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This is VAERS ID 112051

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History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 112051
VAERS Form:
Age:43.7
Sex:Female
Location:California
Vaccinated:1996-08-05
Onset:1996-08-08
Submitted:1998-06-22
Entered:1998-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: ENGERIX-B / SMITHKLINE 490A6 / 3 LA / -
HEPA: VAQTA / MSD 06010 / 0 LA / -
IPV: POLIOVAX / CONNAUGHT LTD L1108 / 1 LA / -
MMR: MMR DISCONTINUED JUNE 1981 / MSD 01020 / 1 LA / -

Administered by: Private      Purchased by: Unknown
Symptoms: ANOREXIA, ALLERG REACT, ASTHENIA, DIARRHEA, CNS DEPRESS

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: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Allergy to various medications; Herniated disc L3-L4
Allergies:
Diagnostic Lab Data: 11/96 tests taken-all normal
CDC 'Split Type': Allergy to various medications; Herniated disc L3-L4

Write-up: 3 days post vax pt felt fatigue, diff in sitting still;


Changed on 12/8/2009

VAERS ID: 112051 Before After
VAERS Form:
Age:43.7 43.0
Sex:Female
Location:California
Vaccinated:1996-08-05
Onset:1996-08-08
Submitted:1998-06-22
Entered:1998-06-24 1998-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: ENGERIX-B HEP B (ENGERIX-B) / SMITHKLINE SMITHKLINE BEECHAM 490A6 / 3 LA / -
HEPA: VAQTA HEP A (VAQTA) / MSD MERCK & CO. INC. 06010 / 0 LA / -
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. L1108 / 1 LA / -
MMR: MMR DISCONTINUED JUNE 1981 MEASLES + MUMPS + RUBELLA (MMR I) / MSD MERCK & CO. INC. 01020 / 1 LA / -

Administered by: Private Unknown      Purchased by: Unknown
Symptoms: Anorexia, Asthenia, Back pain, Depressed level of consciousness, Diarrhoea, Dizziness, Gastrointestinal haemorrhage, Infection, Laryngospasm, Malaise, Nausea, Nervousness, Oedema peripheral, Pain, Tachycardia, Thinking abnormal, Vasodilatation, ANOREXIA, ALLERG REACT, ASTHENIA, DIARRHEA, CNS DEPRESS

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: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Allergy to various medications; Herniated disc L3-L4
Allergies:
Diagnostic Lab Data: 11/96 tests taken-all normal
CDC 'Split Type': Allergy to various medications; Herniated disc L3-L4 (blank)

Write-up: 3 days post vax pt felt fatigue, diff in sitting still;


Changed on 5/14/2017

VAERS ID: 112051 Before After
VAERS Form:
Age:43.0
Sex:Female
Location:California
Vaccinated:1996-08-05
Onset:1996-08-08
Submitted:1998-06-22
Entered:1998-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 490A6 / 3 LA / -
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 06010 / 0 LA / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. L1108 / 1 LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR I) / MERCK & CO. INC. 01020 / 1 LA / -

Administered by: Unknown Private      Purchased by: Unknown Private
Symptoms: Anorexia, Asthenia, Back pain, Depressed level of consciousness, Diarrhoea, Dizziness, Gastrointestinal haemorrhage, Infection, Laryngospasm, Malaise, Nausea, Nervousness, Oedema peripheral, Pain, Tachycardia, Thinking abnormal, Vasodilatation

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: NONE
Current Illness: NONE
Preexisting Conditions: Allergy to various medications; Herniated disc L3-L4
Allergies:
Diagnostic Lab Data: 11/96 tests taken-all normal
CDC 'Split Type':

Write-up: 3 days post vax pt felt fatigue, diff in sitting still;


Changed on 9/14/2017

VAERS ID: 112051 Before After
VAERS Form:(blank) 1
Age:43.0
Sex:Female
Location:California
Vaccinated:1996-08-05
Onset:1996-08-08
Submitted:1998-06-22
Entered:1998-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 490A6 / 3 4 LA / -
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 06010 / 0 1 LA / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. L1108 / 1 2 LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR I) / MERCK & CO. INC. 01020 / 1 2 LA / -

Administered by: Private      Purchased by: Private
Symptoms: Anorexia, Asthenia, Back pain, Depressed level of consciousness, Diarrhoea, Dizziness, Gastrointestinal haemorrhage, Infection, Laryngospasm, Malaise, Nausea, Nervousness, Oedema peripheral, Pain, Tachycardia, Thinking abnormal, Vasodilatation

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: NONE
Current Illness: NONE
Preexisting Conditions: Allergy to various medications; Herniated disc L3-L4
Allergies:
Diagnostic Lab Data: 11/96 tests taken-all normal
CDC 'Split Type':

Write-up: 3 days post vax pt felt fatigue, diff in sitting still;


