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This is VAERS ID 273714

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 273714
VAERS Form:
Age:0.5
Gender:Male
Location:Michigan
Vaccinated:2007-01-15
Onset:2007-01-25
Submitted:2007-03-02
Entered:2007-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084CA / 2 LL / -
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UF058AA / 2 LL / -
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08670B / 2 LL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1110F / 2 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Barium enema, Haematochezia, Ileus paralytic, Intussusception, Abdominal X-ray

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE. Meds: none.
Current Illness: NONE
Preexisting Conditions: NONE. PMH: none. Allergies: NKDA.
Allergies:
Diagnostic Lab Data: Abdominal x-rays and barium enema. Labs and Diagnostics: KUB reveals an abnormal gas pattern which may reflect a mild paralytic ileus or small bowel obstruction. Contrast Barium Enema revealed an intussusception distal to the hepatic fle
CDC 'Split Type':

Write-up: Intussusception diagnosed. History of vomiting for several days then had bloody stools. 03/20/2007 MR received for a 2 night hospital stay for several day history of vomiting. Over the course of the admission the infant developed bloody stools x2 as well"as bilious vomiting. Review of systems on admission (+) for vomiting and lethargy. PE: WNL except mildly difficult to arouse. Intussusception reduced with air enema. The infant was dicharged the following day. Discharge DX: Intussusception.


Changed on 12/8/2009

VAERS ID: 273714 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Michigan
Vaccinated:2007-01-15
Onset:2007-01-25
Submitted:2007-03-02
Entered:2007-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084CA / 2 LL / -
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084CA / 2 LL / -
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UF058AA / 2 LL / -
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08670B / 2 LL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1110F / 2 - / PO

Administered by: Private      Purchased by: Unknown Private
Symptoms: Barium enema, Haematochezia, Ileus paralytic, Intussusception, Lethargy, Small intestinal obstruction, Urinary system X-ray, Vomiting, Abdominal X-ray

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE. Meds: none.
Current Illness: NONE
Preexisting Conditions: NONE. PMH: none. Allergies: NKDA.
Allergies:
Diagnostic Lab Data: Abdominal x-rays and barium enema. Labs and Diagnostics: KUB reveals an abnormal gas pattern which may reflect a mild paralytic ileus or small bowel obstruction. Contrast Barium Enema revealed an intussusception distal to the hepatic fle
CDC 'Split Type':

Write-up: Intussusception diagnosed. History of vomiting for several days then had bloody stools. 03/20/2007 MR received for a 2 night hospital stay for several day history of vomiting. Over the course of the admission the infant developed bloody stools x2 as well"as well as bilious vomiting. Review of systems on admission (+) for vomiting and lethargy. PE: WNL except mildly difficult to arouse. Intussusception reduced with air enema. The infant was dicharged the following day. Discharge DX: Intussusception.


Changed on 3/2/2010

VAERS ID: 273714 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Michigan
Vaccinated:2007-01-15
Onset:2007-01-25
Submitted:2007-03-02
Entered:2007-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084CA / 2 LL / -
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UF058AA / 2 LL / -
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / LEDERLE LABORATORIES B08670B / 2 LL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1110F / 2 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Haematochezia, Ileus paralytic, Intussusception, Lethargy, Small intestinal obstruction, Urinary system X-ray, Vomiting, Abdominal X-ray

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE. Meds: none.
Current Illness: NONE
Preexisting Conditions: NONE. PMH: none. Allergies: NKDA.
Allergies:
Diagnostic Lab Data: Abdominal x-rays and barium enema. Labs and Diagnostics: KUB reveals an abnormal gas pattern which may reflect a mild paralytic ileus or small bowel obstruction. Contrast Barium Enema revealed an intussusception distal to the hepatic fle
CDC 'Split Type':

Write-up: Intussusception diagnosed. History of vomiting for several days then had bloody stools. 03/20/2007 MR received for a 2 night hospital stay for several day history of vomiting. Over the course of the admission the infant developed bloody stools x2 as well as bilious vomiting. Review of systems on admission (+) for vomiting and lethargy. PE: WNL except mildly difficult to arouse. Intussusception reduced with air enema. The infant was dicharged the following day. Discharge DX: Intussusception.


