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This is VAERS ID 281061

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

281061
VAERS Form:
Age:0.4
Gender:Male
Location:California
Vaccinated:2007-04-24
Onset:2007-05-29
Submitted:2007-06-08
Entered:2007-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS GSKAC14B042BA / 1 RA / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR AVPPUF074AA / 1 LA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR AVPY1032-2 / 1 RA / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. MSD0779F / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Bowel sounds abnormal, Dehydration, Diarrhoea haemorrhagic, 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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Guiac positive stools. Abdominal Ultrasound showed intussusception at RLQ, likely ileo-colic.
CDC 'Split Type':

Write-up:Admitted on 5/30/07 after a 2 day history of vomiting, associated with low-grade fever and 2 bouts of bloody diarrhea. Initial impression was acute gastroenteritis with dehydration. While kept NPO, he still had one episode of emesis and one episode of w"atery, pinkish-brown stools which was positive for occult blood. An abdominal series showed signs of obstruction; an abdominal ultrasound diagnosed an intussusception. The patient was transferred to Hospital on 5/31/07 for further management. A bowel en


Changed on 12/8/2009

281061 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:California
Vaccinated:2007-04-24
Onset:2007-05-29
Submitted:2007-06-08
Entered:2007-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS GSKAC14B042BA / 1 RA / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR AVPPUF074AA / 1 LA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR AVPY1032-2 / 1 RA / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. MSD0779F / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Bowel sounds abnormal, Dehydration, Diarrhoea haemorrhagic, Gastroenteritis, Haematochezia, Intestinal obstruction, Intussusception, Large intestinal obstruction reduction, Mucous stools, Pyrexia, Vomiting, Ultrasound abdomen, Abdominal X-ray, Occult blood positive

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Guiac positive stools. Abdominal Ultrasound showed intussusception at RLQ, likely ileo-colic. Labs and Diagnostics: Abd x-ray (+) for obstruction. Abd. US (+) for intussusception of the RLQ. ? ilecolic with obstruction. KUB and Barium
CDC 'Split Type':

Write-up:Admitted on 5/30/07 after a 2 day history of vomiting, associated with low-grade fever and 2 bouts of bloody diarrhea. Initial impression was acute gastroenteritis with dehydration. While kept NPO, he still had one episode of emesis and one episode of w"atery, watery, pinkish-brown stools which was positive for occult blood. An abdominal series showed signs of obstruction; an abdominal ultrasound diagnosed an intussusception. The patient was transferred to Hospital on 5/31/07 for further management. A bowel en enema was performed, which was able to reduce the intussusception. The patient was discharged 24 hours after the procedure. 07/02/2007 Hospital records received from both admitting and transfer hospitals. Infant was initially seen and admitted for c/o bloody/mucusy stool and vomiting with each breast feed. PE significant for hypoactive BS, otherwise WNL. Infant transfered to another facility for management. Intussusception was sucessfully reduced via Hypaque enema. Principal DX: Intussusception.


Changed on 5/13/2013

281061 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:California
Vaccinated:2007-04-24
Onset:2007-05-29
Submitted:2007-06-08
Entered:2007-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS GSKAC14B042BA / 1 RA / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR AVPPUF074AA / 1 LA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR AVPY1032-2 / 1 RA / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. MSD0779F / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. MSD0779F / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Bowel sounds abnormal, Dehydration, Diarrhoea haemorrhagic, Gastroenteritis, Haematochezia, Intestinal obstruction, Intussusception, Large intestinal obstruction reduction, Mucous stools, Pyrexia, Vomiting, Ultrasound abdomen, Abdominal X-ray, Occult blood positive

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Guiac positive stools. Abdominal Ultrasound showed intussusception at RLQ, likely ileo-colic. Labs and Diagnostics: Abd x-ray (+) for obstruction. Abd. US (+) for intussusception of the RLQ. ? ilecolic with obstruction. KUB and Barium
CDC 'Split Type':

Write-up:Admitted on 5/30/07 after a 2 day history of vomiting, associated with low-grade fever and 2 bouts of bloody diarrhea. Initial impression was acute gastroenteritis with dehydration. While kept NPO, he still had one episode of emesis and one episode of watery, pinkish-brown stools which was positive for occult blood. An abdominal series showed signs of obstruction; an abdominal ultrasound diagnosed an intussusception. The patient was transferred to Hospital on 5/31/07 for further management. A bowel enema was performed, which was able to reduce the intussusception. The patient was discharged 24 hours after the procedure. 07/02/2007 Hospital records received from both admitting and transfer hospitals. Infant was initially seen and admitted for c/o bloody/mucusy stool and vomiting with each breast feed. PE significant for hypoactive BS, otherwise WNL. Infant transfered to another facility for management. Intussusception was sucessfully reduced via Hypaque enema. Principal DX: Intussusception.


