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This is VAERS ID 285725

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 285725
VAERS Form:
Age:0.5
Gender:Male
Location:Missouri
Vaccinated:2007-07-03
Onset:2007-07-05
Submitted:2007-07-24
Entered:2007-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B132BA / 2 LL / IM
PPV: PNEUMO (PNU-IMUNE) / WYETH PHARMACEUTICALS, INC B58845H / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0503U / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Blood glucose, Inappropriate schedule of drug administration, Intussusception, Enema administration, 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:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Intussusception by abdominal ultrasound
CDC 'Split Type':

Write-up: Seen for lethargy - pallor. Glucose @ 110. Sent to ER for evaluation and was subsequently admitted for intussusception.


Changed on 12/8/2009

VAERS ID: 285725 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Missouri
Vaccinated:2007-07-03
Onset:2007-07-05
Submitted:2007-07-24
Entered:2007-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B132BA / 2 LL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B132BA / 2 LL / IM
PPV: PNEUMO (PNU-IMUNE) / WYETH PHARMACEUTICALS, INC B58845H / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0503U / 0 - / PO

Administered by: Private      Purchased by: Unknown Private
Symptoms: Blood glucose, Inappropriate schedule of drug administration, Intussusception, Lethargy, Pallor, Enema administration, 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:
Other Medications: None
Current Illness: None
Preexisting Conditions: None records received 8/8/07-PMH: RSV.
Allergies:
Diagnostic Lab Data: Intussusception by abdominal ultrasound records received 8/8/07- