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This is VAERS ID 112819

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 112819
VAERS Form:
Age:2.1
Sex:Male
Location:Michigan
Vaccinated:1998-07-06
Onset:1998-07-13
Submitted:1998-07-20
Entered:1998-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIBTITER / LEDERLE(PRAXIS) - / 0 - / -
MMR: UNK. MEASLES, MUMPS & RUBELLA VIRUS LIVE / UNCLASSIFIED 1316E / 0 - / SC
VARCEL: VARIVAX / MSD 0650H / 0 - / SC

Administered by: Other      Purchased by: Unknown
Symptoms: REACT UNEVAL

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-07-13
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: No relevant data;
Other Medications:
Current Illness:
Preexisting Conditions: acid reflux;anoxic brain damage;apnea;mental retardation;micrencephaly;premature delivery;sz;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': acid reflux;anoxic brain damage;apnea;mental retardation;micrencephaly;premature delivery;sz;

Write-up: pt recv vax 6JUL98 & 12JUL98 pt was put to bed & was nl prior to bedtime;13JUL98 pt was found dead;the reporting nurse noted that the pt did not have any fever or resp problems noted @ bedtime;no autopsy was ordered per family request;


Changed on 12/8/2009

VAERS ID: 112819 Before After
VAERS Form:
Age:2.1
Sex:Male
Location:Michigan
Vaccinated:1998-07-06
Onset:1998-07-13
Submitted:1998-07-20
Entered:1998-07-24 1998-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS - / 0 - / -
MMR: UNK. MEASLES, MUMPS & RUBELLA VIRUS LIVE MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNCLASSIFIED UNKNOWN MANUFACTURER 1316E / 0 - / SC
VARCEL: VARIVAX VARICELLA (VARIVAX) / MSD MERCK & CO. INC. 0650H / 0 - / SC

Administered by: Other      Purchased by: Unknown Other
Symptoms: Unevaluable event, REACT UNEVAL

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-07-13
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: No relevant data;
Other Medications:
Current Illness:
Preexisting Conditions: acid reflux;anoxic brain damage;apnea;mental retardation;micrencephaly;premature delivery;sz;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': acid reflux;anoxic brain damage;apnea;mental retardation;micrencephaly;premature delivery;sz; WAES98070941

Write-up: pt recv vax 6JUL98 & 12JUL98 pt was put to bed & was nl prior to bedtime;13JUL98 pt was found dead;the reporting nurse noted that the pt did not have any fever or resp problems noted @ bedtime;no autopsy was ordered per family request;


Changed on 2/14/2017

VAERS ID: 112819 Before After
VAERS Form:
Age:2.1 2.0
Sex:Male
Location:Michigan
Vaccinated:1998-07-06
Onset:1998-07-13
Submitted:1998-07-20
Entered:1998-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS - / 0 - / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER 1316E / 0 - / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0650H / 0 - / SC

Administered by: Other      Purchased by: Other
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-07-13
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: No relevant data;
Other Medications:
Current Illness:
Preexisting Conditions: acid reflux;anoxic brain damage;apnea;mental retardation;micrencephaly;premature delivery;sz;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES98070941

Write-up: pt recv vax 6JUL98 & 12JUL98 pt was put to bed & was nl prior to bedtime;13JUL98 pt was found dead;the reporting nurse noted that the pt did not have any fever or resp problems noted @ bedtime;no autopsy was ordered per family request;


Changed on 5/14/2017

VAERS ID: 112819 Before After
VAERS Form:
Age:2.0
Sex:Male
Location:Michigan
Vaccinated:1998-07-06
Onset:1998-07-13
Submitted:1998-07-20
Entered:1998-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH - / 0 - / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER 1316E / 0 - / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0650H / 0 - / SC

Administered by: Other      Purchased by: Other
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-07-13
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: No relevant data; data;~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: acid reflux;anoxic brain damage;apnea;mental retardation;micrencephaly;premature delivery;sz;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES98070941

Write-up: pt recv vax 6JUL98 & 12JUL98 pt was put to bed & was nl prior to bedtime;13JUL98 pt was found dead;the reporting nurse noted that the pt did not have any fever or resp problems noted @ bedtime;no autopsy was ordered per family request;


Changed on 9/14/2017

VAERS ID: 112819 Before After
VAERS Form:(blank) 1
Age:2.0
Sex:Male
Location:Michigan
Vaccinated:1998-07-06
Onset:1998-07-13
Submitted:1998-07-20
Entered:1998-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / 0 1 - / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER 1316E / 0 1 - / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0650H / 0 1 - / SC

