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This is VAERS ID 85217

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 85217
VAERS Form:
Age:1.1
Sex:Male
Location:Arkansas
Vaccinated:1996-02-29
Onset:1996-03-08
Submitted:1996-03-25
Entered:1996-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPH: TETRAMUNE / LEDERLE 429965 / 3 RL / IM
MMR: MMR II / MSD 0887D / 0 LA / SC

Administered by: Public      Purchased by: Unknown
Symptoms: APNEA, BRONCHITIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-03-08
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: ATB
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: info recv for death certificate that pt had a resp arrest & acute bronchitis;parents refused autopsy according to funeral director


Changed on 12/8/2009

VAERS ID: 85217 Before After
VAERS Form:
Age:1.1
Sex:Male
Location:Arkansas
Vaccinated:1996-02-29
Onset:1996-03-08
Submitted:1996-03-25
Entered:1996-04-25 1996-04-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPH: TETRAMUNE / LEDERLE 429965 / 3 RL / IM
DTPHIB: DTP + HIB (TETRAMUNE) / LEDERLE LABORATORIES 429965 / 3 RL / IM
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 0887D / 0 LA / SC

Administered by: Public      Purchased by: Unknown Other
Symptoms: Apnoea, Bronchitis, APNEA, BRONCHITIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-03-08
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: ATB
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: info recv for death certificate that pt had a resp arrest & acute bronchitis;parents refused autopsy according to funeral director


Changed on 5/14/2017

VAERS ID: 85217 Before After
VAERS Form:
Age:1.1
Sex:Male
Location:Arkansas
Vaccinated:1996-02-29
Onset:1996-03-08
Submitted:1996-03-25
Entered:1996-04-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 429965 / 3 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0887D / 0 LA / SC

Administered by: Public      Purchased by: Other
Symptoms: Apnoea, Bronchitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-03-08
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: ATB
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: info recv for death certificate that pt had a resp arrest & acute bronchitis;parents refused autopsy according to funeral director


Changed on 9/14/2017

VAERS ID: 85217 Before After
VAERS Form:(blank) 1
Age:1.1
Sex:Male
Location:Arkansas
Vaccinated:1996-02-29
Onset:1996-03-08
Submitted:1996-03-25
Entered:1996-04-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 429965 / 3 4 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0887D / 0 1 LA / SC

Administered by: Public      Purchased by: Other
Symptoms: Apnoea, Bronchitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-03-08
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: ATB
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: info recv for death certificate that pt had a resp arrest & acute bronchitis;parents refused autopsy according to funeral director


Changed on 2/14/2018

VAERS ID: 85217 Before After
VAERS Form:1
Age:1.1
Sex:Male
Location:Arkansas
Vaccinated:1996-02-29
Onset:1996-03-08
Submitted:1996-03-25
Entered:1996-04-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 429965 / 4 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0887D / 1 LA / SC

Administered by: Public      Purchased by: Other
Symptoms: Apnoea, Bronchitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-03-08
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: ATB
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: info recv for death certificate that pt had a resp arrest & acute bronchitis;parents refused autopsy according to funeral director


Changed on 6/14/2018

VAERS ID: 85217 Before After
VAERS Form:1
Age:1.1
Sex:Male
Location:Arkansas
Vaccinated:1996-02-29
Onset:1996-03-08
Submitted:1996-03-25
Entered:1996-04-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 429965 / 4 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0887D / 1 LA / SC

Administered by: Public      Purchased by: Other
Symptoms: Apnoea, Bronchitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-03-08
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: ATB
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: info recv for death certificate that pt had a resp arrest & acute bronchitis;parents refused autopsy according to funeral director


Changed on 8/14/2018

VAERS ID: 85217 Before After
VAERS Form:1
Age:1.1
Sex:Male
Location:Arkansas
Vaccinated:1996-02-29
Onset:1996-03-08
Submitted:1996-03-25
Entered:1996-04-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 429965 / 4 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0887D / 1 LA / SC

Administered by: Public      Purchased by: Other
Symptoms: Apnoea, Bronchitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-03-08
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: ATB
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: info recv for death certificate that pt had a resp arrest & acute bronchitis;parents refused autopsy according to funeral director


Changed on 9/14/2018

VAERS ID: 85217 Before After
VAERS Form:1
Age:1.1
Sex:Male
Location:Arkansas
Vaccinated:1996-02-29
Onset:1996-03-08
Submitted:1996-03-25
Entered:1996-04-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 429965 / 4 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0887D / 1 LA / SC

Administered by: Public      Purchased by: Other
Symptoms: Apnoea, Bronchitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-03-08
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: ATB
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: info recv for death certificate that pt had a resp arrest & acute bronchitis;parents refused autopsy according to funeral director


Changed on 10/14/2018

VAERS ID: 85217 Before After
VAERS Form:1
Age:1.1
Sex:Male
Location:Arkansas
Vaccinated:1996-02-29
Onset:1996-03-08
Submitted:1996-03-25
Entered:1996-04-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 429965 / 4 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0887D / 1 LA / SC

Administered by: Public      Purchased by: Other
Symptoms: Apnoea, Bronchitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-03-08
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: ATB
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: info recv for death certificate that pt had a resp arrest & acute bronchitis;parents refused autopsy according to funeral director

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