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This is VAERS ID 107366

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History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 107366
VAERS Form:
Age:31.6
Sex:Male
Location:Illinois
Vaccinated:1998-01-09
Onset:1998-01-19
Submitted:1998-02-06
Entered:1998-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: UNK. INFLUENZA VACCINE / UNCLASSIFIED - / - - / -
HEPA: HAVRIX / SMITHKLINE - / 0 - / -

Administered by: Private      Purchased by: Unknown
Symptoms: ANA, FLU SYND, HEPATITIS, LAB TEST ABNORM, BILIRUBINEM

Life Threatening? Yes
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? No
Previous Vaccinations:
Other Medications: HIV medication
Current Illness:
Preexisting Conditions: HIV positive
Allergies:
Diagnostic Lab Data: 19JAN98 BILTOT 8;hep a test positive;
CDC 'Split Type':

Write-up: pt recv vax 9JAN98 & approx 10 day later 19JAN98 pt was jaundiced & had elevated liver function test, elevated prothrombin time, & elevated bilirubin of 8;pt tested positive for hep A;hosp;dx acute hep A:


Changed on 12/8/2009

VAERS ID: 107366 Before After
VAERS Form:
Age:31.6
Sex:Male
Location:Illinois
Vaccinated:1998-01-09
Onset:1998-01-19
Submitted:1998-02-06
Entered:1998-02-11 1998-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: UNK. INFLUENZA VACCINE INFLUENZA (SEASONAL) (NO BRAND NAME) / UNCLASSIFIED UNKNOWN MANUFACTURER - / - - / -
HEPA: HAVRIX HEP A (HAVRIX) / SMITHKLINE SMITHKLINE BEECHAM - / 0 - / -

Administered by: Private      Purchased by: Unknown Private
Symptoms: ANA, Antinuclear antibody, Hepatic function abnormal, Hepatitis, Hyperbilirubinaemia, Influenza, Laboratory test abnormal, Vomiting, FLU SYND, HEPATITIS, LAB TEST ABNORM, BILIRUBINEM

Life Threatening? Yes
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? No
Previous Vaccinations:
Other Medications: HIV medication
Current Illness:
Preexisting Conditions: HIV positive
Allergies:
Diagnostic Lab Data: 19JAN98 BILTOT 8;hep a test positive;
CDC 'Split Type': (blank) 980038631

Write-up: pt recv vax 9JAN98 & approx 10 day later 19JAN98 pt was jaundiced & had elevated liver function test, elevated prothrombin time, & elevated bilirubin of 8;pt tested positive for hep A;hosp;dx acute hep A:


Changed on 7/7/2013

VAERS ID: 107366 Before After
VAERS Form:
Age:31.6
Sex:Male
Location:Illinois
Vaccinated:1998-01-09
Onset:1998-01-19
Submitted:1998-02-06
Entered:1998-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / 0 - / -

Administered by: Private      Purchased by: Private
Symptoms: Antinuclear antibody, Hepatic function abnormal, Hepatitis, Hyperbilirubinaemia, Influenza, Laboratory test abnormal, Vomiting

Life Threatening? Yes
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? No
Previous Vaccinations:
Other Medications: HIV medication
Current Illness:
Preexisting Conditions: HIV positive
Allergies:
Diagnostic Lab Data: 19JAN98 BILTOT 8;hep a test positive;
CDC 'Split Type': 980038631

Write-up: pt recv vax 9JAN98 & approx 10 day later 19JAN98 pt was jaundiced & had elevated liver function test, elevated prothrombin time, & elevated bilirubin of 8;pt tested positive for hep A;hosp;dx acute hep A:


Changed on 12/14/2016

VAERS ID: 107366 Before After
VAERS Form:
Age:31.6
Sex:Male
Location:Illinois
Vaccinated:1998-01-09
Onset:1998-01-19
Submitted:1998-02-06
Entered:1998-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / 0 - / -

Administered by: Private      Purchased by: Private
Symptoms: Antinuclear antibody, Hepatic function abnormal, Hepatitis, Hyperbilirubinaemia, Influenza, Laboratory test abnormal, Vomiting

Life Threatening? Yes
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? No
Previous Vaccinations:
Other Medications: HIV medication
Current Illness:
Preexisting Conditions: HIV positive
Allergies:
Diagnostic Lab Data: 19JAN98 BILTOT 8;hep a test positive;
CDC 'Split Type': 980038631

Write-up: pt recv vax 9JAN98 & approx 10 day later 19JAN98 pt was jaundiced & had elevated liver function test, elevated prothrombin time, & elevated bilirubin of 8;pt tested positive for hep A;hosp;dx acute hep A:


Changed on 2/14/2017

VAERS ID: 107366 Before After
VAERS Form:
Age:31.6 31.0
Sex:Male
Location:Illinois
Vaccinated:1998-01-09
Onset:1998-01-19
Submitted:1998-02-06
Entered:1998-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / 0 - / -

