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This is VAERS ID 103870

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History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 103870
VAERS Form:
Age:9.0
Sex:Male
Location:Oklahoma
Vaccinated:1997-09-16
Onset:1997-09-17
Submitted:1997-10-09
Entered:1997-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HAVRIX / SMITHKLINE VHA187A2 / 0 LA / IM

Administered by: Other      Purchased by: Unknown
Symptoms: HYPOTONIA, FEVER, SOMNOLENCE, LEUKOCYTOSIS, PAIN ABDO

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': NONE

Write-up: severe stomach cramps for 5hr, temp of 103-104, limp, not alert;occurred evening of 17SEP97;ER visit resulted in admission;multiple tests run, WBC inc, IV administered;everything but vax rxn r/o;released 1-2 days later;recovered fully


Changed on 12/8/2009

VAERS ID: 103870 Before After
VAERS Form:
Age:9.0
Sex:Male
Location:Oklahoma
Vaccinated:1997-09-16
Onset:1997-09-17
Submitted:1997-10-09
Entered:1997-10-29 1997-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HAVRIX HEP A (HAVRIX) / SMITHKLINE SMITHKLINE BEECHAM VHA187A2 187A2 / 0 LA / IM

Administered by: Other Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Hypotonia, Leukocytosis, Pyrexia, Somnolence, HYPOTONIA, FEVER, SOMNOLENCE, LEUKOCYTOSIS, PAIN ABDO

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': NONE OK9733

Write-up: severe stomach cramps for 5hr, temp of 103-104, limp, not alert;occurred evening of 17SEP97;ER visit resulted in admission;multiple tests run, WBC inc, IV administered;everything but vax rxn r/o;released 1-2 days later;recovered fully


Changed on 5/14/2017

VAERS ID: 103870 Before After
VAERS Form:
Age:9.0
Sex:Male
Location:Oklahoma
Vaccinated:1997-09-16
Onset:1997-09-17
Submitted:1997-10-09
Entered:1997-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 187A2 / 0 LA / IM

Administered by: Unknown Other      Purchased by: Unknown Public
Symptoms: Abdominal pain, Hypotonia, Leukocytosis, Pyrexia, Somnolence

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': OK9733

Write-up: severe stomach cramps for 5hr, temp of 103-104, limp, not alert;occurred evening of 17SEP97;ER visit resulted in admission;multiple tests run, WBC inc, IV administered;everything but vax rxn r/o;released 1-2 days later;recovered fully


Changed on 9/14/2017

VAERS ID: 103870 Before After
VAERS Form:(blank) 1
Age:9.0
Sex:Male
Location:Oklahoma
Vaccinated:1997-09-16
Onset:1997-09-17
Submitted:1997-10-09
Entered:1997-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 187A2 / 0 1 LA / IM

Administered by: Other      Purchased by: Public
Symptoms: Abdominal pain, Hypotonia, Leukocytosis, Pyrexia, Somnolence

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': OK9733

Write-up: severe stomach cramps for 5hr, temp of 103-104, limp, not alert;occurred evening of 17SEP97;ER visit resulted in admission;multiple tests run, WBC inc, IV administered;everything but vax rxn r/o;released 1-2 days later;recovered fully


Changed on 2/14/2018

VAERS ID: 103870 Before After
VAERS Form:1
Age:9.0
Sex:Male
Location:Oklahoma
Vaccinated:1997-09-16
Onset:1997-09-17
Submitted:1997-10-09
Entered:1997-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 187A2 / 1 LA / IM

Administered by: Other      Purchased by: Public
Symptoms: Abdominal pain, Hypotonia, Leukocytosis, Pyrexia, Somnolence

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': OK9733

Write-up: severe stomach cramps for 5hr, temp of 103-104, limp, not alert;occurred evening of 17SEP97;ER visit resulted in admission;multiple tests run, WBC inc, IV administered;everything but vax rxn r/o;released 1-2 days later;recovered fully


Changed on 6/14/2018

VAERS ID: 103870 Before After
VAERS Form:1
Age:9.0
Sex:Male
Location:Oklahoma
Vaccinated:1997-09-16
Onset:1997-09-17
Submitted:1997-10-09
Entered:1997-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 187A2 / 1 LA / IM

Administered by: Other      Purchased by: Public
Symptoms: Abdominal pain, Hypotonia, Leukocytosis, Pyrexia, Somnolence

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': OK9733

Write-up: severe stomach cramps for 5hr, temp of 103-104, limp, not alert;occurred evening of 17SEP97;ER visit resulted in admission;multiple tests run, WBC inc, IV administered;everything but vax rxn r/o;released 1-2 days later;recovered fully


Changed on 8/14/2018

VAERS ID: 103870 Before After
VAERS Form:1
Age:9.0
Sex:Male
Location:Oklahoma
Vaccinated:1997-09-16
Onset:1997-09-17
Submitted:1997-10-09
Entered:1997-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 187A2 / 1 LA / IM

