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This is VAERS ID 213825

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 213825
VAERS Form:
Age:1.0
Sex:Female
Location:Michigan
Vaccinated:2003-05-22
Onset:2003-06-05
Submitted:2003-12-04
Entered:2003-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1012M / 0 RL / SC
PNC: PNEUMO, 7-VALENT (PREVNAR) / LEDERLE LABORATO 491169 / 2 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0865M / 0 LA / SC

Administered by: Private      Purchased by: Unknown
Symptoms: REACT UNEVAL

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2003-06-05
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Child died suddnely at day care on or about 6/5/03. No other specifics known.


Changed on 12/8/2009

VAERS ID: 213825 Before After
VAERS Form:
Age:1.0
Sex:Female
Location:Michigan
Vaccinated:2003-05-22
Onset:2003-06-05
Submitted:2003-12-04
Entered:2003-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1012M / 0 RL / SC
PNC: PNEUMO, 7-VALENT (PREVNAR) PNEUMO (PREVNAR) / LEDERLE LABORATO LEDERLE LABORATORIES 491169 / 2 LL / IM
VARCEL: VARICELLA (VARIVAX) VARICELLA (VARIVAX) / MERCK & CO. INC. 0865M / 0 LA / SC

Administered by: Private      Purchased by: Unknown Public
Symptoms: Bronchitis, Pneumonia, Brain oedema, Bacterial infection, REACT UNEVAL

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2003-06-05
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Child died suddnely suddenly at day care on or about 6/5/03. No other specifics known. Autopsy report report received on 12/16/2003 states COD was bacterial pneumonia, bronchitis, and cerebral edema.


Changed on 3/2/2010

VAERS ID: 213825 Before After
VAERS Form:
Age:1.0
Sex:Female
Location:Michigan
Vaccinated:2003-05-22
Onset:2003-06-05
Submitted:2003-12-04
Entered:2003-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1012M / 0 RL / SC
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / LEDERLE LABORATORIES 491169 / 2 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0865M / 0 LA / SC

Administered by: Private      Purchased by: Public
Symptoms: Bronchitis, Pneumonia, Brain oedema, Bacterial infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2003-06-05
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Child died suddenly at day care on or about 6/5/03. No other specifics known. Autopsy report report received on 12/16/2003 states COD was bacterial pneumonia, bronchitis, and cerebral edema.


Changed on 4/7/2010

VAERS ID: 213825 Before After
VAERS Form:
Age:1.0
Sex:Female
Location:Michigan
Vaccinated:2003-05-22
Onset:2003-06-05
Submitted:2003-12-04
Entered:2003-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1012M / 0 RL / SC
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / LEDERLE LABORATORIES 491169 / 2 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0865M / 0 LA / SC

Administered by: Private      Purchased by: Public
Symptoms: Bronchitis, Pneumonia, Brain oedema, Bacterial infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2003-06-05
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Child died suddenly at day care on or about 6/5/03. No other specifics known. Autopsy report report received on 12/16/2003 states COD was bacterial pneumonia, bronchitis, and cerebral edema.


Changed on 5/14/2017

VAERS ID: 213825 Before After
VAERS Form:
Age:1.0
Sex:Female
Location:Michigan
Vaccinated:2003-05-22
Onset:2003-06-05
Submitted:2003-12-04
Entered:2003-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1012M / 0 RL / SC
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES PFIZER/WYETH 491169 / 2 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0865M / 0 LA / SC

Administered by: Private      Purchased by: Public
Symptoms: Bronchitis, Pneumonia, Brain oedema, Bacterial infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2003-06-05
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Child died suddenly at day care on or about 6/5/03. No other specifics known. Autopsy report report received on 12/16/2003 states COD was bacterial pneumonia, bronchitis, and cerebral edema.


