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History of Changes from the VAERS Wayback Machine |
VAERS ID: | 35493 |
VAERS Form: | |
Age: | 0.2 |
Sex: | Male |
Location: | Michigan |
Vaccinated: | 1991-10-02 |
Onset: | 1991-10-02 |
Submitted: | 1991-10-08 |
Entered: | 1991-10-17 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTP: DTP MICH. PHD. / MICHIGAN DPH | TR1214 / 0 | RL / IM |
HIBV: HIBTITER / LEDERLE(PRAXIS) | M180HH / 0 | LL / IM |
OPV: ORIMUNE / LEDERLE | 0636B / 0 | - / PO |
Administered by: Private Purchased by: Unknown
Symptoms: SIDS
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1991-10-04
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: h/o URI-looks fine
Preexisting Conditions: 2 beats clonus on feet; cranky/colicy infant
Allergies:
Diagnostic Lab Data: Autopsy pending;
CDC 'Split Type':
Write-up: Death from apparent SIDS; sudden infant Death Syndrome;
Vaccinated: | 1991-10-02 |
Onset: | 1991-10-02 |
Submitted: | 1991-10-08 |
Entered: | 1991-10-17 1991-10-15 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTP: DTP MICH. PHD. DTP (NO BRAND NAME) / MICHIGAN DPH MICHIGAN DEPT PUB HLTH | TR1214 / 0 | RL / IM |
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS | M180HH / 0 | LL / IM |
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES | 0636B / 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:1991-10-04
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: h/o URI-looks fine
Preexisting Conditions: 2 beats clonus on feet; cranky/colicy infant
Allergies:
Diagnostic Lab Data: Autopsy pending;
CDC 'Split Type':
Write-up: Death from apparent SIDS; sudden infant Death Syndrome;
Vaccinated: | 1991-10-02 |
Onset: | 1991-10-02 |
Submitted: | 1991-10-08 |
Entered: | 1991-10-15 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH | TR1214 / 0 | RL / IM |
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH | M180HH / 0 | LL / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH | 0636B / 0 | - / PO |
Administered by: Private Purchased by: Private
Symptoms: Sudden infant death syndrome
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1991-10-04
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: h/o URI-looks fine
Preexisting Conditions: 2 beats clonus on feet; cranky/colicy infant
Allergies:
Diagnostic Lab Data: Autopsy pending;
CDC 'Split Type':
Write-up: Death from apparent SIDS; sudden infant Death Syndrome;
Vaccinated: | 1991-10-02 |
Onset: | 1991-10-02 |
Submitted: | 1991-10-08 |
Entered: | 1991-10-15 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH | TR1214 / 0 1 | RL / IM |
HIBV: HIB (HIBTITER) / PFIZER/WYETH | M180HH / 0 1 | LL / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH | 0636B / 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:1991-10-04
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: h/o URI-looks fine
Preexisting Conditions: 2 beats clonus on feet; cranky/colicy infant
Allergies:
Diagnostic Lab Data: Autopsy pending;
CDC 'Split Type':
Write-up: Death from apparent SIDS; sudden infant Death Syndrome;
Vaccinated: | 1991-10-02 |
Onset: | 1991-10-02 |
Submitted: | 1991-10-08 |
Entered: | 1991-10-15 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH | TR1214 / 1 | RL / IM |
HIBV: HIB (HIBTITER) / PFIZER/WYETH | M180HH / 1 | LL / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH | 0636B / 1 | MO / PO |
Administered by: Private Purchased by: Private
Symptoms: Sudden infant death syndrome
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1991-10-04
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: h/o URI-looks fine
Preexisting Conditions: 2 beats clonus on feet; cranky/colicy infant
Allergies:
Diagnostic Lab Data: Autopsy pending;
CDC 'Split Type':
Write-up: Death from apparent SIDS; sudden infant Death Syndrome;
Vaccinated: | 1991-10-02 |
Onset: | 1991-10-02 |
Submitted: | 1991-10-08 |
Entered: | 1991-10-15 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH | TR1214 / 1 | RL / IM |
HIBV: HIB (HIBTITER) / PFIZER/WYETH | M180HH / 1 | LL / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH | 0636B / 1 | MO / PO |
Administered by: Private Purchased by: Private
Symptoms: Sudden infant death syndrome
