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This is VAERS ID 30429

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 30429
VAERS Form:
Age:1.0
Sex:Female
Location:Mississippi
Vaccinated:1991-03-12
Onset:1991-03-13
Submitted:1991-04-18
Entered:1991-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 298915 / 2 LL / -
HIBV: HIBTITER / LEDERLE(PRAXIS) M160FH / 0 RA / -

Administered by: Public      Purchased by: Unknown
Symptoms: AGITATION, CYANOSIS, APNEA, ANOREXIA, BRONCHITIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-14
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: UNK
Current Illness: NONE
Preexisting Conditions: Congenital anormalies many of which are consistent w/those seen in Down''s synd;
Allergies:
Diagnostic Lab Data: Autopsy
CDC 'Split Type':

Write-up: Mom indicated p/immun fussy & irritable running low grade fever, diminished appetite, to ER;PE in ER indicated inflamed posterior pharynx w/o exudate;14MAR91 experienced resp arrest mom called to ER in complete cardiac & Resp arrest;


Changed on 12/8/2009

VAERS ID: 30429 Before After
VAERS Form:
Age:1.0
Sex:Female
Location:Mississippi
Vaccinated:1991-03-12
Onset:1991-03-13
Submitted:1991-04-18
Entered:1991-05-16 1991-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 298915 / 2 LL / -
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M160FH / 0 RA / -

Administered by: Public      Purchased by: Unknown Public
Symptoms: Agitation, Anorexia, Apnoea, Bronchitis, Cardiac failure, Cyanosis, Pharyngitis, Pneumonia, Pyrexia, AGITATION, CYANOSIS, APNEA, ANOREXIA, BRONCHITIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-14
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: UNK
Current Illness: NONE
Preexisting Conditions: Congenital anormalies many of which are consistent w/those seen in Down''s synd;
Allergies:
Diagnostic Lab Data: Autopsy
CDC 'Split Type': (blank) MS9117

Write-up: Mom indicated p/immun fussy & irritable running low grade fever, diminished appetite, to ER;PE in ER indicated inflamed posterior pharynx w/o exudate;14MAR91 experienced resp arrest mom called to ER in complete cardiac & Resp arrest;


Changed on 5/14/2017

VAERS ID: 30429 Before After
VAERS Form:
Age:1.0
Sex:Female
Location:Mississippi
Vaccinated:1991-03-12
Onset:1991-03-13
Submitted:1991-04-18
Entered:1991-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 298915 / 2 LL / -
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M160FH / 0 RA / -

Administered by: Public      Purchased by: Public
Symptoms: Agitation, Anorexia, Apnoea, Bronchitis, Cardiac failure, Cyanosis, Pharyngitis, Pneumonia, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-14
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: UNK
Current Illness: NONE
Preexisting Conditions: Congenital anormalies many of which are consistent w/those seen in Down''s synd;
Allergies:
Diagnostic Lab Data: Autopsy
CDC 'Split Type': MS9117

Write-up: Mom indicated p/immun fussy & irritable running low grade fever, diminished appetite, to ER;PE in ER indicated inflamed posterior pharynx w/o exudate;14MAR91 experienced resp arrest mom called to ER in complete cardiac & Resp arrest;


Changed on 9/14/2017

VAERS ID: 30429 Before After
VAERS Form:(blank) 1
Age:1.0
Sex:Female
Location:Mississippi
Vaccinated:1991-03-12
Onset:1991-03-13
Submitted:1991-04-18
Entered:1991-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 298915 / 2 3 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M160FH / 0 1 RA / -

Administered by: Public      Purchased by: Public
Symptoms: Agitation, Anorexia, Apnoea, Bronchitis, Cardiac failure, Cyanosis, Pharyngitis, Pneumonia, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-14
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: UNK
Current Illness: NONE
Preexisting Conditions: Congenital anormalies many of which are consistent w/those seen in Down''s synd;
Allergies:
Diagnostic Lab Data: Autopsy
CDC 'Split Type': MS9117

Write-up: Mom indicated p/immun fussy & irritable running low grade fever, diminished appetite, to ER;PE in ER indicated inflamed posterior pharynx w/o exudate;14MAR91 experienced resp arrest mom called to ER in complete cardiac & Resp arrest;


Changed on 2/14/2018

VAERS ID: 30429 Before After
VAERS Form:1
Age:1.0
Sex:Female
Location:Mississippi
Vaccinated:1991-03-12
Onset:1991-03-13
Submitted:1991-04-18
Entered:1991-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 298915 / 3 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M160FH / 1 RA / -

