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This is VAERS ID 30604

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 30604
VAERS Form:
Age:0.3
Sex:Female
Location:California
Vaccinated:1991-04-03
Onset:0000-00-00
Submitted:1991-05-09
Entered:1991-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 295978 / 0 LL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M635FN / 0 RL / IM
OPV: ORIMUNE / LEDERLE 0628B / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-04-08
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': NONE

Write-up: Called by Med Exam on 8APR91 child found expired @ home; Likely "SIDS"-autopsy pending @ time;


Changed on 12/8/2009

VAERS ID: 30604 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:California
Vaccinated:1991-04-03
Onset:0000-00-00
Submitted:1991-05-09
Entered:1991-05-21 1991-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 295978 / 0 LL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M635FN / 0 RL / IM
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 0628B / 0 - / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-04-08
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': NONE (blank)

Write-up: Called by Med Exam on 8APR91 child found expired @ home; Likely "SIDS"-autopsy pending @ time;


Changed on 5/14/2017

VAERS ID: 30604 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:California
Vaccinated:1991-04-03
Onset:0000-00-00
Submitted:1991-05-09
Entered:1991-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 295978 / 0 LL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M635FN / 0 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 0628B / 0 - / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-04-08
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type':

Write-up: Called by Med Exam on 8APR91 child found expired @ home; Likely "SIDS"-autopsy pending @ time;


Changed on 9/14/2017

VAERS ID: 30604 Before After
VAERS Form:(blank) 1
Age:0.3
Sex:Female
Location:California
Vaccinated:1991-04-03
Onset:0000-00-00
Submitted:1991-05-09
Entered:1991-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 295978 / 0 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M635FN / 0 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0628B / 0 1 - MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-04-08
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type':

Write-up: Called by Med Exam on 8APR91 child found expired @ home; Likely "SIDS"-autopsy pending @ time;


Changed on 2/14/2018

VAERS ID: 30604 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:California
Vaccinated:1991-04-03
Onset:0000-00-00
Submitted:1991-05-09
Entered:1991-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 295978 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M635FN / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0628B / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-04-08
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type':

Write-up: Called by Med Exam on 8APR91 child found expired @ home; Likely "SIDS"-autopsy pending @ time;


Changed on 6/14/2018

VAERS ID: 30604 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:California
Vaccinated:1991-04-03
Onset:0000-00-00
Submitted:1991-05-09
Entered:1991-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 295978 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M635FN / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0628B / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-04-08
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type':

Write-up: Called by Med Exam on 8APR91 child found expired @ home; Likely "SIDS"-autopsy pending @ time;


Changed on 8/14/2018

VAERS ID: 30604 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:California
Vaccinated:1991-04-03
Onset:0000-00-00
Submitted:1991-05-09
Entered:1991-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 295978 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M635FN / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0628B / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-04-08
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type':

Write-up: Called by Med Exam on 8APR91 child found expired @ home; Likely "SIDS"-autopsy pending @ time;


Changed on 9/14/2018

VAERS ID: 30604 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:California
Vaccinated:1991-04-03
Onset:0000-00-00
Submitted:1991-05-09
Entered:1991-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 295978 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M635FN / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0628B / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-04-08
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type':

Write-up: Called by Med Exam on 8APR91 child found expired @ home; Likely "SIDS"-autopsy pending @ time;


Changed on 10/14/2018

VAERS ID: 30604 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:California
Vaccinated:1991-04-03
Onset:0000-00-00
Submitted:1991-05-09
Entered:1991-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 295978 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M635FN / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0628B / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-04-08
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type':

Write-up: Called by Med Exam on 8APR91 child found expired @ home; Likely "SIDS"-autopsy pending @ time;

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=30604&WAYBACKHISTORY=ON


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