Changed on 5/14/2017

281061 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:California
Vaccinated:2007-04-24
Onset:2007-05-29
Submitted:2007-06-08
Entered:2007-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS GSKAC14B042BA / 1 RA / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR AVPPUF074AA / 1 LA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR AVPY1032-2 / 1 RA / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. MSD0779F / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Bowel sounds abnormal, Dehydration, Diarrhoea haemorrhagic, Gastroenteritis, Haematochezia, Intestinal obstruction, Intussusception, Large intestinal obstruction reduction, Mucous stools, Pyrexia, Vomiting, Ultrasound abdomen, Abdominal X-ray, Occult blood positive

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Guiac positive stools. Abdominal Ultrasound showed intussusception at RLQ, likely ileo-colic. Labs and Diagnostics: Abd x-ray (+) for obstruction. Abd. US (+) for intussusception of the RLQ. ? ilecolic with obstruction. KUB and Barium enema done upon arrival at transfer facility.
CDC 'Split Type':

Write-up:Admitted on 5/30/07 after a 2 day history of vomiting, associated with low-grade fever and 2 bouts of bloody diarrhea. Initial impression was acute gastroenteritis with dehydration. While kept NPO, he still had one episode of emesis and one episode of watery, pinkish-brown stools which was positive for occult blood. An abdominal series showed signs of obstruction; an abdominal ultrasound diagnosed an intussusception. The patient was transferred to Hospital on 5/31/07 for further management. A bowel enema was performed, which was able to reduce the intussusception. The patient was discharged 24 hours after the procedure. 07/02/2007 Hospital records received from both admitting and transfer hospitals. Infant was initially seen and admitted for c/o bloody/mucusy stool and vomiting with each breast feed. PE significant for hypoactive BS, otherwise WNL. Infant transfered to another facility for management. Intussusception was sucessfully reduced via Hypaque enema. Principal DX: Intussusception.


Changed on 9/14/2017

281061 Before After
VAERS Form:(blank) 1
Age:0.4
Gender:Male
Location:California
Vaccinated:2007-04-24
Onset:2007-05-29
Submitted:2007-06-08
Entered:2007-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS GSKAC14B042BA / 1 2 RA / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR AVPPUF074AA / 1 2 LA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR AVPY1032-2 / 1 2 RA / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. MSD0779F / 1 2 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Dehydration, Diarrhoea haemorrhagic, Gastroenteritis, Intussusception, Pyrexia, Vomiting, Ultrasound abdomen, Occult blood positive

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Guiac positive stools. Abdominal Ultrasound showed intussusception at RLQ, likely ileo-colic. Labs and Diagnostics: Abd x-ray (+) for obstruction. Abd. US (+) for intussusception of the RLQ. ? ilecolic with obstruction. KUB and Barium enema done upon arrival at transfer facility.
CDC 'Split Type':

Write-up:Admitted on 5/30/07 after a 2 day history of vomiting, associated with low-grade fever and 2 bouts of bloody diarrhea. Initial impression was acute gastroenteritis with dehydration. While kept NPO, he still had one episode of emesis and one episode of watery, pinkish-brown stools which was positive for occult blood. An abdominal series showed signs of obstruction; an abdominal ultrasound diagnosed an intussusception. The patient was transferred to Hospital on 5/31/07 for further management. A bowel enema was performed, which was able to reduce the intussusception. The patient was discharged 24 hours after the procedure. 07/02/2007 Hospital records received from both admitting and transfer hospitals. Infant was initially seen and admitted for c/o bloody/mucusy stool and vomiting with each breast feed. PE significant for hypoactive BS, otherwise WNL. Infant transfered to another facility for management. Intussusception was sucessfully reduced via Hypaque enema. Principal DX: Intussusception.


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