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This is VAERS ID 121425

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 121425
VAERS Form:
Age:1.0
Sex:Male
Location:Georgia
Vaccinated:1999-03-11
Onset:1999-04-02
Submitted:1999-04-09
Entered:1999-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MMR II / MSD 1357H / 0 RA / SC
OPV: ORIMUNE / LEDERLE 0792A / 2 - / PO
VARCEL: VARIVAX / MSD 1252H / 0 LA / SC

Administered by: Public      Purchased by: Unknown
Symptoms: DEHYDRAT, GASTROENTERITIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-04-03
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: None reported to this facility;


Changed on 12/8/2009

VAERS ID: 121425 Before After
VAERS Form:
Age:1.0
Sex:Male
Location:Georgia
Vaccinated:1999-03-11
Onset:1999-04-02
Submitted:1999-04-09
Entered:1999-04-26 1999-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 1357H / 0 RA / SC
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 0792A / 2 - / PO
VARCEL: VARIVAX VARICELLA (VARIVAX) / MSD MERCK & CO. INC. 1252H / 0 LA / SC

Administered by: Public      Purchased by: Unknown Public
Symptoms: Dehydration, Gastroenteritis, DEHYDRAT, GASTROENTERITIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-04-03
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) GA99033

Write-up: None reported to this facility;


Changed on 5/14/2017

VAERS ID: 121425 Before After
VAERS Form:
Age:1.0
Sex:Male
Location:Georgia
Vaccinated:1999-03-11
Onset:1999-04-02
Submitted:1999-04-09
Entered:1999-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1357H / 0 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 0792A / 2 - / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1252H / 0 LA / SC

Administered by: Public      Purchased by: Public
Symptoms: Dehydration, Gastroenteritis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-04-03
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA99033

Write-up: None reported to this facility;


Changed on 9/14/2017

VAERS ID: 121425 Before After
VAERS Form:(blank) 1
Age:1.0
Sex:Male
Location:Georgia
Vaccinated:1999-03-11
Onset:1999-04-02
Submitted:1999-04-09
Entered:1999-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1357H / 0 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0792A / 2 3 - MO / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1252H / 0 1 LA / SC

Administered by: Public      Purchased by: Public
Symptoms: Dehydration, Gastroenteritis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-04-03
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA99033

Write-up: None reported to this facility;


Changed on 2/14/2018

VAERS ID: 121425 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Georgia
Vaccinated:1999-03-11
Onset:1999-04-02
Submitted:1999-04-09
Entered:1999-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1357H / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0792A / 3 MO / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1252H / 1 LA / SC

Administered by: Public      Purchased by: Public
Symptoms: Dehydration, Gastroenteritis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-04-03
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA99033

Write-up: None reported to this facility;


Changed on 6/14/2018

VAERS ID: 121425 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Georgia
Vaccinated:1999-03-11
Onset:1999-04-02
Submitted:1999-04-09
Entered:1999-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1357H / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0792A / 3 MO / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1252H / 1 LA / SC

Administered by: Public      Purchased by: Public
Symptoms: Dehydration, Gastroenteritis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-04-03
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA99033

Write-up: None reported to this facility;


Changed on 8/14/2018

VAERS ID: 121425 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Georgia
Vaccinated:1999-03-11
Onset:1999-04-02
Submitted:1999-04-09
Entered:1999-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1357H / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0792A / 3 MO / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1252H / 1 LA / SC

Administered by: Public      Purchased by: Public
Symptoms: Dehydration, Gastroenteritis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-04-03
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA99033

Write-up: None reported to this facility;


Changed on 9/14/2018

VAERS ID: 121425 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Georgia
Vaccinated:1999-03-11
Onset:1999-04-02
Submitted:1999-04-09
Entered:1999-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1357H / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0792A / 3 MO / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1252H / 1 LA / SC

Administered by: Public      Purchased by: Public
Symptoms: Dehydration, Gastroenteritis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-04-03
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA99033

Write-up: None reported to this facility;


Changed on 10/14/2018

VAERS ID: 121425 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Georgia
Vaccinated:1999-03-11
Onset:1999-04-02
Submitted:1999-04-09
Entered:1999-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1357H / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0792A / 3 MO / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1252H / 1 LA / SC

Administered by: Public      Purchased by: Public
Symptoms: Dehydration, Gastroenteritis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-04-03
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA99033

Write-up: None reported to this facility;

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