National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts.org
Search Results

This is VAERS ID 90836

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 90836
VAERS Form:
Age:17.5
Sex:Male
Location:California
Vaccinated:1996-09-04
Onset:1996-09-24
Submitted:1996-10-03
Entered:1996-10-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HAVRIX / SMITHKLINE VHA498A2 / 0 A / IM

Administered by: Private      Purchased by: Unknown
Symptoms: ANEMIA HYPOCHROM, JAUNDICE, ANEMIA, ANEMIA HEMOL

Life Threatening? Yes
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: 10     Extended hospital stay? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CBC, serum hemoglobin, haptoglobin, bili, LDH, retic, coombs tests;
CDC 'Split Type': NONE

Write-up: autoimmune hemolytic anemia w/avid IgG warm antibody;jaundice;hgb down to 4.8;hct to 14.0;


Changed on 12/8/2009

VAERS ID: 90836 Before After
VAERS Form:
Age:17.5
Sex:Male
Location:California
Vaccinated:1996-09-04
Onset:1996-09-24
Submitted:1996-10-03
Entered:1996-10-23 1996-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HAVRIX HEP A (HAVRIX) / SMITHKLINE SMITHKLINE BEECHAM VHA498A2 / 0 A / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Anaemia, Haemolytic anaemia, Hypochromic anaemia, Jaundice, ANEMIA HYPOCHROM, JAUNDICE, ANEMIA, ANEMIA HEMOL

Life Threatening? Yes
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: 10     Extended hospital stay? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CBC, serum hemoglobin, haptoglobin, bili, LDH, retic, coombs tests;
CDC 'Split Type': NONE (blank)

Write-up: autoimmune hemolytic anemia w/avid IgG warm antibody;jaundice;hgb down to 4.8;hct to 14.0;


Changed on 2/14/2017

VAERS ID: 90836 Before After
VAERS Form:
Age:17.5 17.0
Sex:Male
Location:California
Vaccinated:1996-09-04
Onset:1996-09-24
Submitted:1996-10-03
Entered:1996-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA498A2 / 0 A / IM

Administered by: Private      Purchased by: Private
Symptoms: Anaemia, Haemolytic anaemia, Hypochromic anaemia, Jaundice

Life Threatening? Yes
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: 10     Extended hospital stay? No
Previous Vaccinations: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CBC, serum hemoglobin, haptoglobin, bili, LDH, retic, coombs tests;
CDC 'Split Type':

Write-up: autoimmune hemolytic anemia w/avid IgG warm antibody;jaundice;hgb down to 4.8;hct to 14.0;


Changed on 5/14/2017

VAERS ID: 90836 Before After
VAERS Form:
Age:17.0
Sex:Male
Location:California
Vaccinated:1996-09-04
Onset:1996-09-24
Submitted:1996-10-03
Entered:1996-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA498A2 / 0 A - / IM IM A

Administered by: Private      Purchased by: Private
Symptoms: Anaemia, Haemolytic anaemia, Hypochromic anaemia, Jaundice

Life Threatening? Yes
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: 10     Extended hospital stay? No
Previous Vaccinations: NONE NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CBC, serum hemoglobin, haptoglobin, bili, LDH, retic, coombs tests;
CDC 'Split Type':

Write-up: autoimmune hemolytic anemia w/avid IgG warm antibody;jaundice;hgb down to 4.8;hct to 14.0;


Changed on 9/14/2017

VAERS ID: 90836 Before After
VAERS Form:(blank) 1
Age:17.0
Sex:Male
Location:California
Vaccinated:1996-09-04
Onset:1996-09-24
Submitted:1996-10-03
Entered:1996-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA498A2 / 0 1 - / IM A

Administered by: Private      Purchased by: Private
Symptoms: Anaemia, Haemolytic anaemia, Hypochromic anaemia, Jaundice

Life Threatening? Yes
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: 10     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CBC, serum hemoglobin, haptoglobin, bili, LDH, retic, coombs tests;
CDC 'Split Type':

Write-up: autoimmune hemolytic anemia w/avid IgG warm antibody;jaundice;hgb down to 4.8;hct to 14.0;


Changed on 2/14/2018

VAERS ID: 90836 Before After
VAERS Form:1
Age:17.0
Sex:Male
Location:California
Vaccinated:1996-09-04
Onset:1996-09-24
Submitted:1996-10-03
Entered:1996-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA498A2 / 1 - / IM A

Administered by: Private      Purchased by: Private
Symptoms: Anaemia, Haemolytic anaemia, Hypochromic anaemia, Jaundice

Life Threatening? Yes
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: 10     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CBC, serum hemoglobin, haptoglobin, bili, LDH, retic, coombs tests;
CDC 'Split Type':

Write-up: autoimmune hemolytic anemia w/avid IgG warm antibody;jaundice;hgb down to 4.8;hct to 14.0;


Changed on 6/14/2018

VAERS ID: 90836 Before After
VAERS Form:1
Age:17.0
Sex:Male
Location:California
Vaccinated:1996-09-04
Onset:1996-09-24
Submitted:1996-10-03
Entered:1996-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA498A2 / 1 - / IM A

Administered by: Private      Purchased by: Private
Symptoms: Anaemia, Haemolytic anaemia, Hypochromic anaemia, Jaundice

Life Threatening? Yes
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: 10     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CBC, serum hemoglobin, haptoglobin, bili, LDH, retic, coombs tests;
CDC 'Split Type':

