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This is VAERS ID 432984

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History of Changes from the VAERS Wayback Machine

First Appeared on 9/14/2011

VAERS ID: 432984
VAERS Form:
Age:63.0
Sex:Male
Location:Missouri
Vaccinated:2011-08-23
Onset:2011-09-01
Submitted:2011-09-03
Entered:2011-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC004AA / 0 LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-09-01
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:
Current Illness: NO
Preexisting Conditions: NO
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: EMPLOYEE RECEIVED HEP B ON 8/23/2011. DONOR PASSED ON 9/1/2011. UNKNOWN IF SHOT ASSOCIATED WITH DEATH.


Changed on 9/14/2017

VAERS ID: 432984 Before After
VAERS Form:(blank) 1
Age:63.0
Sex:Male
Location:Missouri
Vaccinated:2011-08-23
Onset:2011-09-01
Submitted:2011-09-03
Entered:2011-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC004AA / 0 1 LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-09-01
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:
Current Illness: NO
Preexisting Conditions: NO
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: EMPLOYEE RECEIVED HEP B ON 8/23/2011. DONOR PASSED ON 9/1/2011. UNKNOWN IF SHOT ASSOCIATED WITH DEATH.


Changed on 2/14/2018

VAERS ID: 432984 Before After
VAERS Form:1
Age:63.0
Sex:Male
Location:Missouri
Vaccinated:2011-08-23
Onset:2011-09-01
Submitted:2011-09-03
Entered:2011-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC004AA / 1 LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-09-01
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:
Current Illness: NO
Preexisting Conditions: NO
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: EMPLOYEE RECEIVED HEP B ON 8/23/2011. DONOR PASSED ON 9/1/2011. UNKNOWN IF SHOT ASSOCIATED WITH DEATH.


Changed on 6/14/2018

VAERS ID: 432984 Before After
VAERS Form:1
Age:63.0
Sex:Male
Location:Missouri
Vaccinated:2011-08-23
Onset:2011-09-01
Submitted:2011-09-03
Entered:2011-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC004AA / 1 LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-09-01
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:
Current Illness: NO
Preexisting Conditions: NO
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: EMPLOYEE RECEIVED HEP B ON 8/23/2011. DONOR PASSED ON 9/1/2011. UNKNOWN IF SHOT ASSOCIATED WITH DEATH.


Changed on 8/14/2018

VAERS ID: 432984 Before After
VAERS Form:1
Age:63.0
Sex:Male
Location:Missouri
Vaccinated:2011-08-23
Onset:2011-09-01
Submitted:2011-09-03
Entered:2011-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC004AA / 1 LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-09-01
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:
Current Illness: NO
Preexisting Conditions: NO
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: EMPLOYEE RECEIVED HEP B ON 8/23/2011. DONOR PASSED ON 9/1/2011. UNKNOWN IF SHOT ASSOCIATED WITH DEATH.


Changed on 9/14/2018

VAERS ID: 432984 Before After
VAERS Form:1
Age:63.0
Sex:Male
Location:Missouri
Vaccinated:2011-08-23
Onset:2011-09-01
Submitted:2011-09-03
Entered:2011-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC004AA / 1 LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-09-01
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:
Current Illness: NO
Preexisting Conditions: NO
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: EMPLOYEE RECEIVED HEP B ON 8/23/2011. DONOR PASSED ON 9/1/2011. UNKNOWN IF SHOT ASSOCIATED WITH DEATH.


Changed on 10/14/2018

VAERS ID: 432984 Before After
VAERS Form:1
Age:63.0
Sex:Male
Location:Missouri
Vaccinated:2011-08-23
Onset:2011-09-01
Submitted:2011-09-03
Entered:2011-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC004AA / 1 LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-09-01
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:
Current Illness: NO
Preexisting Conditions: NO
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: EMPLOYEE RECEIVED HEP B ON 8/23/2011. DONOR PASSED ON 9/1/2011. UNKNOWN IF SHOT ASSOCIATED WITH DEATH.


Changed on 12/24/2020

VAERS ID: 432984 Before After
VAERS Form:1
Age:63.0
Sex:Male
Location:Missouri
Vaccinated:2011-08-23
Onset:2011-09-01
Submitted:2011-09-03
Entered:2011-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC004AA / 1 LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-09-01
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:
Current Illness: NO
Preexisting Conditions: NO
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: EMPLOYEE RECEIVED HEP B ON 8/23/2011. DONOR PASSED ON 9/1/2011. UNKNOWN IF SHOT ASSOCIATED WITH DEATH.


Changed on 12/30/2020

VAERS ID: 432984 Before After
VAERS Form:1
Age:63.0
Sex:Male
Location:Missouri
Vaccinated:2011-08-23
Onset:2011-09-01
Submitted:2011-09-03
Entered:2011-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC004AA / 1 LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-09-01
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:
Current Illness: NO
Preexisting Conditions: NO
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: EMPLOYEE RECEIVED HEP B ON 8/23/2011. DONOR PASSED ON 9/1/2011. UNKNOWN IF SHOT ASSOCIATED WITH DEATH.


Changed on 5/7/2021

VAERS ID: 432984 Before After
VAERS Form:1
Age:63.0
Sex:Male
Location:Missouri
Vaccinated:2011-08-23
Onset:2011-09-01
Submitted:2011-09-03
Entered:2011-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC004AA / 1 LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-09-01
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:
Current Illness: NO
Preexisting Conditions: NO
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: EMPLOYEE RECEIVED HEP B ON 8/23/2011. DONOR PASSED ON 9/1/2011. UNKNOWN IF SHOT ASSOCIATED WITH DEATH.


Changed on 5/14/2021

VAERS ID: 432984 Before After
VAERS Form:1
Age:63.0
Sex:Male
Location:Missouri
Vaccinated:2011-08-23
Onset:2011-09-01
Submitted:2011-09-03
Entered:2011-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC004AA / 1 LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-09-01
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:
Current Illness: NO
Preexisting Conditions: NO
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: EMPLOYEE RECEIVED HEP B ON 8/23/2011. DONOR PASSED ON 9/1/2011. UNKNOWN IF SHOT ASSOCIATED WITH DEATH.

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