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This is VAERS ID 74166

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 74166
VAERS Form:
Age:10.0
Sex:Male
Location:Indiana
Vaccinated:1995-05-03
Onset:1995-05-04
Submitted:1995-05-15
Entered:1995-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MMR II / MSD 1249A / 1 - / -

Administered by: Other      Purchased by: Unknown
Symptoms: CONVULS, APNEA, ASTHMA, HEART ARREST, BRONCHITIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-05-05
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Blood sugars of 800 and 400; 5MAY95 serum glucose 400-800;
CDC 'Split Type':

Write-up: pt recv vax 3MAY95 & 4MAY95 pt exp dizziness, tiredness; that evening, pt awoke & stated that felt bad & exp nausea; pt got into bed w/mom & began shaking which was felt to be a poss sz; pt taken to ER & was found to be in cardiac arrest


Changed on 12/8/2009

VAERS ID: 74166 Before After
VAERS Form:
Age:10.0
Sex:Male
Location:Indiana
Vaccinated:1995-05-03
Onset:1995-05-04
Submitted:1995-05-15
Entered:1995-05-24 1995-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 1249A / 1 - / -

Administered by: Other Unknown      Purchased by: Unknown
Symptoms: Apnoea, Asthma, Bronchitis, Cardiac arrest, Convulsion, Hyperglycaemia, Malaise, Tremor, CONVULS, APNEA, ASTHMA, HEART ARREST, BRONCHITIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-05-05
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Blood sugars of 800 and 400; 5MAY95 serum glucose 400-800;
CDC 'Split Type': (blank) WAES95050372

Write-up: pt recv vax 3MAY95 & 4MAY95 pt exp dizziness, tiredness; that evening, pt awoke & stated that felt bad & exp nausea; pt got into bed w/mom & began shaking which was felt to be a poss sz; pt taken to ER & was found to be in cardiac arrest


Changed on 5/14/2017

VAERS ID: 74166 Before After
VAERS Form:
Age:10.0
Sex:Male
Location:Indiana
Vaccinated:1995-05-03
Onset:1995-05-04
Submitted:1995-05-15
Entered:1995-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1249A / 1 - / -

Administered by: Unknown Other      Purchased by: Unknown Other
Symptoms: Apnoea, Asthma, Bronchitis, Cardiac arrest, Convulsion, Hyperglycaemia, Malaise, Tremor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-05-05
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Blood sugars of 800 and 400; 5MAY95 serum glucose 400-800;
CDC 'Split Type': WAES95050372

Write-up: pt recv vax 3MAY95 & 4MAY95 pt exp dizziness, tiredness; that evening, pt awoke & stated that felt bad & exp nausea; pt got into bed w/mom & began shaking which was felt to be a poss sz; pt taken to ER & was found to be in cardiac arrest


Changed on 9/14/2017

VAERS ID: 74166 Before After
VAERS Form:(blank) 1
Age:10.0
Sex:Male
Location:Indiana
Vaccinated:1995-05-03
Onset:1995-05-04
Submitted:1995-05-15
Entered:1995-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1249A / 1 2 - / -

Administered by: Other      Purchased by: Other
Symptoms: Apnoea, Asthma, Bronchitis, Cardiac arrest, Convulsion, Hyperglycaemia, Malaise, Tremor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-05-05
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Blood sugars of 800 and 400; 5MAY95 serum glucose 400-800;
CDC 'Split Type': WAES95050372

Write-up: pt recv vax 3MAY95 & 4MAY95 pt exp dizziness, tiredness; that evening, pt awoke & stated that felt bad & exp nausea; pt got into bed w/mom & began shaking which was felt to be a poss sz; pt taken to ER & was found to be in cardiac arrest


Changed on 2/14/2018

VAERS ID: 74166 Before After
VAERS Form:1
Age:10.0
Sex:Male
Location:Indiana
Vaccinated:1995-05-03
Onset:1995-05-04
Submitted:1995-05-15
Entered:1995-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1249A / 2 - / -

