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This is VAERS ID 96862

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History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 96862
VAERS Form:
Age:15.9
Sex:Female
Location:California
Vaccinated:1997-01-31
Onset:1997-01-31
Submitted:1997-03-18
Entered:1997-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HAVRIX / SMITHKLINE VHA189A2 / 0 LA / IM

Administered by: Public      Purchased by: Unknown
Symptoms: DYSPNEA, EDEMA FACE, EDEMA, PAIN, VASODILAT

Life Threatening? Yes
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? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: pt recv vax 31JAN97 10AM pt remained @ school but c/o arm hurting all day;pt went babysitting in the evening: around 9PM face & eyes very swollen;skin bright red;w/in a few min neck starting to swell & breathing labored;taken to hosp ER;


Changed on 12/8/2009

VAERS ID: 96862 Before After
VAERS Form:
Age:15.9 15.0
Sex:Female
Location:California
Vaccinated:1997-01-31
Onset:1997-01-31
Submitted:1997-03-18
Entered:1997-04-14 1997-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HAVRIX HEP A (HAVRIX) / SMITHKLINE SMITHKLINE BEECHAM VHA189A2 189A2 / 0 LA / IM

Administered by: Public Unknown      Purchased by: Unknown
Symptoms: Dyspnoea, Face oedema, Oedema, Pain, Vasodilatation, DYSPNEA, EDEMA FACE, EDEMA, PAIN, VASODILAT

Life Threatening? Yes
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? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': (blank) CA970018

Write-up: pt recv vax 31JAN97 10AM pt remained @ school but c/o arm hurting all day;pt went babysitting in the evening: around 9PM face & eyes very swollen;skin bright red;w/in a few min neck starting to swell & breathing labored;taken to hosp ER;


Changed on 5/14/2017

VAERS ID: 96862 Before After
VAERS Form:
Age:15.0
Sex:Female
Location:California
Vaccinated:1997-01-31
Onset:1997-01-31
Submitted:1997-03-18
Entered:1997-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 189A2 / 0 LA / IM

Administered by: Unknown Public      Purchased by: Unknown Public
Symptoms: Dyspnoea, Face oedema, Oedema, Pain, Vasodilatation

Life Threatening? Yes
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? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': CA970018

Write-up: pt recv vax 31JAN97 10AM pt remained @ school but c/o arm hurting all day;pt went babysitting in the evening: around 9PM face & eyes very swollen;skin bright red;w/in a few min neck starting to swell & breathing labored;taken to hosp ER;


Changed on 9/14/2017

VAERS ID: 96862 Before After
VAERS Form:(blank) 1
Age:15.0
Sex:Female
Location:California
Vaccinated:1997-01-31
Onset:1997-01-31
Submitted:1997-03-18
Entered:1997-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 189A2 / 0 1 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Dyspnoea, Face oedema, Oedema, Pain, Vasodilatation

Life Threatening? Yes
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? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': CA970018

Write-up: pt recv vax 31JAN97 10AM pt remained @ school but c/o arm hurting all day;pt went babysitting in the evening: around 9PM face & eyes very swollen;skin bright red;w/in a few min neck starting to swell & breathing labored;taken to hosp ER;


Changed on 2/14/2018

VAERS ID: 96862 Before After
VAERS Form:1
Age:15.0
Sex:Female
Location:California
Vaccinated:1997-01-31
Onset:1997-01-31
Submitted:1997-03-18
Entered:1997-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 189A2 / 1 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Dyspnoea, Face oedema, Oedema, Pain, Vasodilatation

Life Threatening? Yes
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? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': CA970018

Write-up: pt recv vax 31JAN97 10AM pt remained @ school but c/o arm hurting all day;pt went babysitting in the evening: around 9PM face & eyes very swollen;skin bright red;w/in a few min neck starting to swell & breathing labored;taken to hosp ER;


Changed on 6/14/2018

VAERS ID: 96862 Before After
VAERS Form:1
Age:15.0
Sex:Female
Location:California
Vaccinated:1997-01-31
Onset:1997-01-31
Submitted:1997-03-18
Entered:1997-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 189A2 / 1 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Dyspnoea, Face oedema, Oedema, Pain, Vasodilatation

Life Threatening? Yes
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? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': CA970018

Write-up: pt recv vax 31JAN97 10AM pt remained @ school but c/o arm hurting all day;pt went babysitting in the evening: around 9PM face & eyes very swollen;skin bright red;w/in a few min neck starting to swell & breathing labored;taken to hosp ER;


