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This is VAERS ID 278716

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 278716
VAERS Form:
Age:0.6
Gender:Male
Location:Oklahoma
Vaccinated:2007-05-14
Onset:2007-05-15
Submitted:2007-05-16
Entered:2007-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B090BA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08690B / 3 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1232F / 3 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood culture negative, Carbon dioxide decreased, Diarrhoea, Band neutrophil count increased, Abdominal X-ray

Life Threatening? No
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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abdominal X-ray, air insufflation enema.
CDC 'Split Type':

Write-up: Fever, diarrhea, diagnosis of intussusception.


Changed on 12/8/2009

VAERS ID: 278716 Before After
VAERS Form:
Age:0.6
Gender:Male
Location:Oklahoma
Vaccinated:2007-05-14
Onset:2007-05-15
Submitted:2007-05-16
Entered:2007-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B090BA / 3 LL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B090BA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08690B / 3 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1232F / 3 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood culture negative, Carbon dioxide decreased, Diarrhoea, Full blood count normal, Haematochezia, Intussusception, Lymphocyte count decreased, Pyrexia, Ultrasound kidney normal, Urinary tract infection, Vomiting, Enema administration, Band neutrophil count increased, Neutrophil percentage increased, Abdominal X-ray

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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abdominal X-ray, air insufflation enema. LABS: Blood c/s neg. Renal US was WNL. WBC WNL, segs elevated at 43, bands elevated at 27 & lymphs low at 24. CO2 low at 17 on admit
CDC 'Split Type':

Write-up: Fever, diarrhea, diagnosis of intussusception. 6/1/07 Received vax record from CDC. VAERS database updated. 8/7/07 Received hospital medical records which reveal patient experienced fever, vomiting & bloody stools. Abdominal x-ray in ER revealed IS. Admitted 5/15-5/18/07 & IS reduced by gastrograffin enema. Also diagnosed w/UTI. Progressed well & d/c to home on oral antibiotics for UTI. FINAL DX: Intussusception, s/p reduction by enema; fever; & UTI.


Changed on 3/2/2010

VAERS ID: 278716 Before After
VAERS Form:
Age:0.6
Gender:Male
Location:Oklahoma
Vaccinated:2007-05-14
Onset:2007-05-15
Submitted:2007-05-16
Entered:2007-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B090BA / 3 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B08690B / 3 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1232F / 3 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood culture negative, Carbon dioxide decreased, Diarrhoea, Full blood count normal, Haematochezia, Intussusception, Lymphocyte count decreased, Pyrexia, Ultrasound kidney normal, Urinary tract infection, Vomiting, Enema administration, Band neutrophil count increased, Neutrophil percentage increased, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abdominal X-ray, air insufflation enema. LABS: Blood c/s neg. Renal US was WNL. WBC WNL, segs elevated at 43, bands elevated at 27 & lymphs low at 24. CO2 low at 17 on admit
CDC 'Split Type':

Write-up: Fever, diarrhea, diagnosis of intussusception. 6/1/07 Received vax record from CDC. VAERS database updated. 8/7/07 Received hospital medical records which reveal patient experienced fever, vomiting & bloody stools. Abdominal x-ray in ER revealed IS. Admitted 5/15-5/18/07 & IS reduced by gastrograffin enema. Also diagnosed w/UTI. Progressed well & d/c to home on oral antibiotics for UTI. FINAL DX: Intussusception, s/p reduction by enema; fever; & UTI.


Changed on 4/7/2010

VAERS ID: 278716 Before After
VAERS Form:
Age:0.6
Gender:Male
Location:Oklahoma
Vaccinated:2007-05-14
Onset:2007-05-15
Submitted:2007-05-16
Entered:2007-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B090BA / 3 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08690B / 3 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1232F / 3 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood culture negative, Carbon dioxide decreased, Diarrhoea, Full blood count normal, Haematochezia, Intussusception, Lymphocyte count decreased, Pyrexia, Ultrasound kidney normal, Urinary tract infection, Vomiting, Enema administration, Band neutrophil count increased, Neutrophil percentage increased, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abdominal X-ray, air insufflation enema. LABS: Blood c/s neg. Renal US was WNL. WBC WNL, segs elevated at 43, bands elevated at 27 & lymphs low at 24. CO2 low at 17 on admit
CDC 'Split Type':