Changed on 4/7/2010

VAERS ID: 273714 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Michigan
Vaccinated:2007-01-15
Onset:2007-01-25
Submitted:2007-03-02
Entered:2007-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084CA / 2 LL / -
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UF058AA / 2 LL / -
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08670B / 2 LL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1110F / 2 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Haematochezia, Ileus paralytic, Intussusception, Lethargy, Small intestinal obstruction, Urinary system X-ray, Vomiting, Abdominal X-ray

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE. Meds: none.
Current Illness: NONE
Preexisting Conditions: NONE. PMH: none. Allergies: NKDA.
Allergies:
Diagnostic Lab Data: Abdominal x-rays and barium enema. Labs and Diagnostics: KUB reveals an abnormal gas pattern which may reflect a mild paralytic ileus or small bowel obstruction. Contrast Barium Enema revealed an intussusception distal to the hepatic fle
CDC 'Split Type':

Write-up: Intussusception diagnosed. History of vomiting for several days then had bloody stools. 03/20/2007 MR received for a 2 night hospital stay for several day history of vomiting. Over the course of the admission the infant developed bloody stools x2 as well as bilious vomiting. Review of systems on admission (+) for vomiting and lethargy. PE: WNL except mildly difficult to arouse. Intussusception reduced with air enema. The infant was dicharged the following day. Discharge DX: Intussusception.


Changed on 5/13/2013

VAERS ID: 273714 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Michigan
Vaccinated:2007-01-15
Onset:2007-01-25
Submitted:2007-03-02
Entered:2007-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084CA / 2 LL / -
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UF058AA / 2 LL / -
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08670B / 2 LL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1110F / 2 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1110F / 2 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Haematochezia, Ileus paralytic, Intussusception, Lethargy, Small intestinal obstruction, Urinary system X-ray, Vomiting, Abdominal X-ray

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE. Meds: none.
Current Illness: NONE
Preexisting Conditions: NONE. PMH: none. Allergies: NKDA.
Allergies:
Diagnostic Lab Data: Abdominal x-rays and barium enema. Labs and Diagnostics: KUB reveals an abnormal gas pattern which may reflect a mild paralytic ileus or small bowel obstruction. Contrast Barium Enema revealed an intussusception distal to the hepatic fle
CDC 'Split Type':

Write-up: Intussusception diagnosed. History of vomiting for several days then had bloody stools. 03/20/2007 MR received for a 2 night hospital stay for several day history of vomiting. Over the course of the admission the infant developed bloody stools x2 as well as bilious vomiting. Review of systems on admission (+) for vomiting and lethargy. PE: WNL except mildly difficult to arouse. Intussusception reduced with air enema. The infant was dicharged the following day. Discharge DX: Intussusception.


Changed on 2/14/2017

VAERS ID: 273714 Before After
VAERS Form:
Age:0.5 0.52
Gender:Male
Location:Michigan
Vaccinated:2007-01-15
Onset:2007-01-25
Submitted:2007-03-02
Entered:2007-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084CA / 2 LL / -
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR SANOFI PASTEUR UF058AA / 2 LL / -
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES PFIZER/WYETH B08670B / 2 LL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1110F / 2 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Haematochezia, Ileus paralytic, Intussusception, Lethargy, Small intestinal obstruction, Urinary system X-ray, Vomiting, Abdominal X-ray

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE. Meds: none.
Current Illness: NONE
Preexisting Conditions: NONE. PMH: none. Allergies: NKDA.
Allergies:
Diagnostic Lab Data: Abdominal x-rays and barium enema. Labs and Diagnostics: KUB reveals an abnormal gas pattern which may reflect a mild paralytic ileus or small bowel obstruction. Contrast Barium Enema revealed an intussusception distal to the hepatic fle flexure which was sucessfully reduced. BMP unremarkable.
CDC 'Split Type':

Write-up: Intussusception diagnosed. History of vomiting for several days then had bloody stools. 03/20/2007 MR received for a 2 night hospital stay for several day history of vomiting. Over the course of the admission the infant developed bloody stools x2 as well as bilious vomiting. Review of systems on admission (+) for vomiting and lethargy. PE: WNL except mildly difficult to arouse. Intussusception reduced with air enema. The infant was dicharged the following day. Discharge DX: Intussusception.


