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This is VAERS ID 80104

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History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 80104
VAERS Form:
Age:19.7
Sex:Male
Location:North Carolina
Vaccinated:1995-12-09
Onset:0000-00-00
Submitted:1995-12-11
Entered:1995-12-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HAVRIX / SMITHKLINE VHA433A6 / 0 RA / IM
IPV: IPV / MERIEUX INST K0225 / - LA / SC
TD: TD ADSORBED, ADULTS / WYETH 4958021 / 1 LA / IM
TYP: VIVOTIF BERNA / SWISS SERUM 137702A / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: RASH, PRURITUS

Life Threatening? No
Birth Defect? No
Died? No
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: pt exp same sxs w/dose #1 typhoid
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NONE

Write-up: pt recvd vax 9DEC & devel red rash, itchy, flat x/where pt has scratched it; T97.6;


Changed on 12/8/2009

VAERS ID: 80104 Before After
VAERS Form:
Age:19.7
Sex:Male
Location:North Carolina
Vaccinated:1995-12-09
Onset:0000-00-00
Submitted:1995-12-11
Entered:1995-12-21 1995-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HAVRIX HEP A (HAVRIX) / SMITHKLINE SMITHKLINE BEECHAM VHA433A6 / 0 RA / IM
IPV: IPV POLIO VIRUS, INACT. (NO BRAND NAME) / MERIEUX INST PASTEUR MERIEUX INST. K0225 / - LA / SC
TD: TD ADSORBED, ADULTS TD ADSORBED (NO BRAND NAME) / WYETH WYETH PHARMACEUTICALS, INC 4958021 / 1 LA / IM
TYP: VIVOTIF BERNA TYPHOID LIVE ORAL TY21A (VIVOTIF) / SWISS SERUM BERNA BIOTECH, LTD 137702A / 0 - / PO

Administered by: Private      Purchased by: Unknown Other
Symptoms: Pruritus, Rash, RASH, PRURITUS

Life Threatening? No
Birth Defect? No
Died? No
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: pt exp same sxs w/dose #1 typhoid
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NONE (blank)

Write-up: pt recvd vax 9DEC & devel red rash, itchy, flat x/where pt has scratched it; T97.6;


Changed on 8/31/2010

VAERS ID: 80104 Before After
VAERS Form:
Age:19.7
Sex:Male
Location:North Carolina
Vaccinated:1995-12-09
Onset:0000-00-00
Submitted:1995-12-11
Entered:1995-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA433A6 / 0 RA / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. K0225 / - LA / SC
TD: TD ADSORBED (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4958021 / 1 LA / IM
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD 137702A / 0 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Pruritus, Rash

Life Threatening? No
Birth Defect? No
Died? No
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: pt exp same sxs w/dose #1 typhoid
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recvd vax 9DEC & devel red rash, itchy, flat x/where pt has scratched it; T97.6;


Changed on 2/14/2017

VAERS ID: 80104 Before After
VAERS Form:
Age:19.7 19.0
Sex:Male
Location:North Carolina
Vaccinated:1995-12-09
Onset:0000-00-00
Submitted:1995-12-11
Entered:1995-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA433A6 / 0 RA / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. K0225 / - LA / SC
TD: TD ADSORBED (NO BRAND NAME) / PFIZER/WYETH 4958021 / 1 LA / IM
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD 137702A / 0 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Pruritus, Rash

Life Threatening? No
Birth Defect? No
Died? No
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: pt exp same sxs w/dose #1 typhoid
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recvd vax 9DEC & devel red rash, itchy, flat x/where pt has scratched it; T97.6;


Changed on 5/14/2017

VAERS ID: 80104 Before After
VAERS Form:
Age:19.0
Sex:Male
Location:North Carolina
Vaccinated:1995-12-09
Onset:0000-00-00
Submitted:1995-12-11
Entered:1995-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA433A6 / 0 RA / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. K0225 / - LA / SC
TD: TD ADSORBED (NO BRAND NAME) / PFIZER/WYETH 4958021 / 1 LA / IM
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD 137702A / 0 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Pruritus, Rash

Life Threatening? No
Birth Defect? No
Died? No
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: pt exp same sxs w/dose #1 typhoid typhoid~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recvd vax 9DEC & devel red rash, itchy, flat x/where pt has scratched it; T97.6;


