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This is VAERS ID 122165

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History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 122165
VAERS Form:
Age:
Sex:Unknown
Location:Washington
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1999-05-14
Entered:1999-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HAVRIX / SMITHKLINE - / 0 - / -

Administered by: Public      Purchased by: Unknown
Symptoms: ANAPHYL, RESPIRAT DIS

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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recv vax & exp anaphylaxis w/breathing problems & was hosp;


Changed on 12/8/2009

VAERS ID: 122165 Before After
VAERS Form:
Age:
Sex:Unknown
Location:Washington
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1999-05-14
Entered:1999-05-20 1999-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HAVRIX HEP A (HAVRIX) / SMITHKLINE SMITHKLINE BEECHAM - / 0 - / -

Administered by: Public      Purchased by: Unknown Public
Symptoms: Anaphylactoid reaction, Respiratory disorder, ANAPHYL, RESPIRAT DIS

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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) 19990108451

Write-up: pt recv vax & exp anaphylaxis w/breathing problems & was hosp;


Changed on 5/14/2017

VAERS ID: 122165 Before After
VAERS Form:
Age:
Sex:Unknown
Location:Washington
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1999-05-14
Entered:1999-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / 0 - / -

Administered by: Public      Purchased by: Public
Symptoms: Anaphylactoid reaction, Respiratory disorder

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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 19990108451

Write-up: pt recv vax & exp anaphylaxis w/breathing problems & was hosp;


Changed on 9/14/2017

VAERS ID: 122165 Before After
VAERS Form:(blank) 1
Age:
Sex:Unknown
Location:Washington
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1999-05-14
Entered:1999-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / 0 1 - / -

Administered by: Public      Purchased by: Public
Symptoms: Anaphylactoid reaction, Respiratory disorder

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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 19990108451

Write-up: pt recv vax & exp anaphylaxis w/breathing problems & was hosp;


Changed on 2/14/2018

VAERS ID: 122165 Before After
VAERS Form:1
Age:
Sex:Unknown
Location:Washington
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1999-05-14
Entered:1999-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / 1 - / -

Administered by: Public      Purchased by: Public
Symptoms: Anaphylactoid reaction, Respiratory disorder

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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 19990108451

Write-up: pt recv vax & exp anaphylaxis w/breathing problems & was hosp;


Changed on 6/14/2018

VAERS ID: 122165 Before After
VAERS Form:1
Age:
Sex:Unknown
Location:Washington
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1999-05-14
Entered:1999-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / 1 - / -

Administered by: Public      Purchased by: Public
Symptoms: Anaphylactoid reaction, Respiratory disorder

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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 19990108451

Write-up: pt recv vax & exp anaphylaxis w/breathing problems & was hosp;


Changed on 8/14/2018

VAERS ID: 122165 Before After
VAERS Form:1
Age:
Sex:Unknown
Location:Washington
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1999-05-14
Entered:1999-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / 1 - / -

Administered by: Public      Purchased by: Public
Symptoms: Anaphylactoid reaction, Respiratory disorder

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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 19990108451

Write-up: pt recv vax & exp anaphylaxis w/breathing problems & was hosp;


Changed on 9/14/2018

VAERS ID: 122165 Before After
VAERS Form:1
Age:
Sex:Unknown
Location:Washington
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1999-05-14
Entered:1999-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / 1 - / -

Administered by: Public      Purchased by: Public
Symptoms: Anaphylactoid reaction, Respiratory disorder

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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 19990108451

Write-up: pt recv vax & exp anaphylaxis w/breathing problems & was hosp;


Changed on 10/14/2018

VAERS ID: 122165 Before After
VAERS Form:1
Age:
Sex:Unknown
Location:Washington
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1999-05-14
Entered:1999-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / 1 - / -

Administered by: Public      Purchased by: Public
Symptoms: Anaphylactoid reaction, Respiratory disorder

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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 19990108451

Write-up: pt recv vax & exp anaphylaxis w/breathing problems & was hosp;


Changed on 12/24/2020

VAERS ID: 122165 Before After
VAERS Form:1
Age:
Sex:Unknown
Location:Washington
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1999-05-14
Entered:1999-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / 1 - / -

Administered by: Public      Purchased by: Public
Symptoms: Anaphylactoid reaction, Respiratory disorder

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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 19990108451

Write-up: pt recv vax & exp anaphylaxis w/breathing problems & was hosp;


Changed on 12/30/2020

VAERS ID: 122165 Before After
VAERS Form:1
Age:
Sex:Unknown
Location:Washington
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1999-05-14
Entered:1999-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / 1 - / -

Administered by: Public      Purchased by: Public
Symptoms: Anaphylactoid reaction, Respiratory disorder

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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 19990108451

Write-up: pt recv vax & exp anaphylaxis w/breathing problems & was hosp;


Changed on 5/7/2021

VAERS ID: 122165 Before After
VAERS Form:1
Age:
Sex:Unknown
Location:Washington
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1999-05-14
Entered:1999-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / 1 - / -

Administered by: Public      Purchased by: Public
Symptoms: Anaphylactoid reaction, Respiratory disorder

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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 19990108451

Write-up: pt recv vax & exp anaphylaxis w/breathing problems & was hosp;


Changed on 5/21/2021

VAERS ID: 122165 Before After
VAERS Form:1
Age:
Sex:Unknown
Location:Washington
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:1999-05-14
Entered:1999-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / 1 - / -

Administered by: Public      Purchased by: Public
Symptoms: Anaphylactoid reaction, Respiratory disorder

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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 19990108451

Write-up: pt recv vax & exp anaphylaxis w/breathing problems & was hosp;

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