Changed on 2/14/2018

VAERS ID: 112051 Before After
VAERS Form:1
Age:43.0
Sex:Female
Location:California
Vaccinated:1996-08-05
Onset:1996-08-08
Submitted:1998-06-22
Entered:1998-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 490A6 / 4 LA / -
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 06010 / 1 LA / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. L1108 / 2 LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR I) / MERCK & CO. INC. 01020 / 2 LA / -

Administered by: Private      Purchased by: Private
Symptoms: Anorexia, Asthenia, Back pain, Depressed level of consciousness, Diarrhoea, Dizziness, Gastrointestinal haemorrhage, Infection, Laryngospasm, Malaise, Nausea, Nervousness, Oedema peripheral, Pain, Tachycardia, Thinking abnormal, Vasodilatation

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: NONE
Current Illness: NONE
Preexisting Conditions: Allergy to various medications; Herniated disc L3-L4
Allergies:
Diagnostic Lab Data: 11/96 tests taken-all normal
CDC 'Split Type':

Write-up: 3 days post vax pt felt fatigue, diff in sitting still;


Changed on 6/14/2018

VAERS ID: 112051 Before After
VAERS Form:1
Age:43.0
Sex:Female
Location:California
Vaccinated:1996-08-05
Onset:1996-08-08
Submitted:1998-06-22
Entered:1998-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 490A6 / 4 LA / -
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 06010 / 1 LA / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. L1108 / 2 LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR I) / MERCK & CO. INC. 01020 / 2 LA / -

Administered by: Private      Purchased by: Private
Symptoms: Anorexia, Asthenia, Back pain, Depressed level of consciousness, Diarrhoea, Dizziness, Gastrointestinal haemorrhage, Infection, Laryngospasm, Malaise, Nausea, Nervousness, Oedema peripheral, Pain, Tachycardia, Thinking abnormal, Vasodilatation

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: NONE
Current Illness: NONE
Preexisting Conditions: Allergy to various medications; Herniated disc L3-L4
Allergies:
Diagnostic Lab Data: 11/96 tests taken-all normal
CDC 'Split Type':

Write-up: 3 days post vax pt felt fatigue, diff in sitting still;


Changed on 8/14/2018

VAERS ID: 112051 Before After
VAERS Form:1
Age:43.0
Sex:Female
Location:California
Vaccinated:1996-08-05
Onset:1996-08-08
Submitted:1998-06-22
Entered:1998-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 490A6 / 4 LA / -
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 06010 / 1 LA / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. L1108 / 2 LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR I) / MERCK & CO. INC. 01020 / 2 LA / -

Administered by: Private      Purchased by: Private
Symptoms: Anorexia, Asthenia, Back pain, Depressed level of consciousness, Diarrhoea, Dizziness, Gastrointestinal haemorrhage, Infection, Laryngospasm, Malaise, Nausea, Nervousness, Oedema peripheral, Pain, Tachycardia, Thinking abnormal, Vasodilatation

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: NONE
Current Illness: NONE
Preexisting Conditions: Allergy to various medications; Herniated disc L3-L4
Allergies:
Diagnostic Lab Data: 11/96 tests taken-all normal
CDC 'Split Type':

Write-up: 3 days post vax pt felt fatigue, diff in sitting still;


Changed on 9/14/2018

VAERS ID: 112051 Before After
VAERS Form:1
Age:43.0
Sex:Female
Location:California
Vaccinated:1996-08-05
Onset:1996-08-08
Submitted:1998-06-22
Entered:1998-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 490A6 / 4 LA / -
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 06010 / 1 LA / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. L1108 / 2 LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR I) / MERCK & CO. INC. 01020 / 2 LA / -

Administered by: Private      Purchased by: Private
Symptoms: Anorexia, Asthenia, Back pain, Depressed level of consciousness, Diarrhoea, Dizziness, Gastrointestinal haemorrhage, Infection, Laryngospasm, Malaise, Nausea, Nervousness, Oedema peripheral, Pain, Tachycardia, Thinking abnormal, Vasodilatation

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: NONE
Current Illness: NONE
Preexisting Conditions: Allergy to various medications; Herniated disc L3-L4
Allergies:
Diagnostic Lab Data: 11/96 tests taken-all normal
CDC 'Split Type':

Write-up: 3 days post vax pt felt fatigue, diff in sitting still;


Changed on 10/14/2018

VAERS ID: 112051 Before After
VAERS Form:1
Age:43.0
Sex:Female
Location:California
Vaccinated:1996-08-05
Onset:1996-08-08
Submitted:1998-06-22
Entered:1998-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 490A6 / 4 LA / -
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 06010 / 1 LA / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. L1108 / 2 LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR I) / MERCK & CO. INC. 01020 / 2 LA / -

