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This is VAERS ID 239904

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 239904
VAERS Form:
Age:2.0
Sex:Male
Location:Ohio
Vaccinated:2005-05-20
Onset:2005-05-28
Submitted:2005-06-13
Entered:2005-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0608P / - - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0652P / - - / -

Administered by: Private      Purchased by: Unknown
Symptoms: FEVER

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: UNK
Current Illness: Trach feeding tube, BDP
Preexisting Conditions: Immune system disorder; prematurity; hospitalization
Allergies:
Diagnostic Lab Data: Body temp high temperatures
CDC 'Split Type':

Write-up: Information has been received from a RN concerning a 21 month old immunocompromised male who was vaccinated with a dose of varicella virus vaccine live. Concomitant vaccination included a dose of measles virus vaccine live (Enders-Edmonston) (+) mumps vi"rus vaccine live (Jeryl Lynn) (+) rubella virus vaccine live (Wistar RA 27/3). Subsequently the pt was hospitalized and died two weeks later (not further specified). A product quality complaint was not involved. Additional information was received from th


Changed on 12/8/2009

VAERS ID: 239904 Before After
VAERS Form:
Age:2.0
Sex:Male
Location:Ohio
Vaccinated:2005-05-20
Onset:2005-05-28
Submitted:2005-06-13
Entered:2005-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0608P / - - / -
VARCEL: VARICELLA (VARIVAX) VARICELLA (VARIVAX) / MERCK & CO. INC. 0652P / - - / -

Administered by: Private      Purchased by: Unknown Private
Symptoms: Cardio-respiratory arrest, Cardiomyopathy, Pneumonia, Premature baby, Pyrexia, FEVER

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00 2005-05-29
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: UNK Albnuterol, Flovent, Zantac, Laser, KCL, O2
Current Illness: Trach feeding tube, BDP
Preexisting Conditions: Immune system disorder; prematurity; hospitalization
Allergies:
Diagnostic Lab Data: Body temp high temperatures
CDC 'Split Type': (blank) WAES0506USA00683

Write-up: Information has been received from a RN concerning a 21 month old immunocompromised male who was vaccinated with a dose of varicella virus vaccine live. Concomitant vaccination included a dose of measles virus vaccine live (Enders-Edmonston) (+) mumps vi"rus virus vaccine live (Jeryl Lynn) (+) rubella virus vaccine live (Wistar RA 27/3). Subsequently the pt was hospitalized and died two weeks later (not further specified). A product quality complaint was not involved. Additional information was received from th the RN who reported that the pt had a lot of problems. The pt was hospitalized until he was 20 months old with a diagnosis of extreme prematurity among other problems. The nurse did not know the cause of death but did indicate that high temperatures were involved. Additional information was received from a health professional at a pediatricians office who reported that the pt''s demise had nothing to do with the vaccinations. The pt''s experience was considered to be immediately life threatening and disabling by the RN. Additional information has been requested. Received Autopsy Report which revealed COD as acute bronchopneumonia, bronchopulmonary dysplasia, dilated cardiomyopathy & prematurity.


Changed on 9/14/2017

VAERS ID: 239904 Before After
VAERS Form:(blank) 1
Age:2.0
Sex:Male
Location:Ohio
Vaccinated:2005-05-20
Onset:2005-05-28
Submitted:2005-06-13
Entered:2005-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0608P / - UNK - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0652P / - UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Cardio-respiratory arrest, Cardiomyopathy, Pneumonia, Premature baby, Pyrexia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2005-05-29
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Albnuterol, Flovent, Zantac, Laser, KCL, O2
Current Illness: Trach feeding tube, BDP
Preexisting Conditions: Immune system disorder; prematurity; hospitalization
Allergies:
Diagnostic Lab Data: Body temp high temperatures
CDC 'Split Type': WAES0506USA00683

Write-up: Information has been received from a RN concerning a 21 month old immunocompromised male who was vaccinated with a dose of varicella virus vaccine live. Concomitant vaccination included a dose of measles virus vaccine live (Enders-Edmonston) (+) mumps virus vaccine live (Jeryl Lynn) (+) rubella virus vaccine live (Wistar RA 27/3). Subsequently the pt was hospitalized and died two weeks later (not further specified). A product quality complaint was not involved. Additional information was received from the RN who reported that the pt had a lot of problems. The pt was hospitalized until he was 20 months old with a diagnosis of extreme prematurity among other problems. The nurse did not know the cause of death but did indicate that high temperatures were involved. Additional information was received from a health professional at a pediatricians office who reported that the pt''s demise had nothing to do with the vaccinations. The pt''s experience was considered to be immediately life threatening and disabling by the RN. Additional information has been requested. Received Autopsy Report which revealed COD as acute bronchopneumonia, bronchopulmonary dysplasia, dilated cardiomyopathy & prematurity.


