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This is VAERS ID 111499

(NOTE: This result is from the 2/14/2018 version of the VAERS database)

Case Details

VAERS ID: 111499 (history)  
Form: Version 1.0  
Age:   
Sex: Male  
Location: Tennessee  
Vaccinated:1997-05-13
Onset:1997-05-24
   Days after vaccination:11
Submitted: 1998-06-05
   Days after onset:377
Entered: 1998-06-08
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / 3 - / -

Administered by: Other       Purchased by: Other
Symptoms: Pain
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-05-24
   Days after onset: 365
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp pain & swelling in leg w/dose 2 hep b;~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 19980147961A

Write-up: pt recv vax 13MAY97 & MAY97 exp pain in lt arm;pt unspecified problems grew worse over the next few days & ultimately resulted in pt death on 24MAY98;


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20180214&IDNUMBER=111499


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