Changed on 9/14/2017

VAERS ID: 273714 Before After
VAERS Form:(blank) 1
Age:0.52
Gender:Male
Location:Michigan
Vaccinated:2007-01-15
Onset:2007-01-25
Submitted:2007-03-02
Entered:2007-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084CA / 2 3 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF058AA / 2 3 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08670B / 2 3 LL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1110F / 2 3 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Haematochezia, Intussusception, Vomiting, Abdominal X-ray

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE. Meds: none.
Current Illness: NONE
Preexisting Conditions: NONE. PMH: none. Allergies: NKDA.
Allergies:
Diagnostic Lab Data: Abdominal x-rays and barium enema. Labs and Diagnostics: KUB reveals an abnormal gas pattern which may reflect a mild paralytic ileus or small bowel obstruction. Contrast Barium Enema revealed an intussusception distal to the hepatic flexure which was sucessfully reduced. BMP unremarkable.
CDC 'Split Type':

Write-up: Intussusception diagnosed. History of vomiting for several days then had bloody stools. 03/20/2007 MR received for a 2 night hospital stay for several day history of vomiting. Over the course of the admission the infant developed bloody stools x2 as well as bilious vomiting. Review of systems on admission (+) for vomiting and lethargy. PE: WNL except mildly difficult to arouse. Intussusception reduced with air enema. The infant was dicharged the following day. Discharge DX: Intussusception.


Changed on 2/14/2018

VAERS ID: 273714 Before After
VAERS Form:1
Age:0.52
Gender:Male
Location:Michigan
Vaccinated:2007-01-15
Onset:2007-01-25
Submitted:2007-03-02
Entered:2007-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084CA / 3 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF058AA / 3 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08670B / 3 LL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1110F / 3 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Haematochezia, Intussusception, Vomiting, Abdominal X-ray

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE. Meds: none.
Current Illness: NONE
Preexisting Conditions: NONE. PMH: none. Allergies: NKDA.
Allergies:
Diagnostic Lab Data: Abdominal x-rays and barium enema. Labs and Diagnostics: KUB reveals an abnormal gas pattern which may reflect a mild paralytic ileus or small bowel obstruction. Contrast Barium Enema revealed an intussusception distal to the hepatic flexure which was sucessfully reduced. BMP unremarkable.
CDC 'Split Type':

Write-up: Intussusception diagnosed. History of vomiting for several days then had bloody stools. 03/20/2007 MR received for a 2 night hospital stay for several day history of vomiting. Over the course of the admission the infant developed bloody stools x2 as well as bilious vomiting. Review of systems on admission (+) for vomiting and lethargy. PE: WNL except mildly difficult to arouse. Intussusception reduced with air enema. The infant was dicharged the following day. Discharge DX: Intussusception.


Changed on 6/14/2018

VAERS ID: 273714 Before After
VAERS Form:1
Age:0.52
Gender:Male
Location:Michigan
Vaccinated:2007-01-15
Onset:2007-01-25
Submitted:2007-03-02
Entered:2007-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084CA / 3 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF058AA / 3 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08670B / 3 LL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1110F / 3 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Haematochezia, Intussusception, Vomiting, Abdominal X-ray

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE. Meds: none.
Current Illness: NONE
Preexisting Conditions: NONE. PMH: none. Allergies: NKDA.
Allergies:
Diagnostic Lab Data: Abdominal x-rays and barium enema. Labs and Diagnostics: KUB reveals an abnormal gas pattern which may reflect a mild paralytic ileus or small bowel obstruction. Contrast Barium Enema revealed an intussusception distal to the hepatic flexure which was sucessfully reduced. BMP unremarkable.
CDC 'Split Type':

Write-up: Intussusception diagnosed. History of vomiting for several days then had bloody stools. 03/20/2007 MR received for a 2 night hospital stay for several day history of vomiting. Over the course of the admission the infant developed bloody stools x2 as well as bilious vomiting. Review of systems on admission (+) for vomiting and lethargy. PE: WNL except mildly difficult to arouse. Intussusception reduced with air enema. The infant was dicharged the following day. Discharge DX: Intussusception.

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