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1991-10-04
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: h/o URI-looks fine
Preexisting Conditions: 2 beats clonus on feet; cranky/colicy infant
Allergies:
Diagnostic Lab Data: Autopsy pending;
CDC 'Split Type':
Write-up: Death from apparent SIDS; sudden infant Death Syndrome;
Vaccinated: | 1991-10-02 |
Onset: | 1991-10-02 |
Submitted: | 1991-10-08 |
Entered: | 1991-10-15 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH | TR1214 / 1 | RL / IM |
HIBV: HIB (HIBTITER) / PFIZER/WYETH | M180HH / 1 | LL / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH | 0636B / 1 | MO / PO |
Administered by: Private Purchased by: Private
Symptoms: Sudden infant death syndrome
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1991-10-04
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: h/o URI-looks fine
Preexisting Conditions: 2 beats clonus on feet; cranky/colicy infant
Allergies:
Diagnostic Lab Data: Autopsy pending;
CDC 'Split Type':
Write-up: Death from apparent SIDS; sudden infant Death Syndrome;
Vaccinated: | 1991-10-02 |
Onset: | 1991-10-02 |
Submitted: | 1991-10-08 |
Entered: | 1991-10-15 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH | TR1214 / 1 | RL / IM |
HIBV: HIB (HIBTITER) / PFIZER/WYETH | M180HH / 1 | LL / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH | 0636B / 1 | MO / PO |
Administered by: Private Purchased by: Private
Symptoms: Sudden infant death syndrome
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1991-10-04
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: h/o URI-looks fine
Preexisting Conditions: 2 beats clonus on feet; cranky/colicy infant
Allergies:
Diagnostic Lab Data: Autopsy pending;
CDC 'Split Type':
Write-up: Death from apparent SIDS; sudden infant Death Syndrome;
Vaccinated: | 1991-10-02 |
Onset: | 1991-10-02 |
Submitted: | 1991-10-08 |
Entered: | 1991-10-15 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH | TR1214 / 1 | RL / IM |
HIBV: HIB (HIBTITER) / PFIZER/WYETH | M180HH / 1 | LL / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH | 0636B / 1 | MO / PO |
Administered by: Private Purchased by: Private
Symptoms: Sudden infant death syndrome
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1991-10-04
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: h/o URI-looks fine
Preexisting Conditions: 2 beats clonus on feet; cranky/colicy infant
Allergies:
Diagnostic Lab Data: Autopsy pending;
CDC 'Split Type':
Write-up: Death from apparent SIDS; sudden infant Death Syndrome;
Vaccinated: | 1991-10-02 |
Onset: | 1991-10-02 |
Submitted: | 1991-10-08 |
Entered: | 1991-10-15 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH | TR1214 / 1 | RL / IM |
HIBV: HIB (HIBTITER) / PFIZER/WYETH | M180HH / 1 | LL / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH | 0636B / 1 | MO / PO |
Administered by: Private Purchased by: Private
Symptoms: Sudden infant death syndrome
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1991-10-04
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: h/o URI-looks fine
Preexisting Conditions: 2 beats clonus on feet; cranky/colicy infant
Allergies:
Diagnostic Lab Data: Autopsy pending;
CDC 'Split Type':
Write-up: Death from apparent SIDS; sudden infant Death Syndrome;
Vaccinated: | 1991-10-02 |
Onset: | 1991-10-02 |
Submitted: | 1991-10-08 |
Entered: | 1991-10-15 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH | TR1214 / 1 | RL / IM |
HIBV: HIB (HIBTITER) / PFIZER/WYETH | M180HH / 1 | LL / IM |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH | 0636B / 1 | MO / PO |
Administered by: Private Purchased by: Private
Symptoms: Sudden infant death syndrome
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:1991-10-04
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: h/o URI-looks fine
Preexisting Conditions: 2 beats clonus on feet; cranky/colicy infant
Allergies:
Diagnostic Lab Data: Autopsy pending;
CDC 'Split Type':
Write-up: Death from apparent SIDS; sudden infant Death Syndrome;
Link To This Search Result:
https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=35493&WAYBACKHISTORY=ON
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