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This is VAERS ID 221579

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History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2004

VAERS ID: 221579
VAERS Form:
Age:13.0
Sex:Male
Location:Washington
Vaccinated:1971-11-12
Onset:1971-11-13
Submitted:2004-05-24
Entered:2004-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (UNKNOWN MFR) / UNKNOWN MFR - / - - / -

Administered by: Private      Purchased by: Unknown
Symptoms: REACT UNEVAL

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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:
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Alien abduction, turning green, super-strength, rage attacks


Changed on 12/8/2009

VAERS ID: 221579 Before After
VAERS Form:
Age:13.0
Sex:Male
Location:Washington
Vaccinated:1971-11-12
Onset:1971-11-13
Submitted:2004-05-24
Entered:2004-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (UNKNOWN MFR) MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MFR UNKNOWN MANUFACTURER - / - - / -

Administered by: Private      Purchased by: Unknown Private
Symptoms: Unevaluable event, REACT UNEVAL

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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:
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Alien abduction, turning green, super-strength, rage attacks


Changed on 9/14/2017

VAERS ID: 221579 Before After
VAERS Form:(blank) 1
Age:13.0
Sex:Male
Location:Washington
Vaccinated:1971-11-12
Onset:1971-11-13
Submitted:2004-05-24
Entered:2004-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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:
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Alien abduction, turning green, super-strength, rage attacks


Changed on 2/14/2018

VAERS ID: 221579 Before After
VAERS Form:1
Age:13.0
Sex:Male
Location:Washington
Vaccinated:1971-11-12
Onset:1971-11-13
Submitted:2004-05-24
Entered:2004-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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:
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Alien abduction, turning green, super-strength, rage attacks


Changed on 6/14/2018

VAERS ID: 221579 Before After
VAERS Form:1
Age:13.0
Sex:Male
Location:Washington
Vaccinated:1971-11-12
Onset:1971-11-13
Submitted:2004-05-24
Entered:2004-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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:
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Alien abduction, turning green, super-strength, rage attacks


Changed on 8/14/2018

VAERS ID: 221579 Before After
VAERS Form:1
Age:13.0
Sex:Male
Location:Washington
Vaccinated:1971-11-12
Onset:1971-11-13
Submitted:2004-05-24
Entered:2004-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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:
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Alien abduction, turning green, super-strength, rage attacks


Changed on 9/14/2018

VAERS ID: 221579 Before After
VAERS Form:1
Age:13.0
Sex:Male
Location:Washington
Vaccinated:1971-11-12
Onset:1971-11-13
Submitted:2004-05-24
Entered:2004-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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:
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Alien abduction, turning green, super-strength, rage attacks


Changed on 10/14/2018

VAERS ID: 221579 Before After
VAERS Form:1
Age:13.0
Sex:Male
Location:Washington
Vaccinated:1971-11-12
Onset:1971-11-13
Submitted:2004-05-24
Entered:2004-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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:
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Alien abduction, turning green, super-strength, rage attacks


Changed on 12/10/2020

VAERS ID: 221579 Before After
VAERS Form:1
Age:13.0
Sex:Male
Location:Washington Oregon
Vaccinated:1971-11-12
Onset:1971-11-13
Submitted:2004-05-24
Entered:2004-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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:
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Alien abduction, turning green, super-strength, rage attacks


Changed on 12/24/2020

VAERS ID: 221579 Before After
VAERS Form:1
Age:13.0
Sex:Male
Location:Oregon
Vaccinated:1971-11-12
Onset:1971-11-13
Submitted:2004-05-24
Entered:2004-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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:
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Alien abduction, turning green, super-strength, rage attacks


Changed on 12/30/2020

VAERS ID: 221579 Before After
VAERS Form:1
Age:13.0
Sex:Male
Location:Oregon
Vaccinated:1971-11-12
Onset:1971-11-13
Submitted:2004-05-24
Entered:2004-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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:
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Alien abduction, turning green, super-strength, rage attacks


Changed on 5/7/2021

VAERS ID: 221579 Before After
VAERS Form:1
Age:13.0
Sex:Male
Location:Oregon
Vaccinated:1971-11-12
Onset:1971-11-13
Submitted:2004-05-24
Entered:2004-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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:
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Alien abduction, turning green, super-strength, rage attacks


Changed on 5/21/2021

VAERS ID: 221579 Before After
VAERS Form:1
Age:13.0
Sex:Male
Location:Oregon
Vaccinated:1971-11-12
Onset:1971-11-13
Submitted:2004-05-24
Entered:2004-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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:
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Alien abduction, turning green, super-strength, rage attacks

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