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This is VAERS ID 274768

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 274768
VAERS Form:
Age:0.7
Gender:Male
Location:Indiana
Vaccinated:2007-03-02
Onset:2007-03-05
Submitted:2007-03-13
Entered:2007-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B092AA / 2 LL / -
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UF077AA / 2 RL / -
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B36258C / 2 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1109F / 2 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Abdominal pain, Appendicectomy, Barium double contrast, Abdominal X-ray

Life Threatening? Yes
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: Barium enema (+) for partially resolving ileocolic intussusception.
CDC 'Split Type':

Write-up: Child developed an ileocolic intussusception 3/5/07. To surgery on 3/6/07.


Changed on 12/8/2009

VAERS ID: 274768 Before After
VAERS Form:
Age:0.7
Gender:Male
Location:Indiana
Vaccinated:2007-03-02
Onset:2007-03-05
Submitted:2007-03-13
Entered:2007-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B092AA / 2 LL / -
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B092AA / 2 LL / -
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UF077AA / 2 RL / -
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B36258C / 2 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1109F / 2 - / PO

Administered by: Private      Purchased by: Unknown Private
Symptoms: Abdominal pain, Appendicectomy, Barium double contrast, Barium enema, Intussusception, Laparotomy, Surgery, Vomiting, Abdominal X-ray

Life Threatening? Yes
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: Barium enema (+) for partially resolving ileocolic intussusception. Abdominal Survey:no free air is demonstrated. No gas can be seen on right side of abdomen. Findings may be due to mild constipation. Concern for intusssusception. Barium e
CDC 'Split Type':

Write-up: Child developed an ileocolic intussusception 3/5/07. To surgery on 3/6/07. 04/03/07-records received from facility DC DX: Intussusception. Colicky abdominal pain. No bloody stool. Acute bilious vomiting. Surgical procedure:laparotomy, reduction of intussusception, appendectomy. Post operative diagnosis:ileocolic intussusception.


Changed on 3/2/2010

VAERS ID: 274768 Before After
VAERS Form:
Age:0.7
Gender:Male
Location:Indiana
Vaccinated:2007-03-02
Onset:2007-03-05
Submitted:2007-03-13
Entered:2007-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B092AA / 2 LL / -
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UF077AA / 2 RL / -
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / LEDERLE LABORATORIES B36258C / 2 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1109F / 2 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Appendicectomy, Barium double contrast, Barium enema, Intussusception, Laparotomy, Surgery, Vomiting, Abdominal X-ray

Life Threatening? Yes
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: Barium enema (+) for partially resolving ileocolic intussusception. Abdominal Survey:no free air is demonstrated. No gas can be seen on right side of abdomen. Findings may be due to mild constipation. Concern for intusssusception. Barium e
CDC 'Split Type':

Write-up: Child developed an ileocolic intussusception 3/5/07. To surgery on 3/6/07. 04/03/07-records received from facility DC DX: Intussusception. Colicky abdominal pain. No bloody stool. Acute bilious vomiting. Surgical procedure:laparotomy, reduction of intussusception, appendectomy. Post operative diagnosis:ileocolic intussusception.


Changed on 4/7/2010

VAERS ID: 274768 Before After
VAERS Form:
Age:0.7
Gender:Male
Location:Indiana
Vaccinated:2007-03-02
Onset:2007-03-05
Submitted:2007-03-13
Entered:2007-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B092AA / 2 LL / -
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UF077AA / 2 RL / -
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / LEDERLE LABORATORIES B36258C / 2 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1109F / 2 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Appendicectomy, Barium double contrast, Barium enema, Intussusception, Laparotomy, Surgery, Vomiting, Abdominal X-ray

Life Threatening? Yes
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: Barium enema (+) for partially resolving ileocolic intussusception. Abdominal Survey:no free air is demonstrated. No gas can be seen on right side of abdomen. Findings may be due to mild constipation. Concern for intusssusception. Barium e
CDC 'Split Type':

Write-up: Child developed an ileocolic intussusception 3/5/07. To surgery on 3/6/07. 04/03/07-records received from facility DC DX: Intussusception. Colicky abdominal pain. No bloody stool. Acute bilious vomiting. Surgical procedure:laparotomy, reduction of intussusception, appendectomy. Post operative diagnosis:ileocolic intussusception.


Changed on 5/13/2013

VAERS ID: 274768 Before After
VAERS Form:
Age:0.7
Gender:Male
Location:Indiana
Vaccinated:2007-03-02
Onset:2007-03-05
Submitted:2007-03-13
Entered:2007-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B092AA / 2 LL / -
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UF077AA / 2 RL / -
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B36258C / 2 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1109F / 2 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1109F / 2 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Appendicectomy, Barium double contrast, Barium enema, Intussusception, Laparotomy, Surgery, Vomiting, Abdominal X-ray

Life Threatening? Yes
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: Barium enema (+) for partially resolving ileocolic intussusception. Abdominal Survey:no free air is demonstrated. No gas can be seen on right side of abdomen. Findings may be due to mild constipation. Concern for intusssusception. Barium e
CDC 'Split Type':

Write-up: Child developed an ileocolic intussusception 3/5/07. To surgery on 3/6/07. 04/03/07-records received from facility DC DX: Intussusception. Colicky abdominal pain. No bloody stool. Acute bilious vomiting. Surgical procedure:laparotomy, reduction of intussusception, appendectomy. Post operative diagnosis:ileocolic intussusception.


