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This is VAERS ID 276539

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 276539
VAERS Form:
Age:0.3
Gender:Male
Location:Vermont
Vaccinated:2007-02-27
Onset:2007-04-08
Submitted:2007-04-10
Entered:2007-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 1 RL / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UF014AA / 1 LL / IM
PPV: PNEUMO (PNU-IMUNE) / LEDERLE LABORATORIES B08674 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Abdominal pain, Abnormal faeces, Barium double contrast, Haematochezia, Explorative laparotomy

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Contrast enema in interventional radiology - intussusception record received 4/26/07-US positive for Intussusception.
CDC 'Split Type':

Write-up: Patient developed abd pain, current jelly stools and diagnosed with intussusception. Not able to reduce via gastrografin enema. Brought to OR for ex-lap. Ileo-cecal intussusception reduced manually. Records received 4/26/07-DC Summary for DOS 4/8-4/10/07"DX:Intussusception. HX of vomiting and bloody stool. Exploratory laparotomy and appendectomy


Changed on 12/8/2009

VAERS ID: 276539 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Vermont
Vaccinated:2007-02-27 2007-02-01
Onset:2007-04-08
Submitted:2007-04-10
Entered:2007-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 1 RL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 1 RL / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR SANOFI PASTEUR UF014AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08674 / 1 LL / IM
PPV: PNEUMO (PNU-IMUNE) / LEDERLE LABORATORIES B08674 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 1 - / PO

Administered by: Private      Purchased by: Unknown Public
Symptoms: Abdominal pain, Abnormal faeces, Barium double contrast, Haematochezia, Intussusception, Surgery, Vomiting, Ultrasound abdomen abnormal, Explorative laparotomy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Contrast enema in interventional radiology - intussusception record received 4/26/07-US positive for Intussusception.
CDC 'Split Type':

Write-up: Patient developed abd pain, current jelly stools and diagnosed with intussusception. Not able to reduce via gastrografin enema. Brought to OR for ex-lap. Ileo-cecal intussusception reduced manually. Records received 4/26/07-DC Summary for DOS 4/8-4/10/07"DX:Intussusception. 4/8-4/10/07 DX:Intussusception. HX of vomiting and bloody stool. Exploratory laparotomy and appendectomy


Changed on 3/2/2010

VAERS ID: 276539 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Vermont
Vaccinated:2007-02-01
Onset:2007-04-08
Submitted:2007-04-10
Entered:2007-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF014AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B08674 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal pain, Abnormal faeces, Barium double contrast, Haematochezia, Intussusception, Surgery, Vomiting, Ultrasound abdomen abnormal, Explorative laparotomy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Contrast enema in interventional radiology - intussusception record received 4/26/07-US positive for Intussusception.
CDC 'Split Type':

Write-up: Patient developed abd pain, current jelly stools and diagnosed with intussusception. Not able to reduce via gastrografin enema. Brought to OR for ex-lap. Ileo-cecal intussusception reduced manually. Records received 4/26/07-DC Summary for DOS 4/8-4/10/07 DX:Intussusception. HX of vomiting and bloody stool. Exploratory laparotomy and appendectomy


Changed on 4/7/2010

VAERS ID: 276539 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Vermont
Vaccinated:2007-02-01
Onset:2007-04-08
Submitted:2007-04-10
Entered:2007-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF014AA / 1 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08674 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal pain, Abnormal faeces, Barium double contrast, Haematochezia, Intussusception, Surgery, Vomiting, Ultrasound abdomen abnormal, Explorative laparotomy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Contrast enema in interventional radiology - intussusception record received 4/26/07-US positive for Intussusception.
CDC 'Split Type':

Write-up: Patient developed abd pain, current jelly stools and diagnosed with intussusception. Not able to reduce via gastrografin enema. Brought to OR for ex-lap. Ileo-cecal intussusception reduced manually. Records received 4/26/07-DC Summary for DOS 4/8-4/10/07 DX:Intussusception. HX of vomiting and bloody stool. Exploratory laparotomy and appendectomy


