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This is VAERS ID 613449

History of Changes from the VAERS Wayback Machine

First Appeared on 12/14/2015

VAERS ID: 613449
VAERS Form:
Age:
Sex:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2015-12-07
Entered:2015-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / - UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: TYLENOL; MOTRIN; SARA
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES1512USA002586

Write-up: This spontaneous report was retrieved from a social network via Pfizer (assigned manufacturer control number: 2015420009) and was originally reported by the uncle of a male patient of unknown age. Information about the patient''s medical history and concurrent conditions was not provided. On an unknown date, the patient started therapy with TYLENOL and MOTRIN (for both therapies indication, dose, frequency, route of administration, lot number and expiration date were not provided). Subsequently, the patient was vaccinated with M-M-R II (dose, dose number, route of administration, lot number and expiration date were not provided). Other suspect therapies included SARA (indication, dose, frequency, route of administration, lot number and expiration date were not provided). Concomitant medication was not reported. According to the reporter, on an unknown date, SARA and M-M-R II "killed" his nephew. The reporter stated that he was life flighted to hospital and died. It was also reported that the patient was alive and flew to a county hospital and died. It was unknown if an autopsy was performed. The cause of death was also unknown. Additional information is not expected, since the reporter''s details were not provided.


Changed on 9/14/2017

VAERS ID: 613449 Before After
VAERS Form:(blank) 1
Age:
Sex:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2015-12-07
Entered:2015-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / - UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: TYLENOL; MOTRIN; SARA
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES1512USA002586

Write-up: This spontaneous report was retrieved from a social network via Pfizer (assigned manufacturer control number: 2015420009) and was originally reported by the uncle of a male patient of unknown age. Information about the patient''s medical history and concurrent conditions was not provided. On an unknown date, the patient started therapy with TYLENOL and MOTRIN (for both therapies indication, dose, frequency, route of administration, lot number and expiration date were not provided). Subsequently, the patient was vaccinated with M-M-R II (dose, dose number, route of administration, lot number and expiration date were not provided). Other suspect therapies included SARA (indication, dose, frequency, route of administration, lot number and expiration date were not provided). Concomitant medication was not reported. According to the reporter, on an unknown date, SARA and M-M-R II "killed" his nephew. The reporter stated that he was life flighted to hospital and died. It was also reported that the patient was alive and flew to a county hospital and died. It was unknown if an autopsy was performed. The cause of death was also unknown. Additional information is not expected, since the reporter''s details were not provided.


Changed on 2/14/2018

VAERS ID: 613449 Before After
VAERS Form:1
Age:
Sex:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2015-12-07
Entered:2015-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: TYLENOL; MOTRIN; SARA
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES1512USA002586

Write-up: This spontaneous report was retrieved from a social network via Pfizer (assigned manufacturer control number: 2015420009) and was originally reported by the uncle of a male patient of unknown age. Information about the patient''s medical history and concurrent conditions was not provided. On an unknown date, the patient started therapy with TYLENOL and MOTRIN (for both therapies indication, dose, frequency, route of administration, lot number and expiration date were not provided). Subsequently, the patient was vaccinated with M-M-R II (dose, dose number, route of administration, lot number and expiration date were not provided). Other suspect therapies included SARA (indication, dose, frequency, route of administration, lot number and expiration date were not provided). Concomitant medication was not reported. According to the reporter, on an unknown date, SARA and M-M-R II "killed" his nephew. The reporter stated that he was life flighted to hospital and died. It was also reported that the patient was alive and flew to a county hospital and died. It was unknown if an autopsy was performed. The cause of death was also unknown. Additional information is not expected, since the reporter''s details were not provided.


