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This is VAERS ID 281381

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

281381
VAERS Form:
Age:0.2
Gender:Male
Location:Tennessee
Vaccinated:2007-05-31
Onset:2007-06-05
Submitted:2007-06-07
Entered:2007-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B110AB / 0 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE923AA / 0 UN / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08679A / 0 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1167F / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Appendicectomy, Barium double contrast, Intussusception, Laboratory test normal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Perinatal drug (marijuana) exposure
Allergies:
Diagnostic Lab Data: KUB with dilated loops of bowel records received 6/20/07-Labs: normal electrolyte panel. WBC 14.5. KUB showed multiple dilated gas filled loops of bowel suspicious for developing bowel obstruction. Air enema demonstrated ileocolic intussus
CDC 'Split Type':

Write-up:Intussusception, attempted air contrast enema without resolution. Taken to surgery for repair. Was reduced in surgery; no bowel was resected/remained. 06/13/07-records requested from facility and from pcp for vac rec. krk 6/20/07-vac rec received, support"s submitted documentation on VAERS form. No changes. krk 06/20/07-records received from facility for DOS-6/6-6/7/07- DC DX: Intussusception, Status Post exploratory laparotomy and appendectomy. On 6/5/07 at 7 a.m. began to vomit after feeding. Refusing bo


Changed on 12/8/2009

281381 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Tennessee
Vaccinated:2007-05-31
Onset:2007-06-05
Submitted:2007-06-07
Entered:2007-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B110AB / 0 UN / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B110AB / 0 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE923AA / 0 UN / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08679A / 0 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1167F / 0 - / PO

Administered by: Private      Purchased by: Unknown Public
Symptoms: Appendicectomy, Barium double contrast, Intussusception, Laparotomy, Surgery, Urinary system X-ray, White blood cell count, Laboratory test normal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Perinatal drug (marijuana) exposure
Allergies:
Diagnostic Lab Data: KUB with dilated loops of bowel records received 6/20/07-Labs: normal electrolyte panel. WBC 14.5. KUB showed multiple dilated gas filled loops of bowel suspicious for developing bowel obstruction. Air enema demonstrated ileocolic intussus
CDC 'Split Type':

Write-up:Intussusception, attempted air contrast enema without resolution. Taken to surgery for repair. Was reduced in surgery; no bowel was resected/remained. 06/13/07-records requested from facility and from pcp for vac rec. krk 6/20/07-vac rec received, support"s supports submitted documentation on VAERS form. No changes. krk 06/20/07-records received from facility for DOS-6/6-6/7/07- DC DX: Intussusception, Status Post exploratory laparotomy and appendectomy. On 6/5/07 at 7 a.m. began to vomit after feeding. Refusing bo bottles. No bowel movements since 7 a.m.PE: abdomen soft, slightly distended, positive bowel sounds. Non tender.


Changed on 3/2/2010

281381 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Tennessee
Vaccinated:2007-05-31
Onset:2007-06-05
Submitted:2007-06-07
Entered:2007-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B110AB / 0 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE923AA / 0 UN / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B08679A / 0 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1167F / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Appendicectomy, Barium double contrast, Intussusception, Laparotomy, Surgery, Urinary system X-ray, White blood cell count, Laboratory test normal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Perinatal drug (marijuana) exposure
Allergies:
Diagnostic Lab Data: KUB with dilated loops of bowel records received 6/20/07-Labs: normal electrolyte panel. WBC 14.5. KUB showed multiple dilated gas filled loops of bowel suspicious for developing bowel obstruction. Air enema demonstrated ileocolic intussus
CDC 'Split Type':

Write-up:Intussusception, attempted air contrast enema without resolution. Taken to surgery for repair. Was reduced in surgery; no bowel was resected/remained. 06/13/07-records requested from facility and from pcp for vac rec. krk 6/20/07-vac rec received, supports submitted documentation on VAERS form. No changes. krk 06/20/07-records received from facility for DOS-6/6-6/7/07- DC DX: Intussusception, Status Post exploratory laparotomy and appendectomy. On 6/5/07 at 7 a.m. began to vomit after feeding. Refusing bottles. No bowel movements since 7 a.m.PE: abdomen soft, slightly distended, positive bowel sounds. Non tender.


Changed on 4/7/2010

281381 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Tennessee
Vaccinated:2007-05-31
Onset:2007-06-05
Submitted:2007-06-07
Entered:2007-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B110AB / 0 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE923AA / 0 UN / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08679A / 0 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1167F / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Appendicectomy, Barium double contrast, Intussusception, Laparotomy, Surgery, Urinary system X-ray, White blood cell count, Laboratory test normal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Perinatal drug (marijuana) exposure
Allergies:
Diagnostic Lab Data: KUB with dilated loops of bowel records received 6/20/07-Labs: normal electrolyte panel. WBC 14.5. KUB showed multiple dilated gas filled loops of bowel suspicious for developing bowel obstruction. Air enema demonstrated ileocolic intussus
CDC 'Split Type':

Write-up:Intussusception, attempted air contrast enema without resolution. Taken to surgery for repair. Was reduced in surgery; no bowel was resected/remained. 06/13/07-records requested from facility and from pcp for vac rec. krk 6/20/07-vac rec received, supports submitted documentation on VAERS form. No changes. krk 06/20/07-records received from facility for DOS-6/6-6/7/07- DC DX: Intussusception, Status Post exploratory laparotomy and appendectomy. On 6/5/07 at 7 a.m. began to vomit after feeding. Refusing bottles. No bowel movements since 7 a.m.PE: abdomen soft, slightly distended, positive bowel sounds. Non tender.