Write-up: Fever, diarrhea, diagnosis of intussusception. 6/1/07 Received vax record from CDC. VAERS database updated. 8/7/07 Received hospital medical records which reveal patient experienced fever, vomiting & bloody stools. Abdominal x-ray in ER revealed IS. Admitted 5/15-5/18/07 & IS reduced by gastrograffin enema. Also diagnosed w/UTI. Progressed well & d/c to home on oral antibiotics for UTI. FINAL DX: Intussusception, s/p reduction by enema; fever; & UTI.


Changed on 8/31/2010

VAERS ID: 278716 Before After
VAERS Form:
Age:0.6
Gender:Male
Location:Oklahoma
Vaccinated:2007-05-14
Onset:2007-05-15
Submitted:2007-05-16
Entered:2007-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B090BA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B08690B / 3 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1232F / 3 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood culture negative, Carbon dioxide decreased, Diarrhoea, Full blood count normal, Haematochezia, Intussusception, Lymphocyte count decreased, Pyrexia, Ultrasound kidney normal, Urinary tract infection, Vomiting, Enema administration, Band neutrophil count increased, Neutrophil percentage increased, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abdominal X-ray, air insufflation enema. LABS: Blood c/s neg. Renal US was WNL. WBC WNL, segs elevated at 43, bands elevated at 27 & lymphs low at 24. CO2 low at 17 on admit
CDC 'Split Type':

Write-up: Fever, diarrhea, diagnosis of intussusception. 6/1/07 Received vax record from CDC. VAERS database updated. 8/7/07 Received hospital medical records which reveal patient experienced fever, vomiting & bloody stools. Abdominal x-ray in ER revealed IS. Admitted 5/15-5/18/07 & IS reduced by gastrograffin enema. Also diagnosed w/UTI. Progressed well & d/c to home on oral antibiotics for UTI. FINAL DX: Intussusception, s/p reduction by enema; fever; & UTI.


Changed on 5/13/2013

VAERS ID: 278716 Before After
VAERS Form:
Age:0.6
Gender:Male
Location:Oklahoma
Vaccinated:2007-05-14
Onset:2007-05-15
Submitted:2007-05-16
Entered:2007-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B090BA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08690B / 3 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1232F / 3 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1232F / 3 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood culture negative, Carbon dioxide decreased, Diarrhoea, Full blood count normal, Haematochezia, Intussusception, Lymphocyte count decreased, Pyrexia, Ultrasound kidney normal, Urinary tract infection, Vomiting, Enema administration, Band neutrophil count increased, Neutrophil percentage increased, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abdominal X-ray, air insufflation enema. LABS: Blood c/s neg. Renal US was WNL. WBC WNL, segs elevated at 43, bands elevated at 27 & lymphs low at 24. CO2 low at 17 on admit
CDC 'Split Type':

Write-up: Fever, diarrhea, diagnosis of intussusception. 6/1/07 Received vax record from CDC. VAERS database updated. 8/7/07 Received hospital medical records which reveal patient experienced fever, vomiting & bloody stools. Abdominal x-ray in ER revealed IS. Admitted 5/15-5/18/07 & IS reduced by gastrograffin enema. Also diagnosed w/UTI. Progressed well & d/c to home on oral antibiotics for UTI. FINAL DX: Intussusception, s/p reduction by enema; fever; & UTI.


Changed on 5/14/2017

VAERS ID: 278716 Before After
VAERS Form:
Age:0.6
Gender:Male
Location:Oklahoma
Vaccinated:2007-05-14
Onset:2007-05-15
Submitted:2007-05-16
Entered:2007-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B090BA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08690B / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1232F / 3 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood culture negative, Carbon dioxide decreased, Diarrhoea, Full blood count normal, Haematochezia, Intussusception, Lymphocyte count decreased, Pyrexia, Ultrasound kidney normal, Urinary tract infection, Vomiting, Enema administration, Band neutrophil count increased, Neutrophil percentage increased, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abdominal X-ray, air insufflation enema. LABS: Blood c/s neg. Renal US was WNL. WBC WNL, segs elevated at 43, bands elevated at 27 & lymphs low at 24. CO2 low at 17 on admit
CDC 'Split Type':

