National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 111499

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 111499
VAERS Form:
Age:
Sex:Male
Location:Tennessee
Vaccinated:1997-05-13
Onset:1997-05-24
Submitted:1998-06-05
Entered:1998-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: ENGERIX-B / SMITHKLINE - / 2 - / -

Administered by: Other      Purchased by: Unknown
Symptoms: PAIN

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-05-24
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: pt exp pain & swelling in leg w/dose 2 hep b;
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recv vax 13MAY97 & MAY97 exp pain in lt arm;pt unspecified problems grew worse over the next few days & ultimately resulted in pt death on 24MAY98;


Changed on 12/8/2009

VAERS ID: 111499 Before After
VAERS Form:
Age:
Sex:Male
Location:Tennessee
Vaccinated:1997-05-13
Onset:1997-05-24
Submitted:1998-06-05
Entered:1998-06-09 1998-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: ENGERIX-B HEP B (ENGERIX-B) / SMITHKLINE SMITHKLINE BEECHAM - / 2 - / -

Administered by: Other      Purchased by: Unknown Other
Symptoms: Pain, PAIN

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-05-24
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: pt exp pain & swelling in leg w/dose 2 hep b;
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) 19980147961A

Write-up: pt recv vax 13MAY97 & MAY97 exp pain in lt arm;pt unspecified problems grew worse over the next few days & ultimately resulted in pt death on 24MAY98;


Changed on 5/14/2017

VAERS ID: 111499 Before After
VAERS Form:
Age:
Sex:Male
Location:Tennessee
Vaccinated:1997-05-13
Onset:1997-05-24
Submitted:1998-06-05
Entered:1998-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / 2 - / -

Administered by: Other      Purchased by: Other
Symptoms: Pain

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-05-24
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: pt exp pain & swelling in leg w/dose 2 hep b; b;~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 19980147961A

Write-up: pt recv vax 13MAY97 & MAY97 exp pain in lt arm;pt unspecified problems grew worse over the next few days & ultimately resulted in pt death on 24MAY98;


Changed on 9/14/2017

VAERS ID: 111499 Before After
VAERS Form:(blank) 1
Age:
Sex:Male
Location:Tennessee
Vaccinated:1997-05-13
Onset:1997-05-24
Submitted:1998-06-05
Entered:1998-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / 2 3 - / -

Administered by: Other      Purchased by: Other
Symptoms: Pain

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-05-24
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: pt exp pain & swelling in leg w/dose 2 hep b;~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 19980147961A

Write-up: pt recv vax 13MAY97 & MAY97 exp pain in lt arm;pt unspecified problems grew worse over the next few days & ultimately resulted in pt death on 24MAY98;


Changed on 2/14/2018

VAERS ID: 111499 Before After
VAERS Form:1
Age:
Sex:Male
Location:Tennessee
Vaccinated:1997-05-13
Onset:1997-05-24
Submitted:1998-06-05
Entered:1998-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / 3 - / -

Administered by: Other      Purchased by: Other
Symptoms: Pain

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-05-24
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: pt exp pain & swelling in leg w/dose 2 hep b;~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 19980147961A

Write-up: pt recv vax 13MAY97 & MAY97 exp pain in lt arm;pt unspecified problems grew worse over the next few days & ultimately resulted in pt death on 24MAY98;


Changed on 6/14/2018

VAERS ID: 111499 Before After
VAERS Form:1
Age:
Sex:Male
Location:Tennessee
Vaccinated:1997-05-13
Onset:1997-05-24
Submitted:1998-06-05
Entered:1998-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / 3 - / -

Administered by: Other      Purchased by: Other
Symptoms: Pain

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-05-24
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: pt exp pain & swelling in leg w/dose 2 hep b;~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 19980147961A

Write-up: pt recv vax 13MAY97 & MAY97 exp pain in lt arm;pt unspecified problems grew worse over the next few days & ultimately resulted in pt death on 24MAY98;


Changed on 8/14/2018

VAERS ID: 111499 Before After
VAERS Form:1
Age:
Sex:Male
Location:Tennessee
Vaccinated:1997-05-13
Onset:1997-05-24
Submitted:1998-06-05
Entered:1998-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / 3 - / -

Administered by: Other      Purchased by: Other
Symptoms: Pain

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-05-24
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: pt exp pain & swelling in leg w/dose 2 hep b;~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 19980147961A

Write-up: pt recv vax 13MAY97 & MAY97 exp pain in lt arm;pt unspecified problems grew worse over the next few days & ultimately resulted in pt death on 24MAY98;


Changed on 9/14/2018

VAERS ID: 111499 Before After
VAERS Form:1
Age:
Sex:Male
Location:Tennessee
Vaccinated:1997-05-13
Onset:1997-05-24
Submitted:1998-06-05
Entered:1998-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / 3 - / -

Administered by: Other      Purchased by: Other
Symptoms: Pain

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-05-24
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: pt exp pain & swelling in leg w/dose 2 hep b;~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 19980147961A

Write-up: pt recv vax 13MAY97 & MAY97 exp pain in lt arm;pt unspecified problems grew worse over the next few days & ultimately resulted in pt death on 24MAY98;


Changed on 10/14/2018

VAERS ID: 111499 Before After
VAERS Form:1
Age:
Sex:Male
Location:Tennessee
Vaccinated:1997-05-13
Onset:1997-05-24
Submitted:1998-06-05
Entered:1998-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / 3 - / -

Administered by: Other      Purchased by: Other
Symptoms: Pain

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-05-24
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: pt exp pain & swelling in leg w/dose 2 hep b;~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 19980147961A

Write-up: pt recv vax 13MAY97 & MAY97 exp pain in lt arm;pt unspecified problems grew worse over the next few days & ultimately resulted in pt death on 24MAY98;

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=111499&WAYBACKHISTORY=ON


Copyright © 2020 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166