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This is VAERS ID 281725

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 281725
VAERS Form:
Age:0.3
Gender:Male
Location:California
Vaccinated:2007-04-12
Onset:2007-05-30
Submitted:2007-06-06
Entered:2007-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2510BA / 1 RL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UFO91AA / 1 LL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 20457 / 1 LL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08689D / 1 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1237F / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Abdominal pain, Barium enema, Crying, Blood test normal, Decreased appetite

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: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Barium enema, X rays LABS: KUB in ER suggested IS. Barium enema done which was neg. Blood work was all WNL
CDC 'Split Type':

Write-up: Waxing, weaning fussiness Dx : intussusception. 6/21/07 Received vax rec which confirms RO lot & dose # & also includes multi additional vax received same date. VAERS database updated w/same. 6/26/07 Received hospital med recs which reveal that on 5/30/"07 patient experienced screaming & fussiness then excess sleepiness. When awake, inconsolable, refusal to eat & drawing legs up. Taken to PCP office & sent to ER. Felt to have resolved IS spontaneously. Held overnight for observation. Tolerated oral


Changed on 12/8/2009

VAERS ID: 281725 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:California
Vaccinated:2007-04-12
Onset:2007-05-30
Submitted:2007-06-06
Entered:2007-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2510BA / 1 RL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UFO91AA / 1 LL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 20457 / 1 LL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08689D / 1 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1237F / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Abdominal pain, Barium enema, Crying, Intussusception, Irritability, Screaming, Somnolence, Urinary system X-ray, X-ray, Blood test normal, Decreased appetite

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: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Barium enema, X rays LABS: KUB in ER suggested IS. Barium enema done which was neg. Blood work was all WNL
CDC 'Split Type':

Write-up: Waxing, weaning fussiness Dx : intussusception. 6/21/07 Received vax rec which confirms RO lot & dose # & also includes multi additional vax received same date. VAERS database updated w/same. 6/26/07 Received hospital med recs which reveal that on 5/30/"07 5/30/07 patient experienced screaming & fussiness then excess sleepiness. When awake, inconsolable, refusal to eat & drawing legs up. Taken to PCP office & sent to ER. Felt to have resolved IS spontaneously. Held overnight for observation. Tolerated oral intake well & was d/c to home 5/31/07. FINAL DX: none provided, no D/C summary done.


Changed on 3/2/2010

VAERS ID: 281725 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:California
Vaccinated:2007-04-12
Onset:2007-05-30
Submitted:2007-06-06
Entered:2007-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2510BA / 1 RL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UFO91AA / 1 LL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 20457 / 1 LL / -
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B08689D / 1 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1237F / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Abdominal pain, Barium enema, Crying, Intussusception, Irritability, Screaming, Somnolence, Urinary system X-ray, X-ray, Blood test normal, Decreased appetite

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: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Barium enema, X rays LABS: KUB in ER suggested IS. Barium enema done which was neg. Blood work was all WNL
CDC 'Split Type':

Write-up: Waxing, weaning fussiness Dx : intussusception. 6/21/07 Received vax rec which confirms RO lot & dose # & also includes multi additional vax received same date. VAERS database updated w/same. 6/26/07 Received hospital med recs which reveal that on 5/30/07 patient experienced screaming & fussiness then excess sleepiness. When awake, inconsolable, refusal to eat & drawing legs up. Taken to PCP office & sent to ER. Felt to have resolved IS spontaneously. Held overnight for observation. Tolerated oral intake well & was d/c to home 5/31/07. FINAL DX: none provided, no D/C summary done.


Changed on 4/7/2010

VAERS ID: 281725 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:California
Vaccinated:2007-04-12
Onset:2007-05-30
Submitted:2007-06-06
Entered:2007-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2510BA / 1 RL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UFO91AA / 1 LL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 20457 / 1 LL / -
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08689D / 1 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1237F / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Abdominal pain, Barium enema, Crying, Intussusception, Irritability, Screaming, Somnolence, Urinary system X-ray, X-ray, Blood test normal, Decreased appetite

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: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Barium enema, X rays LABS: KUB in ER suggested IS. Barium enema done which was neg. Blood work was all WNL
CDC 'Split Type':

Write-up: Waxing, weaning fussiness Dx : intussusception. 6/21/07 Received vax rec which confirms RO lot & dose # & also includes multi additional vax received same date. VAERS database updated w/same. 6/26/07 Received hospital med recs which reveal that on 5/30/07 patient experienced screaming & fussiness then excess sleepiness. When awake, inconsolable, refusal to eat & drawing legs up. Taken to PCP office & sent to ER. Felt to have resolved IS spontaneously. Held overnight for observation. Tolerated oral intake well & was d/c to home 5/31/07. FINAL DX: none provided, no D/C summary done.


