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This is VAERS ID 42039

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 42039
VAERS Form:
Age:1.7
Sex:Female
Location:Texas
Vaccinated:1992-02-25
Onset:1992-03-07
Submitted:1992-05-11
Entered:1992-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIBTITER / LEDERLE(PRAXIS) M570HJ / - RL / IM
MMR: MMR II / MSD 1636T / - LL / SC

Administered by: Public      Purchased by: Unknown
Symptoms: SIDS, ARRHYTHMIA, FIBRO MYOCARD, HYPERTROPHY

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-03-07
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: NONE
Other Medications:
Current Illness: NONE
Preexisting Conditions: hx of apical muscular ventricular septal defect
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': hx of apical muscular ventricular septal defect

Write-up: Sudden death w/no etiology @ autopsy; unclear as to whether it is related to vax;


Changed on 12/8/2009

VAERS ID: 42039 Before After
VAERS Form:
Age:1.7
Sex:Female
Location:Texas
Vaccinated:1992-02-25
Onset:1992-03-07
Submitted:1992-05-11
Entered:1992-05-20 1992-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M570HJ / - RL / IM
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 1636T / - LL / SC

Administered by: Public      Purchased by: Unknown Public
Symptoms: Arrhythmia, Hypertrophy, Myocardial fibrosis, SIDS, Sudden infant death syndrome, ARRHYTHMIA, FIBRO MYOCARD, HYPERTROPHY

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-03-07
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: NONE
Other Medications:
Current Illness: NONE
Preexisting Conditions: hx of apical muscular ventricular septal defect
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': hx of apical muscular ventricular septal defect TX92110

Write-up: Sudden death w/no etiology @ autopsy; unclear as to whether it is related to vax;


Changed on 5/14/2017

VAERS ID: 42039 Before After
VAERS Form:
Age:1.7
Sex:Female
Location:Texas
Vaccinated:1992-02-25
Onset:1992-03-07
Submitted:1992-05-11
Entered:1992-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M570HJ / - RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1636T / - LL / SC

Administered by: Public      Purchased by: Public
Symptoms: Arrhythmia, Hypertrophy, Myocardial fibrosis, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-03-07
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: NONE NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: hx of apical muscular ventricular septal defect
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': TX92110

Write-up: Sudden death w/no etiology @ autopsy; unclear as to whether it is related to vax;


Changed on 9/14/2017

VAERS ID: 42039 Before After
VAERS Form:(blank) 1
Age:1.7
Sex:Female
Location:Texas
Vaccinated:1992-02-25
Onset:1992-03-07
Submitted:1992-05-11
Entered:1992-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M570HJ / - UNK RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1636T / - UNK LL / SC

Administered by: Public      Purchased by: Public
Symptoms: Arrhythmia, Hypertrophy, Myocardial fibrosis, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-03-07
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: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: hx of apical muscular ventricular septal defect
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': TX92110

Write-up: Sudden death w/no etiology @ autopsy; unclear as to whether it is related to vax;


Changed on 2/14/2018

VAERS ID: 42039 Before After
VAERS Form:1
Age:1.7
Sex:Female
Location:Texas
Vaccinated:1992-02-25
Onset:1992-03-07
Submitted:1992-05-11
Entered:1992-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M570HJ / UNK RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1636T / UNK LL / SC

Administered by: Public      Purchased by: Public
Symptoms: Arrhythmia, Hypertrophy, Myocardial fibrosis, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-03-07
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: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: hx of apical muscular ventricular septal defect
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': TX92110

Write-up: Sudden death w/no etiology @ autopsy; unclear as to whether it is related to vax;


Changed on 6/14/2018

VAERS ID: 42039 Before After
VAERS Form:1
Age:1.7
Sex:Female
Location:Texas
Vaccinated:1992-02-25
Onset:1992-03-07
Submitted:1992-05-11
Entered:1992-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M570HJ / UNK RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1636T / UNK LL / SC

Administered by: Public      Purchased by: Public
Symptoms: Arrhythmia, Hypertrophy, Myocardial fibrosis, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-03-07
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: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: hx of apical muscular ventricular septal defect
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': TX92110

Write-up: Sudden death w/no etiology @ autopsy; unclear as to whether it is related to vax;


Changed on 8/14/2018

VAERS ID: 42039 Before After
VAERS Form:1
Age:1.7
Sex:Female
Location:Texas
Vaccinated:1992-02-25
Onset:1992-03-07
Submitted:1992-05-11
Entered:1992-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M570HJ / UNK RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1636T / UNK LL / SC

Administered by: Public      Purchased by: Public
Symptoms: Arrhythmia, Hypertrophy, Myocardial fibrosis, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-03-07
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: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: hx of apical muscular ventricular septal defect
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': TX92110

Write-up: Sudden death w/no etiology @ autopsy; unclear as to whether it is related to vax;


Changed on 9/14/2018

VAERS ID: 42039 Before After
VAERS Form:1
Age:1.7
Sex:Female
Location:Texas
Vaccinated:1992-02-25
Onset:1992-03-07
Submitted:1992-05-11
Entered:1992-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M570HJ / UNK RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1636T / UNK LL / SC

Administered by: Public      Purchased by: Public
Symptoms: Arrhythmia, Hypertrophy, Myocardial fibrosis, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-03-07
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: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: hx of apical muscular ventricular septal defect
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': TX92110

Write-up: Sudden death w/no etiology @ autopsy; unclear as to whether it is related to vax;


Changed on 10/14/2018

VAERS ID: 42039 Before After
VAERS Form:1
Age:1.7
Sex:Female
Location:Texas
Vaccinated:1992-02-25
Onset:1992-03-07
Submitted:1992-05-11
Entered:1992-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M570HJ / UNK RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1636T / UNK LL / SC

Administered by: Public      Purchased by: Public
Symptoms: Arrhythmia, Hypertrophy, Myocardial fibrosis, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-03-07
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: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: hx of apical muscular ventricular septal defect
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': TX92110

Write-up: Sudden death w/no etiology @ autopsy; unclear as to whether it is related to vax;

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