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This is VAERS ID 25611

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 25611
VAERS Form:
Age:18.0
Sex:Male
Location:Maryland
Vaccinated:1990-06-29
Onset:1990-06-30
Submitted:0000-00-00
Entered:1990-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MMR II / MSD 409672130R / - - / -

Administered by: Private      Purchased by: Unknown
Symptoms: PAIN CHEST, HEART BLOCK, PERICARDITIS

Life Threatening? No
Birth Defect? No
Died? No
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? Yes, days:     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: medical history of pericarditis
Allergies:
Diagnostic Lab Data: ECG revealed changes consistent /w a recurrence of pericarditis
CDC 'Split Type':

Write-up: Pt developed chest pains and other signs of pericarditis including a pericardial friction rub, hospitalized


Changed on 12/8/2009

VAERS ID: 25611 Before After
VAERS Form:
Age:18.0
Sex:Male
Location:Maryland
Vaccinated:1990-06-29
Onset:1990-06-30
Submitted:0000-00-00
Entered:1990-07-31 1990-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 409672130R / - - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Atrioventricular block, Chest pain, Pericarditis, PAIN CHEST, HEART BLOCK, PERICARDITIS

Life Threatening? No
Birth Defect? No
Died? No
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? Yes, days:     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: medical history of pericarditis
Allergies:
Diagnostic Lab Data: ECG revealed changes consistent /w a recurrence of pericarditis
CDC 'Split Type': (blank) WAES90070002

Write-up: Pt developed chest pains and other signs of pericarditis including a pericardial friction rub, hospitalized


Changed on 5/14/2017

VAERS ID: 25611 Before After
VAERS Form:
Age:18.0
Sex:Male
Location:Maryland
Vaccinated:1990-06-29
Onset:1990-06-30
Submitted:0000-00-00
Entered:1990-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 409672130R / - - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Atrioventricular block, Chest pain, Pericarditis

Life Threatening? No
Birth Defect? No
Died? No
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? Yes, days:     Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: medical history of pericarditis
Allergies:
Diagnostic Lab Data: ECG revealed changes consistent /w a recurrence of pericarditis
CDC 'Split Type': WAES90070002

Write-up: Pt developed chest pains and other signs of pericarditis including a pericardial friction rub, hospitalized


Changed on 9/14/2017

VAERS ID: 25611 Before After
VAERS Form:(blank) 1
Age:18.0
Sex:Male
Location:Maryland
Vaccinated:1990-06-29
Onset:1990-06-30
Submitted:0000-00-00
Entered:1990-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 409672130R / - UNK - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Atrioventricular block, Chest pain, Pericarditis

Life Threatening? No
Birth Defect? No
Died? No
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? Yes, days:     Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: medical history of pericarditis
Allergies:
Diagnostic Lab Data: ECG revealed changes consistent /w a recurrence of pericarditis
CDC 'Split Type': WAES90070002

Write-up: Pt developed chest pains and other signs of pericarditis including a pericardial friction rub, hospitalized


Changed on 2/14/2018

VAERS ID: 25611 Before After
VAERS Form:1
Age:18.0
Sex:Male
Location:Maryland
Vaccinated:1990-06-29
Onset:1990-06-30
Submitted:0000-00-00
Entered:1990-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 409672130R / UNK - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Atrioventricular block, Chest pain, Pericarditis

Life Threatening? No
Birth Defect? No
Died? No
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? Yes, days:     Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: medical history of pericarditis
Allergies:
Diagnostic Lab Data: ECG revealed changes consistent /w a recurrence of pericarditis
CDC 'Split Type': WAES90070002

Write-up: Pt developed chest pains and other signs of pericarditis including a pericardial friction rub, hospitalized


Changed on 6/14/2018

VAERS ID: 25611 Before After
VAERS Form:1
Age:18.0
Sex:Male
Location:Maryland
Vaccinated:1990-06-29
Onset:1990-06-30
Submitted:0000-00-00
Entered:1990-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 409672130R / UNK - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Atrioventricular block, Chest pain, Pericarditis

Life Threatening? No
Birth Defect? No
Died? No
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? Yes, days:     Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: medical history of pericarditis
Allergies:
Diagnostic Lab Data: ECG revealed changes consistent /w a recurrence of pericarditis
CDC 'Split Type': WAES90070002

Write-up: Pt developed chest pains and other signs of pericarditis including a pericardial friction rub, hospitalized


Changed on 8/14/2018

VAERS ID: 25611 Before After
VAERS Form:1
Age:18.0
Sex:Male
Location:Maryland
Vaccinated:1990-06-29
Onset:1990-06-30
Submitted:0000-00-00
Entered:1990-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 409672130R / UNK - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Atrioventricular block, Chest pain, Pericarditis

Life Threatening? No
Birth Defect? No
Died? No
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? Yes, days:     Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: medical history of pericarditis
Allergies:
Diagnostic Lab Data: ECG revealed changes consistent /w a recurrence of pericarditis
CDC 'Split Type': WAES90070002

Write-up: Pt developed chest pains and other signs of pericarditis including a pericardial friction rub, hospitalized


Changed on 9/14/2018

VAERS ID: 25611 Before After
VAERS Form:1
Age:18.0
Sex:Male
Location:Maryland
Vaccinated:1990-06-29
Onset:1990-06-30
Submitted:0000-00-00
Entered:1990-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 409672130R / UNK - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Atrioventricular block, Chest pain, Pericarditis

Life Threatening? No
Birth Defect? No
Died? No
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? Yes, days:     Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: medical history of pericarditis
Allergies:
Diagnostic Lab Data: ECG revealed changes consistent /w a recurrence of pericarditis
CDC 'Split Type': WAES90070002

Write-up: Pt developed chest pains and other signs of pericarditis including a pericardial friction rub, hospitalized


Changed on 10/14/2018

VAERS ID: 25611 Before After
VAERS Form:1
Age:18.0
Sex:Male
Location:Maryland
Vaccinated:1990-06-29
Onset:1990-06-30
Submitted:0000-00-00
Entered:1990-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 409672130R / UNK - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Atrioventricular block, Chest pain, Pericarditis

Life Threatening? No
Birth Defect? No
Died? No
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? Yes, days:     Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: medical history of pericarditis
Allergies:
Diagnostic Lab Data: ECG revealed changes consistent /w a recurrence of pericarditis
CDC 'Split Type': WAES90070002

Write-up: Pt developed chest pains and other signs of pericarditis including a pericardial friction rub, hospitalized

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=25611&WAYBACKHISTORY=ON


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