Write-up: Fever, diarrhea, diagnosis of intussusception. 6/1/07 Received vax record from CDC. VAERS database updated. 8/7/07 Received hospital medical records which reveal patient experienced fever, vomiting & bloody stools. Abdominal x-ray in ER revealed IS. Admitted 5/15-5/18/07 & IS reduced by gastrograffin enema. Also diagnosed w/UTI. Progressed well & d/c to home on oral antibiotics for UTI. FINAL DX: Intussusception, s/p reduction by enema; fever; & UTI.


Changed on 9/14/2017

VAERS ID: 278716 Before After
VAERS Form:(blank) 1
Age:0.6
Gender:Male
Location:Oklahoma
Vaccinated:2007-05-14
Onset:2007-05-15
Submitted:2007-05-16
Entered:2007-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B090BA / 3 4 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08690B / 3 4 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1232F / 3 4 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diarrhoea, Intussusception, Pyrexia, Enema administration, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abdominal X-ray, air insufflation enema. LABS: Blood c/s neg. Renal US was WNL. WBC WNL, segs elevated at 43, bands elevated at 27 & lymphs low at 24. CO2 low at 17 on admit
CDC 'Split Type':

Write-up: Fever, diarrhea, diagnosis of intussusception. 6/1/07 Received vax record from CDC. VAERS database updated. 8/7/07 Received hospital medical records which reveal patient experienced fever, vomiting & bloody stools. Abdominal x-ray in ER revealed IS. Admitted 5/15-5/18/07 & IS reduced by gastrograffin enema. Also diagnosed w/UTI. Progressed well & d/c to home on oral antibiotics for UTI. FINAL DX: Intussusception, s/p reduction by enema; fever; & UTI.


Changed on 2/14/2018

VAERS ID: 278716 Before After
VAERS Form:1
Age:0.6
Gender:Male
Location:Oklahoma
Vaccinated:2007-05-14
Onset:2007-05-15
Submitted:2007-05-16
Entered:2007-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B090BA / 4 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08690B / 4 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1232F / 4 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diarrhoea, Intussusception, Pyrexia, Enema administration, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abdominal X-ray, air insufflation enema. LABS: Blood c/s neg. Renal US was WNL. WBC WNL, segs elevated at 43, bands elevated at 27 & lymphs low at 24. CO2 low at 17 on admit
CDC 'Split Type':

Write-up: Fever, diarrhea, diagnosis of intussusception. 6/1/07 Received vax record from CDC. VAERS database updated. 8/7/07 Received hospital medical records which reveal patient experienced fever, vomiting & bloody stools. Abdominal x-ray in ER revealed IS. Admitted 5/15-5/18/07 & IS reduced by gastrograffin enema. Also diagnosed w/UTI. Progressed well & d/c to home on oral antibiotics for UTI. FINAL DX: Intussusception, s/p reduction by enema; fever; & UTI.


Changed on 6/14/2018

VAERS ID: 278716 Before After
VAERS Form:1
Age:0.6
Gender:Male
Location:Oklahoma
Vaccinated:2007-05-14
Onset:2007-05-15
Submitted:2007-05-16
Entered:2007-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B090BA / 4 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08690B / 4 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1232F / 4 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diarrhoea, Intussusception, Pyrexia, Enema administration, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abdominal X-ray, air insufflation enema. LABS: Blood c/s neg. Renal US was WNL. WBC WNL, segs elevated at 43, bands elevated at 27 & lymphs low at 24. CO2 low at 17 on admit
CDC 'Split Type':

Write-up: Fever, diarrhea, diagnosis of intussusception. 6/1/07 Received vax record from CDC. VAERS database updated. 8/7/07 Received hospital medical records which reveal patient experienced fever, vomiting & bloody stools. Abdominal x-ray in ER revealed IS. Admitted 5/15-5/18/07 & IS reduced by gastrograffin enema. Also diagnosed w/UTI. Progressed well & d/c to home on oral antibiotics for UTI. FINAL DX: Intussusception, s/p reduction by enema; fever; & UTI.

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