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This is VAERS ID 152566

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 152566
VAERS Form:
Age:27.0
Sex:Male
Location:California
Vaccinated:2000-03-30
Onset:2000-04-12
Submitted:2000-05-24
Entered:2000-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MMR II / MSD - / 0 - / SC

Administered by: Other      Purchased by: Unknown
Symptoms: FEVER, RASH, EDEMA FACE, HYPOXIA, ULCER MOUTH

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2000-05-25
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: On 4/12/00, the pt developed facial swelling on the right followed by a rash which spread over the face, neck, chest, back, and some areas of the arms and legs. The reporter noted that the pt had a fever of 104-105 but he did not have lesions in his mouth". The reporter indicated that the pt received therapy with cephalexin for treatment of the swollen cheek after the vax. At the time of the report, 5/18/00, the reporter indicated that the pt was intubated and hospitalized in an ICU. The reporter indicated


Changed on 12/8/2009

VAERS ID: 152566 Before After
VAERS Form:
Age:27.0
Sex:Male
Location:California
Vaccinated:2000-03-30
Onset:2000-04-12
Submitted:2000-05-24
Entered:2000-06-02 2000-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. - / 0 - / SC

Administered by: Other      Purchased by: Unknown Other
Symptoms: Face oedema, Hypoxia, Lymphoma, Mouth ulceration, Pyrexia, Rash, FEVER, RASH, EDEMA FACE, HYPOXIA, ULCER MOUTH

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2000-05-25
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) WAES00052019

Write-up: On 4/12/00, the pt developed facial swelling on the right followed by a rash which spread over the face, neck, chest, back, and some areas of the arms and legs. The reporter noted that the pt had a fever of 104-105 but he did not have lesions in his mouth". mouth. The reporter indicated that the pt received therapy with cephalexin for treatment of the swollen cheek after the vax. At the time of the report, 5/18/00, the reporter indicated that the pt was intubated and hospitalized in an ICU. The reporter indicated that the events were life threatening. Follow-up information dated 9/26/00 stated that a bone marrow biopsy showed Natural Killer Cell Lymphoma. The pt died in the hospital on 5/25/00 after a 10 day admission. It was noted that the final cause of death was Natural Killer Cell Lymphoma.


Changed on 9/14/2017

VAERS ID: 152566 Before After
VAERS Form:(blank) 1
Age:27.0
Sex:Male
Location:California
Vaccinated:2000-03-30
Onset:2000-04-12
Submitted:2000-05-24
Entered:2000-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 0 1 - / SC

Administered by: Other      Purchased by: Other
Symptoms: Face oedema, Hypoxia, Lymphoma, Mouth ulceration, Pyrexia, Rash

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2000-05-25
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES00052019

Write-up: On 4/12/00, the pt developed facial swelling on the right followed by a rash which spread over the face, neck, chest, back, and some areas of the arms and legs. The reporter noted that the pt had a fever of 104-105 but he did not have lesions in his mouth. The reporter indicated that the pt received therapy with cephalexin for treatment of the swollen cheek after the vax. At the time of the report, 5/18/00, the reporter indicated that the pt was intubated and hospitalized in an ICU. The reporter indicated that the events were life threatening. Follow-up information dated 9/26/00 stated that a bone marrow biopsy showed Natural Killer Cell Lymphoma. The pt died in the hospital on 5/25/00 after a 10 day admission. It was noted that the final cause of death was Natural Killer Cell Lymphoma.


Changed on 2/14/2018

VAERS ID: 152566 Before After
VAERS Form:1
Age:27.0
Sex:Male
Location:California
Vaccinated:2000-03-30
Onset:2000-04-12
Submitted:2000-05-24
Entered:2000-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 1 - / SC

Administered by: Other      Purchased by: Other
Symptoms: Face oedema, Hypoxia, Lymphoma, Mouth ulceration, Pyrexia, Rash

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2000-05-25
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES00052019

Write-up: On 4/12/00, the pt developed facial swelling on the right followed by a rash which spread over the face, neck, chest, back, and some areas of the arms and legs. The reporter noted that the pt had a fever of 104-105 but he did not have lesions in his mouth. The reporter indicated that the pt received therapy with cephalexin for treatment of the swollen cheek after the vax. At the time of the report, 5/18/00, the reporter indicated that the pt was intubated and hospitalized in an ICU. The reporter indicated that the events were life threatening. Follow-up information dated 9/26/00 stated that a bone marrow biopsy showed Natural Killer Cell Lymphoma. The pt died in the hospital on 5/25/00 after a 10 day admission. It was noted that the final cause of death was Natural Killer Cell Lymphoma.