Changed on 2/14/2018

VAERS ID: 239904 Before After
VAERS Form:1
Age:2.0
Sex:Male
Location:Ohio
Vaccinated:2005-05-20
Onset:2005-05-28
Submitted:2005-06-13
Entered:2005-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0608P / UNK - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0652P / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Cardio-respiratory arrest, Cardiomyopathy, Pneumonia, Premature baby, Pyrexia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2005-05-29
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Albnuterol, Flovent, Zantac, Laser, KCL, O2
Current Illness: Trach feeding tube, BDP
Preexisting Conditions: Immune system disorder; prematurity; hospitalization
Allergies:
Diagnostic Lab Data: Body temp high temperatures
CDC 'Split Type': WAES0506USA00683

Write-up: Information has been received from a RN concerning a 21 month old immunocompromised male who was vaccinated with a dose of varicella virus vaccine live. Concomitant vaccination included a dose of measles virus vaccine live (Enders-Edmonston) (+) mumps virus vaccine live (Jeryl Lynn) (+) rubella virus vaccine live (Wistar RA 27/3). Subsequently the pt was hospitalized and died two weeks later (not further specified). A product quality complaint was not involved. Additional information was received from the RN who reported that the pt had a lot of problems. The pt was hospitalized until he was 20 months old with a diagnosis of extreme prematurity among other problems. The nurse did not know the cause of death but did indicate that high temperatures were involved. Additional information was received from a health professional at a pediatricians office who reported that the pt''s demise had nothing to do with the vaccinations. The pt''s experience was considered to be immediately life threatening and disabling by the RN. Additional information has been requested. Received Autopsy Report which revealed COD as acute bronchopneumonia, bronchopulmonary dysplasia, dilated cardiomyopathy & prematurity.


Changed on 6/14/2018

VAERS ID: 239904 Before After
VAERS Form:1
Age:2.0
Sex:Male
Location:Ohio
Vaccinated:2005-05-20
Onset:2005-05-28
Submitted:2005-06-13
Entered:2005-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0608P / UNK - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0652P / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Cardio-respiratory arrest, Cardiomyopathy, Pneumonia, Premature baby, Pyrexia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2005-05-29
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Albnuterol, Flovent, Zantac, Laser, KCL, O2
Current Illness: Trach feeding tube, BDP
Preexisting Conditions: Immune system disorder; prematurity; hospitalization
Allergies:
Diagnostic Lab Data: Body temp high temperatures
CDC 'Split Type': WAES0506USA00683

Write-up: Information has been received from a RN concerning a 21 month old immunocompromised male who was vaccinated with a dose of varicella virus vaccine live. Concomitant vaccination included a dose of measles virus vaccine live (Enders-Edmonston) (+) mumps virus vaccine live (Jeryl Lynn) (+) rubella virus vaccine live (Wistar RA 27/3). Subsequently the pt was hospitalized and died two weeks later (not further specified). A product quality complaint was not involved. Additional information was received from the RN who reported that the pt had a lot of problems. The pt was hospitalized until he was 20 months old with a diagnosis of extreme prematurity among other problems. The nurse did not know the cause of death but did indicate that high temperatures were involved. Additional information was received from a health professional at a pediatricians office who reported that the pt''s demise had nothing to do with the vaccinations. The pt''s experience was considered to be immediately life threatening and disabling by the RN. Additional information has been requested. Received Autopsy Report which revealed COD as acute bronchopneumonia, bronchopulmonary dysplasia, dilated cardiomyopathy & prematurity.


Changed on 8/14/2018

VAERS ID: 239904 Before After
VAERS Form:1
Age:2.0
Sex:Male
Location:Ohio
Vaccinated:2005-05-20
Onset:2005-05-28
Submitted:2005-06-13
Entered:2005-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0608P / UNK - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0652P / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Cardio-respiratory arrest, Cardiomyopathy, Pneumonia, Premature baby, Pyrexia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2005-05-29
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Albnuterol, Flovent, Zantac, Laser, KCL, O2
Current Illness: Trach feeding tube, BDP
Preexisting Conditions: Immune system disorder; prematurity; hospitalization
Allergies:
Diagnostic Lab Data: Body temp high temperatures
CDC 'Split Type': WAES0506USA00683

