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This is VAERS ID 120523

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History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 120523
VAERS Form:
Age:36.1
Sex:Male
Location:Ohio
Vaccinated:1997-06-18
Onset:1997-06-22
Submitted:1999-03-18
Entered:1999-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: ENGERIX-B / SMITHKLINE 2186A4 / 0 LA / IM
HEPA: HAVRIX / SMITHKLINE 539A6 / 0 RA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: HEADACHE, ARTHRALGIA, EYE DIS, IMMUNE SYSTEM DIS, BLOOD DYSCRASIA

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: sore throat-didn''t feel well
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: abnormally low blood complement levels-indicates autoimmune disorder
CDC 'Split Type':

Write-up: initial onset w/in days of vax: severe h/a, severe joint & muscle pain, noc sweats, rash, numbness in limbs, eye problems, abd pain; Per follow-up dated 9/18/00, the pt states he developed a autoimmune disorder as a result of the vaccine. The same symptom"s that were recorded earlier continue to wax and wane in severity. He also developed cancer that the doctors suspect is related to this vaccine induced illness.


Changed on 12/8/2009

VAERS ID: 120523 Before After
VAERS Form:
Age:36.1
Sex:Male
Location:Ohio
Vaccinated:1997-06-18
Onset:1997-06-22
Submitted:1999-03-18
Entered:1999-03-26 1999-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: ENGERIX-B HEP B (ENGERIX-B) / SMITHKLINE SMITHKLINE BEECHAM 2186A4 / 0 LA / IM
HEPA: HAVRIX HEP A (HAVRIX) / SMITHKLINE SMITHKLINE BEECHAM 539A6 / 0 RA / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Abdominal pain, Arthralgia, Eye disorder, Headache, Hyperhidrosis, Immune system disorder, Myalgia, Paraesthesia, Rash, Blood disorder, HEADACHE, ARTHRALGIA, EYE DIS, IMMUNE SYSTEM DIS, BLOOD DYSCRASIA

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: sore throat-didn''t feel well
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: abnormally low blood complement levels-indicates autoimmune disorder
CDC 'Split Type':

Write-up: initial onset w/in days of vax: severe h/a, severe joint & muscle pain, noc sweats, rash, numbness in limbs, eye problems, abd pain; Per follow-up dated 9/18/00, the pt states he developed a autoimmune disorder as a result of the vaccine. The same symptom"s symptoms that were recorded earlier continue to wax and wane in severity. He also developed cancer that the doctors suspect is related to this vaccine induced illness.


Changed on 2/14/2017

VAERS ID: 120523 Before After
VAERS Form:
Age:36.1 36.0
Sex:Male
Location:Ohio
Vaccinated:1997-06-18
Onset:1997-06-22
Submitted:1999-03-18
Entered:1999-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2186A4 / 0 LA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 539A6 / 0 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Arthralgia, Eye disorder, Headache, Hyperhidrosis, Immune system disorder, Myalgia, Paraesthesia, Rash, Blood disorder

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: sore throat-didn''t feel well
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: abnormally low blood complement levels-indicates autoimmune disorder
CDC 'Split Type':

Write-up: initial onset w/in days of vax: severe h/a, severe joint & muscle pain, noc sweats, rash, numbness in limbs, eye problems, abd pain; Per follow-up dated 9/18/00, the pt states he developed a autoimmune disorder as a result of the vaccine. The same symptoms that were recorded earlier continue to wax and wane in severity. He also developed cancer that the doctors suspect is related to this vaccine induced illness.


Changed on 5/14/2017

VAERS ID: 120523 Before After
VAERS Form:
Age:36.0
Sex:Male
Location:Ohio
Vaccinated:1997-06-18
Onset:1997-06-22
Submitted:1999-03-18
Entered:1999-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2186A4 / 0 LA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 539A6 / 0 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Arthralgia, Eye disorder, Headache, Hyperhidrosis, Immune system disorder, Myalgia, Paraesthesia, Rash, Blood disorder

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: sore throat-didn''t feel well
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: abnormally low blood complement levels-indicates autoimmune disorder
CDC 'Split Type':

Write-up: initial onset w/in days of vax: severe h/a, severe joint & muscle pain, noc sweats, rash, numbness in limbs, eye problems, abd pain; Per follow-up dated 9/18/00, the pt states he developed a autoimmune disorder as a result of the vaccine. The same symptoms that were recorded earlier continue to wax and wane in severity. He also developed cancer that the doctors suspect is related to this vaccine induced illness. illness.Annual follow-up received on 09/18/00 provides no additional data.


