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This is VAERS ID 107771

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 107771
VAERS Form:
Age:0.4
Sex:Male
Location:New York
Vaccinated:1997-10-31
Onset:1997-11-01
Submitted:1998-02-13
Entered:1998-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: UNK. DTP / UNCLASSIFIED 444250 / 1 LL / -
OPV: ORIMUNE / LEDERLE 7100A / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS, AGITATION, FEVER, INSOMNIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-11-01
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: sl cough
Preexisting Conditions: reactive ariway disease
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: fever, crankiness, sleepless;


Changed on 12/8/2009

VAERS ID: 107771 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:New York
Vaccinated:1997-10-31
Onset:1997-11-01
Submitted:1998-02-13
Entered:1998-02-24 1998-02-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: UNK. DTP DTP (NO BRAND NAME) / UNCLASSIFIED UNKNOWN MANUFACTURER 444250 / 1 LL / -
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 7100A / 1 - / PO

Administered by: Private      Purchased by: Unknown Private
Symptoms: Agitation, Insomnia, Pyrexia, SIDS, Sudden infant death syndrome, AGITATION, FEVER, INSOMNIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-11-01
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: sl cough
Preexisting Conditions: reactive ariway disease
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: fever, crankiness, sleepless;


Changed on 5/14/2017

VAERS ID: 107771 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:New York
Vaccinated:1997-10-31
Onset:1997-11-01
Submitted:1998-02-13
Entered:1998-02-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER 444250 / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 7100A / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Insomnia, Pyrexia, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-11-01
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: sl cough
Preexisting Conditions: reactive ariway disease
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: fever, crankiness, sleepless;


Changed on 9/14/2017

VAERS ID: 107771 Before After
VAERS Form:(blank) 1
Age:0.4
Sex:Male
Location:New York
Vaccinated:1997-10-31
Onset:1997-11-01
Submitted:1998-02-13
Entered:1998-02-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER 444250 / 1 2 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 7100A / 1 2 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Insomnia, Pyrexia, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-11-01
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: sl cough
Preexisting Conditions: reactive ariway disease
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: fever, crankiness, sleepless;


Changed on 2/14/2018

VAERS ID: 107771 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:New York
Vaccinated:1997-10-31
Onset:1997-11-01
Submitted:1998-02-13
Entered:1998-02-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER 444250 / 2 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 7100A / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Insomnia, Pyrexia, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-11-01
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: sl cough
Preexisting Conditions: reactive ariway disease
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: fever, crankiness, sleepless;


Changed on 6/14/2018

VAERS ID: 107771 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:New York
Vaccinated:1997-10-31
Onset:1997-11-01
Submitted:1998-02-13
Entered:1998-02-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER 444250 / 2 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 7100A / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Insomnia, Pyrexia, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-11-01
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: sl cough
Preexisting Conditions: reactive ariway disease
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: fever, crankiness, sleepless;


Changed on 8/14/2018

VAERS ID: 107771 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:New York
Vaccinated:1997-10-31
Onset:1997-11-01
Submitted:1998-02-13
Entered:1998-02-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER 444250 / 2 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 7100A / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Insomnia, Pyrexia, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-11-01
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: sl cough
Preexisting Conditions: reactive ariway disease
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: fever, crankiness, sleepless;


Changed on 9/14/2018

VAERS ID: 107771 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:New York
Vaccinated:1997-10-31
Onset:1997-11-01
Submitted:1998-02-13
Entered:1998-02-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER 444250 / 2 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 7100A / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Insomnia, Pyrexia, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-11-01
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: sl cough
Preexisting Conditions: reactive ariway disease
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: fever, crankiness, sleepless;


Changed on 10/14/2018

VAERS ID: 107771 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:New York
Vaccinated:1997-10-31
Onset:1997-11-01
Submitted:1998-02-13
Entered:1998-02-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER 444250 / 2 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 7100A / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Insomnia, Pyrexia, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-11-01
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: sl cough
Preexisting Conditions: reactive ariway disease
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: fever, crankiness, sleepless;

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