National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 30812

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 30812
VAERS Form:
Age:0.1
Sex:Female
Location:South Carolina
Vaccinated:1991-03-13
Onset:0000-00-00
Submitted:1991-05-17
Entered:1991-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 297906 / 0 LL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M640FN / 0 RL / IM
OPV: ORIMUNE / LEDERLE 283943 / 0 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: SIDS

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)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: Well Baby-viral URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy - SIDS
CDC 'Split Type': NONE

Write-up: Pt died on 14MAR91;


Changed on 12/8/2009

VAERS ID: 30812 Before After
VAERS Form:
Age:0.1
Sex:Female
Location:South Carolina
Vaccinated:1991-03-13
Onset:0000-00-00
Submitted:1991-05-17
Entered:1991-05-30 1991-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 297906 / 0 LL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M640FN / 0 RL / IM
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 283943 / 0 - / PO

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

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)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: Well Baby-viral URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy - SIDS
CDC 'Split Type': NONE SC91056

Write-up: Pt died on 14MAR91;


Changed on 5/14/2017

VAERS ID: 30812 Before After
VAERS Form:
Age:0.1
Sex:Female
Location:South Carolina
Vaccinated:1991-03-13
Onset:0000-00-00
Submitted:1991-05-17
Entered:1991-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 297906 / 0 LL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M640FN / 0 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 283943 / 0 - / PO

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

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)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: NONE NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: Well Baby-viral URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy - SIDS
CDC 'Split Type': SC91056

Write-up: Pt died on 14MAR91;


Changed on 9/14/2017

VAERS ID: 30812 Before After
VAERS Form:(blank) 1
Age:0.1
Sex:Female
Location:South Carolina
Vaccinated:1991-03-13
Onset:0000-00-00
Submitted:1991-05-17
Entered:1991-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 297906 / 0 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M640FN / 0 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 283943 / 0 1 - MO / PO

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

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)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: Well Baby-viral URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy - SIDS
CDC 'Split Type': SC91056

Write-up: Pt died on 14MAR91;


Changed on 2/14/2018

VAERS ID: 30812 Before After
VAERS Form:1
Age:0.1
Sex:Female
Location:South Carolina
Vaccinated:1991-03-13
Onset:0000-00-00
Submitted:1991-05-17
Entered:1991-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 297906 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M640FN / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 283943 / 1 MO / PO

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

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)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: Well Baby-viral URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy - SIDS
CDC 'Split Type': SC91056

Write-up: Pt died on 14MAR91;


Changed on 6/14/2018

VAERS ID: 30812 Before After
VAERS Form:1
Age:0.1
Sex:Female
Location:South Carolina
Vaccinated:1991-03-13
Onset:0000-00-00
Submitted:1991-05-17
Entered:1991-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 297906 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M640FN / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 283943 / 1 MO / PO

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

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)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: Well Baby-viral URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy - SIDS
CDC 'Split Type': SC91056

Write-up: Pt died on 14MAR91;


Changed on 8/14/2018

VAERS ID: 30812 Before After
VAERS Form:1
Age:0.1
Sex:Female
Location:South Carolina
Vaccinated:1991-03-13
Onset:0000-00-00
Submitted:1991-05-17
Entered:1991-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 297906 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M640FN / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 283943 / 1 MO / PO

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

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)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: Well Baby-viral URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy - SIDS
CDC 'Split Type': SC91056

Write-up: Pt died on 14MAR91;


Changed on 9/14/2018

VAERS ID: 30812 Before After
VAERS Form:1
Age:0.1
Sex:Female
Location:South Carolina
Vaccinated:1991-03-13
Onset:0000-00-00
Submitted:1991-05-17
Entered:1991-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 297906 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M640FN / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 283943 / 1 MO / PO

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

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)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: Well Baby-viral URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy - SIDS
CDC 'Split Type': SC91056

Write-up: Pt died on 14MAR91;


Changed on 10/14/2018

VAERS ID: 30812 Before After
VAERS Form:1
Age:0.1
Sex:Female
Location:South Carolina
Vaccinated:1991-03-13
Onset:0000-00-00
Submitted:1991-05-17
Entered:1991-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 297906 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M640FN / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 283943 / 1 MO / PO

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

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)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: Well Baby-viral URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy - SIDS
CDC 'Split Type': SC91056

Write-up: Pt died on 14MAR91;

New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=30812&WAYBACKHISTORY=ON


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