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This is VAERS ID 87843

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History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 87843
VAERS Form:
Age:39.0
Sex:Male
Location:New York
Vaccinated:1996-07-03
Onset:1996-07-03
Submitted:1996-07-09
Entered:1996-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: RECOMBIVAX HB / MSD 0804AMSD / 0 LA / IM
HEPA: HAVRIX / SMITHKLINE VHA470A4 / 0 RA / IM

Administered by: Other      Purchased by: Unknown
Symptoms: CONVULS, SYNCOPE, FIBRILLAT ATR

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recv vax & w/in 3-4 min post vax pt fainted & had a sl sz;these events resolved;pt was transported via ambulance to ER;abd was palpated & went into atrial fibrillation w/in several hr post vax;adm to hosp overnoc for observation


Changed on 12/8/2009

VAERS ID: 87843 Before After
VAERS Form:
Age:39.0
Sex:Male
Location:New York
Vaccinated:1996-07-03
Onset:1996-07-03
Submitted:1996-07-09
Entered:1996-07-17 1996-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: RECOMBIVAX HB HEP B (RECOMBIVAX HB) / MSD MERCK & CO. INC. 0804AMSD / 0 LA / IM
HEPA: HAVRIX HEP A (HAVRIX) / SMITHKLINE SMITHKLINE BEECHAM VHA470A4 / 0 RA / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Atrial fibrillation, Convulsion, Syncope, CONVULS, SYNCOPE, FIBRILLAT ATR

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) 960096831

Write-up: pt recv vax & w/in 3-4 min post vax pt fainted & had a sl sz;these events resolved;pt was transported via ambulance to ER;abd was palpated & went into atrial fibrillation w/in several hr post vax;adm to hosp overnoc for observation


Changed on 5/14/2017

VAERS ID: 87843 Before After
VAERS Form:
Age:39.0
Sex:Male
Location:New York
Vaccinated:1996-07-03
Onset:1996-07-03
Submitted:1996-07-09
Entered:1996-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0804AMSD / 0 LA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA470A4 / 0 RA / IM

Administered by: Other      Purchased by: Other
Symptoms: Atrial fibrillation, Convulsion, Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 960096831

Write-up: pt recv vax & w/in 3-4 min post vax pt fainted & had a sl sz;these events resolved;pt was transported via ambulance to ER;abd was palpated & went into atrial fibrillation w/in several hr post vax;adm to hosp overnoc for observation


Changed on 9/14/2017

VAERS ID: 87843 Before After
VAERS Form:(blank) 1
Age:39.0
Sex:Male
Location:New York
Vaccinated:1996-07-03
Onset:1996-07-03
Submitted:1996-07-09
Entered:1996-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0804AMSD / 0 1 LA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA470A4 / 0 1 RA / IM

Administered by: Other      Purchased by: Other
Symptoms: Atrial fibrillation, Convulsion, Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 960096831

Write-up: pt recv vax & w/in 3-4 min post vax pt fainted & had a sl sz;these events resolved;pt was transported via ambulance to ER;abd was palpated & went into atrial fibrillation w/in several hr post vax;adm to hosp overnoc for observation


Changed on 2/14/2018

VAERS ID: 87843 Before After
VAERS Form:1
Age:39.0
Sex:Male
Location:New York
Vaccinated:1996-07-03
Onset:1996-07-03
Submitted:1996-07-09
Entered:1996-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0804AMSD / 1 LA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA470A4 / 1 RA / IM

Administered by: Other      Purchased by: Other
Symptoms: Atrial fibrillation, Convulsion, Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 960096831

Write-up: pt recv vax & w/in 3-4 min post vax pt fainted & had a sl sz;these events resolved;pt was transported via ambulance to ER;abd was palpated & went into atrial fibrillation w/in several hr post vax;adm to hosp overnoc for observation


Changed on 6/14/2018

VAERS ID: 87843 Before After
VAERS Form:1
Age:39.0
Sex:Male
Location:New York
Vaccinated:1996-07-03
Onset:1996-07-03
Submitted:1996-07-09
Entered:1996-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0804AMSD / 1 LA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA470A4 / 1 RA / IM

Administered by: Other      Purchased by: Other
Symptoms: Atrial fibrillation, Convulsion, Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 960096831

Write-up: pt recv vax & w/in 3-4 min post vax pt fainted & had a sl sz;these events resolved;pt was transported via ambulance to ER;abd was palpated & went into atrial fibrillation w/in several hr post vax;adm to hosp overnoc for observation


Changed on 8/14/2018

VAERS ID: 87843 Before After
VAERS Form:1
Age:39.0
Sex:Male
Location:New York
Vaccinated:1996-07-03
Onset:1996-07-03
Submitted:1996-07-09
Entered:1996-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0804AMSD / 1 LA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA470A4 / 1 RA / IM

