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This is VAERS ID 250504

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 250504
VAERS Form:
Age:1.0
Sex:Male
Location:Virginia
Vaccinated:2005-10-25
Onset:2005-10-30
Submitted:0000-00-00
Entered:2006-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (FLUZONE) / AVENTIS PASTEUR, INC. U1762AA / - - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0935P / - LL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0195P / - RL / -

Administered by: Private      Purchased by: Unknown
Symptoms: Irritability, Pyrexia, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2005-10-30
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Child reportedly fussy, irritable and with mild fever during interval between vaccines and death.


Changed on 12/8/2009

VAERS ID: 250504 Before After
VAERS Form:
Age:1.0
Sex:Male
Location:Virginia
Vaccinated:2005-10-25
Onset:2005-10-30
Submitted:0000-00-00
Entered:2006-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (FLUZONE) INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR, INC. SANOFI PASTEUR U1762AA / - - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0935P / - LL / -
VARCEL: VARICELLA (VARIVAX) VARICELLA (VARIVAX) / MERCK & CO. INC. 0195P / - RL / -

Administered by: Private      Purchased by: Unknown Other
Symptoms: Irritability, Pyrexia, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2005-10-30
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Child reportedly fussy, irritable and with mild fever during interval between vaccines and death. 2/27/06 Received autopsy report which reveals patient''s COD was Sudden Unexpected Death in Childhood/ss No new information found in medical records from PCP.


Changed on 7/7/2013

VAERS ID: 250504 Before After
VAERS Form:
Age:1.0
Sex:Male
Location:Virginia
Vaccinated:2005-10-25
Onset:2005-10-30
Submitted:0000-00-00
Entered:2006-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U1762AA / - - / -
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U1762AA / - - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0935P / - LL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0195P / - RL / -

Administered by: Private      Purchased by: Other
Symptoms: Irritability, Pyrexia, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2005-10-30
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Child reportedly fussy, irritable and with mild fever during interval between vaccines and death. 2/27/06 Received autopsy report which reveals patient''s COD was Sudden Unexpected Death in Childhood/ss No new information found in medical records from PCP.


Changed on 2/14/2017

VAERS ID: 250504 Before After
VAERS Form:
Age:1.0 1.02
Sex:Male
Location:Virginia
Vaccinated:2005-10-25
Onset:2005-10-30
Submitted:0000-00-00
Entered:2006-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U1762AA / - - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0935P / - LL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0195P / - RL / -

Administered by: Private      Purchased by: Other
Symptoms: Irritability, Pyrexia, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2005-10-30
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Child reportedly fussy, irritable and with mild fever during interval between vaccines and death. 2/27/06 Received autopsy report which reveals patient''s COD was Sudden Unexpected Death in Childhood/ss No new information found in medical records from PCP.


Changed on 9/14/2017

VAERS ID: 250504 Before After
VAERS Form:(blank) 1
Age:1.02
Sex:Male
Location:Virginia
Vaccinated:2005-10-25
Onset:2005-10-30
Submitted:0000-00-00
Entered:2006-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U1762AA / - UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0935P / - UNK LL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0195P / - UNK RL / -

Administered by: Private      Purchased by: Other
Symptoms: Irritability, Pyrexia, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2005-10-30
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Child reportedly fussy, irritable and with mild fever during interval between vaccines and death. 2/27/06 Received autopsy report which reveals patient''s COD was Sudden Unexpected Death in Childhood/ss No new information found in medical records from PCP.


Changed on 2/14/2018

VAERS ID: 250504 Before After
VAERS Form:1
Age:1.02
Sex:Male
Location:Virginia
Vaccinated:2005-10-25
Onset:2005-10-30
Submitted:0000-00-00
Entered:2006-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U1762AA / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0935P / UNK LL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0195P / UNK RL / -

Administered by: Private      Purchased by: Other
Symptoms: Irritability, Pyrexia, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2005-10-30
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Child reportedly fussy, irritable and with mild fever during interval between vaccines and death. 2/27/06 Received autopsy report which reveals patient''s COD was Sudden Unexpected Death in Childhood/ss No new information found in medical records from PCP.


Changed on 6/14/2018

VAERS ID: 250504 Before After
VAERS Form:1
Age:1.02
Sex:Male
Location:Virginia
Vaccinated:2005-10-25
Onset:2005-10-30
Submitted:0000-00-00
Entered:2006-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U1762AA / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0935P / UNK LL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0195P / UNK RL / -

Administered by: Private      Purchased by: Other
Symptoms: Irritability, Pyrexia, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2005-10-30
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Child reportedly fussy, irritable and with mild fever during interval between vaccines and death. 2/27/06 Received autopsy report which reveals patient''s COD was Sudden Unexpected Death in Childhood/ss No new information found in medical records from PCP.


Changed on 8/14/2018

VAERS ID: 250504 Before After
VAERS Form:1
Age:1.02
Sex:Male
Location:Virginia
Vaccinated:2005-10-25
Onset:2005-10-30
Submitted:0000-00-00
Entered:2006-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U1762AA / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0935P / UNK LL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0195P / UNK RL / -

Administered by: Private      Purchased by: Other
Symptoms: Irritability, Pyrexia, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2005-10-30
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Child reportedly fussy, irritable and with mild fever during interval between vaccines and death. 2/27/06 Received autopsy report which reveals patient''s COD was Sudden Unexpected Death in Childhood/ss No new information found in medical records from PCP.


Changed on 9/14/2018

VAERS ID: 250504 Before After
VAERS Form:1
Age:1.02
Sex:Male
Location:Virginia
Vaccinated:2005-10-25
Onset:2005-10-30
Submitted:0000-00-00
Entered:2006-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U1762AA / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0935P / UNK LL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0195P / UNK RL / -

Administered by: Private      Purchased by: Other
Symptoms: Irritability, Pyrexia, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2005-10-30
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Child reportedly fussy, irritable and with mild fever during interval between vaccines and death. 2/27/06 Received autopsy report which reveals patient''s COD was Sudden Unexpected Death in Childhood/ss No new information found in medical records from PCP.


Changed on 10/14/2018

VAERS ID: 250504 Before After
VAERS Form:1
Age:1.02
Sex:Male
Location:Virginia
Vaccinated:2005-10-25
Onset:2005-10-30
Submitted:0000-00-00
Entered:2006-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U1762AA / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0935P / UNK LL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0195P / UNK RL / -

Administered by: Private      Purchased by: Other
Symptoms: Irritability, Pyrexia, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2005-10-30
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Child reportedly fussy, irritable and with mild fever during interval between vaccines and death. 2/27/06 Received autopsy report which reveals patient''s COD was Sudden Unexpected Death in Childhood/ss No new information found in medical records from PCP.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=250504&WAYBACKHISTORY=ON


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