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This is VAERS ID 106936

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History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 106936
VAERS Form:
Age:61.5
Sex:Male
Location:Oklahoma
Vaccinated:1997-12-24
Onset:1997-12-24
Submitted:1998-01-12
Entered:1998-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HAVRIX / SMITHKLINE 1286E / 0 RA / IM
MEN: MENOMUNE A/C/Y/W / CONNAUGHT LABS 7H91876 / 0 LA / SC
OPV: ORIMUNE / LEDERLE 0769K / 0 - / PO
YF: YELLOW FEVER / CONNAUGHT LABS 7K81936 / 0 RA / SC

Administered by: Public      Purchased by: Unknown
Symptoms: DIARRHEA, NAUSEA VOMIT, CHILLS FEVER

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: takes meds for stomach condition-unk type
Current Illness: NONE
Preexisting Conditions: nONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: fever, chills, projectile vomiting, nausea, diarrhea x 48hr;adm to hosp;


Changed on 12/8/2009

VAERS ID: 106936 Before After
VAERS Form:
Age:61.5
Sex:Male
Location:Oklahoma
Vaccinated:1997-12-24
Onset:1997-12-24
Submitted:1998-01-12
Entered:1998-01-27 1998-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HAVRIX HEP A (HAVRIX) / SMITHKLINE SMITHKLINE BEECHAM 1286E / 0 RA / IM
MEN: MENOMUNE A/C/Y/W MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABS CONNAUGHT LABORATORIES 7H91876 / 0 LA / SC
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 0769K / 0 - / PO
YF: YELLOW FEVER YELLOW FEVER (YF-VAX) / CONNAUGHT LABS CONNAUGHT LABORATORIES 7K81936 / 0 RA / SC

Administered by: Public      Purchased by: Unknown Other
Symptoms: Diarrhoea, Pyrexia, Vomiting, DIARRHEA, NAUSEA VOMIT, CHILLS FEVER

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: takes meds for stomach condition-unk type
Current Illness: NONE
Preexisting Conditions: nONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': (blank) OK9747

Write-up: fever, chills, projectile vomiting, nausea, diarrhea x 48hr;adm to hosp;


Changed on 2/14/2017

VAERS ID: 106936 Before After
VAERS Form:
Age:61.5 61.0
Sex:Male
Location:Oklahoma
Vaccinated:1997-12-24
Onset:1997-12-24
Submitted:1998-01-12
Entered:1998-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 1286E / 0 RA / IM
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES 7H91876 / 0 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES 0769K / 0 - / PO
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES 7K81936 / 0 RA / SC

Administered by: Public      Purchased by: Other
Symptoms: Diarrhoea, Pyrexia, Vomiting

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: takes meds for stomach condition-unk type
Current Illness: NONE
Preexisting Conditions: nONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': OK9747

Write-up: fever, chills, projectile vomiting, nausea, diarrhea x 48hr;adm to hosp;


Changed on 5/14/2017

VAERS ID: 106936 Before After
VAERS Form:
Age:61.0
Sex:Male
Location:Oklahoma
Vaccinated:1997-12-24
Onset:1997-12-24
Submitted:1998-01-12
Entered:1998-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 1286E / 0 RA / IM
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES 7H91876 / 0 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 0769K / 0 - / PO
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES 7K81936 / 0 RA / SC

Administered by: Public      Purchased by: Other
Symptoms: Diarrhoea, Pyrexia, Vomiting

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: 2 (blank)     Extended hospital stay? No
Previous Vaccinations:
Other Medications: takes meds for stomach condition-unk type
Current Illness: NONE
Preexisting Conditions: nONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': OK9747

Write-up: fever, chills, projectile vomiting, nausea, diarrhea x 48hr;adm to hosp;


Changed on 9/14/2017

VAERS ID: 106936 Before After
VAERS Form:(blank) 1
Age:61.0
Sex:Male
Location:Oklahoma
Vaccinated:1997-12-24
Onset:1997-12-24
Submitted:1998-01-12
Entered:1998-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 1286E / 0 1 RA / IM
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES 7H91876 / 0 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0769K / 0 1 - MO / PO
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES 7K81936 / 0 1 RA / SC

Administered by: Public      Purchased by: Other
Symptoms: Diarrhoea, Pyrexia, Vomiting

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: takes meds for stomach condition-unk type
Current Illness: NONE
Preexisting Conditions: nONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': OK9747

Write-up: fever, chills, projectile vomiting, nausea, diarrhea x 48hr;adm to hosp;


Changed on 2/14/2018

VAERS ID: 106936 Before After
VAERS Form:1
Age:61.0
Sex:Male
Location:Oklahoma
Vaccinated:1997-12-24
Onset:1997-12-24
Submitted:1998-01-12
Entered:1998-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 1286E / 1 RA / IM
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES 7H91876 / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0769K / 1 MO / PO
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES 7K81936 / 1 RA / SC

Administered by: Public      Purchased by: Other
Symptoms: Diarrhoea, Pyrexia, Vomiting

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: takes meds for stomach condition-unk type
Current Illness: NONE
Preexisting Conditions: nONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': OK9747

Write-up: fever, chills, projectile vomiting, nausea, diarrhea x 48hr;adm to hosp;


Changed on 6/14/2018

VAERS ID: 106936 Before After
VAERS Form:1
Age:61.0
Sex:Male
Location:Oklahoma
Vaccinated:1997-12-24
Onset:1997-12-24
Submitted:1998-01-12
Entered:1998-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 1286E / 1 RA / IM
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES 7H91876 / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0769K / 1 MO / PO
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES 7K81936 / 1 RA / SC

