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This is VAERS ID 81053

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History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 81053
VAERS Form:
Age:
Sex:Female
Location:Texas
Vaccinated:1995-03-28
Onset:1995-03-28
Submitted:1995-10-11
Entered:1996-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HAVRIX / SMITHKLINE - / - A / IM

Administered by: Private      Purchased by: Unknown
Symptoms: URTICARIA, 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:
Other Medications:
Current Illness:
Preexisting Conditions: larger woman;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recvd vax; exp sore arm, tender to touch & red welt size of baseball;


Changed on 12/8/2009

VAERS ID: 81053 Before After
VAERS Form:
Age:
Sex:Female
Location:Texas
Vaccinated:1995-03-28
Onset:1995-03-28
Submitted:1995-10-11
Entered:1996-01-24 1996-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HAVRIX HEP A (HAVRIX) / SMITHKLINE SMITHKLINE BEECHAM - / - A / IM

Administered by: Private      Purchased by: Unknown Other
Symptoms: Pain, Urticaria, URTICARIA, 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:
Other Medications:
Current Illness:
Preexisting Conditions: larger woman;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) 950104421

Write-up: pt recvd vax; exp sore arm, tender to touch & red welt size of baseball;


Changed on 5/14/2017

VAERS ID: 81053 Before After
VAERS Form:
Age:
Sex:Female
Location:Texas
Vaccinated:1995-03-28
Onset:1995-03-28
Submitted:1995-10-11
Entered:1996-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / - A - / IM IM A

Administered by: Private      Purchased by: Other
Symptoms: Pain, Urticaria

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: larger woman;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 950104421

Write-up: pt recvd vax; exp sore arm, tender to touch & red welt size of baseball;


Changed on 9/14/2017

VAERS ID: 81053 Before After
VAERS Form:(blank) 1
Age:
Sex:Female
Location:Texas
Vaccinated:1995-03-28
Onset:1995-03-28
Submitted:1995-10-11
Entered:1996-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / - UNK - / IM A

Administered by: Private      Purchased by: Other
Symptoms: Pain, Urticaria

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: larger woman;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 950104421

Write-up: pt recvd vax; exp sore arm, tender to touch & red welt size of baseball;


Changed on 2/14/2018

VAERS ID: 81053 Before After
VAERS Form:1
Age:
Sex:Female
Location:Texas
Vaccinated:1995-03-28
Onset:1995-03-28
Submitted:1995-10-11
Entered:1996-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / UNK - / IM A

Administered by: Private      Purchased by: Other
Symptoms: Pain, Urticaria

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: larger woman;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 950104421

Write-up: pt recvd vax; exp sore arm, tender to touch & red welt size of baseball;


Changed on 6/14/2018

VAERS ID: 81053 Before After
VAERS Form:1
Age:
Sex:Female
Location:Texas
Vaccinated:1995-03-28
Onset:1995-03-28
Submitted:1995-10-11
Entered:1996-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / UNK - / IM A

Administered by: Private      Purchased by: Other
Symptoms: Pain, Urticaria

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: larger woman;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 950104421

Write-up: pt recvd vax; exp sore arm, tender to touch & red welt size of baseball;


Changed on 8/14/2018

VAERS ID: 81053 Before After
VAERS Form:1
Age:
Sex:Female
Location:Texas
Vaccinated:1995-03-28
Onset:1995-03-28
Submitted:1995-10-11
Entered:1996-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / UNK - / IM A

Administered by: Private      Purchased by: Other
Symptoms: Pain, Urticaria

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: larger woman;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 950104421

Write-up: pt recvd vax; exp sore arm, tender to touch & red welt size of baseball;


Changed on 9/14/2018

VAERS ID: 81053 Before After
VAERS Form:1
Age:
Sex:Female
Location:Texas
Vaccinated:1995-03-28
Onset:1995-03-28
Submitted:1995-10-11
Entered:1996-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / UNK - / IM A

Administered by: Private      Purchased by: Other
Symptoms: Pain, Urticaria

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: larger woman;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 950104421

Write-up: pt recvd vax; exp sore arm, tender to touch & red welt size of baseball;


Changed on 10/14/2018

VAERS ID: 81053 Before After
VAERS Form:1
Age:
Sex:Female
Location:Texas
Vaccinated:1995-03-28
Onset:1995-03-28
Submitted:1995-10-11
Entered:1996-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / UNK - / IM A

Administered by: Private      Purchased by: Other
Symptoms: Pain, Urticaria

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: larger woman;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 950104421

Write-up: pt recvd vax; exp sore arm, tender to touch & red welt size of baseball;


Changed on 12/24/2020

VAERS ID: 81053 Before After
VAERS Form:1
Age:
Sex:Female
Location:Texas
Vaccinated:1995-03-28
Onset:1995-03-28
Submitted:1995-10-11
Entered:1996-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / UNK - / IM A

Administered by: Private      Purchased by: Other
Symptoms: Pain, Urticaria

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: larger woman;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 950104421

Write-up: pt recvd vax; exp sore arm, tender to touch & red welt size of baseball;


Changed on 12/30/2020

VAERS ID: 81053 Before After
VAERS Form:1
Age:
Sex:Female
Location:Texas
Vaccinated:1995-03-28
Onset:1995-03-28
Submitted:1995-10-11
Entered:1996-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / UNK - / IM A

Administered by: Private      Purchased by: Other
Symptoms: Pain, Urticaria

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: larger woman;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 950104421

Write-up: pt recvd vax; exp sore arm, tender to touch & red welt size of baseball;


Changed on 5/7/2021

VAERS ID: 81053 Before After
VAERS Form:1
Age:
Sex:Female
Location:Texas
Vaccinated:1995-03-28
Onset:1995-03-28
Submitted:1995-10-11
Entered:1996-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / UNK - / IM A

Administered by: Private      Purchased by: Other
Symptoms: Pain, Urticaria

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: larger woman;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 950104421

Write-up: pt recvd vax; exp sore arm, tender to touch & red welt size of baseball;


Changed on 5/21/2021

VAERS ID: 81053 Before After
VAERS Form:1
Age:
Sex:Female
Location:Texas
Vaccinated:1995-03-28
Onset:1995-03-28
Submitted:1995-10-11
Entered:1996-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / UNK - / IM A

Administered by: Private      Purchased by: Other
Symptoms: Pain, Urticaria

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: larger woman;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 950104421

Write-up: pt recvd vax; exp sore arm, tender to touch & red welt size of baseball;

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