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This is VAERS ID 274395

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

274395
VAERS Form:
Age:0.2
Gender:Female
Location:California
Vaccinated:2007-01-17
Onset:2007-03-15
Submitted:2007-03-20
Entered:2007-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0784F / 0 RL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES 836258A / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0779F / 0 - / PO

Administered by: Other      Purchased by: Unknown
Symptoms: Barium double contrast, Intussusception, Ultrasound scan

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: records received 3/28/07-Intussusception. Confirmed by ultrasound and successfully reduced with air contrast barium enema
CDC 'Split Type':

Write-up:Patient developed intussusception 3/15/07 sent to hospital - reduced with barium air enema. 03/28/07-DC summary received. DC DX: Intussusception. Confirmed by ultrasound and successfully reduced with air contrast barium enema.


Changed on 12/8/2009

274395 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:California
Vaccinated:2007-01-17
Onset:2007-03-15
Submitted:2007-03-20
Entered:2007-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 0 LL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0784F / 0 RL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES 836258A / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0779F / 0 - / PO

Administered by: Other      Purchased by: Unknown
Symptoms: Barium double contrast, Intussusception, Ultrasound scan

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: records received 3/28/07-Intussusception. Confirmed by ultrasound and successfully reduced with air contrast barium enema
CDC 'Split Type':

Write-up:Patient developed intussusception 3/15/07 sent to hospital - reduced with barium air enema. 03/28/07-DC summary received. DC DX: Intussusception. Confirmed by ultrasound and successfully reduced with air contrast barium enema.


Changed on 3/2/2010

274395 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:California
Vaccinated:2007-01-17
Onset:2007-03-15
Submitted:2007-03-20
Entered:2007-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0784F / 0 RL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / LEDERLE LABORATORIES 836258A / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0779F / 0 - / PO

Administered by: Other      Purchased by: Unknown
Symptoms: Barium double contrast, Intussusception, Ultrasound scan

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: records received 3/28/07-Intussusception. Confirmed by ultrasound and successfully reduced with air contrast barium enema
CDC 'Split Type':

Write-up:Patient developed intussusception 3/15/07 sent to hospital - reduced with barium air enema. 03/28/07-DC summary received. DC DX: Intussusception. Confirmed by ultrasound and successfully reduced with air contrast barium enema.


Changed on 4/7/2010

274395 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:California
Vaccinated:2007-01-17
Onset:2007-03-15
Submitted:2007-03-20
Entered:2007-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0784F / 0 RL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / LEDERLE LABORATORIES 836258A / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0779F / 0 - / PO

Administered by: Other      Purchased by: Unknown
Symptoms: Barium double contrast, Intussusception, Ultrasound scan

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: records received 3/28/07-Intussusception. Confirmed by ultrasound and successfully reduced with air contrast barium enema
CDC 'Split Type':

Write-up:Patient developed intussusception 3/15/07 sent to hospital - reduced with barium air enema. 03/28/07-DC summary received. DC DX: Intussusception. Confirmed by ultrasound and successfully reduced with air contrast barium enema.


Changed on 2/13/2013

274395 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:California
Vaccinated:2007-01-17
Onset:2007-03-15
Submitted:2007-03-20
Entered:2007-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0784F / 0 RL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES PFIZER/WYETH 836258A / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0779F / 0 - / PO

Administered by: Other      Purchased by: Unknown
Symptoms: Barium double contrast, Intussusception, Ultrasound scan

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: records received 3/28/07-Intussusception. Confirmed by ultrasound and successfully reduced with air contrast barium enema
CDC 'Split Type':

Write-up:Patient developed intussusception 3/15/07 sent to hospital - reduced with barium air enema. 03/28/07-DC summary received. DC DX: Intussusception. Confirmed by ultrasound and successfully reduced with air contrast barium enema.


Changed on 5/13/2013

274395 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:California
Vaccinated:2007-01-17
Onset:2007-03-15
Submitted:2007-03-20
Entered:2007-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0784F / 0 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 836258A / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0779F / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0779F / 0 - / PO

Administered by: Other      Purchased by: Unknown
Symptoms: Barium double contrast, Intussusception, Ultrasound scan

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: records received 3/28/07-Intussusception. Confirmed by ultrasound and successfully reduced with air contrast barium enema
CDC 'Split Type':

Write-up:Patient developed intussusception 3/15/07 sent to hospital - reduced with barium air enema. 03/28/07-DC summary received. DC DX: Intussusception. Confirmed by ultrasound and successfully reduced with air contrast barium enema.


Changed on 6/14/2014

274395 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:California
Vaccinated:2007-01-17
Onset:2007-03-15
Submitted:2007-03-20
Entered:2007-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0784F / 0 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 836258A / 0 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0779F / 0 - / PO

Administered by: Other      Purchased by: Unknown
Symptoms: Barium double contrast, Intussusception, Ultrasound scan

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: records received 3/28/07-Intussusception. Confirmed by ultrasound and successfully reduced with air contrast barium enema
CDC 'Split Type':

Write-up:Patient developed intussusception 3/15/07 sent to hospital - reduced with barium air enema. 03/28/07-DC summary received. DC DX: Intussusception. Confirmed by ultrasound and successfully reduced with air contrast barium enema.


Changed on 3/14/2015

274395 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:California
Vaccinated:2007-01-17
Onset:2007-03-15
Submitted:2007-03-20
Entered:2007-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0784F / 0 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 836258A / 0 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0779F / 0 - / PO

Administered by: Other      Purchased by: Unknown
Symptoms: Barium double contrast, Intussusception, Ultrasound scan

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: records received 3/28/07-Intussusception. Confirmed by ultrasound and successfully reduced with air contrast barium enema
CDC 'Split Type':

Write-up:Patient developed intussusception 3/15/07 sent to hospital - reduced with barium air enema. 03/28/07-DC summary received. DC DX: Intussusception. Confirmed by ultrasound and successfully reduced with air contrast barium enema.


Changed on 2/14/2017

274395 Before After
VAERS Form:
Age:0.2 0.17
Gender:Female
Location:California
Vaccinated:2007-01-17
Onset:2007-03-15
Submitted:2007-03-20
Entered:2007-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0784F / 0 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 836258A / 0 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0779F / 0 - / PO

Administered by: Other      Purchased by: Unknown
Symptoms: Barium double contrast, Intussusception, Ultrasound scan

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: records received 3/28/07-Intussusception. Confirmed by ultrasound and successfully reduced with air contrast barium enema
CDC 'Split Type':

Write-up:Patient developed intussusception 3/15/07 sent to hospital - reduced with barium air enema. 03/28/07-DC summary received. DC DX: Intussusception. Confirmed by ultrasound and successfully reduced with air contrast barium enema.


Changed on 9/14/2017

274395 Before After
VAERS Form:(blank) 1
Age:0.17
Gender:Female
Location:California
Vaccinated:2007-01-17
Onset:2007-03-15
Submitted:2007-03-20
Entered:2007-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 0 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0784F / 0 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 836258A / 0 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0779F / 0 1 - MO / PO

Administered by: Other      Purchased by: Unknown
Symptoms: Barium double contrast, Intussusception

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: records received 3/28/07-Intussusception. Confirmed by ultrasound and successfully reduced with air contrast barium enema
CDC 'Split Type':

Write-up:Patient developed intussusception 3/15/07 sent to hospital - reduced with barium air enema. 03/28/07-DC summary received. DC DX: Intussusception. Confirmed by ultrasound and successfully reduced with air contrast barium enema.


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