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This is VAERS ID 29967

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 29967
VAERS Form:
Age:0.3
Sex:Male
Location:Florida
Vaccinated:1991-03-21
Onset:1991-03-22
Submitted:1991-03-22
Entered:1991-04-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 291927 / - RL / -
HIBV: HIBTITER / LEDERLE(PRAXIS) M160FH / - LL / -
OPV: ORIMUNE / LEDERLE 291946 / - - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: EDEMA FACE, ASTHENIA, ANOMALY HEART, ANOMALY ART

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-22
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? No
Previous Vaccinations:
Other Medications: Baby Aspirin 1 daily
Current Illness: Congenital Heart Disease
Preexisting Conditions: Hypoplastic lt heart synd
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: TC fr mom infant has swollen eyes; Starts to suck from bottle & quits, ""acts like he is worn out""; Referred for eval; no fever;


Changed on 12/8/2009

VAERS ID: 29967 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Florida
Vaccinated:1991-03-21
Onset:1991-03-22
Submitted:1991-03-22
Entered:1991-04-24 1991-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 291927 / - RL / -
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M160FH / - LL / -
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 291946 / - - / PO

Administered by: Public      Purchased by: Unknown Public
Symptoms: Asthenia, Face oedema, Heart disease congenital, Congenital arterial malformation, EDEMA FACE, ASTHENIA, ANOMALY HEART, ANOMALY ART

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-22
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? No
Previous Vaccinations:
Other Medications: Baby Aspirin 1 daily
Current Illness: Congenital Heart Disease
Preexisting Conditions: Hypoplastic lt heart synd
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) FL91013

Write-up: TC fr mom infant has swollen eyes; Starts to suck from bottle & quits, ""acts "acts like he is worn out""; out"; Referred for eval; no fever;


Changed on 5/14/2017

VAERS ID: 29967 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Florida
Vaccinated:1991-03-21
Onset:1991-03-22
Submitted:1991-03-22
Entered:1991-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291927 / - RL / -
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M160FH / - LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 291946 / - - / PO

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, Face oedema, Heart disease congenital, Congenital arterial malformation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-22
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Baby Aspirin 1 daily
Current Illness: Congenital Heart Disease
Preexisting Conditions: Hypoplastic lt heart synd
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': FL91013

Write-up: TC fr mom infant has swollen eyes; Starts to suck from bottle & quits, "acts like he is worn out"; Referred for eval; no fever;


Changed on 9/14/2017

VAERS ID: 29967 Before After
VAERS Form:(blank) 1
Age:0.3
Sex:Male
Location:Florida
Vaccinated:1991-03-21
Onset:1991-03-22
Submitted:1991-03-22
Entered:1991-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291927 / - UNK RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M160FH / - UNK LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 291946 / - UNK - MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, Face oedema, Heart disease congenital, Congenital arterial malformation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-22
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Baby Aspirin 1 daily
Current Illness: Congenital Heart Disease
Preexisting Conditions: Hypoplastic lt heart synd
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': FL91013

Write-up: TC fr mom infant has swollen eyes; Starts to suck from bottle & quits, "acts like he is worn out"; Referred for eval; no fever;


Changed on 2/14/2018

VAERS ID: 29967 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Florida
Vaccinated:1991-03-21
Onset:1991-03-22
Submitted:1991-03-22
Entered:1991-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291927 / UNK RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M160FH / UNK LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 291946 / UNK MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, Face oedema, Heart disease congenital, Congenital arterial malformation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-22
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Baby Aspirin 1 daily
Current Illness: Congenital Heart Disease
Preexisting Conditions: Hypoplastic lt heart synd
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': FL91013

Write-up: TC fr mom infant has swollen eyes; Starts to suck from bottle & quits, "acts like he is worn out"; Referred for eval; no fever;


Changed on 6/14/2018

VAERS ID: 29967 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Florida
Vaccinated:1991-03-21
Onset:1991-03-22
Submitted:1991-03-22
Entered:1991-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291927 / UNK RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M160FH / UNK LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 291946 / UNK MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, Face oedema, Heart disease congenital, Congenital arterial malformation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-22
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Baby Aspirin 1 daily
Current Illness: Congenital Heart Disease
Preexisting Conditions: Hypoplastic lt heart synd
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': FL91013

Write-up: TC fr mom infant has swollen eyes; Starts to suck from bottle & quits, "acts like he is worn out"; Referred for eval; no fever;


Changed on 8/14/2018

VAERS ID: 29967 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Florida
Vaccinated:1991-03-21
Onset:1991-03-22
Submitted:1991-03-22
Entered:1991-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291927 / UNK RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M160FH / UNK LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 291946 / UNK MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, Face oedema, Heart disease congenital, Congenital arterial malformation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-22
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Baby Aspirin 1 daily
Current Illness: Congenital Heart Disease
Preexisting Conditions: Hypoplastic lt heart synd
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': FL91013

Write-up: TC fr mom infant has swollen eyes; Starts to suck from bottle & quits, "acts like he is worn out"; Referred for eval; no fever;


Changed on 9/14/2018

VAERS ID: 29967 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Florida
Vaccinated:1991-03-21
Onset:1991-03-22
Submitted:1991-03-22
Entered:1991-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291927 / UNK RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M160FH / UNK LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 291946 / UNK MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, Face oedema, Heart disease congenital, Congenital arterial malformation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-22
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Baby Aspirin 1 daily
Current Illness: Congenital Heart Disease
Preexisting Conditions: Hypoplastic lt heart synd
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': FL91013

Write-up: TC fr mom infant has swollen eyes; Starts to suck from bottle & quits, "acts like he is worn out"; Referred for eval; no fever;


Changed on 10/14/2018

VAERS ID: 29967 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Florida
Vaccinated:1991-03-21
Onset:1991-03-22
Submitted:1991-03-22
Entered:1991-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291927 / UNK RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M160FH / UNK LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 291946 / UNK MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Asthenia, Face oedema, Heart disease congenital, Congenital arterial malformation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-22
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Baby Aspirin 1 daily
Current Illness: Congenital Heart Disease
Preexisting Conditions: Hypoplastic lt heart synd
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': FL91013

Write-up: TC fr mom infant has swollen eyes; Starts to suck from bottle & quits, "acts like he is worn out"; Referred for eval; no fever;

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