National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 75868

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 75868
VAERS Form:
Age:37.8
Sex:Male
Location:Maryland
Vaccinated:1995-05-25
Onset:1995-06-18
Submitted:1995-07-11
Entered:1995-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HAVRIX / SMITHKLINE VHA425A6 / - LA / -
MMR: MMR II / MSD 659A / - RA / SC
TD: TD ADSORBED, ADULTS / CONNAUGHT LABS 4E61168 / - RA / -

Administered by: Public      Purchased by: Unknown
Symptoms: ENCEPHALITIS, HERPES ZOSTER

Life Threatening? Yes
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: no relevant data
CDC 'Split Type':

Write-up: pt recvd vax 25MAY95 & 18JUN95 devel shingles;went to hosp;lab eval revealed encephalitis & was admitted;subsequently pt recovered from shingles;reporter felt that encephalitis was life-threatening, pt''s exp was poss vax related;


Changed on 12/8/2009

VAERS ID: 75868 Before After
VAERS Form:
Age:37.8 37.0
Sex:Male
Location:Maryland
Vaccinated:1995-05-25
Onset:1995-06-18
Submitted:1995-07-11
Entered:1995-07-17 1995-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HAVRIX HEP A (HAVRIX) / SMITHKLINE SMITHKLINE BEECHAM VHA425A6 425A6 / - LA / -
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 659A / - RA / SC
TD: TD ADSORBED, ADULTS TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABS CONNAUGHT LABORATORIES 4E61168 / - RA / -

Administered by: Public Unknown      Purchased by: Unknown
Symptoms: Encephalitis, Herpes zoster, ENCEPHALITIS, HERPES ZOSTER

Life Threatening? Yes
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: no relevant data
CDC 'Split Type': (blank) MD95025

Write-up: pt recvd recv vax; devel shingles on 18jun95;dx w/ encephalitis; adm to hosp;felt vax 25MAY95 & 18JUN95 devel shingles;went to hosp;lab eval revealed encephalitis & was admitted;subsequently pt recovered from shingles;reporter felt that encephalitis was life-threatening, pt''s exp was poss vax related; rxn;discharged 29jun95


Changed on 5/14/2017

VAERS ID: 75868 Before After
VAERS Form:
Age:37.0
Sex:Male
Location:Maryland
Vaccinated:1995-05-25
Onset:1995-06-18
Submitted:1995-07-11
Entered:1995-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 425A6 / - LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 659A / - RA / SC
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 4E61168 / - RA / -

Administered by: Unknown Public      Purchased by: Unknown
Symptoms: Encephalitis, Herpes zoster

Life Threatening? Yes
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MD95025

Write-up: pt recv vax; devel shingles on 18jun95;dx w/ encephalitis; adm to hosp;felt vax rxn;discharged 29jun95


Changed on 9/14/2017

VAERS ID: 75868 Before After
VAERS Form:(blank) 1
Age:37.0
Sex:Male
Location:Maryland
Vaccinated:1995-05-25
Onset:1995-06-18
Submitted:1995-07-11
Entered:1995-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 425A6 / - UNK LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 659A / - UNK RA / SC
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 4E61168 / - UNK RA / -

Administered by: Public      Purchased by: Unknown
Symptoms: Encephalitis, Herpes zoster

Life Threatening? Yes
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MD95025

Write-up: pt recv vax; devel shingles on 18jun95;dx w/ encephalitis; adm to hosp;felt vax rxn;discharged 29jun95


Changed on 2/14/2018

VAERS ID: 75868 Before After
VAERS Form:1
Age:37.0
Sex:Male
Location:Maryland
Vaccinated:1995-05-25
Onset:1995-06-18
Submitted:1995-07-11
Entered:1995-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 425A6 / UNK LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 659A / UNK RA / SC
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 4E61168 / UNK RA / -

Administered by: Public      Purchased by: Unknown
Symptoms: Encephalitis, Herpes zoster

Life Threatening? Yes
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MD95025

Write-up: pt recv vax; devel shingles on 18jun95;dx w/ encephalitis; adm to hosp;felt vax rxn;discharged 29jun95


