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This is VAERS ID 34482

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 34482
VAERS Form:
Age:0.1
Sex:Male
Location:New Jersey
Vaccinated:1991-07-31
Onset:1991-08-01
Submitted:1991-08-02
Entered:1991-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP / CONNAUGHT LABS 1D2100 / 0 - / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M130HA / 0 - / IM
OPV: ORIMUNE / LEDERLE 298951 / 0 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: SIDS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-08-01
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: Autopsy-medical examiner 2AUG91
CDC 'Split Type':

Write-up: Pt found dead during sleep 01AUG91; preliminary ME report SIDS:


Changed on 12/8/2009

VAERS ID: 34482 Before After
VAERS Form:
Age:0.1
Sex:Male
Location:New Jersey
Vaccinated:1991-07-31
Onset:1991-08-01
Submitted:1991-08-02
Entered:1991-09-06 1991-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP DTP (NO BRAND NAME) / CONNAUGHT LABS CONNAUGHT LABORATORIES 1D2100 / 0 - / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M130HA / 0 - / IM
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 298951 / 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:1991-08-01
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: Autopsy-medical examiner 2AUG91
CDC 'Split Type': (blank) NJ9116

Write-up: Pt found dead during sleep 01AUG91; preliminary ME report SIDS:


Changed on 5/14/2017

VAERS ID: 34482 Before After
VAERS Form:
Age:0.1
Sex:Male
Location:New Jersey
Vaccinated:1991-07-31
Onset:1991-08-01
Submitted:1991-08-02
Entered:1991-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1D2100 / 0 - / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M130HA / 0 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 298951 / 0 - / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-08-01
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: Autopsy-medical examiner 2AUG91
CDC 'Split Type': NJ9116

Write-up: Pt found dead during sleep 01AUG91; preliminary ME report SIDS:


Changed on 9/14/2017

VAERS ID: 34482 Before After
VAERS Form:(blank) 1
Age:0.1
Sex:Male
Location:New Jersey
Vaccinated:1991-07-31
Onset:1991-08-01
Submitted:1991-08-02
Entered:1991-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1D2100 / 0 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M130HA / 0 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 298951 / 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:1991-08-01
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: Autopsy-medical examiner 2AUG91
CDC 'Split Type': NJ9116

Write-up: Pt found dead during sleep 01AUG91; preliminary ME report SIDS:


Changed on 2/14/2018

VAERS ID: 34482 Before After
VAERS Form:1
Age:0.1
Sex:Male
Location:New Jersey
Vaccinated:1991-07-31
Onset:1991-08-01
Submitted:1991-08-02
Entered:1991-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1D2100 / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M130HA / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 298951 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-08-01
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: Autopsy-medical examiner 2AUG91
CDC 'Split Type': NJ9116

Write-up: Pt found dead during sleep 01AUG91; preliminary ME report SIDS:


Changed on 6/14/2018

VAERS ID: 34482 Before After
VAERS Form:1
Age:0.1
Sex:Male
Location:New Jersey
Vaccinated:1991-07-31
Onset:1991-08-01
Submitted:1991-08-02
Entered:1991-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1D2100 / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M130HA / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 298951 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-08-01
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: Autopsy-medical examiner 2AUG91
CDC 'Split Type': NJ9116

Write-up: Pt found dead during sleep 01AUG91; preliminary ME report SIDS:


Changed on 8/14/2018

VAERS ID: 34482 Before After
VAERS Form:1
Age:0.1
Sex:Male
Location:New Jersey
Vaccinated:1991-07-31
Onset:1991-08-01
Submitted:1991-08-02
Entered:1991-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1D2100 / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M130HA / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 298951 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-08-01
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: Autopsy-medical examiner 2AUG91
CDC 'Split Type': NJ9116

Write-up: Pt found dead during sleep 01AUG91; preliminary ME report SIDS:


Changed on 9/14/2018

VAERS ID: 34482 Before After
VAERS Form:1
Age:0.1
Sex:Male
Location:New Jersey
Vaccinated:1991-07-31
Onset:1991-08-01
Submitted:1991-08-02
Entered:1991-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1D2100 / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M130HA / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 298951 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-08-01
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: Autopsy-medical examiner 2AUG91
CDC 'Split Type': NJ9116

Write-up: Pt found dead during sleep 01AUG91; preliminary ME report SIDS:


Changed on 10/14/2018

VAERS ID: 34482 Before After
VAERS Form:1
Age:0.1
Sex:Male
Location:New Jersey
Vaccinated:1991-07-31
Onset:1991-08-01
Submitted:1991-08-02
Entered:1991-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1D2100 / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M130HA / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 298951 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-08-01
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: Autopsy-medical examiner 2AUG91
CDC 'Split Type': NJ9116

Write-up: Pt found dead during sleep 01AUG91; preliminary ME report SIDS:

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