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This is VAERS ID 279695

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 279695
VAERS Form:
Age:0.3
Gender:Male
Location:New York
Vaccinated:2007-05-04
Onset:2007-05-15
Submitted:2007-05-16
Entered:2007-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B040CA / 1 - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1243F / 1 - / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08670D / 1 - / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 00224 / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal tenderness, Diarrhoea, Abdominal X-ray, Carbon dioxide abnormal

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CO2 = 14 Abd film - air filled loops of distended small bowel.
CDC 'Split Type':

Write-up: Intussusception with vomiting, lethargy


Changed on 12/8/2009

VAERS ID: 279695 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:New York
Vaccinated:2007-05-04
Onset:2007-05-15
Submitted:2007-05-16
Entered:2007-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B040CA / 1 - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1243F / 1 - / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08670D / 1 - / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 00224 / 1 - / PO

Administered by: Private      Purchased by: Unknown Private
Symptoms: Abdominal mass, Abdominal tenderness, Diarrhoea, Full blood count normal, Intussusception, Irritability, Lethargy, Listless, Sick relative, Vomiting, X-ray abnormal, Enema administration, Laboratory test normal, Abdominal X-ray, Oral intake reduced, Carbon dioxide abnormal

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CO2 = 14 Abd film - air filled loops of distended small bowel. LABS: CBC & BMP WNL. Abdominal x-ray revealed IS. Air enema successcully reduced IS.
CDC 'Split Type':

Write-up: Intussusception with vomiting, lethargy lethargy. 6/5/07 Received vax records from PCP which confirms lot & dose # on report. Vax record faxed to CDC. 10/16/07 Received hospital medical records which reveal patient experienced irritability, decreased oral intake, tender abdomen, listlessness, vomiting & nonbloody diarrhea x 1 day. Had sick contact with viral enteritis. Saw pcp who palpated mass in RUQ & sent to ER. Admitted 5/15-5/16/2007 for overnight observation s/p reduction of IS. Progressed well & d/c to home. FINAL DX: ileocecal intussusception, enema reduced. Records faxed to CDC.


Changed on 3/2/2010

VAERS ID: 279695 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:New York
Vaccinated:2007-05-04
Onset:2007-05-15
Submitted:2007-05-16
Entered:2007-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B040CA / 1 - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1243F / 1 - / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B08670D / 1 - / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 00224 / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal mass, Abdominal tenderness, Diarrhoea, Full blood count normal, Intussusception, Irritability, Lethargy, Listless, Sick relative, Vomiting, X-ray abnormal, Enema administration, Laboratory test normal, Abdominal X-ray, Oral intake reduced, Carbon dioxide abnormal

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CO2 = 14 Abd film - air filled loops of distended small bowel. LABS: CBC & BMP WNL. Abdominal x-ray revealed IS. Air enema successcully reduced IS.
CDC 'Split Type':

Write-up: Intussusception with vomiting, lethargy. 6/5/07 Received vax records from PCP which confirms lot & dose # on report. Vax record faxed to CDC. 10/16/07 Received hospital medical records which reveal patient experienced irritability, decreased oral intake, tender abdomen, listlessness, vomiting & nonbloody diarrhea x 1 day. Had sick contact with viral enteritis. Saw pcp who palpated mass in RUQ & sent to ER. Admitted 5/15-5/16/2007 for overnight observation s/p reduction of IS. Progressed well & d/c to home. FINAL DX: ileocecal intussusception, enema reduced. Records faxed to CDC.


