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This is VAERS ID 96864

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 96864
VAERS Form:
Age:1.1
Sex:Female
Location:Arizona
Vaccinated:1997-03-21
Onset:1997-03-28
Submitted:1997-03-31
Entered:1997-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MMR II / MSD 1314B / 0 RA / SC
VARCEL: VARIVAX / MSD 1357D / 0 LA / SC

Administered by: Public      Purchased by: Unknown
Symptoms: INFECT, RESPIRAT DIS

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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: blood taken in ER for genetic work-up & cult r/o RSV;
CDC 'Split Type':

Write-up: pt had resp ill-like sx 27MAR97;unable to appt w/med provider until 28MAR97;infant found in crib by mom AM on 28MAR97 w/no response-amb called-taken to ER;


Changed on 12/8/2009

VAERS ID: 96864 Before After
VAERS Form:
Age:1.1
Sex:Female
Location:Arizona
Vaccinated:1997-03-21
Onset:1997-03-28
Submitted:1997-03-31
Entered:1997-04-14 1997-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 1314B / 0 RA / SC
VARCEL: VARIVAX VARICELLA (VARIVAX) / MSD MERCK & CO. INC. 1357D / 0 LA / SC

Administered by: Public      Purchased by: Unknown Public
Symptoms: Infection, Respiratory disorder, INFECT, RESPIRAT DIS

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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: blood taken in ER for genetic work-up & cult r/o RSV;
CDC 'Split Type': (blank) AZ9710

Write-up: pt had resp ill-like sx 27MAR97;unable to appt w/med provider until 28MAR97;infant found in crib by mom AM on 28MAR97 w/no response-amb called-taken to ER;


Changed on 5/14/2017

VAERS ID: 96864 Before After
VAERS Form:
Age:1.1
Sex:Female
Location:Arizona
Vaccinated:1997-03-21
Onset:1997-03-28
Submitted:1997-03-31
Entered:1997-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1314B / 0 RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1357D / 0 LA / SC

Administered by: Public      Purchased by: Public
Symptoms: Infection, Respiratory disorder

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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: blood taken in ER for genetic work-up & cult r/o RSV;
CDC 'Split Type': AZ9710

Write-up: pt had resp ill-like sx 27MAR97;unable to appt w/med provider until 28MAR97;infant found in crib by mom AM on 28MAR97 w/no response-amb called-taken to ER;


Changed on 9/14/2017

VAERS ID: 96864 Before After
VAERS Form:(blank) 1
Age:1.1
Sex:Female
Location:Arizona
Vaccinated:1997-03-21
Onset:1997-03-28
Submitted:1997-03-31
Entered:1997-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1314B / 0 1 RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1357D / 0 1 LA / SC

Administered by: Public      Purchased by: Public
Symptoms: Infection, Respiratory disorder

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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: blood taken in ER for genetic work-up & cult r/o RSV;
CDC 'Split Type': AZ9710

Write-up: pt had resp ill-like sx 27MAR97;unable to appt w/med provider until 28MAR97;infant found in crib by mom AM on 28MAR97 w/no response-amb called-taken to ER;


Changed on 2/14/2018

VAERS ID: 96864 Before After
VAERS Form:1
Age:1.1
Sex:Female
Location:Arizona
Vaccinated:1997-03-21
Onset:1997-03-28
Submitted:1997-03-31
Entered:1997-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1314B / 1 RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1357D / 1 LA / SC

Administered by: Public      Purchased by: Public
Symptoms: Infection, Respiratory disorder

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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: blood taken in ER for genetic work-up & cult r/o RSV;
CDC 'Split Type': AZ9710

Write-up: pt had resp ill-like sx 27MAR97;unable to appt w/med provider until 28MAR97;infant found in crib by mom AM on 28MAR97 w/no response-amb called-taken to ER;


Changed on 6/14/2018

VAERS ID: 96864 Before After
VAERS Form:1
Age:1.1
Sex:Female
Location:Arizona
Vaccinated:1997-03-21
Onset:1997-03-28
Submitted:1997-03-31
Entered:1997-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1314B / 1 RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1357D / 1 LA / SC

Administered by: Public      Purchased by: Public
Symptoms: Infection, Respiratory disorder

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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: blood taken in ER for genetic work-up & cult r/o RSV;
CDC 'Split Type': AZ9710

Write-up: pt had resp ill-like sx 27MAR97;unable to appt w/med provider until 28MAR97;infant found in crib by mom AM on 28MAR97 w/no response-amb called-taken to ER;


Changed on 8/14/2018

VAERS ID: 96864 Before After
VAERS Form:1
Age:1.1
Sex:Female
Location:Arizona
Vaccinated:1997-03-21
Onset:1997-03-28
Submitted:1997-03-31
Entered:1997-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1314B / 1 RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1357D / 1 LA / SC

Administered by: Public      Purchased by: Public
Symptoms: Infection, Respiratory disorder

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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: blood taken in ER for genetic work-up & cult r/o RSV;
CDC 'Split Type': AZ9710

Write-up: pt had resp ill-like sx 27MAR97;unable to appt w/med provider until 28MAR97;infant found in crib by mom AM on 28MAR97 w/no response-amb called-taken to ER;


Changed on 9/14/2018

VAERS ID: 96864 Before After
VAERS Form:1
Age:1.1
Sex:Female
Location:Arizona
Vaccinated:1997-03-21
Onset:1997-03-28
Submitted:1997-03-31
Entered:1997-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1314B / 1 RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1357D / 1 LA / SC

Administered by: Public      Purchased by: Public
Symptoms: Infection, Respiratory disorder

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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: blood taken in ER for genetic work-up & cult r/o RSV;
CDC 'Split Type': AZ9710

Write-up: pt had resp ill-like sx 27MAR97;unable to appt w/med provider until 28MAR97;infant found in crib by mom AM on 28MAR97 w/no response-amb called-taken to ER;


Changed on 10/14/2018

VAERS ID: 96864 Before After
VAERS Form:1
Age:1.1
Sex:Female
Location:Arizona
Vaccinated:1997-03-21
Onset:1997-03-28
Submitted:1997-03-31
Entered:1997-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1314B / 1 RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1357D / 1 LA / SC

Administered by: Public      Purchased by: Public
Symptoms: Infection, Respiratory disorder

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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: blood taken in ER for genetic work-up & cult r/o RSV;
CDC 'Split Type': AZ9710

Write-up: pt had resp ill-like sx 27MAR97;unable to appt w/med provider until 28MAR97;infant found in crib by mom AM on 28MAR97 w/no response-amb called-taken to ER;

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=96864&WAYBACKHISTORY=ON


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