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This is VAERS ID 77304

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History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 77304
VAERS Form:
Age:18.5
Sex:Female
Location:Pennsylvania
Vaccinated:1995-08-18
Onset:0000-00-00
Submitted:0000-00-00
Entered:1995-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HAVRIX / SMITHKLINE VHA427A6 / 0 LA / IM
MMR: MMR II / MSD 0621B / - LA / SC
TD: TD ADSORBED, ADULTS / CONNAUGHT LABS 5B7104B / 0 RA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: EDEMA FACE, ATAXIA

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UA neg
CDC 'Split Type':

Write-up: facial swelling, unsteadiness


Changed on 12/8/2009

VAERS ID: 77304 Before After
VAERS Form:
Age:18.5
Sex:Female
Location:Pennsylvania
Vaccinated:1995-08-18
Onset:0000-00-00
Submitted:0000-00-00
Entered:1995-09-15 1995-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HAVRIX HEP A (HAVRIX) / SMITHKLINE SMITHKLINE BEECHAM VHA427A6 / 0 LA / IM
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 0621B / - LA / SC
TD: TD ADSORBED, ADULTS TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABS CONNAUGHT LABORATORIES 5B7104B / 0 RA / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Coordination abnormal, Face oedema, EDEMA FACE, ATAXIA

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UA neg
CDC 'Split Type':

Write-up: facial swelling, unsteadiness


Changed on 2/14/2017

VAERS ID: 77304 Before After
VAERS Form:
Age:18.5 18.0
Sex:Female
Location:Pennsylvania
Vaccinated:1995-08-18
Onset:0000-00-00
Submitted:0000-00-00
Entered:1995-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA427A6 / 0 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0621B / - LA / SC
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 5B7104B / 0 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Coordination abnormal, Face oedema

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UA neg
CDC 'Split Type':

Write-up: facial swelling, unsteadiness


Changed on 5/14/2017

VAERS ID: 77304 Before After
VAERS Form:
Age:18.0
Sex:Female
Location:Pennsylvania
Vaccinated:1995-08-18
Onset:0000-00-00
Submitted:0000-00-00
Entered:1995-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA427A6 / 0 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0621B / - LA / SC
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 5B7104B / 0 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Coordination abnormal, Face oedema

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UA neg
CDC 'Split Type':

Write-up: facial swelling, unsteadiness


Changed on 9/14/2017

VAERS ID: 77304 Before After
VAERS Form:(blank) 1
Age:18.0
Sex:Female
Location:Pennsylvania
Vaccinated:1995-08-18
Onset:0000-00-00
Submitted:0000-00-00
Entered:1995-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA427A6 / 0 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0621B / - UNK LA / SC
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 5B7104B / 0 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Coordination abnormal, Face oedema

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UA neg
CDC 'Split Type':

Write-up: facial swelling, unsteadiness


Changed on 2/14/2018

VAERS ID: 77304 Before After
VAERS Form:1
Age:18.0
Sex:Female
Location:Pennsylvania
Vaccinated:1995-08-18
Onset:0000-00-00
Submitted:0000-00-00
Entered:1995-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA427A6 / 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0621B / UNK LA / SC
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 5B7104B / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Coordination abnormal, Face oedema

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UA neg
CDC 'Split Type':

Write-up: facial swelling, unsteadiness


Changed on 6/14/2018

VAERS ID: 77304 Before After
VAERS Form:1
Age:18.0
Sex:Female
Location:Pennsylvania
Vaccinated:1995-08-18
Onset:0000-00-00
Submitted:0000-00-00
Entered:1995-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA427A6 / 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0621B / UNK LA / SC
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 5B7104B / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Coordination abnormal, Face oedema

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UA neg
CDC 'Split Type':

Write-up: facial swelling, unsteadiness


Changed on 8/14/2018

VAERS ID: 77304 Before After
VAERS Form:1
Age:18.0
Sex:Female
Location:Pennsylvania
Vaccinated:1995-08-18
Onset:0000-00-00
Submitted:0000-00-00
Entered:1995-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA427A6 / 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0621B / UNK LA / SC
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 5B7104B / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Coordination abnormal, Face oedema

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UA neg
CDC 'Split Type':

Write-up: facial swelling, unsteadiness


Changed on 9/14/2018

VAERS ID: 77304 Before After
VAERS Form:1
Age:18.0
Sex:Female
Location:Pennsylvania
Vaccinated:1995-08-18
Onset:0000-00-00
Submitted:0000-00-00
Entered:1995-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA427A6 / 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0621B / UNK LA / SC
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 5B7104B / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Coordination abnormal, Face oedema

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UA neg
CDC 'Split Type':

Write-up: facial swelling, unsteadiness


Changed on 10/14/2018

VAERS ID: 77304 Before After
VAERS Form:1
Age:18.0
Sex:Female
Location:Pennsylvania
Vaccinated:1995-08-18
Onset:0000-00-00
Submitted:0000-00-00
Entered:1995-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA427A6 / 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0621B / UNK LA / SC
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 5B7104B / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Coordination abnormal, Face oedema

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UA neg
CDC 'Split Type':

Write-up: facial swelling, unsteadiness


Changed on 12/24/2020

VAERS ID: 77304 Before After
VAERS Form:1
Age:18.0
Sex:Female
Location:Pennsylvania
Vaccinated:1995-08-18
Onset:0000-00-00
Submitted:0000-00-00
Entered:1995-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA427A6 / 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0621B / UNK LA / SC
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 5B7104B / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Coordination abnormal, Face oedema

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UA neg
CDC 'Split Type':

Write-up: facial swelling, unsteadiness


Changed on 12/30/2020

VAERS ID: 77304 Before After
VAERS Form:1
Age:18.0
Sex:Female
Location:Pennsylvania
Vaccinated:1995-08-18
Onset:0000-00-00
Submitted:0000-00-00
Entered:1995-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA427A6 / 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0621B / UNK LA / SC
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 5B7104B / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Coordination abnormal, Face oedema

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UA neg
CDC 'Split Type':

Write-up: facial swelling, unsteadiness


Changed on 5/7/2021

VAERS ID: 77304 Before After
VAERS Form:1
Age:18.0
Sex:Female
Location:Pennsylvania
Vaccinated:1995-08-18
Onset:0000-00-00
Submitted:0000-00-00
Entered:1995-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA427A6 / 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0621B / UNK LA / SC
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 5B7104B / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Coordination abnormal, Face oedema

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UA neg
CDC 'Split Type':

Write-up: facial swelling, unsteadiness


Changed on 5/14/2021

VAERS ID: 77304 Before After
VAERS Form:1
Age:18.0
Sex:Female
Location:Pennsylvania
Vaccinated:1995-08-18
Onset:0000-00-00
Submitted:0000-00-00
Entered:1995-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA427A6 / 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0621B / UNK LA / SC
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 5B7104B / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Coordination abnormal, Face oedema

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UA neg
CDC 'Split Type':

Write-up: facial swelling, unsteadiness

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