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This is VAERS ID 90259

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

VAERS ID: 90259
VAERS Form:
Age:1.0
Sex:Male
Location:Foreign
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1996-09-24
Entered:1996-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 0 - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Injury

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-07-19
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: unk
Current Illness:
Preexisting Conditions: no relevant history
Allergies:
Diagnostic Lab Data: No relevant data;
CDC 'Split Type': WAES96091432

Write-up: pt recv vax & died suddenly 9 days following vax;COD unk;no further details were provided;


Changed on 5/14/2017

VAERS ID: 90259 Before After
VAERS Form:
Age:1.0
Sex:Male
Location:Foreign
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1996-09-24
Entered:1996-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 0 - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Injury

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-07-19
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: unk
Current Illness:
Preexisting Conditions: no relevant history
Allergies:
Diagnostic Lab Data: No relevant data;
CDC 'Split Type': WAES96091432

Write-up: pt recv vax & died suddenly 9 days following vax;COD unk;no further details were provided;


Changed on 9/14/2017

VAERS ID: 90259 Before After
VAERS Form:(blank) 1
Age:1.0
Sex:Male
Location:Foreign
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1996-09-24
Entered:1996-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 0 1 - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Injury

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-07-19
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: unk
Current Illness:
Preexisting Conditions: no relevant history
Allergies:
Diagnostic Lab Data: No relevant data;
CDC 'Split Type': WAES96091432

Write-up: pt recv vax & died suddenly 9 days following vax;COD unk;no further details were provided;


Changed on 2/14/2018

VAERS ID: 90259 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Foreign
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1996-09-24
Entered:1996-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 1 - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Injury

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-07-19
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: unk
Current Illness:
Preexisting Conditions: no relevant history
Allergies:
Diagnostic Lab Data: No relevant data;
CDC 'Split Type': WAES96091432

Write-up: pt recv vax & died suddenly 9 days following vax;COD unk;no further details were provided;


Changed on 6/14/2018

VAERS ID: 90259 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Foreign
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1996-09-24
Entered:1996-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 1 - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Injury

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-07-19
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: unk
Current Illness:
Preexisting Conditions: no relevant history
Allergies:
Diagnostic Lab Data: No relevant data;
CDC 'Split Type': WAES96091432

Write-up: pt recv vax & died suddenly 9 days following vax;COD unk;no further details were provided;


Changed on 8/14/2018

VAERS ID: 90259 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Foreign
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1996-09-24
Entered:1996-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 1 - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Injury

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-07-19
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: unk
Current Illness:
Preexisting Conditions: no relevant history
Allergies:
Diagnostic Lab Data: No relevant data;
CDC 'Split Type': WAES96091432

Write-up: pt recv vax & died suddenly 9 days following vax;COD unk;no further details were provided;


Changed on 9/14/2018

VAERS ID: 90259 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Foreign
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1996-09-24
Entered:1996-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 1 - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Injury

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-07-19
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: unk
Current Illness:
Preexisting Conditions: no relevant history
Allergies:
Diagnostic Lab Data: No relevant data;
CDC 'Split Type': WAES96091432

Write-up: pt recv vax & died suddenly 9 days following vax;COD unk;no further details were provided;


Changed on 10/14/2018

VAERS ID: 90259 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Foreign
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1996-09-24
Entered:1996-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 1 - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Injury

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-07-19
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: unk
Current Illness:
Preexisting Conditions: no relevant history
Allergies:
Diagnostic Lab Data: No relevant data;
CDC 'Split Type': WAES96091432

Write-up: pt recv vax & died suddenly 9 days following vax;COD unk;no further details were provided;

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=90259&WAYBACKHISTORY=ON


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