Changed on 6/14/2018

VAERS ID: 152566 Before After
VAERS Form:1
Age:27.0
Sex:Male
Location:California
Vaccinated:2000-03-30
Onset:2000-04-12
Submitted:2000-05-24
Entered:2000-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 1 - / SC

Administered by: Other      Purchased by: Other
Symptoms: Face oedema, Hypoxia, Lymphoma, Mouth ulceration, Pyrexia, Rash

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2000-05-25
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES00052019

Write-up: On 4/12/00, the pt developed facial swelling on the right followed by a rash which spread over the face, neck, chest, back, and some areas of the arms and legs. The reporter noted that the pt had a fever of 104-105 but he did not have lesions in his mouth. The reporter indicated that the pt received therapy with cephalexin for treatment of the swollen cheek after the vax. At the time of the report, 5/18/00, the reporter indicated that the pt was intubated and hospitalized in an ICU. The reporter indicated that the events were life threatening. Follow-up information dated 9/26/00 stated that a bone marrow biopsy showed Natural Killer Cell Lymphoma. The pt died in the hospital on 5/25/00 after a 10 day admission. It was noted that the final cause of death was Natural Killer Cell Lymphoma.


Changed on 8/14/2018

VAERS ID: 152566 Before After
VAERS Form:1
Age:27.0
Sex:Male
Location:California
Vaccinated:2000-03-30
Onset:2000-04-12
Submitted:2000-05-24
Entered:2000-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 1 - / SC

Administered by: Other      Purchased by: Other
Symptoms: Face oedema, Hypoxia, Lymphoma, Mouth ulceration, Pyrexia, Rash

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2000-05-25
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES00052019

Write-up: On 4/12/00, the pt developed facial swelling on the right followed by a rash which spread over the face, neck, chest, back, and some areas of the arms and legs. The reporter noted that the pt had a fever of 104-105 but he did not have lesions in his mouth. The reporter indicated that the pt received therapy with cephalexin for treatment of the swollen cheek after the vax. At the time of the report, 5/18/00, the reporter indicated that the pt was intubated and hospitalized in an ICU. The reporter indicated that the events were life threatening. Follow-up information dated 9/26/00 stated that a bone marrow biopsy showed Natural Killer Cell Lymphoma. The pt died in the hospital on 5/25/00 after a 10 day admission. It was noted that the final cause of death was Natural Killer Cell Lymphoma.


Changed on 9/14/2018

VAERS ID: 152566 Before After
VAERS Form:1
Age:27.0
Sex:Male
Location:California
Vaccinated:2000-03-30
Onset:2000-04-12
Submitted:2000-05-24
Entered:2000-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 1 - / SC

Administered by: Other      Purchased by: Other
Symptoms: Face oedema, Hypoxia, Lymphoma, Mouth ulceration, Pyrexia, Rash

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2000-05-25
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES00052019

Write-up: On 4/12/00, the pt developed facial swelling on the right followed by a rash which spread over the face, neck, chest, back, and some areas of the arms and legs. The reporter noted that the pt had a fever of 104-105 but he did not have lesions in his mouth. The reporter indicated that the pt received therapy with cephalexin for treatment of the swollen cheek after the vax. At the time of the report, 5/18/00, the reporter indicated that the pt was intubated and hospitalized in an ICU. The reporter indicated that the events were life threatening. Follow-up information dated 9/26/00 stated that a bone marrow biopsy showed Natural Killer Cell Lymphoma. The pt died in the hospital on 5/25/00 after a 10 day admission. It was noted that the final cause of death was Natural Killer Cell Lymphoma.


Changed on 10/14/2018

VAERS ID: 152566 Before After
VAERS Form:1
Age:27.0
Sex:Male
Location:California
Vaccinated:2000-03-30
Onset:2000-04-12
Submitted:2000-05-24
Entered:2000-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 1 - / SC

Administered by: Other      Purchased by: Other
Symptoms: Face oedema, Hypoxia, Lymphoma, Mouth ulceration, Pyrexia, Rash

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2000-05-25
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES00052019

Write-up: On 4/12/00, the pt developed facial swelling on the right followed by a rash which spread over the face, neck, chest, back, and some areas of the arms and legs. The reporter noted that the pt had a fever of 104-105 but he did not have lesions in his mouth. The reporter indicated that the pt received therapy with cephalexin for treatment of the swollen cheek after the vax. At the time of the report, 5/18/00, the reporter indicated that the pt was intubated and hospitalized in an ICU. The reporter indicated that the events were life threatening. Follow-up information dated 9/26/00 stated that a bone marrow biopsy showed Natural Killer Cell Lymphoma. The pt died in the hospital on 5/25/00 after a 10 day admission. It was noted that the final cause of death was Natural Killer Cell Lymphoma.

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