Administered by: Other      Purchased by: Other
Symptoms: Atrial fibrillation, Convulsion, Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 960096831

Write-up: pt recv vax & w/in 3-4 min post vax pt fainted & had a sl sz;these events resolved;pt was transported via ambulance to ER;abd was palpated & went into atrial fibrillation w/in several hr post vax;adm to hosp overnoc for observation


Changed on 9/14/2018

VAERS ID: 87843 Before After
VAERS Form:1
Age:39.0
Sex:Male
Location:New York
Vaccinated:1996-07-03
Onset:1996-07-03
Submitted:1996-07-09
Entered:1996-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0804AMSD / 1 LA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA470A4 / 1 RA / IM

Administered by: Other      Purchased by: Other
Symptoms: Atrial fibrillation, Convulsion, Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 960096831

Write-up: pt recv vax & w/in 3-4 min post vax pt fainted & had a sl sz;these events resolved;pt was transported via ambulance to ER;abd was palpated & went into atrial fibrillation w/in several hr post vax;adm to hosp overnoc for observation


Changed on 10/14/2018

VAERS ID: 87843 Before After
VAERS Form:1
Age:39.0
Sex:Male
Location:New York
Vaccinated:1996-07-03
Onset:1996-07-03
Submitted:1996-07-09
Entered:1996-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0804AMSD / 1 LA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA470A4 / 1 RA / IM

Administered by: Other      Purchased by: Other
Symptoms: Atrial fibrillation, Convulsion, Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 960096831

Write-up: pt recv vax & w/in 3-4 min post vax pt fainted & had a sl sz;these events resolved;pt was transported via ambulance to ER;abd was palpated & went into atrial fibrillation w/in several hr post vax;adm to hosp overnoc for observation


Changed on 12/24/2020

VAERS ID: 87843 Before After
VAERS Form:1
Age:39.0
Sex:Male
Location:New York
Vaccinated:1996-07-03
Onset:1996-07-03
Submitted:1996-07-09
Entered:1996-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0804AMSD / 1 LA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA470A4 / 1 RA / IM

Administered by: Other      Purchased by: Other
Symptoms: Atrial fibrillation, Convulsion, Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 960096831

Write-up: pt recv vax & w/in 3-4 min post vax pt fainted & had a sl sz;these events resolved;pt was transported via ambulance to ER;abd was palpated & went into atrial fibrillation w/in several hr post vax;adm to hosp overnoc for observation


Changed on 12/30/2020

VAERS ID: 87843 Before After
VAERS Form:1
Age:39.0
Sex:Male
Location:New York
Vaccinated:1996-07-03
Onset:1996-07-03
Submitted:1996-07-09
Entered:1996-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0804AMSD / 1 LA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA470A4 / 1 RA / IM

Administered by: Other      Purchased by: Other
Symptoms: Atrial fibrillation, Convulsion, Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 960096831

Write-up: pt recv vax & w/in 3-4 min post vax pt fainted & had a sl sz;these events resolved;pt was transported via ambulance to ER;abd was palpated & went into atrial fibrillation w/in several hr post vax;adm to hosp overnoc for observation


Changed on 5/7/2021

VAERS ID: 87843 Before After
VAERS Form:1
Age:39.0
Sex:Male
Location:New York
Vaccinated:1996-07-03
Onset:1996-07-03
Submitted:1996-07-09
Entered:1996-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0804AMSD / 1 LA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA470A4 / 1 RA / IM

Administered by: Other      Purchased by: Other
Symptoms: Atrial fibrillation, Convulsion, Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 960096831

Write-up: pt recv vax & w/in 3-4 min post vax pt fainted & had a sl sz;these events resolved;pt was transported via ambulance to ER;abd was palpated & went into atrial fibrillation w/in several hr post vax;adm to hosp overnoc for observation


Changed on 5/21/2021

VAERS ID: 87843 Before After
VAERS Form:1
Age:39.0
Sex:Male
Location:New York
Vaccinated:1996-07-03
Onset:1996-07-03
Submitted:1996-07-09
Entered:1996-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0804AMSD / 1 LA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA470A4 / 1 RA / IM

Administered by: Other      Purchased by: Other
Symptoms: Atrial fibrillation, Convulsion, Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 960096831

Write-up: pt recv vax & w/in 3-4 min post vax pt fainted & had a sl sz;these events resolved;pt was transported via ambulance to ER;abd was palpated & went into atrial fibrillation w/in several hr post vax;adm to hosp overnoc for observation

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=87843&WAYBACKHISTORY=ON


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