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This is VAERS ID 90122

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History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 90122
VAERS Form:
Age:5.0
Sex:Male
Location:Mississippi
Vaccinated:1996-05-08
Onset:1996-05-25
Submitted:1996-06-10
Entered:1996-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HAVRIX / SMITHKLINE - / 0 A / IM

Administered by: Public      Purchased by: Unknown
Symptoms: INFECT, NO DRUG EFFECT, HEPATITIS

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt recv vax & 17 days post vax pt presented w/hep A & was hospitalized for tx;pt did not recv immunoglobulin;reporter stated that this case represents an exposure to hep A a/vax rather than a failure of therapy;sx cont;


Changed on 12/8/2009

VAERS ID: 90122 Before After
VAERS Form:
Age:5.0
Sex:Male
Location:Mississippi
Vaccinated:1996-05-08
Onset:1996-05-25
Submitted:1996-06-10
Entered:1996-09-25 1996-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HAVRIX HEP A (HAVRIX) / SMITHKLINE SMITHKLINE BEECHAM - / 0 A / IM

Administered by: Public      Purchased by: Unknown Other
Symptoms: Drug ineffective, Hepatitis, Infection, INFECT, NO DRUG EFFECT, HEPATITIS

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) 960080641

Write-up: pt recv vax & 17 days post vax pt presented w/hep A & was hospitalized for tx;pt did not recv immunoglobulin;reporter stated that this case represents an exposure to hep A a/vax rather than a failure of therapy;sx cont;


Changed on 5/14/2017

VAERS ID: 90122 Before After
VAERS Form:
Age:5.0
Sex:Male
Location:Mississippi
Vaccinated:1996-05-08
Onset:1996-05-25
Submitted:1996-06-10
Entered:1996-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / 0 A - / IM IM A

Administered by: Public      Purchased by: Other
Symptoms: Drug ineffective, Hepatitis, Infection

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 960080641

Write-up: pt recv vax & 17 days post vax pt presented w/hep A & was hospitalized for tx;pt did not recv immunoglobulin;reporter stated that this case represents an exposure to hep A a/vax rather than a failure of therapy;sx cont;


Changed on 9/14/2017

VAERS ID: 90122 Before After
VAERS Form:(blank) 1
Age:5.0
Sex:Male
Location:Mississippi
Vaccinated:1996-05-08
Onset:1996-05-25
Submitted:1996-06-10
Entered:1996-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / 0 1 - / IM A

Administered by: Public      Purchased by: Other
Symptoms: Drug ineffective, Hepatitis, Infection

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 960080641

Write-up: pt recv vax & 17 days post vax pt presented w/hep A & was hospitalized for tx;pt did not recv immunoglobulin;reporter stated that this case represents an exposure to hep A a/vax rather than a failure of therapy;sx cont;


Changed on 2/14/2018

VAERS ID: 90122 Before After
VAERS Form:1
Age:5.0
Sex:Male
Location:Mississippi
Vaccinated:1996-05-08
Onset:1996-05-25
Submitted:1996-06-10
Entered:1996-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / 1 - / IM A

Administered by: Public      Purchased by: Other
Symptoms: Drug ineffective, Hepatitis, Infection

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 960080641

Write-up: pt recv vax & 17 days post vax pt presented w/hep A & was hospitalized for tx;pt did not recv immunoglobulin;reporter stated that this case represents an exposure to hep A a/vax rather than a failure of therapy;sx cont;


Changed on 6/14/2018

VAERS ID: 90122 Before After
VAERS Form:1
Age:5.0
Sex:Male
Location:Mississippi
Vaccinated:1996-05-08
Onset:1996-05-25
Submitted:1996-06-10
Entered:1996-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / 1 - / IM A

Administered by: Public      Purchased by: Other
Symptoms: Drug ineffective, Hepatitis, Infection

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 960080641

Write-up: pt recv vax & 17 days post vax pt presented w/hep A & was hospitalized for tx;pt did not recv immunoglobulin;reporter stated that this case represents an exposure to hep A a/vax rather than a failure of therapy;sx cont;


Changed on 8/14/2018

VAERS ID: 90122 Before After
VAERS Form:1
Age:5.0
Sex:Male
Location:Mississippi
Vaccinated:1996-05-08
Onset:1996-05-25
Submitted:1996-06-10
Entered:1996-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / 1 - / IM A

