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This is VAERS ID 165974

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 165974
VAERS Form:
Age:1.2
Sex:Female
Location:Florida
Vaccinated:2001-01-16
Onset:2001-01-23
Submitted:2001-02-14
Entered:2001-02-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MSD - / - - / SC

Administered by: ??      Purchased by: Unknown
Symptoms: CONVULS, ENCEPHALITIS, IMMUNE SYSTEM DIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: failure to thrive, immunodeficiency
Allergies:
Diagnostic Lab Data: spinal tap - pending
CDC 'Split Type':

Write-up: Information has been received from a physician concerning a 14 month old female with failure to thrive and possible immunodeficiency who on approx. 1/16/01, was vaccinated with MMR II. On approx. 1/23/01, the pt experienced encephalitis, seizures and immu"ne deficiency (that could have possibly been present prior to vaccination). The encephalitis, seizures and immune deficiency required hospitalization. At the time of the report (2/6/01), a spinal tap was pending. The pt''s hospitalization continued and the


Changed on 12/30/2006

VAERS ID: 165974 Before After
VAERS Form:
Age:1.2
Sex:Female
Location:Florida
Vaccinated:2001-01-16
Onset:2001-01-23
Submitted:2001-02-14
Entered:2001-02-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MSD - / - - / SC

Administered by: ??      Purchased by: Unknown
Symptoms: CONVULS, ENCEPHALITIS, IMMUNE SYSTEM DIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: failure to thrive, immunodeficiency
Allergies:
Diagnostic Lab Data: spinal tap - pending
CDC 'Split Type':

Write-up: Information has been received from a physician concerning a 14 month old female with failure to thrive and possible immunodeficiency who on approx. 1/16/01, was vaccinated with MMR II. On approx. 1/23/01, the pt experienced encephalitis, seizures and immu"ne deficiency (that could have possibly been present prior to vaccination). The encephalitis, seizures and immune deficiency required hospitalization. At the time of the report (2/6/01), a spinal tap was pending. The pt''s pt''''s hospitalization continued and the th


Changed on 12/8/2009

VAERS ID: 165974 Before After
VAERS Form:
Age:1.2
Sex:Female
Location:Florida
Vaccinated:2001-01-16
Onset:2001-01-23
Submitted:2001-02-14
Entered:2001-02-21 2001-02-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. - / - - / SC

Administered by: (blank) Unknown      Purchased by: Unknown
Symptoms: Convulsion, Encephalitis, Immune system disorder, CONVULS, ENCEPHALITIS, IMMUNE SYSTEM DIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: failure to thrive, immunodeficiency
Allergies:
Diagnostic Lab Data: spinal tap - pending
CDC 'Split Type': (blank) WAES01020506

Write-up: Information has been received from a physician concerning a 14 month old female with failure to thrive and possible immunodeficiency who on approx. 1/16/01, was vaccinated with MMR II. On approx. 1/23/01, the pt experienced encephalitis, seizures and immu"ne immune deficiency (that could have possibly been present prior to vaccination). The encephalitis, seizures and immune deficiency required hospitalization. At the time of the report (2/6/01), a spinal tap was pending. The pt''''s pt''s hospitalization continued and th the pt was noted to be in poor condition. Additional information has been requested. Follow-up states the pt has died.


Changed on 9/14/2017

VAERS ID: 165974 Before After
VAERS Form:(blank) 1
Age:1.2
Sex:Female
Location:Florida
Vaccinated:2001-01-16
Onset:2001-01-23
Submitted:2001-02-14
Entered:2001-02-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / - UNK - / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Convulsion, Encephalitis, Immune system disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: failure to thrive, immunodeficiency
Allergies:
Diagnostic Lab Data: spinal tap - pending
CDC 'Split Type': WAES01020506

Write-up: Information has been received from a physician concerning a 14 month old female with failure to thrive and possible immunodeficiency who on approx. 1/16/01, was vaccinated with MMR II. On approx. 1/23/01, the pt experienced encephalitis, seizures and immune deficiency (that could have possibly been present prior to vaccination). The encephalitis, seizures and immune deficiency required hospitalization. At the time of the report (2/6/01), a spinal tap was pending. The pt''s hospitalization continued and the pt was noted to be in poor condition. Additional information has been requested. Follow-up states the pt has died.


