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This is VAERS ID 272903

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 272903
VAERS Form:
Age:0.2
Gender:Male
Location:Massachusetts
Vaccinated:2006-09-18
Onset:2006-09-25
Submitted:2007-02-22
Entered:2007-02-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B055AA / 0 LA / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UE830AA / 0 RA / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B22930F / 0 RA / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0695F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Diarrhoea haemorrhagic, Intussusception, Vomiting, Ultrasound abdomen abnormal

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: An abdominal ultrasound showed a target fluid mass in the upper mid-abdomen, consistent with intussusception. A subsequent air contrast enema confirmed the presence of the intussusception and was able to successfully reduce it.
CDC 'Split Type':

Write-up: Baby was taken to the Emergency Department due to vomiting and bloody diarrhea. He was found to have an intussusception, which was reduced with an air contrast enema.


Changed on 12/8/2009

VAERS ID: 272903 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Massachusetts
Vaccinated:2006-09-18
Onset:2006-09-25
Submitted:2007-02-22
Entered:2007-02-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B055AA / 0 LA / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B055AA / 0 LA / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UE830AA / 0 RA / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B22930F / 0 RA / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0695F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Diarrhoea haemorrhagic, Intussusception, Vomiting, Ultrasound abdomen abnormal

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: An abdominal ultrasound showed a target fluid mass in the upper mid-abdomen, consistent with intussusception. A subsequent air contrast enema confirmed the presence of the intussusception and was able to successfully reduce it. LABS: KUB
CDC 'Split Type':

Write-up: Baby was taken to the Emergency Department due to vomiting and bloody diarrhea. He was found to have an intussusception, which was reduced with an air contrast enema. 3/15/07 Medical records reviewed which reveal patient admitted 9/25/06 after 1 day history of multiple episodes of vomiting w/1 episode of currant jelly diarrhea. IS reduced w/air contrast enema. Held overnight for observation. Did well & was d/c to home on 9/26/06. FINAL DX: Intussusception.


Changed on 3/2/2010

VAERS ID: 272903 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Massachusetts
Vaccinated:2006-09-18
Onset:2006-09-25
Submitted:2007-02-22
Entered:2007-02-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B055AA / 0 LA / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UE830AA / 0 RA / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / LEDERLE LABORATORIES B22930F / 0 RA / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0695F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Diarrhoea haemorrhagic, Intussusception, Vomiting, Ultrasound abdomen abnormal

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: An abdominal ultrasound showed a target fluid mass in the upper mid-abdomen, consistent with intussusception. A subsequent air contrast enema confirmed the presence of the intussusception and was able to successfully reduce it. LABS: KUB
CDC 'Split Type':

Write-up: Baby was taken to the Emergency Department due to vomiting and bloody diarrhea. He was found to have an intussusception, which was reduced with an air contrast enema. 3/15/07 Medical records reviewed which reveal patient admitted 9/25/06 after 1 day history of multiple episodes of vomiting w/1 episode of currant jelly diarrhea. IS reduced w/air contrast enema. Held overnight for observation. Did well & was d/c to home on 9/26/06. FINAL DX: Intussusception.


Changed on 4/7/2010

VAERS ID: 272903 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Massachusetts
Vaccinated:2006-09-18
Onset:2006-09-25
Submitted:2007-02-22
Entered:2007-02-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B055AA / 0 LA / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UE830AA / 0 RA / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / LEDERLE LABORATORIES B22930F / 0 RA / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0695F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Diarrhoea haemorrhagic, Intussusception, Vomiting, Ultrasound abdomen abnormal

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: An abdominal ultrasound showed a target fluid mass in the upper mid-abdomen, consistent with intussusception. A subsequent air contrast enema confirmed the presence of the intussusception and was able to successfully reduce it. LABS: KUB
CDC 'Split Type':

Write-up: Baby was taken to the Emergency Department due to vomiting and bloody diarrhea. He was found to have an intussusception, which was reduced with an air contrast enema. 3/15/07 Medical records reviewed which reveal patient admitted 9/25/06 after 1 day history of multiple episodes of vomiting w/1 episode of currant jelly diarrhea. IS reduced w/air contrast enema. Held overnight for observation. Did well & was d/c to home on 9/26/06. FINAL DX: Intussusception.


