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This is VAERS ID 183160

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 183160
VAERS Form:
Age:32.0
Sex:Female
Location:California
Vaccinated:2002-03-21
Onset:2002-03-22
Submitted:2002-03-30
Entered:2002-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 13844 / - - / SC
TD: TD ADSORBED, ADULT (NO BRAND NAME) / AVENTIS PASTEUR, U0519AA / - - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: RESPIRAT DIS, DEATH

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2002-05-01
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: At 17:00 on 3/21/02, she received MMR and Tetanus vaccination. About 12 hours later (05:00 on 3/22/02), she died and was brought back. 05/01/2002 patient expired after being transferred to hospital in Budapest. Records from San Clemente Hospital: Diagnose"d with severe anoxic brain injury, probably alpha coma, seizure disorder, staphylococcus aureus bronchitis, ventricular fibrillation arrest, tachycardia, elevated liver enzymes.


Changed on 12/8/2009

VAERS ID: 183160 Before After
VAERS Form:
Age:32.0
Sex:Female
Location:California
Vaccinated:2002-03-21
Onset:2002-03-22
Submitted:2002-03-30
Entered:2002-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 13844 / - - / SC
TD: TD ADSORBED, ADULT (NO BRAND NAME) TD ADSORBED (NO BRAND NAME) / AVENTIS PASTEUR, AVENTIS PASTEUR U0519AA / - - / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Respiratory disorder, RESPIRAT DIS, DEATH

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2002-05-01
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: At 17:00 on 3/21/02, she received MMR and Tetanus vaccination. About 12 hours later (05:00 on 3/22/02), she died and was brought back. 05/01/2002 patient expired after being transferred to hospital in Budapest. Records from San Clemente Hospital: Diagnose"d Diagnosed with severe anoxic brain injury, probably alpha coma, seizure disorder, staphylococcus aureus bronchitis, ventricular fibrillation arrest, tachycardia, elevated liver enzymes.


Changed on 5/14/2017

VAERS ID: 183160 Before After
VAERS Form:
Age:32.0
Sex:Female
Location:California
Vaccinated:2002-03-21
Onset:2002-03-22
Submitted:2002-03-30
Entered:2002-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 13844 / - - / SC
TD: TD ADSORBED (NO BRAND NAME) / AVENTIS PASTEUR SANOFI PASTEUR U0519AA / - - / IM

Administered by: Private      Purchased by: Private
Symptoms: Respiratory disorder

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2002-05-01
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: At 17:00 on 3/21/02, she received MMR and Tetanus vaccination. About 12 hours later (05:00 on 3/22/02), she died and was brought back. 05/01/2002 patient expired after being transferred to hospital in Budapest. Records from San Clemente Hospital: Diagnosed with severe anoxic brain injury, probably alpha coma, seizure disorder, staphylococcus aureus bronchitis, ventricular fibrillation arrest, tachycardia, elevated liver enzymes.


Changed on 9/14/2017

VAERS ID: 183160 Before After
VAERS Form:(blank) 1
Age:32.0
Sex:Female
Location:California
Vaccinated:2002-03-21
Onset:2002-03-22
Submitted:2002-03-30
Entered:2002-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 13844 / - UNK - / SC
TD: TD ADSORBED (NO BRAND NAME) / SANOFI PASTEUR U0519AA / - UNK - / IM

Administered by: Private      Purchased by: Private
Symptoms: Respiratory disorder

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2002-05-01
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: At 17:00 on 3/21/02, she received MMR and Tetanus vaccination. About 12 hours later (05:00 on 3/22/02), she died and was brought back. 05/01/2002 patient expired after being transferred to hospital in Budapest. Records from San Clemente Hospital: Diagnosed with severe anoxic brain injury, probably alpha coma, seizure disorder, staphylococcus aureus bronchitis, ventricular fibrillation arrest, tachycardia, elevated liver enzymes.


