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This is VAERS ID 80084

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 80084
VAERS Form:
Age:31.0
Sex:Female
Location:California
Vaccinated:1995-12-01
Onset:1995-12-01
Submitted:1995-12-12
Entered:1995-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
CHOL: CHOLERA VACCINE USP / WYETH 4948171 / - RA / -
HEPA: HAVRIX / SMITHKLINE ZHA467AC / - LA / -

Administered by: Private      Purchased by: Unknown
Symptoms: CONVULS, HYPOTENS, HYPERTONIA, PALLOR, AMNESIA

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? No
Previous Vaccinations: n/a
Other Medications: none
Current Illness: none
Preexisting Conditions: pcn allergy;
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type': pcn allergy;

Write-up: pt recvd vax; leaned forward 180 pulse; turned pale, convulsive state;became rigis & passed out;pt came to no memory of incident;felt fine;90/70 pulse 84;


Changed on 12/8/2009

VAERS ID: 80084 Before After
VAERS Form:
Age:31.0
Sex:Female
Location:California
Vaccinated:1995-12-01
Onset:1995-12-01
Submitted:1995-12-12
Entered:1995-12-20 1995-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
CHOL: CHOLERA VACCINE USP CHOLERA (USP) / WYETH WYETH PHARMACEUTICALS, INC 4948171 / - RA / -
HEPA: HAVRIX HEP A (HAVRIX) / SMITHKLINE SMITHKLINE BEECHAM ZHA467AC 467AC / - LA / -

Administered by: Private Unknown      Purchased by: Unknown
Symptoms: Amnesia, Convulsion, Hypertonia, Hypotension, Pallor, Syncope, Tachycardia, CONVULS, HYPOTENS, HYPERTONIA, PALLOR, AMNESIA

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? No
Previous Vaccinations: n/a
Other Medications: none
Current Illness: none
Preexisting Conditions: pcn allergy;
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type': pcn allergy; (blank)

Write-up: pt recvd vax; leaned forward 180 pulse; turned pale, convulsive state;became rigis & passed out;pt came to no memory of incident;felt fine;90/70 pulse 84;


Changed on 8/31/2010

VAERS ID: 80084 Before After
VAERS Form:
Age:31.0
Sex:Female
Location:California
Vaccinated:1995-12-01
Onset:1995-12-01
Submitted:1995-12-12
Entered:1995-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
CHOL: CHOLERA (USP) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4948171 / - RA / -
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 467AC / - LA / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Amnesia, Convulsion, Hypertonia, Hypotension, Pallor, Syncope, Tachycardia

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? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: pcn allergy;
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: pt recvd vax; leaned forward 180 pulse; turned pale, convulsive state;became rigis & passed out;pt came to no memory of incident;felt fine;90/70 pulse 84;


Changed on 5/14/2017

VAERS ID: 80084 Before After
VAERS Form:
Age:31.0
Sex:Female
Location:California
Vaccinated:1995-12-01
Onset:1995-12-01
Submitted:1995-12-12
Entered:1995-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
CHOL: CHOLERA (USP) / PFIZER/WYETH 4948171 / - RA / -
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 467AC / - LA / -

Administered by: Unknown Private      Purchased by: Unknown Private
Symptoms: Amnesia, Convulsion, Hypertonia, Hypotension, Pallor, Syncope, Tachycardia

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? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: pcn allergy;
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: pt recvd vax; leaned forward 180 pulse; turned pale, convulsive state;became rigis & passed out;pt came to no memory of incident;felt fine;90/70 pulse 84;


Changed on 9/14/2017

VAERS ID: 80084 Before After
VAERS Form:(blank) 1
Age:31.0
Sex:Female
Location:California
Vaccinated:1995-12-01
Onset:1995-12-01
Submitted:1995-12-12
Entered:1995-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
CHOL: CHOLERA (USP) / PFIZER/WYETH 4948171 / - UNK RA / -
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 467AC / - UNK LA / -

Administered by: Private      Purchased by: Private
Symptoms: Amnesia, Convulsion, Hypertonia, Hypotension, Pallor, Syncope, Tachycardia

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? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: pcn allergy;
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: pt recvd vax; leaned forward 180 pulse; turned pale, convulsive state;became rigis & passed out;pt came to no memory of incident;felt fine;90/70 pulse 84;


Changed on 2/14/2018

VAERS ID: 80084 Before After
VAERS Form:1
Age:31.0
Sex:Female
Location:California
Vaccinated:1995-12-01
Onset:1995-12-01
Submitted:1995-12-12
Entered:1995-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
CHOL: CHOLERA (USP) / PFIZER/WYETH 4948171 / UNK RA / -
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 467AC / UNK LA / -

Administered by: Private      Purchased by: Private
Symptoms: Amnesia, Convulsion, Hypertonia, Hypotension, Pallor, Syncope, Tachycardia

