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This is VAERS ID 84303

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 84303
VAERS Form:
Age:20.7
Sex:Male
Location:Massachusetts
Vaccinated:1992-09-03
Onset:0000-00-00
Submitted:1996-03-29
Entered:1996-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: UNK. MEASLES, MUMPS & RUBELLA VIRUS LIVE / UNCLASSIFIED - / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: FEVER, INFECT, LAB TEST ABNORM, LUNG DIS, EFFUS PLEURAL

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: Omeprazole, Bactrim, Fluconazole, Clarithromyan;
Current Illness:
Preexisting Conditions: mild hemophilia A, recvd factor vIII x 1, AIDS, hx pneumocystis carinii pneumonia OCT92; allergic to PCN
Allergies:
Diagnostic Lab Data: CD4=<10 for over 1 year; CXR ABN; abdom CT, ERCP;COD progressive pulmonary dz w/bilat pleural effusions
CDC 'Split Type':

Write-up: adm to hosp 31AUG95 w/3wk hx progressive non prod cough,SOB & fevers;devel abd pain,diarrhea;lost 30lbs;pt had multiple diagnostic studies,devel pleural effusion,viral pneumonia & measles pneumonia;


Changed on 12/8/2009

VAERS ID: 84303 Before After
VAERS Form:
Age:20.7
Sex:Male
Location:Massachusetts
Vaccinated:1992-09-03
Onset:0000-00-00
Submitted:1996-03-29
Entered:1996-04-04 1996-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: UNK. MEASLES, MUMPS & RUBELLA VIRUS LIVE MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNCLASSIFIED UNKNOWN MANUFACTURER - / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Drug ineffective, Infection, Laboratory test abnormal, Lung disorder, Pleural effusion, Pneumonia, Pyrexia, FEVER, INFECT, LAB TEST ABNORM, LUNG DIS, EFFUS PLEURAL

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: Omeprazole, Bactrim, Fluconazole, Clarithromyan;
Current Illness:
Preexisting Conditions: mild hemophilia A, recvd factor vIII x 1, AIDS, hx pneumocystis carinii pneumonia OCT92; allergic to PCN
Allergies:
Diagnostic Lab Data: CD4=<10 for over 1 year; CXR ABN; abdom CT, ERCP;COD progressive pulmonary dz w/bilat pleural effusions
CDC 'Split Type':

Write-up: adm to hosp 31AUG95 w/3wk hx progressive non prod cough,SOB & fevers;devel abd pain,diarrhea;lost 30lbs;pt had multiple diagnostic studies,devel pleural effusion,viral pneumonia & measles pneumonia;


Changed on 2/14/2017

VAERS ID: 84303 Before After
VAERS Form:
Age:20.7 20.0
Sex:Male
Location:Massachusetts
Vaccinated:1992-09-03
Onset:0000-00-00
Submitted:1996-03-29
Entered:1996-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Drug ineffective, Infection, Laboratory test abnormal, Lung disorder, Pleural effusion, Pneumonia, Pyrexia

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: Omeprazole, Bactrim, Fluconazole, Clarithromyan;
Current Illness:
Preexisting Conditions: mild hemophilia A, recvd factor vIII x 1, AIDS, hx pneumocystis carinii pneumonia OCT92; allergic to PCN
Allergies:
Diagnostic Lab Data: CD4=<10 for over 1 year; CXR ABN; abdom CT, ERCP;COD progressive pulmonary dz w/bilat pleural effusions
CDC 'Split Type':

Write-up: adm to hosp 31AUG95 w/3wk hx progressive non prod cough,SOB & fevers;devel abd pain,diarrhea;lost 30lbs;pt had multiple diagnostic studies,devel pleural effusion,viral pneumonia & measles pneumonia;


