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This is VAERS ID 278694

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

278694
VAERS Form:
Age:0.4
Gender:Female
Location:Michigan
Vaccinated:2007-03-22
Onset:2007-05-06
Submitted:2007-05-08
Entered:2007-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084CA / 1 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0062U / 1 LL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08646C / 1 LL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1235F / 2 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Barium enema, Haematochezia, Intussusception, Pain

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tobrex eye drops 11/15
Current Illness: Only dacryostenosis
Preexisting Conditions: Neonatal jaundice, dacryostenosis, cystitis, umbilical hernia
Allergies:
Diagnostic Lab Data: Barium enema
CDC 'Split Type':

Write-up:Patient was hospitalized for two days for bowel intussusception and pain (proven by barium enema). Patient had bloody bowel movement and pain.


Changed on 12/8/2009

278694 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Michigan
Vaccinated:2007-03-22
Onset:2007-05-06
Submitted:2007-05-08
Entered:2007-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084CA / 1 RL / -
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084CA / 1 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0062U / 1 LL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08646C / 1 LL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1235F / 2 - / PO

Administered by: Private      Purchased by: Unknown Private
Symptoms: Barium enema, Haematochezia, Intussusception, Pain, Vomiting

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tobrex eye drops 11/15
Current Illness: Only dacryostenosis
Preexisting Conditions: Neonatal jaundice, dacryostenosis, cystitis, umbilical hernia
Allergies:
Diagnostic Lab Data: Barium enema
CDC 'Split Type':

Write-up:Patient was hospitalized for two days for bowel intussusception and pain (proven by barium enema). Patient had bloody bowel movement and pain. 06/12/07-DC Summary received for DOS 5/6-5/7/07-DC DX:Ileocolic Intussusception. S/P Barium Enema Reduction. Two day history vomiting and subsequent bloody stools


Changed on 3/2/2010

278694 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Michigan
Vaccinated:2007-03-22
Onset:2007-05-06
Submitted:2007-05-08
Entered:2007-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084CA / 1 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0062U / 1 LL / -
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B08646C / 1 LL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1235F / 2 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Haematochezia, Intussusception, Pain, Vomiting

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tobrex eye drops 11/15
Current Illness: Only dacryostenosis
Preexisting Conditions: Neonatal jaundice, dacryostenosis, cystitis, umbilical hernia
Allergies:
Diagnostic Lab Data: Barium enema
CDC 'Split Type':

Write-up:Patient was hospitalized for two days for bowel intussusception and pain (proven by barium enema). Patient had bloody bowel movement and pain. 06/12/07-DC Summary received for DOS 5/6-5/7/07-DC DX:Ileocolic Intussusception. S/P Barium Enema Reduction. Two day history vomiting and subsequent bloody stools


Changed on 4/7/2010

278694 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Michigan
Vaccinated:2007-03-22
Onset:2007-05-06
Submitted:2007-05-08
Entered:2007-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084CA / 1 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0062U / 1 LL / -
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08646C / 1 LL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1235F / 2 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Haematochezia, Intussusception, Pain, Vomiting

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tobrex eye drops 11/15
Current Illness: Only dacryostenosis
Preexisting Conditions: Neonatal jaundice, dacryostenosis, cystitis, umbilical hernia
Allergies:
Diagnostic Lab Data: Barium enema
CDC 'Split Type':

Write-up:Patient was hospitalized for two days for bowel intussusception and pain (proven by barium enema). Patient had bloody bowel movement and pain. 06/12/07-DC Summary received for DOS 5/6-5/7/07-DC DX:Ileocolic Intussusception. S/P Barium Enema Reduction. Two day history vomiting and subsequent bloody stools


Changed on 8/31/2010

278694 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Michigan
Vaccinated:2007-03-22
Onset:2007-05-06
Submitted:2007-05-08
Entered:2007-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084CA / 1 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0062U / 1 LL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B08646C / 1 LL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1235F / 2 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Haematochezia, Intussusception, Pain, Vomiting

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tobrex eye drops 11/15
Current Illness: Only dacryostenosis
Preexisting Conditions: Neonatal jaundice, dacryostenosis, cystitis, umbilical hernia
Allergies:
Diagnostic Lab Data: Barium enema
CDC 'Split Type':

Write-up:Patient was hospitalized for two days for bowel intussusception and pain (proven by barium enema). Patient had bloody bowel movement and pain. 06/12/07-DC Summary received for DOS 5/6-5/7/07-DC DX:Ileocolic Intussusception. S/P Barium Enema Reduction. Two day history vomiting and subsequent bloody stools


Changed on 5/13/2013

278694 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Michigan
Vaccinated:2007-03-22
Onset:2007-05-06
Submitted:2007-05-08
Entered:2007-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084CA / 1 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0062U / 1 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08646C / 1 LL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1235F / 2 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1235F / 2 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Haematochezia, Intussusception, Pain, Vomiting

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tobrex eye drops 11/15
Current Illness: Only dacryostenosis
Preexisting Conditions: Neonatal jaundice, dacryostenosis, cystitis, umbilical hernia
Allergies:
Diagnostic Lab Data: Barium enema
CDC 'Split Type':

Write-up:Patient was hospitalized for two days for bowel intussusception and pain (proven by barium enema). Patient had bloody bowel movement and pain. 06/12/07-DC Summary received for DOS 5/6-5/7/07-DC DX:Ileocolic Intussusception. S/P Barium Enema Reduction. Two day history vomiting and subsequent bloody stools


Changed on 2/14/2017

278694 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Michigan
Vaccinated:2007-03-22
Onset:2007-05-06
Submitted:2007-05-08
Entered:2007-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084CA / 1 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0062U / 1 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08646C / 1 LL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1235F / 2 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Haematochezia, Intussusception, Pain, Vomiting

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tobrex eye drops 11/15
Current Illness: Only dacryostenosis
Preexisting Conditions: Neonatal jaundice, dacryostenosis, cystitis, umbilical hernia
Allergies:
Diagnostic Lab Data: Barium enema
CDC 'Split Type':

Write-up:Patient was hospitalized for two days for bowel intussusception and pain (proven by barium enema). Patient had bloody bowel movement and pain. 06/12/07-DC Summary received for DOS 5/6-5/7/07-DC DX:Ileocolic Intussusception. S/P Barium Enema Reduction. Two day history vomiting and subsequent bloody stools


Changed on 9/14/2017

278694 Before After
VAERS Form:(blank) 1
Age:0.4
Gender:Female
Location:Michigan
Vaccinated:2007-03-22
Onset:2007-05-06
Submitted:2007-05-08
Entered:2007-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084CA / 1 2 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0062U / 1 2 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08646C / 1 2 LL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1235F / 2 3 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Haematochezia, Intussusception, Pain

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tobrex eye drops 11/15
Current Illness: Only dacryostenosis
Preexisting Conditions: Neonatal jaundice, dacryostenosis, cystitis, umbilical hernia
Allergies:
Diagnostic Lab Data: Barium enema
CDC 'Split Type':

Write-up:Patient was hospitalized for two days for bowel intussusception and pain (proven by barium enema). Patient had bloody bowel movement and pain. 06/12/07-DC Summary received for DOS 5/6-5/7/07-DC DX:Ileocolic Intussusception. S/P Barium Enema Reduction. Two day history vomiting and subsequent bloody stools


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