Administered by: Public      Purchased by: Other
Symptoms: Drug ineffective, Hepatitis, Infection

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 960080641

Write-up: pt recv vax & 17 days post vax pt presented w/hep A & was hospitalized for tx;pt did not recv immunoglobulin;reporter stated that this case represents an exposure to hep A a/vax rather than a failure of therapy;sx cont;


Changed on 9/14/2018

VAERS ID: 90122 Before After
VAERS Form:1
Age:5.0
Sex:Male
Location:Mississippi
Vaccinated:1996-05-08
Onset:1996-05-25
Submitted:1996-06-10
Entered:1996-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / 1 - / IM A

Administered by: Public      Purchased by: Other
Symptoms: Drug ineffective, Hepatitis, Infection

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 960080641

Write-up: pt recv vax & 17 days post vax pt presented w/hep A & was hospitalized for tx;pt did not recv immunoglobulin;reporter stated that this case represents an exposure to hep A a/vax rather than a failure of therapy;sx cont;


Changed on 10/14/2018

VAERS ID: 90122 Before After
VAERS Form:1
Age:5.0
Sex:Male
Location:Mississippi
Vaccinated:1996-05-08
Onset:1996-05-25
Submitted:1996-06-10
Entered:1996-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / 1 - / IM A

Administered by: Public      Purchased by: Other
Symptoms: Drug ineffective, Hepatitis, Infection

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 960080641

Write-up: pt recv vax & 17 days post vax pt presented w/hep A & was hospitalized for tx;pt did not recv immunoglobulin;reporter stated that this case represents an exposure to hep A a/vax rather than a failure of therapy;sx cont;


Changed on 12/24/2020

VAERS ID: 90122 Before After
VAERS Form:1
Age:5.0
Sex:Male
Location:Mississippi
Vaccinated:1996-05-08
Onset:1996-05-25
Submitted:1996-06-10
Entered:1996-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / 1 - / IM A

Administered by: Public      Purchased by: Other
Symptoms: Drug ineffective, Hepatitis, Infection

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 960080641

Write-up: pt recv vax & 17 days post vax pt presented w/hep A & was hospitalized for tx;pt did not recv immunoglobulin;reporter stated that this case represents an exposure to hep A a/vax rather than a failure of therapy;sx cont;


Changed on 12/30/2020

VAERS ID: 90122 Before After
VAERS Form:1
Age:5.0
Sex:Male
Location:Mississippi
Vaccinated:1996-05-08
Onset:1996-05-25
Submitted:1996-06-10
Entered:1996-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / 1 - / IM A

Administered by: Public      Purchased by: Other
Symptoms: Drug ineffective, Hepatitis, Infection

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 960080641

Write-up: pt recv vax & 17 days post vax pt presented w/hep A & was hospitalized for tx;pt did not recv immunoglobulin;reporter stated that this case represents an exposure to hep A a/vax rather than a failure of therapy;sx cont;


Changed on 5/7/2021

VAERS ID: 90122 Before After
VAERS Form:1
Age:5.0
Sex:Male
Location:Mississippi
Vaccinated:1996-05-08
Onset:1996-05-25
Submitted:1996-06-10
Entered:1996-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / 1 - / IM A

Administered by: Public      Purchased by: Other
Symptoms: Drug ineffective, Hepatitis, Infection

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 960080641

Write-up: pt recv vax & 17 days post vax pt presented w/hep A & was hospitalized for tx;pt did not recv immunoglobulin;reporter stated that this case represents an exposure to hep A a/vax rather than a failure of therapy;sx cont;


Changed on 5/21/2021

VAERS ID: 90122 Before After
VAERS Form:1
Age:5.0
Sex:Male
Location:Mississippi
Vaccinated:1996-05-08
Onset:1996-05-25
Submitted:1996-06-10
Entered:1996-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM - / 1 - / IM A

Administered by: Public      Purchased by: Other
Symptoms: Drug ineffective, Hepatitis, Infection

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 960080641

Write-up: pt recv vax & 17 days post vax pt presented w/hep A & was hospitalized for tx;pt did not recv immunoglobulin;reporter stated that this case represents an exposure to hep A a/vax rather than a failure of therapy;sx cont;

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