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This is VAERS ID 113727

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 113727
VAERS Form:
Age:64.0
Sex:Male
Location:New York
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1998-08-21
Entered:1998-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
YF: YELLOW FEVER / CONNAUGHT LABS - / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: FEVER, LEUKOPENIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: pt treated for multiple myeloma;
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: It was reported that pt (no other specifices reported) recv vax about 2wk prior to the report date of 21AUG98;some time p/vax pt adm to hosp w/fever & leukopenia;It was reportedthat prior to recv vax pt was recently treated for mult myeloma


Changed on 12/8/2009

VAERS ID: 113727 Before After
VAERS Form:
Age:64.0
Sex:Male
Location:New York
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1998-08-21
Entered:1998-09-01 1998-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
YF: YELLOW FEVER YELLOW FEVER (YF-VAX) / CONNAUGHT LABS CONNAUGHT LABORATORIES - / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Leukopenia, Pyrexia, FEVER, LEUKOPENIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: pt treated for multiple myeloma;
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) U199800494

Write-up: It was reported that pt (no other specifices reported) recv vax about 2wk prior to the report date of 21AUG98;some time p/vax pt adm to hosp w/fever & leukopenia;It was reportedthat prior to recv vax pt was recently treated for mult myeloma


Changed on 5/14/2017

VAERS ID: 113727 Before After
VAERS Form:
Age:64.0
Sex:Male
Location:New York
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1998-08-21
Entered:1998-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES - / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Leukopenia, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: pt treated for multiple myeloma;
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': U199800494

Write-up: It was reported that pt (no other specifices reported) recv vax about 2wk prior to the report date of 21AUG98;some time p/vax pt adm to hosp w/fever & leukopenia;It was reportedthat prior to recv vax pt was recently treated for mult myeloma


Changed on 9/14/2017

VAERS ID: 113727 Before After
VAERS Form:(blank) 1
Age:64.0
Sex:Male
Location:New York
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1998-08-21
Entered:1998-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES - / - UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Leukopenia, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: pt treated for multiple myeloma;
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': U199800494

Write-up: It was reported that pt (no other specifices reported) recv vax about 2wk prior to the report date of 21AUG98;some time p/vax pt adm to hosp w/fever & leukopenia;It was reportedthat prior to recv vax pt was recently treated for mult myeloma


Changed on 2/14/2018

VAERS ID: 113727 Before After
VAERS Form:1
Age:64.0
Sex:Male
Location:New York
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1998-08-21
Entered:1998-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES - / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Leukopenia, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: pt treated for multiple myeloma;
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': U199800494

Write-up: It was reported that pt (no other specifices reported) recv vax about 2wk prior to the report date of 21AUG98;some time p/vax pt adm to hosp w/fever & leukopenia;It was reportedthat prior to recv vax pt was recently treated for mult myeloma


Changed on 6/14/2018

VAERS ID: 113727 Before After
VAERS Form:1
Age:64.0
Sex:Male
Location:New York
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1998-08-21
Entered:1998-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES - / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Leukopenia, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: pt treated for multiple myeloma;
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': U199800494

Write-up: It was reported that pt (no other specifices reported) recv vax about 2wk prior to the report date of 21AUG98;some time p/vax pt adm to hosp w/fever & leukopenia;It was reportedthat prior to recv vax pt was recently treated for mult myeloma


Changed on 8/14/2018

VAERS ID: 113727 Before After
VAERS Form:1
Age:64.0
Sex:Male
Location:New York
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1998-08-21
Entered:1998-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES - / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Leukopenia, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: pt treated for multiple myeloma;
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': U199800494

Write-up: It was reported that pt (no other specifices reported) recv vax about 2wk prior to the report date of 21AUG98;some time p/vax pt adm to hosp w/fever & leukopenia;It was reportedthat prior to recv vax pt was recently treated for mult myeloma


Changed on 9/14/2018

VAERS ID: 113727 Before After
VAERS Form:1
Age:64.0
Sex:Male
Location:New York
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1998-08-21
Entered:1998-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES - / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Leukopenia, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: pt treated for multiple myeloma;
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': U199800494

Write-up: It was reported that pt (no other specifices reported) recv vax about 2wk prior to the report date of 21AUG98;some time p/vax pt adm to hosp w/fever & leukopenia;It was reportedthat prior to recv vax pt was recently treated for mult myeloma


Changed on 10/14/2018

VAERS ID: 113727 Before After
VAERS Form:1
Age:64.0
Sex:Male
Location:New York
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1998-08-21
Entered:1998-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES - / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Leukopenia, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: pt treated for multiple myeloma;
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': U199800494

Write-up: It was reported that pt (no other specifices reported) recv vax about 2wk prior to the report date of 21AUG98;some time p/vax pt adm to hosp w/fever & leukopenia;It was reportedthat prior to recv vax pt was recently treated for mult myeloma

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