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This is VAERS ID 101817

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History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 101817
VAERS Form:
Age:28.5
Sex:Male
Location:Georgia
Vaccinated:1997-07-23
Onset:1997-07-24
Submitted:1997-07-28
Entered:1997-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: ENGERIX-B / SMITHKLINE 2214A4 / 1 - / IM
HEPA: VAQTA / MSD 0115E / 1 - / IM
PPV: PNU-IMUNE(R)23 / LEDERLE 433402 / 0 - / IM
TD: TD ADSORBED, ADULTS / CONNAUGHT LABS 6M81430 / 0 - / IM

Administered by: Public      Purchased by: Unknown
Symptoms: HYPOKINESIA, FEVER, HEADACHE, EDEMA, EDEMA PERIPH

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: denies any
Preexisting Conditions: NKA< denies any problems;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 24JUL97 lt arm sore;25JUL95 fever over 102 lt arm swollen from shoulder to elbow, looked like real bad sun burn-could not heal;24JUL97 to ER given pain med to help stop inflammation & ease pain;could not lift head, h/a;dx some type of rxn;


Changed on 12/8/2009

VAERS ID: 101817 Before After
VAERS Form:
Age:28.5
Sex:Male
Location:Georgia
Vaccinated:1997-07-23
Onset:1997-07-24
Submitted:1997-07-28
Entered:1997-08-25 1997-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: ENGERIX-B HEP B (ENGERIX-B) / SMITHKLINE SMITHKLINE BEECHAM 2214A4 / 1 - / IM
HEPA: VAQTA HEP A (VAQTA) / MSD MERCK & CO. INC. 0115E / 1 - / IM
PPV: PNU-IMUNE(R)23 PNEUMO (PNU-IMUNE) / LEDERLE LEDERLE LABORATORIES 433402 / 0 - / IM
TD: TD ADSORBED, ADULTS TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABS CONNAUGHT LABORATORIES 6M81430 / 0 - / IM

Administered by: Public      Purchased by: Unknown Other
Symptoms: Headache, Hypokinesia, Myalgia, Neck pain, Oedema, Oedema peripheral, Pain, Pyrexia, HYPOKINESIA, FEVER, HEADACHE, EDEMA, EDEMA PERIPH

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: denies any
Preexisting Conditions: NKA< denies any problems;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) GA97096

Write-up: 24JUL97 lt arm sore;25JUL95 fever over 102 lt arm swollen from shoulder to elbow, looked like real bad sun burn-could not heal;24JUL97 to ER given pain med to help stop inflammation & ease pain;could not lift head, h/a;dx some type of rxn;


Changed on 2/14/2017

VAERS ID: 101817 Before After
VAERS Form:
Age:28.5 28.0
Sex:Male
Location:Georgia
Vaccinated:1997-07-23
Onset:1997-07-24
Submitted:1997-07-28
Entered:1997-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2214A4 / 1 - / IM
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0115E / 1 - / IM
PPV: PNEUMO (PNU-IMUNE) / LEDERLE LABORATORIES 433402 / 0 - / IM
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 6M81430 / 0 - / IM

Administered by: Public      Purchased by: Other
Symptoms: Headache, Hypokinesia, Myalgia, Neck pain, Oedema, Oedema peripheral, Pain, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: denies any
Preexisting Conditions: NKA< denies any problems;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA97096

Write-up: 24JUL97 lt arm sore;25JUL95 fever over 102 lt arm swollen from shoulder to elbow, looked like real bad sun burn-could not heal;24JUL97 to ER given pain med to help stop inflammation & ease pain;could not lift head, h/a;dx some type of rxn;


Changed on 5/14/2017

VAERS ID: 101817 Before After
VAERS Form:
Age:28.0
Sex:Male
Location:Georgia
Vaccinated:1997-07-23
Onset:1997-07-24
Submitted:1997-07-28
Entered:1997-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2214A4 / 1 - / IM
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0115E / 1 - / IM
PPV: PNEUMO (PNU-IMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 433402 / 0 - / IM
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 6M81430 / 0 - / IM

Administered by: Public      Purchased by: Other
Symptoms: Headache, Hypokinesia, Myalgia, Neck pain, Oedema, Oedema peripheral, Pain, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: denies any
Preexisting Conditions: NKA< denies any problems;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA97096

Write-up: 24JUL97 lt arm sore;25JUL95 fever over 102 lt arm swollen from shoulder to elbow, looked like real bad sun burn-could not heal;24JUL97 to ER given pain med to help stop inflammation & ease pain;could not lift head, h/a;dx some type of rxn;