Changed on 5/13/2013

VAERS ID: 272903 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Massachusetts
Vaccinated:2006-09-18
Onset:2006-09-25
Submitted:2007-02-22
Entered:2007-02-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B055AA / 0 LA / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UE830AA / 0 RA / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B22930F / 0 RA / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0695F / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0695F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Diarrhoea haemorrhagic, Intussusception, Vomiting, Ultrasound abdomen abnormal

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: An abdominal ultrasound showed a target fluid mass in the upper mid-abdomen, consistent with intussusception. A subsequent air contrast enema confirmed the presence of the intussusception and was able to successfully reduce it. LABS: KUB
CDC 'Split Type':

Write-up: Baby was taken to the Emergency Department due to vomiting and bloody diarrhea. He was found to have an intussusception, which was reduced with an air contrast enema. 3/15/07 Medical records reviewed which reveal patient admitted 9/25/06 after 1 day history of multiple episodes of vomiting w/1 episode of currant jelly diarrhea. IS reduced w/air contrast enema. Held overnight for observation. Did well & was d/c to home on 9/26/06. FINAL DX: Intussusception.


Changed on 2/14/2017

VAERS ID: 272903 Before After
VAERS Form:
Age:0.2 0.17
Gender:Male
Location:Massachusetts
Vaccinated:2006-09-18
Onset:2006-09-25
Submitted:2007-02-22
Entered:2007-02-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B055AA / 0 LA / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR SANOFI PASTEUR UE830AA / 0 RA / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES PFIZER/WYETH B22930F / 0 RA / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0695F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Diarrhoea haemorrhagic, Intussusception, Vomiting, Ultrasound abdomen abnormal

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: An abdominal ultrasound showed a target fluid mass in the upper mid-abdomen, consistent with intussusception. A subsequent air contrast enema confirmed the presence of the intussusception and was able to successfully reduce it. LABS: KUB & abd US revealed midtransverse colon intussusception. Air contrast enema was successful in reducing.
CDC 'Split Type':

Write-up: Baby was taken to the Emergency Department due to vomiting and bloody diarrhea. He was found to have an intussusception, which was reduced with an air contrast enema. 3/15/07 Medical records reviewed which reveal patient admitted 9/25/06 after 1 day history of multiple episodes of vomiting w/1 episode of currant jelly diarrhea. IS reduced w/air contrast enema. Held overnight for observation. Did well & was d/c to home on 9/26/06. FINAL DX: Intussusception.


Changed on 9/14/2017

VAERS ID: 272903 Before After
VAERS Form:(blank) 1
Age:0.17
Gender:Male
Location:Massachusetts
Vaccinated:2006-09-18
Onset:2006-09-25
Submitted:2007-02-22
Entered:2007-02-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B055AA / 0 1 LA / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE830AA / 0 1 RA / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B22930F / 0 1 RA / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0695F / 0 1 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Diarrhoea haemorrhagic, Intussusception, Vomiting, Ultrasound abdomen abnormal

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: An abdominal ultrasound showed a target fluid mass in the upper mid-abdomen, consistent with intussusception. A subsequent air contrast enema confirmed the presence of the intussusception and was able to successfully reduce it. LABS: KUB & abd US revealed midtransverse colon intussusception. Air contrast enema was successful in reducing.
CDC 'Split Type':

Write-up: Baby was taken to the Emergency Department due to vomiting and bloody diarrhea. He was found to have an intussusception, which was reduced with an air contrast enema. 3/15/07 Medical records reviewed which reveal patient admitted 9/25/06 after 1 day history of multiple episodes of vomiting w/1 episode of currant jelly diarrhea. IS reduced w/air contrast enema. Held overnight for observation. Did well & was d/c to home on 9/26/06. FINAL DX: Intussusception.


Changed on 2/14/2018

VAERS ID: 272903 Before After
VAERS Form:1
Age:0.17
Gender:Male
Location:Massachusetts
Vaccinated:2006-09-18
Onset:2006-09-25
Submitted:2007-02-22
Entered:2007-02-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B055AA / 1 LA / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE830AA / 1 RA / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B22930F / 1 RA / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0695F / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Diarrhoea haemorrhagic, Intussusception, Vomiting, Ultrasound abdomen abnormal

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: An abdominal ultrasound showed a target fluid mass in the upper mid-abdomen, consistent with intussusception. A subsequent air contrast enema confirmed the presence of the intussusception and was able to successfully reduce it. LABS: KUB & abd US revealed midtransverse colon intussusception. Air contrast enema was successful in reducing.
CDC 'Split Type':

Write-up: Baby was taken to the Emergency Department due to vomiting and bloody diarrhea. He was found to have an intussusception, which was reduced with an air contrast enema. 3/15/07 Medical records reviewed which reveal patient admitted 9/25/06 after 1 day history of multiple episodes of vomiting w/1 episode of currant jelly diarrhea. IS reduced w/air contrast enema. Held overnight for observation. Did well & was d/c to home on 9/26/06. FINAL DX: Intussusception.


