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This is VAERS ID 184904

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

VAERS ID: 184904
VAERS Form:
Age:2.1
Sex:Male
Location:Foreign
Vaccinated:2001-05-16
Onset:2001-06-03
Submitted:2002-05-14
Entered:2002-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 0 - / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase increased, Aspiration, Blood calcium decreased, Blood chloride decreased, Blood creatine phosphokinase increased, Conjunctivitis, Cyanosis, Pyrexia, Sudden infant death syndrome, Upper respiratory tract infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-06-04
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: NONE
Current Illness:
Preexisting Conditions: Febrile convulsion
Allergies:
Diagnostic Lab Data: CRP-less than 7; leucocytes-6.2; hemoglobin-13.5; thrombocytes-153; neutrophils-1.99; lymphocytes-3.42; monocytes-0.72; cephatest-70H; creatinine-95H; urea-4.6; sodium-139; chloride-84; calcium-1.83; glucose-14.1; plasma aspartate aminotran
CDC 'Split Type': WAES0205USA00328

Write-up: Information has been received from a health authority concerning a 25 month old male with a history of 2 episodes of uncomplicated fever convulsions who on 5/16/01 was vaccinated with the 1st dose of MMRII (lot unknown). There was no concomitant medication. On 6/4/01, 19 days post vax, the pt was found lifeless in his bed at 11:55 AM on his back with blue lips and vomit in his pharynx. It was reported that he had conjunctivitis the day before, upper respiratory infection for 1 day and a fever of 38.6C, in the morning but seemed unaffected. He went to sleep about 09:30 AM and at 11:30 AM was observed to be sleeping on his stomach. No petechia or other rash was noted. The autopsy showed no certain cause of death and the cause of death was classified as borderline SIDS. It was reported that no findings point to causal relationship to the vaccine. No further information is available.


Changed on 2/14/2017

VAERS ID: 184904 Before After
VAERS Form:
Age:2.1 2.08
Sex:Male
Location:Foreign
Vaccinated:2001-05-16
Onset:2001-06-03
Submitted:2002-05-14
Entered:2002-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 0 - / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase increased, Aspiration, Blood calcium decreased, Blood chloride decreased, Blood creatine phosphokinase increased, Conjunctivitis, Cyanosis, Pyrexia, Sudden infant death syndrome, Upper respiratory tract infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-06-04
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: NONE
Current Illness:
Preexisting Conditions: Febrile convulsion
Allergies:
Diagnostic Lab Data: CRP-less than 7; leucocytes-6.2; hemoglobin-13.5; thrombocytes-153; neutrophils-1.99; lymphocytes-3.42; monocytes-0.72; cephatest-70H; creatinine-95H; urea-4.6; sodium-139; chloride-84; calcium-1.83; glucose-14.1; plasma aspartate aminotran
CDC 'Split Type': WAES0205USA00328

Write-up: Information has been received from a health authority concerning a 25 month old male with a history of 2 episodes of uncomplicated fever convulsions who on 5/16/01 was vaccinated with the 1st dose of MMRII (lot unknown). There was no concomitant medication. On 6/4/01, 19 days post vax, the pt was found lifeless in his bed at 11:55 AM on his back with blue lips and vomit in his pharynx. It was reported that he had conjunctivitis the day before, upper respiratory infection for 1 day and a fever of 38.6C, in the morning but seemed unaffected. He went to sleep about 09:30 AM and at 11:30 AM was observed to be sleeping on his stomach. No petechia or other rash was noted. The autopsy showed no certain cause of death and the cause of death was classified as borderline SIDS. It was reported that no findings point to causal relationship to the vaccine. No further information is available.


Changed on 5/14/2017

VAERS ID: 184904 Before After
VAERS Form:
Age:2.08
Sex:Male
Location:Foreign
Vaccinated:2001-05-16
Onset:2001-06-03
Submitted:2002-05-14
Entered:2002-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 0 - / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase increased, Aspiration, Blood calcium decreased, Blood chloride decreased, Blood creatine phosphokinase increased, Conjunctivitis, Cyanosis, Pyrexia, Sudden infant death syndrome, Upper respiratory tract infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-06-04
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: NONE
Current Illness:
Preexisting Conditions: Febrile convulsion
Allergies:
Diagnostic Lab Data: CRP-less than 7; leucocytes-6.2; hemoglobin-13.5; thrombocytes-153; neutrophils-1.99; lymphocytes-3.42; monocytes-0.72; cephatest-70H; creatinine-95H; urea-4.6; sodium-139; chloride-84; calcium-1.83; glucose-14.1; plasma aspartate aminotran aminotransferase test 1612; plasma alanine aminotransferase test-1132; serum alkaline phosphatase test-375; serum lactate dehydrogenase test-6567; serum creatine kinase test-5424; total protein-62; albumin-39; urine clear; Autopsy-no certain cause of death
CDC 'Split Type': WAES0205USA00328

