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This is VAERS ID 94040

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 94040
VAERS Form:
Age:1.0
Sex:Male
Location:Alabama
Vaccinated:1996-12-27
Onset:1996-12-29
Submitted:1997-01-07
Entered:1997-01-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPH: TETRAMUNE / LEDERLE 436789 / 3 LL / IM
MMR: MMR II / MSD 0731D / 0 LA / SC

Administered by: Public      Purchased by: Unknown
Symptoms: FEVER, INFECT, ASTHMA, COUGH INC, EAR DIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-12-29
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: NONE
Current Illness: ear infection; minimal wheezing
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recv vax & temp99.4R;on exam, noted TM''s red full;productive cough, minimal wheezing, mucoid nasal discharge;referred to ER;seen in ER same day;t100.8 R:for ear infect & released;to ER 29DEC96 DOA:;pt died for SIDS;


Changed on 12/8/2009

VAERS ID: 94040 Before After
VAERS Form:
Age:1.0
Sex:Male
Location:Alabama
Vaccinated:1996-12-27
Onset:1996-12-29
Submitted:1997-01-07
Entered:1997-01-31 1997-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPH: TETRAMUNE / LEDERLE 436789 / 3 LL / IM
DTPHIB: DTP + HIB (TETRAMUNE) / LEDERLE LABORATORIES 436789 / 3 LL / IM
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 0731D / 0 LA / SC

Administered by: Public      Purchased by: Unknown Public
Symptoms: Asthma, Cough, Ear disorder, Infection, Otitis media, Pyrexia, Rhinitis, Sudden infant death syndrome, FEVER, INFECT, ASTHMA, COUGH INC, EAR DIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-12-29
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: NONE
Current Illness: ear infection; minimal wheezing
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) AL9628

Write-up: pt recv vax & temp99.4R;on exam, noted TM''s red full;productive cough, minimal wheezing, mucoid nasal discharge;referred to ER;seen in ER same day;t100.8 R:for ear infect & released;to ER 29DEC96 DOA:;pt died for SIDS;


Changed on 5/14/2017

VAERS ID: 94040 Before After
VAERS Form:
Age:1.0
Sex:Male
Location:Alabama
Vaccinated:1996-12-27
Onset:1996-12-29
Submitted:1997-01-07
Entered:1997-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 436789 / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0731D / 0 LA / SC

Administered by: Public      Purchased by: Public
Symptoms: Asthma, Cough, Ear disorder, Infection, Otitis media, Pyrexia, Rhinitis, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-12-29
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: NONE
Current Illness: ear infection; minimal wheezing
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': AL9628

Write-up: pt recv vax & temp99.4R;on exam, noted TM''s red full;productive cough, minimal wheezing, mucoid nasal discharge;referred to ER;seen in ER same day;t100.8 R:for ear infect & released;to ER 29DEC96 DOA:;pt died for SIDS;


Changed on 9/14/2017

VAERS ID: 94040 Before After
VAERS Form:(blank) 1
Age:1.0
Sex:Male
Location:Alabama
Vaccinated:1996-12-27
Onset:1996-12-29
Submitted:1997-01-07
Entered:1997-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 436789 / 3 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0731D / 0 1 LA / SC

Administered by: Public      Purchased by: Public
Symptoms: Asthma, Cough, Ear disorder, Infection, Otitis media, Pyrexia, Rhinitis, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-12-29
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: NONE
Current Illness: ear infection; minimal wheezing
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': AL9628

Write-up: pt recv vax & temp99.4R;on exam, noted TM''s red full;productive cough, minimal wheezing, mucoid nasal discharge;referred to ER;seen in ER same day;t100.8 R:for ear infect & released;to ER 29DEC96 DOA:;pt died for SIDS;


Changed on 2/14/2018

VAERS ID: 94040 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Alabama
Vaccinated:1996-12-27
Onset:1996-12-29
Submitted:1997-01-07
Entered:1997-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 436789 / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0731D / 1 LA / SC

Administered by: Public      Purchased by: Public
Symptoms: Asthma, Cough, Ear disorder, Infection, Otitis media, Pyrexia, Rhinitis, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-12-29
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: NONE
Current Illness: ear infection; minimal wheezing
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': AL9628

Write-up: pt recv vax & temp99.4R;on exam, noted TM''s red full;productive cough, minimal wheezing, mucoid nasal discharge;referred to ER;seen in ER same day;t100.8 R:for ear infect & released;to ER 29DEC96 DOA:;pt died for SIDS;


Changed on 6/14/2018

VAERS ID: 94040 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Alabama
Vaccinated:1996-12-27
Onset:1996-12-29
Submitted:1997-01-07
Entered:1997-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 436789 / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0731D / 1 LA / SC

Administered by: Public      Purchased by: Public
Symptoms: Asthma, Cough, Ear disorder, Infection, Otitis media, Pyrexia, Rhinitis, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-12-29
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: NONE
Current Illness: ear infection; minimal wheezing
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': AL9628

Write-up: pt recv vax & temp99.4R;on exam, noted TM''s red full;productive cough, minimal wheezing, mucoid nasal discharge;referred to ER;seen in ER same day;t100.8 R:for ear infect & released;to ER 29DEC96 DOA:;pt died for SIDS;


Changed on 8/14/2018

VAERS ID: 94040 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Alabama
Vaccinated:1996-12-27
Onset:1996-12-29
Submitted:1997-01-07
Entered:1997-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 436789 / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0731D / 1 LA / SC

Administered by: Public      Purchased by: Public
Symptoms: Asthma, Cough, Ear disorder, Infection, Otitis media, Pyrexia, Rhinitis, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-12-29
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: NONE
Current Illness: ear infection; minimal wheezing
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': AL9628

Write-up: pt recv vax & temp99.4R;on exam, noted TM''s red full;productive cough, minimal wheezing, mucoid nasal discharge;referred to ER;seen in ER same day;t100.8 R:for ear infect & released;to ER 29DEC96 DOA:;pt died for SIDS;


Changed on 9/14/2018

VAERS ID: 94040 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Alabama
Vaccinated:1996-12-27
Onset:1996-12-29
Submitted:1997-01-07
Entered:1997-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 436789 / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0731D / 1 LA / SC

Administered by: Public      Purchased by: Public
Symptoms: Asthma, Cough, Ear disorder, Infection, Otitis media, Pyrexia, Rhinitis, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-12-29
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: NONE
Current Illness: ear infection; minimal wheezing
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': AL9628

Write-up: pt recv vax & temp99.4R;on exam, noted TM''s red full;productive cough, minimal wheezing, mucoid nasal discharge;referred to ER;seen in ER same day;t100.8 R:for ear infect & released;to ER 29DEC96 DOA:;pt died for SIDS;


Changed on 10/14/2018

VAERS ID: 94040 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Alabama
Vaccinated:1996-12-27
Onset:1996-12-29
Submitted:1997-01-07
Entered:1997-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 436789 / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0731D / 1 LA / SC

Administered by: Public      Purchased by: Public
Symptoms: Asthma, Cough, Ear disorder, Infection, Otitis media, Pyrexia, Rhinitis, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-12-29
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: NONE
Current Illness: ear infection; minimal wheezing
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': AL9628

Write-up: pt recv vax & temp99.4R;on exam, noted TM''s red full;productive cough, minimal wheezing, mucoid nasal discharge;referred to ER;seen in ER same day;t100.8 R:for ear infect & released;to ER 29DEC96 DOA:;pt died for SIDS;

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