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This is VAERS ID 30428

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 30428
VAERS Form:
Age:0.2
Sex:Male
Location:Nevada
Vaccinated:1991-01-28
Onset:1991-01-29
Submitted:1991-01-30
Entered:1991-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 285916 / 0 RL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M705FE / 0 LL / IM
OPV: ORIMUNE / LEDERLE 0623H / 0 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: APNEA, HEART FAIL, COMA, PETECHIA, HEM

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-01-29
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: NONE
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NONE

Write-up: Appeared well when immun given; Was found by babysitter w/out respiration & pulse; Paramedics called - vomitus in nares & throat; Pronounced DOA @ Hosp Fr Death Certificate: cause of death-SIDS;


Changed on 12/8/2009

VAERS ID: 30428 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Nevada
Vaccinated:1991-01-28
Onset:1991-01-29
Submitted:1991-01-30
Entered:1991-05-16 1991-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 285916 / 0 RL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M705FE / 0 LL / IM
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 0623H / 0 - / PO

Administered by: Public      Purchased by: Unknown Public
Symptoms: Apnoea, Cardiac failure, Coma, Petechiae, Respiratory disorder, Stupor, Sudden infant death syndrome, Haemorrhage, APNEA, HEART FAIL, COMA, PETECHIA, HEM

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-01-29
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: NONE
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NONE NV9105

Write-up: Appeared well when immun given; Was found by babysitter w/out respiration & pulse; Paramedics called - vomitus in nares & throat; Pronounced DOA @ Hosp Fr Death Certificate: cause of death-SIDS;


Changed on 5/14/2017

VAERS ID: 30428 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Nevada
Vaccinated:1991-01-28
Onset:1991-01-29
Submitted:1991-01-30
Entered:1991-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285916 / 0 RL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M705FE / 0 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 0623H / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac failure, Coma, Petechiae, Respiratory disorder, Stupor, Sudden infant death syndrome, Haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-01-29
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: NONE NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NV9105

Write-up: Appeared well when immun given; Was found by babysitter w/out respiration & pulse; Paramedics called - vomitus in nares & throat; Pronounced DOA @ Hosp Fr Death Certificate: cause of death-SIDS;


Changed on 9/14/2017

VAERS ID: 30428 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:Nevada
Vaccinated:1991-01-28
Onset:1991-01-29
Submitted:1991-01-30
Entered:1991-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285916 / 0 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M705FE / 0 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0623H / 0 1 - MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac failure, Coma, Petechiae, Respiratory disorder, Stupor, Sudden infant death syndrome, Haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-01-29
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: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NV9105

Write-up: Appeared well when immun given; Was found by babysitter w/out respiration & pulse; Paramedics called - vomitus in nares & throat; Pronounced DOA @ Hosp Fr Death Certificate: cause of death-SIDS;


Changed on 2/14/2018

VAERS ID: 30428 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Nevada
Vaccinated:1991-01-28
Onset:1991-01-29
Submitted:1991-01-30
Entered:1991-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285916 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M705FE / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0623H / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac failure, Coma, Petechiae, Respiratory disorder, Stupor, Sudden infant death syndrome, Haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-01-29
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: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NV9105

Write-up: Appeared well when immun given; Was found by babysitter w/out respiration & pulse; Paramedics called - vomitus in nares & throat; Pronounced DOA @ Hosp Fr Death Certificate: cause of death-SIDS;


Changed on 6/14/2018

VAERS ID: 30428 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Nevada
Vaccinated:1991-01-28
Onset:1991-01-29
Submitted:1991-01-30
Entered:1991-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285916 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M705FE / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0623H / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac failure, Coma, Petechiae, Respiratory disorder, Stupor, Sudden infant death syndrome, Haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-01-29
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: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NV9105

Write-up: Appeared well when immun given; Was found by babysitter w/out respiration & pulse; Paramedics called - vomitus in nares & throat; Pronounced DOA @ Hosp Fr Death Certificate: cause of death-SIDS;


Changed on 8/14/2018

VAERS ID: 30428 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Nevada
Vaccinated:1991-01-28
Onset:1991-01-29
Submitted:1991-01-30
Entered:1991-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285916 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M705FE / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0623H / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac failure, Coma, Petechiae, Respiratory disorder, Stupor, Sudden infant death syndrome, Haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-01-29
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: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NV9105

Write-up: Appeared well when immun given; Was found by babysitter w/out respiration & pulse; Paramedics called - vomitus in nares & throat; Pronounced DOA @ Hosp Fr Death Certificate: cause of death-SIDS;


Changed on 9/14/2018

VAERS ID: 30428 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Nevada
Vaccinated:1991-01-28
Onset:1991-01-29
Submitted:1991-01-30
Entered:1991-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285916 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M705FE / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0623H / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac failure, Coma, Petechiae, Respiratory disorder, Stupor, Sudden infant death syndrome, Haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-01-29
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: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NV9105

Write-up: Appeared well when immun given; Was found by babysitter w/out respiration & pulse; Paramedics called - vomitus in nares & throat; Pronounced DOA @ Hosp Fr Death Certificate: cause of death-SIDS;


Changed on 10/14/2018

VAERS ID: 30428 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Nevada
Vaccinated:1991-01-28
Onset:1991-01-29
Submitted:1991-01-30
Entered:1991-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285916 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M705FE / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0623H / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cardiac failure, Coma, Petechiae, Respiratory disorder, Stupor, Sudden infant death syndrome, Haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-01-29
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: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NV9105

Write-up: Appeared well when immun given; Was found by babysitter w/out respiration & pulse; Paramedics called - vomitus in nares & throat; Pronounced DOA @ Hosp Fr Death Certificate: cause of death-SIDS;

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=30428&WAYBACKHISTORY=ON


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