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This is VAERS ID 189358

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 189358
VAERS Form:
Age:1.0
Sex:Male
Location:Nevada
Vaccinated:2002-04-16
Onset:2002-04-26
Submitted:2002-08-23
Entered:2002-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0905L / 0 - / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1291L / 0 - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: CONVULS, ENCEPHALITIS, HYPERTENS

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2002-10-25
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: 26     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: LUMBAR PUNCTURE, MRI
CDC 'Split Type':

Write-up: ENCEPHALITIS STATUS EPILEPTICUI 60 Day follow up states seizures, death. On October 25,2002, pt died as a result of complications of his seizures


Changed on 12/8/2009

VAERS ID: 189358 Before After
VAERS Form:
Age:1.0
Sex:Male
Location:Nevada
Vaccinated:2002-04-16
Onset:2002-04-26
Submitted:2002-08-23
Entered:2002-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0905L / 0 - RL / IM
VARCEL: VARICELLA (VARIVAX) VARICELLA (VARIVAX) / MERCK & CO. INC. 1291L / 0 - RL / IM

Administered by: Private Unknown      Purchased by: Unknown
Symptoms: Anaemia, Convulsion, Encephalitis, Hepatomegaly, Hypertension, Thrombocythaemia, Viral infection, CONVULS, ENCEPHALITIS, HYPERTENS

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2002-10-25
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: 26     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: LUMBAR PUNCTURE, MRI
CDC 'Split Type':

Write-up: ENCEPHALITIS STATUS EPILEPTICUI 60 Day follow up states seizures, death. On October 25,2002, pt died as a result of complications of his seizures Discharge Summary received on 9/23/2002 states viral infection, Hepatomegaly, anemia, and thrombocytosis.


Changed on 9/14/2017

VAERS ID: 189358 Before After
VAERS Form:(blank) 1
Age:1.0
Sex:Male
Location:Nevada
Vaccinated:2002-04-16
Onset:2002-04-26
Submitted:2002-08-23
Entered:2002-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0905L / 0 1 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1291L / 0 1 RL / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Anaemia, Convulsion, Encephalitis, Hepatomegaly, Hypertension, Thrombocythaemia, Viral infection

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2002-10-25
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: 26     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: LUMBAR PUNCTURE, MRI
CDC 'Split Type':

Write-up: ENCEPHALITIS STATUS EPILEPTICUI 60 Day follow up states seizures, death. On October 25,2002, pt died as a result of complications of his seizures Discharge Summary received on 9/23/2002 states viral infection, Hepatomegaly, anemia, and thrombocytosis.


Changed on 2/14/2018

VAERS ID: 189358 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Nevada
Vaccinated:2002-04-16
Onset:2002-04-26
Submitted:2002-08-23
Entered:2002-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0905L / 1 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1291L / 1 RL / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Anaemia, Convulsion, Encephalitis, Hepatomegaly, Hypertension, Thrombocythaemia, Viral infection

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2002-10-25
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: 26     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: LUMBAR PUNCTURE, MRI
CDC 'Split Type':

Write-up: ENCEPHALITIS STATUS EPILEPTICUI 60 Day follow up states seizures, death. On October 25,2002, pt died as a result of complications of his seizures Discharge Summary received on 9/23/2002 states viral infection, Hepatomegaly, anemia, and thrombocytosis.


Changed on 6/14/2018

VAERS ID: 189358 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Nevada
Vaccinated:2002-04-16
Onset:2002-04-26
Submitted:2002-08-23
Entered:2002-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0905L / 1 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1291L / 1 RL / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Anaemia, Convulsion, Encephalitis, Hepatomegaly, Hypertension, Thrombocythaemia, Viral infection

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2002-10-25
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: 26     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: LUMBAR PUNCTURE, MRI
CDC 'Split Type':

Write-up: ENCEPHALITIS STATUS EPILEPTICUI 60 Day follow up states seizures, death. On October 25,2002, pt died as a result of complications of his seizures Discharge Summary received on 9/23/2002 states viral infection, Hepatomegaly, anemia, and thrombocytosis.


Changed on 8/14/2018

VAERS ID: 189358 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Nevada
Vaccinated:2002-04-16
Onset:2002-04-26
Submitted:2002-08-23
Entered:2002-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0905L / 1 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1291L / 1 RL / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Anaemia, Convulsion, Encephalitis, Hepatomegaly, Hypertension, Thrombocythaemia, Viral infection

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2002-10-25
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: 26     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: LUMBAR PUNCTURE, MRI
CDC 'Split Type':

Write-up: ENCEPHALITIS STATUS EPILEPTICUI 60 Day follow up states seizures, death. On October 25,2002, pt died as a result of complications of his seizures Discharge Summary received on 9/23/2002 states viral infection, Hepatomegaly, anemia, and thrombocytosis.


Changed on 9/14/2018

VAERS ID: 189358 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Nevada
Vaccinated:2002-04-16
Onset:2002-04-26
Submitted:2002-08-23
Entered:2002-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0905L / 1 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1291L / 1 RL / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Anaemia, Convulsion, Encephalitis, Hepatomegaly, Hypertension, Thrombocythaemia, Viral infection

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2002-10-25
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: 26     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: LUMBAR PUNCTURE, MRI
CDC 'Split Type':

Write-up: ENCEPHALITIS STATUS EPILEPTICUI 60 Day follow up states seizures, death. On October 25,2002, pt died as a result of complications of his seizures Discharge Summary received on 9/23/2002 states viral infection, Hepatomegaly, anemia, and thrombocytosis.


Changed on 10/14/2018

VAERS ID: 189358 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Nevada
Vaccinated:2002-04-16
Onset:2002-04-26
Submitted:2002-08-23
Entered:2002-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0905L / 1 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1291L / 1 RL / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Anaemia, Convulsion, Encephalitis, Hepatomegaly, Hypertension, Thrombocythaemia, Viral infection

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2002-10-25
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: 26     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: LUMBAR PUNCTURE, MRI
CDC 'Split Type':

Write-up: ENCEPHALITIS STATUS EPILEPTICUI 60 Day follow up states seizures, death. On October 25,2002, pt died as a result of complications of his seizures Discharge Summary received on 9/23/2002 states viral infection, Hepatomegaly, anemia, and thrombocytosis.

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