Write-up: Information has been received from a health authority concerning a 25 month old male with a history of 2 episodes of uncomplicated fever convulsions who on 5/16/01 was vaccinated with the 1st dose of MMRII (lot unknown). There was no concomitant medication. On 6/4/01, 19 days post vax, the pt was found lifeless in his bed at 11:55 AM on his back with blue lips and vomit in his pharynx. It was reported that he had conjunctivitis the day before, upper respiratory infection for 1 day and a fever of 38.6C, in the morning but seemed unaffected. He went to sleep about 09:30 AM and at 11:30 AM was observed to be sleeping on his stomach. No petechia or other rash was noted. The autopsy showed no certain cause of death and the cause of death was classified as borderline SIDS. It was reported that no findings point to causal relationship to the vaccine. No further information is available.


Changed on 9/14/2017

VAERS ID: 184904 Before After
VAERS Form:(blank) 1
Age:2.08
Sex:Male
Location:Foreign
Vaccinated:2001-05-16
Onset:2001-06-03
Submitted:2002-05-14
Entered:2002-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 0 1 - / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase increased, Aspiration, Blood calcium decreased, Blood chloride decreased, Blood creatine phosphokinase increased, Conjunctivitis, Cyanosis, Pyrexia, Sudden infant death syndrome, Upper respiratory tract infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-06-04
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: NONE
Current Illness:
Preexisting Conditions: Febrile convulsion
Allergies:
Diagnostic Lab Data: CRP-less than 7; leucocytes-6.2; hemoglobin-13.5; thrombocytes-153; neutrophils-1.99; lymphocytes-3.42; monocytes-0.72; cephatest-70H; creatinine-95H; urea-4.6; sodium-139; chloride-84; calcium-1.83; glucose-14.1; plasma aspartate aminotransferase test 1612; plasma alanine aminotransferase test-1132; serum alkaline phosphatase test-375; serum lactate dehydrogenase test-6567; serum creatine kinase test-5424; total protein-62; albumin-39; urine clear; Autopsy-no certain cause of death
CDC 'Split Type': WAES0205USA00328

Write-up: Information has been received from a health authority concerning a 25 month old male with a history of 2 episodes of uncomplicated fever convulsions who on 5/16/01 was vaccinated with the 1st dose of MMRII (lot unknown). There was no concomitant medication. On 6/4/01, 19 days post vax, the pt was found lifeless in his bed at 11:55 AM on his back with blue lips and vomit in his pharynx. It was reported that he had conjunctivitis the day before, upper respiratory infection for 1 day and a fever of 38.6C, in the morning but seemed unaffected. He went to sleep about 09:30 AM and at 11:30 AM was observed to be sleeping on his stomach. No petechia or other rash was noted. The autopsy showed no certain cause of death and the cause of death was classified as borderline SIDS. It was reported that no findings point to causal relationship to the vaccine. No further information is available.


Changed on 2/14/2018

VAERS ID: 184904 Before After
VAERS Form:1
Age:2.08
Sex:Male
Location:Foreign
Vaccinated:2001-05-16
Onset:2001-06-03
Submitted:2002-05-14
Entered:2002-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 1 - / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase increased, Aspiration, Blood calcium decreased, Blood chloride decreased, Blood creatine phosphokinase increased, Conjunctivitis, Cyanosis, Pyrexia, Sudden infant death syndrome, Upper respiratory tract infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-06-04
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: NONE
Current Illness:
Preexisting Conditions: Febrile convulsion
Allergies:
Diagnostic Lab Data: CRP-less than 7; leucocytes-6.2; hemoglobin-13.5; thrombocytes-153; neutrophils-1.99; lymphocytes-3.42; monocytes-0.72; cephatest-70H; creatinine-95H; urea-4.6; sodium-139; chloride-84; calcium-1.83; glucose-14.1; plasma aspartate aminotransferase test 1612; plasma alanine aminotransferase test-1132; serum alkaline phosphatase test-375; serum lactate dehydrogenase test-6567; serum creatine kinase test-5424; total protein-62; albumin-39; urine clear; Autopsy-no certain cause of death
CDC 'Split Type': WAES0205USA00328

