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This is VAERS ID 56638

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 56638
VAERS Form:
Age:12.4
Sex:Male
Location:Washington
Vaccinated:1993-08-20
Onset:1993-08-21
Submitted:0000-00-00
Entered:1993-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: UNK. HEPATITIS B / UNCLASSIFIED - / 0 - / -
MMR: MMR II / MSD 0425W / 0 - / -

Administered by: Private      Purchased by: Unknown
Symptoms: BRAIN SYND ACUTE, INFECT, ENCEPHALITIS, COMA, EDEMA BRAIN

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-08-23
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: pt exp fever @ 18 mos w/MMR #1 dose;
Other Medications: Depakens, Diamox
Current Illness:
Preexisting Conditions: severe retardation (encephalopathy) w/Lennox-Gastaut sz disorder;
Allergies:
Diagnostic Lab Data: death certificate COD cerebral edema due to or as a consequence of probable infection (encephalitis);
CDC 'Split Type': severe retardation (encephalopathy) w/Lennox-Gastaut sz disorder;

Write-up: deep sleep/unconcious, t102.8, adm to hosp cerebral edema, papilledema/infarctions, brain death/cardio resp failure;


Changed on 12/8/2009

VAERS ID: 56638 Before After
VAERS Form:
Age:12.4
Sex:Male
Location:Washington
Vaccinated:1993-08-20
Onset:1993-08-21
Submitted:0000-00-00
Entered:1993-10-22 1993-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: UNK. HEPATITIS B HEP B (NO BRAND NAME) / UNCLASSIFIED UNKNOWN MANUFACTURER - / 0 - / -
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 0425W / 0 - / -

Administered by: Private      Purchased by: Unknown Other
Symptoms: Coma, Condition aggravated, Delirium, Encephalitis, Infection, Intracranial pressure increased, Stupor, Brain oedema, BRAIN SYND ACUTE, INFECT, ENCEPHALITIS, COMA, EDEMA BRAIN

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-08-23
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: pt exp fever @ 18 mos w/MMR #1 dose;
Other Medications: Depakens, Diamox
Current Illness:
Preexisting Conditions: severe retardation (encephalopathy) w/Lennox-Gastaut sz disorder;
Allergies:
Diagnostic Lab Data: death certificate COD cerebral edema due to or as a consequence of probable infection (encephalitis);
CDC 'Split Type': severe retardation (encephalopathy) w/Lennox-Gastaut sz disorder; (blank)

Write-up: deep sleep/unconcious, t102.8, adm to hosp cerebral edema, papilledema/infarctions, brain death/cardio resp failure;


Changed on 2/14/2017

VAERS ID: 56638 Before After
VAERS Form:
Age:12.4 12.0
Sex:Male
Location:Washington
Vaccinated:1993-08-20
Onset:1993-08-21
Submitted:0000-00-00
Entered:1993-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0425W / 0 - / -

Administered by: Private      Purchased by: Other
Symptoms: Coma, Condition aggravated, Delirium, Encephalitis, Infection, Intracranial pressure increased, Stupor, Brain oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-08-23
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: pt exp fever @ 18 mos w/MMR #1 dose;
Other Medications: Depakens, Diamox
Current Illness:
Preexisting Conditions: severe retardation (encephalopathy) w/Lennox-Gastaut sz disorder;
Allergies:
Diagnostic Lab Data: death certificate COD cerebral edema due to or as a consequence of probable infection (encephalitis);
CDC 'Split Type':

Write-up: deep sleep/unconcious, t102.8, adm to hosp cerebral edema, papilledema/infarctions, brain death/cardio resp failure;


Changed on 5/14/2017

VAERS ID: 56638 Before After
VAERS Form:
Age:12.0
Sex:Male
Location:Washington
Vaccinated:1993-08-20
Onset:1993-08-21
Submitted:0000-00-00
Entered:1993-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0425W / 0 - / -

Administered by: Private      Purchased by: Other
Symptoms: Coma, Condition aggravated, Delirium, Encephalitis, Infection, Intracranial pressure increased, Stupor, Brain oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-08-23
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: pt exp fever @ 18 mos w/MMR #1 dose; dose;~ ()~~~In patient
Other Medications: Depakens, Diamox
Current Illness:
Preexisting Conditions: severe retardation (encephalopathy) w/Lennox-Gastaut sz disorder;
Allergies:
Diagnostic Lab Data: death certificate COD cerebral edema due to or as a consequence of probable infection (encephalitis);
CDC 'Split Type':

Write-up: deep sleep/unconcious, t102.8, adm to hosp cerebral edema, papilledema/infarctions, brain death/cardio resp failure;


Changed on 9/14/2017

VAERS ID: 56638 Before After
VAERS Form:(blank) 1
Age:12.0
Sex:Male
Location:Washington
Vaccinated:1993-08-20
Onset:1993-08-21
Submitted:0000-00-00
Entered:1993-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 1 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0425W / 0 1 - / -

Administered by: Private      Purchased by: Other
Symptoms: Coma, Condition aggravated, Delirium, Encephalitis, Infection, Intracranial pressure increased, Stupor, Brain oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-08-23
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: pt exp fever @ 18 mos w/MMR #1 dose;~ ()~~~In patient
Other Medications: Depakens, Diamox
Current Illness:
Preexisting Conditions: severe retardation (encephalopathy) w/Lennox-Gastaut sz disorder;
Allergies:
Diagnostic Lab Data: death certificate COD cerebral edema due to or as a consequence of probable infection (encephalitis);
CDC 'Split Type':

