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History of Changes from the VAERS Wayback Machine |
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;
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;
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;
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;
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;
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;
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;
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;
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;
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;
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;
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;
Link To This Search Result:
https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=80084&WAYBACKHISTORY=ON
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