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This is VAERS ID 34563

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 34563
VAERS Form:
Age:0.2
Sex:Male
Location:Wisconsin
Vaccinated:1991-07-26
Onset:0000-00-00
Submitted:1991-08-29
Entered:1991-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 295976 / 0 RL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M130HA / 0 LL / IM
OPV: ORIMUNE / LEDERLE 281936 / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-08-06
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: APAP
Current Illness: Cough, diaper dermatitis
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NONE

Write-up: Not known; SIDS


Changed on 12/8/2009

VAERS ID: 34563 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Wisconsin
Vaccinated:1991-07-26
Onset:0000-00-00
Submitted:1991-08-29
Entered:1991-09-09 1991-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 295976 / 0 RL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M130HA / 0 LL / IM
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 281936 / 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:1991-08-06
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: APAP
Current Illness: Cough, diaper dermatitis
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NONE (blank)

Write-up: Not known; SIDS


Changed on 5/14/2017

VAERS ID: 34563 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Wisconsin
Vaccinated:1991-07-26
Onset:0000-00-00
Submitted:1991-08-29
Entered:1991-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 295976 / 0 RL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M130HA / 0 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 281936 / 0 - / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-08-06
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: APAP
Current Illness: Cough, diaper dermatitis
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Not known; SIDS


Changed on 9/14/2017

VAERS ID: 34563 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:Wisconsin
Vaccinated:1991-07-26
Onset:0000-00-00
Submitted:1991-08-29
Entered:1991-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 295976 / 0 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M130HA / 0 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 281936 / 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:1991-08-06
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: APAP
Current Illness: Cough, diaper dermatitis
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Not known; SIDS


Changed on 2/14/2018

VAERS ID: 34563 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Wisconsin
Vaccinated:1991-07-26
Onset:0000-00-00
Submitted:1991-08-29
Entered:1991-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 295976 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M130HA / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 281936 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-08-06
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: APAP
Current Illness: Cough, diaper dermatitis
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Not known; SIDS


Changed on 6/14/2018

VAERS ID: 34563 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Wisconsin
Vaccinated:1991-07-26
Onset:0000-00-00
Submitted:1991-08-29
Entered:1991-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 295976 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M130HA / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 281936 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-08-06
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: APAP
Current Illness: Cough, diaper dermatitis
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Not known; SIDS


Changed on 8/14/2018

VAERS ID: 34563 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Wisconsin
Vaccinated:1991-07-26
Onset:0000-00-00
Submitted:1991-08-29
Entered:1991-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 295976 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M130HA / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 281936 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-08-06
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: APAP
Current Illness: Cough, diaper dermatitis
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Not known; SIDS


Changed on 9/14/2018

VAERS ID: 34563 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Wisconsin
Vaccinated:1991-07-26
Onset:0000-00-00
Submitted:1991-08-29
Entered:1991-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 295976 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M130HA / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 281936 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-08-06
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: APAP
Current Illness: Cough, diaper dermatitis
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Not known; SIDS


Changed on 10/14/2018

VAERS ID: 34563 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Wisconsin
Vaccinated:1991-07-26
Onset:0000-00-00
Submitted:1991-08-29
Entered:1991-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 295976 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M130HA / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 281936 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-08-06
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: APAP
Current Illness: Cough, diaper dermatitis
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Not known; SIDS

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