Administered by: Other      Purchased by: Public
Symptoms: Abdominal pain, Hypotonia, Leukocytosis, Pyrexia, Somnolence

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': OK9733

Write-up: severe stomach cramps for 5hr, temp of 103-104, limp, not alert;occurred evening of 17SEP97;ER visit resulted in admission;multiple tests run, WBC inc, IV administered;everything but vax rxn r/o;released 1-2 days later;recovered fully


Changed on 9/14/2018

VAERS ID: 103870 Before After
VAERS Form:1
Age:9.0
Sex:Male
Location:Oklahoma
Vaccinated:1997-09-16
Onset:1997-09-17
Submitted:1997-10-09
Entered:1997-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 187A2 / 1 LA / IM

Administered by: Other      Purchased by: Public
Symptoms: Abdominal pain, Hypotonia, Leukocytosis, Pyrexia, Somnolence

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': OK9733

Write-up: severe stomach cramps for 5hr, temp of 103-104, limp, not alert;occurred evening of 17SEP97;ER visit resulted in admission;multiple tests run, WBC inc, IV administered;everything but vax rxn r/o;released 1-2 days later;recovered fully


Changed on 10/14/2018

VAERS ID: 103870 Before After
VAERS Form:1
Age:9.0
Sex:Male
Location:Oklahoma
Vaccinated:1997-09-16
Onset:1997-09-17
Submitted:1997-10-09
Entered:1997-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 187A2 / 1 LA / IM

Administered by: Other      Purchased by: Public
Symptoms: Abdominal pain, Hypotonia, Leukocytosis, Pyrexia, Somnolence

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': OK9733

Write-up: severe stomach cramps for 5hr, temp of 103-104, limp, not alert;occurred evening of 17SEP97;ER visit resulted in admission;multiple tests run, WBC inc, IV administered;everything but vax rxn r/o;released 1-2 days later;recovered fully


Changed on 12/24/2020

VAERS ID: 103870 Before After
VAERS Form:1
Age:9.0
Sex:Male
Location:Oklahoma
Vaccinated:1997-09-16
Onset:1997-09-17
Submitted:1997-10-09
Entered:1997-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 187A2 / 1 LA / IM

Administered by: Other      Purchased by: Public
Symptoms: Abdominal pain, Hypotonia, Leukocytosis, Pyrexia, Somnolence

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': OK9733

Write-up: severe stomach cramps for 5hr, temp of 103-104, limp, not alert;occurred evening of 17SEP97;ER visit resulted in admission;multiple tests run, WBC inc, IV administered;everything but vax rxn r/o;released 1-2 days later;recovered fully


Changed on 12/30/2020

VAERS ID: 103870 Before After
VAERS Form:1
Age:9.0
Sex:Male
Location:Oklahoma
Vaccinated:1997-09-16
Onset:1997-09-17
Submitted:1997-10-09
Entered:1997-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 187A2 / 1 LA / IM

Administered by: Other      Purchased by: Public
Symptoms: Abdominal pain, Hypotonia, Leukocytosis, Pyrexia, Somnolence

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': OK9733

Write-up: severe stomach cramps for 5hr, temp of 103-104, limp, not alert;occurred evening of 17SEP97;ER visit resulted in admission;multiple tests run, WBC inc, IV administered;everything but vax rxn r/o;released 1-2 days later;recovered fully


Changed on 5/7/2021

VAERS ID: 103870 Before After
VAERS Form:1
Age:9.0
Sex:Male
Location:Oklahoma
Vaccinated:1997-09-16
Onset:1997-09-17
Submitted:1997-10-09
Entered:1997-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 187A2 / 1 LA / IM

Administered by: Other      Purchased by: Public
Symptoms: Abdominal pain, Hypotonia, Leukocytosis, Pyrexia, Somnolence

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': OK9733

Write-up: severe stomach cramps for 5hr, temp of 103-104, limp, not alert;occurred evening of 17SEP97;ER visit resulted in admission;multiple tests run, WBC inc, IV administered;everything but vax rxn r/o;released 1-2 days later;recovered fully


Changed on 5/21/2021

VAERS ID: 103870 Before After
VAERS Form:1
Age:9.0
Sex:Male
Location:Oklahoma
Vaccinated:1997-09-16
Onset:1997-09-17
Submitted:1997-10-09
Entered:1997-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 187A2 / 1 LA / IM

Administered by: Other      Purchased by: Public
Symptoms: Abdominal pain, Hypotonia, Leukocytosis, Pyrexia, Somnolence

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': OK9733

Write-up: severe stomach cramps for 5hr, temp of 103-104, limp, not alert;occurred evening of 17SEP97;ER visit resulted in admission;multiple tests run, WBC inc, IV administered;everything but vax rxn r/o;released 1-2 days later;recovered fully

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