Write-up: Information has been received from a health authority concerning a 25 month old male with a history of 2 episodes of uncomplicated fever convulsions who on 5/16/01 was vaccinated with the 1st dose of MMRII (lot unknown). There was no concomitant medication. On 6/4/01, 19 days post vax, the pt was found lifeless in his bed at 11:55 AM on his back with blue lips and vomit in his pharynx. It was reported that he had conjunctivitis the day before, upper respiratory infection for 1 day and a fever of 38.6C, in the morning but seemed unaffected. He went to sleep about 09:30 AM and at 11:30 AM was observed to be sleeping on his stomach. No petechia or other rash was noted. The autopsy showed no certain cause of death and the cause of death was classified as borderline SIDS. It was reported that no findings point to causal relationship to the vaccine. No further information is available.


Changed on 6/14/2018

VAERS ID: 184904 Before After
VAERS Form:1
Age:2.08
Sex:Male
Location:Foreign
Vaccinated:2001-05-16
Onset:2001-06-03
Submitted:2002-05-14
Entered:2002-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 1 - / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase increased, Aspiration, Blood calcium decreased, Blood chloride decreased, Blood creatine phosphokinase increased, Conjunctivitis, Cyanosis, Pyrexia, Sudden infant death syndrome, Upper respiratory tract infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-06-04
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: NONE
Current Illness:
Preexisting Conditions: Febrile convulsion
Allergies:
Diagnostic Lab Data: CRP-less than 7; leucocytes-6.2; hemoglobin-13.5; thrombocytes-153; neutrophils-1.99; lymphocytes-3.42; monocytes-0.72; cephatest-70H; creatinine-95H; urea-4.6; sodium-139; chloride-84; calcium-1.83; glucose-14.1; plasma aspartate aminotransferase test 1612; plasma alanine aminotransferase test-1132; serum alkaline phosphatase test-375; serum lactate dehydrogenase test-6567; serum creatine kinase test-5424; total protein-62; albumin-39; urine clear; Autopsy-no certain cause of death
CDC 'Split Type': WAES0205USA00328

Write-up: Information has been received from a health authority concerning a 25 month old male with a history of 2 episodes of uncomplicated fever convulsions who on 5/16/01 was vaccinated with the 1st dose of MMRII (lot unknown). There was no concomitant medication. On 6/4/01, 19 days post vax, the pt was found lifeless in his bed at 11:55 AM on his back with blue lips and vomit in his pharynx. It was reported that he had conjunctivitis the day before, upper respiratory infection for 1 day and a fever of 38.6C, in the morning but seemed unaffected. He went to sleep about 09:30 AM and at 11:30 AM was observed to be sleeping on his stomach. No petechia or other rash was noted. The autopsy showed no certain cause of death and the cause of death was classified as borderline SIDS. It was reported that no findings point to causal relationship to the vaccine. No further information is available.


Changed on 8/14/2018

VAERS ID: 184904 Before After
VAERS Form:1
Age:2.08
Sex:Male
Location:Foreign
Vaccinated:2001-05-16
Onset:2001-06-03
Submitted:2002-05-14
Entered:2002-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 1 - / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase increased, Aspiration, Blood calcium decreased, Blood chloride decreased, Blood creatine phosphokinase increased, Conjunctivitis, Cyanosis, Pyrexia, Sudden infant death syndrome, Upper respiratory tract infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-06-04
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: NONE
Current Illness:
Preexisting Conditions: Febrile convulsion
Allergies:
Diagnostic Lab Data: CRP-less than 7; leucocytes-6.2; hemoglobin-13.5; thrombocytes-153; neutrophils-1.99; lymphocytes-3.42; monocytes-0.72; cephatest-70H; creatinine-95H; urea-4.6; sodium-139; chloride-84; calcium-1.83; glucose-14.1; plasma aspartate aminotransferase test 1612; plasma alanine aminotransferase test-1132; serum alkaline phosphatase test-375; serum lactate dehydrogenase test-6567; serum creatine kinase test-5424; total protein-62; albumin-39; urine clear; Autopsy-no certain cause of death
CDC 'Split Type': WAES0205USA00328

Write-up: Information has been received from a health authority concerning a 25 month old male with a history of 2 episodes of uncomplicated fever convulsions who on 5/16/01 was vaccinated with the 1st dose of MMRII (lot unknown). There was no concomitant medication. On 6/4/01, 19 days post vax, the pt was found lifeless in his bed at 11:55 AM on his back with blue lips and vomit in his pharynx. It was reported that he had conjunctivitis the day before, upper respiratory infection for 1 day and a fever of 38.6C, in the morning but seemed unaffected. He went to sleep about 09:30 AM and at 11:30 AM was observed to be sleeping on his stomach. No petechia or other rash was noted. The autopsy showed no certain cause of death and the cause of death was classified as borderline SIDS. It was reported that no findings point to causal relationship to the vaccine. No further information is available.


