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This is VAERS ID 80481

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History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 80481
VAERS Form:
Age:38.0
Sex:Male
Location:Wisconsin
Vaccinated:1995-04-04
Onset:1995-04-04
Submitted:1995-06-13
Entered:1996-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HAVRIX / SMITHKLINE VHA420A6 / 0 LA / -

Administered by: Other      Purchased by: Unknown
Symptoms: FEVER, MYALGIA, DIARRHEA

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: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recvd vax & 4hrs later exp aches in both shoulder, arms, legs, low grade fever, diarrhea;no treatment given pt feeling better by the next day 5APR95 & has gone back to work


Changed on 12/8/2009

VAERS ID: 80481 Before After
VAERS Form:
Age:38.0
Sex:Male
Location:Wisconsin
Vaccinated:1995-04-04
Onset:1995-04-04
Submitted:1995-06-13
Entered:1996-01-24 1995-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HAVRIX HEP A (HAVRIX) / SMITHKLINE SMITHKLINE BEECHAM VHA420A6 420A6 / 0 LA / -

Administered by: Other Unknown      Purchased by: Unknown
Symptoms: Diarrhoea, Myalgia, Pyrexia, FEVER, MYALGIA, DIARRHEA

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: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) 950031991

Write-up: pt recvd vax & 4hrs later exp aches in both shoulder, arms, legs, low grade fever, diarrhea;no treatment given pt feeling better by the next day 5APR95 & has gone back to work


Changed on 5/14/2017

VAERS ID: 80481 Before After
VAERS Form:
Age:38.0
Sex:Male
Location:Wisconsin
Vaccinated:1995-04-04
Onset:1995-04-04
Submitted:1995-06-13
Entered:1995-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 420A6 / 0 LA / -

Administered by: Unknown Other      Purchased by: Unknown Private
Symptoms: Diarrhoea, Myalgia, Pyrexia

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: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 950031991

Write-up: pt recvd vax & 4hrs later exp aches in both shoulder, arms, legs, low grade fever, diarrhea;no treatment given pt feeling better by the next day 5APR95 & has gone back to work


Changed on 9/14/2017

VAERS ID: 80481 Before After
VAERS Form:(blank) 1
Age:38.0
Sex:Male
Location:Wisconsin
Vaccinated:1995-04-04
Onset:1995-04-04
Submitted:1995-06-13
Entered:1995-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 420A6 / 0 1 LA / -

Administered by: Other      Purchased by: Private
Symptoms: Diarrhoea, Myalgia, Pyrexia

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: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 950031991

Write-up: pt recvd vax & 4hrs later exp aches in both shoulder, arms, legs, low grade fever, diarrhea;no treatment given pt feeling better by the next day 5APR95 & has gone back to work


Changed on 2/14/2018

VAERS ID: 80481 Before After
VAERS Form:1
Age:38.0
Sex:Male
Location:Wisconsin
Vaccinated:1995-04-04
Onset:1995-04-04
Submitted:1995-06-13
Entered:1995-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 420A6 / 1 LA / -

Administered by: Other      Purchased by: Private
Symptoms: Diarrhoea, Myalgia, Pyrexia

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: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 950031991

Write-up: pt recvd vax & 4hrs later exp aches in both shoulder, arms, legs, low grade fever, diarrhea;no treatment given pt feeling better by the next day 5APR95 & has gone back to work


Changed on 6/14/2018

VAERS ID: 80481 Before After
VAERS Form:1
Age:38.0
Sex:Male
Location:Wisconsin
Vaccinated:1995-04-04
Onset:1995-04-04
Submitted:1995-06-13
Entered:1995-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 420A6 / 1 LA / -

Administered by: Other      Purchased by: Private
Symptoms: Diarrhoea, Myalgia, Pyrexia

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: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 950031991

Write-up: pt recvd vax & 4hrs later exp aches in both shoulder, arms, legs, low grade fever, diarrhea;no treatment given pt feeling better by the next day 5APR95 & has gone back to work


Changed on 8/14/2018

VAERS ID: 80481 Before After
VAERS Form:1
Age:38.0
Sex:Male
Location:Wisconsin
Vaccinated:1995-04-04
Onset:1995-04-04
Submitted:1995-06-13
Entered:1995-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 420A6 / 1 LA / -

