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; |