Changed on 9/14/2018

VAERS ID: 184904 Before After
VAERS Form:1
Age:2.08
Sex:Male
Location:Foreign
Vaccinated:2001-05-16
Onset:2001-06-03
Submitted:2002-05-14
Entered:2002-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 1 - / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase increased, Aspiration, Blood calcium decreased, Blood chloride decreased, Blood creatine phosphokinase increased, Conjunctivitis, Cyanosis, Pyrexia, Sudden infant death syndrome, Upper respiratory tract infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-06-04
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: NONE
Current Illness:
Preexisting Conditions: Febrile convulsion
Allergies:
Diagnostic Lab Data: CRP-less than 7; leucocytes-6.2; hemoglobin-13.5; thrombocytes-153; neutrophils-1.99; lymphocytes-3.42; monocytes-0.72; cephatest-70H; creatinine-95H; urea-4.6; sodium-139; chloride-84; calcium-1.83; glucose-14.1; plasma aspartate aminotransferase test 1612; plasma alanine aminotransferase test-1132; serum alkaline phosphatase test-375; serum lactate dehydrogenase test-6567; serum creatine kinase test-5424; total protein-62; albumin-39; urine clear; Autopsy-no certain cause of death
CDC 'Split Type': WAES0205USA00328

Write-up: Information has been received from a health authority concerning a 25 month old male with a history of 2 episodes of uncomplicated fever convulsions who on 5/16/01 was vaccinated with the 1st dose of MMRII (lot unknown). There was no concomitant medication. On 6/4/01, 19 days post vax, the pt was found lifeless in his bed at 11:55 AM on his back with blue lips and vomit in his pharynx. It was reported that he had conjunctivitis the day before, upper respiratory infection for 1 day and a fever of 38.6C, in the morning but seemed unaffected. He went to sleep about 09:30 AM and at 11:30 AM was observed to be sleeping on his stomach. No petechia or other rash was noted. The autopsy showed no certain cause of death and the cause of death was classified as borderline SIDS. It was reported that no findings point to causal relationship to the vaccine. No further information is available.


Changed on 10/14/2018

VAERS ID: 184904 Before After
VAERS Form:1
Age:2.08
Sex:Male
Location:Foreign
Vaccinated:2001-05-16
Onset:2001-06-03
Submitted:2002-05-14
Entered:2002-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 1 - / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase increased, Aspiration, Blood calcium decreased, Blood chloride decreased, Blood creatine phosphokinase increased, Conjunctivitis, Cyanosis, Pyrexia, Sudden infant death syndrome, Upper respiratory tract infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-06-04
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: NONE
Current Illness:
Preexisting Conditions: Febrile convulsion
Allergies:
Diagnostic Lab Data: CRP-less than 7; leucocytes-6.2; hemoglobin-13.5; thrombocytes-153; neutrophils-1.99; lymphocytes-3.42; monocytes-0.72; cephatest-70H; creatinine-95H; urea-4.6; sodium-139; chloride-84; calcium-1.83; glucose-14.1; plasma aspartate aminotransferase test 1612; plasma alanine aminotransferase test-1132; serum alkaline phosphatase test-375; serum lactate dehydrogenase test-6567; serum creatine kinase test-5424; total protein-62; albumin-39; urine clear; Autopsy-no certain cause of death
CDC 'Split Type': WAES0205USA00328

Write-up: Information has been received from a health authority concerning a 25 month old male with a history of 2 episodes of uncomplicated fever convulsions who on 5/16/01 was vaccinated with the 1st dose of MMRII (lot unknown). There was no concomitant medication. On 6/4/01, 19 days post vax, the pt was found lifeless in his bed at 11:55 AM on his back with blue lips and vomit in his pharynx. It was reported that he had conjunctivitis the day before, upper respiratory infection for 1 day and a fever of 38.6C, in the morning but seemed unaffected. He went to sleep about 09:30 AM and at 11:30 AM was observed to be sleeping on his stomach. No petechia or other rash was noted. The autopsy showed no certain cause of death and the cause of death was classified as borderline SIDS. It was reported that no findings point to causal relationship to the vaccine. No further information is available.

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