National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 277783

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 277783
VAERS Form:
Age:0.2
Gender:Male
Location:Arizona
Vaccinated:2007-03-08
Onset:2007-04-24
Submitted:2007-05-02
Entered:2007-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B059CA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1272F / 0 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08684D / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1231F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception, Laparotomy

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: April 24, 2007 patient was treated for intersusseption records received 5/15/07-intussusception. exploratory laparotomy.


Changed on 12/8/2009

VAERS ID: 277783 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Arizona
Vaccinated:2007-03-08
Onset:2007-04-24
Submitted:2007-05-02
Entered:2007-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B059CA / 0 LL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B059CA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1272F / 0 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08684D / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1231F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception, Laparotomy

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: April 24, 2007 patient was treated for intersusseption records received 5/15/07-intussusception. exploratory laparotomy.


Changed on 3/2/2010

VAERS ID: 277783 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Arizona
Vaccinated:2007-03-08
Onset:2007-04-24
Submitted:2007-05-02
Entered:2007-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B059CA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1272F / 0 RL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B08684D / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1231F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception, Laparotomy

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: April 24, 2007 patient was treated for intersusseption records received 5/15/07-intussusception. exploratory laparotomy.


Changed on 4/7/2010

VAERS ID: 277783 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Arizona
Vaccinated:2007-03-08
Onset:2007-04-24
Submitted:2007-05-02
Entered:2007-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B059CA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1272F / 0 RL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08684D / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1231F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception, Laparotomy

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: April 24, 2007 patient was treated for intersusseption records received 5/15/07-intussusception. exploratory laparotomy.


Changed on 8/31/2010

VAERS ID: 277783 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Arizona
Vaccinated:2007-03-08
Onset:2007-04-24
Submitted:2007-05-02
Entered:2007-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B059CA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1272F / 0 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B08684D / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1231F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception, Laparotomy

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: April 24, 2007 patient was treated for intersusseption records received 5/15/07-intussusception. exploratory laparotomy.


Changed on 5/13/2013

VAERS ID: 277783 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Arizona
Vaccinated:2007-03-08
Onset:2007-04-24
Submitted:2007-05-02
Entered:2007-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B059CA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1272F / 0 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08684D / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1231F / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1231F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception, Laparotomy

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: April 24, 2007 patient was treated for intersusseption records received 5/15/07-intussusception. exploratory laparotomy.


Changed on 5/14/2017

VAERS ID: 277783 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Arizona
Vaccinated:2007-03-08
Onset:2007-04-24
Submitted:2007-05-02
Entered:2007-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B059CA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1272F / 0 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08684D / 0 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1231F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception, Laparotomy

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: April 24, 2007 patient was treated for intersusseption records received 5/15/07-intussusception. exploratory laparotomy.


Changed on 9/14/2017

VAERS ID: 277783 Before After
VAERS Form:(blank) 1
Age:0.2
Gender:Male
Location:Arizona
Vaccinated:2007-03-08
Onset:2007-04-24
Submitted:2007-05-02
Entered:2007-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B059CA / 0 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1272F / 0 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08684D / 0 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1231F / 0 1 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: April 24, 2007 patient was treated for intersusseption records received 5/15/07-intussusception. exploratory laparotomy.


Changed on 2/14/2018

VAERS ID: 277783 Before After
VAERS Form:1
Age:0.2
Gender:Male
Location:Arizona
Vaccinated:2007-03-08
Onset:2007-04-24
Submitted:2007-05-02
Entered:2007-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B059CA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1272F / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08684D / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1231F / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: April 24, 2007 patient was treated for intersusseption records received 5/15/07-intussusception. exploratory laparotomy.


Changed on 6/14/2018

VAERS ID: 277783 Before After
VAERS Form:1
Age:0.2
Gender:Male
Location:Arizona
Vaccinated:2007-03-08
Onset:2007-04-24
Submitted:2007-05-02
Entered:2007-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B059CA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1272F / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08684D / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1231F / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: April 24, 2007 patient was treated for intersusseption records received 5/15/07-intussusception. exploratory laparotomy.

New Search

Link To This Search Result:

http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=277783&WAYBACKHISTORY=ON


Copyright © 2018 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166