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This is VAERS ID 64763

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 64763
VAERS Form:
Age:17.8
Sex:Male
Location:New York
Vaccinated:1994-06-09
Onset:1994-06-13
Submitted:1994-07-13
Entered:1994-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MMR II / MSD 1740W / 1 - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: HEMATURIA, LEUKOCYTOSIS, NECK RIGID, COAGUL DIS, FIBRIN INC

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1994-06-20
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: coumadin;
Current Illness:
Preexisting Conditions: autoimmune disorder (anti-phospholipid antibody syndrome), allergy ASA, obesity; medical hx: recurrent thrombosis; VDRL positive;
Allergies:
Diagnostic Lab Data: mild leukocytosis & negative cxs;
CDC 'Split Type':

Write-up: approx 2 weeks p/2nd dose of MMR, pt was hospitalized due to febrile illness, abdominal pain, & thrombocytopenia; warfarin sodium crystalline was discontinued; pt developed DIC & adult respiratory distress syndrome; died from DIC & ARDS;


Changed on 12/8/2009

VAERS ID: 64763 Before After
VAERS Form:
Age:17.8 17.0
Sex:Male
Location:New York
Vaccinated:1994-06-09
Onset:1994-06-13
Submitted:1994-07-13
Entered:1994-07-20 1994-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 1740W / 1 - / IM

Administered by: Other Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Coagulopathy, Fibrin increased, Haematuria, Leukocytosis, Respiratory disorder, Thrombocytopenia, Nuchal rigidity, HEMATURIA, LEUKOCYTOSIS, NECK RIGID, COAGUL DIS, FIBRIN INC

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1994-06-20
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: coumadin;
Current Illness:
Preexisting Conditions: autoimmune disorder (anti-phospholipid antibody syndrome), allergy ASA, obesity; medical hx: recurrent thrombosis; VDRL positive;
Allergies:
Diagnostic Lab Data: mild leukocytosis & negative cxs;
CDC 'Split Type': (blank) WAES94061179

Write-up: approx 2 weeks p/2nd dose of MMR, pt was hospitalized due to febrile illness, abdominal pain, & thrombocytopenia; warfarin sodium crystalline was discontinued; pt developed DIC & adult respiratory distress syndrome; died from DIC & ARDS;


Changed on 5/14/2017

VAERS ID: 64763 Before After
VAERS Form:
Age:17.0
Sex:Male
Location:New York
Vaccinated:1994-06-09
Onset:1994-06-13
Submitted:1994-07-13
Entered:1994-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1740W / 1 - / IM

Administered by: Unknown Other      Purchased by: Unknown Other
Symptoms: Abdominal pain, Coagulopathy, Fibrin increased, Haematuria, Leukocytosis, Respiratory disorder, Thrombocytopenia, Nuchal rigidity

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1994-06-20
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: coumadin;
Current Illness:
Preexisting Conditions: autoimmune disorder (anti-phospholipid antibody syndrome), allergy ASA, obesity; medical hx: recurrent thrombosis; VDRL positive;
Allergies:
Diagnostic Lab Data: mild leukocytosis & negative cxs;
CDC 'Split Type': WAES94061179

Write-up: approx 2 weeks p/2nd dose of MMR, pt was hospitalized due to febrile illness, abdominal pain, & thrombocytopenia; warfarin sodium crystalline was discontinued; pt developed DIC & adult respiratory distress syndrome; died from DIC & ARDS;


Changed on 9/14/2017

VAERS ID: 64763 Before After
VAERS Form:(blank) 1
Age:17.0
Sex:Male
Location:New York
Vaccinated:1994-06-09
Onset:1994-06-13
Submitted:1994-07-13
Entered:1994-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1740W / 1 2 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Coagulopathy, Fibrin increased, Haematuria, Leukocytosis, Respiratory disorder, Thrombocytopenia, Nuchal rigidity

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1994-06-20
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: coumadin;
Current Illness:
Preexisting Conditions: autoimmune disorder (anti-phospholipid antibody syndrome), allergy ASA, obesity; medical hx: recurrent thrombosis; VDRL positive;
Allergies:
Diagnostic Lab Data: mild leukocytosis & negative cxs;
CDC 'Split Type': WAES94061179

Write-up: approx 2 weeks p/2nd dose of MMR, pt was hospitalized due to febrile illness, abdominal pain, & thrombocytopenia; warfarin sodium crystalline was discontinued; pt developed DIC & adult respiratory distress syndrome; died from DIC & ARDS;


Changed on 2/14/2018

VAERS ID: 64763 Before After
VAERS Form:1
Age:17.0
Sex:Male
Location:New York
Vaccinated:1994-06-09
Onset:1994-06-13
Submitted:1994-07-13
Entered:1994-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1740W / 2 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Coagulopathy, Fibrin increased, Haematuria, Leukocytosis, Respiratory disorder, Thrombocytopenia, Nuchal rigidity