Changed on 8/31/2010

281381 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Tennessee
Vaccinated:2007-05-31
Onset:2007-06-05
Submitted:2007-06-07
Entered:2007-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B110AB / 0 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE923AA / 0 UN / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B08679A / 0 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1167F / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Appendicectomy, Barium double contrast, Intussusception, Laparotomy, Surgery, Urinary system X-ray, White blood cell count, Laboratory test normal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Perinatal drug (marijuana) exposure
Allergies:
Diagnostic Lab Data: KUB with dilated loops of bowel records received 6/20/07-Labs: normal electrolyte panel. WBC 14.5. KUB showed multiple dilated gas filled loops of bowel suspicious for developing bowel obstruction. Air enema demonstrated ileocolic intussus
CDC 'Split Type':

Write-up:Intussusception, attempted air contrast enema without resolution. Taken to surgery for repair. Was reduced in surgery; no bowel was resected/remained. 06/13/07-records requested from facility and from pcp for vac rec. krk 6/20/07-vac rec received, supports submitted documentation on VAERS form. No changes. krk 06/20/07-records received from facility for DOS-6/6-6/7/07- DC DX: Intussusception, Status Post exploratory laparotomy and appendectomy. On 6/5/07 at 7 a.m. began to vomit after feeding. Refusing bottles. No bowel movements since 7 a.m.PE: abdomen soft, slightly distended, positive bowel sounds. Non tender.


Changed on 5/13/2013

281381 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Tennessee
Vaccinated:2007-05-31
Onset:2007-06-05
Submitted:2007-06-07
Entered:2007-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B110AB / 0 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE923AA / 0 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08679A / 0 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1167F / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1167F / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Appendicectomy, Barium double contrast, Intussusception, Laparotomy, Surgery, Urinary system X-ray, White blood cell count, Laboratory test normal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Perinatal drug (marijuana) exposure
Allergies:
Diagnostic Lab Data: KUB with dilated loops of bowel records received 6/20/07-Labs: normal electrolyte panel. WBC 14.5. KUB showed multiple dilated gas filled loops of bowel suspicious for developing bowel obstruction. Air enema demonstrated ileocolic intussus
CDC 'Split Type':

Write-up:Intussusception, attempted air contrast enema without resolution. Taken to surgery for repair. Was reduced in surgery; no bowel was resected/remained. 06/13/07-records requested from facility and from pcp for vac rec. krk 6/20/07-vac rec received, supports submitted documentation on VAERS form. No changes. krk 06/20/07-records received from facility for DOS-6/6-6/7/07- DC DX: Intussusception, Status Post exploratory laparotomy and appendectomy. On 6/5/07 at 7 a.m. began to vomit after feeding. Refusing bottles. No bowel movements since 7 a.m.PE: abdomen soft, slightly distended, positive bowel sounds. Non tender.


Changed on 2/14/2017

281381 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Tennessee
Vaccinated:2007-05-31
Onset:2007-06-05
Submitted:2007-06-07
Entered:2007-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B110AB / 0 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE923AA / 0 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08679A / 0 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1167F / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Appendicectomy, Barium double contrast, Intussusception, Laparotomy, Surgery, Urinary system X-ray, White blood cell count, Laboratory test normal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Perinatal drug (marijuana) exposure
Allergies:
Diagnostic Lab Data: KUB with dilated loops of bowel records received 6/20/07-Labs: normal electrolyte panel. WBC 14.5. KUB showed multiple dilated gas filled loops of bowel suspicious for developing bowel obstruction. Air enema demonstrated ileocolic intussus intussusception on right side which was not reduced during enema studies.
CDC 'Split Type':

Write-up:Intussusception, attempted air contrast enema without resolution. Taken to surgery for repair. Was reduced in surgery; no bowel was resected/remained. 06/13/07-records requested from facility and from pcp for vac rec. krk 6/20/07-vac rec received, supports submitted documentation on VAERS form. No changes. krk 06/20/07-records received from facility for DOS-6/6-6/7/07- DC DX: Intussusception, Status Post exploratory laparotomy and appendectomy. On 6/5/07 at 7 a.m. began to vomit after feeding. Refusing bottles. No bowel movements since 7 a.m.PE: abdomen soft, slightly distended, positive bowel sounds. Non tender.


Changed on 9/14/2017

281381 Before After
VAERS Form:(blank) 1
Age:0.2
Gender:Male
Location:Tennessee
Vaccinated:2007-05-31
Onset:2007-06-05
Submitted:2007-06-07
Entered:2007-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B110AB / 0 1 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE923AA / 0 1 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08679A / 0 1 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1167F / 0 1 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium double contrast, Intussusception, Surgery, Urinary system 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)? No
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Perinatal drug (marijuana) exposure
Allergies:
Diagnostic Lab Data: KUB with dilated loops of bowel records received 6/20/07-Labs: normal electrolyte panel. WBC 14.5. KUB showed multiple dilated gas filled loops of bowel suspicious for developing bowel obstruction. Air enema demonstrated ileocolic intussusception on right side which was not reduced during enema studies.
CDC 'Split Type':

Write-up:Intussusception, attempted air contrast enema without resolution. Taken to surgery for repair. Was reduced in surgery; no bowel was resected/remained. 06/13/07-records requested from facility and from pcp for vac rec. krk 6/20/07-vac rec received, supports submitted documentation on VAERS form. No changes. krk 06/20/07-records received from facility for DOS-6/6-6/7/07- DC DX: Intussusception, Status Post exploratory laparotomy and appendectomy. On 6/5/07 at 7 a.m. began to vomit after feeding. Refusing bottles. No bowel movements since 7 a.m.PE: abdomen soft, slightly distended, positive bowel sounds. Non tender.


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