Changed on 2/14/2018

VAERS ID: 183160 Before After
VAERS Form:1
Age:32.0
Sex:Female
Location:California
Vaccinated:2002-03-21
Onset:2002-03-22
Submitted:2002-03-30
Entered:2002-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 13844 / UNK - / SC
TD: TD ADSORBED (NO BRAND NAME) / SANOFI PASTEUR U0519AA / UNK - / IM

Administered by: Private      Purchased by: Private
Symptoms: Respiratory disorder

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2002-05-01
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: At 17:00 on 3/21/02, she received MMR and Tetanus vaccination. About 12 hours later (05:00 on 3/22/02), she died and was brought back. 05/01/2002 patient expired after being transferred to hospital in Budapest. Records from San Clemente Hospital: Diagnosed with severe anoxic brain injury, probably alpha coma, seizure disorder, staphylococcus aureus bronchitis, ventricular fibrillation arrest, tachycardia, elevated liver enzymes.


Changed on 6/14/2018

VAERS ID: 183160 Before After
VAERS Form:1
Age:32.0
Sex:Female
Location:California
Vaccinated:2002-03-21
Onset:2002-03-22
Submitted:2002-03-30
Entered:2002-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 13844 / UNK - / SC
TD: TD ADSORBED (NO BRAND NAME) / SANOFI PASTEUR U0519AA / UNK - / IM

Administered by: Private      Purchased by: Private
Symptoms: Respiratory disorder

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2002-05-01
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: At 17:00 on 3/21/02, she received MMR and Tetanus vaccination. About 12 hours later (05:00 on 3/22/02), she died and was brought back. 05/01/2002 patient expired after being transferred to hospital in Budapest. Records from San Clemente Hospital: Diagnosed with severe anoxic brain injury, probably alpha coma, seizure disorder, staphylococcus aureus bronchitis, ventricular fibrillation arrest, tachycardia, elevated liver enzymes.


Changed on 8/14/2018

VAERS ID: 183160 Before After
VAERS Form:1
Age:32.0
Sex:Female
Location:California
Vaccinated:2002-03-21
Onset:2002-03-22
Submitted:2002-03-30
Entered:2002-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 13844 / UNK - / SC
TD: TD ADSORBED (NO BRAND NAME) / SANOFI PASTEUR U0519AA / UNK - / IM

Administered by: Private      Purchased by: Private
Symptoms: Respiratory disorder

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2002-05-01
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: At 17:00 on 3/21/02, she received MMR and Tetanus vaccination. About 12 hours later (05:00 on 3/22/02), she died and was brought back. 05/01/2002 patient expired after being transferred to hospital in Budapest. Records from San Clemente Hospital: Diagnosed with severe anoxic brain injury, probably alpha coma, seizure disorder, staphylococcus aureus bronchitis, ventricular fibrillation arrest, tachycardia, elevated liver enzymes.


Changed on 9/14/2018

VAERS ID: 183160 Before After
VAERS Form:1
Age:32.0
Sex:Female
Location:California
Vaccinated:2002-03-21
Onset:2002-03-22
Submitted:2002-03-30
Entered:2002-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 13844 / UNK - / SC
TD: TD ADSORBED (NO BRAND NAME) / SANOFI PASTEUR U0519AA / UNK - / IM

Administered by: Private      Purchased by: Private
Symptoms: Respiratory disorder

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2002-05-01
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: At 17:00 on 3/21/02, she received MMR and Tetanus vaccination. About 12 hours later (05:00 on 3/22/02), she died and was brought back. 05/01/2002 patient expired after being transferred to hospital in Budapest. Records from San Clemente Hospital: Diagnosed with severe anoxic brain injury, probably alpha coma, seizure disorder, staphylococcus aureus bronchitis, ventricular fibrillation arrest, tachycardia, elevated liver enzymes.


Changed on 10/14/2018

VAERS ID: 183160 Before After
VAERS Form:1
Age:32.0
Sex:Female
Location:California
Vaccinated:2002-03-21
Onset:2002-03-22
Submitted:2002-03-30
Entered:2002-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 13844 / UNK - / SC
TD: TD ADSORBED (NO BRAND NAME) / SANOFI PASTEUR U0519AA / UNK - / IM

Administered by: Private      Purchased by: Private
Symptoms: Respiratory disorder

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2002-05-01
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: At 17:00 on 3/21/02, she received MMR and Tetanus vaccination. About 12 hours later (05:00 on 3/22/02), she died and was brought back. 05/01/2002 patient expired after being transferred to hospital in Budapest. Records from San Clemente Hospital: Diagnosed with severe anoxic brain injury, probably alpha coma, seizure disorder, staphylococcus aureus bronchitis, ventricular fibrillation arrest, tachycardia, elevated liver enzymes.

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