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This is VAERS ID 167376

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 167376
VAERS Form:
Age:1.3
Sex:Female
Location:Unknown
Vaccinated:2001-02-20
Onset:2001-02-23
Submitted:2001-03-15
Entered:2001-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MSD 1308K / 0 - / SC
PNC: PNEUMO, 7-VALENT (PREVNAR) / LEDERLE 472355 / 1 - / IM
VARCEL: VARICELLA (VARIVAX) / MSD 1466K / 0 - / SC

Administered by: ??      Purchased by: Unknown
Symptoms: ASTHMA, EDEMA LUNG, HEART ARREST, ECCHYMOSIS, BRONCHITIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-02-23
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: Albuterol, Zithromax.
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt was seen for a well 15 month checkup on 2/20/01. She had mild wheezing and was afebrile. She was given MMR, Varivax and Prevnar #2. She was treated with albuterol syrup and Zithromax. She had a cardiopulmonary arrest on 2/23/01. Is there a correlation"between mild wheezing, any of the vaccines, the medications used and sudden death? Pt had unexplained cardiopulmonary arrest and expired.


Changed on 12/8/2009

VAERS ID: 167376 Before After
VAERS Form:
Age:1.3
Sex:Female
Location:Unknown Virginia
Vaccinated:2001-02-20
Onset:2001-02-23
Submitted:2001-03-15
Entered:2001-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 1308K / 0 - / SC
PNC: PNEUMO, 7-VALENT (PREVNAR) PNEUMO (PREVNAR) / LEDERLE LEDERLE LABORATORIES 472355 / 1 - / IM
VARCEL: VARICELLA (VARIVAX) VARICELLA (VARIVAX) / MSD MERCK & CO. INC. 1466K / 0 - / SC

Administered by: (blank) Unknown      Purchased by: Unknown
Symptoms: Bronchitis acute, Cardio-respiratory arrest, Nasal congestion, Pulmonary oedema, Wheezing, Contusion, ASTHMA, EDEMA LUNG, HEART ARREST, ECCHYMOSIS, BRONCHITIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-02-23
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: Albuterol, Zithromax.
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt was seen for a well 15 month checkup on 2/20/01. She had mild wheezing and was afebrile. She was given MMR, Varivax and Prevnar #2. She was treated with albuterol syrup and Zithromax. She had a cardiopulmonary arrest on 2/23/01. Is there a correlation"between correlation between mild wheezing, any of the vaccines, the medications used and sudden death? Pt had unexplained cardiopulmonary arrest and expired. Autopsy also states bruise right side of forehead, congestion, pulmonary edema. Cause of death given as acute bronchitis.


Changed on 3/2/2010

VAERS ID: 167376 Before After
VAERS Form:
Age:1.3
Sex:Female
Location:Virginia
Vaccinated:2001-02-20
Onset:2001-02-23
Submitted:2001-03-15
Entered:2001-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1308K / 0 - / SC
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / LEDERLE LABORATORIES 472355 / 1 - / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1466K / 0 - / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Bronchitis acute, Cardio-respiratory arrest, Nasal congestion, Pulmonary oedema, Wheezing, Contusion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-02-23
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: Albuterol, Zithromax.
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt was seen for a well 15 month checkup on 2/20/01. She had mild wheezing and was afebrile. She was given MMR, Varivax and Prevnar #2. She was treated with albuterol syrup and Zithromax. She had a cardiopulmonary arrest on 2/23/01. Is there a correlation between mild wheezing, any of the vaccines, the medications used and sudden death? Pt had unexplained cardiopulmonary arrest and expired. Autopsy also states bruise right side of forehead, congestion, pulmonary edema. Cause of death given as acute bronchitis.


Changed on 4/7/2010

VAERS ID: 167376 Before After
VAERS Form:
Age:1.3
Sex:Female
Location:Virginia
Vaccinated:2001-02-20
Onset:2001-02-23
Submitted:2001-03-15
Entered:2001-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1308K / 0 - / SC
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / LEDERLE LABORATORIES 472355 / 1 - / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1466K / 0 - / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Bronchitis acute, Cardio-respiratory arrest, Nasal congestion, Pulmonary oedema, Wheezing, Contusion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-02-23
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: Albuterol, Zithromax.
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt was seen for a well 15 month checkup on 2/20/01. She had mild wheezing and was afebrile. She was given MMR, Varivax and Prevnar #2. She was treated with albuterol syrup and Zithromax. She had a cardiopulmonary arrest on 2/23/01. Is there a correlation between mild wheezing, any of the vaccines, the medications used and sudden death? Pt had unexplained cardiopulmonary arrest and expired. Autopsy also states bruise right side of forehead, congestion, pulmonary edema. Cause of death given as acute bronchitis.


