VAERS ID: |
113717 (history) |
Form: |
Version .0 |
Age: |
53.6 |
Sex: |
Male |
Location: |
Tennessee |
Vaccinated: | 1998-05-20 |
Onset: | 1998-05-26 |
Days after vaccination: | 6 |
Submitted: |
1998-06-02 |
Days after onset: | 7 |
Entered: |
1998-08-31 |
Days after submission: | 90 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM |
2186A4 / 1 |
RA / IM |
Administered by: Public Purchased by: Public Symptoms: Hepatic failure SMQs:, Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1998-05-26
Days after onset: 0
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA Other Medications: Hep B vax dose 1; Current Illness: liver failure Preexisting Conditions: NKA, liver failure Allergies: Diagnostic Lab Data: liver failure CDC Split Type: TN98027
Write-up: liver failure |