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This is VAERS ID 270992

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 270992
VAERS Form:
Age:0.2
Gender:Male
Location:North Carolina
Vaccinated:2006-10-30
Onset:2007-01-11
Submitted:2007-01-22
Entered:2007-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 0 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0279F / 0 LL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08658A / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0577F / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Abdominal discomfort, Haematochezia, Intussusception, Lethargy, Pallor

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: US demonstrated intussusception initially to the level of the splenic flexure. Reduction was unsuccessful prior to surgery. Surgery on 01/11/07-Operative reduction of intussusception and appendectomy. Labs:WBC 22.4, platelets 910000.
CDC 'Split Type':

Write-up: Bloody stool, intussusception, requiring surgery.


Changed on 12/8/2009

VAERS ID: 270992 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:North Carolina
Vaccinated:2006-10-30
Onset:2007-01-11
Submitted:2007-01-22
Entered:2007-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 0 RL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 0 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0279F / 0 LL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08658A / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0577F / 0 - / PO

Administered by: Private      Purchased by: Unknown Private
Symptoms: Abdominal discomfort, Haematochezia, Intussusception, Lethargy, Pallor, Surgery, Vomiting, White blood cell count increased, Platelet count increased

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: US demonstrated intussusception initially to the level of the splenic flexure. Reduction was unsuccessful prior to surgery. Surgery on 01/11/07-Operative reduction of intussusception and appendectomy. Labs:WBC 22.4, platelets 910000.
CDC 'Split Type': (blank) NC07010

Write-up: Bloody stool, intussusception, requiring surgery. 02/13/07-records received and reviewed for DOS 1/11-1/14/07 DC DX:Intussusception Presented with lethargy, abdominal discomfort, paleness, and pulling up of his legs. Multiple bilious vomiting and blood in stool. Poor feeding. Palpable mass in right upper and epigastric area. Baby has currant jelly stool.


Changed on 3/2/2010

VAERS ID: 270992 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:North Carolina
Vaccinated:2006-10-30
Onset:2007-01-11
Submitted:2007-01-22
Entered:2007-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 0 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0279F / 0 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / LEDERLE LABORATORIES B08658A / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0577F / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal discomfort, Haematochezia, Intussusception, Lethargy, Pallor, Surgery, Vomiting, White blood cell count increased, Platelet count increased

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: US demonstrated intussusception initially to the level of the splenic flexure. Reduction was unsuccessful prior to surgery. Surgery on 01/11/07-Operative reduction of intussusception and appendectomy. Labs:WBC 22.4, platelets 910000.
CDC 'Split Type': NC07010

Write-up: Bloody stool, intussusception, requiring surgery. 02/13/07-records received and reviewed for DOS 1/11-1/14/07 DC DX:Intussusception Presented with lethargy, abdominal discomfort, paleness, and pulling up of his legs. Multiple bilious vomiting and blood in stool. Poor feeding. Palpable mass in right upper and epigastric area. Baby has currant jelly stool.


Changed on 4/7/2010

VAERS ID: 270992 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:North Carolina
Vaccinated:2006-10-30
Onset:2007-01-11
Submitted:2007-01-22
Entered:2007-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 0 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0279F / 0 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08658A / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0577F / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal discomfort, Haematochezia, Intussusception, Lethargy, Pallor, Surgery, Vomiting, White blood cell count increased, Platelet count increased

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: US demonstrated intussusception initially to the level of the splenic flexure. Reduction was unsuccessful prior to surgery. Surgery on 01/11/07-Operative reduction of intussusception and appendectomy. Labs:WBC 22.4, platelets 910000.
CDC 'Split Type': NC07010

Write-up: Bloody stool, intussusception, requiring surgery. 02/13/07-records received and reviewed for DOS 1/11-1/14/07 DC DX:Intussusception Presented with lethargy, abdominal discomfort, paleness, and pulling up of his legs. Multiple bilious vomiting and blood in stool. Poor feeding. Palpable mass in right upper and epigastric area. Baby has currant jelly stool.


Changed on 5/13/2013

VAERS ID: 270992 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:North Carolina
Vaccinated:2006-10-30
Onset:2007-01-11
Submitted:2007-01-22
Entered:2007-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 0 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0279F / 0 LL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08658A / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0577F / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0577F / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal discomfort, Haematochezia, Intussusception, Lethargy, Pallor, Surgery, Vomiting, White blood cell count increased, Platelet count increased

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: US demonstrated intussusception initially to the level of the splenic flexure. Reduction was unsuccessful prior to surgery. Surgery on 01/11/07-Operative reduction of intussusception and appendectomy. Labs:WBC 22.4, platelets 910000.
CDC 'Split Type': NC07010

Write-up: Bloody stool, intussusception, requiring surgery. 02/13/07-records received and reviewed for DOS 1/11-1/14/07 DC DX:Intussusception Presented with lethargy, abdominal discomfort, paleness, and pulling up of his legs. Multiple bilious vomiting and blood in stool. Poor feeding. Palpable mass in right upper and epigastric area. Baby has currant jelly stool.


