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This is VAERS ID 40527

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History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 40527
VAERS Form:
Age:0.3
Sex:Male
Location:Washington
Vaccinated:1991-12-16
Onset:1991-12-16
Submitted:1992-01-06
Entered:1992-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 306924 / 1 RL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M680HE / 1 LL / IM
OPV: ORIMUNE / LEDERLE 308957 / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: LYMPHADENO, EDEMA LUNG, LIVER DAMAGE, ATELECTASIS, HEM

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-12-16
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: NA
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NONE

Write-up: SIDS found dead in crib;


Changed on 12/8/2009

VAERS ID: 40527 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Washington
Vaccinated:1991-12-16
Onset:1991-12-16
Submitted:1992-01-06
Entered:1992-03-26 1992-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 306924 / 1 RL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M680HE / 1 LL / IM
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 308957 / 1 - / PO

Administered by: Private      Purchased by: Unknown Public
Symptoms: Atelectasis, Hepatocellular damage, Lymphadenopathy, Petechiae, Pulmonary oedema, Spleen disorder, Sudden infant death syndrome, Haemorrhage, LYMPHADENO, EDEMA LUNG, LIVER DAMAGE, ATELECTASIS, HEM

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-12-16
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: NA
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NONE WA92673

Write-up: SIDS found dead in crib;


Changed on 5/14/2017

VAERS ID: 40527 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Washington
Vaccinated:1991-12-16
Onset:1991-12-16
Submitted:1992-01-06
Entered:1992-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 306924 / 1 RL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M680HE / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 308957 / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Atelectasis, Hepatocellular damage, Lymphadenopathy, Petechiae, Pulmonary oedema, Spleen disorder, Sudden infant death syndrome, Haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-12-16
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: NA NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': WA92673

Write-up: SIDS found dead in crib;


Changed on 9/14/2017

VAERS ID: 40527 Before After
VAERS Form:(blank) 1
Age:0.3
Sex:Male
Location:Washington
Vaccinated:1991-12-16
Onset:1991-12-16
Submitted:1992-01-06
Entered:1992-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 306924 / 1 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M680HE / 1 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 308957 / 1 2 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Atelectasis, Hepatocellular damage, Lymphadenopathy, Petechiae, Pulmonary oedema, Spleen disorder, Sudden infant death syndrome, Haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-12-16
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: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': WA92673

Write-up: SIDS found dead in crib;


Changed on 2/14/2018

VAERS ID: 40527 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Washington
Vaccinated:1991-12-16
Onset:1991-12-16
Submitted:1992-01-06
Entered:1992-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 306924 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M680HE / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 308957 / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Atelectasis, Hepatocellular damage, Lymphadenopathy, Petechiae, Pulmonary oedema, Spleen disorder, Sudden infant death syndrome, Haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-12-16
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: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': WA92673

Write-up: SIDS found dead in crib;


Changed on 6/14/2018

VAERS ID: 40527 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Washington
Vaccinated:1991-12-16
Onset:1991-12-16
Submitted:1992-01-06
Entered:1992-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 306924 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M680HE / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 308957 / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Atelectasis, Hepatocellular damage, Lymphadenopathy, Petechiae, Pulmonary oedema, Spleen disorder, Sudden infant death syndrome, Haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-12-16
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: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': WA92673

Write-up: SIDS found dead in crib;


Changed on 8/14/2018

VAERS ID: 40527 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Washington
Vaccinated:1991-12-16
Onset:1991-12-16
Submitted:1992-01-06
Entered:1992-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 306924 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M680HE / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 308957 / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Atelectasis, Hepatocellular damage, Lymphadenopathy, Petechiae, Pulmonary oedema, Spleen disorder, Sudden infant death syndrome, Haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-12-16
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: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': WA92673

Write-up: SIDS found dead in crib;


Changed on 9/14/2018

VAERS ID: 40527 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Washington
Vaccinated:1991-12-16
Onset:1991-12-16
Submitted:1992-01-06
Entered:1992-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 306924 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M680HE / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 308957 / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Atelectasis, Hepatocellular damage, Lymphadenopathy, Petechiae, Pulmonary oedema, Spleen disorder, Sudden infant death syndrome, Haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-12-16
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: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': WA92673

Write-up: SIDS found dead in crib;


Changed on 10/14/2018

VAERS ID: 40527 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Washington
Vaccinated:1991-12-16
Onset:1991-12-16
Submitted:1992-01-06
Entered:1992-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 306924 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M680HE / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 308957 / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Atelectasis, Hepatocellular damage, Lymphadenopathy, Petechiae, Pulmonary oedema, Spleen disorder, Sudden infant death syndrome, Haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-12-16
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: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': WA92673

Write-up: SIDS found dead in crib;


Changed on 12/24/2020

VAERS ID: 40527 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Washington
Vaccinated:1991-12-16
Onset:1991-12-16
Submitted:1992-01-06
Entered:1992-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 306924 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M680HE / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 308957 / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Atelectasis, Hepatocellular damage, Lymphadenopathy, Petechiae, Pulmonary oedema, Spleen disorder, Sudden infant death syndrome, Haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-12-16
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: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': WA92673

Write-up: SIDS found dead in crib;


Changed on 12/30/2020

VAERS ID: 40527 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Washington
Vaccinated:1991-12-16
Onset:1991-12-16
Submitted:1992-01-06
Entered:1992-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 306924 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M680HE / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 308957 / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Atelectasis, Hepatocellular damage, Lymphadenopathy, Petechiae, Pulmonary oedema, Spleen disorder, Sudden infant death syndrome, Haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-12-16
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: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': WA92673

Write-up: SIDS found dead in crib;


Changed on 5/7/2021

VAERS ID: 40527 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Washington
Vaccinated:1991-12-16
Onset:1991-12-16
Submitted:1992-01-06
Entered:1992-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 306924 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M680HE / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 308957 / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Atelectasis, Hepatocellular damage, Lymphadenopathy, Petechiae, Pulmonary oedema, Spleen disorder, Sudden infant death syndrome, Haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-12-16
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: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': WA92673

Write-up: SIDS found dead in crib;


Changed on 5/21/2021

VAERS ID: 40527 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Washington
Vaccinated:1991-12-16
Onset:1991-12-16
Submitted:1992-01-06
Entered:1992-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 306924 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M680HE / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 308957 / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Atelectasis, Hepatocellular damage, Lymphadenopathy, Petechiae, Pulmonary oedema, Spleen disorder, Sudden infant death syndrome, Haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-12-16
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: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': WA92673

Write-up: SIDS found dead in crib;

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