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This is VAERS ID 160423

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 160423
VAERS Form:
Age:15.0
Sex:Male
Location:Alaska
Vaccinated:2000-02-17
Onset:2000-03-08
Submitted:2000-03-17
Entered:2000-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: ENGERIX-B / SMITHKLINE ENG3132B9 / 1 LA / IM
HEPA: HAVRIX / SMITHKLINE VHA618A7 / 1 LA / IM

Administered by: Other      Purchased by: Unknown
Symptoms: APNEA, HEART ARREST

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-03-08
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:
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Post vax, the pt was playing badminton in high school physical education class when he collapsed. CPR started by PE teacher and school nurse until paramedics arrived. Expired at hospital. Autopsy performed. Pathology tissues of heart sent for conduction s"tudies.


Changed on 12/8/2009

VAERS ID: 160423 Before After
VAERS Form:
Age:15.0
Sex:Male
Location:Alaska
Vaccinated:2000-02-17
Onset:2000-03-08
Submitted:2000-03-17
Entered:2000-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: ENGERIX-B HEP B (ENGERIX-B) / SMITHKLINE SMITHKLINE BEECHAM ENG3132B9 3132B9 / 1 LA / IM
HEPA: HAVRIX HEP A (HAVRIX) / SMITHKLINE SMITHKLINE BEECHAM VHA618A7 618A7 / 1 LA / IM

Administered by: Other      Purchased by: Unknown Public
Symptoms: Apnoea, Cardiac arrest, APNEA, HEART ARREST

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-03-08
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:
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) AK200021

Write-up: Post vax, the pt was playing badminton in high school physical education class when he collapsed. CPR started by PE teacher and school nurse until paramedics arrived. Expired at hospital. Autopsy performed. Pathology tissues of heart sent for conduction s"tudies. studies.


Changed on 9/14/2017

VAERS ID: 160423 Before After
VAERS Form:(blank) 1
Age:15.0
Sex:Male
Location:Alaska
Vaccinated:2000-02-17
Onset:2000-03-08
Submitted:2000-03-17
Entered:2000-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 3132B9 / 1 2 LA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 618A7 / 1 2 LA / IM

Administered by: Other      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-03-08
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:
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': AK200021

Write-up: Post vax, the pt was playing badminton in high school physical education class when he collapsed. CPR started by PE teacher and school nurse until paramedics arrived. Expired at hospital. Autopsy performed. Pathology tissues of heart sent for conduction studies.


Changed on 2/14/2018

VAERS ID: 160423 Before After
VAERS Form:1
Age:15.0
Sex:Male
Location:Alaska
Vaccinated:2000-02-17
Onset:2000-03-08
Submitted:2000-03-17
Entered:2000-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 3132B9 / 2 LA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 618A7 / 2 LA / IM

Administered by: Other      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-03-08
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:
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': AK200021

Write-up: Post vax, the pt was playing badminton in high school physical education class when he collapsed. CPR started by PE teacher and school nurse until paramedics arrived. Expired at hospital. Autopsy performed. Pathology tissues of heart sent for conduction studies.


Changed on 6/14/2018

VAERS ID: 160423 Before After
VAERS Form:1
Age:15.0
Sex:Male
Location:Alaska
Vaccinated:2000-02-17
Onset:2000-03-08
Submitted:2000-03-17
Entered:2000-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 3132B9 / 2 LA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 618A7 / 2 LA / IM

Administered by: Other      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-03-08
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:
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': AK200021

Write-up: Post vax, the pt was playing badminton in high school physical education class when he collapsed. CPR started by PE teacher and school nurse until paramedics arrived. Expired at hospital. Autopsy performed. Pathology tissues of heart sent for conduction studies.


Changed on 8/14/2018

VAERS ID: 160423 Before After
VAERS Form:1
Age:15.0
Sex:Male
Location:Alaska
Vaccinated:2000-02-17
Onset:2000-03-08
Submitted:2000-03-17
Entered:2000-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 3132B9 / 2 LA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 618A7 / 2 LA / IM

Administered by: Other      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-03-08
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:
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': AK200021

Write-up: Post vax, the pt was playing badminton in high school physical education class when he collapsed. CPR started by PE teacher and school nurse until paramedics arrived. Expired at hospital. Autopsy performed. Pathology tissues of heart sent for conduction studies.


Changed on 9/14/2018

VAERS ID: 160423 Before After
VAERS Form:1
Age:15.0
Sex:Male
Location:Alaska
Vaccinated:2000-02-17
Onset:2000-03-08
Submitted:2000-03-17
Entered:2000-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 3132B9 / 2 LA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 618A7 / 2 LA / IM

Administered by: Other      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-03-08
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:
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': AK200021

Write-up: Post vax, the pt was playing badminton in high school physical education class when he collapsed. CPR started by PE teacher and school nurse until paramedics arrived. Expired at hospital. Autopsy performed. Pathology tissues of heart sent for conduction studies.


Changed on 10/14/2018

VAERS ID: 160423 Before After
VAERS Form:1
Age:15.0
Sex:Male
Location:Alaska
Vaccinated:2000-02-17
Onset:2000-03-08
Submitted:2000-03-17
Entered:2000-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 3132B9 / 2 LA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 618A7 / 2 LA / IM

Administered by: Other      Purchased by: Public
Symptoms: Apnoea, Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-03-08
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:
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': AK200021

Write-up: Post vax, the pt was playing badminton in high school physical education class when he collapsed. CPR started by PE teacher and school nurse until paramedics arrived. Expired at hospital. Autopsy performed. Pathology tissues of heart sent for conduction studies.

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