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This is VAERS ID 119050

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History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 119050
VAERS Form:
Age:21.2
Sex:Male
Location:Utah
Vaccinated:1998-11-23
Onset:1998-12-08
Submitted:1999-02-05
Entered:1999-02-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: ENGERIX-B / SMITHKLINE 2703B6 / - - / -
HEPA: VAQTA / MSD 0717H / - - / -
MMR: MMR II / MSD 1007H / - - / -
VARCEL: VARIVAX / MSD 0671H / - - / -

Administered by: Public      Purchased by: Unknown
Symptoms: INFECT, RASH VESIC BULL, KIDNEY FUNC ABNORM, REACT AGGRAV

Life Threatening? Yes
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: 6     Extended hospital stay? No
Previous Vaccinations: UNK
Other Medications: Cellcept, Prednisone, Prograf
Current Illness: UNK
Preexisting Conditions: Immunosuppression, renal transplant
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': Immunosuppression, renal transplant

Write-up: Pt recv vax on 11/23/98; on 12/18/98 pt exp varicella skin lesions in the esophagus & lungs, increased kidney rejection; tx=acyclovir; pt imp 1/12/99


Changed on 12/8/2009

VAERS ID: 119050 Before After
VAERS Form:
Age:21.2
Sex:Male
Location:Utah
Vaccinated:1998-11-23
Onset:1998-12-08
Submitted:1999-02-05
Entered:1999-02-19 1999-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: ENGERIX-B HEP B (ENGERIX-B) / SMITHKLINE SMITHKLINE BEECHAM 2703B6 / - - / -
HEPA: VAQTA HEP A (VAQTA) / MSD MERCK & CO. INC. 0717H / - - / -
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 1007H / - - / -
VARCEL: VARIVAX VARICELLA (VARIVAX) / MSD MERCK & CO. INC. 0671H / - - / -

Administered by: Public      Purchased by: Unknown Public
Symptoms: Condition aggravated, Dermatitis bullous, Infection, Renal impairment, INFECT, RASH VESIC BULL, KIDNEY FUNC ABNORM, REACT AGGRAV

Life Threatening? Yes
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: 6     Extended hospital stay? No
Previous Vaccinations: UNK
Other Medications: Cellcept, Prednisone, Prograf
Current Illness: UNK
Preexisting Conditions: Immunosuppression, renal transplant
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': Immunosuppression, renal transplant WAES98121486

Write-up: Pt recv vax on 11/23/98; on 12/18/98 pt exp varicella skin lesions in the esophagus & lungs, increased kidney rejection; tx=acyclovir; pt imp 1/12/99


Changed on 2/14/2017

VAERS ID: 119050 Before After
VAERS Form:
Age:21.2 21.0
Sex:Male
Location:Utah
Vaccinated:1998-11-23
Onset:1998-12-08
Submitted:1999-02-05
Entered:1999-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2703B6 / - - / -
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0717H / - - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1007H / - - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0671H / - - / -

Administered by: Public      Purchased by: Public
Symptoms: Condition aggravated, Dermatitis bullous, Infection, Renal impairment

Life Threatening? Yes
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: 6     Extended hospital stay? No
Previous Vaccinations: UNK
Other Medications: Cellcept, Prednisone, Prograf
Current Illness: UNK
Preexisting Conditions: Immunosuppression, renal transplant
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES98121486

Write-up: Pt recv vax on 11/23/98; on 12/18/98 pt exp varicella skin lesions in the esophagus & lungs, increased kidney rejection; tx=acyclovir; pt imp 1/12/99


Changed on 5/14/2017

VAERS ID: 119050 Before After
VAERS Form:
Age:21.0
Sex:Male
Location:Utah
Vaccinated:1998-11-23
Onset:1998-12-08
Submitted:1999-02-05
Entered:1999-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2703B6 / - - / -
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0717H / - - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1007H / - - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0671H / - - / -

Administered by: Public      Purchased by: Public
Symptoms: Condition aggravated, Dermatitis bullous, Infection, Renal impairment

Life Threatening? Yes
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: 6     Extended hospital stay? No
Previous Vaccinations: UNK UNK~ ()~~~In patient
Other Medications: Cellcept, Prednisone, Prograf
Current Illness: UNK
Preexisting Conditions: Immunosuppression, renal transplant
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES98121486

Write-up: Pt recv vax on 11/23/98; on 12/18/98 pt exp varicella skin lesions in the esophagus & lungs, increased kidney rejection; tx=acyclovir; pt imp 1/12/99


