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This is VAERS ID 113717

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 113717
VAERS Form:
Age:53.6
Sex:Male
Location:Tennessee
Vaccinated:1998-05-20
Onset:1998-05-26
Submitted:1998-06-02
Entered:1998-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: ENGERIX-B / SMITHKLINE 2186A4 / 1 RA / IM

Administered by: Public      Purchased by: Unknown
Symptoms: LIVER FAIL

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-05-26
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: NA
Other Medications: Hep B vax dose 1;
Current Illness: liver failure
Preexisting Conditions: NKA, liver failure
Allergies:
Diagnostic Lab Data: liver failure
CDC 'Split Type': NKA, liver failure

Write-up: liver failure


Changed on 12/8/2009

VAERS ID: 113717 Before After
VAERS Form:
Age:53.6
Sex:Male
Location:Tennessee
Vaccinated:1998-05-20
Onset:1998-05-26
Submitted:1998-06-02
Entered:1998-09-01 1998-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: ENGERIX-B HEP B (ENGERIX-B) / SMITHKLINE SMITHKLINE BEECHAM 2186A4 / 1 RA / IM

Administered by: Public      Purchased by: Unknown Public
Symptoms: Hepatic failure, LIVER FAIL

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-05-26
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: NA
Other Medications: Hep B vax dose 1;
Current Illness: liver failure
Preexisting Conditions: NKA, liver failure
Allergies:
Diagnostic Lab Data: liver failure
CDC 'Split Type': NKA, liver failure TN98027

Write-up: liver failure


Changed on 2/14/2017

VAERS ID: 113717 Before After
VAERS Form:
Age:53.6 53.0
Sex:Male
Location:Tennessee
Vaccinated:1998-05-20
Onset:1998-05-26
Submitted:1998-06-02
Entered:1998-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2186A4 / 1 RA / IM

Administered by: Public      Purchased by: Public
Symptoms: Hepatic failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-05-26
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: NA
Other Medications: Hep B vax dose 1;
Current Illness: liver failure
Preexisting Conditions: NKA, liver failure
Allergies:
Diagnostic Lab Data: liver failure
CDC 'Split Type': TN98027

Write-up: liver failure


Changed on 5/14/2017

VAERS ID: 113717 Before After
VAERS Form:
Age:53.0
Sex:Male
Location:Tennessee
Vaccinated:1998-05-20
Onset:1998-05-26
Submitted:1998-06-02
Entered:1998-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2186A4 / 1 RA / IM

Administered by: Public      Purchased by: Public
Symptoms: Hepatic failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-05-26
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: NA NA~ ()~~~In patient
Other Medications: Hep B vax dose 1;
Current Illness: liver failure
Preexisting Conditions: NKA, liver failure
Allergies:
Diagnostic Lab Data: liver failure
CDC 'Split Type': TN98027

Write-up: liver failure


Changed on 9/14/2017

VAERS ID: 113717 Before After
VAERS Form:(blank) 1
Age:53.0
Sex:Male
Location:Tennessee
Vaccinated:1998-05-20
Onset:1998-05-26
Submitted:1998-06-02
Entered:1998-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2186A4 / 1 2 RA / IM

Administered by: Public      Purchased by: Public
Symptoms: Hepatic failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-05-26
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: NA~ ()~~~In patient
Other Medications: Hep B vax dose 1;
Current Illness: liver failure
Preexisting Conditions: NKA, liver failure
Allergies:
Diagnostic Lab Data: liver failure
CDC 'Split Type': TN98027

Write-up: liver failure


Changed on 2/14/2018

VAERS ID: 113717 Before After
VAERS Form:1
Age:53.0
Sex:Male
Location:Tennessee
Vaccinated:1998-05-20
Onset:1998-05-26
Submitted:1998-06-02
Entered:1998-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2186A4 / 2 RA / IM

Administered by: Public      Purchased by: Public
Symptoms: Hepatic failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-05-26
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: NA~ ()~~~In patient
Other Medications: Hep B vax dose 1;
Current Illness: liver failure
Preexisting Conditions: NKA, liver failure
Allergies:
Diagnostic Lab Data: liver failure
CDC 'Split Type': TN98027

Write-up: liver failure


Changed on 6/14/2018

VAERS ID: 113717 Before After
VAERS Form:1
Age:53.0
Sex:Male
Location:Tennessee
Vaccinated:1998-05-20
Onset:1998-05-26
Submitted:1998-06-02
Entered:1998-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2186A4 / 2 RA / IM

Administered by: Public      Purchased by: Public
Symptoms: Hepatic failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-05-26
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: NA~ ()~~~In patient
Other Medications: Hep B vax dose 1;
Current Illness: liver failure
Preexisting Conditions: NKA, liver failure
Allergies:
Diagnostic Lab Data: liver failure
CDC 'Split Type': TN98027

Write-up: liver failure


Changed on 8/14/2018

VAERS ID: 113717 Before After
VAERS Form:1
Age:53.0
Sex:Male
Location:Tennessee
Vaccinated:1998-05-20
Onset:1998-05-26
Submitted:1998-06-02
Entered:1998-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2186A4 / 2 RA / IM

Administered by: Public      Purchased by: Public
Symptoms: Hepatic failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-05-26
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: NA~ ()~~~In patient
Other Medications: Hep B vax dose 1;
Current Illness: liver failure
Preexisting Conditions: NKA, liver failure
Allergies:
Diagnostic Lab Data: liver failure
CDC 'Split Type': TN98027

Write-up: liver failure


Changed on 9/14/2018

VAERS ID: 113717 Before After
VAERS Form:1
Age:53.0
Sex:Male
Location:Tennessee
Vaccinated:1998-05-20
Onset:1998-05-26
Submitted:1998-06-02
Entered:1998-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2186A4 / 2 RA / IM

Administered by: Public      Purchased by: Public
Symptoms: Hepatic failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-05-26
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: NA~ ()~~~In patient
Other Medications: Hep B vax dose 1;
Current Illness: liver failure
Preexisting Conditions: NKA, liver failure
Allergies:
Diagnostic Lab Data: liver failure
CDC 'Split Type': TN98027

Write-up: liver failure


Changed on 10/14/2018

VAERS ID: 113717 Before After
VAERS Form:1
Age:53.0
Sex:Male
Location:Tennessee
Vaccinated:1998-05-20
Onset:1998-05-26
Submitted:1998-06-02
Entered:1998-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2186A4 / 2 RA / IM

Administered by: Public      Purchased by: Public
Symptoms: Hepatic failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-05-26
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: NA~ ()~~~In patient
Other Medications: Hep B vax dose 1;
Current Illness: liver failure
Preexisting Conditions: NKA, liver failure
Allergies:
Diagnostic Lab Data: liver failure
CDC 'Split Type': TN98027

Write-up: liver failure

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