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This is VAERS ID 80977

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 80977
VAERS Form:
Age:49.1
Sex:Male
Location:Michigan
Vaccinated:1995-11-20
Onset:1995-11-22
Submitted:1996-01-18
Entered:1996-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: RECOMBIVAX HB / MSD 1530W / 0 RA / IM
HEPA: HAVRIX / SMITHKLINE VHA425A6 / 0 LA / IM

Administered by: Other      Purchased by: Unknown
Symptoms: PHLEB, COLITIS

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 11     Extended hospital stay? No
Previous Vaccinations: NONE
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': PCN allergy, ing heartbeat, colitis

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;


Changed on 12/8/2009

VAERS ID: 80977 Before After
VAERS Form:
Age:49.1
Sex:Male
Location:Michigan
Vaccinated:1995-11-20
Onset:1995-11-22
Submitted:1996-01-18
Entered:1996-01-24 1996-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: RECOMBIVAX HB HEP B (RECOMBIVAX HB) / MSD MERCK & CO. INC. 1530W / 0 RA / IM
HEPA: HAVRIX HEP A (HAVRIX) / SMITHKLINE SMITHKLINE BEECHAM VHA425A6 / 0 LA / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Colitis, Phlebitis, PHLEB, COLITIS

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 11     Extended hospital stay? No
Previous Vaccinations: NONE
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': PCN allergy, ing heartbeat, colitis (blank)

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;


Changed on 2/14/2017

VAERS ID: 80977 Before After
VAERS Form:
Age:49.1 49.0
Sex:Male
Location:Michigan
Vaccinated:1995-11-20
Onset:1995-11-22
Submitted:1996-01-18
Entered:1996-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1530W / 0 RA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA425A6 / 0 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Colitis, Phlebitis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 11     Extended hospital stay? No
Previous Vaccinations: NONE
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;


Changed on 5/14/2017

VAERS ID: 80977 Before After
VAERS Form:
Age:49.0
Sex:Male
Location:Michigan
Vaccinated:1995-11-20
Onset:1995-11-22
Submitted:1996-01-18
Entered:1996-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1530W / 0 RA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA425A6 / 0 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Colitis, Phlebitis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 11     Extended hospital stay? No
Previous Vaccinations: NONE 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;


Changed on 9/14/2017

VAERS ID: 80977 Before After
VAERS Form:(blank) 1
Age:49.0
Sex:Male
Location:Michigan
Vaccinated:1995-11-20
Onset:1995-11-22
Submitted:1996-01-18
Entered:1996-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1530W / 0 1 RA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM VHA425A6 / 0 1 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Colitis, Phlebitis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 11     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;


Changed on 2/14/2018

VAERS ID: 80977 Before After
VAERS Form:1
Age:49.0
Sex:Male
Location:Michigan
Vaccinated:1995-11-20
Onset:1995-11-22
Submitted:1996-01-18
Entered:1996-01-22
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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 11     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;


Changed on 6/14/2018

VAERS ID: 80977 Before After
VAERS Form:1
Age:49.0
Sex:Male
Location:Michigan
Vaccinated:1995-11-20
Onset:1995-11-22
Submitted:1996-01-18
Entered:1996-01-22
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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 11     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;


Changed on 8/14/2018

VAERS ID: 80977 Before After
VAERS Form:1
Age:49.0
Sex:Male
Location:Michigan
Vaccinated:1995-11-20
Onset:1995-11-22
Submitted:1996-01-18
Entered:1996-01-22
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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 11     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;


Changed on 9/14/2018

VAERS ID: 80977 Before After
VAERS Form:1
Age:49.0
Sex:Male
Location:Michigan
Vaccinated:1995-11-20
Onset:1995-11-22
Submitted:1996-01-18
Entered:1996-01-22
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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 11     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;


Changed on 10/14/2018

VAERS ID: 80977 Before After
VAERS Form:1
Age:49.0
Sex:Male
Location:Michigan
Vaccinated:1995-11-20
Onset:1995-11-22
Submitted:1996-01-18
Entered:1996-01-22
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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 11     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;


Changed on 12/24/2020

VAERS ID: 80977 Before After
VAERS Form:1
Age:49.0
Sex:Male
Location:Michigan
Vaccinated:1995-11-20
Onset:1995-11-22
Submitted:1996-01-18
Entered:1996-01-22
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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 11     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;


Changed on 12/30/2020

VAERS ID: 80977 Before After
VAERS Form:1
Age:49.0
Sex:Male
Location:Michigan
Vaccinated:1995-11-20
Onset:1995-11-22
Submitted:1996-01-18
Entered:1996-01-22
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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 11     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;

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