Changed on 5/14/2017

VAERS ID: 84303 Before After
VAERS Form:
Age:20.0
Sex:Male
Location:Massachusetts
Vaccinated:1992-09-03
Onset:0000-00-00
Submitted:1996-03-29
Entered:1996-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Drug ineffective, Infection, Laboratory test abnormal, Lung disorder, Pleural effusion, Pneumonia, Pyrexia

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: Omeprazole, Bactrim, Fluconazole, Clarithromyan;
Current Illness:
Preexisting Conditions: mild hemophilia A, recvd factor vIII x 1, AIDS, hx pneumocystis carinii pneumonia OCT92; allergic to PCN
Allergies:
Diagnostic Lab Data: CD4=<10 for over 1 year; CXR ABN; abdom CT, ERCP;COD progressive pulmonary dz w/bilat pleural effusions
CDC 'Split Type':

Write-up: adm to hosp 31AUG95 w/3wk hx progressive non prod cough,SOB & fevers;devel abd pain,diarrhea;lost 30lbs;pt had multiple diagnostic studies,devel pleural effusion,viral pneumonia & measles pneumonia;


Changed on 9/14/2017

VAERS ID: 84303 Before After
VAERS Form:(blank) 1
Age:20.0
Sex:Male
Location:Massachusetts
Vaccinated:1992-09-03
Onset:0000-00-00
Submitted:1996-03-29
Entered:1996-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Drug ineffective, Infection, Laboratory test abnormal, Lung disorder, Pleural effusion, Pneumonia, Pyrexia

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: Omeprazole, Bactrim, Fluconazole, Clarithromyan;
Current Illness:
Preexisting Conditions: mild hemophilia A, recvd factor vIII x 1, AIDS, hx pneumocystis carinii pneumonia OCT92; allergic to PCN
Allergies:
Diagnostic Lab Data: CD4=<10 for over 1 year; CXR ABN; abdom CT, ERCP;COD progressive pulmonary dz w/bilat pleural effusions
CDC 'Split Type':

Write-up: adm to hosp 31AUG95 w/3wk hx progressive non prod cough,SOB & fevers;devel abd pain,diarrhea;lost 30lbs;pt had multiple diagnostic studies,devel pleural effusion,viral pneumonia & measles pneumonia;


Changed on 2/14/2018

VAERS ID: 84303 Before After
VAERS Form:1
Age:20.0
Sex:Male
Location:Massachusetts
Vaccinated:1992-09-03
Onset:0000-00-00
Submitted:1996-03-29
Entered:1996-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Drug ineffective, Infection, Laboratory test abnormal, Lung disorder, Pleural effusion, Pneumonia, Pyrexia

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: Omeprazole, Bactrim, Fluconazole, Clarithromyan;
Current Illness:
Preexisting Conditions: mild hemophilia A, recvd factor vIII x 1, AIDS, hx pneumocystis carinii pneumonia OCT92; allergic to PCN
Allergies:
Diagnostic Lab Data: CD4=<10 for over 1 year; CXR ABN; abdom CT, ERCP;COD progressive pulmonary dz w/bilat pleural effusions
CDC 'Split Type':

Write-up: adm to hosp 31AUG95 w/3wk hx progressive non prod cough,SOB & fevers;devel abd pain,diarrhea;lost 30lbs;pt had multiple diagnostic studies,devel pleural effusion,viral pneumonia & measles pneumonia;


Changed on 6/14/2018

VAERS ID: 84303 Before After
VAERS Form:1
Age:20.0
Sex:Male
Location:Massachusetts
Vaccinated:1992-09-03
Onset:0000-00-00
Submitted:1996-03-29
Entered:1996-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Drug ineffective, Infection, Laboratory test abnormal, Lung disorder, Pleural effusion, Pneumonia, Pyrexia

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: Omeprazole, Bactrim, Fluconazole, Clarithromyan;
Current Illness:
Preexisting Conditions: mild hemophilia A, recvd factor vIII x 1, AIDS, hx pneumocystis carinii pneumonia OCT92; allergic to PCN
Allergies:
Diagnostic Lab Data: CD4=<10 for over 1 year; CXR ABN; abdom CT, ERCP;COD progressive pulmonary dz w/bilat pleural effusions
CDC 'Split Type':