Changed on 9/14/2017

VAERS ID: 80104 Before After
VAERS Form:(blank) 1
Age:19.0
Sex:Male
Location:North Carolina
Vaccinated:1995-12-09
Onset:0000-00-00
Submitted:1995-12-11
Entered:1995-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA433A6 / 0 1 RA / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. K0225 / - UNK LA / SC
TD: TD ADSORBED (NO BRAND NAME) / PFIZER/WYETH 4958021 / 1 2 LA / IM
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD 137702A / 0 1 - MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Pruritus, Rash

Life Threatening? No
Birth Defect? No
Died? No
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: pt exp same sxs w/dose #1 typhoid~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recvd vax 9DEC & devel red rash, itchy, flat x/where pt has scratched it; T97.6;


Changed on 11/14/2017

VAERS ID: 80104 Before After
VAERS Form:1
Age:19.0
Sex:Male
Location:North Carolina
Vaccinated:1995-12-09
Onset:0000-00-00
Submitted:1995-12-11
Entered:1995-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA433A6 / 1 RA / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. K0225 / UNK LA / SC
TD: TD ADSORBED (NO BRAND NAME) / PFIZER/WYETH 4958021 / 2 LA / IM
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD BERNA BIOTECH, LTD. 137702A / 1 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Pruritus, Rash

Life Threatening? No
Birth Defect? No
Died? No
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: pt exp same sxs w/dose #1 typhoid~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recvd vax 9DEC & devel red rash, itchy, flat x/where pt has scratched it; T97.6;


Changed on 2/14/2018

VAERS ID: 80104 Before After
VAERS Form:1
Age:19.0
Sex:Male
Location:North Carolina
Vaccinated:1995-12-09
Onset:0000-00-00
Submitted:1995-12-11
Entered:1995-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA433A6 / 1 RA / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. K0225 / UNK LA / SC
TD: TD ADSORBED (NO BRAND NAME) / PFIZER/WYETH 4958021 / 2 LA / IM
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD. 137702A / 1 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Pruritus, Rash

Life Threatening? No
Birth Defect? No
Died? No
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: pt exp same sxs w/dose #1 typhoid~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recvd vax 9DEC & devel red rash, itchy, flat x/where pt has scratched it; T97.6;


Changed on 6/14/2018

VAERS ID: 80104 Before After
VAERS Form:1
Age:19.0
Sex:Male
Location:North Carolina
Vaccinated:1995-12-09
Onset:0000-00-00
Submitted:1995-12-11
Entered:1995-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA433A6 / 1 RA / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. K0225 / UNK LA / SC
TD: TD ADSORBED (NO BRAND NAME) / PFIZER/WYETH 4958021 / 2 LA / IM
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD. 137702A / 1 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Pruritus, Rash

Life Threatening? No
Birth Defect? No
Died? No
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: pt exp same sxs w/dose #1 typhoid~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recvd vax 9DEC & devel red rash, itchy, flat x/where pt has scratched it; T97.6;


Changed on 8/14/2018

VAERS ID: 80104 Before After
VAERS Form:1
Age:19.0
Sex:Male
Location:North Carolina
Vaccinated:1995-12-09
Onset:0000-00-00
Submitted:1995-12-11
Entered:1995-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA433A6 / 1 RA / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. K0225 / UNK LA / SC
TD: TD ADSORBED (NO BRAND NAME) / PFIZER/WYETH 4958021 / 2 LA / IM
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD. 137702A / 1 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Pruritus, Rash

Life Threatening? No
Birth Defect? No
Died? No
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: pt exp same sxs w/dose #1 typhoid~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recvd vax 9DEC & devel red rash, itchy, flat x/where pt has scratched it; T97.6;


Changed on 9/14/2018

VAERS ID: 80104 Before After
VAERS Form:1
Age:19.0
Sex:Male
Location:North Carolina
Vaccinated:1995-12-09
Onset:0000-00-00
Submitted:1995-12-11
Entered:1995-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA433A6 / 1 RA / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. K0225 / UNK LA / SC
TD: TD ADSORBED (NO BRAND NAME) / PFIZER/WYETH 4958021 / 2 LA / IM
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD. 137702A / 1 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Pruritus, Rash

Life Threatening? No
Birth Defect? No
Died? No
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: pt exp same sxs w/dose #1 typhoid~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recvd vax 9DEC & devel red rash, itchy, flat x/where pt has scratched it; T97.6;


