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This is VAERS ID 34926

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 34926
VAERS Form:
Age:0.5
Sex:Female
Location:Virginia
Vaccinated:1991-08-14
Onset:1991-08-17
Submitted:1991-09-10
Entered:1991-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 306927 / 1 LL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M180HB / 1 RL / IM
OPV: ORIMUNE / LEDERLE 302938 / 1 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: SIDS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-08-17
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: Sodium fluride drops-2 drops daily
Current Illness: well child
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Coroner''s report
CDC 'Split Type':

Write-up: Pt attended well peds clinic on 14AUG91; according to exam pt well that day & had no problems w/previous immun; DTP #2, OPV #2, HIB #2 given w/o difficulty; Mom given standard instr for fever control; Death occured 3 days later; dx SIDS;


Changed on 12/8/2009

VAERS ID: 34926 Before After
VAERS Form:
Age:0.5
Sex:Female
Location:Virginia
Vaccinated:1991-08-14
Onset:1991-08-17
Submitted:1991-09-10
Entered:1991-09-25 1991-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 306927 / 1 LL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M180HB / 1 RL / IM
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 302938 / 1 - / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-08-17
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: Sodium fluride drops-2 drops daily
Current Illness: well child
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Coroner''s report
CDC 'Split Type': (blank) VA91076

Write-up: Pt attended well peds clinic on 14AUG91; according to exam pt well that day & had no problems w/previous immun; DTP #2, OPV #2, HIB #2 given w/o difficulty; Mom given standard instr for fever control; Death occured 3 days later; dx SIDS;


Changed on 5/14/2017

VAERS ID: 34926 Before After
VAERS Form:
Age:0.5
Sex:Female
Location:Virginia
Vaccinated:1991-08-14
Onset:1991-08-17
Submitted:1991-09-10
Entered:1991-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 306927 / 1 LL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M180HB / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 302938 / 1 - / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-08-17
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: Sodium fluride drops-2 drops daily
Current Illness: well child
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Coroner''s report
CDC 'Split Type': VA91076

Write-up: Pt attended well peds clinic on 14AUG91; according to exam pt well that day & had no problems w/previous immun; DTP #2, OPV #2, HIB #2 given w/o difficulty; Mom given standard instr for fever control; Death occured 3 days later; dx SIDS;


Changed on 9/14/2017

VAERS ID: 34926 Before After
VAERS Form:(blank) 1
Age:0.5
Sex:Female
Location:Virginia
Vaccinated:1991-08-14
Onset:1991-08-17
Submitted:1991-09-10
Entered:1991-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 306927 / 1 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M180HB / 1 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 302938 / 1 2 - MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-08-17
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: Sodium fluride drops-2 drops daily
Current Illness: well child
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Coroner''s report
CDC 'Split Type': VA91076

Write-up: Pt attended well peds clinic on 14AUG91; according to exam pt well that day & had no problems w/previous immun; DTP #2, OPV #2, HIB #2 given w/o difficulty; Mom given standard instr for fever control; Death occured 3 days later; dx SIDS;


Changed on 2/14/2018

VAERS ID: 34926 Before After
VAERS Form:1
Age:0.5
Sex:Female
Location:Virginia
Vaccinated:1991-08-14
Onset:1991-08-17
Submitted:1991-09-10
Entered:1991-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 306927 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M180HB / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 302938 / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-08-17
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: Sodium fluride drops-2 drops daily
Current Illness: well child
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Coroner''s report
CDC 'Split Type': VA91076

Write-up: Pt attended well peds clinic on 14AUG91; according to exam pt well that day & had no problems w/previous immun; DTP #2, OPV #2, HIB #2 given w/o difficulty; Mom given standard instr for fever control; Death occured 3 days later; dx SIDS;


Changed on 6/14/2018

VAERS ID: 34926 Before After
VAERS Form:1
Age:0.5
Sex:Female
Location:Virginia
Vaccinated:1991-08-14
Onset:1991-08-17
Submitted:1991-09-10
Entered:1991-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 306927 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M180HB / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 302938 / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-08-17
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: Sodium fluride drops-2 drops daily
Current Illness: well child
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Coroner''s report
CDC 'Split Type': VA91076

Write-up: Pt attended well peds clinic on 14AUG91; according to exam pt well that day & had no problems w/previous immun; DTP #2, OPV #2, HIB #2 given w/o difficulty; Mom given standard instr for fever control; Death occured 3 days later; dx SIDS;


Changed on 8/14/2018

VAERS ID: 34926 Before After
VAERS Form:1
Age:0.5
Sex:Female
Location:Virginia
Vaccinated:1991-08-14
Onset:1991-08-17
Submitted:1991-09-10
Entered:1991-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 306927 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M180HB / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 302938 / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-08-17
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: Sodium fluride drops-2 drops daily
Current Illness: well child
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Coroner''s report
CDC 'Split Type': VA91076

Write-up: Pt attended well peds clinic on 14AUG91; according to exam pt well that day & had no problems w/previous immun; DTP #2, OPV #2, HIB #2 given w/o difficulty; Mom given standard instr for fever control; Death occured 3 days later; dx SIDS;


Changed on 9/14/2018

VAERS ID: 34926 Before After
VAERS Form:1
Age:0.5
Sex:Female
Location:Virginia
Vaccinated:1991-08-14
Onset:1991-08-17
Submitted:1991-09-10
Entered:1991-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 306927 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M180HB / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 302938 / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-08-17
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: Sodium fluride drops-2 drops daily
Current Illness: well child
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Coroner''s report
CDC 'Split Type': VA91076

Write-up: Pt attended well peds clinic on 14AUG91; according to exam pt well that day & had no problems w/previous immun; DTP #2, OPV #2, HIB #2 given w/o difficulty; Mom given standard instr for fever control; Death occured 3 days later; dx SIDS;


Changed on 10/14/2018

VAERS ID: 34926 Before After
VAERS Form:1
Age:0.5
Sex:Female
Location:Virginia
Vaccinated:1991-08-14
Onset:1991-08-17
Submitted:1991-09-10
Entered:1991-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 306927 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M180HB / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 302938 / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-08-17
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: Sodium fluride drops-2 drops daily
Current Illness: well child
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Coroner''s report
CDC 'Split Type': VA91076

Write-up: Pt attended well peds clinic on 14AUG91; according to exam pt well that day & had no problems w/previous immun; DTP #2, OPV #2, HIB #2 given w/o difficulty; Mom given standard instr for fever control; Death occured 3 days later; dx SIDS;

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