Administered by: Public      Purchased by: Other
Symptoms: Diarrhoea, Pyrexia, Vomiting

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: takes meds for stomach condition-unk type
Current Illness: NONE
Preexisting Conditions: nONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': OK9747

Write-up: fever, chills, projectile vomiting, nausea, diarrhea x 48hr;adm to hosp;


Changed on 8/14/2018

VAERS ID: 106936 Before After
VAERS Form:1
Age:61.0
Sex:Male
Location:Oklahoma
Vaccinated:1997-12-24
Onset:1997-12-24
Submitted:1998-01-12
Entered:1998-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 1286E / 1 RA / IM
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES 7H91876 / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0769K / 1 MO / PO
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES 7K81936 / 1 RA / SC

Administered by: Public      Purchased by: Other
Symptoms: Diarrhoea, Pyrexia, Vomiting

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: takes meds for stomach condition-unk type
Current Illness: NONE
Preexisting Conditions: nONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': OK9747

Write-up: fever, chills, projectile vomiting, nausea, diarrhea x 48hr;adm to hosp;


Changed on 9/14/2018

VAERS ID: 106936 Before After
VAERS Form:1
Age:61.0
Sex:Male
Location:Oklahoma
Vaccinated:1997-12-24
Onset:1997-12-24
Submitted:1998-01-12
Entered:1998-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 1286E / 1 RA / IM
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES 7H91876 / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0769K / 1 MO / PO
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES 7K81936 / 1 RA / SC

Administered by: Public      Purchased by: Other
Symptoms: Diarrhoea, Pyrexia, Vomiting

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: takes meds for stomach condition-unk type
Current Illness: NONE
Preexisting Conditions: nONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': OK9747

Write-up: fever, chills, projectile vomiting, nausea, diarrhea x 48hr;adm to hosp;


Changed on 10/14/2018

VAERS ID: 106936 Before After
VAERS Form:1
Age:61.0
Sex:Male
Location:Oklahoma
Vaccinated:1997-12-24
Onset:1997-12-24
Submitted:1998-01-12
Entered:1998-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 1286E / 1 RA / IM
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES 7H91876 / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0769K / 1 MO / PO
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES 7K81936 / 1 RA / SC

Administered by: Public      Purchased by: Other
Symptoms: Diarrhoea, Pyrexia, Vomiting

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: takes meds for stomach condition-unk type
Current Illness: NONE
Preexisting Conditions: nONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': OK9747

Write-up: fever, chills, projectile vomiting, nausea, diarrhea x 48hr;adm to hosp;


Changed on 12/24/2020

VAERS ID: 106936 Before After
VAERS Form:1
Age:61.0
Sex:Male
Location:Oklahoma
Vaccinated:1997-12-24
Onset:1997-12-24
Submitted:1998-01-12
Entered:1998-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 1286E / 1 RA / IM
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES 7H91876 / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0769K / 1 MO / PO
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES 7K81936 / 1 RA / SC

Administered by: Public      Purchased by: Other
Symptoms: Diarrhoea, Pyrexia, Vomiting

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: takes meds for stomach condition-unk type
Current Illness: NONE
Preexisting Conditions: nONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': OK9747

Write-up: fever, chills, projectile vomiting, nausea, diarrhea x 48hr;adm to hosp;


Changed on 12/30/2020

VAERS ID: 106936 Before After
VAERS Form:1
Age:61.0
Sex:Male
Location:Oklahoma
Vaccinated:1997-12-24
Onset:1997-12-24
Submitted:1998-01-12
Entered:1998-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 1286E / 1 RA / IM
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES 7H91876 / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0769K / 1 MO / PO
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES 7K81936 / 1 RA / SC

Administered by: Public      Purchased by: Other
Symptoms: Diarrhoea, Pyrexia, Vomiting

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: takes meds for stomach condition-unk type
Current Illness: NONE
Preexisting Conditions: nONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': OK9747

Write-up: fever, chills, projectile vomiting, nausea, diarrhea x 48hr;adm to hosp;


Changed on 5/7/2021

VAERS ID: 106936 Before After
VAERS Form:1
Age:61.0
Sex:Male
Location:Oklahoma
Vaccinated:1997-12-24
Onset:1997-12-24
Submitted:1998-01-12
Entered:1998-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 1286E / 1 RA / IM
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES 7H91876 / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0769K / 1 MO / PO
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES 7K81936 / 1 RA / SC

Administered by: Public      Purchased by: Other
Symptoms: Diarrhoea, Pyrexia, Vomiting

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: takes meds for stomach condition-unk type
Current Illness: NONE
Preexisting Conditions: nONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': OK9747

Write-up: fever, chills, projectile vomiting, nausea, diarrhea x 48hr;adm to hosp;


Changed on 5/21/2021

VAERS ID: 106936 Before After
VAERS Form:1
Age:61.0
Sex:Male
Location:Oklahoma
Vaccinated:1997-12-24
Onset:1997-12-24
Submitted:1998-01-12
Entered:1998-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 1286E / 1 RA / IM
MEN: MENINGOCOCCAL (MENOMUNE) / CONNAUGHT LABORATORIES 7H91876 / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0769K / 1 MO / PO
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES 7K81936 / 1 RA / SC

Administered by: Public      Purchased by: Other
Symptoms: Diarrhoea, Pyrexia, Vomiting

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: takes meds for stomach condition-unk type
Current Illness: NONE
Preexisting Conditions: nONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': OK9747

Write-up: fever, chills, projectile vomiting, nausea, diarrhea x 48hr;adm to hosp;

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