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This is VAERS ID 432209

History of Changes from the VAERS Wayback Machine

First Appeared on 9/14/2011

VAERS ID: 432209
VAERS Form:
Age:48.0
Sex:Male
Location:Tennessee
Vaccinated:2011-08-25
Onset:0000-00-00
Submitted:2011-08-30
Entered:2011-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0103AA / 1 LA / SC

Administered by: Public      Purchased by: Unknown
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-08-27
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: None
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt. wife reports pt. died.


Changed on 9/14/2017

VAERS ID: 432209 Before After
VAERS Form:(blank) 1
Age:48.0
Sex:Male
Location:Tennessee
Vaccinated:2011-08-25
Onset:0000-00-00
Submitted:2011-08-30
Entered:2011-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0103AA / 1 2 LA / SC

Administered by: Public      Purchased by: Unknown
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-08-27
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: None
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt. wife reports pt. died.


Changed on 2/14/2018

VAERS ID: 432209 Before After
VAERS Form:1
Age:48.0
Sex:Male
Location:Tennessee
Vaccinated:2011-08-25
Onset:0000-00-00
Submitted:2011-08-30
Entered:2011-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0103AA / 2 LA / SC

Administered by: Public      Purchased by: Unknown
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-08-27
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: None
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt. wife reports pt. died.


Changed on 6/14/2018

VAERS ID: 432209 Before After
VAERS Form:1
Age:48.0
Sex:Male
Location:Tennessee
Vaccinated:2011-08-25
Onset:0000-00-00
Submitted:2011-08-30
Entered:2011-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0103AA / 2 LA / SC

Administered by: Public      Purchased by: Unknown
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-08-27
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: None
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt. wife reports pt. died.


Changed on 8/14/2018

VAERS ID: 432209 Before After
VAERS Form:1
Age:48.0
Sex:Male
Location:Tennessee
Vaccinated:2011-08-25
Onset:0000-00-00
Submitted:2011-08-30
Entered:2011-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0103AA / 2 LA / SC

Administered by: Public      Purchased by: Unknown
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-08-27
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: None
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt. wife reports pt. died.


Changed on 9/14/2018

VAERS ID: 432209 Before After
VAERS Form:1
Age:48.0
Sex:Male
Location:Tennessee
Vaccinated:2011-08-25
Onset:0000-00-00
Submitted:2011-08-30
Entered:2011-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0103AA / 2 LA / SC

Administered by: Public      Purchased by: Unknown
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-08-27
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: None
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt. wife reports pt. died.


Changed on 10/14/2018

VAERS ID: 432209 Before After
VAERS Form:1
Age:48.0
Sex:Male
Location:Tennessee
Vaccinated:2011-08-25
Onset:0000-00-00
Submitted:2011-08-30
Entered:2011-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0103AA / 2 LA / SC

Administered by: Public      Purchased by: Unknown
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-08-27
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: None
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt. wife reports pt. died.

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