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This is VAERS ID 79876

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History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 79876
VAERS Form:
Age:6.1
Sex:Female
Location:Ohio
Vaccinated:1995-11-20
Onset:0000-00-00
Submitted:1995-11-29
Entered:1995-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HAVRIX / SMITHKLINE VHA165A2 / 0 LA / IM
TYP: TYPHOID / WYETH 4940176 / 1 RA / SC

Administered by: Public      Purchased by: Unknown
Symptoms: CONVULS, SYNCOPE

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recvd vax & exp sz & passed out;


Changed on 12/8/2009

VAERS ID: 79876 Before After
VAERS Form:
Age:6.1 6.0
Sex:Female
Location:Ohio
Vaccinated:1995-11-20
Onset:0000-00-00
Submitted:1995-11-29
Entered:1995-12-13 1995-12-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HAVRIX HEP A (HAVRIX) / SMITHKLINE SMITHKLINE BEECHAM VHA165A2 165A2 / 0 LA / IM
TYP: TYPHOID TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / WYETH WYETH PHARMACEUTICALS, INC 4940176 / 1 RA / SC

Administered by: Public Unknown      Purchased by: Unknown
Symptoms: Convulsion, Syncope, CONVULS, SYNCOPE

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recvd vax & exp sz & passed out;


Changed on 8/31/2010

VAERS ID: 79876 Before After
VAERS Form:
Age:6.0
Sex:Female
Location:Ohio
Vaccinated:1995-11-20
Onset:0000-00-00
Submitted:1995-11-29
Entered:1995-12-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 165A2 / 0 LA / IM
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4940176 / 1 RA / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Convulsion, Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recvd vax & exp sz & passed out;


Changed on 5/14/2017

VAERS ID: 79876 Before After
VAERS Form:
Age:6.0
Sex:Female
Location:Ohio
Vaccinated:1995-11-20
Onset:0000-00-00
Submitted:1995-11-29
Entered:1995-12-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 165A2 / 0 LA / IM
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / PFIZER/WYETH 4940176 / 1 RA / SC

Administered by: Unknown Public      Purchased by: Unknown
Symptoms: Convulsion, Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recvd vax & exp sz & passed out;


Changed on 9/14/2017

VAERS ID: 79876 Before After
VAERS Form:(blank) 1
Age:6.0
Sex:Female
Location:Ohio
Vaccinated:1995-11-20
Onset:0000-00-00
Submitted:1995-11-29
Entered:1995-12-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 165A2 / 0 1 LA / IM
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / PFIZER/WYETH 4940176 / 1 2 RA / SC

Administered by: Public      Purchased by: Unknown
Symptoms: Convulsion, Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recvd vax & exp sz & passed out;


Changed on 2/14/2018

VAERS ID: 79876 Before After
VAERS Form:1
Age:6.0
Sex:Female
Location:Ohio
Vaccinated:1995-11-20
Onset:0000-00-00
Submitted:1995-11-29
Entered:1995-12-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 165A2 / 1 LA / IM
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / PFIZER/WYETH 4940176 / 2 RA / SC

Administered by: Public      Purchased by: Unknown
Symptoms: Convulsion, Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recvd vax & exp sz & passed out;


Changed on 6/14/2018

VAERS ID: 79876 Before After
VAERS Form:1
Age:6.0
Sex:Female
Location:Ohio
Vaccinated:1995-11-20
Onset:0000-00-00
Submitted:1995-11-29
Entered:1995-12-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 165A2 / 1 LA / IM
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / PFIZER/WYETH 4940176 / 2 RA / SC

Administered by: Public      Purchased by: Unknown
Symptoms: Convulsion, Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recvd vax & exp sz & passed out;


Changed on 8/14/2018

VAERS ID: 79876 Before After
VAERS Form:1
Age:6.0
Sex:Female
Location:Ohio
Vaccinated:1995-11-20
Onset:0000-00-00
Submitted:1995-11-29
Entered:1995-12-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 165A2 / 1 LA / IM
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / PFIZER/WYETH 4940176 / 2 RA / SC

Administered by: Public      Purchased by: Unknown
Symptoms: Convulsion, Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recvd vax & exp sz & passed out;


Changed on 9/14/2018

VAERS ID: 79876 Before After
VAERS Form:1
Age:6.0
Sex:Female
Location:Ohio
Vaccinated:1995-11-20
Onset:0000-00-00
Submitted:1995-11-29
Entered:1995-12-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 165A2 / 1 LA / IM
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / PFIZER/WYETH 4940176 / 2 RA / SC

Administered by: Public      Purchased by: Unknown
Symptoms: Convulsion, Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recvd vax & exp sz & passed out;


Changed on 10/14/2018

VAERS ID: 79876 Before After
VAERS Form:1
Age:6.0
Sex:Female
Location:Ohio
Vaccinated:1995-11-20
Onset:0000-00-00
Submitted:1995-11-29
Entered:1995-12-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 165A2 / 1 LA / IM
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / PFIZER/WYETH 4940176 / 2 RA / SC

Administered by: Public      Purchased by: Unknown
Symptoms: Convulsion, Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recvd vax & exp sz & passed out;


Changed on 12/24/2020

VAERS ID: 79876 Before After
VAERS Form:1
Age:6.0
Sex:Female
Location:Ohio
Vaccinated:1995-11-20
Onset:0000-00-00
Submitted:1995-11-29
Entered:1995-12-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 165A2 / 1 LA / IM
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / PFIZER/WYETH 4940176 / 2 RA / SC

Administered by: Public      Purchased by: Unknown
Symptoms: Convulsion, Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recvd vax & exp sz & passed out;


Changed on 12/30/2020

VAERS ID: 79876 Before After
VAERS Form:1
Age:6.0
Sex:Female
Location:Ohio
Vaccinated:1995-11-20
Onset:0000-00-00
Submitted:1995-11-29
Entered:1995-12-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 165A2 / 1 LA / IM
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / PFIZER/WYETH 4940176 / 2 RA / SC

Administered by: Public      Purchased by: Unknown
Symptoms: Convulsion, Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recvd vax & exp sz & passed out;


Changed on 5/7/2021

VAERS ID: 79876 Before After
VAERS Form:1
Age:6.0
Sex:Female
Location:Ohio
Vaccinated:1995-11-20
Onset:0000-00-00
Submitted:1995-11-29
Entered:1995-12-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 165A2 / 1 LA / IM
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / PFIZER/WYETH 4940176 / 2 RA / SC

Administered by: Public      Purchased by: Unknown
Symptoms: Convulsion, Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recvd vax & exp sz & passed out;


Changed on 5/14/2021

VAERS ID: 79876 Before After
VAERS Form:1
Age:6.0
Sex:Female
Location:Ohio
Vaccinated:1995-11-20
Onset:0000-00-00
Submitted:1995-11-29
Entered:1995-12-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 165A2 / 1 LA / IM
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / PFIZER/WYETH 4940176 / 2 RA / SC

Administered by: Public      Purchased by: Unknown
Symptoms: Convulsion, Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recvd vax & exp sz & passed out;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=79876&WAYBACKHISTORY=ON


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