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This is VAERS ID 459278

History of Changes from the VAERS Wayback Machine

First Appeared on 8/13/2012

VAERS ID: 459278
VAERS Form:
Age:0.3
Sex:Male
Location:Illinois
Vaccinated:1990-05-07
Onset:0000-00-00
Submitted:2012-07-14
Entered:2012-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - LG / IM
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - LG / IM

Administered by: Private      Purchased by: Other
Symptoms: Death, Pulse absent, Pyrexia, Respiratory arrest, Resuscitation, Sudden infant death syndrome, Respiratory tract congestion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-05-08
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: Infant Tylenol
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: On 05/07/1990 Scott went to the Doctor and had a physical, which the doctor said he was in good health and doing well for his age and he also received 2 vaccinations MMR and DPT. He was congested and had a fever after receiving his shots. I gave him infant Tylenol during the day and before I put him to sleep. At 7am approximately 12 hours later I found patient in his bed not breathing and without a pulse. I performed CPR but patient died. The coroner determined that the cause of death was SIDS.


Changed on 1/7/2013

VAERS ID: 459278 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Illinois
Vaccinated:1990-05-07
Onset:0000-00-00
Submitted:2012-07-14
Entered:2012-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - LG / IM
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - LG / IM

Administered by: Private      Purchased by: Other
Symptoms: Death, Pulse absent, Pyrexia, Respiratory arrest, Resuscitation, Sudden infant death syndrome, Respiratory tract congestion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-05-08
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: Infant Tylenol
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: On 05/07/1990 Scott patient went to the Doctor and had a physical, which the doctor said he was in good health and doing well for his age and he also received 2 vaccinations MMR and DPT. He was congested and had a fever after receiving his shots. I gave him infant Tylenol during the day and before I put him to sleep. At 7am approximately 12 hours later I found patient in his bed not breathing and without a pulse. I performed CPR but patient died. The coroner determined that the cause of death was SIDS.


Changed on 6/14/2014

VAERS ID: 459278 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Illinois
Vaccinated:1990-05-07
Onset:0000-00-00
Submitted:2012-07-14
Entered:2012-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - LG / IM
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - LG / IM

Administered by: Private      Purchased by: Other
Symptoms: Death, Pulse absent, Pyrexia, Respiratory arrest, Resuscitation, Sudden infant death syndrome, Respiratory tract congestion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-05-08
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: Infant Tylenol
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: On 05/07/1990 patient went to the Doctor and had a physical, which the doctor said he was in good health and doing well for his age and he also received 2 vaccinations MMR and DPT. He was congested and had a fever after receiving his shots. I gave him infant Tylenol during the day and before I put him to sleep. At 7am approximately 12 hours later I found patient in his bed not breathing and without a pulse. I performed CPR but patient died. The coroner determined that the cause of death was SIDS.


Changed on 3/14/2015

VAERS ID: 459278 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Illinois
Vaccinated:1990-05-07
Onset:0000-00-00
Submitted:2012-07-14
Entered:2012-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - LG / IM
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - LG / IM

Administered by: Private      Purchased by: Other
Symptoms: Death, Pulse absent, Pyrexia, Respiratory arrest, Resuscitation, Sudden infant death syndrome, Respiratory tract congestion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-05-08
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: Infant Tylenol
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: On 05/07/1990 patient went to the Doctor and had a physical, which the doctor said he was in good health and doing well for his age and he also received 2 vaccinations MMR and DPT. He was congested and had a fever after receiving his shots. I gave him infant Tylenol during the day and before I put him to sleep. At 7am approximately 12 hours later I found patient in his bed not breathing and without a pulse. I performed CPR but patient died. The coroner determined that the cause of death was SIDS.


Changed on 2/14/2017

VAERS ID: 459278 Before After
VAERS Form:
Age:0.3 0.27
Sex:Male
Location:Illinois
Vaccinated:1990-05-07
Onset:0000-00-00
Submitted:2012-07-14
Entered:2012-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - LG / IM
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - LG / IM

Administered by: Private      Purchased by: Other
Symptoms: Death, Pulse absent, Pyrexia, Respiratory arrest, Resuscitation, Sudden infant death syndrome, Respiratory tract congestion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-05-08
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: Infant Tylenol
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: On 05/07/1990 patient went to the Doctor and had a physical, which the doctor said he was in good health and doing well for his age and he also received 2 vaccinations MMR and DPT. He was congested and had a fever after receiving his shots. I gave him infant Tylenol during the day and before I put him to sleep. At 7am approximately 12 hours later I found patient in his bed not breathing and without a pulse. I performed CPR but patient died. The coroner determined that the cause of death was SIDS.


Changed on 9/14/2017

VAERS ID: 459278 Before After
VAERS Form:(blank) 1
Age:0.27
Sex:Male
Location:Illinois
Vaccinated:1990-05-07
Onset:0000-00-00
Submitted:2012-07-14
Entered:2012-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK LG / IM
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK LG / IM

Administered by: Private      Purchased by: Other
Symptoms: Death, Pulse absent, Pyrexia, Respiratory arrest, Resuscitation, Sudden infant death syndrome, Respiratory tract congestion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-05-08
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: Infant Tylenol
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: On 05/07/1990 patient went to the Doctor and had a physical, which the doctor said he was in good health and doing well for his age and he also received 2 vaccinations MMR and DPT. He was congested and had a fever after receiving his shots. I gave him infant Tylenol during the day and before I put him to sleep. At 7am approximately 12 hours later I found patient in his bed not breathing and without a pulse. I performed CPR but patient died. The coroner determined that the cause of death was SIDS.