Administered by: Private      Purchased by: Private
Symptoms: Anorexia, Asthenia, Back pain, Depressed level of consciousness, Diarrhoea, Dizziness, Gastrointestinal haemorrhage, Infection, Laryngospasm, Malaise, Nausea, Nervousness, Oedema peripheral, Pain, Tachycardia, Thinking abnormal, Vasodilatation

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: NONE
Current Illness: NONE
Preexisting Conditions: Allergy to various medications; Herniated disc L3-L4
Allergies:
Diagnostic Lab Data: 11/96 tests taken-all normal
CDC 'Split Type':

Write-up: 3 days post vax pt felt fatigue, diff in sitting still;


Changed on 12/24/2020

VAERS ID: 112051 Before After
VAERS Form:1
Age:43.0
Sex:Female
Location:California
Vaccinated:1996-08-05
Onset:1996-08-08
Submitted:1998-06-22
Entered:1998-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 490A6 / 4 LA / -
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 06010 / 1 LA / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. L1108 / 2 LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR I) / MERCK & CO. INC. 01020 / 2 LA / -

Administered by: Private      Purchased by: Private
Symptoms: Anorexia, Asthenia, Back pain, Depressed level of consciousness, Diarrhoea, Dizziness, Gastrointestinal haemorrhage, Infection, Laryngospasm, Malaise, Nausea, Nervousness, Oedema peripheral, Pain, Tachycardia, Thinking abnormal, Vasodilatation

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: NONE
Current Illness: NONE
Preexisting Conditions: Allergy to various medications; Herniated disc L3-L4
Allergies:
Diagnostic Lab Data: 11/96 tests taken-all normal
CDC 'Split Type':

Write-up: 3 days post vax pt felt fatigue, diff in sitting still;


Changed on 12/30/2020

VAERS ID: 112051 Before After
VAERS Form:1
Age:43.0
Sex:Female
Location:California
Vaccinated:1996-08-05
Onset:1996-08-08
Submitted:1998-06-22
Entered:1998-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 490A6 / 4 LA / -
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 06010 / 1 LA / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. L1108 / 2 LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR I) / MERCK & CO. INC. 01020 / 2 LA / -

Administered by: Private      Purchased by: Private
Symptoms: Anorexia, Asthenia, Back pain, Depressed level of consciousness, Diarrhoea, Dizziness, Gastrointestinal haemorrhage, Infection, Laryngospasm, Malaise, Nausea, Nervousness, Oedema peripheral, Pain, Tachycardia, Thinking abnormal, Vasodilatation

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: NONE
Current Illness: NONE
Preexisting Conditions: Allergy to various medications; Herniated disc L3-L4
Allergies:
Diagnostic Lab Data: 11/96 tests taken-all normal
CDC 'Split Type':

Write-up: 3 days post vax pt felt fatigue, diff in sitting still;


Changed on 5/7/2021

VAERS ID: 112051 Before After
VAERS Form:1
Age:43.0
Sex:Female
Location:California
Vaccinated:1996-08-05
Onset:1996-08-08
Submitted:1998-06-22
Entered:1998-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 490A6 / 4 LA / -
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 06010 / 1 LA / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. L1108 / 2 LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR I) / MERCK & CO. INC. 01020 / 2 LA / -

Administered by: Private      Purchased by: Private
Symptoms: Anorexia, Asthenia, Back pain, Depressed level of consciousness, Diarrhoea, Dizziness, Gastrointestinal haemorrhage, Infection, Laryngospasm, Malaise, Nausea, Nervousness, Oedema peripheral, Pain, Tachycardia, Thinking abnormal, Vasodilatation

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: NONE
Current Illness: NONE
Preexisting Conditions: Allergy to various medications; Herniated disc L3-L4
Allergies:
Diagnostic Lab Data: 11/96 tests taken-all normal
CDC 'Split Type':

Write-up: 3 days post vax pt felt fatigue, diff in sitting still;


Changed on 5/21/2021

VAERS ID: 112051 Before After
VAERS Form:1
Age:43.0
Sex:Female
Location:California
Vaccinated:1996-08-05
Onset:1996-08-08
Submitted:1998-06-22
Entered:1998-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 490A6 / 4 LA / -
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 06010 / 1 LA / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. L1108 / 2 LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR I) / MERCK & CO. INC. 01020 / 2 LA / -

Administered by: Private      Purchased by: Private
Symptoms: Anorexia, Asthenia, Back pain, Depressed level of consciousness, Diarrhoea, Dizziness, Gastrointestinal haemorrhage, Infection, Laryngospasm, Malaise, Nausea, Nervousness, Oedema peripheral, Pain, Tachycardia, Thinking abnormal, Vasodilatation

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: NONE
Current Illness: NONE
Preexisting Conditions: Allergy to various medications; Herniated disc L3-L4
Allergies:
Diagnostic Lab Data: 11/96 tests taken-all normal
CDC 'Split Type':

Write-up: 3 days post vax pt felt fatigue, diff in sitting still;

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=112051&WAYBACKHISTORY=ON


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