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This is VAERS ID 54070

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 54070
VAERS Form:
Age:17.2
Sex:Male
Location:Wisconsin
Vaccinated:1992-10-15
Onset:0000-00-00
Submitted:1993-01-28
Entered:1993-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MMR II / MSD 0433V / - - / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-11-03
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: death being investigated by ME:
CDC 'Split Type':

Write-up: pt was found dead in bed; no other sx were noted;


Changed on 12/8/2009

VAERS ID: 54070 Before After
VAERS Form:
Age:17.2
Sex:Male
Location:Wisconsin
Vaccinated:1992-10-15
Onset:0000-00-00
Submitted:1993-01-28
Entered:1993-06-23 1993-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 0433V / - - / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-11-03
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: death being investigated by ME:
CDC 'Split Type': (blank) WI93038

Write-up: pt was found dead in bed; no other sx were noted;


Changed on 2/14/2017

VAERS ID: 54070 Before After
VAERS Form:
Age:17.2 17.0
Sex:Male
Location:Wisconsin
Vaccinated:1992-10-15
Onset:0000-00-00
Submitted:1993-01-28
Entered:1993-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0433V / - - / SC

Administered by: Public      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-11-03
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: death being investigated by ME:
CDC 'Split Type': WI93038

Write-up: pt was found dead in bed; no other sx were noted;


Changed on 5/14/2017

VAERS ID: 54070 Before After
VAERS Form:
Age:17.0
Sex:Male
Location:Wisconsin
Vaccinated:1992-10-15
Onset:0000-00-00
Submitted:1993-01-28
Entered:1993-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0433V / - - / SC

Administered by: Public      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-11-03
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: death being investigated by ME:
CDC 'Split Type': WI93038

Write-up: pt was found dead in bed; no other sx were noted;


Changed on 9/14/2017

VAERS ID: 54070 Before After
VAERS Form:(blank) 1
Age:17.0
Sex:Male
Location:Wisconsin
Vaccinated:1992-10-15
Onset:0000-00-00
Submitted:1993-01-28
Entered:1993-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0433V / - UNK - / SC

Administered by: Public      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-11-03
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: death being investigated by ME:
CDC 'Split Type': WI93038

Write-up: pt was found dead in bed; no other sx were noted;


Changed on 2/14/2018

VAERS ID: 54070 Before After
VAERS Form:1
Age:17.0
Sex:Male
Location:Wisconsin
Vaccinated:1992-10-15
Onset:0000-00-00
Submitted:1993-01-28
Entered:1993-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0433V / UNK - / SC

Administered by: Public      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-11-03
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: death being investigated by ME:
CDC 'Split Type': WI93038

Write-up: pt was found dead in bed; no other sx were noted;


Changed on 6/14/2018

VAERS ID: 54070 Before After
VAERS Form:1
Age:17.0
Sex:Male
Location:Wisconsin
Vaccinated:1992-10-15
Onset:0000-00-00
Submitted:1993-01-28
Entered:1993-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0433V / UNK - / SC

Administered by: Public      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-11-03
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: death being investigated by ME:
CDC 'Split Type': WI93038

Write-up: pt was found dead in bed; no other sx were noted;


Changed on 8/14/2018

VAERS ID: 54070 Before After
VAERS Form:1
Age:17.0
Sex:Male
Location:Wisconsin
Vaccinated:1992-10-15
Onset:0000-00-00
Submitted:1993-01-28
Entered:1993-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0433V / UNK - / SC

Administered by: Public      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-11-03
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: death being investigated by ME:
CDC 'Split Type': WI93038

Write-up: pt was found dead in bed; no other sx were noted;


Changed on 9/14/2018

VAERS ID: 54070 Before After
VAERS Form:1
Age:17.0
Sex:Male
Location:Wisconsin
Vaccinated:1992-10-15
Onset:0000-00-00
Submitted:1993-01-28
Entered:1993-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0433V / UNK - / SC

Administered by: Public      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-11-03
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: death being investigated by ME:
CDC 'Split Type': WI93038

Write-up: pt was found dead in bed; no other sx were noted;


Changed on 10/14/2018

VAERS ID: 54070 Before After
VAERS Form:1
Age:17.0
Sex:Male
Location:Wisconsin
Vaccinated:1992-10-15
Onset:0000-00-00
Submitted:1993-01-28
Entered:1993-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0433V / UNK - / SC

Administered by: Public      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1992-11-03
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: death being investigated by ME:
CDC 'Split Type': WI93038

Write-up: pt was found dead in bed; no other sx were noted;

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