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This is VAERS ID 429528

History of Changes from the VAERS Wayback Machine

First Appeared on 8/12/2011

VAERS ID: 429528
VAERS Form:
Age:1.3
Sex:Female
Location:Georgia
Vaccinated:2011-07-27
Onset:2011-08-06
Submitted:2011-08-11
Entered:2011-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1643Z / 0 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1705Z / 0 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Acidosis, Blood gases abnormal, Death, Pyrexia, Respiratory arrest, Resuscitation, Autopsy, Laboratory test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-08-08
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Ex-27wk preemie. RSV requiring hospitalization - 11/10.
Allergies:
Diagnostic Lab Data: ABG at ER showed acidosis. No other testing done at ER due to rapidity of clinical decline. Autopsy inconclusive. Further testing of tissue samples being done by state lab. Results pending.
CDC 'Split Type':

Write-up: Onset of fever on 8-6-11 up to 102 degrees. Playful when afebrile. Seen in doctor''s office on 8/8. Presented later to ER where resp. arrest occurred during evaluation. CPR and defibrillation with aggressive IV inotropes unsuccessful. (intermittent fever present 8/6-8/8).


Changed on 6/14/2014

VAERS ID: 429528 Before After
VAERS Form:
Age:1.3
Sex:Female
Location:Georgia
Vaccinated:2011-07-27
Onset:2011-08-06
Submitted:2011-08-11
Entered:2011-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1643Z / 0 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1705Z / 0 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Acidosis, Blood gases abnormal, Death, Pyrexia, Respiratory arrest, Resuscitation, Autopsy, Laboratory test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-08-08
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Ex-27wk preemie. RSV requiring hospitalization - 11/10.
Allergies:
Diagnostic Lab Data: ABG at ER showed acidosis. No other testing done at ER due to rapidity of clinical decline. Autopsy inconclusive. Further testing of tissue samples being done by state lab. Results pending.
CDC 'Split Type':

Write-up: Onset of fever on 8-6-11 up to 102 degrees. Playful when afebrile. Seen in doctor''s office on 8/8. Presented later to ER where resp. arrest occurred during evaluation. CPR and defibrillation with aggressive IV inotropes unsuccessful. (intermittent fever present 8/6-8/8).


Changed on 2/14/2017

VAERS ID: 429528 Before After
VAERS Form:
Age:1.3 1.25
Sex:Female
Location:Georgia
Vaccinated:2011-07-27
Onset:2011-08-06
Submitted:2011-08-11
Entered:2011-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1643Z / 0 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1705Z / 0 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Acidosis, Blood gases abnormal, Death, Pyrexia, Respiratory arrest, Resuscitation, Autopsy, Laboratory test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-08-08
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Ex-27wk preemie. RSV requiring hospitalization - 11/10.
Allergies:
Diagnostic Lab Data: ABG at ER showed acidosis. No other testing done at ER due to rapidity of clinical decline. Autopsy inconclusive. Further testing of tissue samples being done by state lab. Results pending.
CDC 'Split Type':

Write-up: Onset of fever on 8-6-11 up to 102 degrees. Playful when afebrile. Seen in doctor''s office on 8/8. Presented later to ER where resp. arrest occurred during evaluation. CPR and defibrillation with aggressive IV inotropes unsuccessful. (intermittent fever present 8/6-8/8).


Changed on 4/14/2017

VAERS ID: 429528 Before After
VAERS Form:
Age:1.25
Sex:Female
Location:Georgia
Vaccinated:2011-07-27
Onset:2011-08-06
Submitted:2011-08-11
Entered:2011-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1643Z / 0 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1705Z / 0 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Acidosis, Blood gases abnormal, Death, Pyrexia, Respiratory arrest, Resuscitation, Autopsy, Laboratory test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-08-08
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Ex-27wk preemie. RSV requiring hospitalization - 11/10.
Allergies:
Diagnostic Lab Data: ABG at ER showed acidosis. No other testing done at ER due to rapidity of clinical decline. Autopsy inconclusive. Further testing of tissue samples being done by state lab. Results pending.
CDC 'Split Type':

Write-up: Onset of fever on 8-6-11 up to 102 degrees. Playful when afebrile. Seen in doctor''s office on 8/8. Presented later to ER where resp. arrest occurred during evaluation. CPR and defibrillation with aggressive IV inotropes unsuccessful. (intermittent fever present 8/6-8/8).


Changed on 9/14/2017

VAERS ID: 429528 Before After
VAERS Form:(blank) 1
Age:1.25
Sex:Female
Location:Georgia
Vaccinated:2011-07-27
Onset:2011-08-06
Submitted:2011-08-11
Entered:2011-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1643Z / 0 1 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1705Z / 0 1 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Acidosis, Blood gases abnormal, Death, Pyrexia, Respiratory arrest, Resuscitation, Autopsy, Laboratory test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-08-08
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Ex-27wk preemie. RSV requiring hospitalization - 11/10.
Allergies:
Diagnostic Lab Data: ABG at ER showed acidosis. No other testing done at ER due to rapidity of clinical decline. Autopsy inconclusive. Further testing of tissue samples being done by state lab. Results pending.
CDC 'Split Type':

Write-up: Onset of fever on 8-6-11 up to 102 degrees. Playful when afebrile. Seen in doctor''s office on 8/8. Presented later to ER where resp. arrest occurred during evaluation. CPR and defibrillation with aggressive IV inotropes unsuccessful. (intermittent fever present 8/6-8/8).