Changed on 8/31/2010

VAERS ID: 281725 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:California
Vaccinated:2007-04-12
Onset:2007-05-30
Submitted:2007-06-06
Entered:2007-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2510BA / 1 RL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UFO91AA / 1 LL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 20457 / 1 LL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B08689D / 1 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1237F / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Abdominal pain, Barium enema, Crying, Intussusception, Irritability, Screaming, Somnolence, Urinary system X-ray, X-ray, Blood test normal, Decreased appetite

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: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Barium enema, X rays LABS: KUB in ER suggested IS. Barium enema done which was neg. Blood work was all WNL
CDC 'Split Type':

Write-up: Waxing, weaning fussiness Dx : intussusception. 6/21/07 Received vax rec which confirms RO lot & dose # & also includes multi additional vax received same date. VAERS database updated w/same. 6/26/07 Received hospital med recs which reveal that on 5/30/07 patient experienced screaming & fussiness then excess sleepiness. When awake, inconsolable, refusal to eat & drawing legs up. Taken to PCP office & sent to ER. Felt to have resolved IS spontaneously. Held overnight for observation. Tolerated oral intake well & was d/c to home 5/31/07. FINAL DX: none provided, no D/C summary done.


Changed on 5/13/2013

VAERS ID: 281725 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:California
Vaccinated:2007-04-12
Onset:2007-05-30
Submitted:2007-06-06
Entered:2007-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2510BA / 1 RL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UFO91AA / 1 LL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 20457 / 1 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08689D / 1 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1237F / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1237F / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Abdominal pain, Barium enema, Crying, Intussusception, Irritability, Screaming, Somnolence, Urinary system X-ray, X-ray, Blood test normal, Decreased appetite

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: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Barium enema, X rays LABS: KUB in ER suggested IS. Barium enema done which was neg. Blood work was all WNL
CDC 'Split Type':

Write-up: Waxing, weaning fussiness Dx : intussusception. 6/21/07 Received vax rec which confirms RO lot & dose # & also includes multi additional vax received same date. VAERS database updated w/same. 6/26/07 Received hospital med recs which reveal that on 5/30/07 patient experienced screaming & fussiness then excess sleepiness. When awake, inconsolable, refusal to eat & drawing legs up. Taken to PCP office & sent to ER. Felt to have resolved IS spontaneously. Held overnight for observation. Tolerated oral intake well & was d/c to home 5/31/07. FINAL DX: none provided, no D/C summary done.


Changed on 5/14/2017

VAERS ID: 281725 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:California
Vaccinated:2007-04-12
Onset:2007-05-30
Submitted:2007-06-06
Entered:2007-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2510BA / 1 RL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UFO91AA / 1 LL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 20457 / 1 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08689D / 1 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1237F / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Abdominal pain, Barium enema, Crying, Intussusception, Irritability, Screaming, Somnolence, Urinary system X-ray, X-ray, Blood test normal, Decreased appetite

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: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Barium enema, X rays LABS: KUB in ER suggested IS. Barium enema done which was neg. Blood work was all WNL
CDC 'Split Type':

Write-up: Waxing, weaning fussiness Dx : intussusception. 6/21/07 Received vax rec which confirms RO lot & dose # & also includes multi additional vax received same date. VAERS database updated w/same. 6/26/07 Received hospital med recs which reveal that on 5/30/07 patient experienced screaming & fussiness then excess sleepiness. When awake, inconsolable, refusal to eat & drawing legs up. Taken to PCP office & sent to ER. Felt to have resolved IS spontaneously. Held overnight for observation. Tolerated oral intake well & was d/c to home 5/31/07. FINAL DX: none provided, no D/C summary done.


