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This is VAERS ID 162446

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 162446
VAERS Form:
Age:57.0
Sex:Male
Location:Maryland
Vaccinated:2000-11-01
Onset:2000-11-03
Submitted:2000-11-17
Entered:2000-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HAVRIX / SMITHKLINE VHA67036 / 0 - / IM
TD: TD ADSORBED, ADULTS / CONNAUGHT LABS U0193AA / 0 - / IM

Administered by: Public      Purchased by: Unknown
Symptoms: DIC, FEVER, SOMNOLENCE, SKIN DISCOLOR, BUNDLE BRANCH BLOCK

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-11-05
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: NONE
Preexisting Conditions: High blood pressure
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Reportedly on 11/3/00, the pt presented to the hospital ER with lethargy, fever and skin the color of purple. He was transferred to a university hospital on 11/4/00. The pt went into organ failure and disseminated intravascular coagulation. The pt died on"11/5/00, the pt''s wife refused an autopsy.


Changed on 12/30/2006

VAERS ID: 162446 Before After
VAERS Form:
Age:57.0
Sex:Male
Location:Maryland
Vaccinated:2000-11-01
Onset:2000-11-03
Submitted:2000-11-17
Entered:2000-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HAVRIX / SMITHKLINE VHA67036 / 0 - / IM
TD: TD ADSORBED, ADULTS / CONNAUGHT LABS U0193AA / 0 - / IM

Administered by: Public      Purchased by: Unknown
Symptoms: DIC, FEVER, SOMNOLENCE, SKIN DISCOLOR, BUNDLE BRANCH BLOCK

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-11-05
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: NONE
Preexisting Conditions: High blood pressure
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Reportedly on 11/3/00, the pt presented to the hospital ER with lethargy, fever and skin the color of purple. He was transferred to a university hospital on 11/4/00. The pt went into organ failure and disseminated intravascular coagulation. The pt died on"11/5/00, the pt''s pt''''s wife refused an autopsy.


Changed on 12/8/2009

VAERS ID: 162446 Before After
VAERS Form:
Age:57.0
Sex:Male
Location:Maryland
Vaccinated:2000-11-01
Onset:2000-11-03
Submitted:2000-11-17
Entered:2000-11-27 2000-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HAVRIX HEP A (HAVRIX) / SMITHKLINE SMITHKLINE BEECHAM VHA67036 / 0 - / IM
TD: TD ADSORBED, ADULTS TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABS CONNAUGHT LABORATORIES U0193AA / 0 - / IM

Administered by: Public      Purchased by: Unknown Private
Symptoms: Bundle branch block, DIC, Disseminated intravascular coagulation, Lethargy, Pyrexia, Skin discolouration, FEVER, SOMNOLENCE, SKIN DISCOLOR, BUNDLE BRANCH BLOCK

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-11-05
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: NONE
Preexisting Conditions: High blood pressure
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) U2000008210

Write-up: Reportedly on 11/3/00, the pt presented to the hospital ER with lethargy, fever and skin the color of purple. He was transferred to a university hospital on 11/4/00. The pt went into organ failure and disseminated intravascular coagulation. The pt died on"11/5/00, on 11/5/00, the pt''''s pt''s wife refused an autopsy.


Changed on 5/14/2017

VAERS ID: 162446 Before After
VAERS Form:
Age:57.0
Sex:Male
Location:Maryland
Vaccinated:2000-11-01
Onset:2000-11-03
Submitted:2000-11-17
Entered:2000-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA67036 / 0 - / IM
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES U0193AA / 0 - / IM

Administered by: Public      Purchased by: Private
Symptoms: Bundle branch block, Disseminated intravascular coagulation, Lethargy, Pyrexia, Skin discolouration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-11-05
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 Yes
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: High blood pressure
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': U2000008210

Write-up: Reportedly on 11/3/00, the pt presented to the hospital ER with lethargy, fever and skin the color of purple. He was transferred to a university hospital on 11/4/00. The pt went into organ failure and disseminated intravascular coagulation. The pt died on 11/5/00, the pt''s wife refused an autopsy.


Changed on 9/14/2017

VAERS ID: 162446 Before After
VAERS Form:(blank) 1
Age:57.0
Sex:Male
Location:Maryland
Vaccinated:2000-11-01
Onset:2000-11-03
Submitted:2000-11-17
Entered:2000-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA67036 / 0 1 - / IM
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES U0193AA / 0 1 - / IM

Administered by: Public      Purchased by: Private
Symptoms: Bundle branch block, Disseminated intravascular coagulation, Lethargy, Pyrexia, Skin discolouration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-11-05
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? Yes
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: High blood pressure
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': U2000008210

Write-up: Reportedly on 11/3/00, the pt presented to the hospital ER with lethargy, fever and skin the color of purple. He was transferred to a university hospital on 11/4/00. The pt went into organ failure and disseminated intravascular coagulation. The pt died on 11/5/00, the pt''s wife refused an autopsy.


