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From the 6/11/2021 release of VAERS data:

This is VAERS ID 80140



Case Details

VAERS ID: 80140 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Rhode Island  
Vaccinated:1995-10-06
Onset:1995-12-03
   Days after vaccination:58
Submitted: 0000-00-00
Entered: 1995-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0785B / 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0435B / 1 LL / SC

Administered by: Private       Purchased by: Public
Symptoms: Aplastic anaemia, Mental retardation severity unspecified
SMQs:, Agranulocytosis (narrow), Haematopoietic cytopenias affecting more than one type of blood cell (narrow), Haematopoietic erythropenia (narrow), Myelodysplastic syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Albuterol nebulizer solution
Current Illness: NONE
Preexisting Conditions: hx of asthma
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recvd vax 6OCT95 & devel aplastic anemia 3DEC95;


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