Changed on 9/14/2017

VAERS ID: 213825 Before After
VAERS Form:(blank) 1
Age:1.0
Sex:Female
Location:Michigan
Vaccinated:2003-05-22
Onset:2003-06-05
Submitted:2003-12-04
Entered:2003-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1012M / 0 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 491169 / 2 3 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0865M / 0 1 LA / SC

Administered by: Private      Purchased by: Public
Symptoms: Bronchitis, Pneumonia, Brain oedema, Bacterial infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2003-06-05
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Child died suddenly at day care on or about 6/5/03. No other specifics known. Autopsy report report received on 12/16/2003 states COD was bacterial pneumonia, bronchitis, and cerebral edema.


Changed on 2/14/2018

VAERS ID: 213825 Before After
VAERS Form:1
Age:1.0
Sex:Female
Location:Michigan
Vaccinated:2003-05-22
Onset:2003-06-05
Submitted:2003-12-04
Entered:2003-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1012M / 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 491169 / 3 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0865M / 1 LA / SC

Administered by: Private      Purchased by: Public
Symptoms: Bronchitis, Pneumonia, Brain oedema, Bacterial infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2003-06-05
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Child died suddenly at day care on or about 6/5/03. No other specifics known. Autopsy report report received on 12/16/2003 states COD was bacterial pneumonia, bronchitis, and cerebral edema.


Changed on 6/14/2018

VAERS ID: 213825 Before After
VAERS Form:1
Age:1.0
Sex:Female
Location:Michigan
Vaccinated:2003-05-22
Onset:2003-06-05
Submitted:2003-12-04
Entered:2003-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1012M / 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 491169 / 3 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0865M / 1 LA / SC

Administered by: Private      Purchased by: Public
Symptoms: Bronchitis, Pneumonia, Brain oedema, Bacterial infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2003-06-05
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Child died suddenly at day care on or about 6/5/03. No other specifics known. Autopsy report report received on 12/16/2003 states COD was bacterial pneumonia, bronchitis, and cerebral edema.


Changed on 8/14/2018

VAERS ID: 213825 Before After
VAERS Form:1
Age:1.0
Sex:Female
Location:Michigan
Vaccinated:2003-05-22
Onset:2003-06-05
Submitted:2003-12-04
Entered:2003-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1012M / 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 491169 / 3 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0865M / 1 LA / SC

Administered by: Private      Purchased by: Public
Symptoms: Bronchitis, Pneumonia, Brain oedema, Bacterial infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2003-06-05
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Child died suddenly at day care on or about 6/5/03. No other specifics known. Autopsy report report received on 12/16/2003 states COD was bacterial pneumonia, bronchitis, and cerebral edema.


Changed on 9/14/2018

VAERS ID: 213825 Before After
VAERS Form:1
Age:1.0
Sex:Female
Location:Michigan
Vaccinated:2003-05-22
Onset:2003-06-05
Submitted:2003-12-04
Entered:2003-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1012M / 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 491169 / 3 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0865M / 1 LA / SC

Administered by: Private      Purchased by: Public
Symptoms: Bronchitis, Pneumonia, Brain oedema, Bacterial infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2003-06-05
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Child died suddenly at day care on or about 6/5/03. No other specifics known. Autopsy report report received on 12/16/2003 states COD was bacterial pneumonia, bronchitis, and cerebral edema.


Changed on 10/14/2018

VAERS ID: 213825 Before After
VAERS Form:1
Age:1.0
Sex:Female
Location:Michigan
Vaccinated:2003-05-22
Onset:2003-06-05
Submitted:2003-12-04
Entered:2003-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1012M / 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 491169 / 3 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0865M / 1 LA / SC

Administered by: Private      Purchased by: Public
Symptoms: Bronchitis, Pneumonia, Brain oedema, Bacterial infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2003-06-05
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Child died suddenly at day care on or about 6/5/03. No other specifics known. Autopsy report report received on 12/16/2003 states COD was bacterial pneumonia, bronchitis, and cerebral edema.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=213825&WAYBACKHISTORY=ON


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