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This is VAERS ID 108704

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History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 108704
VAERS Form:
Age:40.0
Sex:Male
Location:New York
Vaccinated:1996-09-26
Onset:1996-09-26
Submitted:1998-03-17
Entered:1998-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HAVRIX / SMITHKLINE - / 0 - / -

Administered by: Private      Purchased by: Unknown
Symptoms: DIZZINESS, TWITCH, EYE DIS

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: blood factor V deficienty, prosthetic aortic heart valve
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recv vax 26SEP96 & immed p/vax devel eye quivering & also became dizzy;other people recv vax @ the same time as pt & did not exp these sx;


Changed on 12/8/2009

VAERS ID: 108704 Before After
VAERS Form:
Age:40.0
Sex:Male
Location:New York
Vaccinated:1996-09-26
Onset:1996-09-26
Submitted:1998-03-17
Entered:1998-03-20 1998-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HAVRIX HEP A (HAVRIX) / SMITHKLINE SMITHKLINE BEECHAM - / 0 - / -

Administered by: Private      Purchased by: Unknown Private
Symptoms: Dizziness, Eye disorder, Muscle twitching, DIZZINESS, TWITCH, EYE DIS

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: blood factor V deficienty, prosthetic aortic heart valve
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) 19980039171A

Write-up: pt recv vax 26SEP96 & immed p/vax devel eye quivering & also became dizzy;other people recv vax @ the same time as pt & did not exp these sx;


Changed on 5/14/2017

VAERS ID: 108704 Before After
VAERS Form:
Age:40.0
Sex:Male
Location:New York
Vaccinated:1996-09-26
Onset:1996-09-26
Submitted:1998-03-17
Entered:1998-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / 0 - / -

Administered by: Private      Purchased by: Private
Symptoms: Dizziness, Eye disorder, Muscle twitching

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: blood factor V deficienty, prosthetic aortic heart valve
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 19980039171A

Write-up: pt recv vax 26SEP96 & immed p/vax devel eye quivering & also became dizzy;other people recv vax @ the same time as pt & did not exp these sx;


Changed on 9/14/2017

VAERS ID: 108704 Before After
VAERS Form:(blank) 1
Age:40.0
Sex:Male
Location:New York
Vaccinated:1996-09-26
Onset:1996-09-26
Submitted:1998-03-17
Entered:1998-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / 0 1 - / -

Administered by: Private      Purchased by: Private
Symptoms: Dizziness, Eye disorder, Muscle twitching

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: blood factor V deficienty, prosthetic aortic heart valve
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 19980039171A

Write-up: pt recv vax 26SEP96 & immed p/vax devel eye quivering & also became dizzy;other people recv vax @ the same time as pt & did not exp these sx;


Changed on 2/14/2018

VAERS ID: 108704 Before After
VAERS Form:1
Age:40.0
Sex:Male
Location:New York
Vaccinated:1996-09-26
Onset:1996-09-26
Submitted:1998-03-17
Entered:1998-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / 1 - / -

Administered by: Private      Purchased by: Private
Symptoms: Dizziness, Eye disorder, Muscle twitching

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: blood factor V deficienty, prosthetic aortic heart valve
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 19980039171A

Write-up: pt recv vax 26SEP96 & immed p/vax devel eye quivering & also became dizzy;other people recv vax @ the same time as pt & did not exp these sx;


Changed on 6/14/2018

VAERS ID: 108704 Before After
VAERS Form:1
Age:40.0
Sex:Male
Location:New York
Vaccinated:1996-09-26
Onset:1996-09-26
Submitted:1998-03-17
Entered:1998-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / 1 - / -

Administered by: Private      Purchased by: Private
Symptoms: Dizziness, Eye disorder, Muscle twitching

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: blood factor V deficienty, prosthetic aortic heart valve
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 19980039171A

Write-up: pt recv vax 26SEP96 & immed p/vax devel eye quivering & also became dizzy;other people recv vax @ the same time as pt & did not exp these sx;


Changed on 8/14/2018

VAERS ID: 108704 Before After
VAERS Form:1
Age:40.0
Sex:Male
Location:New York
Vaccinated:1996-09-26
Onset:1996-09-26
Submitted:1998-03-17
Entered:1998-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / 1 - / -