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1994-06-20
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: coumadin;
Current Illness:
Preexisting Conditions: autoimmune disorder (anti-phospholipid antibody syndrome), allergy ASA, obesity; medical hx: recurrent thrombosis; VDRL positive;
Allergies:
Diagnostic Lab Data: mild leukocytosis & negative cxs;
CDC 'Split Type': WAES94061179

Write-up: approx 2 weeks p/2nd dose of MMR, pt was hospitalized due to febrile illness, abdominal pain, & thrombocytopenia; warfarin sodium crystalline was discontinued; pt developed DIC & adult respiratory distress syndrome; died from DIC & ARDS;


Changed on 6/14/2018

VAERS ID: 64763 Before After
VAERS Form:1
Age:17.0
Sex:Male
Location:New York
Vaccinated:1994-06-09
Onset:1994-06-13
Submitted:1994-07-13
Entered:1994-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1740W / 2 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Coagulopathy, Fibrin increased, Haematuria, Leukocytosis, Respiratory disorder, Thrombocytopenia, Nuchal rigidity

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1994-06-20
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: coumadin;
Current Illness:
Preexisting Conditions: autoimmune disorder (anti-phospholipid antibody syndrome), allergy ASA, obesity; medical hx: recurrent thrombosis; VDRL positive;
Allergies:
Diagnostic Lab Data: mild leukocytosis & negative cxs;
CDC 'Split Type': WAES94061179

Write-up: approx 2 weeks p/2nd dose of MMR, pt was hospitalized due to febrile illness, abdominal pain, & thrombocytopenia; warfarin sodium crystalline was discontinued; pt developed DIC & adult respiratory distress syndrome; died from DIC & ARDS;


Changed on 8/14/2018

VAERS ID: 64763 Before After
VAERS Form:1
Age:17.0
Sex:Male
Location:New York
Vaccinated:1994-06-09
Onset:1994-06-13
Submitted:1994-07-13
Entered:1994-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1740W / 2 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Coagulopathy, Fibrin increased, Haematuria, Leukocytosis, Respiratory disorder, Thrombocytopenia, Nuchal rigidity

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1994-06-20
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: coumadin;
Current Illness:
Preexisting Conditions: autoimmune disorder (anti-phospholipid antibody syndrome), allergy ASA, obesity; medical hx: recurrent thrombosis; VDRL positive;
Allergies:
Diagnostic Lab Data: mild leukocytosis & negative cxs;
CDC 'Split Type': WAES94061179

Write-up: approx 2 weeks p/2nd dose of MMR, pt was hospitalized due to febrile illness, abdominal pain, & thrombocytopenia; warfarin sodium crystalline was discontinued; pt developed DIC & adult respiratory distress syndrome; died from DIC & ARDS;


Changed on 9/14/2018

VAERS ID: 64763 Before After
VAERS Form:1
Age:17.0
Sex:Male
Location:New York
Vaccinated:1994-06-09
Onset:1994-06-13
Submitted:1994-07-13
Entered:1994-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1740W / 2 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Coagulopathy, Fibrin increased, Haematuria, Leukocytosis, Respiratory disorder, Thrombocytopenia, Nuchal rigidity

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1994-06-20
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: coumadin;
Current Illness:
Preexisting Conditions: autoimmune disorder (anti-phospholipid antibody syndrome), allergy ASA, obesity; medical hx: recurrent thrombosis; VDRL positive;
Allergies:
Diagnostic Lab Data: mild leukocytosis & negative cxs;
CDC 'Split Type': WAES94061179

Write-up: approx 2 weeks p/2nd dose of MMR, pt was hospitalized due to febrile illness, abdominal pain, & thrombocytopenia; warfarin sodium crystalline was discontinued; pt developed DIC & adult respiratory distress syndrome; died from DIC & ARDS;


Changed on 10/14/2018

VAERS ID: 64763 Before After
VAERS Form:1
Age:17.0
Sex:Male
Location:New York
Vaccinated:1994-06-09
Onset:1994-06-13
Submitted:1994-07-13
Entered:1994-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1740W / 2 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Coagulopathy, Fibrin increased, Haematuria, Leukocytosis, Respiratory disorder, Thrombocytopenia, Nuchal rigidity

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1994-06-20
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: coumadin;
Current Illness:
Preexisting Conditions: autoimmune disorder (anti-phospholipid antibody syndrome), allergy ASA, obesity; medical hx: recurrent thrombosis; VDRL positive;
Allergies:
Diagnostic Lab Data: mild leukocytosis & negative cxs;
CDC 'Split Type': WAES94061179

Write-up: approx 2 weeks p/2nd dose of MMR, pt was hospitalized due to febrile illness, abdominal pain, & thrombocytopenia; warfarin sodium crystalline was discontinued; pt developed DIC & adult respiratory distress syndrome; died from DIC & ARDS;

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