National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 30241

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 30241
VAERS Form:
Age:0.2
Sex:Male
Location:Pennsylvania
Vaccinated:1991-04-02
Onset:1991-04-04
Submitted:1991-04-04
Entered:1991-05-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP / CONNAUGHT LABS 0C21045 / 0 L / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M680EN / 0 - / IM
OPV: ORIMUNE / LEDERLE 628F1 / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: SIDS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-04-04
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: Well baby
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Request for Autopsy Report
CDC 'Split Type':

Write-up: Expired; suspect SIDS-brought to Hosp p/being found unresponsive by babysitter; No fever, irritability prior;


Changed on 12/8/2009

VAERS ID: 30241 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Pennsylvania
Vaccinated:1991-04-02
Onset:1991-04-04
Submitted:1991-04-04
Entered:1991-05-08 1991-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP DTP (NO BRAND NAME) / CONNAUGHT LABS CONNAUGHT LABORATORIES 0C21045 / 0 L / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M680EN / 0 - / IM
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 628F1 / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: SIDS, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-04-04
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: Well baby
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Request for Autopsy Report
CDC 'Split Type': (blank) CO3808

Write-up: Expired; suspect SIDS-brought to Hosp p/being found unresponsive by babysitter; No fever, irritability prior;


Changed on 5/14/2017

VAERS ID: 30241 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Pennsylvania
Vaccinated:1991-04-02
Onset:1991-04-04
Submitted:1991-04-04
Entered:1991-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0C21045 / 0 L - / IM IM L
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M680EN / 0 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 628F1 / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-04-04
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: Well baby
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Request for Autopsy Report
CDC 'Split Type': CO3808

Write-up: Expired; suspect SIDS-brought to Hosp p/being found unresponsive by babysitter; No fever, irritability prior;


Changed on 9/14/2017

VAERS ID: 30241 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:Pennsylvania
Vaccinated:1991-04-02
Onset:1991-04-04
Submitted:1991-04-04
Entered:1991-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0C21045 / 0 1 - / IM L
HIBV: HIB (HIBTITER) / PFIZER/WYETH M680EN / 0 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 628F1 / 0 1 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-04-04
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: Well baby
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Request for Autopsy Report
CDC 'Split Type': CO3808

Write-up: Expired; suspect SIDS-brought to Hosp p/being found unresponsive by babysitter; No fever, irritability prior;


Changed on 2/14/2018

VAERS ID: 30241 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Pennsylvania
Vaccinated:1991-04-02
Onset:1991-04-04
Submitted:1991-04-04
Entered:1991-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0C21045 / 1 - / IM L
HIBV: HIB (HIBTITER) / PFIZER/WYETH M680EN / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 628F1 / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-04-04
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: Well baby
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Request for Autopsy Report
CDC 'Split Type': CO3808

Write-up: Expired; suspect SIDS-brought to Hosp p/being found unresponsive by babysitter; No fever, irritability prior;


Changed on 6/14/2018

VAERS ID: 30241 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Pennsylvania
Vaccinated:1991-04-02
Onset:1991-04-04
Submitted:1991-04-04
Entered:1991-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0C21045 / 1 - / IM L
HIBV: HIB (HIBTITER) / PFIZER/WYETH M680EN / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 628F1 / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-04-04
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: Well baby
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Request for Autopsy Report
CDC 'Split Type': CO3808

Write-up: Expired; suspect SIDS-brought to Hosp p/being found unresponsive by babysitter; No fever, irritability prior;


Changed on 8/14/2018

VAERS ID: 30241 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Pennsylvania
Vaccinated:1991-04-02
Onset:1991-04-04
Submitted:1991-04-04
Entered:1991-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0C21045 / 1 - / IM L
HIBV: HIB (HIBTITER) / PFIZER/WYETH M680EN / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 628F1 / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-04-04
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: Well baby
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Request for Autopsy Report
CDC 'Split Type': CO3808

Write-up: Expired; suspect SIDS-brought to Hosp p/being found unresponsive by babysitter; No fever, irritability prior;


Changed on 9/14/2018

VAERS ID: 30241 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Pennsylvania
Vaccinated:1991-04-02
Onset:1991-04-04
Submitted:1991-04-04
Entered:1991-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0C21045 / 1 - / IM L
HIBV: HIB (HIBTITER) / PFIZER/WYETH M680EN / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 628F1 / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-04-04
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: Well baby
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Request for Autopsy Report
CDC 'Split Type': CO3808

Write-up: Expired; suspect SIDS-brought to Hosp p/being found unresponsive by babysitter; No fever, irritability prior;


Changed on 10/14/2018

VAERS ID: 30241 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Pennsylvania
Vaccinated:1991-04-02
Onset:1991-04-04
Submitted:1991-04-04
Entered:1991-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0C21045 / 1 - / IM L
HIBV: HIB (HIBTITER) / PFIZER/WYETH M680EN / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 628F1 / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-04-04
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: Well baby
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Request for Autopsy Report
CDC 'Split Type': CO3808

Write-up: Expired; suspect SIDS-brought to Hosp p/being found unresponsive by babysitter; No fever, irritability prior;

New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=30241&WAYBACKHISTORY=ON


Copyright © 2019 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166