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This is VAERS ID 127043

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 127043
VAERS Form:
Age:1.0
Sex:Male
Location:Wisconsin
Vaccinated:1998-10-07
Onset:1998-12-21
Submitted:1999-08-02
Entered:1999-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MMR II / MSD 1004H / 0 LL / IM
VARCEL: VARIVAX / MSD 0845H / 0 RL / -

Administered by: Private      Purchased by: Unknown
Symptoms: REACT AGGRAV, PNEUMONIA ASPIR, STENO ESOPH

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-12-21
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: Iron drops; albuterol PRN; Synagis every mo, 11/11 & 12/8/98 MFR Medimmune, lot# 808047
Current Illness: NONE
Preexisting Conditions: TE fistula, CP, prematurity, hyaline membrane disease, spit fistula, aspiration, G tube
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: death; autopsy performed by county; aspiration pneumonia;


Changed on 12/8/2009

VAERS ID: 127043 Before After
VAERS Form:
Age:1.0
Sex:Male
Location:Wisconsin
Vaccinated:1998-10-07
Onset:1998-12-21
Submitted:1999-08-02
Entered:1999-08-12 1999-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 1004H / 0 LL / IM
VARCEL: VARIVAX VARICELLA (VARIVAX) / MSD MERCK & CO. INC. 0845H / 0 RL / -

Administered by: Private      Purchased by: Unknown Public
Symptoms: Condition aggravated, Oesophageal stenosis, Pneumonia aspiration, REACT AGGRAV, PNEUMONIA ASPIR, STENO ESOPH

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-12-21
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: Iron drops; albuterol PRN; Synagis every mo, 11/11 & 12/8/98 MFR Medimmune, lot# 808047
Current Illness: NONE
Preexisting Conditions: TE fistula, CP, prematurity, hyaline membrane disease, spit fistula, aspiration, G tube
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: death; autopsy performed by county; aspiration pneumonia;


Changed on 5/14/2017

VAERS ID: 127043 Before After
VAERS Form:
Age:1.0
Sex:Male
Location:Wisconsin
Vaccinated:1998-10-07
Onset:1998-12-21
Submitted:1999-08-02
Entered:1999-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1004H / 0 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0845H / 0 RL / -

Administered by: Private      Purchased by: Public
Symptoms: Condition aggravated, Oesophageal stenosis, Pneumonia aspiration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-12-21
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: Iron drops; albuterol PRN; Synagis every mo, 11/11 & 12/8/98 MFR Medimmune, lot# 808047
Current Illness: NONE
Preexisting Conditions: TE fistula, CP, prematurity, hyaline membrane disease, spit fistula, aspiration, G tube
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: death; autopsy performed by county; aspiration pneumonia;


Changed on 9/14/2017

VAERS ID: 127043 Before After
VAERS Form:(blank) 1
Age:1.0
Sex:Male
Location:Wisconsin
Vaccinated:1998-10-07
Onset:1998-12-21
Submitted:1999-08-02
Entered:1999-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1004H / 0 1 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0845H / 0 1 RL / -

Administered by: Private      Purchased by: Public
Symptoms: Condition aggravated, Oesophageal stenosis, Pneumonia aspiration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-12-21
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: Iron drops; albuterol PRN; Synagis every mo, 11/11 & 12/8/98 MFR Medimmune, lot# 808047
Current Illness: NONE
Preexisting Conditions: TE fistula, CP, prematurity, hyaline membrane disease, spit fistula, aspiration, G tube
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: death; autopsy performed by county; aspiration pneumonia;


Changed on 2/14/2018

VAERS ID: 127043 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Wisconsin
Vaccinated:1998-10-07
Onset:1998-12-21
Submitted:1999-08-02
Entered:1999-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1004H / 1 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0845H / 1 RL / -

Administered by: Private      Purchased by: Public
Symptoms: Condition aggravated, Oesophageal stenosis, Pneumonia aspiration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-12-21
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: Iron drops; albuterol PRN; Synagis every mo, 11/11 & 12/8/98 MFR Medimmune, lot# 808047
Current Illness: NONE
Preexisting Conditions: TE fistula, CP, prematurity, hyaline membrane disease, spit fistula, aspiration, G tube
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: death; autopsy performed by county; aspiration pneumonia;


Changed on 6/14/2018

VAERS ID: 127043 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Wisconsin
Vaccinated:1998-10-07
Onset:1998-12-21
Submitted:1999-08-02
Entered:1999-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1004H / 1 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0845H / 1 RL / -

Administered by: Private      Purchased by: Public
Symptoms: Condition aggravated, Oesophageal stenosis, Pneumonia aspiration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-12-21
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: Iron drops; albuterol PRN; Synagis every mo, 11/11 & 12/8/98 MFR Medimmune, lot# 808047
Current Illness: NONE
Preexisting Conditions: TE fistula, CP, prematurity, hyaline membrane disease, spit fistula, aspiration, G tube
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: death; autopsy performed by county; aspiration pneumonia;


Changed on 8/14/2018

VAERS ID: 127043 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Wisconsin
Vaccinated:1998-10-07
Onset:1998-12-21
Submitted:1999-08-02
Entered:1999-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1004H / 1 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0845H / 1 RL / -

Administered by: Private      Purchased by: Public
Symptoms: Condition aggravated, Oesophageal stenosis, Pneumonia aspiration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-12-21
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: Iron drops; albuterol PRN; Synagis every mo, 11/11 & 12/8/98 MFR Medimmune, lot# 808047
Current Illness: NONE
Preexisting Conditions: TE fistula, CP, prematurity, hyaline membrane disease, spit fistula, aspiration, G tube
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: death; autopsy performed by county; aspiration pneumonia;


Changed on 9/14/2018

VAERS ID: 127043 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Wisconsin
Vaccinated:1998-10-07
Onset:1998-12-21
Submitted:1999-08-02
Entered:1999-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1004H / 1 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0845H / 1 RL / -

Administered by: Private      Purchased by: Public
Symptoms: Condition aggravated, Oesophageal stenosis, Pneumonia aspiration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-12-21
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: Iron drops; albuterol PRN; Synagis every mo, 11/11 & 12/8/98 MFR Medimmune, lot# 808047
Current Illness: NONE
Preexisting Conditions: TE fistula, CP, prematurity, hyaline membrane disease, spit fistula, aspiration, G tube
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: death; autopsy performed by county; aspiration pneumonia;


Changed on 10/14/2018

VAERS ID: 127043 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Wisconsin
Vaccinated:1998-10-07
Onset:1998-12-21
Submitted:1999-08-02
Entered:1999-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1004H / 1 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0845H / 1 RL / -

Administered by: Private      Purchased by: Public
Symptoms: Condition aggravated, Oesophageal stenosis, Pneumonia aspiration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-12-21
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: Iron drops; albuterol PRN; Synagis every mo, 11/11 & 12/8/98 MFR Medimmune, lot# 808047
Current Illness: NONE
Preexisting Conditions: TE fistula, CP, prematurity, hyaline membrane disease, spit fistula, aspiration, G tube
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: death; autopsy performed by county; aspiration pneumonia;

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=127043&WAYBACKHISTORY=ON


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