Changed on 6/14/2018

VAERS ID: 75868 Before After
VAERS Form:1
Age:37.0
Sex:Male
Location:Maryland
Vaccinated:1995-05-25
Onset:1995-06-18
Submitted:1995-07-11
Entered:1995-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 425A6 / UNK LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 659A / UNK RA / SC
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 4E61168 / UNK RA / -

Administered by: Public      Purchased by: Unknown
Symptoms: Encephalitis, Herpes zoster

Life Threatening? Yes
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MD95025

Write-up: pt recv vax; devel shingles on 18jun95;dx w/ encephalitis; adm to hosp;felt vax rxn;discharged 29jun95


Changed on 8/14/2018

VAERS ID: 75868 Before After
VAERS Form:1
Age:37.0
Sex:Male
Location:Maryland
Vaccinated:1995-05-25
Onset:1995-06-18
Submitted:1995-07-11
Entered:1995-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 425A6 / UNK LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 659A / UNK RA / SC
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 4E61168 / UNK RA / -

Administered by: Public      Purchased by: Unknown
Symptoms: Encephalitis, Herpes zoster

Life Threatening? Yes
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MD95025

Write-up: pt recv vax; devel shingles on 18jun95;dx w/ encephalitis; adm to hosp;felt vax rxn;discharged 29jun95


Changed on 9/14/2018

VAERS ID: 75868 Before After
VAERS Form:1
Age:37.0
Sex:Male
Location:Maryland
Vaccinated:1995-05-25
Onset:1995-06-18
Submitted:1995-07-11
Entered:1995-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 425A6 / UNK LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 659A / UNK RA / SC
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 4E61168 / UNK RA / -

Administered by: Public      Purchased by: Unknown
Symptoms: Encephalitis, Herpes zoster

Life Threatening? Yes
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MD95025

Write-up: pt recv vax; devel shingles on 18jun95;dx w/ encephalitis; adm to hosp;felt vax rxn;discharged 29jun95


Changed on 10/14/2018

VAERS ID: 75868 Before After
VAERS Form:1
Age:37.0
Sex:Male
Location:Maryland
Vaccinated:1995-05-25
Onset:1995-06-18
Submitted:1995-07-11
Entered:1995-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 425A6 / UNK LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 659A / UNK RA / SC
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 4E61168 / UNK RA / -

Administered by: Public      Purchased by: Unknown
Symptoms: Encephalitis, Herpes zoster

Life Threatening? Yes
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MD95025

Write-up: pt recv vax; devel shingles on 18jun95;dx w/ encephalitis; adm to hosp;felt vax rxn;discharged 29jun95


Changed on 12/24/2020

VAERS ID: 75868 Before After
VAERS Form:1
Age:37.0
Sex:Male
Location:Maryland
Vaccinated:1995-05-25
Onset:1995-06-18
Submitted:1995-07-11
Entered:1995-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 425A6 / UNK LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 659A / UNK RA / SC
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 4E61168 / UNK RA / -

Administered by: Public      Purchased by: Unknown
Symptoms: Encephalitis, Herpes zoster

Life Threatening? Yes
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MD95025

Write-up: pt recv vax; devel shingles on 18jun95;dx w/ encephalitis; adm to hosp;felt vax rxn;discharged 29jun95


Changed on 12/30/2020

VAERS ID: 75868 Before After
VAERS Form:1
Age:37.0
Sex:Male
Location:Maryland
Vaccinated:1995-05-25
Onset:1995-06-18
Submitted:1995-07-11
Entered:1995-07-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 425A6 / UNK LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 659A / UNK RA / SC
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 4E61168 / UNK RA / -

Administered by: Public      Purchased by: Unknown
Symptoms: Encephalitis, Herpes zoster

Life Threatening? Yes
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': MD95025

Write-up: pt recv vax; devel shingles on 18jun95;dx w/ encephalitis; adm to hosp;felt vax rxn;discharged 29jun95

New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=75868&WAYBACKHISTORY=ON


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166