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This is VAERS ID 169360

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 169360
VAERS Form:
Age:5.0
Sex:Male
Location:Kentucky
Vaccinated:2000-09-08
Onset:2000-09-08
Submitted:0000-00-00
Entered:2001-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED, PED. (NO BRAND NAME) / CONNAUGHT LABS - / 3 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD R12901 / 3 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MSD 0406K / 1 LL / SC

Administered by: Private      Purchased by: Unknown
Symptoms: FEVER

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-12
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: Seizures;MMR II;1;.30;In Patient
Other Medications:
Current Illness:
Preexisting Conditions: Condition caused by prior vaccine (seizures and developmentally delayed).
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': Condition caused by prior vaccine (seizures and developmentally delayed).

Write-up: Seizures and developmentally delayed with 1st set of vaccines. Had a high temperature and death with 2nd set.


Changed on 12/8/2009

VAERS ID: 169360 Before After
VAERS Form:
Age:5.0
Sex:Male
Location:Kentucky
Vaccinated:2000-09-08
Onset:2000-09-08
Submitted:0000-00-00
Entered:2001-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED, PED. (NO BRAND NAME) DT ADSORBED (NO BRAND NAME) / CONNAUGHT LABS CONNAUGHT LABORATORIES - / 3 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. R12901 / 3 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 0406K / 1 LL / SC

Administered by: Private      Purchased by: Unknown Private
Symptoms: Pyrexia, FEVER

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-12
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: Seizures;MMR II;1;.30;In Seizures;Measles + Mumps + Rubella (MMR II);1;0;In Patient
Other Medications:
Current Illness:
Preexisting Conditions: Condition caused by prior vaccine (seizures and developmentally delayed).
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': Condition caused by prior vaccine (seizures and developmentally delayed). (blank)

Write-up: Seizures and developmentally delayed with 1st set of vaccines. Had a high temperature and death with 2nd set.


Changed on 5/14/2017

VAERS ID: 169360 Before After
VAERS Form:
Age:5.0
Sex:Male
Location:Kentucky
Vaccinated:2000-09-08
Onset:2000-09-08
Submitted:0000-00-00
Entered:2001-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES - / 3 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R12901 / 3 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0406K / 1 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-12
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: Seizures;Measles Seizures~Measles + Mumps + Rubella (MMR II);1;0;In II)~1~0.00~In Patient
Other Medications:
Current Illness:
Preexisting Conditions: Condition caused by prior vaccine (seizures and developmentally delayed).
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Seizures and developmentally delayed with 1st set of vaccines. Had a high temperature and death with 2nd set.


Changed on 9/14/2017

VAERS ID: 169360 Before After
VAERS Form:(blank) 1
Age:5.0
Sex:Male
Location:Kentucky
Vaccinated:2000-09-08
Onset:2000-09-08
Submitted:0000-00-00
Entered:2001-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES - / 3 4 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R12901 / 3 4 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0406K / 1 2 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-12
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: Seizures~Measles + Mumps + Rubella (MMR II)~1~0.00~In Patient
Other Medications:
Current Illness:
Preexisting Conditions: Condition caused by prior vaccine (seizures and developmentally delayed).
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Seizures and developmentally delayed with 1st set of vaccines. Had a high temperature and death with 2nd set.


Changed on 2/14/2018

VAERS ID: 169360 Before After
VAERS Form:1
Age:5.0
Sex:Male
Location:Kentucky
Vaccinated:2000-09-08
Onset:2000-09-08
Submitted:0000-00-00
Entered:2001-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES - / 4 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R12901 / 4 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0406K / 2 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-12
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: Seizures~Measles + Mumps + Rubella (MMR II)~1~0.00~In Patient
Other Medications:
Current Illness:
Preexisting Conditions: Condition caused by prior vaccine (seizures and developmentally delayed).
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Seizures and developmentally delayed with 1st set of vaccines. Had a high temperature and death with 2nd set.


Changed on 6/14/2018

VAERS ID: 169360 Before After
VAERS Form:1
Age:5.0
Sex:Male
Location:Kentucky
Vaccinated:2000-09-08
Onset:2000-09-08
Submitted:0000-00-00
Entered:2001-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES - / 4 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R12901 / 4 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0406K / 2 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-12
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: Seizures~Measles + Mumps + Rubella (MMR II)~1~0.00~In Patient
Other Medications:
Current Illness:
Preexisting Conditions: Condition caused by prior vaccine (seizures and developmentally delayed).
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Seizures and developmentally delayed with 1st set of vaccines. Had a high temperature and death with 2nd set.


Changed on 8/14/2018

VAERS ID: 169360 Before After
VAERS Form:1
Age:5.0
Sex:Male
Location:Kentucky
Vaccinated:2000-09-08
Onset:2000-09-08
Submitted:0000-00-00
Entered:2001-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES - / 4 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R12901 / 4 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0406K / 2 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-12
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: Seizures~Measles + Mumps + Rubella (MMR II)~1~0.00~In Patient
Other Medications:
Current Illness:
Preexisting Conditions: Condition caused by prior vaccine (seizures and developmentally delayed).
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Seizures and developmentally delayed with 1st set of vaccines. Had a high temperature and death with 2nd set.


Changed on 9/14/2018

VAERS ID: 169360 Before After
VAERS Form:1
Age:5.0
Sex:Male
Location:Kentucky
Vaccinated:2000-09-08
Onset:2000-09-08
Submitted:0000-00-00
Entered:2001-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES - / 4 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R12901 / 4 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0406K / 2 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-12
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: Seizures~Measles + Mumps + Rubella (MMR II)~1~0.00~In Patient
Other Medications:
Current Illness:
Preexisting Conditions: Condition caused by prior vaccine (seizures and developmentally delayed).
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Seizures and developmentally delayed with 1st set of vaccines. Had a high temperature and death with 2nd set.


Changed on 10/14/2018

VAERS ID: 169360 Before After
VAERS Form:1
Age:5.0
Sex:Male
Location:Kentucky
Vaccinated:2000-09-08
Onset:2000-09-08
Submitted:0000-00-00
Entered:2001-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES - / 4 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R12901 / 4 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0406K / 2 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-12
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: Seizures~Measles + Mumps + Rubella (MMR II)~1~0.00~In Patient
Other Medications:
Current Illness:
Preexisting Conditions: Condition caused by prior vaccine (seizures and developmentally delayed).
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Seizures and developmentally delayed with 1st set of vaccines. Had a high temperature and death with 2nd set.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=169360&WAYBACKHISTORY=ON


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