Administered by: Other      Purchased by: Other
Symptoms: Apnoea, Asthma, Bronchitis, Cardiac arrest, Convulsion, Hyperglycaemia, Malaise, Tremor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-05-05
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Blood sugars of 800 and 400; 5MAY95 serum glucose 400-800;
CDC 'Split Type': WAES95050372

Write-up: pt recv vax 3MAY95 & 4MAY95 pt exp dizziness, tiredness; that evening, pt awoke & stated that felt bad & exp nausea; pt got into bed w/mom & began shaking which was felt to be a poss sz; pt taken to ER & was found to be in cardiac arrest


Changed on 6/14/2018

VAERS ID: 74166 Before After
VAERS Form:1
Age:10.0
Sex:Male
Location:Indiana
Vaccinated:1995-05-03
Onset:1995-05-04
Submitted:1995-05-15
Entered:1995-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1249A / 2 - / -

Administered by: Other      Purchased by: Other
Symptoms: Apnoea, Asthma, Bronchitis, Cardiac arrest, Convulsion, Hyperglycaemia, Malaise, Tremor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-05-05
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Blood sugars of 800 and 400; 5MAY95 serum glucose 400-800;
CDC 'Split Type': WAES95050372

Write-up: pt recv vax 3MAY95 & 4MAY95 pt exp dizziness, tiredness; that evening, pt awoke & stated that felt bad & exp nausea; pt got into bed w/mom & began shaking which was felt to be a poss sz; pt taken to ER & was found to be in cardiac arrest


Changed on 8/14/2018

VAERS ID: 74166 Before After
VAERS Form:1
Age:10.0
Sex:Male
Location:Indiana
Vaccinated:1995-05-03
Onset:1995-05-04
Submitted:1995-05-15
Entered:1995-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1249A / 2 - / -

Administered by: Other      Purchased by: Other
Symptoms: Apnoea, Asthma, Bronchitis, Cardiac arrest, Convulsion, Hyperglycaemia, Malaise, Tremor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-05-05
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Blood sugars of 800 and 400; 5MAY95 serum glucose 400-800;
CDC 'Split Type': WAES95050372

Write-up: pt recv vax 3MAY95 & 4MAY95 pt exp dizziness, tiredness; that evening, pt awoke & stated that felt bad & exp nausea; pt got into bed w/mom & began shaking which was felt to be a poss sz; pt taken to ER & was found to be in cardiac arrest


Changed on 9/14/2018

VAERS ID: 74166 Before After
VAERS Form:1
Age:10.0
Sex:Male
Location:Indiana
Vaccinated:1995-05-03
Onset:1995-05-04
Submitted:1995-05-15
Entered:1995-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1249A / 2 - / -

Administered by: Other      Purchased by: Other
Symptoms: Apnoea, Asthma, Bronchitis, Cardiac arrest, Convulsion, Hyperglycaemia, Malaise, Tremor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-05-05
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Blood sugars of 800 and 400; 5MAY95 serum glucose 400-800;
CDC 'Split Type': WAES95050372

Write-up: pt recv vax 3MAY95 & 4MAY95 pt exp dizziness, tiredness; that evening, pt awoke & stated that felt bad & exp nausea; pt got into bed w/mom & began shaking which was felt to be a poss sz; pt taken to ER & was found to be in cardiac arrest


Changed on 10/14/2018

VAERS ID: 74166 Before After
VAERS Form:1
Age:10.0
Sex:Male
Location:Indiana
Vaccinated:1995-05-03
Onset:1995-05-04
Submitted:1995-05-15
Entered:1995-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1249A / 2 - / -

Administered by: Other      Purchased by: Other
Symptoms: Apnoea, Asthma, Bronchitis, Cardiac arrest, Convulsion, Hyperglycaemia, Malaise, Tremor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1995-05-05
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Blood sugars of 800 and 400; 5MAY95 serum glucose 400-800;
CDC 'Split Type': WAES95050372

Write-up: pt recv vax 3MAY95 & 4MAY95 pt exp dizziness, tiredness; that evening, pt awoke & stated that felt bad & exp nausea; pt got into bed w/mom & began shaking which was felt to be a poss sz; pt taken to ER & was found to be in cardiac arrest

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