Changed on 4/7/2010

VAERS ID: 279695 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:New York
Vaccinated:2007-05-04
Onset:2007-05-15
Submitted:2007-05-16
Entered:2007-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B040CA / 1 - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1243F / 1 - / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08670D / 1 - / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 00224 / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal mass, Abdominal tenderness, Diarrhoea, Full blood count normal, Intussusception, Irritability, Lethargy, Listless, Sick relative, Vomiting, X-ray abnormal, Enema administration, Laboratory test normal, Abdominal X-ray, Oral intake reduced, Carbon dioxide abnormal

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CO2 = 14 Abd film - air filled loops of distended small bowel. LABS: CBC & BMP WNL. Abdominal x-ray revealed IS. Air enema successcully reduced IS.
CDC 'Split Type':

Write-up: Intussusception with vomiting, lethargy. 6/5/07 Received vax records from PCP which confirms lot & dose # on report. Vax record faxed to CDC. 10/16/07 Received hospital medical records which reveal patient experienced irritability, decreased oral intake, tender abdomen, listlessness, vomiting & nonbloody diarrhea x 1 day. Had sick contact with viral enteritis. Saw pcp who palpated mass in RUQ & sent to ER. Admitted 5/15-5/16/2007 for overnight observation s/p reduction of IS. Progressed well & d/c to home. FINAL DX: ileocecal intussusception, enema reduced. Records faxed to CDC.


Changed on 8/31/2010

VAERS ID: 279695 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:New York
Vaccinated:2007-05-04
Onset:2007-05-15
Submitted:2007-05-16
Entered:2007-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B040CA / 1 - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1243F / 1 - / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B08670D / 1 - / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 00224 / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal mass, Abdominal tenderness, Diarrhoea, Full blood count normal, Intussusception, Irritability, Lethargy, Listless, Sick relative, Vomiting, X-ray abnormal, Enema administration, Laboratory test normal, Abdominal X-ray, Oral intake reduced, Carbon dioxide abnormal

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CO2 = 14 Abd film - air filled loops of distended small bowel. LABS: CBC & BMP WNL. Abdominal x-ray revealed IS. Air enema successcully reduced IS.
CDC 'Split Type':

Write-up: Intussusception with vomiting, lethargy. 6/5/07 Received vax records from PCP which confirms lot & dose # on report. Vax record faxed to CDC. 10/16/07 Received hospital medical records which reveal patient experienced irritability, decreased oral intake, tender abdomen, listlessness, vomiting & nonbloody diarrhea x 1 day. Had sick contact with viral enteritis. Saw pcp who palpated mass in RUQ & sent to ER. Admitted 5/15-5/16/2007 for overnight observation s/p reduction of IS. Progressed well & d/c to home. FINAL DX: ileocecal intussusception, enema reduced. Records faxed to CDC.


Changed on 5/13/2013

VAERS ID: 279695 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:New York
Vaccinated:2007-05-04
Onset:2007-05-15
Submitted:2007-05-16
Entered:2007-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B040CA / 1 - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1243F / 1 - / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08670D / 1 - / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 00224 / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 00224 / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal mass, Abdominal tenderness, Diarrhoea, Full blood count normal, Intussusception, Irritability, Lethargy, Listless, Sick relative, Vomiting, X-ray abnormal, Enema administration, Laboratory test normal, Abdominal X-ray, Oral intake reduced, Carbon dioxide abnormal

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CO2 = 14 Abd film - air filled loops of distended small bowel. LABS: CBC & BMP WNL. Abdominal x-ray revealed IS. Air enema successcully reduced IS.
CDC 'Split Type':

Write-up: Intussusception with vomiting, lethargy. 6/5/07 Received vax records from PCP which confirms lot & dose # on report. Vax record faxed to CDC. 10/16/07 Received hospital medical records which reveal patient experienced irritability, decreased oral intake, tender abdomen, listlessness, vomiting & nonbloody diarrhea x 1 day. Had sick contact with viral enteritis. Saw pcp who palpated mass in RUQ & sent to ER. Admitted 5/15-5/16/2007 for overnight observation s/p reduction of IS. Progressed well & d/c to home. FINAL DX: ileocecal intussusception, enema reduced. Records faxed to CDC.