Changed on 9/14/2017

VAERS ID: 120523 Before After
VAERS Form:(blank) 1
Age:36.0
Sex:Male
Location:Ohio
Vaccinated:1997-06-18
Onset:1997-06-22
Submitted:1999-03-18
Entered:1999-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2186A4 / 0 1 LA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 539A6 / 0 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Arthralgia, Eye disorder, Headache, Hyperhidrosis, Immune system disorder, Myalgia, Paraesthesia, Rash, Blood disorder

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: sore throat-didn''t feel well
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: abnormally low blood complement levels-indicates autoimmune disorder
CDC 'Split Type':

Write-up: initial onset w/in days of vax: severe h/a, severe joint & muscle pain, noc sweats, rash, numbness in limbs, eye problems, abd pain; Per follow-up dated 9/18/00, the pt states he developed a autoimmune disorder as a result of the vaccine. The same symptoms that were recorded earlier continue to wax and wane in severity. He also developed cancer that the doctors suspect is related to this vaccine induced illness.Annual follow-up received on 09/18/00 provides no additional data.


Changed on 2/14/2018

VAERS ID: 120523 Before After
VAERS Form:1
Age:36.0
Sex:Male
Location:Ohio
Vaccinated:1997-06-18
Onset:1997-06-22
Submitted:1999-03-18
Entered:1999-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2186A4 / 1 LA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 539A6 / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Arthralgia, Eye disorder, Headache, Hyperhidrosis, Immune system disorder, Myalgia, Paraesthesia, Rash, Blood disorder

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: sore throat-didn''t feel well
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: abnormally low blood complement levels-indicates autoimmune disorder
CDC 'Split Type':

Write-up: initial onset w/in days of vax: severe h/a, severe joint & muscle pain, noc sweats, rash, numbness in limbs, eye problems, abd pain; Per follow-up dated 9/18/00, the pt states he developed a autoimmune disorder as a result of the vaccine. The same symptoms that were recorded earlier continue to wax and wane in severity. He also developed cancer that the doctors suspect is related to this vaccine induced illness.Annual follow-up received on 09/18/00 provides no additional data.


Changed on 6/14/2018

VAERS ID: 120523 Before After
VAERS Form:1
Age:36.0
Sex:Male
Location:Ohio
Vaccinated:1997-06-18
Onset:1997-06-22
Submitted:1999-03-18
Entered:1999-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2186A4 / 1 LA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 539A6 / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Arthralgia, Eye disorder, Headache, Hyperhidrosis, Immune system disorder, Myalgia, Paraesthesia, Rash, Blood disorder

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: sore throat-didn''t feel well
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: abnormally low blood complement levels-indicates autoimmune disorder
CDC 'Split Type':

Write-up: initial onset w/in days of vax: severe h/a, severe joint & muscle pain, noc sweats, rash, numbness in limbs, eye problems, abd pain; Per follow-up dated 9/18/00, the pt states he developed a autoimmune disorder as a result of the vaccine. The same symptoms that were recorded earlier continue to wax and wane in severity. He also developed cancer that the doctors suspect is related to this vaccine induced illness.Annual follow-up received on 09/18/00 provides no additional data.


Changed on 8/14/2018

VAERS ID: 120523 Before After
VAERS Form:1
Age:36.0
Sex:Male
Location:Ohio
Vaccinated:1997-06-18
Onset:1997-06-22
Submitted:1999-03-18
Entered:1999-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2186A4 / 1 LA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 539A6 / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Arthralgia, Eye disorder, Headache, Hyperhidrosis, Immune system disorder, Myalgia, Paraesthesia, Rash, Blood disorder

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: sore throat-didn''t feel well
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: abnormally low blood complement levels-indicates autoimmune disorder
CDC 'Split Type':

Write-up: initial onset w/in days of vax: severe h/a, severe joint & muscle pain, noc sweats, rash, numbness in limbs, eye problems, abd pain; Per follow-up dated 9/18/00, the pt states he developed a autoimmune disorder as a result of the vaccine. The same symptoms that were recorded earlier continue to wax and wane in severity. He also developed cancer that the doctors suspect is related to this vaccine induced illness.Annual follow-up received on 09/18/00 provides no additional data.


Changed on 9/14/2018

VAERS ID: 120523 Before After
VAERS Form:1
Age:36.0
Sex:Male
Location:Ohio
Vaccinated:1997-06-18
Onset:1997-06-22
Submitted:1999-03-18
Entered:1999-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2186A4 / 1 LA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 539A6 / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Arthralgia, Eye disorder, Headache, Hyperhidrosis, Immune system disorder, Myalgia, Paraesthesia, Rash, Blood disorder

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: sore throat-didn''t feel well
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: abnormally low blood complement levels-indicates autoimmune disorder
CDC 'Split Type':

Write-up: initial onset w/in days of vax: severe h/a, severe joint & muscle pain, noc sweats, rash, numbness in limbs, eye problems, abd pain; Per follow-up dated 9/18/00, the pt states he developed a autoimmune disorder as a result of the vaccine. The same symptoms that were recorded earlier continue to wax and wane in severity. He also developed cancer that the doctors suspect is related to this vaccine induced illness.Annual follow-up received on 09/18/00 provides no additional data.


