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This is VAERS ID 121246

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History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 121246
VAERS Form:
Age:48.9
Sex:Male
Location:Texas
Vaccinated:1999-03-07
Onset:1999-03-28
Submitted:1999-04-10
Entered:1999-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HAVRIX / SMITHKLINE VHA568A6 / - LA / IM

Administered by: Other      Purchased by: Unknown
Symptoms: DYSPNEA, ASTHENIA, JAUNDICE, ANEMIA HEMOL, RBC ABNORM

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 11     Extended hospital stay? No
Previous Vaccinations: NA
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: multiple blood test;CT Scans;Bone marrow test;
CDC 'Split Type': NONE

Write-up: pt exp fatigue initially w/SOB which progressively worsened;saw personal MD on 30MAR99 & hosp until 9APR99;dx w/acute hemolytic anemia & cold agglutinin;pt required 9 units of blood;seen & treated by 4 hematologists


Changed on 12/8/2009

VAERS ID: 121246 Before After
VAERS Form:
Age:48.9 48.0
Sex:Male
Location:Texas
Vaccinated:1999-03-07
Onset:1999-03-28
Submitted:1999-04-10
Entered:1999-04-16 1999-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HAVRIX HEP A (HAVRIX) / SMITHKLINE SMITHKLINE BEECHAM VHA568A6 568A6 / - LA / IM

Administered by: Other Unknown      Purchased by: Unknown
Symptoms: Asthenia, Dyspnoea, Haemolytic anaemia, Jaundice, Peripheral vascular disorder, Red blood cell abnormality, DYSPNEA, ASTHENIA, JAUNDICE, ANEMIA HEMOL, RBC ABNORM

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 11     Extended hospital stay? No
Previous Vaccinations: NA
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: multiple blood test;CT Scans;Bone marrow test;
CDC 'Split Type': NONE (blank)

Write-up: pt exp fatigue initially w/SOB which progressively worsened;saw personal MD on 30MAR99 & hosp until 9APR99;dx w/acute hemolytic anemia & cold agglutinin;pt required 9 units of blood;seen & treated by 4 hematologists


Changed on 5/14/2017

VAERS ID: 121246 Before After
VAERS Form:
Age:48.0
Sex:Male
Location:Texas
Vaccinated:1999-03-07
Onset:1999-03-28
Submitted:1999-04-10
Entered:1999-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 568A6 / - LA / IM

Administered by: Unknown Other      Purchased by: Unknown Other
Symptoms: Asthenia, Dyspnoea, Haemolytic anaemia, Jaundice, Peripheral vascular disorder, Red blood cell abnormality

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: multiple blood test;CT Scans;Bone marrow test;
CDC 'Split Type':

Write-up: pt exp fatigue initially w/SOB which progressively worsened;saw personal MD on 30MAR99 & hosp until 9APR99;dx w/acute hemolytic anemia & cold agglutinin;pt required 9 units of blood;seen & treated by 4 hematologists


Changed on 9/14/2017

VAERS ID: 121246 Before After
VAERS Form:(blank) 1
Age:48.0
Sex:Male
Location:Texas
Vaccinated:1999-03-07
Onset:1999-03-28
Submitted:1999-04-10
Entered:1999-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 568A6 / - UNK LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Dyspnoea, Haemolytic anaemia, Jaundice, Peripheral vascular disorder, Red blood cell abnormality

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: multiple blood test;CT Scans;Bone marrow test;
CDC 'Split Type':

Write-up: pt exp fatigue initially w/SOB which progressively worsened;saw personal MD on 30MAR99 & hosp until 9APR99;dx w/acute hemolytic anemia & cold agglutinin;pt required 9 units of blood;seen & treated by 4 hematologists


Changed on 2/14/2018

VAERS ID: 121246 Before After
VAERS Form:1
Age:48.0
Sex:Male
Location:Texas
Vaccinated:1999-03-07
Onset:1999-03-28
Submitted:1999-04-10
Entered:1999-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 568A6 / UNK LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Dyspnoea, Haemolytic anaemia, Jaundice, Peripheral vascular disorder, Red blood cell abnormality

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: multiple blood test;CT Scans;Bone marrow test;
CDC 'Split Type':

Write-up: pt exp fatigue initially w/SOB which progressively worsened;saw personal MD on 30MAR99 & hosp until 9APR99;dx w/acute hemolytic anemia & cold agglutinin;pt required 9 units of blood;seen & treated by 4 hematologists


Changed on 6/14/2018

VAERS ID: 121246 Before After
VAERS Form:1
Age:48.0
Sex:Male
Location:Texas
Vaccinated:1999-03-07
Onset:1999-03-28
Submitted:1999-04-10
Entered:1999-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 568A6 / UNK LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Dyspnoea, Haemolytic anaemia, Jaundice, Peripheral vascular disorder, Red blood cell abnormality

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: multiple blood test;CT Scans;Bone marrow test;
CDC 'Split Type':

Write-up: pt exp fatigue initially w/SOB which progressively worsened;saw personal MD on 30MAR99 & hosp until 9APR99;dx w/acute hemolytic anemia & cold agglutinin;pt required 9 units of blood;seen & treated by 4 hematologists