Changed on 9/14/2017

VAERS ID: 119050 Before After
VAERS Form:(blank) 1
Age:21.0
Sex:Male
Location:Utah
Vaccinated:1998-11-23
Onset:1998-12-08
Submitted:1999-02-05
Entered:1999-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2703B6 / - UNK - / -
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0717H / - UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1007H / - UNK - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0671H / - UNK - / -

Administered by: Public      Purchased by: Public
Symptoms: Condition aggravated, Dermatitis bullous, Infection, Renal impairment

Life Threatening? Yes
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: 6     Extended hospital stay? No
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: Cellcept, Prednisone, Prograf
Current Illness: UNK
Preexisting Conditions: Immunosuppression, renal transplant
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES98121486

Write-up: Pt recv vax on 11/23/98; on 12/18/98 pt exp varicella skin lesions in the esophagus & lungs, increased kidney rejection; tx=acyclovir; pt imp 1/12/99


Changed on 2/14/2018

VAERS ID: 119050 Before After
VAERS Form:1
Age:21.0
Sex:Male
Location:Utah
Vaccinated:1998-11-23
Onset:1998-12-08
Submitted:1999-02-05
Entered:1999-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2703B6 / UNK - / -
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0717H / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1007H / UNK - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0671H / UNK - / -

Administered by: Public      Purchased by: Public
Symptoms: Condition aggravated, Dermatitis bullous, Infection, Renal impairment

Life Threatening? Yes
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: 6     Extended hospital stay? No
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: Cellcept, Prednisone, Prograf
Current Illness: UNK
Preexisting Conditions: Immunosuppression, renal transplant
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES98121486

Write-up: Pt recv vax on 11/23/98; on 12/18/98 pt exp varicella skin lesions in the esophagus & lungs, increased kidney rejection; tx=acyclovir; pt imp 1/12/99


Changed on 6/14/2018

VAERS ID: 119050 Before After
VAERS Form:1
Age:21.0
Sex:Male
Location:Utah
Vaccinated:1998-11-23
Onset:1998-12-08
Submitted:1999-02-05
Entered:1999-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2703B6 / UNK - / -
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0717H / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1007H / UNK - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0671H / UNK - / -

Administered by: Public      Purchased by: Public
Symptoms: Condition aggravated, Dermatitis bullous, Infection, Renal impairment

Life Threatening? Yes
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: 6     Extended hospital stay? No
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: Cellcept, Prednisone, Prograf
Current Illness: UNK
Preexisting Conditions: Immunosuppression, renal transplant
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES98121486

Write-up: Pt recv vax on 11/23/98; on 12/18/98 pt exp varicella skin lesions in the esophagus & lungs, increased kidney rejection; tx=acyclovir; pt imp 1/12/99


Changed on 8/14/2018

VAERS ID: 119050 Before After
VAERS Form:1
Age:21.0
Sex:Male
Location:Utah
Vaccinated:1998-11-23
Onset:1998-12-08
Submitted:1999-02-05
Entered:1999-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2703B6 / UNK - / -
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0717H / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1007H / UNK - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0671H / UNK - / -

Administered by: Public      Purchased by: Public
Symptoms: Condition aggravated, Dermatitis bullous, Infection, Renal impairment

Life Threatening? Yes
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: 6     Extended hospital stay? No
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: Cellcept, Prednisone, Prograf
Current Illness: UNK
Preexisting Conditions: Immunosuppression, renal transplant
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES98121486

Write-up: Pt recv vax on 11/23/98; on 12/18/98 pt exp varicella skin lesions in the esophagus & lungs, increased kidney rejection; tx=acyclovir; pt imp 1/12/99


Changed on 9/14/2018

VAERS ID: 119050 Before After
VAERS Form:1
Age:21.0
Sex:Male
Location:Utah
Vaccinated:1998-11-23
Onset:1998-12-08
Submitted:1999-02-05
Entered:1999-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2703B6 / UNK - / -
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0717H / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1007H / UNK - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0671H / UNK - / -

Administered by: Public      Purchased by: Public
Symptoms: Condition aggravated, Dermatitis bullous, Infection, Renal impairment

Life Threatening? Yes
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: 6     Extended hospital stay? No
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: Cellcept, Prednisone, Prograf
Current Illness: UNK
Preexisting Conditions: Immunosuppression, renal transplant
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES98121486

Write-up: Pt recv vax on 11/23/98; on 12/18/98 pt exp varicella skin lesions in the esophagus & lungs, increased kidney rejection; tx=acyclovir; pt imp 1/12/99