Administered by: Other      Purchased by: Private
Symptoms: Diarrhoea, Myalgia, Pyrexia

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: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 950031991

Write-up: pt recvd vax & 4hrs later exp aches in both shoulder, arms, legs, low grade fever, diarrhea;no treatment given pt feeling better by the next day 5APR95 & has gone back to work


Changed on 9/14/2018

VAERS ID: 80481 Before After
VAERS Form:1
Age:38.0
Sex:Male
Location:Wisconsin
Vaccinated:1995-04-04
Onset:1995-04-04
Submitted:1995-06-13
Entered:1995-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 420A6 / 1 LA / -

Administered by: Other      Purchased by: Private
Symptoms: Diarrhoea, Myalgia, Pyrexia

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: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 950031991

Write-up: pt recvd vax & 4hrs later exp aches in both shoulder, arms, legs, low grade fever, diarrhea;no treatment given pt feeling better by the next day 5APR95 & has gone back to work


Changed on 10/14/2018

VAERS ID: 80481 Before After
VAERS Form:1
Age:38.0
Sex:Male
Location:Wisconsin
Vaccinated:1995-04-04
Onset:1995-04-04
Submitted:1995-06-13
Entered:1995-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 420A6 / 1 LA / -

Administered by: Other      Purchased by: Private
Symptoms: Diarrhoea, Myalgia, Pyrexia

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: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 950031991

Write-up: pt recvd vax & 4hrs later exp aches in both shoulder, arms, legs, low grade fever, diarrhea;no treatment given pt feeling better by the next day 5APR95 & has gone back to work


Changed on 12/24/2020

VAERS ID: 80481 Before After
VAERS Form:1
Age:38.0
Sex:Male
Location:Wisconsin
Vaccinated:1995-04-04
Onset:1995-04-04
Submitted:1995-06-13
Entered:1995-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 420A6 / 1 LA / -

Administered by: Other      Purchased by: Private
Symptoms: Diarrhoea, Myalgia, Pyrexia

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: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 950031991

Write-up: pt recvd vax & 4hrs later exp aches in both shoulder, arms, legs, low grade fever, diarrhea;no treatment given pt feeling better by the next day 5APR95 & has gone back to work


Changed on 12/30/2020

VAERS ID: 80481 Before After
VAERS Form:1
Age:38.0
Sex:Male
Location:Wisconsin
Vaccinated:1995-04-04
Onset:1995-04-04
Submitted:1995-06-13
Entered:1995-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 420A6 / 1 LA / -

Administered by: Other      Purchased by: Private
Symptoms: Diarrhoea, Myalgia, Pyrexia

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: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 950031991

Write-up: pt recvd vax & 4hrs later exp aches in both shoulder, arms, legs, low grade fever, diarrhea;no treatment given pt feeling better by the next day 5APR95 & has gone back to work


Changed on 5/7/2021

VAERS ID: 80481 Before After
VAERS Form:1
Age:38.0
Sex:Male
Location:Wisconsin
Vaccinated:1995-04-04
Onset:1995-04-04
Submitted:1995-06-13
Entered:1995-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 420A6 / 1 LA / -

Administered by: Other      Purchased by: Private
Symptoms: Diarrhoea, Myalgia, Pyrexia

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: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 950031991

Write-up: pt recvd vax & 4hrs later exp aches in both shoulder, arms, legs, low grade fever, diarrhea;no treatment given pt feeling better by the next day 5APR95 & has gone back to work


Changed on 5/14/2021

VAERS ID: 80481 Before After
VAERS Form:1
Age:38.0
Sex:Male
Location:Wisconsin
Vaccinated:1995-04-04
Onset:1995-04-04
Submitted:1995-06-13
Entered:1995-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 420A6 / 1 LA / -

Administered by: Other      Purchased by: Private
Symptoms: Diarrhoea, Myalgia, Pyrexia

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: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 950031991

Write-up: pt recvd vax & 4hrs later exp aches in both shoulder, arms, legs, low grade fever, diarrhea;no treatment given pt feeling better by the next day 5APR95 & has gone back to work

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