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This is VAERS ID 35466

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 35466
VAERS Form:
Age:0.2
Sex:Male
Location:New Jersey
Vaccinated:1991-09-13
Onset:1991-09-13
Submitted:0000-00-00
Entered:1991-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP / CONNAUGHT LABS 1E21008 / 0 - / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M180H / - - / IM
OPV: ORIMUNE / LEDERLE 0627D / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: REACT UNEVAL

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-09-14
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:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: PT found dead in his crib;


Changed on 12/8/2009

VAERS ID: 35466 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:New Jersey
Vaccinated:1991-09-13
Onset:1991-09-13
Submitted:0000-00-00
Entered:1991-10-11 1991-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP DTP (NO BRAND NAME) / CONNAUGHT LABS CONNAUGHT LABORATORIES 1E21008 / 0 - / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M180H / - - / IM
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 0627D / 0 - / PO

Administered by: Private      Purchased by: Unknown Private
Symptoms: Unevaluable event, REACT UNEVAL

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-09-14
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:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: PT found dead in his crib;


Changed on 5/14/2017

VAERS ID: 35466 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:New Jersey
Vaccinated:1991-09-13
Onset:1991-09-13
Submitted:0000-00-00
Entered:1991-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1E21008 / 0 - / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M180H / - - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 0627D / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-09-14
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: ~ ()~~~In patient
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: PT found dead in his crib;


Changed on 9/14/2017

VAERS ID: 35466 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:New Jersey
Vaccinated:1991-09-13
Onset:1991-09-13
Submitted:0000-00-00
Entered:1991-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1E21008 / 0 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M180H / - UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0627D / 0 1 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-09-14
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: ~ ()~~~In patient
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: PT found dead in his crib;


Changed on 2/14/2018

VAERS ID: 35466 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:New Jersey
Vaccinated:1991-09-13
Onset:1991-09-13
Submitted:0000-00-00
Entered:1991-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1E21008 / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M180H / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0627D / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-09-14
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: ~ ()~~~In patient
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: PT found dead in his crib;


Changed on 6/14/2018

VAERS ID: 35466 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:New Jersey
Vaccinated:1991-09-13
Onset:1991-09-13
Submitted:0000-00-00
Entered:1991-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1E21008 / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M180H / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0627D / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-09-14
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: ~ ()~~~In patient
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: PT found dead in his crib;


Changed on 8/14/2018

VAERS ID: 35466 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:New Jersey
Vaccinated:1991-09-13
Onset:1991-09-13
Submitted:0000-00-00
Entered:1991-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1E21008 / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M180H / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0627D / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-09-14
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: ~ ()~~~In patient
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: PT found dead in his crib;


Changed on 9/14/2018

VAERS ID: 35466 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:New Jersey
Vaccinated:1991-09-13
Onset:1991-09-13
Submitted:0000-00-00
Entered:1991-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1E21008 / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M180H / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0627D / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-09-14
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: ~ ()~~~In patient
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: PT found dead in his crib;


Changed on 10/14/2018

VAERS ID: 35466 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:New Jersey
Vaccinated:1991-09-13
Onset:1991-09-13
Submitted:0000-00-00
Entered:1991-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1E21008 / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M180H / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0627D / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-09-14
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: ~ ()~~~In patient
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: PT found dead in his crib;

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