National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 79959

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 79959
VAERS Form:
Age:49.6
Sex:Male
Location:California
Vaccinated:1995-12-01
Onset:1995-12-02
Submitted:1995-12-06
Entered:1995-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED, PEDIATRIC / CONNAUGHT LABS 5H71003 / 1 RA / IM
HEPA: HAVRIX / SMITHKLINE VHA467A6 / 0 LA / IM
OPV: ORIMUNE / LEDERLE 0720H / - - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: HYPOKINESIA, PAIN, EDEMA PERIPH, VASODILAT

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: NONE
Current Illness: NONE
Preexisting Conditions: PCN
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt states on Saturday morning devel redness, pain & swelling in the rt arm & rt axilla p/DT inj on friday, states it was difficult to move rt arm d/t pain & swelling;pt reported this to MD''s office on 4DEC; MD advised pt to be seen;


Changed on 12/8/2009

VAERS ID: 79959 Before After
VAERS Form:
Age:49.6
Sex:Male
Location:California
Vaccinated:1995-12-01
Onset:1995-12-02
Submitted:1995-12-06
Entered:1995-12-15 1995-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED, PEDIATRIC DT ADSORBED (NO BRAND NAME) / CONNAUGHT LABS CONNAUGHT LABORATORIES 5H71003 / 1 RA / IM
HEPA: HAVRIX HEP A (HAVRIX) / SMITHKLINE SMITHKLINE BEECHAM VHA467A6 / 0 LA / IM
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 0720H / - - / PO

Administered by: Private      Purchased by: Unknown Private
Symptoms: Hypokinesia, Oedema peripheral, Pain, Vasodilatation, HYPOKINESIA, PAIN, EDEMA PERIPH, VASODILAT

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: NONE
Current Illness: NONE
Preexisting Conditions: PCN
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt states on Saturday morning devel redness, pain & swelling in the rt arm & rt axilla p/DT inj on friday, states it was difficult to move rt arm d/t pain & swelling;pt reported this to MD''s office on 4DEC; MD advised pt to be seen;


Changed on 2/14/2017

VAERS ID: 79959 Before After
VAERS Form:
Age:49.6 49.0
Sex:Male
Location:California
Vaccinated:1995-12-01
Onset:1995-12-02
Submitted:1995-12-06
Entered:1995-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 5H71003 / 1 RA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA467A6 / 0 LA / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES 0720H / - - / PO

Administered by: Private      Purchased by: Private
Symptoms: Hypokinesia, Oedema peripheral, Pain, Vasodilatation

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: NONE
Current Illness: NONE
Preexisting Conditions: PCN
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt states on Saturday morning devel redness, pain & swelling in the rt arm & rt axilla p/DT inj on friday, states it was difficult to move rt arm d/t pain & swelling;pt reported this to MD''s office on 4DEC; MD advised pt to be seen;


Changed on 5/14/2017

VAERS ID: 79959 Before After
VAERS Form:
Age:49.0
Sex:Male
Location:California
Vaccinated:1995-12-01
Onset:1995-12-02
Submitted:1995-12-06
Entered:1995-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 5H71003 / 1 RA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA467A6 / 0 LA / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 0720H / - - / PO

Administered by: Private      Purchased by: Private
Symptoms: Hypokinesia, Oedema peripheral, Pain, Vasodilatation

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

Write-up: pt states on Saturday morning devel redness, pain & swelling in the rt arm & rt axilla p/DT inj on friday, states it was difficult to move rt arm d/t pain & swelling;pt reported this to MD''s office on 4DEC; MD advised pt to be seen;


Changed on 9/14/2017

VAERS ID: 79959 Before After
VAERS Form:(blank) 1
Age:49.0
Sex:Male
Location:California
Vaccinated:1995-12-01
Onset:1995-12-02
Submitted:1995-12-06
Entered:1995-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 5H71003 / 1 2 RA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA467A6 / 0 1 LA / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0720H / - UNK - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Hypokinesia, Oedema peripheral, Pain, Vasodilatation

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

Write-up: pt states on Saturday morning devel redness, pain & swelling in the rt arm & rt axilla p/DT inj on friday, states it was difficult to move rt arm d/t pain & swelling;pt reported this to MD''s office on 4DEC; MD advised pt to be seen;


Changed on 2/14/2018

VAERS ID: 79959 Before After
VAERS Form:1
Age:49.0
Sex:Male
Location:California
Vaccinated:1995-12-01
Onset:1995-12-02
Submitted:1995-12-06
Entered:1995-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 5H71003 / 2 RA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA467A6 / 1 LA / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0720H / UNK MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Hypokinesia, Oedema peripheral, Pain, Vasodilatation

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

Write-up: pt states on Saturday morning devel redness, pain & swelling in the rt arm & rt axilla p/DT inj on friday, states it was difficult to move rt arm d/t pain & swelling;pt reported this to MD''s office on 4DEC; MD advised pt to be seen;


Changed on 6/14/2018

VAERS ID: 79959 Before After
VAERS Form:1
Age:49.0
Sex:Male
Location:California
Vaccinated:1995-12-01
Onset:1995-12-02
Submitted:1995-12-06
Entered:1995-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 5H71003 / 2 RA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA467A6 / 1 LA / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0720H / UNK MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Hypokinesia, Oedema peripheral, Pain, Vasodilatation

