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This is VAERS ID 37837

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 37837
VAERS Form:
Age:1.3
Sex:Male
Location:California
Vaccinated:1991-07-12
Onset:1991-07-30
Submitted:1991-12-05
Entered:1991-12-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MMR II / MSD 0862T / 0 LL / SC

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS, APNEA, HEART ARREST

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-07-30
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: AUG90 @ 6mos w/DTP #3 pt exp rxn;
Other Medications: APAP, Phenobarb
Current Illness: NONE
Preexisting Conditions: seizure disorder
Allergies:
Diagnostic Lab Data: Autospy signed out as SIDS;
CDC 'Split Type': seizure disorder

Write-up: Pt has onset of sz disorder w/fever AUG90 p/3rd DTP/OPV/HBOC; recurrent afebrile sz; on 12JUL91 had MMR died of respiratory/cardiac arrest 30JUL cause undetermined;


Changed on 12/8/2009

VAERS ID: 37837 Before After
VAERS Form:
Age:1.3
Sex:Male
Location:California
Vaccinated:1991-07-12
Onset:1991-07-30
Submitted:1991-12-05
Entered:1991-12-12 1991-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 0862T / 0 LL / SC

Administered by: Private      Purchased by: Unknown Private
Symptoms: Apnoea, Cardiac arrest, SIDS, Sudden infant death syndrome, APNEA, HEART ARREST

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-07-30
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: AUG90 @ 6mos w/DTP #3 pt exp rxn;
Other Medications: APAP, Phenobarb
Current Illness: NONE
Preexisting Conditions: seizure disorder
Allergies:
Diagnostic Lab Data: Autospy signed out as SIDS;
CDC 'Split Type': seizure disorder (blank)

Write-up: Pt has onset of sz disorder w/fever AUG90 p/3rd DTP/OPV/HBOC; recurrent afebrile sz; on 12JUL91 had MMR died of respiratory/cardiac arrest 30JUL cause undetermined;


Changed on 5/14/2017

VAERS ID: 37837 Before After
VAERS Form:
Age:1.3
Sex:Male
Location:California
Vaccinated:1991-07-12
Onset:1991-07-30
Submitted:1991-12-05
Entered:1991-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0862T / 0 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-07-30
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: AUG90 @ 6mos w/DTP #3 pt exp rxn; rxn;~ ()~~~In patient
Other Medications: APAP, Phenobarb
Current Illness: NONE
Preexisting Conditions: seizure disorder
Allergies:
Diagnostic Lab Data: Autospy signed out as SIDS;
CDC 'Split Type':

Write-up: Pt has onset of sz disorder w/fever AUG90 p/3rd DTP/OPV/HBOC; recurrent afebrile sz; on 12JUL91 had MMR died of respiratory/cardiac arrest 30JUL cause undetermined;


Changed on 9/14/2017

VAERS ID: 37837 Before After
VAERS Form:(blank) 1
Age:1.3
Sex:Male
Location:California
Vaccinated:1991-07-12
Onset:1991-07-30
Submitted:1991-12-05
Entered:1991-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0862T / 0 1 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-07-30
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: AUG90 @ 6mos w/DTP #3 pt exp rxn;~ ()~~~In patient
Other Medications: APAP, Phenobarb
Current Illness: NONE
Preexisting Conditions: seizure disorder
Allergies:
Diagnostic Lab Data: Autospy signed out as SIDS;
CDC 'Split Type':

Write-up: Pt has onset of sz disorder w/fever AUG90 p/3rd DTP/OPV/HBOC; recurrent afebrile sz; on 12JUL91 had MMR died of respiratory/cardiac arrest 30JUL cause undetermined;


Changed on 2/14/2018

VAERS ID: 37837 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:California
Vaccinated:1991-07-12
Onset:1991-07-30
Submitted:1991-12-05
Entered:1991-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0862T / 1 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-07-30
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: AUG90 @ 6mos w/DTP #3 pt exp rxn;~ ()~~~In patient
Other Medications: APAP, Phenobarb
Current Illness: NONE
Preexisting Conditions: seizure disorder
Allergies:
Diagnostic Lab Data: Autospy signed out as SIDS;
CDC 'Split Type':

Write-up: Pt has onset of sz disorder w/fever AUG90 p/3rd DTP/OPV/HBOC; recurrent afebrile sz; on 12JUL91 had MMR died of respiratory/cardiac arrest 30JUL cause undetermined;


Changed on 6/14/2018

VAERS ID: 37837 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:California
Vaccinated:1991-07-12
Onset:1991-07-30
Submitted:1991-12-05
Entered:1991-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0862T / 1 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-07-30
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: AUG90 @ 6mos w/DTP #3 pt exp rxn;~ ()~~~In patient
Other Medications: APAP, Phenobarb
Current Illness: NONE
Preexisting Conditions: seizure disorder
Allergies:
Diagnostic Lab Data: Autospy signed out as SIDS;
CDC 'Split Type':

Write-up: Pt has onset of sz disorder w/fever AUG90 p/3rd DTP/OPV/HBOC; recurrent afebrile sz; on 12JUL91 had MMR died of respiratory/cardiac arrest 30JUL cause undetermined;


Changed on 8/14/2018

VAERS ID: 37837 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:California
Vaccinated:1991-07-12
Onset:1991-07-30
Submitted:1991-12-05
Entered:1991-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0862T / 1 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-07-30
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: AUG90 @ 6mos w/DTP #3 pt exp rxn;~ ()~~~In patient
Other Medications: APAP, Phenobarb
Current Illness: NONE
Preexisting Conditions: seizure disorder
Allergies:
Diagnostic Lab Data: Autospy signed out as SIDS;
CDC 'Split Type':

Write-up: Pt has onset of sz disorder w/fever AUG90 p/3rd DTP/OPV/HBOC; recurrent afebrile sz; on 12JUL91 had MMR died of respiratory/cardiac arrest 30JUL cause undetermined;


Changed on 9/14/2018

VAERS ID: 37837 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:California
Vaccinated:1991-07-12
Onset:1991-07-30
Submitted:1991-12-05
Entered:1991-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0862T / 1 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-07-30
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: AUG90 @ 6mos w/DTP #3 pt exp rxn;~ ()~~~In patient
Other Medications: APAP, Phenobarb
Current Illness: NONE
Preexisting Conditions: seizure disorder
Allergies:
Diagnostic Lab Data: Autospy signed out as SIDS;
CDC 'Split Type':

Write-up: Pt has onset of sz disorder w/fever AUG90 p/3rd DTP/OPV/HBOC; recurrent afebrile sz; on 12JUL91 had MMR died of respiratory/cardiac arrest 30JUL cause undetermined;


Changed on 10/14/2018

VAERS ID: 37837 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:California
Vaccinated:1991-07-12
Onset:1991-07-30
Submitted:1991-12-05
Entered:1991-12-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0862T / 1 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-07-30
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: AUG90 @ 6mos w/DTP #3 pt exp rxn;~ ()~~~In patient
Other Medications: APAP, Phenobarb
Current Illness: NONE
Preexisting Conditions: seizure disorder
Allergies:
Diagnostic Lab Data: Autospy signed out as SIDS;
CDC 'Split Type':

Write-up: Pt has onset of sz disorder w/fever AUG90 p/3rd DTP/OPV/HBOC; recurrent afebrile sz; on 12JUL91 had MMR died of respiratory/cardiac arrest 30JUL cause undetermined;

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