Changed on 2/14/2017

VAERS ID: 167376 Before After
VAERS Form:
Age:1.3 1.25
Sex:Female
Location:Virginia
Vaccinated:2001-02-20
Onset:2001-02-23
Submitted:2001-03-15
Entered:2001-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1308K / 0 - / SC
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES 472355 / 1 - / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1466K / 0 - / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Bronchitis acute, Cardio-respiratory arrest, Nasal congestion, Pulmonary oedema, Wheezing, Contusion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-02-23
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: Albuterol, Zithromax.
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt was seen for a well 15 month checkup on 2/20/01. She had mild wheezing and was afebrile. She was given MMR, Varivax and Prevnar #2. She was treated with albuterol syrup and Zithromax. She had a cardiopulmonary arrest on 2/23/01. Is there a correlation between mild wheezing, any of the vaccines, the medications used and sudden death? Pt had unexplained cardiopulmonary arrest and expired. Autopsy also states bruise right side of forehead, congestion, pulmonary edema. Cause of death given as acute bronchitis.


Changed on 5/14/2017

VAERS ID: 167376 Before After
VAERS Form:
Age:1.25
Sex:Female
Location:Virginia
Vaccinated:2001-02-20
Onset:2001-02-23
Submitted:2001-03-15
Entered:2001-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1308K / 0 - / SC
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES PFIZER/WYETH 472355 / 1 - / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1466K / 0 - / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Bronchitis acute, Cardio-respiratory arrest, Nasal congestion, Pulmonary oedema, Wheezing, Contusion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-02-23
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: Albuterol, Zithromax.
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt was seen for a well 15 month checkup on 2/20/01. She had mild wheezing and was afebrile. She was given MMR, Varivax and Prevnar #2. She was treated with albuterol syrup and Zithromax. She had a cardiopulmonary arrest on 2/23/01. Is there a correlation between mild wheezing, any of the vaccines, the medications used and sudden death? Pt had unexplained cardiopulmonary arrest and expired. Autopsy also states bruise right side of forehead, congestion, pulmonary edema. Cause of death given as acute bronchitis.


Changed on 9/14/2017

VAERS ID: 167376 Before After
VAERS Form:(blank) 1
Age:1.25
Sex:Female
Location:Virginia
Vaccinated:2001-02-20
Onset:2001-02-23
Submitted:2001-03-15
Entered:2001-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1308K / 0 1 - / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 472355 / 1 2 - / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1466K / 0 1 - / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Bronchitis acute, Cardio-respiratory arrest, Nasal congestion, Pulmonary oedema, Wheezing, Contusion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-02-23
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: Albuterol, Zithromax.
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt was seen for a well 15 month checkup on 2/20/01. She had mild wheezing and was afebrile. She was given MMR, Varivax and Prevnar #2. She was treated with albuterol syrup and Zithromax. She had a cardiopulmonary arrest on 2/23/01. Is there a correlation between mild wheezing, any of the vaccines, the medications used and sudden death? Pt had unexplained cardiopulmonary arrest and expired. Autopsy also states bruise right side of forehead, congestion, pulmonary edema. Cause of death given as acute bronchitis.


Changed on 2/14/2018

VAERS ID: 167376 Before After
VAERS Form:1
Age:1.25
Sex:Female
Location:Virginia
Vaccinated:2001-02-20
Onset:2001-02-23
Submitted:2001-03-15
Entered:2001-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1308K / 1 - / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 472355 / 2 - / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1466K / 1 - / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Bronchitis acute, Cardio-respiratory arrest, Nasal congestion, Pulmonary oedema, Wheezing, Contusion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-02-23
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: Albuterol, Zithromax.
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt was seen for a well 15 month checkup on 2/20/01. She had mild wheezing and was afebrile. She was given MMR, Varivax and Prevnar #2. She was treated with albuterol syrup and Zithromax. She had a cardiopulmonary arrest on 2/23/01. Is there a correlation between mild wheezing, any of the vaccines, the medications used and sudden death? Pt had unexplained cardiopulmonary arrest and expired. Autopsy also states bruise right side of forehead, congestion, pulmonary edema. Cause of death given as acute bronchitis.