Write-up: adm to hosp 31AUG95 w/3wk hx progressive non prod cough,SOB & fevers;devel abd pain,diarrhea;lost 30lbs;pt had multiple diagnostic studies,devel pleural effusion,viral pneumonia & measles pneumonia;


Changed on 8/14/2018

VAERS ID: 84303 Before After
VAERS Form:1
Age:20.0
Sex:Male
Location:Massachusetts
Vaccinated:1992-09-03
Onset:0000-00-00
Submitted:1996-03-29
Entered:1996-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Drug ineffective, Infection, Laboratory test abnormal, Lung disorder, Pleural effusion, Pneumonia, Pyrexia

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: Omeprazole, Bactrim, Fluconazole, Clarithromyan;
Current Illness:
Preexisting Conditions: mild hemophilia A, recvd factor vIII x 1, AIDS, hx pneumocystis carinii pneumonia OCT92; allergic to PCN
Allergies:
Diagnostic Lab Data: CD4=<10 for over 1 year; CXR ABN; abdom CT, ERCP;COD progressive pulmonary dz w/bilat pleural effusions
CDC 'Split Type':

Write-up: adm to hosp 31AUG95 w/3wk hx progressive non prod cough,SOB & fevers;devel abd pain,diarrhea;lost 30lbs;pt had multiple diagnostic studies,devel pleural effusion,viral pneumonia & measles pneumonia;


Changed on 9/14/2018

VAERS ID: 84303 Before After
VAERS Form:1
Age:20.0
Sex:Male
Location:Massachusetts
Vaccinated:1992-09-03
Onset:0000-00-00
Submitted:1996-03-29
Entered:1996-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Drug ineffective, Infection, Laboratory test abnormal, Lung disorder, Pleural effusion, Pneumonia, Pyrexia

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: Omeprazole, Bactrim, Fluconazole, Clarithromyan;
Current Illness:
Preexisting Conditions: mild hemophilia A, recvd factor vIII x 1, AIDS, hx pneumocystis carinii pneumonia OCT92; allergic to PCN
Allergies:
Diagnostic Lab Data: CD4=<10 for over 1 year; CXR ABN; abdom CT, ERCP;COD progressive pulmonary dz w/bilat pleural effusions
CDC 'Split Type':

Write-up: adm to hosp 31AUG95 w/3wk hx progressive non prod cough,SOB & fevers;devel abd pain,diarrhea;lost 30lbs;pt had multiple diagnostic studies,devel pleural effusion,viral pneumonia & measles pneumonia;


Changed on 10/14/2018

VAERS ID: 84303 Before After
VAERS Form:1
Age:20.0
Sex:Male
Location:Massachusetts
Vaccinated:1992-09-03
Onset:0000-00-00
Submitted:1996-03-29
Entered:1996-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Drug ineffective, Infection, Laboratory test abnormal, Lung disorder, Pleural effusion, Pneumonia, Pyrexia

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: Omeprazole, Bactrim, Fluconazole, Clarithromyan;
Current Illness:
Preexisting Conditions: mild hemophilia A, recvd factor vIII x 1, AIDS, hx pneumocystis carinii pneumonia OCT92; allergic to PCN
Allergies:
Diagnostic Lab Data: CD4=<10 for over 1 year; CXR ABN; abdom CT, ERCP;COD progressive pulmonary dz w/bilat pleural effusions
CDC 'Split Type':

Write-up: adm to hosp 31AUG95 w/3wk hx progressive non prod cough,SOB & fevers;devel abd pain,diarrhea;lost 30lbs;pt had multiple diagnostic studies,devel pleural effusion,viral pneumonia & measles pneumonia;

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=84303&WAYBACKHISTORY=ON


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