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This is VAERS ID 39041

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

VAERS ID: 39041
VAERS Form:
Age:1.3
Sex:Female
Location:Maryland
Vaccinated:1992-01-04
Onset:1992-01-05
Submitted:1992-01-13
Entered:1992-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / WYETH PHARMACEUTICALS, INC M650HD / 3 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1158T / 0 - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-01-05
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: Hemangioma
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': 920007001

Write-up: Pt recvd MMR/HIBTITTER on 4JAN92 & had fever of 101 R x 24 hrs later; died 5JAN92;


Changed on 8/31/2010

VAERS ID: 39041 Before After
VAERS Form:
Age:1.3
Sex:Female
Location:Maryland
Vaccinated:1992-01-04
Onset:1992-01-05
Submitted:1992-01-13
Entered:1992-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH M650HD / 3 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1158T / 0 - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-01-05
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: Hemangioma
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': 920007001

Write-up: Pt recvd MMR/HIBTITTER on 4JAN92 & had fever of 101 R x 24 hrs later; died 5JAN92;


Changed on 9/14/2017

VAERS ID: 39041 Before After
VAERS Form:(blank) 1
Age:1.3
Sex:Female
Location:Maryland
Vaccinated:1992-01-04
Onset:1992-01-05
Submitted:1992-01-13
Entered:1992-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M650HD / 3 4 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1158T / 0 1 - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-01-05
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: Hemangioma
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': 920007001

Write-up: Pt recvd MMR/HIBTITTER on 4JAN92 & had fever of 101 R x 24 hrs later; died 5JAN92;


Changed on 2/14/2018

VAERS ID: 39041 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:Maryland
Vaccinated:1992-01-04
Onset:1992-01-05
Submitted:1992-01-13
Entered:1992-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M650HD / 4 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1158T / 1 - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-01-05
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: Hemangioma
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': 920007001

Write-up: Pt recvd MMR/HIBTITTER on 4JAN92 & had fever of 101 R x 24 hrs later; died 5JAN92;


Changed on 6/14/2018

VAERS ID: 39041 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:Maryland
Vaccinated:1992-01-04
Onset:1992-01-05
Submitted:1992-01-13
Entered:1992-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M650HD / 4 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1158T / 1 - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-01-05
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: Hemangioma
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': 920007001

Write-up: Pt recvd MMR/HIBTITTER on 4JAN92 & had fever of 101 R x 24 hrs later; died 5JAN92;


Changed on 8/14/2018

VAERS ID: 39041 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:Maryland
Vaccinated:1992-01-04
Onset:1992-01-05
Submitted:1992-01-13
Entered:1992-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M650HD / 4 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1158T / 1 - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-01-05
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: Hemangioma
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': 920007001

Write-up: Pt recvd MMR/HIBTITTER on 4JAN92 & had fever of 101 R x 24 hrs later; died 5JAN92;


Changed on 9/14/2018

VAERS ID: 39041 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:Maryland
Vaccinated:1992-01-04
Onset:1992-01-05
Submitted:1992-01-13
Entered:1992-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M650HD / 4 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1158T / 1 - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-01-05
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: Hemangioma
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': 920007001

Write-up: Pt recvd MMR/HIBTITTER on 4JAN92 & had fever of 101 R x 24 hrs later; died 5JAN92;


Changed on 10/14/2018

VAERS ID: 39041 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:Maryland
Vaccinated:1992-01-04
Onset:1992-01-05
Submitted:1992-01-13
Entered:1992-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M650HD / 4 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1158T / 1 - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-01-05
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: Hemangioma
Allergies:
Diagnostic Lab Data: NA
CDC 'Split Type': 920007001

Write-up: Pt recvd MMR/HIBTITTER on 4JAN92 & had fever of 101 R x 24 hrs later; died 5JAN92;

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=39041&WAYBACKHISTORY=ON


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