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This is VAERS ID 278583

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

278583
VAERS Form:
Age:0.8
Gender:Male
Location:Colorado
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2007-05-07
Entered:2007-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 2 - / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF011AA / 2 - / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08670E / 2 - / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1082F / 2 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Barium double contrast, Dehydration, Intussusception, Decreased appetite

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: Air enema diagnosed and reduced obstruction
CDC 'Split Type':

Write-up:Vomiting, dehydration, had intussusception reduced with air enema.


Changed on 12/8/2009

278583 Before After
VAERS Form:
Age:0.8
Gender:Male
Location:Colorado
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2007-05-07
Entered:2007-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 2 - / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 2 - / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF011AA / 2 - / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08670E / 2 - / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1082F / 2 - / PO

Administered by: Private      Purchased by: Unknown Other
Symptoms: Barium double contrast, Dehydration, Intussusception, Somnolence, Vomiting, Decreased appetite

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: Air enema diagnosed and reduced obstruction records received 6/20/07-air enema reduction
CDC 'Split Type':

Write-up:Vomiting, dehydration, had intussusception reduced with air enema. 06/20/07-records received for DOS 4/28-4/29/07-Impression:Ileocolic Intussusception status post air enema reduction. Complaint of vomiting for 7 hours and has vomited 4 times day of admission. No diarrhea. No abdominal pain. Returned to ER with 2 days of vomiting and decreased PO intake. Sleepy, decreased response level.


Changed on 3/2/2010

278583 Before After
VAERS Form:
Age:0.8
Gender:Male
Location:Colorado
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2007-05-07
Entered:2007-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 2 - / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF011AA / 2 - / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B08670E / 2 - / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1082F / 2 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Barium double contrast, Dehydration, Intussusception, Somnolence, Vomiting, Decreased appetite

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: Air enema diagnosed and reduced obstruction records received 6/20/07-air enema reduction
CDC 'Split Type':

Write-up:Vomiting, dehydration, had intussusception reduced with air enema. 06/20/07-records received for DOS 4/28-4/29/07-Impression:Ileocolic Intussusception status post air enema reduction. Complaint of vomiting for 7 hours and has vomited 4 times day of admission. No diarrhea. No abdominal pain. Returned to ER with 2 days of vomiting and decreased PO intake. Sleepy, decreased response level.


Changed on 4/7/2010

278583 Before After
VAERS Form:
Age:0.8
Gender:Male
Location:Colorado
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2007-05-07
Entered:2007-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 2 - / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF011AA / 2 - / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08670E / 2 - / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1082F / 2 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Barium double contrast, Dehydration, Intussusception, Somnolence, Vomiting, Decreased appetite

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: Air enema diagnosed and reduced obstruction records received 6/20/07-air enema reduction
CDC 'Split Type':

Write-up:Vomiting, dehydration, had intussusception reduced with air enema. 06/20/07-records received for DOS 4/28-4/29/07-Impression:Ileocolic Intussusception status post air enema reduction. Complaint of vomiting for 7 hours and has vomited 4 times day of admission. No diarrhea. No abdominal pain. Returned to ER with 2 days of vomiting and decreased PO intake. Sleepy, decreased response level.


Changed on 8/31/2010

278583 Before After
VAERS Form:
Age:0.8
Gender:Male
Location:Colorado
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2007-05-07
Entered:2007-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 2 - / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF011AA / 2 - / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B08670E / 2 - / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1082F / 2 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Barium double contrast, Dehydration, Intussusception, Somnolence, Vomiting, Decreased appetite

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: Air enema diagnosed and reduced obstruction records received 6/20/07-air enema reduction
CDC 'Split Type':

Write-up:Vomiting, dehydration, had intussusception reduced with air enema. 06/20/07-records received for DOS 4/28-4/29/07-Impression:Ileocolic Intussusception status post air enema reduction. Complaint of vomiting for 7 hours and has vomited 4 times day of admission. No diarrhea. No abdominal pain. Returned to ER with 2 days of vomiting and decreased PO intake. Sleepy, decreased response level.


Changed on 5/13/2013

278583 Before After
VAERS Form:
Age:0.8
Gender:Male
Location:Colorado
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2007-05-07
Entered:2007-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 2 - / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF011AA / 2 - / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08670E / 2 - / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1082F / 2 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1082F / 2 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Barium double contrast, Dehydration, Intussusception, Somnolence, Vomiting, Decreased appetite

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: Air enema diagnosed and reduced obstruction records received 6/20/07-air enema reduction
CDC 'Split Type':

Write-up:Vomiting, dehydration, had intussusception reduced with air enema. 06/20/07-records received for DOS 4/28-4/29/07-Impression:Ileocolic Intussusception status post air enema reduction. Complaint of vomiting for 7 hours and has vomited 4 times day of admission. No diarrhea. No abdominal pain. Returned to ER with 2 days of vomiting and decreased PO intake. Sleepy, decreased response level.


Changed on 2/14/2017

278583 Before After
VAERS Form:
Age:0.8 0.83
Gender:Male
Location:Colorado
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2007-05-07
Entered:2007-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 2 - / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF011AA / 2 - / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08670E / 2 - / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1082F / 2 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Barium double contrast, Dehydration, Intussusception, Somnolence, Vomiting, Decreased appetite

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: Air enema diagnosed and reduced obstruction records received 6/20/07-air enema reduction
CDC 'Split Type':

Write-up:Vomiting, dehydration, had intussusception reduced with air enema. 06/20/07-records received for DOS 4/28-4/29/07-Impression:Ileocolic Intussusception status post air enema reduction. Complaint of vomiting for 7 hours and has vomited 4 times day of admission. No diarrhea. No abdominal pain. Returned to ER with 2 days of vomiting and decreased PO intake. Sleepy, decreased response level.


Changed on 9/14/2017

278583 Before After
VAERS Form:(blank) 1
Age:0.83
Gender:Male
Location:Colorado
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2007-05-07
Entered:2007-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 2 3 - / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF011AA / 2 3 - / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08670E / 2 3 - / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1082F / 2 3 - MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Barium double contrast, Dehydration, Intussusception, Vomiting

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: Air enema diagnosed and reduced obstruction records received 6/20/07-air enema reduction
CDC 'Split Type':

Write-up:Vomiting, dehydration, had intussusception reduced with air enema. 06/20/07-records received for DOS 4/28-4/29/07-Impression:Ileocolic Intussusception status post air enema reduction. Complaint of vomiting for 7 hours and has vomited 4 times day of admission. No diarrhea. No abdominal pain. Returned to ER with 2 days of vomiting and decreased PO intake. Sleepy, decreased response level.


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