Administered by: Private      Purchased by: Private
Symptoms: Antinuclear antibody, Hepatic function abnormal, Hepatitis, Hyperbilirubinaemia, Influenza, Laboratory test abnormal, Vomiting

Life Threatening? Yes
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? No
Previous Vaccinations:
Other Medications: HIV medication
Current Illness:
Preexisting Conditions: HIV positive
Allergies:
Diagnostic Lab Data: 19JAN98 BILTOT 8;hep a test positive;
CDC 'Split Type': 980038631

Write-up: pt recv vax 9JAN98 & approx 10 day later 19JAN98 pt was jaundiced & had elevated liver function test, elevated prothrombin time, & elevated bilirubin of 8;pt tested positive for hep A;hosp;dx acute hep A:


Changed on 5/14/2017

VAERS ID: 107366 Before After
VAERS Form:
Age:31.0
Sex:Male
Location:Illinois
Vaccinated:1998-01-09
Onset:1998-01-19
Submitted:1998-02-06
Entered:1998-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / 0 - / -

Administered by: Private      Purchased by: Private
Symptoms: Antinuclear antibody, Hepatic function abnormal, Hepatitis, Hyperbilirubinaemia, Influenza, Laboratory test abnormal, Vomiting

Life Threatening? Yes
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: mult meds for HIV medication infect
Current Illness: HIV positive asymptomatic
Preexisting Conditions: HIV positive
Allergies:
Diagnostic Lab Data: 19JAN98 BILTOT 8;hep a test positive; elevated liver nezymes;8.0 biliruben;IGM positive;hep A antibody;
CDC 'Split Type': 980038631 (blank)

Write-up: pt recv vax 9JAN98 & approx 10 day later 19JAN98 pt was jaundiced & had elevated liver function test, elevated prothrombin time, & elevated bilirubin of 8;pt tested positive for hep A;hosp;dx devel flu like sx w/nausea, vomiting dx acute hep A: A


Changed on 9/14/2017

VAERS ID: 107366 Before After
VAERS Form:(blank) 1
Age:31.0
Sex:Male
Location:Illinois
Vaccinated:1998-01-09
Onset:1998-01-19
Submitted:1998-02-06
Entered:1998-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK - / -
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / 0 1 - / -

Administered by: Private      Purchased by: Private
Symptoms: Antinuclear antibody, Hepatic function abnormal, Hepatitis, Hyperbilirubinaemia, Influenza, Laboratory test abnormal, Vomiting

Life Threatening? Yes
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: mult meds for HIV infect
Current Illness: HIV positive asymptomatic
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: elevated liver nezymes;8.0 biliruben;IGM positive;hep A antibody;
CDC 'Split Type':

Write-up: pt devel flu like sx w/nausea, vomiting dx acute hep A


Changed on 2/14/2018

VAERS ID: 107366 Before After
VAERS Form:1
Age:31.0
Sex:Male
Location:Illinois
Vaccinated:1998-01-09
Onset:1998-01-19
Submitted:1998-02-06
Entered:1998-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / 1 - / -

Administered by: Private      Purchased by: Private
Symptoms: Antinuclear antibody, Hepatic function abnormal, Hepatitis, Hyperbilirubinaemia, Influenza, Laboratory test abnormal, Vomiting

Life Threatening? Yes
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: mult meds for HIV infect
Current Illness: HIV positive asymptomatic
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: elevated liver nezymes;8.0 biliruben;IGM positive;hep A antibody;
CDC 'Split Type':

Write-up: pt devel flu like sx w/nausea, vomiting dx acute hep A


Changed on 6/14/2018

VAERS ID: 107366 Before After
VAERS Form:1
Age:31.0
Sex:Male
Location:Illinois
Vaccinated:1998-01-09
Onset:1998-01-19
Submitted:1998-02-06
Entered:1998-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / 1 - / -

Administered by: Private      Purchased by: Private
Symptoms: Antinuclear antibody, Hepatic function abnormal, Hepatitis, Hyperbilirubinaemia, Influenza, Laboratory test abnormal, Vomiting

Life Threatening? Yes
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: mult meds for HIV infect
Current Illness: HIV positive asymptomatic
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: elevated liver nezymes;8.0 biliruben;IGM positive;hep A antibody;
CDC 'Split Type':

Write-up: pt devel flu like sx w/nausea, vomiting dx acute hep A


Changed on 8/14/2018

VAERS ID: 107366 Before After
VAERS Form:1
Age:31.0
Sex:Male
Location:Illinois
Vaccinated:1998-01-09
Onset:1998-01-19
Submitted:1998-02-06
Entered:1998-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / 1 - / -

Administered by: Private      Purchased by: Private
Symptoms: Antinuclear antibody, Hepatic function abnormal, Hepatitis, Hyperbilirubinaemia, Influenza, Laboratory test abnormal, Vomiting

Life Threatening? Yes
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: mult meds for HIV infect
Current Illness: HIV positive asymptomatic
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: elevated liver nezymes;8.0 biliruben;IGM positive;hep A antibody;
CDC 'Split Type':

