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This is VAERS ID 35493

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

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;

Changed on 12/8/2009

VAERS ID: 35493 Before After
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 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;

Changed on 5/14/2017

VAERS ID: 35493 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Michigan
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;

Changed on 9/14/2017

VAERS ID: 35493 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:Michigan
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;

Changed on 2/14/2018

VAERS ID: 35493 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Michigan
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;

Changed on 6/14/2018

VAERS ID: 35493 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Michigan
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;

Changed on 8/14/2018

VAERS ID: 35493 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Michigan
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;

Changed on 9/14/2018

VAERS ID: 35493 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Michigan
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;

Changed on 10/14/2018

VAERS ID: 35493 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Michigan
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;

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=35493&WAYBACKHISTORY=ON


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