Changed on 10/14/2018

VAERS ID: 119050 Before After
VAERS Form:1
Age:21.0
Sex:Male
Location:Utah
Vaccinated:1998-11-23
Onset:1998-12-08
Submitted:1999-02-05
Entered:1999-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2703B6 / UNK - / -
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0717H / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1007H / UNK - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0671H / UNK - / -

Administered by: Public      Purchased by: Public
Symptoms: Condition aggravated, Dermatitis bullous, Infection, Renal impairment

Life Threatening? Yes
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: 6     Extended hospital stay? No
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: Cellcept, Prednisone, Prograf
Current Illness: UNK
Preexisting Conditions: Immunosuppression, renal transplant
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES98121486

Write-up: Pt recv vax on 11/23/98; on 12/18/98 pt exp varicella skin lesions in the esophagus & lungs, increased kidney rejection; tx=acyclovir; pt imp 1/12/99


Changed on 12/24/2020

VAERS ID: 119050 Before After
VAERS Form:1
Age:21.0
Sex:Male
Location:Utah
Vaccinated:1998-11-23
Onset:1998-12-08
Submitted:1999-02-05
Entered:1999-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2703B6 / UNK - / -
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0717H / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1007H / UNK - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0671H / UNK - / -

Administered by: Public      Purchased by: Public
Symptoms: Condition aggravated, Dermatitis bullous, Infection, Renal impairment

Life Threatening? Yes
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: 6     Extended hospital stay? No
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: Cellcept, Prednisone, Prograf
Current Illness: UNK
Preexisting Conditions: Immunosuppression, renal transplant
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES98121486

Write-up: Pt recv vax on 11/23/98; on 12/18/98 pt exp varicella skin lesions in the esophagus & lungs, increased kidney rejection; tx=acyclovir; pt imp 1/12/99


Changed on 12/30/2020

VAERS ID: 119050 Before After
VAERS Form:1
Age:21.0
Sex:Male
Location:Utah
Vaccinated:1998-11-23
Onset:1998-12-08
Submitted:1999-02-05
Entered:1999-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2703B6 / UNK - / -
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0717H / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1007H / UNK - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0671H / UNK - / -

Administered by: Public      Purchased by: Public
Symptoms: Condition aggravated, Dermatitis bullous, Infection, Renal impairment

Life Threatening? Yes
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: 6     Extended hospital stay? No
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: Cellcept, Prednisone, Prograf
Current Illness: UNK
Preexisting Conditions: Immunosuppression, renal transplant
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES98121486

Write-up: Pt recv vax on 11/23/98; on 12/18/98 pt exp varicella skin lesions in the esophagus & lungs, increased kidney rejection; tx=acyclovir; pt imp 1/12/99


Changed on 5/7/2021

VAERS ID: 119050 Before After
VAERS Form:1
Age:21.0
Sex:Male
Location:Utah
Vaccinated:1998-11-23
Onset:1998-12-08
Submitted:1999-02-05
Entered:1999-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2703B6 / UNK - / -
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0717H / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1007H / UNK - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0671H / UNK - / -

Administered by: Public      Purchased by: Public
Symptoms: Condition aggravated, Dermatitis bullous, Infection, Renal impairment

Life Threatening? Yes
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: 6     Extended hospital stay? No
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: Cellcept, Prednisone, Prograf
Current Illness: UNK
Preexisting Conditions: Immunosuppression, renal transplant
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES98121486

Write-up: Pt recv vax on 11/23/98; on 12/18/98 pt exp varicella skin lesions in the esophagus & lungs, increased kidney rejection; tx=acyclovir; pt imp 1/12/99


Changed on 5/21/2021

VAERS ID: 119050 Before After
VAERS Form:1
Age:21.0
Sex:Male
Location:Utah
Vaccinated:1998-11-23
Onset:1998-12-08
Submitted:1999-02-05
Entered:1999-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2703B6 / UNK - / -
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0717H / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1007H / UNK - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0671H / UNK - / -

Administered by: Public      Purchased by: Public
Symptoms: Condition aggravated, Dermatitis bullous, Infection, Renal impairment

Life Threatening? Yes
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: 6     Extended hospital stay? No
Previous Vaccinations: UNK~ ()~~~In patient
Other Medications: Cellcept, Prednisone, Prograf
Current Illness: UNK
Preexisting Conditions: Immunosuppression, renal transplant
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES98121486

Write-up: Pt recv vax on 11/23/98; on 12/18/98 pt exp varicella skin lesions in the esophagus & lungs, increased kidney rejection; tx=acyclovir; pt imp 1/12/99

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