| VAERS ID: |
80977 (history) |
| Form: |
Version 1.0 |
| Age: |
49.0 |
| Sex: |
Male |
| Location: |
Michigan |
| Vaccinated: | 1995-11-20 |
| Onset: | 1995-11-22 |
| Days after vaccination: | 2 |
| Submitted: |
1996-01-18 |
| Days after onset: | 57 |
| Entered: |
1996-01-22 |
| Days after submission: | 4 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. |
1530W / 1 |
RA / IM |
| HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM |
VHA425A6 / 1 |
LA / IM |
Administered by: Other Purchased by: Other
Symptoms: Colitis,
Phlebitis
SMQs:, Pseudomembranous colitis (broad), Thrombophlebitis (broad), Gastrointestinal nonspecific inflammation (narrow), Ischaemic colitis (broad), Noninfectious diarrhoea (broad), Immune-mediated/autoimmune disorders (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 11 days
Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Pentasa;cortofoam enema
Current Illness: phlebitis, colitis
Preexisting Conditions: PCN allergy, ing heartbeat, colitis
Allergies:
Diagnostic Lab Data: doppler of lt leg, arteriogram showed no clot
CDC Split Type:
Write-up: pt states had phlebitis in lt leg 2 days p/vax;pt hospitalized 9DEC96 thru 11DEC96 & 15DEC95 thru 22DEC95;had colitis & placed on TPN;tx by MD; |