Changed on 2/14/2018

VAERS ID: 165974 Before After
VAERS Form:1
Age:1.2
Sex:Female
Location:Florida
Vaccinated:2001-01-16
Onset:2001-01-23
Submitted:2001-02-14
Entered:2001-02-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Convulsion, Encephalitis, Immune system disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: failure to thrive, immunodeficiency
Allergies:
Diagnostic Lab Data: spinal tap - pending
CDC 'Split Type': WAES01020506

Write-up: Information has been received from a physician concerning a 14 month old female with failure to thrive and possible immunodeficiency who on approx. 1/16/01, was vaccinated with MMR II. On approx. 1/23/01, the pt experienced encephalitis, seizures and immune deficiency (that could have possibly been present prior to vaccination). The encephalitis, seizures and immune deficiency required hospitalization. At the time of the report (2/6/01), a spinal tap was pending. The pt''s hospitalization continued and the pt was noted to be in poor condition. Additional information has been requested. Follow-up states the pt has died.


Changed on 6/14/2018

VAERS ID: 165974 Before After
VAERS Form:1
Age:1.2
Sex:Female
Location:Florida
Vaccinated:2001-01-16
Onset:2001-01-23
Submitted:2001-02-14
Entered:2001-02-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Convulsion, Encephalitis, Immune system disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: failure to thrive, immunodeficiency
Allergies:
Diagnostic Lab Data: spinal tap - pending
CDC 'Split Type': WAES01020506

Write-up: Information has been received from a physician concerning a 14 month old female with failure to thrive and possible immunodeficiency who on approx. 1/16/01, was vaccinated with MMR II. On approx. 1/23/01, the pt experienced encephalitis, seizures and immune deficiency (that could have possibly been present prior to vaccination). The encephalitis, seizures and immune deficiency required hospitalization. At the time of the report (2/6/01), a spinal tap was pending. The pt''s hospitalization continued and the pt was noted to be in poor condition. Additional information has been requested. Follow-up states the pt has died.


Changed on 8/14/2018

VAERS ID: 165974 Before After
VAERS Form:1
Age:1.2
Sex:Female
Location:Florida
Vaccinated:2001-01-16
Onset:2001-01-23
Submitted:2001-02-14
Entered:2001-02-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Convulsion, Encephalitis, Immune system disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: failure to thrive, immunodeficiency
Allergies:
Diagnostic Lab Data: spinal tap - pending
CDC 'Split Type': WAES01020506

Write-up: Information has been received from a physician concerning a 14 month old female with failure to thrive and possible immunodeficiency who on approx. 1/16/01, was vaccinated with MMR II. On approx. 1/23/01, the pt experienced encephalitis, seizures and immune deficiency (that could have possibly been present prior to vaccination). The encephalitis, seizures and immune deficiency required hospitalization. At the time of the report (2/6/01), a spinal tap was pending. The pt''s hospitalization continued and the pt was noted to be in poor condition. Additional information has been requested. Follow-up states the pt has died.


Changed on 9/14/2018

VAERS ID: 165974 Before After
VAERS Form:1
Age:1.2
Sex:Female
Location:Florida
Vaccinated:2001-01-16
Onset:2001-01-23
Submitted:2001-02-14
Entered:2001-02-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Convulsion, Encephalitis, Immune system disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: failure to thrive, immunodeficiency
Allergies:
Diagnostic Lab Data: spinal tap - pending
CDC 'Split Type': WAES01020506

Write-up: Information has been received from a physician concerning a 14 month old female with failure to thrive and possible immunodeficiency who on approx. 1/16/01, was vaccinated with MMR II. On approx. 1/23/01, the pt experienced encephalitis, seizures and immune deficiency (that could have possibly been present prior to vaccination). The encephalitis, seizures and immune deficiency required hospitalization. At the time of the report (2/6/01), a spinal tap was pending. The pt''s hospitalization continued and the pt was noted to be in poor condition. Additional information has been requested. Follow-up states the pt has died.


Changed on 10/14/2018

VAERS ID: 165974 Before After
VAERS Form:1
Age:1.2
Sex:Female
Location:Florida
Vaccinated:2001-01-16
Onset:2001-01-23
Submitted:2001-02-14
Entered:2001-02-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Convulsion, Encephalitis, Immune system disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: failure to thrive, immunodeficiency
Allergies:
Diagnostic Lab Data: spinal tap - pending
CDC 'Split Type': WAES01020506

Write-up: Information has been received from a physician concerning a 14 month old female with failure to thrive and possible immunodeficiency who on approx. 1/16/01, was vaccinated with MMR II. On approx. 1/23/01, the pt experienced encephalitis, seizures and immune deficiency (that could have possibly been present prior to vaccination). The encephalitis, seizures and immune deficiency required hospitalization. At the time of the report (2/6/01), a spinal tap was pending. The pt''s hospitalization continued and the pt was noted to be in poor condition. Additional information has been requested. Follow-up states the pt has died.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=165974&WAYBACKHISTORY=ON


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