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This is VAERS ID 97015

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 97015
VAERS Form:
Age:1.3
Sex:Male
Location:New Hampshire
Vaccinated:1996-12-30
Onset:1997-01-10
Submitted:1997-01-14
Entered:1997-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MMR II / MSD 1418B / 1 LL / -

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS, DEHYDRAT

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-01-10
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: NONE
Current Illness: laceration
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy pending;
CDC 'Split Type':

Write-up: death 10JAN97 seen 3JAN97 in ER for laceration;


Changed on 12/8/2009

VAERS ID: 97015 Before After
VAERS Form:
Age:1.3
Sex:Male
Location:New Hampshire
Vaccinated:1996-12-30
Onset:1997-01-10
Submitted:1997-01-14
Entered:1997-04-22 1997-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 1418B / 1 LL / -

Administered by: Private Unknown      Purchased by: Unknown
Symptoms: Dehydration, SIDS, Sudden infant death syndrome, DEHYDRAT

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-01-10
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: NONE
Current Illness: laceration
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy pending;
CDC 'Split Type': (blank) NH97002

Write-up: death 10JAN97 seen 3JAN97 in ER for laceration;


Changed on 5/14/2017

VAERS ID: 97015 Before After
VAERS Form:
Age:1.3
Sex:Male
Location:New Hampshire
Vaccinated:1996-12-30
Onset:1997-01-10
Submitted:1997-01-14
Entered:1997-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1418B / 1 LL / -

Administered by: Unknown Private      Purchased by: Unknown Public
Symptoms: Dehydration, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-01-10
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: NONE
Current Illness: laceration
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy pending;
CDC 'Split Type': NH97002

Write-up: death 10JAN97 seen 3JAN97 in ER for laceration;


Changed on 9/14/2017

VAERS ID: 97015 Before After
VAERS Form:(blank) 1
Age:1.3
Sex:Male
Location:New Hampshire
Vaccinated:1996-12-30
Onset:1997-01-10
Submitted:1997-01-14
Entered:1997-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1418B / 1 2 LL / -

Administered by: Private      Purchased by: Public
Symptoms: Dehydration, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-01-10
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: NONE
Current Illness: laceration
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy pending;
CDC 'Split Type': NH97002

Write-up: death 10JAN97 seen 3JAN97 in ER for laceration;


Changed on 2/14/2018

VAERS ID: 97015 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:New Hampshire
Vaccinated:1996-12-30
Onset:1997-01-10
Submitted:1997-01-14
Entered:1997-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1418B / 2 LL / -

Administered by: Private      Purchased by: Public
Symptoms: Dehydration, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-01-10
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: NONE
Current Illness: laceration
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy pending;
CDC 'Split Type': NH97002

Write-up: death 10JAN97 seen 3JAN97 in ER for laceration;


Changed on 6/14/2018

VAERS ID: 97015 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:New Hampshire
Vaccinated:1996-12-30
Onset:1997-01-10
Submitted:1997-01-14
Entered:1997-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1418B / 2 LL / -

Administered by: Private      Purchased by: Public
Symptoms: Dehydration, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-01-10
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: NONE
Current Illness: laceration
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy pending;
CDC 'Split Type': NH97002

Write-up: death 10JAN97 seen 3JAN97 in ER for laceration;


Changed on 8/14/2018

VAERS ID: 97015 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:New Hampshire
Vaccinated:1996-12-30
Onset:1997-01-10
Submitted:1997-01-14
Entered:1997-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1418B / 2 LL / -

Administered by: Private      Purchased by: Public
Symptoms: Dehydration, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-01-10
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: NONE
Current Illness: laceration
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy pending;
CDC 'Split Type': NH97002

Write-up: death 10JAN97 seen 3JAN97 in ER for laceration;


Changed on 9/14/2018

VAERS ID: 97015 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:New Hampshire
Vaccinated:1996-12-30
Onset:1997-01-10
Submitted:1997-01-14
Entered:1997-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1418B / 2 LL / -

Administered by: Private      Purchased by: Public
Symptoms: Dehydration, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-01-10
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: NONE
Current Illness: laceration
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy pending;
CDC 'Split Type': NH97002

Write-up: death 10JAN97 seen 3JAN97 in ER for laceration;


Changed on 10/14/2018

VAERS ID: 97015 Before After
VAERS Form:1
Age:1.3
Sex:Male
Location:New Hampshire
Vaccinated:1996-12-30
Onset:1997-01-10
Submitted:1997-01-14
Entered:1997-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1418B / 2 LL / -

Administered by: Private      Purchased by: Public
Symptoms: Dehydration, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-01-10
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: NONE
Current Illness: laceration
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy pending;
CDC 'Split Type': NH97002

Write-up: death 10JAN97 seen 3JAN97 in ER for laceration;

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=97015&WAYBACKHISTORY=ON


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