Changed on 2/14/2018

VAERS ID: 429528 Before After
VAERS Form:1
Age:1.25
Sex:Female
Location:Georgia
Vaccinated:2011-07-27
Onset:2011-08-06
Submitted:2011-08-11
Entered:2011-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1643Z / 1 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1705Z / 1 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Acidosis, Blood gases abnormal, Death, Pyrexia, Respiratory arrest, Resuscitation, Autopsy, Laboratory test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-08-08
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Ex-27wk preemie. RSV requiring hospitalization - 11/10.
Allergies:
Diagnostic Lab Data: ABG at ER showed acidosis. No other testing done at ER due to rapidity of clinical decline. Autopsy inconclusive. Further testing of tissue samples being done by state lab. Results pending.
CDC 'Split Type':

Write-up: Onset of fever on 8-6-11 up to 102 degrees. Playful when afebrile. Seen in doctor''s office on 8/8. Presented later to ER where resp. arrest occurred during evaluation. CPR and defibrillation with aggressive IV inotropes unsuccessful. (intermittent fever present 8/6-8/8).


Changed on 6/14/2018

VAERS ID: 429528 Before After
VAERS Form:1
Age:1.25
Sex:Female
Location:Georgia
Vaccinated:2011-07-27
Onset:2011-08-06
Submitted:2011-08-11
Entered:2011-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1643Z / 1 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1705Z / 1 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Acidosis, Blood gases abnormal, Death, Pyrexia, Respiratory arrest, Resuscitation, Autopsy, Laboratory test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-08-08
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Ex-27wk preemie. RSV requiring hospitalization - 11/10.
Allergies:
Diagnostic Lab Data: ABG at ER showed acidosis. No other testing done at ER due to rapidity of clinical decline. Autopsy inconclusive. Further testing of tissue samples being done by state lab. Results pending.
CDC 'Split Type':

Write-up: Onset of fever on 8-6-11 up to 102 degrees. Playful when afebrile. Seen in doctor''s office on 8/8. Presented later to ER where resp. arrest occurred during evaluation. CPR and defibrillation with aggressive IV inotropes unsuccessful. (intermittent fever present 8/6-8/8).


Changed on 8/14/2018

VAERS ID: 429528 Before After
VAERS Form:1
Age:1.25
Sex:Female
Location:Georgia
Vaccinated:2011-07-27
Onset:2011-08-06
Submitted:2011-08-11
Entered:2011-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1643Z / 1 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1705Z / 1 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Acidosis, Blood gases abnormal, Death, Pyrexia, Respiratory arrest, Resuscitation, Autopsy, Laboratory test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-08-08
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Ex-27wk preemie. RSV requiring hospitalization - 11/10.
Allergies:
Diagnostic Lab Data: ABG at ER showed acidosis. No other testing done at ER due to rapidity of clinical decline. Autopsy inconclusive. Further testing of tissue samples being done by state lab. Results pending.
CDC 'Split Type':

Write-up: Onset of fever on 8-6-11 up to 102 degrees. Playful when afebrile. Seen in doctor''s office on 8/8. Presented later to ER where resp. arrest occurred during evaluation. CPR and defibrillation with aggressive IV inotropes unsuccessful. (intermittent fever present 8/6-8/8).


Changed on 9/14/2018

VAERS ID: 429528 Before After
VAERS Form:1
Age:1.25
Sex:Female
Location:Georgia
Vaccinated:2011-07-27
Onset:2011-08-06
Submitted:2011-08-11
Entered:2011-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1643Z / 1 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1705Z / 1 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Acidosis, Blood gases abnormal, Death, Pyrexia, Respiratory arrest, Resuscitation, Autopsy, Laboratory test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-08-08
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Ex-27wk preemie. RSV requiring hospitalization - 11/10.
Allergies:
Diagnostic Lab Data: ABG at ER showed acidosis. No other testing done at ER due to rapidity of clinical decline. Autopsy inconclusive. Further testing of tissue samples being done by state lab. Results pending.
CDC 'Split Type':

Write-up: Onset of fever on 8-6-11 up to 102 degrees. Playful when afebrile. Seen in doctor''s office on 8/8. Presented later to ER where resp. arrest occurred during evaluation. CPR and defibrillation with aggressive IV inotropes unsuccessful. (intermittent fever present 8/6-8/8).


Changed on 10/14/2018

VAERS ID: 429528 Before After
VAERS Form:1
Age:1.25
Sex:Female
Location:Georgia
Vaccinated:2011-07-27
Onset:2011-08-06
Submitted:2011-08-11
Entered:2011-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1643Z / 1 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1705Z / 1 LL / SC

Administered by: Private      Purchased by: Private
Symptoms: Acidosis, Blood gases abnormal, Death, Pyrexia, Respiratory arrest, Resuscitation, Autopsy, Laboratory test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-08-08
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Ex-27wk preemie. RSV requiring hospitalization - 11/10.
Allergies:
Diagnostic Lab Data: ABG at ER showed acidosis. No other testing done at ER due to rapidity of clinical decline. Autopsy inconclusive. Further testing of tissue samples being done by state lab. Results pending.
CDC 'Split Type':

Write-up: Onset of fever on 8-6-11 up to 102 degrees. Playful when afebrile. Seen in doctor''s office on 8/8. Presented later to ER where resp. arrest occurred during evaluation. CPR and defibrillation with aggressive IV inotropes unsuccessful. (intermittent fever present 8/6-8/8).

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=429528&WAYBACKHISTORY=ON


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