related to immun.


Changed on 8/14/2018

VAERS ID: 29812 Before After
VAERS Form:1
Age:0.2
Sex:Unknown
Location:Texas
Vaccinated:1991-03-06
Onset:1991-03-08
Submitted:1991-03-11
Entered:1991-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES - / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Infection, Myocarditis, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-08
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: PUB~ ()~~~In patient
Other Medications: NA
Current Illness: PUB
Preexisting Conditions: PUB
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': 910055001

Write-up: 2 mo infant rec''d DTP/OPV/HIBTITER on 6MAR91; Died 8MAR91; Reported as SIDS; Autopsy is being performed;pt found to have generalized viremia & viral myocarditis.Reporter states that death was not in any way related to immun.


Changed on 9/14/2018

VAERS ID: 29812 Before After
VAERS Form:1
Age:0.2
Sex:Unknown
Location:Texas
Vaccinated:1991-03-06
Onset:1991-03-08
Submitted:1991-03-11
Entered:1991-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES - / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Infection, Myocarditis, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-08
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: PUB~ ()~~~In patient
Other Medications: NA
Current Illness: PUB
Preexisting Conditions: PUB
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': 910055001

Write-up: 2 mo infant rec''d DTP/OPV/HIBTITER on 6MAR91; Died 8MAR91; Reported as SIDS; Autopsy is being performed;pt found to have generalized viremia & viral myocarditis.Reporter states that death was not in any way related to immun.


Changed on 10/14/2018

VAERS ID: 29812 Before After
VAERS Form:1
Age:0.2
Sex:Unknown
Location:Texas
Vaccinated:1991-03-06
Onset:1991-03-08
Submitted:1991-03-11
Entered:1991-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES - / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Infection, Myocarditis, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-08
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: PUB~ ()~~~In patient
Other Medications: NA
Current Illness: PUB
Preexisting Conditions: PUB
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': 910055001

Write-up: 2 mo infant rec''d DTP/OPV/HIBTITER on 6MAR91; Died 8MAR91; Reported as SIDS; Autopsy is being performed;pt found to have generalized viremia & viral myocarditis.Reporter states that death was not in any way related to immun.

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