Changed on 8/14/2018

VAERS ID: 96862 Before After
VAERS Form:1
Age:15.0
Sex:Female
Location:California
Vaccinated:1997-01-31
Onset:1997-01-31
Submitted:1997-03-18
Entered:1997-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 189A2 / 1 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Dyspnoea, Face oedema, Oedema, Pain, Vasodilatation

Life Threatening? Yes
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? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': CA970018

Write-up: pt recv vax 31JAN97 10AM pt remained @ school but c/o arm hurting all day;pt went babysitting in the evening: around 9PM face & eyes very swollen;skin bright red;w/in a few min neck starting to swell & breathing labored;taken to hosp ER;


Changed on 9/14/2018

VAERS ID: 96862 Before After
VAERS Form:1
Age:15.0
Sex:Female
Location:California
Vaccinated:1997-01-31
Onset:1997-01-31
Submitted:1997-03-18
Entered:1997-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 189A2 / 1 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Dyspnoea, Face oedema, Oedema, Pain, Vasodilatation

Life Threatening? Yes
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? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': CA970018

Write-up: pt recv vax 31JAN97 10AM pt remained @ school but c/o arm hurting all day;pt went babysitting in the evening: around 9PM face & eyes very swollen;skin bright red;w/in a few min neck starting to swell & breathing labored;taken to hosp ER;


Changed on 10/14/2018

VAERS ID: 96862 Before After
VAERS Form:1
Age:15.0
Sex:Female
Location:California
Vaccinated:1997-01-31
Onset:1997-01-31
Submitted:1997-03-18
Entered:1997-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 189A2 / 1 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Dyspnoea, Face oedema, Oedema, Pain, Vasodilatation

Life Threatening? Yes
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? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': CA970018

Write-up: pt recv vax 31JAN97 10AM pt remained @ school but c/o arm hurting all day;pt went babysitting in the evening: around 9PM face & eyes very swollen;skin bright red;w/in a few min neck starting to swell & breathing labored;taken to hosp ER;


Changed on 12/24/2020

VAERS ID: 96862 Before After
VAERS Form:1
Age:15.0
Sex:Female
Location:California
Vaccinated:1997-01-31
Onset:1997-01-31
Submitted:1997-03-18
Entered:1997-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 189A2 / 1 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Dyspnoea, Face oedema, Oedema, Pain, Vasodilatation

Life Threatening? Yes
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? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': CA970018

Write-up: pt recv vax 31JAN97 10AM pt remained @ school but c/o arm hurting all day;pt went babysitting in the evening: around 9PM face & eyes very swollen;skin bright red;w/in a few min neck starting to swell & breathing labored;taken to hosp ER;


Changed on 12/30/2020

VAERS ID: 96862 Before After
VAERS Form:1
Age:15.0
Sex:Female
Location:California
Vaccinated:1997-01-31
Onset:1997-01-31
Submitted:1997-03-18
Entered:1997-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 189A2 / 1 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Dyspnoea, Face oedema, Oedema, Pain, Vasodilatation

Life Threatening? Yes
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? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': CA970018

Write-up: pt recv vax 31JAN97 10AM pt remained @ school but c/o arm hurting all day;pt went babysitting in the evening: around 9PM face & eyes very swollen;skin bright red;w/in a few min neck starting to swell & breathing labored;taken to hosp ER;


Changed on 5/7/2021

VAERS ID: 96862 Before After
VAERS Form:1
Age:15.0
Sex:Female
Location:California
Vaccinated:1997-01-31
Onset:1997-01-31
Submitted:1997-03-18
Entered:1997-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 189A2 / 1 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Dyspnoea, Face oedema, Oedema, Pain, Vasodilatation

Life Threatening? Yes
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? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': CA970018

Write-up: pt recv vax 31JAN97 10AM pt remained @ school but c/o arm hurting all day;pt went babysitting in the evening: around 9PM face & eyes very swollen;skin bright red;w/in a few min neck starting to swell & breathing labored;taken to hosp ER;


Changed on 5/21/2021

VAERS ID: 96862 Before After
VAERS Form:1
Age:15.0
Sex:Female
Location:California
Vaccinated:1997-01-31
Onset:1997-01-31
Submitted:1997-03-18
Entered:1997-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 189A2 / 1 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Dyspnoea, Face oedema, Oedema, Pain, Vasodilatation

Life Threatening? Yes
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? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': CA970018

Write-up: pt recv vax 31JAN97 10AM pt remained @ school but c/o arm hurting all day;pt went babysitting in the evening: around 9PM face & eyes very swollen;skin bright red;w/in a few min neck starting to swell & breathing labored;taken to hosp ER;

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=96862&WAYBACKHISTORY=ON


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