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This is VAERS ID 103150

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History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 103150
VAERS Form:
Age:65.1
Sex:Male
Location:California
Vaccinated:1997-08-12
Onset:1997-09-25
Submitted:1997-10-10
Entered:1997-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HAVRIX / SMITHKLINE 0122E / 1 - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: PAIN BACK, GUILLAIN BARRE SYND, ASTHENIA, PARESTHESIA

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? Yes, days: 9     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt adm to hosp on 1OCT97 w/1wk history of back pain progressing to weakness;dx w/GBS;


Changed on 12/8/2009

VAERS ID: 103150 Before After
VAERS Form:
Age:65.1
Sex:Male
Location:California
Vaccinated:1997-08-12
Onset:1997-09-25
Submitted:1997-10-10
Entered:1997-10-16 1997-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HAVRIX HEP A (HAVRIX) / SMITHKLINE SMITHKLINE BEECHAM 0122E / 1 - / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Asthenia, Back pain, Guillain-Barre syndrome, Paraesthesia, PAIN BACK, GUILLAIN BARRE SYND, ASTHENIA, PARESTHESIA

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? Yes, days: 9     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt adm to hosp on 1OCT97 w/1wk history of back pain progressing to weakness;dx w/GBS;


Changed on 2/14/2017

VAERS ID: 103150 Before After
VAERS Form:
Age:65.1 65.0
Sex:Male
Location:California
Vaccinated:1997-08-12
Onset:1997-09-25
Submitted:1997-10-10
Entered:1997-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 0122E / 1 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Back pain, Guillain-Barre syndrome, Paraesthesia

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? Yes, days: 9     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt adm to hosp on 1OCT97 w/1wk history of back pain progressing to weakness;dx w/GBS;


Changed on 5/14/2017

VAERS ID: 103150 Before After
VAERS Form:
Age:65.0
Sex:Male
Location:California
Vaccinated:1997-08-12
Onset:1997-09-25
Submitted:1997-10-10
Entered:1997-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 0122E / 1 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Back pain, Guillain-Barre syndrome, Paraesthesia

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? Yes, days: 9     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt adm to hosp on 1OCT97 w/1wk history of back pain progressing to weakness;dx w/GBS;


Changed on 9/14/2017

VAERS ID: 103150 Before After
VAERS Form:(blank) 1
Age:65.0
Sex:Male
Location:California
Vaccinated:1997-08-12
Onset:1997-09-25
Submitted:1997-10-10
Entered:1997-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 0122E / 1 2 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Back pain, Guillain-Barre syndrome, Paraesthesia

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? Yes, days: 9     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt adm to hosp on 1OCT97 w/1wk history of back pain progressing to weakness;dx w/GBS;


Changed on 2/14/2018

VAERS ID: 103150 Before After
VAERS Form:1
Age:65.0
Sex:Male
Location:California
Vaccinated:1997-08-12
Onset:1997-09-25
Submitted:1997-10-10
Entered:1997-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 0122E / 2 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Back pain, Guillain-Barre syndrome, Paraesthesia

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? Yes, days: 9     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt adm to hosp on 1OCT97 w/1wk history of back pain progressing to weakness;dx w/GBS;


Changed on 6/14/2018

VAERS ID: 103150 Before After
VAERS Form:1
Age:65.0
Sex:Male
Location:California
Vaccinated:1997-08-12
Onset:1997-09-25
Submitted:1997-10-10
Entered:1997-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 0122E / 2 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Back pain, Guillain-Barre syndrome, Paraesthesia

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? Yes, days: 9     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt adm to hosp on 1OCT97 w/1wk history of back pain progressing to weakness;dx w/GBS;


Changed on 8/14/2018

VAERS ID: 103150 Before After
VAERS Form:1
Age:65.0
Sex:Male
Location:California
Vaccinated:1997-08-12
Onset:1997-09-25
Submitted:1997-10-10
Entered:1997-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 0122E / 2 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Back pain, Guillain-Barre syndrome, Paraesthesia

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? Yes, days: 9     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt adm to hosp on 1OCT97 w/1wk history of back pain progressing to weakness;dx w/GBS;


Changed on 9/14/2018

VAERS ID: 103150 Before After
VAERS Form:1
Age:65.0
Sex:Male
Location:California
Vaccinated:1997-08-12
Onset:1997-09-25
Submitted:1997-10-10
Entered:1997-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 0122E / 2 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Back pain, Guillain-Barre syndrome, Paraesthesia

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? Yes, days: 9     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt adm to hosp on 1OCT97 w/1wk history of back pain progressing to weakness;dx w/GBS;


Changed on 10/14/2018

VAERS ID: 103150 Before After
VAERS Form:1
Age:65.0
Sex:Male
Location:California
Vaccinated:1997-08-12
Onset:1997-09-25
Submitted:1997-10-10
Entered:1997-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 0122E / 2 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Back pain, Guillain-Barre syndrome, Paraesthesia

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? Yes, days: 9     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt adm to hosp on 1OCT97 w/1wk history of back pain progressing to weakness;dx w/GBS;


Changed on 12/24/2020

VAERS ID: 103150 Before After
VAERS Form:1
Age:65.0
Sex:Male
Location:California
Vaccinated:1997-08-12
Onset:1997-09-25
Submitted:1997-10-10
Entered:1997-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 0122E / 2 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Back pain, Guillain-Barre syndrome, Paraesthesia

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? Yes, days: 9     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt adm to hosp on 1OCT97 w/1wk history of back pain progressing to weakness;dx w/GBS;


Changed on 12/30/2020

VAERS ID: 103150 Before After
VAERS Form:1
Age:65.0
Sex:Male
Location:California
Vaccinated:1997-08-12
Onset:1997-09-25
Submitted:1997-10-10
Entered:1997-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 0122E / 2 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Back pain, Guillain-Barre syndrome, Paraesthesia

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? Yes, days: 9     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt adm to hosp on 1OCT97 w/1wk history of back pain progressing to weakness;dx w/GBS;


Changed on 5/7/2021

VAERS ID: 103150 Before After
VAERS Form:1
Age:65.0
Sex:Male
Location:California
Vaccinated:1997-08-12
Onset:1997-09-25
Submitted:1997-10-10
Entered:1997-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 0122E / 2 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Back pain, Guillain-Barre syndrome, Paraesthesia

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? Yes, days: 9     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt adm to hosp on 1OCT97 w/1wk history of back pain progressing to weakness;dx w/GBS;


Changed on 5/21/2021

VAERS ID: 103150 Before After
VAERS Form:1
Age:65.0
Sex:Male
Location:California
Vaccinated:1997-08-12
Onset:1997-09-25
Submitted:1997-10-10
Entered:1997-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 0122E / 2 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Back pain, Guillain-Barre syndrome, Paraesthesia

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? Yes, days: 9     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt adm to hosp on 1OCT97 w/1wk history of back pain progressing to weakness;dx w/GBS;

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