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This is VAERS ID 280707

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

280707
VAERS Form:
Age:0.3
Gender:Male
Location:Texas
Vaccinated:2007-04-02
Onset:2007-05-06
Submitted:2007-06-06
Entered:2007-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF010AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B36258H / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Blood gases abnormal, Diarrhoea, Decreased appetite, 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: 1     Extended hospital stay? No
Previous Vaccinations: None.~ ()~~0~In Patient
Other Medications: No
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: 05/07/07 post- Air reduction US abdomen showed successful pneumatic reduction of ileocolic intussusception. x-ray of abdomen showed relative paucity of gas in right abdomen and region of right and transverse colon. Abdominal ultrasound con
CDC 'Split Type': None

Write-up:ER 05/06/07 abnl x-ray abdomen; 05/7/07 Us abdomen ''''findings highly suggestive of ileocolic intussusception. tx ''''Air reduction.'''' 06/07/07-rcords received from facility for DOS 5/8-5/11/07-DC DX: Intussusception. One day history of emesis, nonbilious, n"onbloody and multiple episodes of diarrhea with no blood no mucus. Refusing to eat. Seen in ER.


Changed on 12/8/2009

280707 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Texas
Vaccinated:2007-04-02
Onset:2007-05-06
Submitted:2007-06-06
Entered:2007-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079AA / 1 RL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF010AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B36258H / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Blood gases abnormal, Diarrhoea, Intussusception, Vomiting, X-ray abnormal, Ultrasound abdomen abnormal, Decreased appetite, 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: 1     Extended hospital stay? No
Previous Vaccinations: None.~ ()~~0~In Patient
Other Medications: No
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: 05/07/07 post- Air reduction US abdomen showed successful pneumatic reduction of ileocolic intussusception. x-ray of abdomen showed relative paucity of gas in right abdomen and region of right and transverse colon. Abdominal ultrasound con
CDC 'Split Type': None (blank)

Write-up:ER 05/06/07 abnl x-ray abdomen; 05/7/07 Us abdomen ''''findings ''findings highly suggestive of ileocolic intussusception. tx ''''Air reduction.'''' ''Air reduction.'' 06/07/07-rcords received from facility for DOS 5/8-5/11/07-DC DX: Intussusception. One day history of emesis, nonbilious, n"onbloody nonbloody and multiple episodes of diarrhea with no blood no mucus. Refusing to eat. Seen in ER.


Changed on 3/2/2010

280707 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Texas
Vaccinated:2007-04-02
Onset:2007-05-06
Submitted:2007-06-06
Entered:2007-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF010AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B36258H / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Blood gases abnormal, Diarrhoea, Intussusception, Vomiting, X-ray abnormal, Ultrasound abdomen abnormal, Decreased appetite, 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: 1     Extended hospital stay? No
Previous Vaccinations: None.~ ()~~0~In Patient
Other Medications: No
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: 05/07/07 post- Air reduction US abdomen showed successful pneumatic reduction of ileocolic intussusception. x-ray of abdomen showed relative paucity of gas in right abdomen and region of right and transverse colon. Abdominal ultrasound con
CDC 'Split Type':

Write-up:ER 05/06/07 abnl x-ray abdomen; 05/7/07 Us abdomen ''findings highly suggestive of ileocolic intussusception. tx ''Air reduction.'' 06/07/07-rcords received from facility for DOS 5/8-5/11/07-DC DX: Intussusception. One day history of emesis, nonbilious, nonbloody and multiple episodes of diarrhea with no blood no mucus. Refusing to eat. Seen in ER.


Changed on 4/7/2010

280707 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Texas
Vaccinated:2007-04-02
Onset:2007-05-06
Submitted:2007-06-06
Entered:2007-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF010AA / 1 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B36258H / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Blood gases abnormal, Diarrhoea, Intussusception, Vomiting, X-ray abnormal, Ultrasound abdomen abnormal, Decreased appetite, 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: 1     Extended hospital stay? No
Previous Vaccinations: None.~ ()~~0~In Patient
Other Medications: No
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: 05/07/07 post- Air reduction US abdomen showed successful pneumatic reduction of ileocolic intussusception. x-ray of abdomen showed relative paucity of gas in right abdomen and region of right and transverse colon. Abdominal ultrasound con
CDC 'Split Type':

Write-up:ER 05/06/07 abnl x-ray abdomen; 05/7/07 Us abdomen ''findings highly suggestive of ileocolic intussusception. tx ''Air reduction.'' 06/07/07-rcords received from facility for DOS 5/8-5/11/07-DC DX: Intussusception. One day history of emesis, nonbilious, nonbloody and multiple episodes of diarrhea with no blood no mucus. Refusing to eat. Seen in ER.


