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This is VAERS ID 39360

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

VAERS ID: 39360
VAERS Form:
Age:1.5
Sex:Unknown
Location:Foreign
Vaccinated:1990-01-31
Onset:1990-01-31
Submitted:0000-00-00
Entered:1992-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / - - / IM
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-01-31
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: No relevant hx
Allergies:
Diagnostic Lab Data: Autopsy performed-results not yet available;
CDC 'Split Type': WAES90021194

Write-up: Pt recvd MMR/DT/Polio vax 31JAN90 @ 10AM; @ noon pt ate lunch & was sent to bed; @ 3PM pt was found dead; autopsy was performed; MD felt uncertain regarding the causality of vax;


Changed on 5/14/2017

VAERS ID: 39360 Before After
VAERS Form:
Age:1.5
Sex:Unknown
Location:Foreign
Vaccinated:1990-01-31
Onset:1990-01-31
Submitted:0000-00-00
Entered:1992-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / - - / IM
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-01-31
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: ~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions: No relevant hx
Allergies:
Diagnostic Lab Data: Autopsy performed-results not yet available;
CDC 'Split Type': WAES90021194

Write-up: Pt recvd MMR/DT/Polio vax 31JAN90 @ 10AM; @ noon pt ate lunch & was sent to bed; @ 3PM pt was found dead; autopsy was performed; MD felt uncertain regarding the causality of vax;


Changed on 9/14/2017

VAERS ID: 39360 Before After
VAERS Form:(blank) 1
Age:1.5
Sex:Unknown
Location:Foreign
Vaccinated:1990-01-31
Onset:1990-01-31
Submitted:0000-00-00
Entered:1992-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / - UNK - / IM
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-01-31
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: ~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions: No relevant hx
Allergies:
Diagnostic Lab Data: Autopsy performed-results not yet available;
CDC 'Split Type': WAES90021194

Write-up: Pt recvd MMR/DT/Polio vax 31JAN90 @ 10AM; @ noon pt ate lunch & was sent to bed; @ 3PM pt was found dead; autopsy was performed; MD felt uncertain regarding the causality of vax;


Changed on 2/14/2018

VAERS ID: 39360 Before After
VAERS Form:1
Age:1.5
Sex:Unknown
Location:Foreign
Vaccinated:1990-01-31
Onset:1990-01-31
Submitted:0000-00-00
Entered:1992-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / IM
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-01-31
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: ~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions: No relevant hx
Allergies:
Diagnostic Lab Data: Autopsy performed-results not yet available;
CDC 'Split Type': WAES90021194

Write-up: Pt recvd MMR/DT/Polio vax 31JAN90 @ 10AM; @ noon pt ate lunch & was sent to bed; @ 3PM pt was found dead; autopsy was performed; MD felt uncertain regarding the causality of vax;


Changed on 6/14/2018

VAERS ID: 39360 Before After
VAERS Form:1
Age:1.5
Sex:Unknown
Location:Foreign
Vaccinated:1990-01-31
Onset:1990-01-31
Submitted:0000-00-00
Entered:1992-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / IM
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-01-31
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: ~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions: No relevant hx
Allergies:
Diagnostic Lab Data: Autopsy performed-results not yet available;
CDC 'Split Type': WAES90021194

Write-up: Pt recvd MMR/DT/Polio vax 31JAN90 @ 10AM; @ noon pt ate lunch & was sent to bed; @ 3PM pt was found dead; autopsy was performed; MD felt uncertain regarding the causality of vax;


Changed on 8/14/2018

VAERS ID: 39360 Before After
VAERS Form:1
Age:1.5
Sex:Unknown
Location:Foreign
Vaccinated:1990-01-31
Onset:1990-01-31
Submitted:0000-00-00
Entered:1992-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / IM
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-01-31
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: ~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions: No relevant hx
Allergies:
Diagnostic Lab Data: Autopsy performed-results not yet available;
CDC 'Split Type': WAES90021194

Write-up: Pt recvd MMR/DT/Polio vax 31JAN90 @ 10AM; @ noon pt ate lunch & was sent to bed; @ 3PM pt was found dead; autopsy was performed; MD felt uncertain regarding the causality of vax;


Changed on 9/14/2018

VAERS ID: 39360 Before After
VAERS Form:1
Age:1.5
Sex:Unknown
Location:Foreign
Vaccinated:1990-01-31
Onset:1990-01-31
Submitted:0000-00-00
Entered:1992-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / IM
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-01-31
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: ~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions: No relevant hx
Allergies:
Diagnostic Lab Data: Autopsy performed-results not yet available;
CDC 'Split Type': WAES90021194

Write-up: Pt recvd MMR/DT/Polio vax 31JAN90 @ 10AM; @ noon pt ate lunch & was sent to bed; @ 3PM pt was found dead; autopsy was performed; MD felt uncertain regarding the causality of vax;


Changed on 10/14/2018

VAERS ID: 39360 Before After
VAERS Form:1
Age:1.5
Sex:Unknown
Location:Foreign
Vaccinated:1990-01-31
Onset:1990-01-31
Submitted:0000-00-00
Entered:1992-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / IM
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1990-01-31
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: ~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions: No relevant hx
Allergies:
Diagnostic Lab Data: Autopsy performed-results not yet available;
CDC 'Split Type': WAES90021194

Write-up: Pt recvd MMR/DT/Polio vax 31JAN90 @ 10AM; @ noon pt ate lunch & was sent to bed; @ 3PM pt was found dead; autopsy was performed; MD felt uncertain regarding the causality of vax;

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=39360&WAYBACKHISTORY=ON


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