Changed on 6/14/2018

VAERS ID: 613449 Before After
VAERS Form:1
Age:
Sex:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2015-12-07
Entered:2015-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: TYLENOL; MOTRIN; SARA
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES1512USA002586

Write-up: This spontaneous report was retrieved from a social network via Pfizer (assigned manufacturer control number: 2015420009) and was originally reported by the uncle of a male patient of unknown age. Information about the patient''s medical history and concurrent conditions was not provided. On an unknown date, the patient started therapy with TYLENOL and MOTRIN (for both therapies indication, dose, frequency, route of administration, lot number and expiration date were not provided). Subsequently, the patient was vaccinated with M-M-R II (dose, dose number, route of administration, lot number and expiration date were not provided). Other suspect therapies included SARA (indication, dose, frequency, route of administration, lot number and expiration date were not provided). Concomitant medication was not reported. According to the reporter, on an unknown date, SARA and M-M-R II "killed" his nephew. The reporter stated that he was life flighted to hospital and died. It was also reported that the patient was alive and flew to a county hospital and died. It was unknown if an autopsy was performed. The cause of death was also unknown. Additional information is not expected, since the reporter''s details were not provided.


Changed on 8/14/2018

VAERS ID: 613449 Before After
VAERS Form:1
Age:
Sex:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2015-12-07
Entered:2015-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: TYLENOL; MOTRIN; SARA
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES1512USA002586

Write-up: This spontaneous report was retrieved from a social network via Pfizer (assigned manufacturer control number: 2015420009) and was originally reported by the uncle of a male patient of unknown age. Information about the patient''s medical history and concurrent conditions was not provided. On an unknown date, the patient started therapy with TYLENOL and MOTRIN (for both therapies indication, dose, frequency, route of administration, lot number and expiration date were not provided). Subsequently, the patient was vaccinated with M-M-R II (dose, dose number, route of administration, lot number and expiration date were not provided). Other suspect therapies included SARA (indication, dose, frequency, route of administration, lot number and expiration date were not provided). Concomitant medication was not reported. According to the reporter, on an unknown date, SARA and M-M-R II "killed" his nephew. The reporter stated that he was life flighted to hospital and died. It was also reported that the patient was alive and flew to a county hospital and died. It was unknown if an autopsy was performed. The cause of death was also unknown. Additional information is not expected, since the reporter''s details were not provided.


Changed on 9/14/2018

VAERS ID: 613449 Before After
VAERS Form:1
Age:
Sex:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2015-12-07
Entered:2015-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: TYLENOL; MOTRIN; SARA
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES1512USA002586

Write-up: This spontaneous report was retrieved from a social network via Pfizer (assigned manufacturer control number: 2015420009) and was originally reported by the uncle of a male patient of unknown age. Information about the patient''s medical history and concurrent conditions was not provided. On an unknown date, the patient started therapy with TYLENOL and MOTRIN (for both therapies indication, dose, frequency, route of administration, lot number and expiration date were not provided). Subsequently, the patient was vaccinated with M-M-R II (dose, dose number, route of administration, lot number and expiration date were not provided). Other suspect therapies included SARA (indication, dose, frequency, route of administration, lot number and expiration date were not provided). Concomitant medication was not reported. According to the reporter, on an unknown date, SARA and M-M-R II "killed" his nephew. The reporter stated that he was life flighted to hospital and died. It was also reported that the patient was alive and flew to a county hospital and died. It was unknown if an autopsy was performed. The cause of death was also unknown. Additional information is not expected, since the reporter''s details were not provided.


Changed on 10/14/2018

VAERS ID: 613449 Before After
VAERS Form:1
Age:
Sex:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2015-12-07
Entered:2015-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: TYLENOL; MOTRIN; SARA
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES1512USA002586

Write-up: This spontaneous report was retrieved from a social network via Pfizer (assigned manufacturer control number: 2015420009) and was originally reported by the uncle of a male patient of unknown age. Information about the patient''s medical history and concurrent conditions was not provided. On an unknown date, the patient started therapy with TYLENOL and MOTRIN (for both therapies indication, dose, frequency, route of administration, lot number and expiration date were not provided). Subsequently, the patient was vaccinated with M-M-R II (dose, dose number, route of administration, lot number and expiration date were not provided). Other suspect therapies included SARA (indication, dose, frequency, route of administration, lot number and expiration date were not provided). Concomitant medication was not reported. According to the reporter, on an unknown date, SARA and M-M-R II "killed" his nephew. The reporter stated that he was life flighted to hospital and died. It was also reported that the patient was alive and flew to a county hospital and died. It was unknown if an autopsy was performed. The cause of death was also unknown. Additional information is not expected, since the reporter''s details were not provided.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=613449&WAYBACKHISTORY=ON


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