Administered by: Public      Purchased by: Public
Symptoms: Agitation, Anorexia, Apnoea, Bronchitis, Cardiac failure, Cyanosis, Pharyngitis, Pneumonia, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-14
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: UNK
Current Illness: NONE
Preexisting Conditions: Congenital anormalies many of which are consistent w/those seen in Down''s synd;
Allergies:
Diagnostic Lab Data: Autopsy
CDC 'Split Type': MS9117

Write-up: Mom indicated p/immun fussy & irritable running low grade fever, diminished appetite, to ER;PE in ER indicated inflamed posterior pharynx w/o exudate;14MAR91 experienced resp arrest mom called to ER in complete cardiac & Resp arrest;


Changed on 6/14/2018

VAERS ID: 30429 Before After
VAERS Form:1
Age:1.0
Sex:Female
Location:Mississippi
Vaccinated:1991-03-12
Onset:1991-03-13
Submitted:1991-04-18
Entered:1991-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 298915 / 3 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M160FH / 1 RA / -

Administered by: Public      Purchased by: Public
Symptoms: Agitation, Anorexia, Apnoea, Bronchitis, Cardiac failure, Cyanosis, Pharyngitis, Pneumonia, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-14
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: UNK
Current Illness: NONE
Preexisting Conditions: Congenital anormalies many of which are consistent w/those seen in Down''s synd;
Allergies:
Diagnostic Lab Data: Autopsy
CDC 'Split Type': MS9117

Write-up: Mom indicated p/immun fussy & irritable running low grade fever, diminished appetite, to ER;PE in ER indicated inflamed posterior pharynx w/o exudate;14MAR91 experienced resp arrest mom called to ER in complete cardiac & Resp arrest;


Changed on 8/14/2018

VAERS ID: 30429 Before After
VAERS Form:1
Age:1.0
Sex:Female
Location:Mississippi
Vaccinated:1991-03-12
Onset:1991-03-13
Submitted:1991-04-18
Entered:1991-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 298915 / 3 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M160FH / 1 RA / -

Administered by: Public      Purchased by: Public
Symptoms: Agitation, Anorexia, Apnoea, Bronchitis, Cardiac failure, Cyanosis, Pharyngitis, Pneumonia, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-14
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: UNK
Current Illness: NONE
Preexisting Conditions: Congenital anormalies many of which are consistent w/those seen in Down''s synd;
Allergies:
Diagnostic Lab Data: Autopsy
CDC 'Split Type': MS9117

Write-up: Mom indicated p/immun fussy & irritable running low grade fever, diminished appetite, to ER;PE in ER indicated inflamed posterior pharynx w/o exudate;14MAR91 experienced resp arrest mom called to ER in complete cardiac & Resp arrest;


Changed on 9/14/2018

VAERS ID: 30429 Before After
VAERS Form:1
Age:1.0
Sex:Female
Location:Mississippi
Vaccinated:1991-03-12
Onset:1991-03-13
Submitted:1991-04-18
Entered:1991-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 298915 / 3 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M160FH / 1 RA / -

Administered by: Public      Purchased by: Public
Symptoms: Agitation, Anorexia, Apnoea, Bronchitis, Cardiac failure, Cyanosis, Pharyngitis, Pneumonia, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-14
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: UNK
Current Illness: NONE
Preexisting Conditions: Congenital anormalies many of which are consistent w/those seen in Down''s synd;
Allergies:
Diagnostic Lab Data: Autopsy
CDC 'Split Type': MS9117

Write-up: Mom indicated p/immun fussy & irritable running low grade fever, diminished appetite, to ER;PE in ER indicated inflamed posterior pharynx w/o exudate;14MAR91 experienced resp arrest mom called to ER in complete cardiac & Resp arrest;


Changed on 10/14/2018

VAERS ID: 30429 Before After
VAERS Form:1
Age:1.0
Sex:Female
Location:Mississippi
Vaccinated:1991-03-12
Onset:1991-03-13
Submitted:1991-04-18
Entered:1991-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 298915 / 3 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M160FH / 1 RA / -

Administered by: Public      Purchased by: Public
Symptoms: Agitation, Anorexia, Apnoea, Bronchitis, Cardiac failure, Cyanosis, Pharyngitis, Pneumonia, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-03-14
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: UNK
Current Illness: NONE
Preexisting Conditions: Congenital anormalies many of which are consistent w/those seen in Down''s synd;
Allergies:
Diagnostic Lab Data: Autopsy
CDC 'Split Type': MS9117

Write-up: Mom indicated p/immun fussy & irritable running low grade fever, diminished appetite, to ER;PE in ER indicated inflamed posterior pharynx w/o exudate;14MAR91 experienced resp arrest mom called to ER in complete cardiac & Resp arrest;

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