Changed on 8/14/2018

VAERS ID: 121246 Before After
VAERS Form:1
Age:48.0
Sex:Male
Location:Texas
Vaccinated:1999-03-07
Onset:1999-03-28
Submitted:1999-04-10
Entered:1999-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 568A6 / UNK LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Dyspnoea, Haemolytic anaemia, Jaundice, Peripheral vascular disorder, Red blood cell abnormality

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: multiple blood test;CT Scans;Bone marrow test;
CDC 'Split Type':

Write-up: pt exp fatigue initially w/SOB which progressively worsened;saw personal MD on 30MAR99 & hosp until 9APR99;dx w/acute hemolytic anemia & cold agglutinin;pt required 9 units of blood;seen & treated by 4 hematologists


Changed on 9/14/2018

VAERS ID: 121246 Before After
VAERS Form:1
Age:48.0
Sex:Male
Location:Texas
Vaccinated:1999-03-07
Onset:1999-03-28
Submitted:1999-04-10
Entered:1999-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 568A6 / UNK LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Dyspnoea, Haemolytic anaemia, Jaundice, Peripheral vascular disorder, Red blood cell abnormality

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: multiple blood test;CT Scans;Bone marrow test;
CDC 'Split Type':

Write-up: pt exp fatigue initially w/SOB which progressively worsened;saw personal MD on 30MAR99 & hosp until 9APR99;dx w/acute hemolytic anemia & cold agglutinin;pt required 9 units of blood;seen & treated by 4 hematologists


Changed on 10/14/2018

VAERS ID: 121246 Before After
VAERS Form:1
Age:48.0
Sex:Male
Location:Texas
Vaccinated:1999-03-07
Onset:1999-03-28
Submitted:1999-04-10
Entered:1999-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 568A6 / UNK LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Dyspnoea, Haemolytic anaemia, Jaundice, Peripheral vascular disorder, Red blood cell abnormality

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: multiple blood test;CT Scans;Bone marrow test;
CDC 'Split Type':

Write-up: pt exp fatigue initially w/SOB which progressively worsened;saw personal MD on 30MAR99 & hosp until 9APR99;dx w/acute hemolytic anemia & cold agglutinin;pt required 9 units of blood;seen & treated by 4 hematologists


Changed on 12/24/2020

VAERS ID: 121246 Before After
VAERS Form:1
Age:48.0
Sex:Male
Location:Texas
Vaccinated:1999-03-07
Onset:1999-03-28
Submitted:1999-04-10
Entered:1999-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 568A6 / UNK LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Dyspnoea, Haemolytic anaemia, Jaundice, Peripheral vascular disorder, Red blood cell abnormality

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: multiple blood test;CT Scans;Bone marrow test;
CDC 'Split Type':

Write-up: pt exp fatigue initially w/SOB which progressively worsened;saw personal MD on 30MAR99 & hosp until 9APR99;dx w/acute hemolytic anemia & cold agglutinin;pt required 9 units of blood;seen & treated by 4 hematologists


Changed on 12/30/2020

VAERS ID: 121246 Before After
VAERS Form:1
Age:48.0
Sex:Male
Location:Texas
Vaccinated:1999-03-07
Onset:1999-03-28
Submitted:1999-04-10
Entered:1999-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 568A6 / UNK LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Dyspnoea, Haemolytic anaemia, Jaundice, Peripheral vascular disorder, Red blood cell abnormality

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: multiple blood test;CT Scans;Bone marrow test;
CDC 'Split Type':

Write-up: pt exp fatigue initially w/SOB which progressively worsened;saw personal MD on 30MAR99 & hosp until 9APR99;dx w/acute hemolytic anemia & cold agglutinin;pt required 9 units of blood;seen & treated by 4 hematologists


Changed on 5/7/2021

VAERS ID: 121246 Before After
VAERS Form:1
Age:48.0
Sex:Male
Location:Texas
Vaccinated:1999-03-07
Onset:1999-03-28
Submitted:1999-04-10
Entered:1999-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 568A6 / UNK LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Dyspnoea, Haemolytic anaemia, Jaundice, Peripheral vascular disorder, Red blood cell abnormality

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: multiple blood test;CT Scans;Bone marrow test;
CDC 'Split Type':

Write-up: pt exp fatigue initially w/SOB which progressively worsened;saw personal MD on 30MAR99 & hosp until 9APR99;dx w/acute hemolytic anemia & cold agglutinin;pt required 9 units of blood;seen & treated by 4 hematologists


Changed on 5/21/2021

VAERS ID: 121246 Before After
VAERS Form:1
Age:48.0
Sex:Male
Location:Texas
Vaccinated:1999-03-07
Onset:1999-03-28
Submitted:1999-04-10
Entered:1999-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 568A6 / UNK LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Dyspnoea, Haemolytic anaemia, Jaundice, Peripheral vascular disorder, Red blood cell abnormality

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: multiple blood test;CT Scans;Bone marrow test;
CDC 'Split Type':

Write-up: pt exp fatigue initially w/SOB which progressively worsened;saw personal MD on 30MAR99 & hosp until 9APR99;dx w/acute hemolytic anemia & cold agglutinin;pt required 9 units of blood;seen & treated by 4 hematologists

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=121246&WAYBACKHISTORY=ON


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