Administered by: Other      Purchased by: Other
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-07-13
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: No relevant data;~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: acid reflux;anoxic brain damage;apnea;mental retardation;micrencephaly;premature delivery;sz;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES98070941

Write-up: pt recv vax 6JUL98 & 12JUL98 pt was put to bed & was nl prior to bedtime;13JUL98 pt was found dead;the reporting nurse noted that the pt did not have any fever or resp problems noted @ bedtime;no autopsy was ordered per family request;


Changed on 2/14/2018

VAERS ID: 112819 Before After
VAERS Form:1
Age:2.0
Sex:Male
Location:Michigan
Vaccinated:1998-07-06
Onset:1998-07-13
Submitted:1998-07-20
Entered:1998-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / 1 - / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER 1316E / 1 - / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0650H / 1 - / SC

Administered by: Other      Purchased by: Other
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-07-13
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: No relevant data;~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: acid reflux;anoxic brain damage;apnea;mental retardation;micrencephaly;premature delivery;sz;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES98070941

Write-up: pt recv vax 6JUL98 & 12JUL98 pt was put to bed & was nl prior to bedtime;13JUL98 pt was found dead;the reporting nurse noted that the pt did not have any fever or resp problems noted @ bedtime;no autopsy was ordered per family request;


Changed on 6/14/2018

VAERS ID: 112819 Before After
VAERS Form:1
Age:2.0
Sex:Male
Location:Michigan
Vaccinated:1998-07-06
Onset:1998-07-13
Submitted:1998-07-20
Entered:1998-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / 1 - / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER 1316E / 1 - / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0650H / 1 - / SC

Administered by: Other      Purchased by: Other
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-07-13
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: No relevant data;~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: acid reflux;anoxic brain damage;apnea;mental retardation;micrencephaly;premature delivery;sz;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES98070941

Write-up: pt recv vax 6JUL98 & 12JUL98 pt was put to bed & was nl prior to bedtime;13JUL98 pt was found dead;the reporting nurse noted that the pt did not have any fever or resp problems noted @ bedtime;no autopsy was ordered per family request;


Changed on 8/14/2018

VAERS ID: 112819 Before After
VAERS Form:1
Age:2.0
Sex:Male
Location:Michigan
Vaccinated:1998-07-06
Onset:1998-07-13
Submitted:1998-07-20
Entered:1998-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / 1 - / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER 1316E / 1 - / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0650H / 1 - / SC

Administered by: Other      Purchased by: Other
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-07-13
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: No relevant data;~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: acid reflux;anoxic brain damage;apnea;mental retardation;micrencephaly;premature delivery;sz;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES98070941

Write-up: pt recv vax 6JUL98 & 12JUL98 pt was put to bed & was nl prior to bedtime;13JUL98 pt was found dead;the reporting nurse noted that the pt did not have any fever or resp problems noted @ bedtime;no autopsy was ordered per family request;


Changed on 9/14/2018

VAERS ID: 112819 Before After
VAERS Form:1
Age:2.0
Sex:Male
Location:Michigan
Vaccinated:1998-07-06
Onset:1998-07-13
Submitted:1998-07-20
Entered:1998-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / 1 - / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER 1316E / 1 - / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0650H / 1 - / SC

Administered by: Other      Purchased by: Other
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-07-13
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: No relevant data;~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: acid reflux;anoxic brain damage;apnea;mental retardation;micrencephaly;premature delivery;sz;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES98070941

Write-up: pt recv vax 6JUL98 & 12JUL98 pt was put to bed & was nl prior to bedtime;13JUL98 pt was found dead;the reporting nurse noted that the pt did not have any fever or resp problems noted @ bedtime;no autopsy was ordered per family request;


Changed on 10/14/2018

VAERS ID: 112819 Before After
VAERS Form:1
Age:2.0
Sex:Male
Location:Michigan
Vaccinated:1998-07-06
Onset:1998-07-13
Submitted:1998-07-20
Entered:1998-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / 1 - / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER 1316E / 1 - / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0650H / 1 - / SC

Administered by: Other      Purchased by: Other
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-07-13
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: No relevant data;~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: acid reflux;anoxic brain damage;apnea;mental retardation;micrencephaly;premature delivery;sz;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES98070941

Write-up: pt recv vax 6JUL98 & 12JUL98 pt was put to bed & was nl prior to bedtime;13JUL98 pt was found dead;the reporting nurse noted that the pt did not have any fever or resp problems noted @ bedtime;no autopsy was ordered per family request;

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=112819&WAYBACKHISTORY=ON


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