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This is VAERS ID 280397

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 280397
VAERS Form:
Age:0.5
Gender:Male
Location:North Carolina
Vaccinated:2007-03-03
Onset:2007-05-18
Submitted:2007-05-29
Entered:2007-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B069AA / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1160R / 2 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08658E / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0980F / 3 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Abdominal pain, Barium enema, Chest X-ray, Chest X-ray normal, Culture stool negative

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: Asthma, Undescended testicle, umbilical hernia. NKDA.
Allergies:
Diagnostic Lab Data: CBC, Chemistry, Barium enema reduction, Chest X-Ray. Labs and Diagnostics: Infant had a Barium Enema which was (+) for Intussusception which was reduced per radiologist. CXR (-). Stool cx (-) E. coli, Salmonella, Shigella, and Campylobact
CDC 'Split Type':

Write-up: Present to healthcare system on 5-19-07 with Abdominal pain. Pt had a bloody mucus stool during ER visit. Barium enema study was positive for intussusception-Was Reduced and observed overnight. 06/11/2007 MR received for o/n hospitalization 5/19-20/2007"for Intussusception. Infant developed intermittant acute abdominal pain on 5/18/2007. Pain continued and on 5/19/07 infant passed a large bloody, mucusy, stool in the ED. Intussusception which was reduced per radiologist by air contrast Barium Enema. DX:


Changed on 12/8/2009

VAERS ID: 280397 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:North Carolina
Vaccinated:2007-03-03
Onset:2007-05-18
Submitted:2007-05-29
Entered:2007-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B069AA / 2 RL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B069AA / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1160R / 2 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08658E / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0980F / 3 - / PO

Administered by: Private      Purchased by: Unknown Public
Symptoms: Abdominal pain, Barium enema, Chest X-ray, Chest X-ray normal, Culture stool negative, Full blood count, Haematochezia, Intussusception, Mucous stools, Parasite stool test negative, Laboratory test

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: Asthma, Undescended testicle, umbilical hernia. NKDA.
Allergies:
Diagnostic Lab Data: CBC, Chemistry, Barium enema reduction, Chest X-Ray. Labs and Diagnostics: Infant had a Barium Enema which was (+) for Intussusception which was reduced per radiologist. CXR (-). Stool cx (-) E. coli, Salmonella, Shigella, and Campylobact
CDC 'Split Type': (blank) NC07054

Write-up: Present to healthcare system on 5-19-07 with Abdominal pain. Pt had a bloody mucus stool during ER visit. Barium enema study was positive for intussusception-Was Reduced and observed overnight. 06/11/2007 MR received for o/n hospitalization 5/19-20/2007"for 5/19-20/2007 for Intussusception. Infant developed intermittant acute abdominal pain on 5/18/2007. Pain continued and on 5/19/07 infant passed a large bloody, mucusy, stool in the ED. Intussusception which was reduced per radiologist by air contrast Barium Enema. DX: Intussusception-reduced.


Changed on 3/2/2010

VAERS ID: 280397 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:North Carolina
Vaccinated:2007-03-03
Onset:2007-05-18
Submitted:2007-05-29
Entered:2007-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B069AA / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1160R / 2 RL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B08658E / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0980F / 3 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal pain, Barium enema, Chest X-ray, Chest X-ray normal, Culture stool negative, Full blood count, Haematochezia, Intussusception, Mucous stools, Parasite stool test negative, Laboratory test

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: Asthma, Undescended testicle, umbilical hernia. NKDA.
Allergies:
Diagnostic Lab Data: CBC, Chemistry, Barium enema reduction, Chest X-Ray. Labs and Diagnostics: Infant had a Barium Enema which was (+) for Intussusception which was reduced per radiologist. CXR (-). Stool cx (-) E. coli, Salmonella, Shigella, and Campylobact
CDC 'Split Type': NC07054

Write-up: Present to healthcare system on 5-19-07 with Abdominal pain. Pt had a bloody mucus stool during ER visit. Barium enema study was positive for intussusception-Was Reduced and observed overnight. 06/11/2007 MR received for o/n hospitalization 5/19-20/2007 for Intussusception. Infant developed intermittant acute abdominal pain on 5/18/2007. Pain continued and on 5/19/07 infant passed a large bloody, mucusy, stool in the ED. Intussusception which was reduced per radiologist by air contrast Barium Enema. DX: Intussusception-reduced.