Write-up: autoimmune hemolytic anemia w/avid IgG warm antibody;jaundice;hgb down to 4.8;hct to 14.0;


Changed on 8/14/2018

VAERS ID: 90836 Before After
VAERS Form:1
Age:17.0
Sex:Male
Location:California
Vaccinated:1996-09-04
Onset:1996-09-24
Submitted:1996-10-03
Entered:1996-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA498A2 / 1 - / IM A

Administered by: Private      Purchased by: Private
Symptoms: Anaemia, Haemolytic anaemia, Hypochromic anaemia, Jaundice

Life Threatening? Yes
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: 10     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CBC, serum hemoglobin, haptoglobin, bili, LDH, retic, coombs tests;
CDC 'Split Type':

Write-up: autoimmune hemolytic anemia w/avid IgG warm antibody;jaundice;hgb down to 4.8;hct to 14.0;


Changed on 9/14/2018

VAERS ID: 90836 Before After
VAERS Form:1
Age:17.0
Sex:Male
Location:California
Vaccinated:1996-09-04
Onset:1996-09-24
Submitted:1996-10-03
Entered:1996-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA498A2 / 1 - / IM A

Administered by: Private      Purchased by: Private
Symptoms: Anaemia, Haemolytic anaemia, Hypochromic anaemia, Jaundice

Life Threatening? Yes
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: 10     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CBC, serum hemoglobin, haptoglobin, bili, LDH, retic, coombs tests;
CDC 'Split Type':

Write-up: autoimmune hemolytic anemia w/avid IgG warm antibody;jaundice;hgb down to 4.8;hct to 14.0;


Changed on 10/14/2018

VAERS ID: 90836 Before After
VAERS Form:1
Age:17.0
Sex:Male
Location:California
Vaccinated:1996-09-04
Onset:1996-09-24
Submitted:1996-10-03
Entered:1996-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA498A2 / 1 - / IM A

Administered by: Private      Purchased by: Private
Symptoms: Anaemia, Haemolytic anaemia, Hypochromic anaemia, Jaundice

Life Threatening? Yes
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: 10     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CBC, serum hemoglobin, haptoglobin, bili, LDH, retic, coombs tests;
CDC 'Split Type':

Write-up: autoimmune hemolytic anemia w/avid IgG warm antibody;jaundice;hgb down to 4.8;hct to 14.0;


Changed on 12/24/2020

VAERS ID: 90836 Before After
VAERS Form:1
Age:17.0
Sex:Male
Location:California
Vaccinated:1996-09-04
Onset:1996-09-24
Submitted:1996-10-03
Entered:1996-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA498A2 / 1 - / IM A

Administered by: Private      Purchased by: Private
Symptoms: Anaemia, Haemolytic anaemia, Hypochromic anaemia, Jaundice

Life Threatening? Yes
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: 10     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CBC, serum hemoglobin, haptoglobin, bili, LDH, retic, coombs tests;
CDC 'Split Type':

Write-up: autoimmune hemolytic anemia w/avid IgG warm antibody;jaundice;hgb down to 4.8;hct to 14.0;


Changed on 12/30/2020

VAERS ID: 90836 Before After
VAERS Form:1
Age:17.0
Sex:Male
Location:California
Vaccinated:1996-09-04
Onset:1996-09-24
Submitted:1996-10-03
Entered:1996-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA498A2 / 1 - / IM A

Administered by: Private      Purchased by: Private
Symptoms: Anaemia, Haemolytic anaemia, Hypochromic anaemia, Jaundice

Life Threatening? Yes
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: 10     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CBC, serum hemoglobin, haptoglobin, bili, LDH, retic, coombs tests;
CDC 'Split Type':

Write-up: autoimmune hemolytic anemia w/avid IgG warm antibody;jaundice;hgb down to 4.8;hct to 14.0;


Changed on 5/7/2021

VAERS ID: 90836 Before After
VAERS Form:1
Age:17.0
Sex:Male
Location:California
Vaccinated:1996-09-04
Onset:1996-09-24
Submitted:1996-10-03
Entered:1996-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA498A2 / 1 - / IM A

Administered by: Private      Purchased by: Private
Symptoms: Anaemia, Haemolytic anaemia, Hypochromic anaemia, Jaundice

Life Threatening? Yes
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: 10     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CBC, serum hemoglobin, haptoglobin, bili, LDH, retic, coombs tests;
CDC 'Split Type':

Write-up: autoimmune hemolytic anemia w/avid IgG warm antibody;jaundice;hgb down to 4.8;hct to 14.0;


Changed on 5/21/2021

VAERS ID: 90836 Before After
VAERS Form:1
Age:17.0
Sex:Male
Location:California
Vaccinated:1996-09-04
Onset:1996-09-24
Submitted:1996-10-03
Entered:1996-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA498A2 / 1 - / IM A

Administered by: Private      Purchased by: Private
Symptoms: Anaemia, Haemolytic anaemia, Hypochromic anaemia, Jaundice

Life Threatening? Yes
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: 10     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CBC, serum hemoglobin, haptoglobin, bili, LDH, retic, coombs tests;
CDC 'Split Type':

Write-up: autoimmune hemolytic anemia w/avid IgG warm antibody;jaundice;hgb down to 4.8;hct to 14.0;

New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=90836&WAYBACKHISTORY=ON


Copyright © 2022 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166