Changed on 8/31/2010

VAERS ID: 276539 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Vermont
Vaccinated:2007-02-01
Onset:2007-04-08
Submitted:2007-04-10
Entered:2007-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF014AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B08674 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal pain, Abnormal faeces, Barium double contrast, Haematochezia, Intussusception, Surgery, Vomiting, Ultrasound abdomen abnormal, Explorative laparotomy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Contrast enema in interventional radiology - intussusception record received 4/26/07-US positive for Intussusception.
CDC 'Split Type':

Write-up: Patient developed abd pain, current jelly stools and diagnosed with intussusception. Not able to reduce via gastrografin enema. Brought to OR for ex-lap. Ileo-cecal intussusception reduced manually. Records received 4/26/07-DC Summary for DOS 4/8-4/10/07 DX:Intussusception. HX of vomiting and bloody stool. Exploratory laparotomy and appendectomy


Changed on 5/13/2013

VAERS ID: 276539 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Vermont
Vaccinated:2007-02-01
Onset:2007-04-08
Submitted:2007-04-10
Entered:2007-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF014AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08674 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal pain, Abnormal faeces, Barium double contrast, Haematochezia, Intussusception, Surgery, Vomiting, Ultrasound abdomen abnormal, Explorative laparotomy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Contrast enema in interventional radiology - intussusception record received 4/26/07-US positive for Intussusception.
CDC 'Split Type':

Write-up: Patient developed abd pain, current jelly stools and diagnosed with intussusception. Not able to reduce via gastrografin enema. Brought to OR for ex-lap. Ileo-cecal intussusception reduced manually. Records received 4/26/07-DC Summary for DOS 4/8-4/10/07 DX:Intussusception. HX of vomiting and bloody stool. Exploratory laparotomy and appendectomy


Changed on 5/14/2017

VAERS ID: 276539 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Vermont
Vaccinated:2007-02-01
Onset:2007-04-08
Submitted:2007-04-10
Entered:2007-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF014AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08674 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal pain, Abnormal faeces, Barium double contrast, Haematochezia, Intussusception, Surgery, Vomiting, Ultrasound abdomen abnormal, Explorative laparotomy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Contrast enema in interventional radiology - intussusception record received 4/26/07-US positive for Intussusception.
CDC 'Split Type':

Write-up: Patient developed abd pain, current jelly stools and diagnosed with intussusception. Not able to reduce via gastrografin enema. Brought to OR for ex-lap. Ileo-cecal intussusception reduced manually. Records received 4/26/07-DC Summary for DOS 4/8-4/10/07 DX:Intussusception. HX of vomiting and bloody stool. Exploratory laparotomy and appendectomy


Changed on 9/14/2017

VAERS ID: 276539 Before After
VAERS Form:(blank) 1
Age:0.3
Gender:Male
Location:Vermont
Vaccinated:2007-02-01
Onset:2007-04-08
Submitted:2007-04-10
Entered:2007-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 1 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF014AA / 1 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08674 / 1 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 1 2 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal pain, Abnormal faeces, Barium double contrast, Intussusception, Surgery, Explorative laparotomy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Contrast enema in interventional radiology - intussusception record received 4/26/07-US positive for Intussusception.
CDC 'Split Type':

Write-up: Patient developed abd pain, current jelly stools and diagnosed with intussusception. Not able to reduce via gastrografin enema. Brought to OR for ex-lap. Ileo-cecal intussusception reduced manually. Records received 4/26/07-DC Summary for DOS 4/8-4/10/07 DX:Intussusception. HX of vomiting and bloody stool. Exploratory laparotomy and appendectomy


Changed on 2/14/2018

VAERS ID: 276539 Before After
VAERS Form:1
Age:0.3
Gender:Male
Location:Vermont
Vaccinated:2007-02-01
Onset:2007-04-08
Submitted:2007-04-10
Entered:2007-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF014AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08674 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal pain, Abnormal faeces, Barium double contrast, Intussusception, Surgery, Explorative laparotomy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Contrast enema in interventional radiology - intussusception record received 4/26/07-US positive for Intussusception.
CDC 'Split Type':

Write-up: Patient developed abd pain, current jelly stools and diagnosed with intussusception. Not able to reduce via gastrografin enema. Brought to OR for ex-lap. Ileo-cecal intussusception reduced manually. Records received 4/26/07-DC Summary for DOS 4/8-4/10/07 DX:Intussusception. HX of vomiting and bloody stool. Exploratory laparotomy and appendectomy


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