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History of Changes from the VAERS Wayback Machine |
VAERS ID: | 239566 |
VAERS Form: | |
Age: | |
Sex: | Male |
Location: | Unknown |
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: | 2005-06-06 |
Entered: | 2005-06-10 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. | - / - | - / - |
Administered by: Other Purchased by: Unknown
Symptoms: REACT UNEVAL
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: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type':
Write-up: Information has been received from a consumer concerning her son who was vaccinated with measles virus vaccine live (Enders-Edmonston) (+) mumps virus vaccine live (Jeryl Lynn) (+) rubella virus vaccine live (Wistar RA 27/3). Subsequently, her son passed"away. Medical attention was sought. No product quality complaint involved. No further information is available.
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: | 2005-06-06 |
Entered: | 2005-06-10 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. | - / - | - / - |
Administered by: Other Purchased by: Unknown Other
Symptoms: Unevaluable event, REACT UNEVAL
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: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': (blank) WAES0506USA00124
Write-up: Information has been received from a consumer concerning her son who was vaccinated with measles virus vaccine live (Enders-Edmonston) (+) mumps virus vaccine live (Jeryl Lynn) (+) rubella virus vaccine live (Wistar RA 27/3). Subsequently, her son passed"away. passed away. Medical attention was sought. No product quality complaint involved. No further information is available.
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: | 2005-06-06 |
Entered: | 2005-06-10 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. | - / - UNK | - / - |
Administered by: Other Purchased by: Other
Symptoms: Unevaluable event
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: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES0506USA00124
Write-up: Information has been received from a consumer concerning her son who was vaccinated with measles virus vaccine live (Enders-Edmonston) (+) mumps virus vaccine live (Jeryl Lynn) (+) rubella virus vaccine live (Wistar RA 27/3). Subsequently, her son passed away. Medical attention was sought. No product quality complaint involved. No further information is available.
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: | 2005-06-06 |
Entered: | 2005-06-10 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. | - / UNK | - / - |
Administered by: Other Purchased by: Other
Symptoms: Unevaluable event
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: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES0506USA00124
Write-up: Information has been received from a consumer concerning her son who was vaccinated with measles virus vaccine live (Enders-Edmonston) (+) mumps virus vaccine live (Jeryl Lynn) (+) rubella virus vaccine live (Wistar RA 27/3). Subsequently, her son passed away. Medical attention was sought. No product quality complaint involved. No further information is available.
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: | 2005-06-06 |
Entered: | 2005-06-10 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. | - / UNK | - / - |
Administered by: Other Purchased by: Other
Symptoms: Unevaluable event
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: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES0506USA00124
Write-up: Information has been received from a consumer concerning her son who was vaccinated with measles virus vaccine live (Enders-Edmonston) (+) mumps virus vaccine live (Jeryl Lynn) (+) rubella virus vaccine live (Wistar RA 27/3). Subsequently, her son passed away. Medical attention was sought. No product quality complaint involved. No further information is available.
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: | 2005-06-06 |
Entered: | 2005-06-10 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. | - / UNK | - / - |
Administered by: Other Purchased by: Other
Symptoms: Unevaluable event
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: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES0506USA00124
Write-up: Information has been received from a consumer concerning her son who was vaccinated with measles virus vaccine live (Enders-Edmonston) (+) mumps virus vaccine live (Jeryl Lynn) (+) rubella virus vaccine live (Wistar RA 27/3). Subsequently, her son passed away. Medical attention was sought. No product quality complaint involved. No further information is available.
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: | 2005-06-06 |
Entered: | 2005-06-10 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. | - / UNK | - / - |
Administered by: Other Purchased by: Other
Symptoms: Unevaluable event
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: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES0506USA00124
Write-up: Information has been received from a consumer concerning her son who was vaccinated with measles virus vaccine live (Enders-Edmonston) (+) mumps virus vaccine live (Jeryl Lynn) (+) rubella virus vaccine live (Wistar RA 27/3). Subsequently, her son passed away. Medical attention was sought. No product quality complaint involved. No further information is available.
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: | 2005-06-06 |
Entered: | 2005-06-10 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. | - / UNK | - / - |
Administered by: Other Purchased by: Other
Symptoms: Unevaluable event
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: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES0506USA00124
Write-up: Information has been received from a consumer concerning her son who was vaccinated with measles virus vaccine live (Enders-Edmonston) (+) mumps virus vaccine live (Jeryl Lynn) (+) rubella virus vaccine live (Wistar RA 27/3). Subsequently, her son passed away. Medical attention was sought. No product quality complaint involved. No further information is available.
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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=239566&WAYBACKHISTORY=ON
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