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This is VAERS ID 184346

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 184346
VAERS Form:
Age:1.1
Sex:Female
Location:California
Vaccinated:2002-04-04
Onset:2002-04-27
Submitted:2002-05-01
Entered:2002-05-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1379L / 0 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0573L / 0 LL / SC

Administered by: Private      Purchased by: Unknown
Symptoms: REACT UNEVAL, INFECT, HEART ARREST, SHOCK

Life Threatening? Yes
Birth Defect? No
Died? No
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:
Current Illness: RSV Bronchiolitis and pneumonia
Preexisting Conditions: Congenital ichthyosis, failure to thrive,
Allergies:
Diagnostic Lab Data: VZV-DFA (+)
CDC 'Split Type':

Write-up: Disseminated VZV with multi-organ failure, shock, CV arrest. Diagnosed with Superficial cellulitis, Otitis externa, hepatomegaly


Changed on 12/8/2009

VAERS ID: 184346 Before After
VAERS Form:
Age:1.1
Sex:Female
Location:California
Vaccinated:2002-04-04
Onset:2002-04-27
Submitted:2002-05-01
Entered:2002-05-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1379L / 0 RL / SC
VARCEL: VARICELLA (VARIVAX) VARICELLA (VARIVAX) / MERCK & CO. INC. 0573L / 0 LL / SC

Administered by: Private      Purchased by: Unknown Private
Symptoms: Cardiac arrest, Infection, Multi-organ failure, Respiratory arrest, Shock, REACT UNEVAL, INFECT, HEART ARREST, SHOCK

Life Threatening? Yes
Birth Defect? No
Died? No Yes
   Date died:0000-00-00 2002-07-16
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: (blank) 44     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: RSV Bronchiolitis and pneumonia
Preexisting Conditions: Congenital ichthyosis, failure to thrive,
Allergies:
Diagnostic Lab Data: VZV-DFA (+)
CDC 'Split Type':

Write-up: Disseminated VZV with multi-organ failure, shock, CV arrest. Diagnosed with Superficial cellulitis, Otitis externa, hepatomegaly hepatomegaly. 3/16/05 Autopsy report received which revealed COD to be respiratory arrest and congenital ichthyosis w/Netherton''s syndrome. Patient arrested in pediatrician''s office & unable to be revived/ss


Changed on 2/14/2017

VAERS ID: 184346 Before After
VAERS Form:
Age:1.1 1.08
Sex:Female
Location:California
Vaccinated:2002-04-04
Onset:2002-04-27
Submitted:2002-05-01
Entered:2002-05-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1379L / 0 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0573L / 0 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Cardiac arrest, Infection, Multi-organ failure, Respiratory arrest, Shock

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2002-07-16
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: 44     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: RSV Bronchiolitis and pneumonia
Preexisting Conditions: Congenital ichthyosis, failure to thrive,
Allergies:
Diagnostic Lab Data: VZV-DFA (+)
CDC 'Split Type':

Write-up: Disseminated VZV with multi-organ failure, shock, CV arrest. Diagnosed with Superficial cellulitis, Otitis externa, hepatomegaly. 3/16/05 Autopsy report received which revealed COD to be respiratory arrest and congenital ichthyosis w/Netherton''s syndrome. Patient arrested in pediatrician''s office & unable to be revived/ss


Changed on 9/14/2017

VAERS ID: 184346 Before After
VAERS Form:(blank) 1
Age:1.08
Sex:Female
Location:California
Vaccinated:2002-04-04
Onset:2002-04-27
Submitted:2002-05-01
Entered:2002-05-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1379L / 0 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0573L / 0 1 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Cardiac arrest, Infection, Multi-organ failure, Respiratory arrest, Shock

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2002-07-16
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: 44     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: RSV Bronchiolitis and pneumonia
Preexisting Conditions: Congenital ichthyosis, failure to thrive,
Allergies:
Diagnostic Lab Data: VZV-DFA (+)
CDC 'Split Type':

Write-up: Disseminated VZV with multi-organ failure, shock, CV arrest. Diagnosed with Superficial cellulitis, Otitis externa, hepatomegaly. 3/16/05 Autopsy report received which revealed COD to be respiratory arrest and congenital ichthyosis w/Netherton''s syndrome. Patient arrested in pediatrician''s office & unable to be revived/ss


Changed on 2/14/2018

VAERS ID: 184346 Before After
VAERS Form:1
Age:1.08
Sex:Female
Location:California
Vaccinated:2002-04-04
Onset:2002-04-27
Submitted:2002-05-01
Entered:2002-05-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1379L / 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0573L / 1 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Cardiac arrest, Infection, Multi-organ failure, Respiratory arrest, Shock