Changed on 10/14/2018

VAERS ID: 80104 Before After
VAERS Form:1
Age:19.0
Sex:Male
Location:North Carolina
Vaccinated:1995-12-09
Onset:0000-00-00
Submitted:1995-12-11
Entered:1995-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA433A6 / 1 RA / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. K0225 / UNK LA / SC
TD: TD ADSORBED (NO BRAND NAME) / PFIZER/WYETH 4958021 / 2 LA / IM
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD. 137702A / 1 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Pruritus, Rash

Life Threatening? No
Birth Defect? No
Died? No
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: pt exp same sxs w/dose #1 typhoid~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recvd vax 9DEC & devel red rash, itchy, flat x/where pt has scratched it; T97.6;


Changed on 12/10/2020

VAERS ID: 80104 Before After
VAERS Form:1
Age:19.0
Sex:Male
Location:North Carolina California
Vaccinated:1995-12-09
Onset:0000-00-00
Submitted:1995-12-11
Entered:1995-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA433A6 / 1 RA / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. K0225 / UNK LA / SC
TD: TD ADSORBED (NO BRAND NAME) / PFIZER/WYETH 4958021 / 2 LA / IM
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD. 137702A / 1 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Pruritus, Rash

Life Threatening? No
Birth Defect? No
Died? No
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: pt exp same sxs w/dose #1 typhoid~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recvd vax 9DEC & devel red rash, itchy, flat x/where pt has scratched it; T97.6;


Changed on 12/24/2020

VAERS ID: 80104 Before After
VAERS Form:1
Age:19.0
Sex:Male
Location:California
Vaccinated:1995-12-09
Onset:0000-00-00
Submitted:1995-12-11
Entered:1995-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA433A6 / 1 RA / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. K0225 / UNK LA / SC
TD: TD ADSORBED (NO BRAND NAME) / PFIZER/WYETH 4958021 / 2 LA / IM
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD. 137702A / 1 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Pruritus, Rash

Life Threatening? No
Birth Defect? No
Died? No
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: pt exp same sxs w/dose #1 typhoid~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recvd vax 9DEC & devel red rash, itchy, flat x/where pt has scratched it; T97.6;


Changed on 12/30/2020

VAERS ID: 80104 Before After
VAERS Form:1
Age:19.0
Sex:Male
Location:California
Vaccinated:1995-12-09
Onset:0000-00-00
Submitted:1995-12-11
Entered:1995-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA433A6 / 1 RA / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. K0225 / UNK LA / SC
TD: TD ADSORBED (NO BRAND NAME) / PFIZER/WYETH 4958021 / 2 LA / IM
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD. 137702A / 1 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Pruritus, Rash

Life Threatening? No
Birth Defect? No
Died? No
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: pt exp same sxs w/dose #1 typhoid~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recvd vax 9DEC & devel red rash, itchy, flat x/where pt has scratched it; T97.6;


Changed on 5/7/2021

VAERS ID: 80104 Before After
VAERS Form:1
Age:19.0
Sex:Male
Location:California
Vaccinated:1995-12-09
Onset:0000-00-00
Submitted:1995-12-11
Entered:1995-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA433A6 / 1 RA / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. K0225 / UNK LA / SC
TD: TD ADSORBED (NO BRAND NAME) / PFIZER/WYETH 4958021 / 2 LA / IM
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD. 137702A / 1 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Pruritus, Rash

Life Threatening? No
Birth Defect? No
Died? No
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: pt exp same sxs w/dose #1 typhoid~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recvd vax 9DEC & devel red rash, itchy, flat x/where pt has scratched it; T97.6;


Changed on 5/14/2021

VAERS ID: 80104 Before After
VAERS Form:1
Age:19.0
Sex:Male
Location:California
Vaccinated:1995-12-09
Onset:0000-00-00
Submitted:1995-12-11
Entered:1995-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA433A6 / 1 RA / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. K0225 / UNK LA / SC
TD: TD ADSORBED (NO BRAND NAME) / PFIZER/WYETH 4958021 / 2 LA / IM
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD. 137702A / 1 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Pruritus, Rash

Life Threatening? No
Birth Defect? No
Died? No
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: pt exp same sxs w/dose #1 typhoid~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recvd vax 9DEC & devel red rash, itchy, flat x/where pt has scratched it; T97.6;

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