Changed on 9/14/2017

VAERS ID: 281725 Before After
VAERS Form:(blank) 1
Age:0.3
Gender:Male
Location:California
Vaccinated:2007-04-12
Onset:2007-05-30
Submitted:2007-06-06
Entered:2007-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2510BA / 1 2 RL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UFO91AA / 1 2 LL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 20457 / 1 2 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08689D / 1 2 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1237F / 1 2 - MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Barium enema, Intussusception, Irritability, 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:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Barium enema, X rays LABS: KUB in ER suggested IS. Barium enema done which was neg. Blood work was all WNL
CDC 'Split Type':

Write-up: Waxing, weaning fussiness Dx : intussusception. 6/21/07 Received vax rec which confirms RO lot & dose # & also includes multi additional vax received same date. VAERS database updated w/same. 6/26/07 Received hospital med recs which reveal that on 5/30/07 patient experienced screaming & fussiness then excess sleepiness. When awake, inconsolable, refusal to eat & drawing legs up. Taken to PCP office & sent to ER. Felt to have resolved IS spontaneously. Held overnight for observation. Tolerated oral intake well & was d/c to home 5/31/07. FINAL DX: none provided, no D/C summary done.


Changed on 2/14/2018

VAERS ID: 281725 Before After
VAERS Form:1
Age:0.3
Gender:Male
Location:California
Vaccinated:2007-04-12
Onset:2007-05-30
Submitted:2007-06-06
Entered:2007-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2510BA / 2 RL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UFO91AA / 2 LL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 20457 / 2 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08689D / 2 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1237F / 2 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Barium enema, Intussusception, Irritability, 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:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Barium enema, X rays LABS: KUB in ER suggested IS. Barium enema done which was neg. Blood work was all WNL
CDC 'Split Type':

Write-up: Waxing, weaning fussiness Dx : intussusception. 6/21/07 Received vax rec which confirms RO lot & dose # & also includes multi additional vax received same date. VAERS database updated w/same. 6/26/07 Received hospital med recs which reveal that on 5/30/07 patient experienced screaming & fussiness then excess sleepiness. When awake, inconsolable, refusal to eat & drawing legs up. Taken to PCP office & sent to ER. Felt to have resolved IS spontaneously. Held overnight for observation. Tolerated oral intake well & was d/c to home 5/31/07. FINAL DX: none provided, no D/C summary done.


Changed on 6/14/2018

VAERS ID: 281725 Before After
VAERS Form:1
Age:0.3
Gender:Male
Location:California
Vaccinated:2007-04-12
Onset:2007-05-30
Submitted:2007-06-06
Entered:2007-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2510BA / 2 RL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UFO91AA / 2 LL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 20457 / 2 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08689D / 2 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1237F / 2 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Barium enema, Intussusception, Irritability, 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:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Barium enema, X rays LABS: KUB in ER suggested IS. Barium enema done which was neg. Blood work was all WNL
CDC 'Split Type':

Write-up: Waxing, weaning fussiness Dx : intussusception. 6/21/07 Received vax rec which confirms RO lot & dose # & also includes multi additional vax received same date. VAERS database updated w/same. 6/26/07 Received hospital med recs which reveal that on 5/30/07 patient experienced screaming & fussiness then excess sleepiness. When awake, inconsolable, refusal to eat & drawing legs up. Taken to PCP office & sent to ER. Felt to have resolved IS spontaneously. Held overnight for observation. Tolerated oral intake well & was d/c to home 5/31/07. FINAL DX: none provided, no D/C summary done.


Changed on 8/14/2018

VAERS ID: 281725 Before After
VAERS Form:1
Age:0.3
Gender:Male
Location:California
Vaccinated:2007-04-12
Onset:2007-05-30
Submitted:2007-06-06
Entered:2007-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2510BA / 2 RL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UFO91AA / 2 LL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 20457 / 2 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08689D / 2 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1237F / 2 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Barium enema, Intussusception, Irritability, 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:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Barium enema, X rays LABS: KUB in ER suggested IS. Barium enema done which was neg. Blood work was all WNL
CDC 'Split Type':

Write-up: Waxing, weaning fussiness Dx : intussusception. 6/21/07 Received vax rec which confirms RO lot & dose # & also includes multi additional vax received same date. VAERS database updated w/same. 6/26/07 Received hospital med recs which reveal that on 5/30/07 patient experienced screaming & fussiness then excess sleepiness. When awake, inconsolable, refusal to eat & drawing legs up. Taken to PCP office & sent to ER. Felt to have resolved IS spontaneously. Held overnight for observation. Tolerated oral intake well & was d/c to home 5/31/07. FINAL DX: none provided, no D/C summary done.

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