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This is VAERS ID 115471

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History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 115471
VAERS Form:
Age:50.4
Sex:Female
Location:Alabama
Vaccinated:1998-09-11
Onset:1998-09-21
Submitted:1998-10-01
Entered:1998-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HAVRIX / SMITHKLINE VHAS84A4 / - RA / IM
TYP: TYPHOID VI / CONNAUGHT LABS PO3232 / - RA / IM
YF: YELLOW FEVER / CONNAUGHT LABS 0960540 / - RA / SC

Administered by: Public      Purchased by: Unknown
Symptoms: GUILLAIN BARRE SYND

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: lt mastectomy
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt dx of GBS onset 10 days p/vax per MD;


Changed on 12/8/2009

VAERS ID: 115471 Before After
VAERS Form:
Age:50.4 50.0
Sex:Female
Location:Alabama
Vaccinated:1998-09-11
Onset:1998-09-21
Submitted:1998-10-01
Entered:1998-11-02 1998-10-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HAVRIX HEP A (HAVRIX) / SMITHKLINE SMITHKLINE BEECHAM VHAS84A4 84A4 / - RA / IM
TYP: TYPHOID VI TYPHOID VI POLYSACCHARIDE (TYPHIM VI) / CONNAUGHT LABS CONNAUGHT LABORATORIES PO3232 / - RA / IM
YF: YELLOW FEVER YELLOW FEVER (YF-VAX) / CONNAUGHT LABS CONNAUGHT LABORATORIES 0960540 / - RA / SC

Administered by: Public Unknown      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome, GUILLAIN BARRE SYND

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: lt mastectomy
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) AL9812

Write-up: pt dx of GBS onset 10 days p/vax per MD;


Changed on 9/14/2017

VAERS ID: 115471 Before After
VAERS Form:(blank) 1
Age:50.0
Sex:Female
Location:Alabama
Vaccinated:1998-09-11
Onset:1998-09-21
Submitted:1998-10-01
Entered:1998-10-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 84A4 / - UNK RA / IM
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI) / CONNAUGHT LABORATORIES PO3232 / - UNK RA / IM
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES 0960540 / - UNK RA / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: lt mastectomy
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': AL9812

Write-up: pt dx of GBS onset 10 days p/vax per MD;


Changed on 2/14/2018

VAERS ID: 115471 Before After
VAERS Form:1
Age:50.0
Sex:Female
Location:Alabama
Vaccinated:1998-09-11
Onset:1998-09-21
Submitted:1998-10-01
Entered:1998-10-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 84A4 / UNK RA / IM
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI) / CONNAUGHT LABORATORIES PO3232 / UNK RA / IM
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES 0960540 / UNK RA / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: lt mastectomy
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': AL9812

Write-up: pt dx of GBS onset 10 days p/vax per MD;


Changed on 6/14/2018

VAERS ID: 115471 Before After
VAERS Form:1
Age:50.0
Sex:Female
Location:Alabama
Vaccinated:1998-09-11
Onset:1998-09-21
Submitted:1998-10-01
Entered:1998-10-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 84A4 / UNK RA / IM
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI) / CONNAUGHT LABORATORIES PO3232 / UNK RA / IM
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES 0960540 / UNK RA / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: lt mastectomy
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': AL9812

Write-up: pt dx of GBS onset 10 days p/vax per MD;


Changed on 8/14/2018

VAERS ID: 115471 Before After
VAERS Form:1
Age:50.0
Sex:Female
Location:Alabama
Vaccinated:1998-09-11
Onset:1998-09-21
Submitted:1998-10-01
Entered:1998-10-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 84A4 / UNK RA / IM
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI) / CONNAUGHT LABORATORIES PO3232 / UNK RA / IM
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES 0960540 / UNK RA / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: lt mastectomy
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': AL9812

Write-up: pt dx of GBS onset 10 days p/vax per MD;


Changed on 9/14/2018

VAERS ID: 115471 Before After
VAERS Form:1
Age:50.0
Sex:Female
Location:Alabama
Vaccinated:1998-09-11
Onset:1998-09-21
Submitted:1998-10-01
Entered:1998-10-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 84A4 / UNK RA / IM
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI) / CONNAUGHT LABORATORIES PO3232 / UNK RA / IM
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES 0960540 / UNK RA / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: lt mastectomy
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': AL9812

Write-up: pt dx of GBS onset 10 days p/vax per MD;


Changed on 10/14/2018

VAERS ID: 115471 Before After
VAERS Form:1
Age:50.0
Sex:Female
Location:Alabama
Vaccinated:1998-09-11
Onset:1998-09-21
Submitted:1998-10-01
Entered:1998-10-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 84A4 / UNK RA / IM
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI) / CONNAUGHT LABORATORIES PO3232 / UNK RA / IM
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES 0960540 / UNK RA / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: lt mastectomy
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': AL9812

Write-up: pt dx of GBS onset 10 days p/vax per MD;


Changed on 12/24/2020

VAERS ID: 115471 Before After
VAERS Form:1
Age:50.0
Sex:Female
Location:Alabama
Vaccinated:1998-09-11
Onset:1998-09-21
Submitted:1998-10-01
Entered:1998-10-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 84A4 / UNK RA / IM
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI) / CONNAUGHT LABORATORIES PO3232 / UNK RA / IM
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES 0960540 / UNK RA / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: lt mastectomy
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': AL9812

Write-up: pt dx of GBS onset 10 days p/vax per MD;


Changed on 12/30/2020

VAERS ID: 115471 Before After
VAERS Form:1
Age:50.0
Sex:Female
Location:Alabama
Vaccinated:1998-09-11
Onset:1998-09-21
Submitted:1998-10-01
Entered:1998-10-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 84A4 / UNK RA / IM
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI) / CONNAUGHT LABORATORIES PO3232 / UNK RA / IM
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES 0960540 / UNK RA / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: lt mastectomy
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': AL9812

Write-up: pt dx of GBS onset 10 days p/vax per MD;


Changed on 5/7/2021

VAERS ID: 115471 Before After
VAERS Form:1
Age:50.0
Sex:Female
Location:Alabama
Vaccinated:1998-09-11
Onset:1998-09-21
Submitted:1998-10-01
Entered:1998-10-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 84A4 / UNK RA / IM
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI) / CONNAUGHT LABORATORIES PO3232 / UNK RA / IM
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES 0960540 / UNK RA / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: lt mastectomy
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': AL9812

Write-up: pt dx of GBS onset 10 days p/vax per MD;


Changed on 5/21/2021

VAERS ID: 115471 Before After
VAERS Form:1
Age:50.0
Sex:Female
Location:Alabama
Vaccinated:1998-09-11
Onset:1998-09-21
Submitted:1998-10-01
Entered:1998-10-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 84A4 / UNK RA / IM
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI) / CONNAUGHT LABORATORIES PO3232 / UNK RA / IM
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES 0960540 / UNK RA / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Guillain-Barre syndrome

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: lt mastectomy
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': AL9812

Write-up: pt dx of GBS onset 10 days p/vax per MD;

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