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This is VAERS ID 259715

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 259715
VAERS Form:
Age:0.8
Sex:Female
Location:Missouri
Vaccinated:2006-05-12
Onset:2006-05-18
Submitted:2006-07-18
Entered:2006-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1163R / 2 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0381R / 0 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1110R / 0 RL / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Febrile convulsion, Pulmonary oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-05-18
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: unknown
Current Illness: postmortem=pneumonia
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data: unknown time vaccine administered is also unknown but filled in a time so could complete form.
CDC 'Split Type':

Write-up: Infant febrile morning of 5/18/2006 around 5:30 a.m. No other S/S per parent. Parent administered tylenol. Midday infant began seizing, mom called 911, infant transported and later pronounced dead at hospital.


Changed on 12/8/2009

VAERS ID: 259715 Before After
VAERS Form:
Age:0.8
Sex:Female
Location:Missouri
Vaccinated:2006-05-12
Onset:2006-05-18
Submitted:2006-07-18
Entered:2006-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1163R / 2 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0381R / 0 RL / SC
VARCEL: VARICELLA (VARIVAX) VARICELLA (VARIVAX) / MERCK & CO. INC. 1110R / 0 RL / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Febrile convulsion, Pulmonary oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-05-18
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: unknown
Current Illness: postmortem=pneumonia
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data: unknown time vaccine administered is also unknown but filled in a time so could complete form.
CDC 'Split Type':

Write-up: Infant febrile morning of 5/18/2006 around 5:30 a.m. No other S/S per parent. Parent administered tylenol. Midday infant began seizing, mom called 911, infant transported and later pronounced dead at hospital. 7/19/06 Received death certificate which stated COD as pulmonary edema due to protracted febrile seizure. 7/28/06 Received tag-2 report from PCP. Family had moved to another state. Records accompanying report included vax records, Death Summary from ER & Autopsy Report. COD stated as non-cardiogenic pulmonary edema as the result of febrile seizures/ss


Changed on 2/14/2017

VAERS ID: 259715 Before After
VAERS Form:
Age:0.8 0.84
Sex:Female
Location:Missouri
Vaccinated:2006-05-12
Onset:2006-05-18
Submitted:2006-07-18
Entered:2006-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1163R / 2 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0381R / 0 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1110R / 0 RL / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Febrile convulsion, Pulmonary oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-05-18
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: unknown
Current Illness: postmortem=pneumonia
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data: unknown time vaccine administered is also unknown but filled in a time so could complete form.
CDC 'Split Type':

Write-up: Infant febrile morning of 5/18/2006 around 5:30 a.m. No other S/S per parent. Parent administered tylenol. Midday infant began seizing, mom called 911, infant transported and later pronounced dead at hospital. 7/19/06 Received death certificate which stated COD as pulmonary edema due to protracted febrile seizure. 7/28/06 Received tag-2 report from PCP. Family had moved to another state. Records accompanying report included vax records, Death Summary from ER & Autopsy Report. COD stated as non-cardiogenic pulmonary edema as the result of febrile seizures/ss


Changed on 9/14/2017

VAERS ID: 259715 Before After
VAERS Form:(blank) 1
Age:0.84
Sex:Female
Location:Missouri
Vaccinated:2006-05-12
Onset:2006-05-18
Submitted:2006-07-18
Entered:2006-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1163R / 2 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0381R / 0 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1110R / 0 1 RL / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Febrile convulsion, Pulmonary oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-05-18
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: unknown
Current Illness: postmortem=pneumonia
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data: unknown time vaccine administered is also unknown but filled in a time so could complete form.
CDC 'Split Type':

Write-up: Infant febrile morning of 5/18/2006 around 5:30 a.m. No other S/S per parent. Parent administered tylenol. Midday infant began seizing, mom called 911, infant transported and later pronounced dead at hospital. 7/19/06 Received death certificate which stated COD as pulmonary edema due to protracted febrile seizure. 7/28/06 Received tag-2 report from PCP. Family had moved to another state. Records accompanying report included vax records, Death Summary from ER & Autopsy Report. COD stated as non-cardiogenic pulmonary edema as the result of febrile seizures/ss


Changed on 2/14/2018

VAERS ID: 259715 Before After
VAERS Form:1
Age:0.84
Sex:Female
Location:Missouri
Vaccinated:2006-05-12
Onset:2006-05-18
Submitted:2006-07-18
Entered:2006-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1163R / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0381R / 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1110R / 1 RL / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Febrile convulsion, Pulmonary oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-05-18
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: unknown
Current Illness: postmortem=pneumonia
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data: unknown time vaccine administered is also unknown but filled in a time so could complete form.
CDC 'Split Type':

