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This is VAERS ID 273890

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 273890
VAERS Form:
Age:0.2
Gender:Male
Location:Washington
Vaccinated:2007-01-23
Onset:2007-03-10
Submitted:2007-03-13
Entered:2007-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21BO89AA / - LL / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UFO52AA / - LL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES BO8666A / - RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1115F / - - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception, Ultrasound scan, Enema administration, Laboratory test

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: US labs records received 3/20/07-X-Ray-Ileocolonic intussusception with successful reduction by air enema. Labs WNL Cultures negative
CDC 'Split Type':

Write-up: Intussusception dxd by US treated with enema resolved and d/cd from hospital 03/20/07-records received from facility for DOS: 3/10/07-DX:Bloody diarrhea, dehydration, abdominal pain, vomiting. HX:bloody stools for 2 days. PE:WNL, abdomen soft nondisten"ed and nontender.


Changed on 12/8/2009

VAERS ID: 273890 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Washington
Vaccinated:2007-01-23
Onset:2007-03-10
Submitted:2007-03-13
Entered:2007-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21BO89AA / - LL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21BO89AA / - LL / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UFO52AA / - LL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES BO8666A / - RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1115F / - - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception, Ultrasound scan, Enema administration, Laboratory test

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: US labs records received 3/20/07-X-Ray-Ileocolonic intussusception with successful reduction by air enema. Labs WNL Cultures negative
CDC 'Split Type':

Write-up: Intussusception dxd by US treated with enema resolved and d/cd from hospital 03/20/07-records received from facility for DOS: 3/10/07-DX:Bloody diarrhea, dehydration, abdominal pain, vomiting. HX:bloody stools for 2 days. PE:WNL, abdomen soft nondisten"ed nondistened and nontender.


Changed on 3/2/2010

VAERS ID: 273890 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Washington
Vaccinated:2007-01-23
Onset:2007-03-10
Submitted:2007-03-13
Entered:2007-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21BO89AA / - LL / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UFO52AA / - LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / LEDERLE LABORATORIES BO8666A / - RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1115F / - - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception, Ultrasound scan, Enema administration, Laboratory test

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: US labs records received 3/20/07-X-Ray-Ileocolonic intussusception with successful reduction by air enema. Labs WNL Cultures negative
CDC 'Split Type':

Write-up: Intussusception dxd by US treated with enema resolved and d/cd from hospital 03/20/07-records received from facility for DOS: 3/10/07-DX:Bloody diarrhea, dehydration, abdominal pain, vomiting. HX:bloody stools for 2 days. PE:WNL, abdomen soft nondistened and nontender.


Changed on 4/7/2010

VAERS ID: 273890 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Washington
Vaccinated:2007-01-23
Onset:2007-03-10
Submitted:2007-03-13
Entered:2007-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21BO89AA / - LL / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UFO52AA / - LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / LEDERLE LABORATORIES BO8666A / - RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1115F / - - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception, Ultrasound scan, Enema administration, Laboratory test

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: US labs records received 3/20/07-X-Ray-Ileocolonic intussusception with successful reduction by air enema. Labs WNL Cultures negative
CDC 'Split Type':

Write-up: Intussusception dxd by US treated with enema resolved and d/cd from hospital 03/20/07-records received from facility for DOS: 3/10/07-DX:Bloody diarrhea, dehydration, abdominal pain, vomiting. HX:bloody stools for 2 days. PE:WNL, abdomen soft nondistened and nontender.


Changed on 5/13/2013

VAERS ID: 273890 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Washington
Vaccinated:2007-01-23
Onset:2007-03-10
Submitted:2007-03-13
Entered:2007-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21BO89AA / - LL / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UFO52AA / - LL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES BO8666A / - RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1115F / - - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1115F / - - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception, Ultrasound scan, Enema administration, Laboratory test

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: US labs records received 3/20/07-X-Ray-Ileocolonic intussusception with successful reduction by air enema. Labs WNL Cultures negative
CDC 'Split Type':

Write-up: Intussusception dxd by US treated with enema resolved and d/cd from hospital 03/20/07-records received from facility for DOS: 3/10/07-DX:Bloody diarrhea, dehydration, abdominal pain, vomiting. HX:bloody stools for 2 days. PE:WNL, abdomen soft nondistened and nontender.


