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This is VAERS ID 76687

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 76687
VAERS Form:
Age:1.4
Sex:Male
Location:Minnesota
Vaccinated:1991-07-24
Onset:1991-08-01
Submitted:0000-00-00
Entered:1994-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: UNK. HAEMOPHILUS B / UNCLASSIFIED - / - - / -
MMR: UNK. MEASLES, MUMPS & RUBELLA VIRUS LIVE / UNCLASSIFIED - / - - / -

Administered by: Private      Purchased by: Unknown
Symptoms: FEVER, RASH, PHARYNGITIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-08-03
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: prematurity ( 27 wks gestation,1220 grams birth wt); hypertonia (cerebral palsy); devel delay; none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: fever, rash , red throat;


Changed on 12/8/2009

VAERS ID: 76687 Before After
VAERS Form:
Age:1.4
Sex:Male
Location:Minnesota
Vaccinated:1991-07-24
Onset:1991-08-01
Submitted:0000-00-00
Entered:1994-09-12 1994-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: UNK. HAEMOPHILUS B HIB (NO BRAND NAME) / UNCLASSIFIED UNKNOWN MANUFACTURER - / - - / -
MMR: UNK. MEASLES, MUMPS & RUBELLA VIRUS LIVE MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNCLASSIFIED UNKNOWN MANUFACTURER - / - - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Pharyngitis, Pyrexia, Rash, FEVER, RASH, PHARYNGITIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-08-03
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: prematurity ( 27 wks gestation,1220 grams birth wt); hypertonia (cerebral palsy); devel delay; none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: fever, rash , red throat;


Changed on 5/14/2017

VAERS ID: 76687 Before After
VAERS Form:
Age:1.4
Sex:Male
Location:Minnesota
Vaccinated:1991-07-24
Onset:1991-08-01
Submitted:0000-00-00
Entered:1994-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Pharyngitis, Pyrexia, Rash

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-08-03
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: prematurity ( 27 wks gestation,1220 grams birth wt); hypertonia (cerebral palsy); devel delay; none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: fever, rash , red throat;


Changed on 9/14/2017

VAERS ID: 76687 Before After
VAERS Form:(blank) 1
Age:1.4
Sex:Male
Location:Minnesota
Vaccinated:1991-07-24
Onset:1991-08-01
Submitted:0000-00-00
Entered:1994-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Pharyngitis, Pyrexia, Rash

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-08-03
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: prematurity ( 27 wks gestation,1220 grams birth wt); hypertonia (cerebral palsy); devel delay; none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: fever, rash , red throat;


Changed on 2/14/2018

VAERS ID: 76687 Before After
VAERS Form:1
Age:1.4
Sex:Male
Location:Minnesota
Vaccinated:1991-07-24
Onset:1991-08-01
Submitted:0000-00-00
Entered:1994-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Pharyngitis, Pyrexia, Rash

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-08-03
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: prematurity ( 27 wks gestation,1220 grams birth wt); hypertonia (cerebral palsy); devel delay; none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: fever, rash , red throat;


Changed on 6/14/2018

VAERS ID: 76687 Before After
VAERS Form:1
Age:1.4
Sex:Male
Location:Minnesota
Vaccinated:1991-07-24
Onset:1991-08-01
Submitted:0000-00-00
Entered:1994-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Pharyngitis, Pyrexia, Rash

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-08-03
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: prematurity ( 27 wks gestation,1220 grams birth wt); hypertonia (cerebral palsy); devel delay; none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: fever, rash , red throat;


Changed on 8/14/2018

VAERS ID: 76687 Before After
VAERS Form:1
Age:1.4
Sex:Male
Location:Minnesota
Vaccinated:1991-07-24
Onset:1991-08-01
Submitted:0000-00-00
Entered:1994-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Pharyngitis, Pyrexia, Rash

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-08-03
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: prematurity ( 27 wks gestation,1220 grams birth wt); hypertonia (cerebral palsy); devel delay; none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: fever, rash , red throat;


Changed on 9/14/2018

VAERS ID: 76687 Before After
VAERS Form:1
Age:1.4
Sex:Male
Location:Minnesota
Vaccinated:1991-07-24
Onset:1991-08-01
Submitted:0000-00-00
Entered:1994-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Pharyngitis, Pyrexia, Rash

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-08-03
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: prematurity ( 27 wks gestation,1220 grams birth wt); hypertonia (cerebral palsy); devel delay; none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: fever, rash , red throat;


Changed on 10/14/2018

VAERS ID: 76687 Before After
VAERS Form:1
Age:1.4
Sex:Male
Location:Minnesota
Vaccinated:1991-07-24
Onset:1991-08-01
Submitted:0000-00-00
Entered:1994-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Pharyngitis, Pyrexia, Rash

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1993-08-03
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: prematurity ( 27 wks gestation,1220 grams birth wt); hypertonia (cerebral palsy); devel delay; none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: fever, rash , red throat;

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=76687&WAYBACKHISTORY=ON


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