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This is VAERS ID 76675

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 76675
VAERS Form:
Age:
Sex:Unknown
Location:Georgia
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1995-08-15
Entered:1995-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
M: ATTENUVAX / MSD - / - - / -

Administered by: Other      Purchased by: Unknown
Symptoms: REACT UNEVAL

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data;
CDC 'Split Type':

Write-up: pt recv vax which was reconstituted w/pancuronium bromide instead of appropriate diluent;pt died;addtl info has been requested;


Changed on 12/8/2009

VAERS ID: 76675 Before After
VAERS Form:
Age:
Sex:Unknown
Location:Georgia
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1995-08-15
Entered:1995-08-24 1995-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
M: ATTENUVAX / MSD - / - - / -
MEA: MEASLES (ATTENUVAX) / MERCK & CO. INC. - / - - / -

Administered by: Other      Purchased by: Unknown Other
Symptoms: Unevaluable event, REACT UNEVAL

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data;
CDC 'Split Type': (blank) WAES95080500

Write-up: pt recv vax which was reconstituted w/pancuronium bromide instead of appropriate diluent;pt died;addtl info has been requested;


Changed on 5/14/2017

VAERS ID: 76675 Before After
VAERS Form:
Age:
Sex:Unknown
Location:Georgia
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1995-08-15
Entered:1995-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEA: MEASLES (ATTENUVAX) / MERCK & CO. INC. - / - - / -

Administered by: Other      Purchased by: Other
Symptoms: Unevaluable event

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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data;
CDC 'Split Type': WAES95080500

Write-up: pt recv vax which was reconstituted w/pancuronium bromide instead of appropriate diluent;pt died;addtl info has been requested;


Changed on 9/14/2017

VAERS ID: 76675 Before After
VAERS Form:(blank) 1
Age:
Sex:Unknown
Location:Georgia
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1995-08-15
Entered:1995-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEA: MEASLES (ATTENUVAX) / MERCK & CO. INC. - / - UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Unevaluable event

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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data;
CDC 'Split Type': WAES95080500

Write-up: pt recv vax which was reconstituted w/pancuronium bromide instead of appropriate diluent;pt died;addtl info has been requested;


Changed on 2/14/2018

VAERS ID: 76675 Before After
VAERS Form:1
Age:
Sex:Unknown
Location:Georgia
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1995-08-15
Entered:1995-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEA: MEASLES (ATTENUVAX) / MERCK & CO. INC. - / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Unevaluable event

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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data;
CDC 'Split Type': WAES95080500

Write-up: pt recv vax which was reconstituted w/pancuronium bromide instead of appropriate diluent;pt died;addtl info has been requested;


Changed on 6/14/2018

VAERS ID: 76675 Before After
VAERS Form:1
Age:
Sex:Unknown
Location:Georgia
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1995-08-15
Entered:1995-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEA: MEASLES (ATTENUVAX) / MERCK & CO. INC. - / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Unevaluable event

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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data;
CDC 'Split Type': WAES95080500

Write-up: pt recv vax which was reconstituted w/pancuronium bromide instead of appropriate diluent;pt died;addtl info has been requested;


Changed on 8/14/2018

VAERS ID: 76675 Before After
VAERS Form:1
Age:
Sex:Unknown
Location:Georgia
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1995-08-15
Entered:1995-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEA: MEASLES (ATTENUVAX) / MERCK & CO. INC. - / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Unevaluable event

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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data;
CDC 'Split Type': WAES95080500

Write-up: pt recv vax which was reconstituted w/pancuronium bromide instead of appropriate diluent;pt died;addtl info has been requested;


Changed on 9/14/2018

VAERS ID: 76675 Before After
VAERS Form:1
Age:
Sex:Unknown
Location:Georgia
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1995-08-15
Entered:1995-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEA: MEASLES (ATTENUVAX) / MERCK & CO. INC. - / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Unevaluable event

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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data;
CDC 'Split Type': WAES95080500

Write-up: pt recv vax which was reconstituted w/pancuronium bromide instead of appropriate diluent;pt died;addtl info has been requested;


Changed on 10/14/2018

VAERS ID: 76675 Before After
VAERS Form:1
Age:
Sex:Unknown
Location:Georgia
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1995-08-15
Entered:1995-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEA: MEASLES (ATTENUVAX) / MERCK & CO. INC. - / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Unevaluable event

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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data;
CDC 'Split Type': WAES95080500

Write-up: pt recv vax which was reconstituted w/pancuronium bromide instead of appropriate diluent;pt died;addtl info has been requested;

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=76675&WAYBACKHISTORY=ON


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