Administered by: Private      Purchased by: Private
Symptoms: Dizziness, Eye disorder, Muscle twitching

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: blood factor V deficienty, prosthetic aortic heart valve
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 19980039171A

Write-up: pt recv vax 26SEP96 & immed p/vax devel eye quivering & also became dizzy;other people recv vax @ the same time as pt & did not exp these sx;


Changed on 9/14/2018

VAERS ID: 108704 Before After
VAERS Form:1
Age:40.0
Sex:Male
Location:New York
Vaccinated:1996-09-26
Onset:1996-09-26
Submitted:1998-03-17
Entered:1998-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / 1 - / -

Administered by: Private      Purchased by: Private
Symptoms: Dizziness, Eye disorder, Muscle twitching

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: blood factor V deficienty, prosthetic aortic heart valve
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 19980039171A

Write-up: pt recv vax 26SEP96 & immed p/vax devel eye quivering & also became dizzy;other people recv vax @ the same time as pt & did not exp these sx;


Changed on 10/14/2018

VAERS ID: 108704 Before After
VAERS Form:1
Age:40.0
Sex:Male
Location:New York
Vaccinated:1996-09-26
Onset:1996-09-26
Submitted:1998-03-17
Entered:1998-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / 1 - / -

Administered by: Private      Purchased by: Private
Symptoms: Dizziness, Eye disorder, Muscle twitching

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: blood factor V deficienty, prosthetic aortic heart valve
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 19980039171A

Write-up: pt recv vax 26SEP96 & immed p/vax devel eye quivering & also became dizzy;other people recv vax @ the same time as pt & did not exp these sx;


Changed on 12/24/2020

VAERS ID: 108704 Before After
VAERS Form:1
Age:40.0
Sex:Male
Location:New York
Vaccinated:1996-09-26
Onset:1996-09-26
Submitted:1998-03-17
Entered:1998-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / 1 - / -

Administered by: Private      Purchased by: Private
Symptoms: Dizziness, Eye disorder, Muscle twitching

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: blood factor V deficienty, prosthetic aortic heart valve
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 19980039171A

Write-up: pt recv vax 26SEP96 & immed p/vax devel eye quivering & also became dizzy;other people recv vax @ the same time as pt & did not exp these sx;


Changed on 12/30/2020

VAERS ID: 108704 Before After
VAERS Form:1
Age:40.0
Sex:Male
Location:New York
Vaccinated:1996-09-26
Onset:1996-09-26
Submitted:1998-03-17
Entered:1998-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / 1 - / -

Administered by: Private      Purchased by: Private
Symptoms: Dizziness, Eye disorder, Muscle twitching

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: blood factor V deficienty, prosthetic aortic heart valve
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 19980039171A

Write-up: pt recv vax 26SEP96 & immed p/vax devel eye quivering & also became dizzy;other people recv vax @ the same time as pt & did not exp these sx;


Changed on 5/7/2021

VAERS ID: 108704 Before After
VAERS Form:1
Age:40.0
Sex:Male
Location:New York
Vaccinated:1996-09-26
Onset:1996-09-26
Submitted:1998-03-17
Entered:1998-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / 1 - / -

Administered by: Private      Purchased by: Private
Symptoms: Dizziness, Eye disorder, Muscle twitching

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: blood factor V deficienty, prosthetic aortic heart valve
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 19980039171A

Write-up: pt recv vax 26SEP96 & immed p/vax devel eye quivering & also became dizzy;other people recv vax @ the same time as pt & did not exp these sx;


Changed on 5/21/2021

VAERS ID: 108704 Before After
VAERS Form:1
Age:40.0
Sex:Male
Location:New York
Vaccinated:1996-09-26
Onset:1996-09-26
Submitted:1998-03-17
Entered:1998-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / 1 - / -

Administered by: Private      Purchased by: Private
Symptoms: Dizziness, Eye disorder, Muscle twitching

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: blood factor V deficienty, prosthetic aortic heart valve
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 19980039171A

Write-up: pt recv vax 26SEP96 & immed p/vax devel eye quivering & also became dizzy;other people recv vax @ the same time as pt & did not exp these sx;

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=108704&WAYBACKHISTORY=ON


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