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This is VAERS ID 61523

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

VAERS ID: 61523
VAERS Form:
Age:9.4
Sex:Female
Location:Foreign
Vaccinated:1993-08-24
Onset:1993-08-25
Submitted:0000-00-00
Entered:1994-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 - / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / - - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / - - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 - / -

Administered by: Unknown      Purchased by: Unknown
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:
Other Medications: Lioresal, Lamictal, Trileptal;
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 940021301

Write-up: 25AUG93 1 day p/vax pt exp sudden death; The reporter stated that event was possibly related to the vax; No further will be available;


Changed on 2/14/2017

VAERS ID: 61523 Before After
VAERS Form:
Age:9.4 9.0
Sex:Female
Location:Foreign
Vaccinated:1993-08-24
Onset:1993-08-25
Submitted:0000-00-00
Entered:1994-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 - / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / - - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / - - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 - / -

Administered by: Unknown      Purchased by: Unknown
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:
Other Medications: Lioresal, Lamictal, Trileptal;
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 940021301

Write-up: 25AUG93 1 day p/vax pt exp sudden death; The reporter stated that event was possibly related to the vax; No further will be available;


Changed on 5/14/2017

VAERS ID: 61523 Before After
VAERS Form:
Age:9.0
Sex:Female
Location:Foreign
Vaccinated:1993-08-24
Onset:1993-08-25
Submitted:0000-00-00
Entered:1994-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 - / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / - - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / - - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 - / -

Administered by: Unknown      Purchased by: Unknown
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: ~ ()~~~In patient
Other Medications: Lioresal, Lamictal, Trileptal;
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 940021301

Write-up: 25AUG93 1 day p/vax pt exp sudden death; The reporter stated that event was possibly related to the vax; No further will be available;


Changed on 9/14/2017

VAERS ID: 61523 Before After
VAERS Form:(blank) 1
Age:9.0
Sex:Female
Location:Foreign
Vaccinated:1993-08-24
Onset:1993-08-25
Submitted:0000-00-00
Entered:1994-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 3 - / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / - UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / - UNK - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 3 - / -

Administered by: Unknown      Purchased by: Unknown
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: ~ ()~~~In patient
Other Medications: Lioresal, Lamictal, Trileptal;
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 940021301

Write-up: 25AUG93 1 day p/vax pt exp sudden death; The reporter stated that event was possibly related to the vax; No further will be available;


Changed on 2/14/2018

VAERS ID: 61523 Before After
VAERS Form:1
Age:9.0
Sex:Female
Location:Foreign
Vaccinated:1993-08-24
Onset:1993-08-25
Submitted:0000-00-00
Entered:1994-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 3 - / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 3 - / -

Administered by: Unknown      Purchased by: Unknown
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: ~ ()~~~In patient
Other Medications: Lioresal, Lamictal, Trileptal;
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 940021301

Write-up: 25AUG93 1 day p/vax pt exp sudden death; The reporter stated that event was possibly related to the vax; No further will be available;


Changed on 6/14/2018

VAERS ID: 61523 Before After
VAERS Form:1
Age:9.0
Sex:Female
Location:Foreign
Vaccinated:1993-08-24
Onset:1993-08-25
Submitted:0000-00-00
Entered:1994-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 3 - / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 3 - / -

Administered by: Unknown      Purchased by: Unknown
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: ~ ()~~~In patient
Other Medications: Lioresal, Lamictal, Trileptal;
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 940021301

Write-up: 25AUG93 1 day p/vax pt exp sudden death; The reporter stated that event was possibly related to the vax; No further will be available;


Changed on 8/14/2018

VAERS ID: 61523 Before After
VAERS Form:1
Age:9.0
Sex:Female
Location:Foreign
Vaccinated:1993-08-24
Onset:1993-08-25
Submitted:0000-00-00
Entered:1994-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 3 - / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 3 - / -

Administered by: Unknown      Purchased by: Unknown
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: ~ ()~~~In patient
Other Medications: Lioresal, Lamictal, Trileptal;
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 940021301

Write-up: 25AUG93 1 day p/vax pt exp sudden death; The reporter stated that event was possibly related to the vax; No further will be available;


Changed on 9/14/2018

VAERS ID: 61523 Before After
VAERS Form:1
Age:9.0
Sex:Female
Location:Foreign
Vaccinated:1993-08-24
Onset:1993-08-25
Submitted:0000-00-00
Entered:1994-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 3 - / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 3 - / -

Administered by: Unknown      Purchased by: Unknown
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: ~ ()~~~In patient
Other Medications: Lioresal, Lamictal, Trileptal;
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 940021301

Write-up: 25AUG93 1 day p/vax pt exp sudden death; The reporter stated that event was possibly related to the vax; No further will be available;


Changed on 10/14/2018

VAERS ID: 61523 Before After
VAERS Form:1
Age:9.0
Sex:Female
Location:Foreign
Vaccinated:1993-08-24
Onset:1993-08-25
Submitted:0000-00-00
Entered:1994-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 3 - / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 3 - / -

Administered by: Unknown      Purchased by: Unknown
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: ~ ()~~~In patient
Other Medications: Lioresal, Lamictal, Trileptal;
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 940021301

Write-up: 25AUG93 1 day p/vax pt exp sudden death; The reporter stated that event was possibly related to the vax; No further will be available;

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=61523&WAYBACKHISTORY=ON


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