Changed on 10/14/2018

VAERS ID: 120523 Before After
VAERS Form:1
Age:36.0
Sex:Male
Location:Ohio
Vaccinated:1997-06-18
Onset:1997-06-22
Submitted:1999-03-18
Entered:1999-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2186A4 / 1 LA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 539A6 / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Arthralgia, Eye disorder, Headache, Hyperhidrosis, Immune system disorder, Myalgia, Paraesthesia, Rash, Blood disorder

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: sore throat-didn''t feel well
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: abnormally low blood complement levels-indicates autoimmune disorder
CDC 'Split Type':

Write-up: initial onset w/in days of vax: severe h/a, severe joint & muscle pain, noc sweats, rash, numbness in limbs, eye problems, abd pain; Per follow-up dated 9/18/00, the pt states he developed a autoimmune disorder as a result of the vaccine. The same symptoms that were recorded earlier continue to wax and wane in severity. He also developed cancer that the doctors suspect is related to this vaccine induced illness.Annual follow-up received on 09/18/00 provides no additional data.


Changed on 12/24/2020

VAERS ID: 120523 Before After
VAERS Form:1
Age:36.0
Sex:Male
Location:Ohio
Vaccinated:1997-06-18
Onset:1997-06-22
Submitted:1999-03-18
Entered:1999-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2186A4 / 1 LA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 539A6 / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Arthralgia, Eye disorder, Headache, Hyperhidrosis, Immune system disorder, Myalgia, Paraesthesia, Rash, Blood disorder

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: sore throat-didn''t feel well
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: abnormally low blood complement levels-indicates autoimmune disorder
CDC 'Split Type':

Write-up: initial onset w/in days of vax: severe h/a, severe joint & muscle pain, noc sweats, rash, numbness in limbs, eye problems, abd pain; Per follow-up dated 9/18/00, the pt states he developed a autoimmune disorder as a result of the vaccine. The same symptoms that were recorded earlier continue to wax and wane in severity. He also developed cancer that the doctors suspect is related to this vaccine induced illness.Annual follow-up received on 09/18/00 provides no additional data.


Changed on 12/30/2020

VAERS ID: 120523 Before After
VAERS Form:1
Age:36.0
Sex:Male
Location:Ohio
Vaccinated:1997-06-18
Onset:1997-06-22
Submitted:1999-03-18
Entered:1999-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2186A4 / 1 LA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 539A6 / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Arthralgia, Eye disorder, Headache, Hyperhidrosis, Immune system disorder, Myalgia, Paraesthesia, Rash, Blood disorder

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: sore throat-didn''t feel well
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: abnormally low blood complement levels-indicates autoimmune disorder
CDC 'Split Type':

Write-up: initial onset w/in days of vax: severe h/a, severe joint & muscle pain, noc sweats, rash, numbness in limbs, eye problems, abd pain; Per follow-up dated 9/18/00, the pt states he developed a autoimmune disorder as a result of the vaccine. The same symptoms that were recorded earlier continue to wax and wane in severity. He also developed cancer that the doctors suspect is related to this vaccine induced illness.Annual follow-up received on 09/18/00 provides no additional data.


Changed on 5/7/2021

VAERS ID: 120523 Before After
VAERS Form:1
Age:36.0
Sex:Male
Location:Ohio
Vaccinated:1997-06-18
Onset:1997-06-22
Submitted:1999-03-18
Entered:1999-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2186A4 / 1 LA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 539A6 / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Arthralgia, Eye disorder, Headache, Hyperhidrosis, Immune system disorder, Myalgia, Paraesthesia, Rash, Blood disorder

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: sore throat-didn''t feel well
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: abnormally low blood complement levels-indicates autoimmune disorder
CDC 'Split Type':

Write-up: initial onset w/in days of vax: severe h/a, severe joint & muscle pain, noc sweats, rash, numbness in limbs, eye problems, abd pain; Per follow-up dated 9/18/00, the pt states he developed a autoimmune disorder as a result of the vaccine. The same symptoms that were recorded earlier continue to wax and wane in severity. He also developed cancer that the doctors suspect is related to this vaccine induced illness.Annual follow-up received on 09/18/00 provides no additional data.


Changed on 5/21/2021

VAERS ID: 120523 Before After
VAERS Form:1
Age:36.0
Sex:Male
Location:Ohio
Vaccinated:1997-06-18
Onset:1997-06-22
Submitted:1999-03-18
Entered:1999-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2186A4 / 1 LA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 539A6 / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Arthralgia, Eye disorder, Headache, Hyperhidrosis, Immune system disorder, Myalgia, Paraesthesia, Rash, Blood disorder

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: sore throat-didn''t feel well
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: abnormally low blood complement levels-indicates autoimmune disorder
CDC 'Split Type':

Write-up: initial onset w/in days of vax: severe h/a, severe joint & muscle pain, noc sweats, rash, numbness in limbs, eye problems, abd pain; Per follow-up dated 9/18/00, the pt states he developed a autoimmune disorder as a result of the vaccine. The same symptoms that were recorded earlier continue to wax and wane in severity. He also developed cancer that the doctors suspect is related to this vaccine induced illness.Annual follow-up received on 09/18/00 provides no additional data.

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