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This is VAERS ID 248538

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 248538
VAERS Form:
Age:1.1
Sex:Male
Location:Pennsylvania
Vaccinated:2005-11-22
Onset:2005-11-23
Submitted:2005-11-25
Entered:2005-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (FLUZONE) / AVENTIS PASTEUR, U1787DA / 0 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1072P / 0 - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0418R / 0 - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: APNEA, MALAISE, PHARYNGITIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2005-11-24
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient became ill within 24 hours of vaccine administration with URI symptoms, He was then discovered by parents to have stopped breathing.


Changed on 12/8/2009

VAERS ID: 248538 Before After
VAERS Form:
Age:1.1
Sex:Male
Location:Pennsylvania
Vaccinated:2005-11-22
Onset:2005-11-23
Submitted:2005-11-25
Entered:2005-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (FLUZONE) INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR, SANOFI PASTEUR U1787DA / 0 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1072P / 0 - / -
VARCEL: VARICELLA (VARIVAX) VARICELLA (VARIVAX) / MERCK & CO. INC. 0418R / 0 - / -

Administered by: Unknown      Purchased by: Unknown Public
Symptoms: Apnoea, Malaise, Upper respiratory tract infection, APNEA, MALAISE, PHARYNGITIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2005-11-24
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient became ill within 24 hours of vaccine administration with URI symptoms, He was then discovered by parents to have stopped breathing.


Changed on 7/7/2013

VAERS ID: 248538 Before After
VAERS Form:
Age:1.1
Sex:Male
Location:Pennsylvania
Vaccinated:2005-11-22
Onset:2005-11-23
Submitted:2005-11-25
Entered:2005-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U1787DA / 0 - / -
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U1787DA / 0 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1072P / 0 - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0418R / 0 - / -

Administered by: Unknown      Purchased by: Public
Symptoms: Apnoea, Malaise, Upper respiratory tract infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2005-11-24
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient became ill within 24 hours of vaccine administration with URI symptoms, He was then discovered by parents to have stopped breathing.


Changed on 2/14/2017

VAERS ID: 248538 Before After
VAERS Form:
Age:1.1 1.07
Sex:Male
Location:Pennsylvania
Vaccinated:2005-11-22
Onset:2005-11-23
Submitted:2005-11-25
Entered:2005-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U1787DA / 0 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1072P / 0 - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0418R / 0 - / -

Administered by: Unknown      Purchased by: Public
Symptoms: Apnoea, Malaise, Upper respiratory tract infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2005-11-24
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient became ill within 24 hours of vaccine administration with URI symptoms, He was then discovered by parents to have stopped breathing.


Changed on 9/14/2017

VAERS ID: 248538 Before After
VAERS Form:(blank) 1
Age:1.07
Sex:Male
Location:Pennsylvania
Vaccinated:2005-11-22
Onset:2005-11-23
Submitted:2005-11-25
Entered:2005-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U1787DA / 0 1 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1072P / 0 1 - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0418R / 0 1 - / -

Administered by: Unknown      Purchased by: Public
Symptoms: Apnoea, Malaise, Upper respiratory tract infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2005-11-24
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient became ill within 24 hours of vaccine administration with URI symptoms, He was then discovered by parents to have stopped breathing.


Changed on 2/14/2018

VAERS ID: 248538 Before After
VAERS Form:1
Age:1.07
Sex:Male
Location:Pennsylvania
Vaccinated:2005-11-22
Onset:2005-11-23
Submitted:2005-11-25
Entered:2005-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U1787DA / 1 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1072P / 1 - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0418R / 1 - / -

Administered by: Unknown      Purchased by: Public
Symptoms: Apnoea, Malaise, Upper respiratory tract infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2005-11-24
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient became ill within 24 hours of vaccine administration with URI symptoms, He was then discovered by parents to have stopped breathing.


Changed on 6/14/2018

VAERS ID: 248538 Before After
VAERS Form:1
Age:1.07
Sex:Male
Location:Pennsylvania
Vaccinated:2005-11-22
Onset:2005-11-23
Submitted:2005-11-25
Entered:2005-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U1787DA / 1 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1072P / 1 - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0418R / 1 - / -

Administered by: Unknown      Purchased by: Public
Symptoms: Apnoea, Malaise, Upper respiratory tract infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2005-11-24
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient became ill within 24 hours of vaccine administration with URI symptoms, He was then discovered by parents to have stopped breathing.


Changed on 8/14/2018

VAERS ID: 248538 Before After
VAERS Form:1
Age:1.07
Sex:Male
Location:Pennsylvania
Vaccinated:2005-11-22
Onset:2005-11-23
Submitted:2005-11-25
Entered:2005-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U1787DA / 1 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1072P / 1 - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0418R / 1 - / -

Administered by: Unknown      Purchased by: Public
Symptoms: Apnoea, Malaise, Upper respiratory tract infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2005-11-24
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient became ill within 24 hours of vaccine administration with URI symptoms, He was then discovered by parents to have stopped breathing.


Changed on 9/14/2018

VAERS ID: 248538 Before After
VAERS Form:1
Age:1.07
Sex:Male
Location:Pennsylvania
Vaccinated:2005-11-22
Onset:2005-11-23
Submitted:2005-11-25
Entered:2005-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U1787DA / 1 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1072P / 1 - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0418R / 1 - / -

Administered by: Unknown      Purchased by: Public
Symptoms: Apnoea, Malaise, Upper respiratory tract infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2005-11-24
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient became ill within 24 hours of vaccine administration with URI symptoms, He was then discovered by parents to have stopped breathing.


Changed on 10/14/2018

VAERS ID: 248538 Before After
VAERS Form:1
Age:1.07
Sex:Male
Location:Pennsylvania
Vaccinated:2005-11-22
Onset:2005-11-23
Submitted:2005-11-25
Entered:2005-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U1787DA / 1 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1072P / 1 - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0418R / 1 - / -

Administered by: Unknown      Purchased by: Public
Symptoms: Apnoea, Malaise, Upper respiratory tract infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2005-11-24
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient became ill within 24 hours of vaccine administration with URI symptoms, He was then discovered by parents to have stopped breathing.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=248538&WAYBACKHISTORY=ON


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