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This is VAERS ID 80140

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 80140
VAERS Form:
Age:1.0
Sex:Male
Location:Rhode Island
Vaccinated:1995-10-06
Onset:1995-12-03
Submitted:0000-00-00
Entered:1995-12-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MMR II / MSD 0785B / 0 RL / SC
VARCEL: VARIVAX / MSD 0435B / 0 LL / SC

Administered by: Private      Purchased by: Unknown
Symptoms: MENTAL RETARD, ANEMIA APLAST

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: 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;


Changed on 12/8/2009

VAERS ID: 80140 Before After
VAERS Form:
Age:1.0
Sex:Male
Location:Rhode Island
Vaccinated:1995-10-06
Onset:1995-12-03
Submitted:0000-00-00
Entered:1995-12-21 1995-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 0785B / 0 RL / SC
VARCEL: VARIVAX VARICELLA (VARIVAX) / MSD MERCK & CO. INC. 0435B / 0 LL / SC

Administered by: Private      Purchased by: Unknown Public
Symptoms: Aplastic anaemia, Mental retardation severity unspecified, MENTAL RETARD, ANEMIA APLAST

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: 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;


Changed on 5/14/2017

VAERS ID: 80140 Before After
VAERS Form:
Age:1.0
Sex:Male
Location:Rhode Island
Vaccinated:1995-10-06
Onset:1995-12-03
Submitted:0000-00-00
Entered:1995-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0785B / 0 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0435B / 0 LL / SC

Administered by: Private      Purchased by: Public
Symptoms: Aplastic anaemia, Mental retardation severity unspecified

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: 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;


Changed on 9/14/2017

VAERS ID: 80140 Before After
VAERS Form:(blank) 1
Age:1.0
Sex:Male
Location:Rhode Island
Vaccinated:1995-10-06
Onset:1995-12-03
Submitted:0000-00-00
Entered:1995-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0785B / 0 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0435B / 0 1 LL / SC

Administered by: Private      Purchased by: Public
Symptoms: Aplastic anaemia, Mental retardation severity unspecified

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: 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;


Changed on 2/14/2018

VAERS ID: 80140 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Rhode Island
Vaccinated:1995-10-06
Onset:1995-12-03
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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: 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;


Changed on 6/14/2018

VAERS ID: 80140 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Rhode Island
Vaccinated:1995-10-06
Onset:1995-12-03
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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: 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;


Changed on 8/14/2018

VAERS ID: 80140 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Rhode Island
Vaccinated:1995-10-06
Onset:1995-12-03
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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: 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;


Changed on 9/14/2018

VAERS ID: 80140 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Rhode Island
Vaccinated:1995-10-06
Onset:1995-12-03
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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: 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;


Changed on 10/14/2018

VAERS ID: 80140 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Rhode Island
Vaccinated:1995-10-06
Onset:1995-12-03
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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: 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;


Changed on 12/24/2020

VAERS ID: 80140 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Rhode Island
Vaccinated:1995-10-06
Onset:1995-12-03
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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: 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;


Changed on 12/30/2020

VAERS ID: 80140 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Rhode Island
Vaccinated:1995-10-06
Onset:1995-12-03
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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: 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;


Changed on 5/7/2021

VAERS ID: 80140 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Rhode Island
Vaccinated:1995-10-06
Onset:1995-12-03
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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: 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;


Changed on 5/14/2021

VAERS ID: 80140 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Rhode Island
Vaccinated:1995-10-06
Onset:1995-12-03
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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: 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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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=80140&WAYBACKHISTORY=ON


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