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This is VAERS ID 30208

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 30208
VAERS Form:
Age:0.2
Sex:Female
Location:Ohio
Vaccinated:1991-03-20
Onset:1991-03-27
Submitted:1991-04-12
Entered:1991-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 285917 / 0 LL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M160FH / 0 RL / IM
OPV: ORIMUNE / LEDERLE 0621F / 0 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: SIDS, SOMNOLENCE, RHINITIS, APNEA, HEART FAIL

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-27
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: APAP, Dimetapp
Current Illness: NONE
Preexisting Conditions: Pyloric stenosis w/pyloromyotomy 5MAR91
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: S&S of ""runny nose"", afternoon naps were longer than usual 5 days prior-5AM check by mom & was breathing, not breathing @ 815AM;


Changed on 12/8/2009

VAERS ID: 30208 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Ohio
Vaccinated:1991-03-20
Onset:1991-03-27
Submitted:1991-04-12
Entered:1991-05-07 1991-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 285917 / 0 LL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M160FH / 0 RL / IM
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 0621F / 0 - / PO

Administered by: Public      Purchased by: Unknown Public
Symptoms: Apnoea, Cardiac failure, Rhinitis, SIDS, Somnolence, Sudden infant death syndrome, SOMNOLENCE, RHINITIS, APNEA, HEART FAIL

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-27
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: APAP, Dimetapp
Current Illness: NONE
Preexisting Conditions: Pyloric stenosis w/pyloromyotomy 5MAR91
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) OH91041

Write-up: S&S of ""runny nose"", "runny nose", afternoon naps were longer than usual 5 days prior-5AM check by mom & was breathing, not breathing @ 815AM;


Changed on 5/14/2017

VAERS ID: 30208 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Ohio
Vaccinated:1991-03-20
Onset:1991-03-27
Submitted:1991-04-12
Entered:1991-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285917 / 0 LL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M160FH / 0 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 0621F / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac failure, Rhinitis, Somnolence, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-27
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: APAP, Dimetapp
Current Illness: NONE
Preexisting Conditions: Pyloric stenosis w/pyloromyotomy 5MAR91
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': OH91041

Write-up: S&S of "runny nose", afternoon naps were longer than usual 5 days prior-5AM check by mom & was breathing, not breathing @ 815AM;


Changed on 9/14/2017

VAERS ID: 30208 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Female
Location:Ohio
Vaccinated:1991-03-20
Onset:1991-03-27
Submitted:1991-04-12
Entered:1991-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285917 / 0 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M160FH / 0 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0621F / 0 1 - MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac failure, Rhinitis, Somnolence, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-27
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: APAP, Dimetapp
Current Illness: NONE
Preexisting Conditions: Pyloric stenosis w/pyloromyotomy 5MAR91
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': OH91041

Write-up: S&S of "runny nose", afternoon naps were longer than usual 5 days prior-5AM check by mom & was breathing, not breathing @ 815AM;


Changed on 2/14/2018

VAERS ID: 30208 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Ohio
Vaccinated:1991-03-20
Onset:1991-03-27
Submitted:1991-04-12
Entered:1991-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285917 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M160FH / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0621F / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac failure, Rhinitis, Somnolence, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-27
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: APAP, Dimetapp
Current Illness: NONE
Preexisting Conditions: Pyloric stenosis w/pyloromyotomy 5MAR91
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': OH91041

Write-up: S&S of "runny nose", afternoon naps were longer than usual 5 days prior-5AM check by mom & was breathing, not breathing @ 815AM;


Changed on 6/14/2018

VAERS ID: 30208 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Ohio
Vaccinated:1991-03-20
Onset:1991-03-27
Submitted:1991-04-12
Entered:1991-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285917 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M160FH / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0621F / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac failure, Rhinitis, Somnolence, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-27
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: APAP, Dimetapp
Current Illness: NONE
Preexisting Conditions: Pyloric stenosis w/pyloromyotomy 5MAR91
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': OH91041

Write-up: S&S of "runny nose", afternoon naps were longer than usual 5 days prior-5AM check by mom & was breathing, not breathing @ 815AM;


Changed on 8/14/2018

VAERS ID: 30208 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Ohio
Vaccinated:1991-03-20
Onset:1991-03-27
Submitted:1991-04-12
Entered:1991-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285917 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M160FH / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0621F / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac failure, Rhinitis, Somnolence, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-27
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: APAP, Dimetapp
Current Illness: NONE
Preexisting Conditions: Pyloric stenosis w/pyloromyotomy 5MAR91
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': OH91041

Write-up: S&S of "runny nose", afternoon naps were longer than usual 5 days prior-5AM check by mom & was breathing, not breathing @ 815AM;


Changed on 9/14/2018

VAERS ID: 30208 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Ohio
Vaccinated:1991-03-20
Onset:1991-03-27
Submitted:1991-04-12
Entered:1991-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285917 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M160FH / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0621F / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac failure, Rhinitis, Somnolence, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-27
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: APAP, Dimetapp
Current Illness: NONE
Preexisting Conditions: Pyloric stenosis w/pyloromyotomy 5MAR91
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': OH91041

Write-up: S&S of "runny nose", afternoon naps were longer than usual 5 days prior-5AM check by mom & was breathing, not breathing @ 815AM;


Changed on 10/14/2018

VAERS ID: 30208 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Ohio
Vaccinated:1991-03-20
Onset:1991-03-27
Submitted:1991-04-12
Entered:1991-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285917 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M160FH / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0621F / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac failure, Rhinitis, Somnolence, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-27
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: APAP, Dimetapp
Current Illness: NONE
Preexisting Conditions: Pyloric stenosis w/pyloromyotomy 5MAR91
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': OH91041

Write-up: S&S of "runny nose", afternoon naps were longer than usual 5 days prior-5AM check by mom & was breathing, not breathing @ 815AM;

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