Changed on 8/31/2010

280707 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Texas
Vaccinated:2007-04-02
Onset:2007-05-06
Submitted:2007-06-06
Entered:2007-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF010AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B36258H / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Blood gases abnormal, Diarrhoea, Intussusception, Vomiting, X-ray abnormal, Ultrasound abdomen abnormal, Decreased appetite, 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: 1     Extended hospital stay? No
Previous Vaccinations: None.~ ()~~0~In Patient
Other Medications: No
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: 05/07/07 post- Air reduction US abdomen showed successful pneumatic reduction of ileocolic intussusception. x-ray of abdomen showed relative paucity of gas in right abdomen and region of right and transverse colon. Abdominal ultrasound con
CDC 'Split Type':

Write-up:ER 05/06/07 abnl x-ray abdomen; 05/7/07 Us abdomen ''findings highly suggestive of ileocolic intussusception. tx ''Air reduction.'' 06/07/07-rcords received from facility for DOS 5/8-5/11/07-DC DX: Intussusception. One day history of emesis, nonbilious, nonbloody and multiple episodes of diarrhea with no blood no mucus. Refusing to eat. Seen in ER.


Changed on 5/13/2013

280707 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Texas
Vaccinated:2007-04-02
Onset:2007-05-06
Submitted:2007-06-06
Entered:2007-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF010AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B36258H / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Blood gases abnormal, Diarrhoea, Intussusception, Vomiting, X-ray abnormal, Ultrasound abdomen abnormal, Decreased appetite, 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: 1     Extended hospital stay? No
Previous Vaccinations: None.~ ()~~0~In Patient
Other Medications: No
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: 05/07/07 post- Air reduction US abdomen showed successful pneumatic reduction of ileocolic intussusception. x-ray of abdomen showed relative paucity of gas in right abdomen and region of right and transverse colon. Abdominal ultrasound con
CDC 'Split Type':

Write-up:ER 05/06/07 abnl x-ray abdomen; 05/7/07 Us abdomen ''findings highly suggestive of ileocolic intussusception. tx ''Air reduction.'' 06/07/07-rcords received from facility for DOS 5/8-5/11/07-DC DX: Intussusception. One day history of emesis, nonbilious, nonbloody and multiple episodes of diarrhea with no blood no mucus. Refusing to eat. Seen in ER.


Changed on 2/14/2017

280707 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Texas
Vaccinated:2007-04-02
Onset:2007-05-06
Submitted:2007-06-06
Entered:2007-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF010AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B36258H / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Blood gases abnormal, Diarrhoea, Intussusception, Vomiting, X-ray abnormal, Ultrasound abdomen abnormal, Decreased appetite, 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: 1     Extended hospital stay? No
Previous Vaccinations: None.~ ()~~0~In ()~~0.00~In Patient
Other Medications: No
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: 05/07/07 post- Air reduction US abdomen showed successful pneumatic reduction of ileocolic intussusception. x-ray of abdomen showed relative paucity of gas in right abdomen and region of right and transverse colon. Abdominal ultrasound con confirmed soft tissue mass with multiple lymph nodes associated with it in right upper quadrant has 4 layered appearance highly suggestive of intussusception. Air contrast enema with successful reduction of ileocolic intussusception. Labs: WBC 15.2
CDC 'Split Type':

Write-up:ER 05/06/07 abnl x-ray abdomen; 05/7/07 Us abdomen ''findings highly suggestive of ileocolic intussusception. tx ''Air reduction.'' 06/07/07-rcords received from facility for DOS 5/8-5/11/07-DC DX: Intussusception. One day history of emesis, nonbilious, nonbloody and multiple episodes of diarrhea with no blood no mucus. Refusing to eat. Seen in ER.


Changed on 9/14/2017

280707 Before After
VAERS Form:(blank) 1
Age:0.3
Gender:Male
Location:Texas
Vaccinated:2007-04-02
Onset:2007-05-06
Submitted:2007-06-06
Entered:2007-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079AA / 1 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF010AA / 1 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B36258H / 1 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 1 2 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Intussusception, X-ray abnormal, Ultrasound abdomen abnormal, 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: 1     Extended hospital stay? No
Previous Vaccinations: None.~ ()~~0.00~In Patient
Other Medications: No
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: 05/07/07 post- Air reduction US abdomen showed successful pneumatic reduction of ileocolic intussusception. x-ray of abdomen showed relative paucity of gas in right abdomen and region of right and transverse colon. Abdominal ultrasound confirmed soft tissue mass with multiple lymph nodes associated with it in right upper quadrant has 4 layered appearance highly suggestive of intussusception. Air contrast enema with successful reduction of ileocolic intussusception. Labs: WBC 15.2
CDC 'Split Type':

Write-up:ER 05/06/07 abnl x-ray abdomen; 05/7/07 Us abdomen ''findings highly suggestive of ileocolic intussusception. tx ''Air reduction.'' 06/07/07-rcords received from facility for DOS 5/8-5/11/07-DC DX: Intussusception. One day history of emesis, nonbilious, nonbloody and multiple episodes of diarrhea with no blood no mucus. Refusing to eat. Seen in ER.


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