Write-up: Infant febrile morning of 5/18/2006 around 5:30 a.m. No other S/S per parent. Parent administered tylenol. Midday infant began seizing, mom called 911, infant transported and later pronounced dead at hospital. 7/19/06 Received death certificate which stated COD as pulmonary edema due to protracted febrile seizure. 7/28/06 Received tag-2 report from PCP. Family had moved to another state. Records accompanying report included vax records, Death Summary from ER & Autopsy Report. COD stated as non-cardiogenic pulmonary edema as the result of febrile seizures/ss


Changed on 6/14/2018

VAERS ID: 259715 Before After
VAERS Form:1
Age:0.84
Sex:Female
Location:Missouri
Vaccinated:2006-05-12
Onset:2006-05-18
Submitted:2006-07-18
Entered:2006-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1163R / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0381R / 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1110R / 1 RL / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Febrile convulsion, Pulmonary oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-05-18
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: unknown
Current Illness: postmortem=pneumonia
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data: unknown time vaccine administered is also unknown but filled in a time so could complete form.
CDC 'Split Type':

Write-up: Infant febrile morning of 5/18/2006 around 5:30 a.m. No other S/S per parent. Parent administered tylenol. Midday infant began seizing, mom called 911, infant transported and later pronounced dead at hospital. 7/19/06 Received death certificate which stated COD as pulmonary edema due to protracted febrile seizure. 7/28/06 Received tag-2 report from PCP. Family had moved to another state. Records accompanying report included vax records, Death Summary from ER & Autopsy Report. COD stated as non-cardiogenic pulmonary edema as the result of febrile seizures/ss


Changed on 8/14/2018

VAERS ID: 259715 Before After
VAERS Form:1
Age:0.84
Sex:Female
Location:Missouri
Vaccinated:2006-05-12
Onset:2006-05-18
Submitted:2006-07-18
Entered:2006-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1163R / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0381R / 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1110R / 1 RL / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Febrile convulsion, Pulmonary oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-05-18
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: unknown
Current Illness: postmortem=pneumonia
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data: unknown time vaccine administered is also unknown but filled in a time so could complete form.
CDC 'Split Type':

Write-up: Infant febrile morning of 5/18/2006 around 5:30 a.m. No other S/S per parent. Parent administered tylenol. Midday infant began seizing, mom called 911, infant transported and later pronounced dead at hospital. 7/19/06 Received death certificate which stated COD as pulmonary edema due to protracted febrile seizure. 7/28/06 Received tag-2 report from PCP. Family had moved to another state. Records accompanying report included vax records, Death Summary from ER & Autopsy Report. COD stated as non-cardiogenic pulmonary edema as the result of febrile seizures/ss


Changed on 9/14/2018

VAERS ID: 259715 Before After
VAERS Form:1
Age:0.84
Sex:Female
Location:Missouri
Vaccinated:2006-05-12
Onset:2006-05-18
Submitted:2006-07-18
Entered:2006-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1163R / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0381R / 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1110R / 1 RL / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Febrile convulsion, Pulmonary oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-05-18
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: unknown
Current Illness: postmortem=pneumonia
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data: unknown time vaccine administered is also unknown but filled in a time so could complete form.
CDC 'Split Type':

Write-up: Infant febrile morning of 5/18/2006 around 5:30 a.m. No other S/S per parent. Parent administered tylenol. Midday infant began seizing, mom called 911, infant transported and later pronounced dead at hospital. 7/19/06 Received death certificate which stated COD as pulmonary edema due to protracted febrile seizure. 7/28/06 Received tag-2 report from PCP. Family had moved to another state. Records accompanying report included vax records, Death Summary from ER & Autopsy Report. COD stated as non-cardiogenic pulmonary edema as the result of febrile seizures/ss


Changed on 10/14/2018

VAERS ID: 259715 Before After
VAERS Form:1
Age:0.84
Sex:Female
Location:Missouri
Vaccinated:2006-05-12
Onset:2006-05-18
Submitted:2006-07-18
Entered:2006-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1163R / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0381R / 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1110R / 1 RL / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Febrile convulsion, Pulmonary oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-05-18
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: unknown
Current Illness: postmortem=pneumonia
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data: unknown time vaccine administered is also unknown but filled in a time so could complete form.
CDC 'Split Type':

Write-up: Infant febrile morning of 5/18/2006 around 5:30 a.m. No other S/S per parent. Parent administered tylenol. Midday infant began seizing, mom called 911, infant transported and later pronounced dead at hospital. 7/19/06 Received death certificate which stated COD as pulmonary edema due to protracted febrile seizure. 7/28/06 Received tag-2 report from PCP. Family had moved to another state. Records accompanying report included vax records, Death Summary from ER & Autopsy Report. COD stated as non-cardiogenic pulmonary edema as the result of febrile seizures/ss

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=259715&WAYBACKHISTORY=ON


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