Changed on 2/14/2017

VAERS ID: 274768 Before After
VAERS Form:
Age:0.7 0.65
Gender:Male
Location:Indiana
Vaccinated:2007-03-02
Onset:2007-03-05
Submitted:2007-03-13
Entered:2007-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B092AA / 2 LL / -
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR SANOFI PASTEUR UF077AA / 2 RL / -
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES PFIZER/WYETH B36258C / 2 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1109F / 2 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Appendicectomy, Barium double contrast, Barium enema, Intussusception, Laparotomy, Surgery, Vomiting, Abdominal X-ray

Life Threatening? Yes
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: Barium enema (+) for partially resolving ileocolic intussusception. Abdominal Survey:no free air is demonstrated. No gas can be seen on right side of abdomen. Findings may be due to mild constipation. Concern for intusssusception. Barium e enema. ileocolic intussusception that reduced easily from distal transverse colon to ileoceal valve but was unable to completely reduce the intussusception despite several attempts.
CDC 'Split Type':

Write-up: Child developed an ileocolic intussusception 3/5/07. To surgery on 3/6/07. 04/03/07-records received from facility DC DX: Intussusception. Colicky abdominal pain. No bloody stool. Acute bilious vomiting. Surgical procedure:laparotomy, reduction of intussusception, appendectomy. Post operative diagnosis:ileocolic intussusception.


Changed on 9/14/2017

VAERS ID: 274768 Before After
VAERS Form:(blank) 1
Age:0.65
Gender:Male
Location:Indiana
Vaccinated:2007-03-02
Onset:2007-03-05
Submitted:2007-03-13
Entered:2007-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B092AA / 2 3 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF077AA / 2 3 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B36258C / 2 3 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1109F / 2 3 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Intussusception, Surgery

Life Threatening? Yes
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: Barium enema (+) for partially resolving ileocolic intussusception. Abdominal Survey:no free air is demonstrated. No gas can be seen on right side of abdomen. Findings may be due to mild constipation. Concern for intusssusception. Barium enema. ileocolic intussusception that reduced easily from distal transverse colon to ileoceal valve but was unable to completely reduce the intussusception despite several attempts.
CDC 'Split Type':

Write-up: Child developed an ileocolic intussusception 3/5/07. To surgery on 3/6/07. 04/03/07-records received from facility DC DX: Intussusception. Colicky abdominal pain. No bloody stool. Acute bilious vomiting. Surgical procedure:laparotomy, reduction of intussusception, appendectomy. Post operative diagnosis:ileocolic intussusception.


Changed on 2/14/2018

VAERS ID: 274768 Before After
VAERS Form:1
Age:0.65
Gender:Male
Location:Indiana
Vaccinated:2007-03-02
Onset:2007-03-05
Submitted:2007-03-13
Entered:2007-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B092AA / 3 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF077AA / 3 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B36258C / 3 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1109F / 3 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Intussusception, Surgery

Life Threatening? Yes
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: Barium enema (+) for partially resolving ileocolic intussusception. Abdominal Survey:no free air is demonstrated. No gas can be seen on right side of abdomen. Findings may be due to mild constipation. Concern for intusssusception. Barium enema. ileocolic intussusception that reduced easily from distal transverse colon to ileoceal valve but was unable to completely reduce the intussusception despite several attempts.
CDC 'Split Type':

Write-up: Child developed an ileocolic intussusception 3/5/07. To surgery on 3/6/07. 04/03/07-records received from facility DC DX: Intussusception. Colicky abdominal pain. No bloody stool. Acute bilious vomiting. Surgical procedure:laparotomy, reduction of intussusception, appendectomy. Post operative diagnosis:ileocolic intussusception.


Changed on 6/14/2018

VAERS ID: 274768 Before After
VAERS Form:1
Age:0.65
Gender:Male
Location:Indiana
Vaccinated:2007-03-02
Onset:2007-03-05
Submitted:2007-03-13
Entered:2007-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B092AA / 3 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF077AA / 3 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B36258C / 3 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1109F / 3 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Intussusception, Surgery

Life Threatening? Yes
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: Barium enema (+) for partially resolving ileocolic intussusception. Abdominal Survey:no free air is demonstrated. No gas can be seen on right side of abdomen. Findings may be due to mild constipation. Concern for intusssusception. Barium enema. ileocolic intussusception that reduced easily from distal transverse colon to ileoceal valve but was unable to completely reduce the intussusception despite several attempts.
CDC 'Split Type':

Write-up: Child developed an ileocolic intussusception 3/5/07. To surgery on 3/6/07. 04/03/07-records received from facility DC DX: Intussusception. Colicky abdominal pain. No bloody stool. Acute bilious vomiting. Surgical procedure:laparotomy, reduction of intussusception, appendectomy. Post operative diagnosis:ileocolic intussusception.

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