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This is VAERS ID 109026

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 109026
VAERS Form:
Age:0.2
Sex:Male
Location:New Hampshire
Vaccinated:1996-02-29
Onset:0000-00-00
Submitted:1998-03-24
Entered:1998-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPH: TETRAMUNE / LEDERLE 427821 / 1 RL / IM
OPV: ORIMUNE / LEDERLE 725C5 / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS, BRAIN SYND ACUTE, ENCEPHALOPATHY, HYPOXIA, SLEEP POSITION

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-04-12
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS


Changed on 12/8/2009

VAERS ID: 109026 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:New Hampshire
Vaccinated:1996-02-29
Onset:0000-00-00
Submitted:1998-03-24
Entered:1998-04-03 1998-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPH: TETRAMUNE / LEDERLE 427821 / 1 RL / IM
DTPHIB: DTP + HIB (TETRAMUNE) / LEDERLE LABORATORIES 427821 / 1 RL / IM
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 725C5 / 1 - / PO

Administered by: Private Unknown      Purchased by: Unknown
Symptoms: Delirium, Encephalopathy, Hypoxia, SIDS, Sudden infant death syndrome, Unevaluable event, BRAIN SYND ACUTE, ENCEPHALOPATHY, HYPOXIA, SLEEP POSITION

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-04-12
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) NH9636

Write-up: SIDS


Changed on 5/14/2017

VAERS ID: 109026 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:New Hampshire
Vaccinated:1996-02-29
Onset:0000-00-00
Submitted:1998-03-24
Entered:1998-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 427821 / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 725C5 / 1 - / PO

Administered by: Unknown Private      Purchased by: Unknown Public
Symptoms: Delirium, Encephalopathy, Hypoxia, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-04-12
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH9636

Write-up: SIDS


Changed on 9/14/2017

VAERS ID: 109026 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:New Hampshire
Vaccinated:1996-02-29
Onset:0000-00-00
Submitted:1998-03-24
Entered:1998-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 427821 / 1 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 725C5 / 1 2 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Delirium, Encephalopathy, Hypoxia, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-04-12
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH9636

Write-up: SIDS


Changed on 2/14/2018

VAERS ID: 109026 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:New Hampshire
Vaccinated:1996-02-29
Onset:0000-00-00
Submitted:1998-03-24
Entered:1998-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 427821 / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 725C5 / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Delirium, Encephalopathy, Hypoxia, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-04-12
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH9636

Write-up: SIDS


Changed on 6/14/2018

VAERS ID: 109026 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:New Hampshire
Vaccinated:1996-02-29
Onset:0000-00-00
Submitted:1998-03-24
Entered:1998-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 427821 / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 725C5 / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Delirium, Encephalopathy, Hypoxia, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-04-12
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH9636

Write-up: SIDS


Changed on 8/14/2018

VAERS ID: 109026 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:New Hampshire
Vaccinated:1996-02-29
Onset:0000-00-00
Submitted:1998-03-24
Entered:1998-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 427821 / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 725C5 / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Delirium, Encephalopathy, Hypoxia, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-04-12
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH9636

Write-up: SIDS


Changed on 9/14/2018

VAERS ID: 109026 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:New Hampshire
Vaccinated:1996-02-29
Onset:0000-00-00
Submitted:1998-03-24
Entered:1998-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 427821 / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 725C5 / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Delirium, Encephalopathy, Hypoxia, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-04-12
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH9636

Write-up: SIDS


Changed on 10/14/2018

VAERS ID: 109026 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:New Hampshire
Vaccinated:1996-02-29
Onset:0000-00-00
Submitted:1998-03-24
Entered:1998-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 427821 / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 725C5 / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Delirium, Encephalopathy, Hypoxia, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-04-12
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH9636

Write-up: SIDS

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