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

Write-up: pt states on Saturday morning devel redness, pain & swelling in the rt arm & rt axilla p/DT inj on friday, states it was difficult to move rt arm d/t pain & swelling;pt reported this to MD''s office on 4DEC; MD advised pt to be seen;


Changed on 8/14/2018

VAERS ID: 79959 Before After
VAERS Form:1
Age:49.0
Sex:Male
Location:California
Vaccinated:1995-12-01
Onset:1995-12-02
Submitted:1995-12-06
Entered:1995-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 5H71003 / 2 RA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA467A6 / 1 LA / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0720H / UNK MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Hypokinesia, Oedema peripheral, Pain, Vasodilatation

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

Write-up: pt states on Saturday morning devel redness, pain & swelling in the rt arm & rt axilla p/DT inj on friday, states it was difficult to move rt arm d/t pain & swelling;pt reported this to MD''s office on 4DEC; MD advised pt to be seen;


Changed on 9/14/2018

VAERS ID: 79959 Before After
VAERS Form:1
Age:49.0
Sex:Male
Location:California
Vaccinated:1995-12-01
Onset:1995-12-02
Submitted:1995-12-06
Entered:1995-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 5H71003 / 2 RA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA467A6 / 1 LA / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0720H / UNK MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Hypokinesia, Oedema peripheral, Pain, Vasodilatation

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

Write-up: pt states on Saturday morning devel redness, pain & swelling in the rt arm & rt axilla p/DT inj on friday, states it was difficult to move rt arm d/t pain & swelling;pt reported this to MD''s office on 4DEC; MD advised pt to be seen;


Changed on 10/14/2018

VAERS ID: 79959 Before After
VAERS Form:1
Age:49.0
Sex:Male
Location:California
Vaccinated:1995-12-01
Onset:1995-12-02
Submitted:1995-12-06
Entered:1995-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 5H71003 / 2 RA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA467A6 / 1 LA / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0720H / UNK MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Hypokinesia, Oedema peripheral, Pain, Vasodilatation

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

Write-up: pt states on Saturday morning devel redness, pain & swelling in the rt arm & rt axilla p/DT inj on friday, states it was difficult to move rt arm d/t pain & swelling;pt reported this to MD''s office on 4DEC; MD advised pt to be seen;


Changed on 12/24/2020

VAERS ID: 79959 Before After
VAERS Form:1
Age:49.0
Sex:Male
Location:California
Vaccinated:1995-12-01
Onset:1995-12-02
Submitted:1995-12-06
Entered:1995-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 5H71003 / 2 RA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA467A6 / 1 LA / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0720H / UNK MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Hypokinesia, Oedema peripheral, Pain, Vasodilatation

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

Write-up: pt states on Saturday morning devel redness, pain & swelling in the rt arm & rt axilla p/DT inj on friday, states it was difficult to move rt arm d/t pain & swelling;pt reported this to MD''s office on 4DEC; MD advised pt to be seen;


Changed on 12/30/2020

VAERS ID: 79959 Before After
VAERS Form:1
Age:49.0
Sex:Male
Location:California
Vaccinated:1995-12-01
Onset:1995-12-02
Submitted:1995-12-06
Entered:1995-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 5H71003 / 2 RA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA467A6 / 1 LA / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0720H / UNK MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Hypokinesia, Oedema peripheral, Pain, Vasodilatation

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

Write-up: pt states on Saturday morning devel redness, pain & swelling in the rt arm & rt axilla p/DT inj on friday, states it was difficult to move rt arm d/t pain & swelling;pt reported this to MD''s office on 4DEC; MD advised pt to be seen;


Changed on 5/7/2021

VAERS ID: 79959 Before After
VAERS Form:1
Age:49.0
Sex:Male
Location:California
Vaccinated:1995-12-01
Onset:1995-12-02
Submitted:1995-12-06
Entered:1995-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 5H71003 / 2 RA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA467A6 / 1 LA / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0720H / UNK MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Hypokinesia, Oedema peripheral, Pain, Vasodilatation

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

Write-up: pt states on Saturday morning devel redness, pain & swelling in the rt arm & rt axilla p/DT inj on friday, states it was difficult to move rt arm d/t pain & swelling;pt reported this to MD''s office on 4DEC; MD advised pt to be seen;


Changed on 5/14/2021

VAERS ID: 79959 Before After
VAERS Form:1
Age:49.0
Sex:Male
Location:California
Vaccinated:1995-12-01
Onset:1995-12-02
Submitted:1995-12-06
Entered:1995-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 5H71003 / 2 RA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA467A6 / 1 LA / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0720H / UNK MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Hypokinesia, Oedema peripheral, Pain, Vasodilatation

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

Write-up: pt states on Saturday morning devel redness, pain & swelling in the rt arm & rt axilla p/DT inj on friday, states it was difficult to move rt arm d/t pain & swelling;pt reported this to MD''s office on 4DEC; MD advised pt to be seen;

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=79959&WAYBACKHISTORY=ON


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166