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This is VAERS ID 64421

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

VAERS ID: 64421
VAERS Form:
Age:1.9
Sex:Male
Location:Foreign
Vaccinated:1994-06-06
Onset:1994-06-09
Submitted:1994-06-27
Entered:1994-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / - - / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Myocarditis, Pharyngitis, Rhinitis

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1994-06-10
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: 10JUN94: Lumbar puncture nl, blood cx nl;
CDC 'Split Type': WAES94067509

Write-up: 09JUN94 pt expd rhino-pharyngitis & was rx''d w/sulphamethoxazole trimethoprim & cetrizine; 10JUN94 pt died; 11JUN94 an autopsy was performed & fulminant myocarditis was found;


Changed on 5/14/2017

VAERS ID: 64421 Before After
VAERS Form:
Age:1.9
Sex:Male
Location:Foreign
Vaccinated:1994-06-06
Onset:1994-06-09
Submitted:1994-06-27
Entered:1994-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / - - / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Myocarditis, Pharyngitis, Rhinitis

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1994-06-10
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: 10JUN94: Lumbar puncture nl, blood cx nl;
CDC 'Split Type': WAES94067509

Write-up: 09JUN94 pt expd rhino-pharyngitis & was rx''d w/sulphamethoxazole trimethoprim & cetrizine; 10JUN94 pt died; 11JUN94 an autopsy was performed & fulminant myocarditis was found;


Changed on 9/14/2017

VAERS ID: 64421 Before After
VAERS Form:(blank) 1
Age:1.9
Sex:Male
Location:Foreign
Vaccinated:1994-06-06
Onset:1994-06-09
Submitted:1994-06-27
Entered:1994-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / - UNK - / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Myocarditis, Pharyngitis, Rhinitis

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1994-06-10
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: 10JUN94: Lumbar puncture nl, blood cx nl;
CDC 'Split Type': WAES94067509

Write-up: 09JUN94 pt expd rhino-pharyngitis & was rx''d w/sulphamethoxazole trimethoprim & cetrizine; 10JUN94 pt died; 11JUN94 an autopsy was performed & fulminant myocarditis was found;


Changed on 2/14/2018

VAERS ID: 64421 Before After
VAERS Form:1
Age:1.9
Sex:Male
Location:Foreign
Vaccinated:1994-06-06
Onset:1994-06-09
Submitted:1994-06-27
Entered:1994-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Myocarditis, Pharyngitis, Rhinitis

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1994-06-10
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: 10JUN94: Lumbar puncture nl, blood cx nl;
CDC 'Split Type': WAES94067509

Write-up: 09JUN94 pt expd rhino-pharyngitis & was rx''d w/sulphamethoxazole trimethoprim & cetrizine; 10JUN94 pt died; 11JUN94 an autopsy was performed & fulminant myocarditis was found;


Changed on 6/14/2018

VAERS ID: 64421 Before After
VAERS Form:1
Age:1.9
Sex:Male
Location:Foreign
Vaccinated:1994-06-06
Onset:1994-06-09
Submitted:1994-06-27
Entered:1994-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Myocarditis, Pharyngitis, Rhinitis

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1994-06-10
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: 10JUN94: Lumbar puncture nl, blood cx nl;
CDC 'Split Type': WAES94067509

Write-up: 09JUN94 pt expd rhino-pharyngitis & was rx''d w/sulphamethoxazole trimethoprim & cetrizine; 10JUN94 pt died; 11JUN94 an autopsy was performed & fulminant myocarditis was found;


Changed on 8/14/2018

VAERS ID: 64421 Before After
VAERS Form:1
Age:1.9
Sex:Male
Location:Foreign
Vaccinated:1994-06-06
Onset:1994-06-09
Submitted:1994-06-27
Entered:1994-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Myocarditis, Pharyngitis, Rhinitis

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1994-06-10
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: 10JUN94: Lumbar puncture nl, blood cx nl;
CDC 'Split Type': WAES94067509

Write-up: 09JUN94 pt expd rhino-pharyngitis & was rx''d w/sulphamethoxazole trimethoprim & cetrizine; 10JUN94 pt died; 11JUN94 an autopsy was performed & fulminant myocarditis was found;


Changed on 9/14/2018

VAERS ID: 64421 Before After
VAERS Form:1
Age:1.9
Sex:Male
Location:Foreign
Vaccinated:1994-06-06
Onset:1994-06-09
Submitted:1994-06-27
Entered:1994-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Myocarditis, Pharyngitis, Rhinitis

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1994-06-10
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: 10JUN94: Lumbar puncture nl, blood cx nl;
CDC 'Split Type': WAES94067509

Write-up: 09JUN94 pt expd rhino-pharyngitis & was rx''d w/sulphamethoxazole trimethoprim & cetrizine; 10JUN94 pt died; 11JUN94 an autopsy was performed & fulminant myocarditis was found;


Changed on 10/14/2018

VAERS ID: 64421 Before After
VAERS Form:1
Age:1.9
Sex:Male
Location:Foreign
Vaccinated:1994-06-06
Onset:1994-06-09
Submitted:1994-06-27
Entered:1994-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Myocarditis, Pharyngitis, Rhinitis

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1994-06-10
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: 10JUN94: Lumbar puncture nl, blood cx nl;
CDC 'Split Type': WAES94067509

Write-up: 09JUN94 pt expd rhino-pharyngitis & was rx''d w/sulphamethoxazole trimethoprim & cetrizine; 10JUN94 pt died; 11JUN94 an autopsy was performed & fulminant myocarditis was found;

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=64421&WAYBACKHISTORY=ON


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