Write-up: deep sleep/unconcious, t102.8, adm to hosp cerebral edema, papilledema/infarctions, brain death/cardio resp failure;


Changed on 2/14/2018

VAERS ID: 56638 Before After
VAERS Form:1
Age:12.0
Sex:Male
Location:Washington
Vaccinated:1993-08-20
Onset:1993-08-21
Submitted:0000-00-00
Entered:1993-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0425W / 1 - / -

Administered by: Private      Purchased by: Other
Symptoms: Coma, Condition aggravated, Delirium, Encephalitis, Infection, Intracranial pressure increased, Stupor, Brain oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-08-23
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: pt exp fever @ 18 mos w/MMR #1 dose;~ ()~~~In patient
Other Medications: Depakens, Diamox
Current Illness:
Preexisting Conditions: severe retardation (encephalopathy) w/Lennox-Gastaut sz disorder;
Allergies:
Diagnostic Lab Data: death certificate COD cerebral edema due to or as a consequence of probable infection (encephalitis);
CDC 'Split Type':

Write-up: deep sleep/unconcious, t102.8, adm to hosp cerebral edema, papilledema/infarctions, brain death/cardio resp failure;


Changed on 6/14/2018

VAERS ID: 56638 Before After
VAERS Form:1
Age:12.0
Sex:Male
Location:Washington
Vaccinated:1993-08-20
Onset:1993-08-21
Submitted:0000-00-00
Entered:1993-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0425W / 1 - / -

Administered by: Private      Purchased by: Other
Symptoms: Coma, Condition aggravated, Delirium, Encephalitis, Infection, Intracranial pressure increased, Stupor, Brain oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-08-23
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: pt exp fever @ 18 mos w/MMR #1 dose;~ ()~~~In patient
Other Medications: Depakens, Diamox
Current Illness:
Preexisting Conditions: severe retardation (encephalopathy) w/Lennox-Gastaut sz disorder;
Allergies:
Diagnostic Lab Data: death certificate COD cerebral edema due to or as a consequence of probable infection (encephalitis);
CDC 'Split Type':

Write-up: deep sleep/unconcious, t102.8, adm to hosp cerebral edema, papilledema/infarctions, brain death/cardio resp failure;


Changed on 8/14/2018

VAERS ID: 56638 Before After
VAERS Form:1
Age:12.0
Sex:Male
Location:Washington
Vaccinated:1993-08-20
Onset:1993-08-21
Submitted:0000-00-00
Entered:1993-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0425W / 1 - / -

Administered by: Private      Purchased by: Other
Symptoms: Coma, Condition aggravated, Delirium, Encephalitis, Infection, Intracranial pressure increased, Stupor, Brain oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-08-23
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: pt exp fever @ 18 mos w/MMR #1 dose;~ ()~~~In patient
Other Medications: Depakens, Diamox
Current Illness:
Preexisting Conditions: severe retardation (encephalopathy) w/Lennox-Gastaut sz disorder;
Allergies:
Diagnostic Lab Data: death certificate COD cerebral edema due to or as a consequence of probable infection (encephalitis);
CDC 'Split Type':

Write-up: deep sleep/unconcious, t102.8, adm to hosp cerebral edema, papilledema/infarctions, brain death/cardio resp failure;


Changed on 9/14/2018

VAERS ID: 56638 Before After
VAERS Form:1
Age:12.0
Sex:Male
Location:Washington
Vaccinated:1993-08-20
Onset:1993-08-21
Submitted:0000-00-00
Entered:1993-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0425W / 1 - / -

Administered by: Private      Purchased by: Other
Symptoms: Coma, Condition aggravated, Delirium, Encephalitis, Infection, Intracranial pressure increased, Stupor, Brain oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-08-23
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: pt exp fever @ 18 mos w/MMR #1 dose;~ ()~~~In patient
Other Medications: Depakens, Diamox
Current Illness:
Preexisting Conditions: severe retardation (encephalopathy) w/Lennox-Gastaut sz disorder;
Allergies:
Diagnostic Lab Data: death certificate COD cerebral edema due to or as a consequence of probable infection (encephalitis);
CDC 'Split Type':

Write-up: deep sleep/unconcious, t102.8, adm to hosp cerebral edema, papilledema/infarctions, brain death/cardio resp failure;


Changed on 10/14/2018

VAERS ID: 56638 Before After
VAERS Form:1
Age:12.0
Sex:Male
Location:Washington
Vaccinated:1993-08-20
Onset:1993-08-21
Submitted:0000-00-00
Entered:1993-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0425W / 1 - / -

Administered by: Private      Purchased by: Other
Symptoms: Coma, Condition aggravated, Delirium, Encephalitis, Infection, Intracranial pressure increased, Stupor, Brain oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-08-23
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: pt exp fever @ 18 mos w/MMR #1 dose;~ ()~~~In patient
Other Medications: Depakens, Diamox
Current Illness:
Preexisting Conditions: severe retardation (encephalopathy) w/Lennox-Gastaut sz disorder;
Allergies:
Diagnostic Lab Data: death certificate COD cerebral edema due to or as a consequence of probable infection (encephalitis);
CDC 'Split Type':

Write-up: deep sleep/unconcious, t102.8, adm to hosp cerebral edema, papilledema/infarctions, brain death/cardio resp failure;

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