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This is VAERS ID 106427

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 106427
VAERS Form:
Age:46.9
Sex:Male
Location:Tennessee
Vaccinated:1997-10-03
Onset:0000-00-00
Submitted:1997-11-21
Entered:1998-01-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: ENGERIX-B / SMITHKLINE 230086 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-10-07
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: NONE
Other Medications:
Current Illness: NONE
Preexisting Conditions: diabetes
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': diabetes

Write-up:


Changed on 12/8/2009

VAERS ID: 106427 Before After
VAERS Form:
Age:46.9
Sex:Male
Location:Tennessee
Vaccinated:1997-10-03
Onset:0000-00-00
Submitted:1997-11-21
Entered:1998-01-20 1998-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: ENGERIX-B HEP B (ENGERIX-B) / SMITHKLINE SMITHKLINE BEECHAM 230086 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-10-07
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: NONE
Other Medications:
Current Illness: NONE
Preexisting Conditions: diabetes
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': diabetes (blank)

Write-up:


Changed on 2/14/2017

VAERS ID: 106427 Before After
VAERS Form:
Age:46.9 46.0
Sex:Male
Location:Tennessee
Vaccinated:1997-10-03
Onset:0000-00-00
Submitted:1997-11-21
Entered:1998-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 230086 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-10-07
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: NONE
Other Medications:
Current Illness: NONE
Preexisting Conditions: diabetes
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:


Changed on 5/14/2017

VAERS ID: 106427 Before After
VAERS Form:
Age:46.0
Sex:Male
Location:Tennessee
Vaccinated:1997-10-03
Onset:0000-00-00
Submitted:1997-11-21
Entered:1998-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 230086 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-10-07
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: NONE NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: diabetes
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:


Changed on 9/14/2017

VAERS ID: 106427 Before After
VAERS Form:(blank) 1
Age:46.0
Sex:Male
Location:Tennessee
Vaccinated:1997-10-03
Onset:0000-00-00
Submitted:1997-11-21
Entered:1998-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 230086 / 1 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-10-07
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: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: diabetes
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:


Changed on 2/14/2018

VAERS ID: 106427 Before After
VAERS Form:1
Age:46.0
Sex:Male
Location:Tennessee
Vaccinated:1997-10-03
Onset:0000-00-00
Submitted:1997-11-21
Entered:1998-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 230086 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-10-07
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: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: diabetes
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:


Changed on 6/14/2018

VAERS ID: 106427 Before After
VAERS Form:1
Age:46.0
Sex:Male
Location:Tennessee
Vaccinated:1997-10-03
Onset:0000-00-00
Submitted:1997-11-21
Entered:1998-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 230086 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-10-07
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: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: diabetes
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:


Changed on 8/14/2018

VAERS ID: 106427 Before After
VAERS Form:1
Age:46.0
Sex:Male
Location:Tennessee
Vaccinated:1997-10-03
Onset:0000-00-00
Submitted:1997-11-21
Entered:1998-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 230086 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-10-07
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: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: diabetes
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:


Changed on 9/14/2018

VAERS ID: 106427 Before After
VAERS Form:1
Age:46.0
Sex:Male
Location:Tennessee
Vaccinated:1997-10-03
Onset:0000-00-00
Submitted:1997-11-21
Entered:1998-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 230086 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-10-07
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: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: diabetes
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:


Changed on 10/14/2018

VAERS ID: 106427 Before After
VAERS Form:1
Age:46.0
Sex:Male
Location:Tennessee
Vaccinated:1997-10-03
Onset:0000-00-00
Submitted:1997-11-21
Entered:1998-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 230086 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-10-07
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: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: diabetes
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:

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