Changed on 2/14/2017

VAERS ID: 273890 Before After
VAERS Form:
Age:0.2 0.16
Gender:Male
Location:Washington
Vaccinated:2007-01-23
Onset:2007-03-10
Submitted:2007-03-13
Entered:2007-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21BO89AA / - LL / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR SANOFI PASTEUR UFO52AA / - LL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES PFIZER/WYETH BO8666A / - RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1115F / - - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception, Ultrasound scan, Enema administration, Laboratory test

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: US labs records received 3/20/07-X-Ray-Ileocolonic intussusception with successful reduction by air enema. Labs WNL Cultures negative
CDC 'Split Type':

Write-up: Intussusception dxd by US treated with enema resolved and d/cd from hospital 03/20/07-records received from facility for DOS: 3/10/07-DX:Bloody diarrhea, dehydration, abdominal pain, vomiting. HX:bloody stools for 2 days. PE:WNL, abdomen soft nondistened and nontender.


Changed on 9/14/2017

VAERS ID: 273890 Before After
VAERS Form:(blank) 1
Age:0.16
Gender:Male
Location:Washington
Vaccinated:2007-01-23
Onset:2007-03-10
Submitted:2007-03-13
Entered:2007-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21BO89AA / - UNK LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UFO52AA / - UNK LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH BO8666A / - UNK RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1115F / - UNK - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception, Ultrasound scan, Enema administration, Laboratory test

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: US labs records received 3/20/07-X-Ray-Ileocolonic intussusception with successful reduction by air enema. Labs WNL Cultures negative
CDC 'Split Type':

Write-up: Intussusception dxd by US treated with enema resolved and d/cd from hospital 03/20/07-records received from facility for DOS: 3/10/07-DX:Bloody diarrhea, dehydration, abdominal pain, vomiting. HX:bloody stools for 2 days. PE:WNL, abdomen soft nondistened and nontender.


Changed on 2/14/2018

VAERS ID: 273890 Before After
VAERS Form:1
Age:0.16
Gender:Male
Location:Washington
Vaccinated:2007-01-23
Onset:2007-03-10
Submitted:2007-03-13
Entered:2007-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21BO89AA / UNK LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UFO52AA / UNK LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH BO8666A / UNK RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1115F / UNK MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception, Ultrasound scan, Enema administration, Laboratory test

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: US labs records received 3/20/07-X-Ray-Ileocolonic intussusception with successful reduction by air enema. Labs WNL Cultures negative
CDC 'Split Type':

Write-up: Intussusception dxd by US treated with enema resolved and d/cd from hospital 03/20/07-records received from facility for DOS: 3/10/07-DX:Bloody diarrhea, dehydration, abdominal pain, vomiting. HX:bloody stools for 2 days. PE:WNL, abdomen soft nondistened and nontender.


Changed on 6/14/2018

VAERS ID: 273890 Before After
VAERS Form:1
Age:0.16
Gender:Male
Location:Washington
Vaccinated:2007-01-23
Onset:2007-03-10
Submitted:2007-03-13
Entered:2007-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21BO89AA / UNK LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UFO52AA / UNK LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH BO8666A / UNK RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1115F / UNK MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception, Ultrasound scan, Enema administration, Laboratory test

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: US labs records received 3/20/07-X-Ray-Ileocolonic intussusception with successful reduction by air enema. Labs WNL Cultures negative
CDC 'Split Type':

Write-up: Intussusception dxd by US treated with enema resolved and d/cd from hospital 03/20/07-records received from facility for DOS: 3/10/07-DX:Bloody diarrhea, dehydration, abdominal pain, vomiting. HX:bloody stools for 2 days. PE:WNL, abdomen soft nondistened and nontender.

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