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2002-07-16
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: 44     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: RSV Bronchiolitis and pneumonia
Preexisting Conditions: Congenital ichthyosis, failure to thrive,
Allergies:
Diagnostic Lab Data: VZV-DFA (+)
CDC 'Split Type':

Write-up: Disseminated VZV with multi-organ failure, shock, CV arrest. Diagnosed with Superficial cellulitis, Otitis externa, hepatomegaly. 3/16/05 Autopsy report received which revealed COD to be respiratory arrest and congenital ichthyosis w/Netherton''s syndrome. Patient arrested in pediatrician''s office & unable to be revived/ss


Changed on 6/14/2018

VAERS ID: 184346 Before After
VAERS Form:1
Age:1.08
Sex:Female
Location:California
Vaccinated:2002-04-04
Onset:2002-04-27
Submitted:2002-05-01
Entered:2002-05-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1379L / 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0573L / 1 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Cardiac arrest, Infection, Multi-organ failure, Respiratory arrest, Shock

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2002-07-16
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: 44     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: RSV Bronchiolitis and pneumonia
Preexisting Conditions: Congenital ichthyosis, failure to thrive,
Allergies:
Diagnostic Lab Data: VZV-DFA (+)
CDC 'Split Type':

Write-up: Disseminated VZV with multi-organ failure, shock, CV arrest. Diagnosed with Superficial cellulitis, Otitis externa, hepatomegaly. 3/16/05 Autopsy report received which revealed COD to be respiratory arrest and congenital ichthyosis w/Netherton''s syndrome. Patient arrested in pediatrician''s office & unable to be revived/ss


Changed on 8/14/2018

VAERS ID: 184346 Before After
VAERS Form:1
Age:1.08
Sex:Female
Location:California
Vaccinated:2002-04-04
Onset:2002-04-27
Submitted:2002-05-01
Entered:2002-05-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1379L / 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0573L / 1 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Cardiac arrest, Infection, Multi-organ failure, Respiratory arrest, Shock

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2002-07-16
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: 44     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: RSV Bronchiolitis and pneumonia
Preexisting Conditions: Congenital ichthyosis, failure to thrive,
Allergies:
Diagnostic Lab Data: VZV-DFA (+)
CDC 'Split Type':

Write-up: Disseminated VZV with multi-organ failure, shock, CV arrest. Diagnosed with Superficial cellulitis, Otitis externa, hepatomegaly. 3/16/05 Autopsy report received which revealed COD to be respiratory arrest and congenital ichthyosis w/Netherton''s syndrome. Patient arrested in pediatrician''s office & unable to be revived/ss


Changed on 9/14/2018

VAERS ID: 184346 Before After
VAERS Form:1
Age:1.08
Sex:Female
Location:California
Vaccinated:2002-04-04
Onset:2002-04-27
Submitted:2002-05-01
Entered:2002-05-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1379L / 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0573L / 1 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Cardiac arrest, Infection, Multi-organ failure, Respiratory arrest, Shock

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2002-07-16
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: 44     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: RSV Bronchiolitis and pneumonia
Preexisting Conditions: Congenital ichthyosis, failure to thrive,
Allergies:
Diagnostic Lab Data: VZV-DFA (+)
CDC 'Split Type':

Write-up: Disseminated VZV with multi-organ failure, shock, CV arrest. Diagnosed with Superficial cellulitis, Otitis externa, hepatomegaly. 3/16/05 Autopsy report received which revealed COD to be respiratory arrest and congenital ichthyosis w/Netherton''s syndrome. Patient arrested in pediatrician''s office & unable to be revived/ss


Changed on 10/14/2018

VAERS ID: 184346 Before After
VAERS Form:1
Age:1.08
Sex:Female
Location:California
Vaccinated:2002-04-04
Onset:2002-04-27
Submitted:2002-05-01
Entered:2002-05-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1379L / 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0573L / 1 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Cardiac arrest, Infection, Multi-organ failure, Respiratory arrest, Shock

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2002-07-16
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: 44     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: RSV Bronchiolitis and pneumonia
Preexisting Conditions: Congenital ichthyosis, failure to thrive,
Allergies:
Diagnostic Lab Data: VZV-DFA (+)
CDC 'Split Type':

Write-up: Disseminated VZV with multi-organ failure, shock, CV arrest. Diagnosed with Superficial cellulitis, Otitis externa, hepatomegaly. 3/16/05 Autopsy report received which revealed COD to be respiratory arrest and congenital ichthyosis w/Netherton''s syndrome. Patient arrested in pediatrician''s office & unable to be revived/ss

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