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This is VAERS ID 43261

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 43261
VAERS Form:
Age:1.5
Sex:Female
Location:Arizona
Vaccinated:1991-08-28
Onset:1991-09-06
Submitted:1992-06-04
Entered:1992-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: UNK. DTP / UNCLASSIFIED - / - - / -
MMR: UNK. MEASLES, MUMPS & RUBELLA VIRUS LIVE / UNCLASSIFIED - / - - / -
OPV: UNK. POLIOVIRUS LIVE ORAL TRIVALENT / UNCLASSIFIED - / - - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy-had to wait 8 wks for report;
CDC 'Split Type': NONE

Write-up:


Changed on 12/8/2009

VAERS ID: 43261 Before After
VAERS Form:
Age:1.5
Sex:Female
Location:Arizona
Vaccinated:1991-08-28
Onset:1991-09-06
Submitted:1992-06-04
Entered:1992-07-02 1992-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: UNK. DTP DTP (NO BRAND NAME) / UNCLASSIFIED UNKNOWN MANUFACTURER - / - - / -
MMR: UNK. MEASLES, MUMPS & RUBELLA VIRUS LIVE MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNCLASSIFIED UNKNOWN MANUFACTURER - / - - / -
OPV: UNK. POLIOVIRUS LIVE ORAL TRIVALENT POLIO VIRUS, ORAL (NO BRAND NAME) / UNCLASSIFIED UNKNOWN MANUFACTURER - / - - / -

Administered by: Private      Purchased by: Unknown Private
Symptoms: Unevaluable event, REACT UNEVAL

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy-had to wait 8 wks for report;
CDC 'Split Type': NONE (blank)

Write-up:


Changed on 5/14/2017

VAERS ID: 43261 Before After
VAERS Form:
Age:1.5
Sex:Female
Location:Arizona
Vaccinated:1991-08-28
Onset:1991-09-06
Submitted:1992-06-04
Entered:1992-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Private      Purchased by: Private
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy-had to wait 8 wks for report;
CDC 'Split Type':

Write-up:


Changed on 9/14/2017

VAERS ID: 43261 Before After
VAERS Form:(blank) 1
Age:1.5
Sex:Female
Location:Arizona
Vaccinated:1991-08-28
Onset:1991-09-06
Submitted:1992-06-04
Entered:1992-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy-had to wait 8 wks for report;
CDC 'Split Type':

Write-up:


Changed on 2/14/2018

VAERS ID: 43261 Before After
VAERS Form:1
Age:1.5
Sex:Female
Location:Arizona
Vaccinated:1991-08-28
Onset:1991-09-06
Submitted:1992-06-04
Entered:1992-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy-had to wait 8 wks for report;
CDC 'Split Type':

Write-up:


Changed on 6/14/2018

VAERS ID: 43261 Before After
VAERS Form:1
Age:1.5
Sex:Female
Location:Arizona
Vaccinated:1991-08-28
Onset:1991-09-06
Submitted:1992-06-04
Entered:1992-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy-had to wait 8 wks for report;
CDC 'Split Type':

Write-up:


Changed on 8/14/2018

VAERS ID: 43261 Before After
VAERS Form:1
Age:1.5
Sex:Female
Location:Arizona
Vaccinated:1991-08-28
Onset:1991-09-06
Submitted:1992-06-04
Entered:1992-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy-had to wait 8 wks for report;
CDC 'Split Type':

Write-up:


Changed on 9/14/2018

VAERS ID: 43261 Before After
VAERS Form:1
Age:1.5
Sex:Female
Location:Arizona
Vaccinated:1991-08-28
Onset:1991-09-06
Submitted:1992-06-04
Entered:1992-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy-had to wait 8 wks for report;
CDC 'Split Type':

Write-up:


Changed on 10/14/2018

VAERS ID: 43261 Before After
VAERS Form:1
Age:1.5
Sex:Female
Location:Arizona
Vaccinated:1991-08-28
Onset:1991-09-06
Submitted:1992-06-04
Entered:1992-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy-had to wait 8 wks for report;
CDC 'Split Type':

Write-up:

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=43261&WAYBACKHISTORY=ON


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