Changed on 4/7/2010

VAERS ID: 280397 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:North Carolina
Vaccinated:2007-03-03
Onset:2007-05-18
Submitted:2007-05-29
Entered:2007-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B069AA / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1160R / 2 RL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08658E / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0980F / 3 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal pain, Barium enema, Chest X-ray, Chest X-ray normal, Culture stool negative, Full blood count, Haematochezia, Intussusception, Mucous stools, Parasite stool test negative, Laboratory test

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: Asthma, Undescended testicle, umbilical hernia. NKDA.
Allergies:
Diagnostic Lab Data: CBC, Chemistry, Barium enema reduction, Chest X-Ray. Labs and Diagnostics: Infant had a Barium Enema which was (+) for Intussusception which was reduced per radiologist. CXR (-). Stool cx (-) E. coli, Salmonella, Shigella, and Campylobact
CDC 'Split Type': NC07054

Write-up: Present to healthcare system on 5-19-07 with Abdominal pain. Pt had a bloody mucus stool during ER visit. Barium enema study was positive for intussusception-Was Reduced and observed overnight. 06/11/2007 MR received for o/n hospitalization 5/19-20/2007 for Intussusception. Infant developed intermittant acute abdominal pain on 5/18/2007. Pain continued and on 5/19/07 infant passed a large bloody, mucusy, stool in the ED. Intussusception which was reduced per radiologist by air contrast Barium Enema. DX: Intussusception-reduced.


Changed on 8/31/2010

VAERS ID: 280397 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:North Carolina
Vaccinated:2007-03-03
Onset:2007-05-18
Submitted:2007-05-29
Entered:2007-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B069AA / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1160R / 2 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B08658E / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0980F / 3 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal pain, Barium enema, Chest X-ray, Chest X-ray normal, Culture stool negative, Full blood count, Haematochezia, Intussusception, Mucous stools, Parasite stool test negative, Laboratory test

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: Asthma, Undescended testicle, umbilical hernia. NKDA.
Allergies:
Diagnostic Lab Data: CBC, Chemistry, Barium enema reduction, Chest X-Ray. Labs and Diagnostics: Infant had a Barium Enema which was (+) for Intussusception which was reduced per radiologist. CXR (-). Stool cx (-) E. coli, Salmonella, Shigella, and Campylobact
CDC 'Split Type': NC07054

Write-up: Present to healthcare system on 5-19-07 with Abdominal pain. Pt had a bloody mucus stool during ER visit. Barium enema study was positive for intussusception-Was Reduced and observed overnight. 06/11/2007 MR received for o/n hospitalization 5/19-20/2007 for Intussusception. Infant developed intermittant acute abdominal pain on 5/18/2007. Pain continued and on 5/19/07 infant passed a large bloody, mucusy, stool in the ED. Intussusception which was reduced per radiologist by air contrast Barium Enema. DX: Intussusception-reduced.


Changed on 5/13/2013

VAERS ID: 280397 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:North Carolina
Vaccinated:2007-03-03
Onset:2007-05-18
Submitted:2007-05-29
Entered:2007-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B069AA / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1160R / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08658E / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0980F / 3 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0980F / 3 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal pain, Barium enema, Chest X-ray, Chest X-ray normal, Culture stool negative, Full blood count, Haematochezia, Intussusception, Mucous stools, Parasite stool test negative, Laboratory test

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: Asthma, Undescended testicle, umbilical hernia. NKDA.
Allergies:
Diagnostic Lab Data: CBC, Chemistry, Barium enema reduction, Chest X-Ray. Labs and Diagnostics: Infant had a Barium Enema which was (+) for Intussusception which was reduced per radiologist. CXR (-). Stool cx (-) E. coli, Salmonella, Shigella, and Campylobact
CDC 'Split Type': NC07054

Write-up: Present to healthcare system on 5-19-07 with Abdominal pain. Pt had a bloody mucus stool during ER visit. Barium enema study was positive for intussusception-Was Reduced and observed overnight. 06/11/2007 MR received for o/n hospitalization 5/19-20/2007 for Intussusception. Infant developed intermittant acute abdominal pain on 5/18/2007. Pain continued and on 5/19/07 infant passed a large bloody, mucusy, stool in the ED. Intussusception which was reduced per radiologist by air contrast Barium Enema. DX: Intussusception-reduced.


Changed on 2/14/2017

VAERS ID: 280397 Before After
VAERS Form:
Age:0.5 0.53
Gender:Male
Location:North Carolina
Vaccinated:2007-03-03
Onset:2007-05-18
Submitted:2007-05-29
Entered:2007-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B069AA / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1160R / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08658E / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0980F / 3 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal pain, Barium enema, Chest X-ray, Chest X-ray normal, Culture stool negative, Full blood count, Haematochezia, Intussusception, Mucous stools, Parasite stool test negative, Laboratory test

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: Asthma, Undescended testicle, umbilical hernia. NKDA.
Allergies:
Diagnostic Lab Data: CBC, Chemistry, Barium enema reduction, Chest X-Ray. Labs and Diagnostics: Infant had a Barium Enema which was (+) for Intussusception which was reduced per radiologist. CXR (-). Stool cx (-) E. coli, Salmonella, Shigella, and Campylobact Campylobacter. No O&P present.
CDC 'Split Type': NC07054

Write-up: Present to healthcare system on 5-19-07 with Abdominal pain. Pt had a bloody mucus stool during ER visit. Barium enema study was positive for intussusception-Was Reduced and observed overnight. 06/11/2007 MR received for o/n hospitalization 5/19-20/2007 for Intussusception. Infant developed intermittant acute abdominal pain on 5/18/2007. Pain continued and on 5/19/07 infant passed a large bloody, mucusy, stool in the ED. Intussusception which was reduced per radiologist by air contrast Barium Enema. DX: Intussusception-reduced.