Changed on 6/14/2018

VAERS ID: 167376 Before After
VAERS Form:1
Age:1.25
Sex:Female
Location:Virginia
Vaccinated:2001-02-20
Onset:2001-02-23
Submitted:2001-03-15
Entered:2001-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1308K / 1 - / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 472355 / 2 - / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1466K / 1 - / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Bronchitis acute, Cardio-respiratory arrest, Nasal congestion, Pulmonary oedema, Wheezing, Contusion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-02-23
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: Albuterol, Zithromax.
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt was seen for a well 15 month checkup on 2/20/01. She had mild wheezing and was afebrile. She was given MMR, Varivax and Prevnar #2. She was treated with albuterol syrup and Zithromax. She had a cardiopulmonary arrest on 2/23/01. Is there a correlation between mild wheezing, any of the vaccines, the medications used and sudden death? Pt had unexplained cardiopulmonary arrest and expired. Autopsy also states bruise right side of forehead, congestion, pulmonary edema. Cause of death given as acute bronchitis.


Changed on 8/14/2018

VAERS ID: 167376 Before After
VAERS Form:1
Age:1.25
Sex:Female
Location:Virginia
Vaccinated:2001-02-20
Onset:2001-02-23
Submitted:2001-03-15
Entered:2001-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1308K / 1 - / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 472355 / 2 - / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1466K / 1 - / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Bronchitis acute, Cardio-respiratory arrest, Nasal congestion, Pulmonary oedema, Wheezing, Contusion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-02-23
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: Albuterol, Zithromax.
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt was seen for a well 15 month checkup on 2/20/01. She had mild wheezing and was afebrile. She was given MMR, Varivax and Prevnar #2. She was treated with albuterol syrup and Zithromax. She had a cardiopulmonary arrest on 2/23/01. Is there a correlation between mild wheezing, any of the vaccines, the medications used and sudden death? Pt had unexplained cardiopulmonary arrest and expired. Autopsy also states bruise right side of forehead, congestion, pulmonary edema. Cause of death given as acute bronchitis.


Changed on 9/14/2018

VAERS ID: 167376 Before After
VAERS Form:1
Age:1.25
Sex:Female
Location:Virginia
Vaccinated:2001-02-20
Onset:2001-02-23
Submitted:2001-03-15
Entered:2001-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1308K / 1 - / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 472355 / 2 - / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1466K / 1 - / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Bronchitis acute, Cardio-respiratory arrest, Nasal congestion, Pulmonary oedema, Wheezing, Contusion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-02-23
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: Albuterol, Zithromax.
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt was seen for a well 15 month checkup on 2/20/01. She had mild wheezing and was afebrile. She was given MMR, Varivax and Prevnar #2. She was treated with albuterol syrup and Zithromax. She had a cardiopulmonary arrest on 2/23/01. Is there a correlation between mild wheezing, any of the vaccines, the medications used and sudden death? Pt had unexplained cardiopulmonary arrest and expired. Autopsy also states bruise right side of forehead, congestion, pulmonary edema. Cause of death given as acute bronchitis.


Changed on 10/14/2018

VAERS ID: 167376 Before After
VAERS Form:1
Age:1.25
Sex:Female
Location:Virginia
Vaccinated:2001-02-20
Onset:2001-02-23
Submitted:2001-03-15
Entered:2001-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1308K / 1 - / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 472355 / 2 - / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1466K / 1 - / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Bronchitis acute, Cardio-respiratory arrest, Nasal congestion, Pulmonary oedema, Wheezing, Contusion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-02-23
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: Albuterol, Zithromax.
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt was seen for a well 15 month checkup on 2/20/01. She had mild wheezing and was afebrile. She was given MMR, Varivax and Prevnar #2. She was treated with albuterol syrup and Zithromax. She had a cardiopulmonary arrest on 2/23/01. Is there a correlation between mild wheezing, any of the vaccines, the medications used and sudden death? Pt had unexplained cardiopulmonary arrest and expired. Autopsy also states bruise right side of forehead, congestion, pulmonary edema. Cause of death given as acute bronchitis.

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