Write-up: Information has been received from a RN concerning a 21 month old immunocompromised male who was vaccinated with a dose of varicella virus vaccine live. Concomitant vaccination included a dose of measles virus vaccine live (Enders-Edmonston) (+) mumps virus vaccine live (Jeryl Lynn) (+) rubella virus vaccine live (Wistar RA 27/3). Subsequently the pt was hospitalized and died two weeks later (not further specified). A product quality complaint was not involved. Additional information was received from the RN who reported that the pt had a lot of problems. The pt was hospitalized until he was 20 months old with a diagnosis of extreme prematurity among other problems. The nurse did not know the cause of death but did indicate that high temperatures were involved. Additional information was received from a health professional at a pediatricians office who reported that the pt''s demise had nothing to do with the vaccinations. The pt''s experience was considered to be immediately life threatening and disabling by the RN. Additional information has been requested. Received Autopsy Report which revealed COD as acute bronchopneumonia, bronchopulmonary dysplasia, dilated cardiomyopathy & prematurity.


Changed on 9/14/2018

VAERS ID: 239904 Before After
VAERS Form:1
Age:2.0
Sex:Male
Location:Ohio
Vaccinated:2005-05-20
Onset:2005-05-28
Submitted:2005-06-13
Entered:2005-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0608P / UNK - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0652P / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Cardio-respiratory arrest, Cardiomyopathy, Pneumonia, Premature baby, Pyrexia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2005-05-29
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Albnuterol, Flovent, Zantac, Laser, KCL, O2
Current Illness: Trach feeding tube, BDP
Preexisting Conditions: Immune system disorder; prematurity; hospitalization
Allergies:
Diagnostic Lab Data: Body temp high temperatures
CDC 'Split Type': WAES0506USA00683

Write-up: Information has been received from a RN concerning a 21 month old immunocompromised male who was vaccinated with a dose of varicella virus vaccine live. Concomitant vaccination included a dose of measles virus vaccine live (Enders-Edmonston) (+) mumps virus vaccine live (Jeryl Lynn) (+) rubella virus vaccine live (Wistar RA 27/3). Subsequently the pt was hospitalized and died two weeks later (not further specified). A product quality complaint was not involved. Additional information was received from the RN who reported that the pt had a lot of problems. The pt was hospitalized until he was 20 months old with a diagnosis of extreme prematurity among other problems. The nurse did not know the cause of death but did indicate that high temperatures were involved. Additional information was received from a health professional at a pediatricians office who reported that the pt''s demise had nothing to do with the vaccinations. The pt''s experience was considered to be immediately life threatening and disabling by the RN. Additional information has been requested. Received Autopsy Report which revealed COD as acute bronchopneumonia, bronchopulmonary dysplasia, dilated cardiomyopathy & prematurity.


Changed on 10/14/2018

VAERS ID: 239904 Before After
VAERS Form:1
Age:2.0
Sex:Male
Location:Ohio
Vaccinated:2005-05-20
Onset:2005-05-28
Submitted:2005-06-13
Entered:2005-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0608P / UNK - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0652P / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Cardio-respiratory arrest, Cardiomyopathy, Pneumonia, Premature baby, Pyrexia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2005-05-29
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Albnuterol, Flovent, Zantac, Laser, KCL, O2
Current Illness: Trach feeding tube, BDP
Preexisting Conditions: Immune system disorder; prematurity; hospitalization
Allergies:
Diagnostic Lab Data: Body temp high temperatures
CDC 'Split Type': WAES0506USA00683

Write-up: Information has been received from a RN concerning a 21 month old immunocompromised male who was vaccinated with a dose of varicella virus vaccine live. Concomitant vaccination included a dose of measles virus vaccine live (Enders-Edmonston) (+) mumps virus vaccine live (Jeryl Lynn) (+) rubella virus vaccine live (Wistar RA 27/3). Subsequently the pt was hospitalized and died two weeks later (not further specified). A product quality complaint was not involved. Additional information was received from the RN who reported that the pt had a lot of problems. The pt was hospitalized until he was 20 months old with a diagnosis of extreme prematurity among other problems. The nurse did not know the cause of death but did indicate that high temperatures were involved. Additional information was received from a health professional at a pediatricians office who reported that the pt''s demise had nothing to do with the vaccinations. The pt''s experience was considered to be immediately life threatening and disabling by the RN. Additional information has been requested. Received Autopsy Report which revealed COD as acute bronchopneumonia, bronchopulmonary dysplasia, dilated cardiomyopathy & prematurity.

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