Changed on 2/14/2018

VAERS ID: 459278 Before After
VAERS Form:1
Age:0.27
Sex:Male
Location:Illinois
Vaccinated:1990-05-07
Onset:0000-00-00
Submitted:2012-07-14
Entered:2012-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK LG / IM
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK LG / IM

Administered by: Private      Purchased by: Other
Symptoms: Death, Pulse absent, Pyrexia, Respiratory arrest, Resuscitation, Sudden infant death syndrome, Respiratory tract congestion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-05-08
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: Infant Tylenol
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: On 05/07/1990 patient went to the Doctor and had a physical, which the doctor said he was in good health and doing well for his age and he also received 2 vaccinations MMR and DPT. He was congested and had a fever after receiving his shots. I gave him infant Tylenol during the day and before I put him to sleep. At 7am approximately 12 hours later I found patient in his bed not breathing and without a pulse. I performed CPR but patient died. The coroner determined that the cause of death was SIDS.


Changed on 6/14/2018

VAERS ID: 459278 Before After
VAERS Form:1
Age:0.27
Sex:Male
Location:Illinois
Vaccinated:1990-05-07
Onset:0000-00-00
Submitted:2012-07-14
Entered:2012-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK LG / IM
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK LG / IM

Administered by: Private      Purchased by: Other
Symptoms: Death, Pulse absent, Pyrexia, Respiratory arrest, Resuscitation, Sudden infant death syndrome, Respiratory tract congestion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-05-08
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: Infant Tylenol
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: On 05/07/1990 patient went to the Doctor and had a physical, which the doctor said he was in good health and doing well for his age and he also received 2 vaccinations MMR and DPT. He was congested and had a fever after receiving his shots. I gave him infant Tylenol during the day and before I put him to sleep. At 7am approximately 12 hours later I found patient in his bed not breathing and without a pulse. I performed CPR but patient died. The coroner determined that the cause of death was SIDS.


Changed on 8/14/2018

VAERS ID: 459278 Before After
VAERS Form:1
Age:0.27
Sex:Male
Location:Illinois
Vaccinated:1990-05-07
Onset:0000-00-00
Submitted:2012-07-14
Entered:2012-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK LG / IM
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK LG / IM

Administered by: Private      Purchased by: Other
Symptoms: Death, Pulse absent, Pyrexia, Respiratory arrest, Resuscitation, Sudden infant death syndrome, Respiratory tract congestion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-05-08
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: Infant Tylenol
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: On 05/07/1990 patient went to the Doctor and had a physical, which the doctor said he was in good health and doing well for his age and he also received 2 vaccinations MMR and DPT. He was congested and had a fever after receiving his shots. I gave him infant Tylenol during the day and before I put him to sleep. At 7am approximately 12 hours later I found patient in his bed not breathing and without a pulse. I performed CPR but patient died. The coroner determined that the cause of death was SIDS.


Changed on 9/14/2018

VAERS ID: 459278 Before After
VAERS Form:1
Age:0.27
Sex:Male
Location:Illinois
Vaccinated:1990-05-07
Onset:0000-00-00
Submitted:2012-07-14
Entered:2012-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK LG / IM
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK LG / IM

Administered by: Private      Purchased by: Other
Symptoms: Death, Pulse absent, Pyrexia, Respiratory arrest, Resuscitation, Sudden infant death syndrome, Respiratory tract congestion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-05-08
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: Infant Tylenol
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: On 05/07/1990 patient went to the Doctor and had a physical, which the doctor said he was in good health and doing well for his age and he also received 2 vaccinations MMR and DPT. He was congested and had a fever after receiving his shots. I gave him infant Tylenol during the day and before I put him to sleep. At 7am approximately 12 hours later I found patient in his bed not breathing and without a pulse. I performed CPR but patient died. The coroner determined that the cause of death was SIDS.


Changed on 10/14/2018

VAERS ID: 459278 Before After
VAERS Form:1
Age:0.27
Sex:Male
Location:Illinois
Vaccinated:1990-05-07
Onset:0000-00-00
Submitted:2012-07-14
Entered:2012-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK LG / IM
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK LG / IM

Administered by: Private      Purchased by: Other
Symptoms: Death, Pulse absent, Pyrexia, Respiratory arrest, Resuscitation, Sudden infant death syndrome, Respiratory tract congestion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-05-08
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: Infant Tylenol
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: On 05/07/1990 patient went to the Doctor and had a physical, which the doctor said he was in good health and doing well for his age and he also received 2 vaccinations MMR and DPT. He was congested and had a fever after receiving his shots. I gave him infant Tylenol during the day and before I put him to sleep. At 7am approximately 12 hours later I found patient in his bed not breathing and without a pulse. I performed CPR but patient died. The coroner determined that the cause of death was SIDS.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=459278&WAYBACKHISTORY=ON


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