Changed on 9/14/2017

VAERS ID: 101817 Before After
VAERS Form:(blank) 1
Age:28.0
Sex:Male
Location:Georgia
Vaccinated:1997-07-23
Onset:1997-07-24
Submitted:1997-07-28
Entered:1997-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2214A4 / 1 2 - / IM
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0115E / 1 2 - / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 433402 / 0 1 - / IM
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 6M81430 / 0 1 - / IM

Administered by: Public      Purchased by: Other
Symptoms: Headache, Hypokinesia, Myalgia, Neck pain, Oedema, Oedema peripheral, Pain, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: denies any
Preexisting Conditions: NKA< denies any problems;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA97096

Write-up: 24JUL97 lt arm sore;25JUL95 fever over 102 lt arm swollen from shoulder to elbow, looked like real bad sun burn-could not heal;24JUL97 to ER given pain med to help stop inflammation & ease pain;could not lift head, h/a;dx some type of rxn;


Changed on 2/14/2018

VAERS ID: 101817 Before After
VAERS Form:1
Age:28.0
Sex:Male
Location:Georgia
Vaccinated:1997-07-23
Onset:1997-07-24
Submitted:1997-07-28
Entered:1997-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2214A4 / 2 - / IM
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0115E / 2 - / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 433402 / 1 - / IM
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 6M81430 / 1 - / IM

Administered by: Public      Purchased by: Other
Symptoms: Headache, Hypokinesia, Myalgia, Neck pain, Oedema, Oedema peripheral, Pain, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: denies any
Preexisting Conditions: NKA< denies any problems;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA97096

Write-up: 24JUL97 lt arm sore;25JUL95 fever over 102 lt arm swollen from shoulder to elbow, looked like real bad sun burn-could not heal;24JUL97 to ER given pain med to help stop inflammation & ease pain;could not lift head, h/a;dx some type of rxn;


Changed on 6/14/2018

VAERS ID: 101817 Before After
VAERS Form:1
Age:28.0
Sex:Male
Location:Georgia
Vaccinated:1997-07-23
Onset:1997-07-24
Submitted:1997-07-28
Entered:1997-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2214A4 / 2 - / IM
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0115E / 2 - / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 433402 / 1 - / IM
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 6M81430 / 1 - / IM

Administered by: Public      Purchased by: Other
Symptoms: Headache, Hypokinesia, Myalgia, Neck pain, Oedema, Oedema peripheral, Pain, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: denies any
Preexisting Conditions: NKA< denies any problems;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA97096

Write-up: 24JUL97 lt arm sore;25JUL95 fever over 102 lt arm swollen from shoulder to elbow, looked like real bad sun burn-could not heal;24JUL97 to ER given pain med to help stop inflammation & ease pain;could not lift head, h/a;dx some type of rxn;


Changed on 8/14/2018

VAERS ID: 101817 Before After
VAERS Form:1
Age:28.0
Sex:Male
Location:Georgia
Vaccinated:1997-07-23
Onset:1997-07-24
Submitted:1997-07-28
Entered:1997-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2214A4 / 2 - / IM
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0115E / 2 - / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 433402 / 1 - / IM
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 6M81430 / 1 - / IM

Administered by: Public      Purchased by: Other
Symptoms: Headache, Hypokinesia, Myalgia, Neck pain, Oedema, Oedema peripheral, Pain, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: denies any
Preexisting Conditions: NKA< denies any problems;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA97096

Write-up: 24JUL97 lt arm sore;25JUL95 fever over 102 lt arm swollen from shoulder to elbow, looked like real bad sun burn-could not heal;24JUL97 to ER given pain med to help stop inflammation & ease pain;could not lift head, h/a;dx some type of rxn;


Changed on 9/14/2018

VAERS ID: 101817 Before After
VAERS Form:1
Age:28.0
Sex:Male
Location:Georgia
Vaccinated:1997-07-23
Onset:1997-07-24
Submitted:1997-07-28
Entered:1997-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2214A4 / 2 - / IM
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0115E / 2 - / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 433402 / 1 - / IM
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 6M81430 / 1 - / IM

Administered by: Public      Purchased by: Other
Symptoms: Headache, Hypokinesia, Myalgia, Neck pain, Oedema, Oedema peripheral, Pain, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: denies any
Preexisting Conditions: NKA< denies any problems;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA97096

Write-up: 24JUL97 lt arm sore;25JUL95 fever over 102 lt arm swollen from shoulder to elbow, looked like real bad sun burn-could not heal;24JUL97 to ER given pain med to help stop inflammation & ease pain;could not lift head, h/a;dx some type of rxn;


