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This is VAERS ID 151821

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 151821
VAERS Form:
Age:52.0
Sex:Male
Location:Unknown
Vaccinated:1999-12-21
Onset:1999-12-21
Submitted:2000-04-21
Entered:2000-06-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
LYME: LYMERIX / SMITHKLINE - / 0 - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: CHILLS, ARTHRALGIA

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? No
Previous Vaccinations:
Other Medications: Dilantin, Lipitor, Lopressor, Acetylsalicylic acid
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 75 minutes post vax on 12/21/99, the pt/surgeon was in the middle of an operation when he suddenly experienced diffuse arthralgias throughout his body. Three minutes later, he experienced rigors. The adverse reaction was severe enough that the surgeon had"to step away from the operation that he was performing. The rigors spontaneously resolved after a duration of two minutes, and the pt could then continue the operation. The arthralgias resolved after approximately one hour.The most recent information r


Changed on 12/8/2009

VAERS ID: 151821 Before After
VAERS Form:
Age:52.0
Sex:Male
Location:Unknown
Vaccinated:1999-12-21
Onset:1999-12-21
Submitted:2000-04-21
Entered:2000-06-13 2000-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
LYME: LYMERIX LYME (LYMERIX) / SMITHKLINE SMITHKLINE BEECHAM - / 0 - / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Arthralgia, Chills, CHILLS, ARTHRALGIA

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? No
Previous Vaccinations:
Other Medications: Dilantin, Lipitor, Lopressor, Acetylsalicylic acid
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) 20000005691

Write-up: 75 minutes post vax on 12/21/99, the pt/surgeon was in the middle of an operation when he suddenly experienced diffuse arthralgias throughout his body. Three minutes later, he experienced rigors. The adverse reaction was severe enough that the surgeon had"to had to step away from the operation that he was performing. The rigors spontaneously resolved after a duration of two minutes, and the pt could then continue the operation. The arthralgias resolved after approximately one hour.The hour. The most recent information r received on 1/5/00 reports the condition of the pt is resolved.


Changed on 5/14/2017

VAERS ID: 151821 Before After
VAERS Form:
Age:52.0
Sex:Male
Location:Unknown
Vaccinated:1999-12-21
Onset:1999-12-21
Submitted:2000-04-21
Entered:2000-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
LYME: LYME (LYMERIX) / SMITHKLINE BEECHAM - / 0 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Arthralgia, Chills

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? No
Previous Vaccinations:
Other Medications: Dilantin, Lipitor, Lopressor, Acetylsalicylic acid
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 20000005691

Write-up: 75 minutes post vax on 12/21/99, the pt/surgeon was in the middle of an operation when he suddenly experienced diffuse arthralgias throughout his body. Three minutes later, he experienced rigors. The adverse reaction was severe enough that the surgeon had to step away from the operation that he was performing. The rigors spontaneously resolved after a duration of two minutes, and the pt could then continue the operation. The arthralgias resolved after approximately one hour. The most recent information received on 1/5/00 reports the condition of the pt is resolved.


Changed on 9/14/2017

VAERS ID: 151821 Before After
VAERS Form:(blank) 1
Age:52.0
Sex:Male
Location:Unknown
Vaccinated:1999-12-21
Onset:1999-12-21
Submitted:2000-04-21
Entered:2000-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
LYME: LYME (LYMERIX) / SMITHKLINE BEECHAM - / 0 1 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Arthralgia, Chills

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? No
Previous Vaccinations:
Other Medications: Dilantin, Lipitor, Lopressor, Acetylsalicylic acid
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 20000005691

Write-up: 75 minutes post vax on 12/21/99, the pt/surgeon was in the middle of an operation when he suddenly experienced diffuse arthralgias throughout his body. Three minutes later, he experienced rigors. The adverse reaction was severe enough that the surgeon had to step away from the operation that he was performing. The rigors spontaneously resolved after a duration of two minutes, and the pt could then continue the operation. The arthralgias resolved after approximately one hour. The most recent information received on 1/5/00 reports the condition of the pt is resolved.


