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This is VAERS ID 99047

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 99047
VAERS Form:
Age:1.2
Sex:Female
Location:Minnesota
Vaccinated:1997-06-02
Onset:1997-06-09
Submitted:1997-06-10
Entered:1997-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MMR II / MSD 0239E / 0 LA / SC
OPV: ORIMUNE / LEDERLE 0754H / 2 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: CHILLS, CYANOSIS, APNEA, CARDIOVASC DIS, ANOMALY CONGEN

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-06-09
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: NONE
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy results pending;
CDC 'Split Type': NONE

Write-up: pt seen for well check 2JUN97;nl H & P;given vax & 9JUN97 devel fever & rash was treated symptomatically;pt was put down 8PM & checked 9PM; then @ 10PM was noted to be cold & blue;taken to ER unable to resusitate;


Changed on 12/8/2009

VAERS ID: 99047 Before After
VAERS Form:
Age:1.2
Sex:Female
Location:Minnesota
Vaccinated:1997-06-02
Onset:1997-06-09
Submitted:1997-06-10
Entered:1997-06-18 1997-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 0239E / 0 LA / SC
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 0754H / 2 - / PO

Administered by: Private      Purchased by: Unknown Private
Symptoms: Apnoea, Cardiovascular disorder, Chills, Congenital anomaly, Cyanosis, Pulmonary oedema, Pyrexia, Rash, CHILLS, CYANOSIS, APNEA, CARDIOVASC DIS, ANOMALY CONGEN

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-06-09
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: NONE
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy results pending;
CDC 'Split Type': NONE (blank)

Write-up: pt seen for well check 2JUN97;nl H & P;given vax & 9JUN97 devel fever & rash was treated symptomatically;pt was put down 8PM & checked 9PM; then @ 10PM was noted to be cold & blue;taken to ER unable to resusitate;


Changed on 5/14/2017

VAERS ID: 99047 Before After
VAERS Form:
Age:1.2
Sex:Female
Location:Minnesota
Vaccinated:1997-06-02
Onset:1997-06-09
Submitted:1997-06-10
Entered:1997-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0239E / 0 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 0754H / 2 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiovascular disorder, Chills, Congenital anomaly, Cyanosis, Pulmonary oedema, Pyrexia, Rash

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-06-09
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: NONE NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy results pending;
CDC 'Split Type':

Write-up: pt seen for well check 2JUN97;nl H & P;given vax & 9JUN97 devel fever & rash was treated symptomatically;pt was put down 8PM & checked 9PM; then @ 10PM was noted to be cold & blue;taken to ER unable to resusitate;


Changed on 9/14/2017

VAERS ID: 99047 Before After
VAERS Form:(blank) 1
Age:1.2
Sex:Female
Location:Minnesota
Vaccinated:1997-06-02
Onset:1997-06-09
Submitted:1997-06-10
Entered:1997-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0239E / 0 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0754H / 2 3 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiovascular disorder, Chills, Congenital anomaly, Cyanosis, Pulmonary oedema, Pyrexia, Rash

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-06-09
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: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy results pending;
CDC 'Split Type':

Write-up: pt seen for well check 2JUN97;nl H & P;given vax & 9JUN97 devel fever & rash was treated symptomatically;pt was put down 8PM & checked 9PM; then @ 10PM was noted to be cold & blue;taken to ER unable to resusitate;


Changed on 2/14/2018

VAERS ID: 99047 Before After
VAERS Form:1
Age:1.2
Sex:Female
Location:Minnesota
Vaccinated:1997-06-02
Onset:1997-06-09
Submitted:1997-06-10
Entered:1997-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0239E / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0754H / 3 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiovascular disorder, Chills, Congenital anomaly, Cyanosis, Pulmonary oedema, Pyrexia, Rash

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-06-09
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: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy results pending;
CDC 'Split Type':

Write-up: pt seen for well check 2JUN97;nl H & P;given vax & 9JUN97 devel fever & rash was treated symptomatically;pt was put down 8PM & checked 9PM; then @ 10PM was noted to be cold & blue;taken to ER unable to resusitate;


Changed on 6/14/2018

VAERS ID: 99047 Before After
VAERS Form:1
Age:1.2
Sex:Female
Location:Minnesota
Vaccinated:1997-06-02
Onset:1997-06-09
Submitted:1997-06-10
Entered:1997-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0239E / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0754H / 3 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiovascular disorder, Chills, Congenital anomaly, Cyanosis, Pulmonary oedema, Pyrexia, Rash

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-06-09
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: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy results pending;
CDC 'Split Type':

Write-up: pt seen for well check 2JUN97;nl H & P;given vax & 9JUN97 devel fever & rash was treated symptomatically;pt was put down 8PM & checked 9PM; then @ 10PM was noted to be cold & blue;taken to ER unable to resusitate;


Changed on 8/14/2018

VAERS ID: 99047 Before After
VAERS Form:1
Age:1.2
Sex:Female
Location:Minnesota
Vaccinated:1997-06-02
Onset:1997-06-09
Submitted:1997-06-10
Entered:1997-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0239E / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0754H / 3 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiovascular disorder, Chills, Congenital anomaly, Cyanosis, Pulmonary oedema, Pyrexia, Rash

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-06-09
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: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy results pending;
CDC 'Split Type':

Write-up: pt seen for well check 2JUN97;nl H & P;given vax & 9JUN97 devel fever & rash was treated symptomatically;pt was put down 8PM & checked 9PM; then @ 10PM was noted to be cold & blue;taken to ER unable to resusitate;


Changed on 9/14/2018

VAERS ID: 99047 Before After
VAERS Form:1
Age:1.2
Sex:Female
Location:Minnesota
Vaccinated:1997-06-02
Onset:1997-06-09
Submitted:1997-06-10
Entered:1997-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0239E / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0754H / 3 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiovascular disorder, Chills, Congenital anomaly, Cyanosis, Pulmonary oedema, Pyrexia, Rash

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-06-09
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: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy results pending;
CDC 'Split Type':

Write-up: pt seen for well check 2JUN97;nl H & P;given vax & 9JUN97 devel fever & rash was treated symptomatically;pt was put down 8PM & checked 9PM; then @ 10PM was noted to be cold & blue;taken to ER unable to resusitate;


Changed on 10/14/2018

VAERS ID: 99047 Before After
VAERS Form:1
Age:1.2
Sex:Female
Location:Minnesota
Vaccinated:1997-06-02
Onset:1997-06-09
Submitted:1997-06-10
Entered:1997-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0239E / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0754H / 3 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiovascular disorder, Chills, Congenital anomaly, Cyanosis, Pulmonary oedema, Pyrexia, Rash

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-06-09
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: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy results pending;
CDC 'Split Type':

Write-up: pt seen for well check 2JUN97;nl H & P;given vax & 9JUN97 devel fever & rash was treated symptomatically;pt was put down 8PM & checked 9PM; then @ 10PM was noted to be cold & blue;taken to ER unable to resusitate;

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=99047&WAYBACKHISTORY=ON


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