Changed on 9/14/2017

VAERS ID: 280397 Before After
VAERS Form:(blank) 1
Age:0.53
Gender:Male
Location:North Carolina
Vaccinated:2007-03-03
Onset:2007-05-18
Submitted:2007-05-29
Entered:2007-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B069AA / 2 3 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1160R / 2 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08658E / 2 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0980F / 3 4 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal pain, Barium enema, Chest X-ray, Full blood count, Haematochezia, Intussusception, Mucous stools, Laboratory test

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: Asthma, Undescended testicle, umbilical hernia. NKDA.
Allergies:
Diagnostic Lab Data: CBC, Chemistry, Barium enema reduction, Chest X-Ray. Labs and Diagnostics: Infant had a Barium Enema which was (+) for Intussusception which was reduced per radiologist. CXR (-). Stool cx (-) E. coli, Salmonella, Shigella, and Campylobacter. No O&P present.
CDC 'Split Type': NC07054

Write-up: Present to healthcare system on 5-19-07 with Abdominal pain. Pt had a bloody mucus stool during ER visit. Barium enema study was positive for intussusception-Was Reduced and observed overnight. 06/11/2007 MR received for o/n hospitalization 5/19-20/2007 for Intussusception. Infant developed intermittant acute abdominal pain on 5/18/2007. Pain continued and on 5/19/07 infant passed a large bloody, mucusy, stool in the ED. Intussusception which was reduced per radiologist by air contrast Barium Enema. DX: Intussusception-reduced.


Changed on 2/14/2018

VAERS ID: 280397 Before After
VAERS Form:1
Age:0.53
Gender:Male
Location:North Carolina
Vaccinated:2007-03-03
Onset:2007-05-18
Submitted:2007-05-29
Entered:2007-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B069AA / 3 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1160R / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08658E / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0980F / 4 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal pain, Barium enema, Chest X-ray, Full blood count, Haematochezia, Intussusception, Mucous stools, Laboratory test

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: Asthma, Undescended testicle, umbilical hernia. NKDA.
Allergies:
Diagnostic Lab Data: CBC, Chemistry, Barium enema reduction, Chest X-Ray. Labs and Diagnostics: Infant had a Barium Enema which was (+) for Intussusception which was reduced per radiologist. CXR (-). Stool cx (-) E. coli, Salmonella, Shigella, and Campylobacter. No O&P present.
CDC 'Split Type': NC07054

Write-up: Present to healthcare system on 5-19-07 with Abdominal pain. Pt had a bloody mucus stool during ER visit. Barium enema study was positive for intussusception-Was Reduced and observed overnight. 06/11/2007 MR received for o/n hospitalization 5/19-20/2007 for Intussusception. Infant developed intermittant acute abdominal pain on 5/18/2007. Pain continued and on 5/19/07 infant passed a large bloody, mucusy, stool in the ED. Intussusception which was reduced per radiologist by air contrast Barium Enema. DX: Intussusception-reduced.


Changed on 6/14/2018

VAERS ID: 280397 Before After
VAERS Form:1
Age:0.53
Gender:Male
Location:North Carolina
Vaccinated:2007-03-03
Onset:2007-05-18
Submitted:2007-05-29
Entered:2007-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B069AA / 3 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1160R / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08658E / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0980F / 4 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal pain, Barium enema, Chest X-ray, Full blood count, Haematochezia, Intussusception, Mucous stools, Laboratory test

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: Asthma, Undescended testicle, umbilical hernia. NKDA.
Allergies:
Diagnostic Lab Data: CBC, Chemistry, Barium enema reduction, Chest X-Ray. Labs and Diagnostics: Infant had a Barium Enema which was (+) for Intussusception which was reduced per radiologist. CXR (-). Stool cx (-) E. coli, Salmonella, Shigella, and Campylobacter. No O&P present.
CDC 'Split Type': NC07054

Write-up: Present to healthcare system on 5-19-07 with Abdominal pain. Pt had a bloody mucus stool during ER visit. Barium enema study was positive for intussusception-Was Reduced and observed overnight. 06/11/2007 MR received for o/n hospitalization 5/19-20/2007 for Intussusception. Infant developed intermittant acute abdominal pain on 5/18/2007. Pain continued and on 5/19/07 infant passed a large bloody, mucusy, stool in the ED. Intussusception which was reduced per radiologist by air contrast Barium Enema. DX: Intussusception-reduced.

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