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This is VAERS ID 473483

History of Changes from the VAERS Wayback Machine

First Appeared on 11/13/2012

VAERS ID: 473483
VAERS Form:
Age:31.0
Sex:Male
Location:Oklahoma
Vaccinated:2012-10-30
Onset:2012-10-31
Submitted:2012-11-07
Entered:2012-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR H1354 / - LA / IM
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD 3000128 / - - / PO
YF: YELLOW FEVER (YF-VAX) / SANOFI PASTEUR UH296AB / - LA / SC

Administered by: Private      Purchased by: Private
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-10-31
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: Soma
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pronounced dead at home in bed.


Changed on 4/13/2013

VAERS ID: 473483 Before After
VAERS Form:
Age:31.0
Sex:Male
Location:Oklahoma
Vaccinated:2012-10-30
Onset:2012-10-31
Submitted:2012-11-07
Entered:2012-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB566AN / - LA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR H1354 / - LA / IM
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD 3000128 / - - / PO
YF: YELLOW FEVER (YF-VAX) / SANOFI PASTEUR UH296AB / - LA / SC

Administered by: Private      Purchased by: Private
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-10-31
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: Soma
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pronounced dead at home in bed.


Changed on 6/14/2014

VAERS ID: 473483 Before After
VAERS Form:
Age:31.0
Sex:Male
Location:Oklahoma
Vaccinated:2012-10-30
Onset:2012-10-31
Submitted:2012-11-07
Entered:2012-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB566AN / - LA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR H1354 / - LA / IM
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD 3000128 / - - / PO
YF: YELLOW FEVER (YF-VAX) / SANOFI PASTEUR UH296AB / - LA / SC

Administered by: Private      Purchased by: Private
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-10-31
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: Soma
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pronounced dead at home in bed.


Changed on 3/14/2015

VAERS ID: 473483 Before After
VAERS Form:
Age:31.0
Sex:Male
Location:Oklahoma
Vaccinated:2012-10-30
Onset:2012-10-31
Submitted:2012-11-07
Entered:2012-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB566AN / - LA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR H1354 / - LA / IM
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD 3000128 / - - / PO
YF: YELLOW FEVER (YF-VAX) / SANOFI PASTEUR UH296AB / - LA / SC

Administered by: Private      Purchased by: Private
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-10-31
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: Soma
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pronounced dead at home in bed.


Changed on 9/14/2017

VAERS ID: 473483 Before After
VAERS Form:(blank) 1
Age:31.0
Sex:Male
Location:Oklahoma
Vaccinated:2012-10-30
Onset:2012-10-31
Submitted:2012-11-07
Entered:2012-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB566AN / - UNK LA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR H1354 / - UNK LA / IM
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD BERNA BIOTECH, LTD. 3000128 / - UNK - MO / PO
YF: YELLOW FEVER (YF-VAX) / SANOFI PASTEUR UH296AB / - UNK LA / SC

Administered by: Private      Purchased by: Private
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-10-31
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: Soma
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pronounced dead at home in bed.


Changed on 2/14/2018

VAERS ID: 473483 Before After
VAERS Form:1
Age:31.0
Sex:Male
Location:Oklahoma
Vaccinated:2012-10-30
Onset:2012-10-31
Submitted:2012-11-07
Entered:2012-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB566AN / UNK LA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR H1354 / UNK LA / IM
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD. 3000128 / UNK MO / PO
YF: YELLOW FEVER (YF-VAX) / SANOFI PASTEUR UH296AB / UNK LA / SC

Administered by: Private      Purchased by: Private
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-10-31
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: Soma
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pronounced dead at home in bed.


Changed on 6/14/2018

VAERS ID: 473483 Before After
VAERS Form:1
Age:31.0
Sex:Male
Location:Oklahoma
Vaccinated:2012-10-30
Onset:2012-10-31
Submitted:2012-11-07
Entered:2012-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB566AN / UNK LA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR H1354 / UNK LA / IM
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD. 3000128 / UNK MO / PO
YF: YELLOW FEVER (YF-VAX) / SANOFI PASTEUR UH296AB / UNK LA / SC

Administered by: Private      Purchased by: Private
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-10-31
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: Soma
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pronounced dead at home in bed.


Changed on 8/14/2018

VAERS ID: 473483 Before After
VAERS Form:1
Age:31.0
Sex:Male
Location:Oklahoma
Vaccinated:2012-10-30
Onset:2012-10-31
Submitted:2012-11-07
Entered:2012-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB566AN / UNK LA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR H1354 / UNK LA / IM
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD. 3000128 / UNK MO / PO
YF: YELLOW FEVER (YF-VAX) / SANOFI PASTEUR UH296AB / UNK LA / SC

Administered by: Private      Purchased by: Private
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-10-31
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: Soma
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pronounced dead at home in bed.


Changed on 9/14/2018

VAERS ID: 473483 Before After
VAERS Form:1
Age:31.0
Sex:Male
Location:Oklahoma
Vaccinated:2012-10-30
Onset:2012-10-31
Submitted:2012-11-07
Entered:2012-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB566AN / UNK LA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR H1354 / UNK LA / IM
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD. 3000128 / UNK MO / PO
YF: YELLOW FEVER (YF-VAX) / SANOFI PASTEUR UH296AB / UNK LA / SC

Administered by: Private      Purchased by: Private
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-10-31
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: Soma
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pronounced dead at home in bed.


Changed on 10/14/2018

VAERS ID: 473483 Before After
VAERS Form:1
Age:31.0
Sex:Male
Location:Oklahoma
Vaccinated:2012-10-30
Onset:2012-10-31
Submitted:2012-11-07
Entered:2012-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB566AN / UNK LA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR H1354 / UNK LA / IM
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD. 3000128 / UNK MO / PO
YF: YELLOW FEVER (YF-VAX) / SANOFI PASTEUR UH296AB / UNK LA / SC

Administered by: Private      Purchased by: Private
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-10-31
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: Soma
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pronounced dead at home in bed.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=473483&WAYBACKHISTORY=ON


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