Write-up: pt devel flu like sx w/nausea, vomiting dx acute hep A


Changed on 9/14/2018

VAERS ID: 107366 Before After
VAERS Form:1
Age:31.0
Sex:Male
Location:Illinois
Vaccinated:1998-01-09
Onset:1998-01-19
Submitted:1998-02-06
Entered:1998-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / 1 - / -

Administered by: Private      Purchased by: Private
Symptoms: Antinuclear antibody, Hepatic function abnormal, Hepatitis, Hyperbilirubinaemia, Influenza, Laboratory test abnormal, Vomiting

Life Threatening? Yes
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: mult meds for HIV infect
Current Illness: HIV positive asymptomatic
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: elevated liver nezymes;8.0 biliruben;IGM positive;hep A antibody;
CDC 'Split Type':

Write-up: pt devel flu like sx w/nausea, vomiting dx acute hep A


Changed on 10/14/2018

VAERS ID: 107366 Before After
VAERS Form:1
Age:31.0
Sex:Male
Location:Illinois
Vaccinated:1998-01-09
Onset:1998-01-19
Submitted:1998-02-06
Entered:1998-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / 1 - / -

Administered by: Private      Purchased by: Private
Symptoms: Antinuclear antibody, Hepatic function abnormal, Hepatitis, Hyperbilirubinaemia, Influenza, Laboratory test abnormal, Vomiting

Life Threatening? Yes
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: mult meds for HIV infect
Current Illness: HIV positive asymptomatic
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: elevated liver nezymes;8.0 biliruben;IGM positive;hep A antibody;
CDC 'Split Type':

Write-up: pt devel flu like sx w/nausea, vomiting dx acute hep A


Changed on 12/24/2020

VAERS ID: 107366 Before After
VAERS Form:1
Age:31.0
Sex:Male
Location:Illinois
Vaccinated:1998-01-09
Onset:1998-01-19
Submitted:1998-02-06
Entered:1998-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / 1 - / -

Administered by: Private      Purchased by: Private
Symptoms: Antinuclear antibody, Hepatic function abnormal, Hepatitis, Hyperbilirubinaemia, Influenza, Laboratory test abnormal, Vomiting

Life Threatening? Yes
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: mult meds for HIV infect
Current Illness: HIV positive asymptomatic
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: elevated liver nezymes;8.0 biliruben;IGM positive;hep A antibody;
CDC 'Split Type':

Write-up: pt devel flu like sx w/nausea, vomiting dx acute hep A


Changed on 12/30/2020

VAERS ID: 107366 Before After
VAERS Form:1
Age:31.0
Sex:Male
Location:Illinois
Vaccinated:1998-01-09
Onset:1998-01-19
Submitted:1998-02-06
Entered:1998-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / 1 - / -

Administered by: Private      Purchased by: Private
Symptoms: Antinuclear antibody, Hepatic function abnormal, Hepatitis, Hyperbilirubinaemia, Influenza, Laboratory test abnormal, Vomiting

Life Threatening? Yes
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: mult meds for HIV infect
Current Illness: HIV positive asymptomatic
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: elevated liver nezymes;8.0 biliruben;IGM positive;hep A antibody;
CDC 'Split Type':

Write-up: pt devel flu like sx w/nausea, vomiting dx acute hep A


Changed on 5/7/2021

VAERS ID: 107366 Before After
VAERS Form:1
Age:31.0
Sex:Male
Location:Illinois
Vaccinated:1998-01-09
Onset:1998-01-19
Submitted:1998-02-06
Entered:1998-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / 1 - / -

Administered by: Private      Purchased by: Private
Symptoms: Antinuclear antibody, Hepatic function abnormal, Hepatitis, Hyperbilirubinaemia, Influenza, Laboratory test abnormal, Vomiting

Life Threatening? Yes
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: mult meds for HIV infect
Current Illness: HIV positive asymptomatic
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: elevated liver nezymes;8.0 biliruben;IGM positive;hep A antibody;
CDC 'Split Type':

Write-up: pt devel flu like sx w/nausea, vomiting dx acute hep A


Changed on 5/21/2021

VAERS ID: 107366 Before After
VAERS Form:1
Age:31.0
Sex:Male
Location:Illinois
Vaccinated:1998-01-09
Onset:1998-01-19
Submitted:1998-02-06
Entered:1998-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / 1 - / -

Administered by: Private      Purchased by: Private
Symptoms: Antinuclear antibody, Hepatic function abnormal, Hepatitis, Hyperbilirubinaemia, Influenza, Laboratory test abnormal, Vomiting

Life Threatening? Yes
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? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: mult meds for HIV infect
Current Illness: HIV positive asymptomatic
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: elevated liver nezymes;8.0 biliruben;IGM positive;hep A antibody;
CDC 'Split Type':

Write-up: pt devel flu like sx w/nausea, vomiting dx acute hep A

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=107366&WAYBACKHISTORY=ON


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