Changed on 6/14/2018

VAERS ID: 272903 Before After
VAERS Form:1
Age:0.17
Gender:Male
Location:Massachusetts
Vaccinated:2006-09-18
Onset:2006-09-25
Submitted:2007-02-22
Entered:2007-02-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B055AA / 1 LA / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE830AA / 1 RA / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B22930F / 1 RA / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0695F / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Diarrhoea haemorrhagic, Intussusception, Vomiting, Ultrasound abdomen abnormal

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: An abdominal ultrasound showed a target fluid mass in the upper mid-abdomen, consistent with intussusception. A subsequent air contrast enema confirmed the presence of the intussusception and was able to successfully reduce it. LABS: KUB & abd US revealed midtransverse colon intussusception. Air contrast enema was successful in reducing.
CDC 'Split Type':

Write-up: Baby was taken to the Emergency Department due to vomiting and bloody diarrhea. He was found to have an intussusception, which was reduced with an air contrast enema. 3/15/07 Medical records reviewed which reveal patient admitted 9/25/06 after 1 day history of multiple episodes of vomiting w/1 episode of currant jelly diarrhea. IS reduced w/air contrast enema. Held overnight for observation. Did well & was d/c to home on 9/26/06. FINAL DX: Intussusception.


Changed on 8/14/2018

VAERS ID: 272903 Before After
VAERS Form:1
Age:0.17
Gender:Male
Location:Massachusetts
Vaccinated:2006-09-18
Onset:2006-09-25
Submitted:2007-02-22
Entered:2007-02-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B055AA / 1 LA / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE830AA / 1 RA / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B22930F / 1 RA / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0695F / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Diarrhoea haemorrhagic, Intussusception, Vomiting, Ultrasound abdomen abnormal

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: An abdominal ultrasound showed a target fluid mass in the upper mid-abdomen, consistent with intussusception. A subsequent air contrast enema confirmed the presence of the intussusception and was able to successfully reduce it. LABS: KUB & abd US revealed midtransverse colon intussusception. Air contrast enema was successful in reducing.
CDC 'Split Type':

Write-up: Baby was taken to the Emergency Department due to vomiting and bloody diarrhea. He was found to have an intussusception, which was reduced with an air contrast enema. 3/15/07 Medical records reviewed which reveal patient admitted 9/25/06 after 1 day history of multiple episodes of vomiting w/1 episode of currant jelly diarrhea. IS reduced w/air contrast enema. Held overnight for observation. Did well & was d/c to home on 9/26/06. FINAL DX: Intussusception.


Changed on 9/14/2018

VAERS ID: 272903 Before After
VAERS Form:1
Age:0.17
Gender:Male
Location:Massachusetts
Vaccinated:2006-09-18
Onset:2006-09-25
Submitted:2007-02-22
Entered:2007-02-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B055AA / 1 LA / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE830AA / 1 RA / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B22930F / 1 RA / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0695F / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Diarrhoea haemorrhagic, Intussusception, Vomiting, Ultrasound abdomen abnormal

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: An abdominal ultrasound showed a target fluid mass in the upper mid-abdomen, consistent with intussusception. A subsequent air contrast enema confirmed the presence of the intussusception and was able to successfully reduce it. LABS: KUB & abd US revealed midtransverse colon intussusception. Air contrast enema was successful in reducing.
CDC 'Split Type':

Write-up: Baby was taken to the Emergency Department due to vomiting and bloody diarrhea. He was found to have an intussusception, which was reduced with an air contrast enema. 3/15/07 Medical records reviewed which reveal patient admitted 9/25/06 after 1 day history of multiple episodes of vomiting w/1 episode of currant jelly diarrhea. IS reduced w/air contrast enema. Held overnight for observation. Did well & was d/c to home on 9/26/06. FINAL DX: Intussusception.

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