Changed on 10/14/2018

VAERS ID: 101817 Before After
VAERS Form:1
Age:28.0
Sex:Male
Location:Georgia
Vaccinated:1997-07-23
Onset:1997-07-24
Submitted:1997-07-28
Entered:1997-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2214A4 / 2 - / IM
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0115E / 2 - / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 433402 / 1 - / IM
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 6M81430 / 1 - / IM

Administered by: Public      Purchased by: Other
Symptoms: Headache, Hypokinesia, Myalgia, Neck pain, Oedema, Oedema peripheral, Pain, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: denies any
Preexisting Conditions: NKA< denies any problems;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA97096

Write-up: 24JUL97 lt arm sore;25JUL95 fever over 102 lt arm swollen from shoulder to elbow, looked like real bad sun burn-could not heal;24JUL97 to ER given pain med to help stop inflammation & ease pain;could not lift head, h/a;dx some type of rxn;


Changed on 12/24/2020

VAERS ID: 101817 Before After
VAERS Form:1
Age:28.0
Sex:Male
Location:Georgia
Vaccinated:1997-07-23
Onset:1997-07-24
Submitted:1997-07-28
Entered:1997-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2214A4 / 2 - / IM
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0115E / 2 - / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 433402 / 1 - / IM
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 6M81430 / 1 - / IM

Administered by: Public      Purchased by: Other
Symptoms: Headache, Hypokinesia, Myalgia, Neck pain, Oedema, Oedema peripheral, Pain, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: denies any
Preexisting Conditions: NKA< denies any problems;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA97096

Write-up: 24JUL97 lt arm sore;25JUL95 fever over 102 lt arm swollen from shoulder to elbow, looked like real bad sun burn-could not heal;24JUL97 to ER given pain med to help stop inflammation & ease pain;could not lift head, h/a;dx some type of rxn;


Changed on 12/30/2020

VAERS ID: 101817 Before After
VAERS Form:1
Age:28.0
Sex:Male
Location:Georgia
Vaccinated:1997-07-23
Onset:1997-07-24
Submitted:1997-07-28
Entered:1997-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2214A4 / 2 - / IM
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0115E / 2 - / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 433402 / 1 - / IM
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 6M81430 / 1 - / IM

Administered by: Public      Purchased by: Other
Symptoms: Headache, Hypokinesia, Myalgia, Neck pain, Oedema, Oedema peripheral, Pain, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: denies any
Preexisting Conditions: NKA< denies any problems;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA97096

Write-up: 24JUL97 lt arm sore;25JUL95 fever over 102 lt arm swollen from shoulder to elbow, looked like real bad sun burn-could not heal;24JUL97 to ER given pain med to help stop inflammation & ease pain;could not lift head, h/a;dx some type of rxn;


Changed on 5/7/2021

VAERS ID: 101817 Before After
VAERS Form:1
Age:28.0
Sex:Male
Location:Georgia
Vaccinated:1997-07-23
Onset:1997-07-24
Submitted:1997-07-28
Entered:1997-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2214A4 / 2 - / IM
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0115E / 2 - / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 433402 / 1 - / IM
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 6M81430 / 1 - / IM

Administered by: Public      Purchased by: Other
Symptoms: Headache, Hypokinesia, Myalgia, Neck pain, Oedema, Oedema peripheral, Pain, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: denies any
Preexisting Conditions: NKA< denies any problems;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA97096

Write-up: 24JUL97 lt arm sore;25JUL95 fever over 102 lt arm swollen from shoulder to elbow, looked like real bad sun burn-could not heal;24JUL97 to ER given pain med to help stop inflammation & ease pain;could not lift head, h/a;dx some type of rxn;


Changed on 5/21/2021

VAERS ID: 101817 Before After
VAERS Form:1
Age:28.0
Sex:Male
Location:Georgia
Vaccinated:1997-07-23
Onset:1997-07-24
Submitted:1997-07-28
Entered:1997-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2214A4 / 2 - / IM
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0115E / 2 - / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 433402 / 1 - / IM
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 6M81430 / 1 - / IM

Administered by: Public      Purchased by: Other
Symptoms: Headache, Hypokinesia, Myalgia, Neck pain, Oedema, Oedema peripheral, Pain, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: denies any
Preexisting Conditions: NKA< denies any problems;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GA97096

Write-up: 24JUL97 lt arm sore;25JUL95 fever over 102 lt arm swollen from shoulder to elbow, looked like real bad sun burn-could not heal;24JUL97 to ER given pain med to help stop inflammation & ease pain;could not lift head, h/a;dx some type of rxn;

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