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This is VAERS ID 94918

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

VAERS ID: 94918
VAERS Form:
Age:1.0
Sex:Male
Location:Foreign
Vaccinated:1996-07-10
Onset:1996-07-19
Submitted:1997-02-10
Entered:1997-02-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Injury

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: unk
Current Illness:
Preexisting Conditions: reflux, gastroesophageal
Allergies:
Diagnostic Lab Data: 1996 viral serology negative;blood cult negative;
CDC 'Split Type': WAES97020157

Write-up: pt recv vax 10JUL96 & 19JUL96 pt suddenly died;lab eval by viral serology revealed a neg result CMV, influenza, rickettsias mycoplasma, HIV, RSV, ECHO virus, coxsackie virus, EBV;blood cult neg;COD cranial trauma;


Changed on 9/14/2017

VAERS ID: 94918 Before After
VAERS Form:(blank) 1
Age:1.0
Sex:Male
Location:Foreign
Vaccinated:1996-07-10
Onset:1996-07-19
Submitted:1997-02-10
Entered:1997-02-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / - UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Injury

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: unk
Current Illness:
Preexisting Conditions: reflux, gastroesophageal
Allergies:
Diagnostic Lab Data: 1996 viral serology negative;blood cult negative;
CDC 'Split Type': WAES97020157

Write-up: pt recv vax 10JUL96 & 19JUL96 pt suddenly died;lab eval by viral serology revealed a neg result CMV, influenza, rickettsias mycoplasma, HIV, RSV, ECHO virus, coxsackie virus, EBV;blood cult neg;COD cranial trauma;


Changed on 2/14/2018

VAERS ID: 94918 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Foreign
Vaccinated:1996-07-10
Onset:1996-07-19
Submitted:1997-02-10
Entered:1997-02-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Injury

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: unk
Current Illness:
Preexisting Conditions: reflux, gastroesophageal
Allergies:
Diagnostic Lab Data: 1996 viral serology negative;blood cult negative;
CDC 'Split Type': WAES97020157

Write-up: pt recv vax 10JUL96 & 19JUL96 pt suddenly died;lab eval by viral serology revealed a neg result CMV, influenza, rickettsias mycoplasma, HIV, RSV, ECHO virus, coxsackie virus, EBV;blood cult neg;COD cranial trauma;


Changed on 6/14/2018

VAERS ID: 94918 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Foreign
Vaccinated:1996-07-10
Onset:1996-07-19
Submitted:1997-02-10
Entered:1997-02-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Injury

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: unk
Current Illness:
Preexisting Conditions: reflux, gastroesophageal
Allergies:
Diagnostic Lab Data: 1996 viral serology negative;blood cult negative;
CDC 'Split Type': WAES97020157

Write-up: pt recv vax 10JUL96 & 19JUL96 pt suddenly died;lab eval by viral serology revealed a neg result CMV, influenza, rickettsias mycoplasma, HIV, RSV, ECHO virus, coxsackie virus, EBV;blood cult neg;COD cranial trauma;


Changed on 8/14/2018

VAERS ID: 94918 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Foreign
Vaccinated:1996-07-10
Onset:1996-07-19
Submitted:1997-02-10
Entered:1997-02-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Injury

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: unk
Current Illness:
Preexisting Conditions: reflux, gastroesophageal
Allergies:
Diagnostic Lab Data: 1996 viral serology negative;blood cult negative;
CDC 'Split Type': WAES97020157

Write-up: pt recv vax 10JUL96 & 19JUL96 pt suddenly died;lab eval by viral serology revealed a neg result CMV, influenza, rickettsias mycoplasma, HIV, RSV, ECHO virus, coxsackie virus, EBV;blood cult neg;COD cranial trauma;


Changed on 9/14/2018

VAERS ID: 94918 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Foreign
Vaccinated:1996-07-10
Onset:1996-07-19
Submitted:1997-02-10
Entered:1997-02-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Injury

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: unk
Current Illness:
Preexisting Conditions: reflux, gastroesophageal
Allergies:
Diagnostic Lab Data: 1996 viral serology negative;blood cult negative;
CDC 'Split Type': WAES97020157

Write-up: pt recv vax 10JUL96 & 19JUL96 pt suddenly died;lab eval by viral serology revealed a neg result CMV, influenza, rickettsias mycoplasma, HIV, RSV, ECHO virus, coxsackie virus, EBV;blood cult neg;COD cranial trauma;


Changed on 10/14/2018

VAERS ID: 94918 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Foreign
Vaccinated:1996-07-10
Onset:1996-07-19
Submitted:1997-02-10
Entered:1997-02-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Injury

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: unk
Current Illness:
Preexisting Conditions: reflux, gastroesophageal
Allergies:
Diagnostic Lab Data: 1996 viral serology negative;blood cult negative;
CDC 'Split Type': WAES97020157

Write-up: pt recv vax 10JUL96 & 19JUL96 pt suddenly died;lab eval by viral serology revealed a neg result CMV, influenza, rickettsias mycoplasma, HIV, RSV, ECHO virus, coxsackie virus, EBV;blood cult neg;COD cranial trauma;

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