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This is VAERS ID 30386

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 30386
VAERS Form:
Age:0.2
Sex:Male
Location:Pennsylvania
Vaccinated:1991-05-02
Onset:1991-05-05
Submitted:1991-05-06
Entered:1991-05-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP / CONNAUGHT LABS 0C21045 / 0 RL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M560FP / - - / -
OPV: ORIMUNE / LEDERLE 295957 / 0 - / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-05-05
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: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Healthy infant found dead in crib by parents


Changed on 12/8/2009

VAERS ID: 30386 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Pennsylvania
Vaccinated:1991-05-02
Onset:1991-05-05
Submitted:1991-05-06
Entered:1991-05-14 1991-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP DTP (NO BRAND NAME) / CONNAUGHT LABS CONNAUGHT LABORATORIES 0C21045 / 0 RL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M560FP / - - / -
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 295957 / 0 - / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-05-05
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: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Healthy infant found dead in crib by parents


Changed on 5/14/2017

VAERS ID: 30386 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Pennsylvania
Vaccinated:1991-05-02
Onset:1991-05-05
Submitted:1991-05-06
Entered:1991-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0C21045 / 0 RL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M560FP / - - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 295957 / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-05-05
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: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Healthy infant found dead in crib by parents


Changed on 9/14/2017

VAERS ID: 30386 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:Pennsylvania
Vaccinated:1991-05-02
Onset:1991-05-05
Submitted:1991-05-06
Entered:1991-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0C21045 / 0 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M560FP / - UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 295957 / 0 1 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-05-05
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: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Healthy infant found dead in crib by parents


Changed on 2/14/2018

VAERS ID: 30386 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Pennsylvania
Vaccinated:1991-05-02
Onset:1991-05-05
Submitted:1991-05-06
Entered:1991-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0C21045 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M560FP / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 295957 / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-05-05
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: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Healthy infant found dead in crib by parents


Changed on 6/14/2018

VAERS ID: 30386 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Pennsylvania
Vaccinated:1991-05-02
Onset:1991-05-05
Submitted:1991-05-06
Entered:1991-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0C21045 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M560FP / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 295957 / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-05-05
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: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Healthy infant found dead in crib by parents


Changed on 8/14/2018

VAERS ID: 30386 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Pennsylvania
Vaccinated:1991-05-02
Onset:1991-05-05
Submitted:1991-05-06
Entered:1991-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0C21045 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M560FP / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 295957 / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-05-05
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: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Healthy infant found dead in crib by parents


Changed on 9/14/2018

VAERS ID: 30386 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Pennsylvania
Vaccinated:1991-05-02
Onset:1991-05-05
Submitted:1991-05-06
Entered:1991-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0C21045 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M560FP / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 295957 / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-05-05
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: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Healthy infant found dead in crib by parents


Changed on 10/14/2018

VAERS ID: 30386 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Pennsylvania
Vaccinated:1991-05-02
Onset:1991-05-05
Submitted:1991-05-06
Entered:1991-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0C21045 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M560FP / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 295957 / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-05-05
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: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Healthy infant found dead in crib by parents

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=30386&WAYBACKHISTORY=ON


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