Changed on 2/14/2018

VAERS ID: 162446 Before After
VAERS Form:1
Age:57.0
Sex:Male
Location:Maryland
Vaccinated:2000-11-01
Onset:2000-11-03
Submitted:2000-11-17
Entered:2000-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA67036 / 1 - / IM
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES U0193AA / 1 - / IM

Administered by: Public      Purchased by: Private
Symptoms: Bundle branch block, Disseminated intravascular coagulation, Lethargy, Pyrexia, Skin discolouration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-11-05
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? Yes
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: High blood pressure
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': U2000008210

Write-up: Reportedly on 11/3/00, the pt presented to the hospital ER with lethargy, fever and skin the color of purple. He was transferred to a university hospital on 11/4/00. The pt went into organ failure and disseminated intravascular coagulation. The pt died on 11/5/00, the pt''s wife refused an autopsy.


Changed on 6/14/2018

VAERS ID: 162446 Before After
VAERS Form:1
Age:57.0
Sex:Male
Location:Maryland
Vaccinated:2000-11-01
Onset:2000-11-03
Submitted:2000-11-17
Entered:2000-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA67036 / 1 - / IM
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES U0193AA / 1 - / IM

Administered by: Public      Purchased by: Private
Symptoms: Bundle branch block, Disseminated intravascular coagulation, Lethargy, Pyrexia, Skin discolouration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-11-05
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? Yes
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: High blood pressure
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': U2000008210

Write-up: Reportedly on 11/3/00, the pt presented to the hospital ER with lethargy, fever and skin the color of purple. He was transferred to a university hospital on 11/4/00. The pt went into organ failure and disseminated intravascular coagulation. The pt died on 11/5/00, the pt''s wife refused an autopsy.


Changed on 8/14/2018

VAERS ID: 162446 Before After
VAERS Form:1
Age:57.0
Sex:Male
Location:Maryland
Vaccinated:2000-11-01
Onset:2000-11-03
Submitted:2000-11-17
Entered:2000-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA67036 / 1 - / IM
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES U0193AA / 1 - / IM

Administered by: Public      Purchased by: Private
Symptoms: Bundle branch block, Disseminated intravascular coagulation, Lethargy, Pyrexia, Skin discolouration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-11-05
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? Yes
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: High blood pressure
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': U2000008210

Write-up: Reportedly on 11/3/00, the pt presented to the hospital ER with lethargy, fever and skin the color of purple. He was transferred to a university hospital on 11/4/00. The pt went into organ failure and disseminated intravascular coagulation. The pt died on 11/5/00, the pt''s wife refused an autopsy.


Changed on 9/14/2018

VAERS ID: 162446 Before After
VAERS Form:1
Age:57.0
Sex:Male
Location:Maryland
Vaccinated:2000-11-01
Onset:2000-11-03
Submitted:2000-11-17
Entered:2000-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA67036 / 1 - / IM
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES U0193AA / 1 - / IM

Administered by: Public      Purchased by: Private
Symptoms: Bundle branch block, Disseminated intravascular coagulation, Lethargy, Pyrexia, Skin discolouration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-11-05
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? Yes
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: High blood pressure
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': U2000008210

Write-up: Reportedly on 11/3/00, the pt presented to the hospital ER with lethargy, fever and skin the color of purple. He was transferred to a university hospital on 11/4/00. The pt went into organ failure and disseminated intravascular coagulation. The pt died on 11/5/00, the pt''s wife refused an autopsy.


Changed on 10/14/2018

VAERS ID: 162446 Before After
VAERS Form:1
Age:57.0
Sex:Male
Location:Maryland
Vaccinated:2000-11-01
Onset:2000-11-03
Submitted:2000-11-17
Entered:2000-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA67036 / 1 - / IM
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES U0193AA / 1 - / IM

Administered by: Public      Purchased by: Private
Symptoms: Bundle branch block, Disseminated intravascular coagulation, Lethargy, Pyrexia, Skin discolouration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-11-05
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? Yes
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: High blood pressure
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': U2000008210

Write-up: Reportedly on 11/3/00, the pt presented to the hospital ER with lethargy, fever and skin the color of purple. He was transferred to a university hospital on 11/4/00. The pt went into organ failure and disseminated intravascular coagulation. The pt died on 11/5/00, the pt''s wife refused an autopsy.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=162446&WAYBACKHISTORY=ON


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