Changed on 2/14/2017

VAERS ID: 270992 Before After
VAERS Form:
Age:0.2 0.18
Gender:Male
Location:North Carolina
Vaccinated:2006-10-30
Onset:2007-01-11
Submitted:2007-01-22
Entered:2007-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 0 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0279F / 0 LL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES PFIZER/WYETH B08658A / 0 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0577F / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal discomfort, Haematochezia, Intussusception, Lethargy, Pallor, Surgery, Vomiting, White blood cell count increased, Platelet count increased

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: US demonstrated intussusception initially to the level of the splenic flexure. Reduction was unsuccessful prior to surgery. Surgery on 01/11/07-Operative reduction of intussusception and appendectomy. Labs:WBC 22.4, platelets 910000.
CDC 'Split Type': NC07010

Write-up: Bloody stool, intussusception, requiring surgery. 02/13/07-records received and reviewed for DOS 1/11-1/14/07 DC DX:Intussusception Presented with lethargy, abdominal discomfort, paleness, and pulling up of his legs. Multiple bilious vomiting and blood in stool. Poor feeding. Palpable mass in right upper and epigastric area. Baby has currant jelly stool.


Changed on 9/14/2017

VAERS ID: 270992 Before After
VAERS Form:(blank) 1
Age:0.18
Gender:Male
Location:North Carolina
Vaccinated:2006-10-30
Onset:2007-01-11
Submitted:2007-01-22
Entered:2007-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 0 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0279F / 0 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08658A / 0 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0577F / 0 1 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Haematochezia, Intussusception, Surgery

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: US demonstrated intussusception initially to the level of the splenic flexure. Reduction was unsuccessful prior to surgery. Surgery on 01/11/07-Operative reduction of intussusception and appendectomy. Labs:WBC 22.4, platelets 910000.
CDC 'Split Type': NC07010

Write-up: Bloody stool, intussusception, requiring surgery. 02/13/07-records received and reviewed for DOS 1/11-1/14/07 DC DX:Intussusception Presented with lethargy, abdominal discomfort, paleness, and pulling up of his legs. Multiple bilious vomiting and blood in stool. Poor feeding. Palpable mass in right upper and epigastric area. Baby has currant jelly stool.


Changed on 2/14/2018

VAERS ID: 270992 Before After
VAERS Form:1
Age:0.18
Gender:Male
Location:North Carolina
Vaccinated:2006-10-30
Onset:2007-01-11
Submitted:2007-01-22
Entered:2007-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0279F / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08658A / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0577F / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Haematochezia, Intussusception, Surgery

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: US demonstrated intussusception initially to the level of the splenic flexure. Reduction was unsuccessful prior to surgery. Surgery on 01/11/07-Operative reduction of intussusception and appendectomy. Labs:WBC 22.4, platelets 910000.
CDC 'Split Type': NC07010

Write-up: Bloody stool, intussusception, requiring surgery. 02/13/07-records received and reviewed for DOS 1/11-1/14/07 DC DX:Intussusception Presented with lethargy, abdominal discomfort, paleness, and pulling up of his legs. Multiple bilious vomiting and blood in stool. Poor feeding. Palpable mass in right upper and epigastric area. Baby has currant jelly stool.


Changed on 6/14/2018

VAERS ID: 270992 Before After
VAERS Form:1
Age:0.18
Gender:Male
Location:North Carolina
Vaccinated:2006-10-30
Onset:2007-01-11
Submitted:2007-01-22
Entered:2007-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0279F / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08658A / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0577F / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Haematochezia, Intussusception, Surgery

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: US demonstrated intussusception initially to the level of the splenic flexure. Reduction was unsuccessful prior to surgery. Surgery on 01/11/07-Operative reduction of intussusception and appendectomy. Labs:WBC 22.4, platelets 910000.
CDC 'Split Type': NC07010

Write-up: Bloody stool, intussusception, requiring surgery. 02/13/07-records received and reviewed for DOS 1/11-1/14/07 DC DX:Intussusception Presented with lethargy, abdominal discomfort, paleness, and pulling up of his legs. Multiple bilious vomiting and blood in stool. Poor feeding. Palpable mass in right upper and epigastric area. Baby has currant jelly stool.

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