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This is VAERS ID 81039

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History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 81039
VAERS Form:
Age:26.0
Sex:Female
Location:California
Vaccinated:1995-09-05
Onset:1995-09-05
Submitted:1995-10-30
Entered:1996-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HAVRIX / SMITHKLINE VHA440A6 / 0 A / IM
YF: UNK.YELLOW FEVER / UNCLASSIFIED - / - - / -

Administered by: Private      Purchased by: Unknown
Symptoms: PAIN INJECT SITE, HEADACHE

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recvd vax; later in eve, exp severe HA, fatigue & inject site soreness in arm;apap given; 3 days later recovered


Changed on 12/8/2009

VAERS ID: 81039 Before After
VAERS Form:
Age:26.0
Sex:Female
Location:California
Vaccinated:1995-09-05
Onset:1995-09-05
Submitted:1995-10-30
Entered:1996-01-24 1996-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HAVRIX HEP A (HAVRIX) / SMITHKLINE SMITHKLINE BEECHAM VHA440A6 / 0 A / IM
YF: UNK.YELLOW FEVER YELLOW FEVER (NO BRAND NAME) / UNCLASSIFIED UNKNOWN MANUFACTURER - / - - / -

Administered by: Private      Purchased by: Unknown Private
Symptoms: Headache, Injection site pain, PAIN INJECT SITE, HEADACHE

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) 950090681

Write-up: pt recvd vax; later in eve, exp severe HA, fatigue & inject site soreness in arm;apap given; 3 days later recovered


Changed on 5/14/2017

VAERS ID: 81039 Before After
VAERS Form:
Age:26.0
Sex:Female
Location:California
Vaccinated:1995-09-05
Onset:1995-09-05
Submitted:1995-10-30
Entered:1996-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA440A6 / 0 A - / IM IM A
YF: YELLOW FEVER (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Private      Purchased by: Private
Symptoms: Headache, Injection site pain

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 950090681

Write-up: pt recvd vax; later in eve, exp severe HA, fatigue & inject site soreness in arm;apap given; 3 days later recovered


Changed on 9/14/2017

VAERS ID: 81039 Before After
VAERS Form:(blank) 1
Age:26.0
Sex:Female
Location:California
Vaccinated:1995-09-05
Onset:1995-09-05
Submitted:1995-10-30
Entered:1996-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA440A6 / 0 1 - / IM A
YF: YELLOW FEVER (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Headache, Injection site pain

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 950090681

Write-up: pt recvd vax; later in eve, exp severe HA, fatigue & inject site soreness in arm;apap given; 3 days later recovered


Changed on 2/14/2018

VAERS ID: 81039 Before After
VAERS Form:1
Age:26.0
Sex:Female
Location:California
Vaccinated:1995-09-05
Onset:1995-09-05
Submitted:1995-10-30
Entered:1996-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA440A6 / 1 - / IM A
YF: YELLOW FEVER (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Headache, Injection site pain

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 950090681

Write-up: pt recvd vax; later in eve, exp severe HA, fatigue & inject site soreness in arm;apap given; 3 days later recovered


Changed on 6/14/2018

VAERS ID: 81039 Before After
VAERS Form:1
Age:26.0
Sex:Female
Location:California
Vaccinated:1995-09-05
Onset:1995-09-05
Submitted:1995-10-30
Entered:1996-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA440A6 / 1 - / IM A
YF: YELLOW FEVER (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Headache, Injection site pain

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 950090681

Write-up: pt recvd vax; later in eve, exp severe HA, fatigue & inject site soreness in arm;apap given; 3 days later recovered


Changed on 8/14/2018

VAERS ID: 81039 Before After
VAERS Form:1
Age:26.0
Sex:Female
Location:California
Vaccinated:1995-09-05
Onset:1995-09-05
Submitted:1995-10-30
Entered:1996-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA440A6 / 1 - / IM A
YF: YELLOW FEVER (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Headache, Injection site pain

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 950090681

Write-up: pt recvd vax; later in eve, exp severe HA, fatigue & inject site soreness in arm;apap given; 3 days later recovered


Changed on 9/14/2018

VAERS ID: 81039 Before After
VAERS Form:1
Age:26.0
Sex:Female
Location:California
Vaccinated:1995-09-05
Onset:1995-09-05
Submitted:1995-10-30
Entered:1996-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA440A6 / 1 - / IM A
YF: YELLOW FEVER (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Headache, Injection site pain

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 950090681

Write-up: pt recvd vax; later in eve, exp severe HA, fatigue & inject site soreness in arm;apap given; 3 days later recovered


Changed on 10/14/2018

VAERS ID: 81039 Before After
VAERS Form:1
Age:26.0
Sex:Female
Location:California
Vaccinated:1995-09-05
Onset:1995-09-05
Submitted:1995-10-30
Entered:1996-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA440A6 / 1 - / IM A
YF: YELLOW FEVER (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Headache, Injection site pain

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 950090681

Write-up: pt recvd vax; later in eve, exp severe HA, fatigue & inject site soreness in arm;apap given; 3 days later recovered


Changed on 12/24/2020

VAERS ID: 81039 Before After
VAERS Form:1
Age:26.0
Sex:Female
Location:California
Vaccinated:1995-09-05
Onset:1995-09-05
Submitted:1995-10-30
Entered:1996-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA440A6 / 1 - / IM A
YF: YELLOW FEVER (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Headache, Injection site pain

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 950090681

Write-up: pt recvd vax; later in eve, exp severe HA, fatigue & inject site soreness in arm;apap given; 3 days later recovered


Changed on 12/30/2020

VAERS ID: 81039 Before After
VAERS Form:1
Age:26.0
Sex:Female
Location:California
Vaccinated:1995-09-05
Onset:1995-09-05
Submitted:1995-10-30
Entered:1996-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA440A6 / 1 - / IM A
YF: YELLOW FEVER (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Headache, Injection site pain

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 950090681

Write-up: pt recvd vax; later in eve, exp severe HA, fatigue & inject site soreness in arm;apap given; 3 days later recovered


Changed on 5/7/2021

VAERS ID: 81039 Before After
VAERS Form:1
Age:26.0
Sex:Female
Location:California
Vaccinated:1995-09-05
Onset:1995-09-05
Submitted:1995-10-30
Entered:1996-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA440A6 / 1 - / IM A
YF: YELLOW FEVER (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Headache, Injection site pain

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 950090681

Write-up: pt recvd vax; later in eve, exp severe HA, fatigue & inject site soreness in arm;apap given; 3 days later recovered


Changed on 5/14/2021

VAERS ID: 81039 Before After
VAERS Form:1
Age:26.0
Sex:Female
Location:California
Vaccinated:1995-09-05
Onset:1995-09-05
Submitted:1995-10-30
Entered:1996-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA440A6 / 1 - / IM A
YF: YELLOW FEVER (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Headache, Injection site pain

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 950090681

Write-up: pt recvd vax; later in eve, exp severe HA, fatigue & inject site soreness in arm;apap given; 3 days later recovered

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=81039&WAYBACKHISTORY=ON


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