Changed on 5/14/2017

VAERS ID: 279695 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:New York
Vaccinated:2007-05-04
Onset:2007-05-15
Submitted:2007-05-16
Entered:2007-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B040CA / 1 - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1243F / 1 - / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08670D / 1 - / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 00224 / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal mass, Abdominal tenderness, Diarrhoea, Full blood count normal, Intussusception, Irritability, Lethargy, Listless, Sick relative, Vomiting, X-ray abnormal, Enema administration, Laboratory test normal, Abdominal X-ray, Oral intake reduced, Carbon dioxide abnormal

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CO2 = 14 Abd film - air filled loops of distended small bowel. LABS: CBC & BMP WNL. Abdominal x-ray revealed IS. Air enema successcully reduced IS.
CDC 'Split Type':

Write-up: Intussusception with vomiting, lethargy. 6/5/07 Received vax records from PCP which confirms lot & dose # on report. Vax record faxed to CDC. 10/16/07 Received hospital medical records which reveal patient experienced irritability, decreased oral intake, tender abdomen, listlessness, vomiting & nonbloody diarrhea x 1 day. Had sick contact with viral enteritis. Saw pcp who palpated mass in RUQ & sent to ER. Admitted 5/15-5/16/2007 for overnight observation s/p reduction of IS. Progressed well & d/c to home. FINAL DX: ileocecal intussusception, enema reduced. Records faxed to CDC.


Changed on 9/14/2017

VAERS ID: 279695 Before After
VAERS Form:(blank) 1
Age:0.3
Gender:Male
Location:New York
Vaccinated:2007-05-04
Onset:2007-05-15
Submitted:2007-05-16
Entered:2007-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B040CA / 1 2 - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1243F / 1 2 - / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08670D / 1 2 - / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 00224 / 1 2 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception, Lethargy, Vomiting, X-ray abnormal, Abdominal X-ray, Carbon dioxide abnormal

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CO2 = 14 Abd film - air filled loops of distended small bowel. LABS: CBC & BMP WNL. Abdominal x-ray revealed IS. Air enema successcully reduced IS.
CDC 'Split Type':

Write-up: Intussusception with vomiting, lethargy. 6/5/07 Received vax records from PCP which confirms lot & dose # on report. Vax record faxed to CDC. 10/16/07 Received hospital medical records which reveal patient experienced irritability, decreased oral intake, tender abdomen, listlessness, vomiting & nonbloody diarrhea x 1 day. Had sick contact with viral enteritis. Saw pcp who palpated mass in RUQ & sent to ER. Admitted 5/15-5/16/2007 for overnight observation s/p reduction of IS. Progressed well & d/c to home. FINAL DX: ileocecal intussusception, enema reduced. Records faxed to CDC.


Changed on 2/14/2018

VAERS ID: 279695 Before After
VAERS Form:1
Age:0.3
Gender:Male
Location:New York
Vaccinated:2007-05-04
Onset:2007-05-15
Submitted:2007-05-16
Entered:2007-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B040CA / 2 - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1243F / 2 - / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08670D / 2 - / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 00224 / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception, Lethargy, Vomiting, X-ray abnormal, Abdominal X-ray, Carbon dioxide abnormal

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CO2 = 14 Abd film - air filled loops of distended small bowel. LABS: CBC & BMP WNL. Abdominal x-ray revealed IS. Air enema successcully reduced IS.
CDC 'Split Type':

Write-up: Intussusception with vomiting, lethargy. 6/5/07 Received vax records from PCP which confirms lot & dose # on report. Vax record faxed to CDC. 10/16/07 Received hospital medical records which reveal patient experienced irritability, decreased oral intake, tender abdomen, listlessness, vomiting & nonbloody diarrhea x 1 day. Had sick contact with viral enteritis. Saw pcp who palpated mass in RUQ & sent to ER. Admitted 5/15-5/16/2007 for overnight observation s/p reduction of IS. Progressed well & d/c to home. FINAL DX: ileocecal intussusception, enema reduced. Records faxed to CDC.


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