National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 92503

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 92503
VAERS Form:
Age:1.3
Sex:Female
Location:New York
Vaccinated:1996-11-05
Onset:1996-11-13
Submitted:1996-11-27
Entered:1996-12-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIBTITER / LEDERLE(PRAXIS) - / - - / -
MMR: MMR II / MSD - / 0 - / SC

Administered by: Other      Purchased by: Unknown
Symptoms: CORONARY ART DIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-11-13
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: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data;
CDC 'Split Type':

Write-up: pt recv vax 5NOV96 & 13NOV96 pt died;pt had been an otherwise healthy individual;COD unk;MD did not think death was d/t vax;gross post-mortem revealed no anomalies;MD awaiting microscopy & toxicology reports;


Changed on 12/8/2009

VAERS ID: 92503 Before After
VAERS Form:
Age:1.3
Sex:Female
Location:New York
Vaccinated:1996-11-05
Onset:1996-11-13
Submitted:1996-11-27
Entered:1996-12-03 1996-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS - / - - / -
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. - / 0 - / SC

Administered by: Other      Purchased by: Unknown Other
Symptoms: Coronary artery disease, CORONARY ART DIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-11-13
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: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data;
CDC 'Split Type': (blank) WAES96111526

Write-up: pt recv vax 5NOV96 & 13NOV96 pt died;pt had been an otherwise healthy individual;COD unk;MD did not think death was d/t vax;gross post-mortem revealed no anomalies;MD awaiting microscopy & toxicology reports;


Changed on 5/14/2017

VAERS ID: 92503 Before After
VAERS Form:
Age:1.3
Sex:Female
Location:New York
Vaccinated:1996-11-05
Onset:1996-11-13
Submitted:1996-11-27
Entered:1996-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH - / - - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 0 - / SC

Administered by: Other      Purchased by: Other
Symptoms: Coronary artery disease

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-11-13
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: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data;
CDC 'Split Type': WAES96111526

Write-up: pt recv vax 5NOV96 & 13NOV96 pt died;pt had been an otherwise healthy individual;COD unk;MD did not think death was d/t vax;gross post-mortem revealed no anomalies;MD awaiting microscopy & toxicology reports;


Changed on 9/14/2017

VAERS ID: 92503 Before After
VAERS Form:(blank) 1
Age:1.3
Sex:Female
Location:New York
Vaccinated:1996-11-05
Onset:1996-11-13
Submitted:1996-11-27
Entered:1996-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / - UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 0 1 - / SC

Administered by: Other      Purchased by: Other
Symptoms: Coronary artery disease

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-11-13
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: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data;
CDC 'Split Type': WAES96111526

Write-up: pt recv vax 5NOV96 & 13NOV96 pt died;pt had been an otherwise healthy individual;COD unk;MD did not think death was d/t vax;gross post-mortem revealed no anomalies;MD awaiting microscopy & toxicology reports;


Changed on 2/14/2018

VAERS ID: 92503 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:New York
Vaccinated:1996-11-05
Onset:1996-11-13
Submitted:1996-11-27
Entered:1996-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 1 - / SC

Administered by: Other      Purchased by: Other
Symptoms: Coronary artery disease

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-11-13
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: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data;
CDC 'Split Type': WAES96111526

Write-up: pt recv vax 5NOV96 & 13NOV96 pt died;pt had been an otherwise healthy individual;COD unk;MD did not think death was d/t vax;gross post-mortem revealed no anomalies;MD awaiting microscopy & toxicology reports;


Changed on 6/14/2018

VAERS ID: 92503 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:New York
Vaccinated:1996-11-05
Onset:1996-11-13
Submitted:1996-11-27
Entered:1996-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 1 - / SC

Administered by: Other      Purchased by: Other
Symptoms: Coronary artery disease

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-11-13
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: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data;
CDC 'Split Type': WAES96111526

Write-up: pt recv vax 5NOV96 & 13NOV96 pt died;pt had been an otherwise healthy individual;COD unk;MD did not think death was d/t vax;gross post-mortem revealed no anomalies;MD awaiting microscopy & toxicology reports;


Changed on 8/14/2018

VAERS ID: 92503 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:New York
Vaccinated:1996-11-05
Onset:1996-11-13
Submitted:1996-11-27
Entered:1996-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 1 - / SC

Administered by: Other      Purchased by: Other
Symptoms: Coronary artery disease

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-11-13
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: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data;
CDC 'Split Type': WAES96111526

Write-up: pt recv vax 5NOV96 & 13NOV96 pt died;pt had been an otherwise healthy individual;COD unk;MD did not think death was d/t vax;gross post-mortem revealed no anomalies;MD awaiting microscopy & toxicology reports;


Changed on 9/14/2018

VAERS ID: 92503 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:New York
Vaccinated:1996-11-05
Onset:1996-11-13
Submitted:1996-11-27
Entered:1996-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 1 - / SC

Administered by: Other      Purchased by: Other
Symptoms: Coronary artery disease

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-11-13
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: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data;
CDC 'Split Type': WAES96111526

Write-up: pt recv vax 5NOV96 & 13NOV96 pt died;pt had been an otherwise healthy individual;COD unk;MD did not think death was d/t vax;gross post-mortem revealed no anomalies;MD awaiting microscopy & toxicology reports;


Changed on 10/14/2018

VAERS ID: 92503 Before After
VAERS Form:1
Age:1.3
Sex:Female
Location:New York
Vaccinated:1996-11-05
Onset:1996-11-13
Submitted:1996-11-27
Entered:1996-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 1 - / SC

Administered by: Other      Purchased by: Other
Symptoms: Coronary artery disease

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-11-13
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: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data;
CDC 'Split Type': WAES96111526

Write-up: pt recv vax 5NOV96 & 13NOV96 pt died;pt had been an otherwise healthy individual;COD unk;MD did not think death was d/t vax;gross post-mortem revealed no anomalies;MD awaiting microscopy & toxicology reports;

New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=92503&WAYBACKHISTORY=ON


Copyright © 2019 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166