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? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: pcn allergy;
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: pt recvd vax; leaned forward 180 pulse; turned pale, convulsive state;became rigis & passed out;pt came to no memory of incident;felt fine;90/70 pulse 84;


Changed on 6/14/2018

VAERS ID: 80084 Before After
VAERS Form:1
Age:31.0
Sex:Female
Location:California
Vaccinated:1995-12-01
Onset:1995-12-01
Submitted:1995-12-12
Entered:1995-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
CHOL: CHOLERA (USP) / PFIZER/WYETH 4948171 / UNK RA / -
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 467AC / UNK LA / -

Administered by: Private      Purchased by: Private
Symptoms: Amnesia, Convulsion, Hypertonia, Hypotension, Pallor, Syncope, Tachycardia

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? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: pcn allergy;
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: pt recvd vax; leaned forward 180 pulse; turned pale, convulsive state;became rigis & passed out;pt came to no memory of incident;felt fine;90/70 pulse 84;


Changed on 8/14/2018

VAERS ID: 80084 Before After
VAERS Form:1
Age:31.0
Sex:Female
Location:California
Vaccinated:1995-12-01
Onset:1995-12-01
Submitted:1995-12-12
Entered:1995-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
CHOL: CHOLERA (USP) / PFIZER/WYETH 4948171 / UNK RA / -
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 467AC / UNK LA / -

Administered by: Private      Purchased by: Private
Symptoms: Amnesia, Convulsion, Hypertonia, Hypotension, Pallor, Syncope, Tachycardia

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? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: pcn allergy;
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: pt recvd vax; leaned forward 180 pulse; turned pale, convulsive state;became rigis & passed out;pt came to no memory of incident;felt fine;90/70 pulse 84;


Changed on 9/14/2018

VAERS ID: 80084 Before After
VAERS Form:1
Age:31.0
Sex:Female
Location:California
Vaccinated:1995-12-01
Onset:1995-12-01
Submitted:1995-12-12
Entered:1995-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
CHOL: CHOLERA (USP) / PFIZER/WYETH 4948171 / UNK RA / -
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 467AC / UNK LA / -

Administered by: Private      Purchased by: Private
Symptoms: Amnesia, Convulsion, Hypertonia, Hypotension, Pallor, Syncope, Tachycardia

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? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: pcn allergy;
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: pt recvd vax; leaned forward 180 pulse; turned pale, convulsive state;became rigis & passed out;pt came to no memory of incident;felt fine;90/70 pulse 84;


Changed on 10/14/2018

VAERS ID: 80084 Before After
VAERS Form:1
Age:31.0
Sex:Female
Location:California
Vaccinated:1995-12-01
Onset:1995-12-01
Submitted:1995-12-12
Entered:1995-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
CHOL: CHOLERA (USP) / PFIZER/WYETH 4948171 / UNK RA / -
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 467AC / UNK LA / -

Administered by: Private      Purchased by: Private
Symptoms: Amnesia, Convulsion, Hypertonia, Hypotension, Pallor, Syncope, Tachycardia

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? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: pcn allergy;
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: pt recvd vax; leaned forward 180 pulse; turned pale, convulsive state;became rigis & passed out;pt came to no memory of incident;felt fine;90/70 pulse 84;


Changed on 12/24/2020

VAERS ID: 80084 Before After
VAERS Form:1
Age:31.0
Sex:Female
Location:California
Vaccinated:1995-12-01
Onset:1995-12-01
Submitted:1995-12-12
Entered:1995-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
CHOL: CHOLERA (USP) / PFIZER/WYETH 4948171 / UNK RA / -
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 467AC / UNK LA / -

Administered by: Private      Purchased by: Private
Symptoms: Amnesia, Convulsion, Hypertonia, Hypotension, Pallor, Syncope, Tachycardia

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? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: pcn allergy;
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: pt recvd vax; leaned forward 180 pulse; turned pale, convulsive state;became rigis & passed out;pt came to no memory of incident;felt fine;90/70 pulse 84;


Changed on 12/30/2020

VAERS ID: 80084 Before After
VAERS Form:1
Age:31.0
Sex:Female
Location:California
Vaccinated:1995-12-01
Onset:1995-12-01
Submitted:1995-12-12
Entered:1995-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
CHOL: CHOLERA (USP) / PFIZER/WYETH 4948171 / UNK RA / -
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 467AC / UNK LA / -

Administered by: Private      Purchased by: Private
Symptoms: Amnesia, Convulsion, Hypertonia, Hypotension, Pallor, Syncope, Tachycardia

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? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: pcn allergy;
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: pt recvd vax; leaned forward 180 pulse; turned pale, convulsive state;became rigis & passed out;pt came to no memory of incident;felt fine;90/70 pulse 84;

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=80084&WAYBACKHISTORY=ON


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