Changed on 2/14/2018

VAERS ID: 151821 Before After
VAERS Form:1
Age:52.0
Sex:Male
Location:Unknown
Vaccinated:1999-12-21
Onset:1999-12-21
Submitted:2000-04-21
Entered:2000-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
LYME: LYME (LYMERIX) / SMITHKLINE BEECHAM - / 1 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Arthralgia, Chills

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? No
Previous Vaccinations:
Other Medications: Dilantin, Lipitor, Lopressor, Acetylsalicylic acid
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 20000005691

Write-up: 75 minutes post vax on 12/21/99, the pt/surgeon was in the middle of an operation when he suddenly experienced diffuse arthralgias throughout his body. Three minutes later, he experienced rigors. The adverse reaction was severe enough that the surgeon had to step away from the operation that he was performing. The rigors spontaneously resolved after a duration of two minutes, and the pt could then continue the operation. The arthralgias resolved after approximately one hour. The most recent information received on 1/5/00 reports the condition of the pt is resolved.


Changed on 6/14/2018

VAERS ID: 151821 Before After
VAERS Form:1
Age:52.0
Sex:Male
Location:Unknown
Vaccinated:1999-12-21
Onset:1999-12-21
Submitted:2000-04-21
Entered:2000-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
LYME: LYME (LYMERIX) / SMITHKLINE BEECHAM - / 1 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Arthralgia, Chills

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? No
Previous Vaccinations:
Other Medications: Dilantin, Lipitor, Lopressor, Acetylsalicylic acid
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 20000005691

Write-up: 75 minutes post vax on 12/21/99, the pt/surgeon was in the middle of an operation when he suddenly experienced diffuse arthralgias throughout his body. Three minutes later, he experienced rigors. The adverse reaction was severe enough that the surgeon had to step away from the operation that he was performing. The rigors spontaneously resolved after a duration of two minutes, and the pt could then continue the operation. The arthralgias resolved after approximately one hour. The most recent information received on 1/5/00 reports the condition of the pt is resolved.


Changed on 8/14/2018

VAERS ID: 151821 Before After
VAERS Form:1
Age:52.0
Sex:Male
Location:Unknown
Vaccinated:1999-12-21
Onset:1999-12-21
Submitted:2000-04-21
Entered:2000-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
LYME: LYME (LYMERIX) / SMITHKLINE BEECHAM - / 1 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Arthralgia, Chills

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? No
Previous Vaccinations:
Other Medications: Dilantin, Lipitor, Lopressor, Acetylsalicylic acid
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 20000005691

Write-up: 75 minutes post vax on 12/21/99, the pt/surgeon was in the middle of an operation when he suddenly experienced diffuse arthralgias throughout his body. Three minutes later, he experienced rigors. The adverse reaction was severe enough that the surgeon had to step away from the operation that he was performing. The rigors spontaneously resolved after a duration of two minutes, and the pt could then continue the operation. The arthralgias resolved after approximately one hour. The most recent information received on 1/5/00 reports the condition of the pt is resolved.


Changed on 9/14/2018

VAERS ID: 151821 Before After
VAERS Form:1
Age:52.0
Sex:Male
Location:Unknown
Vaccinated:1999-12-21
Onset:1999-12-21
Submitted:2000-04-21
Entered:2000-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
LYME: LYME (LYMERIX) / SMITHKLINE BEECHAM - / 1 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Arthralgia, Chills

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? No
Previous Vaccinations:
Other Medications: Dilantin, Lipitor, Lopressor, Acetylsalicylic acid
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 20000005691

Write-up: 75 minutes post vax on 12/21/99, the pt/surgeon was in the middle of an operation when he suddenly experienced diffuse arthralgias throughout his body. Three minutes later, he experienced rigors. The adverse reaction was severe enough that the surgeon had to step away from the operation that he was performing. The rigors spontaneously resolved after a duration of two minutes, and the pt could then continue the operation. The arthralgias resolved after approximately one hour. The most recent information received on 1/5/00 reports the condition of the pt is resolved.


Changed on 10/14/2018

VAERS ID: 151821 Before After
VAERS Form:1
Age:52.0
Sex:Male
Location:Unknown
Vaccinated:1999-12-21
Onset:1999-12-21
Submitted:2000-04-21
Entered:2000-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
LYME: LYME (LYMERIX) / SMITHKLINE BEECHAM - / 1 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Arthralgia, Chills

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? No
Previous Vaccinations:
Other Medications: Dilantin, Lipitor, Lopressor, Acetylsalicylic acid
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 20000005691

Write-up: 75 minutes post vax on 12/21/99, the pt/surgeon was in the middle of an operation when he suddenly experienced diffuse arthralgias throughout his body. Three minutes later, he experienced rigors. The adverse reaction was severe enough that the surgeon had to step away from the operation that he was performing. The rigors spontaneously resolved after a duration of two minutes, and the pt could then continue the operation. The arthralgias resolved after approximately one hour. The most recent information received on 1/5/00 reports the condition of the pt is resolved.

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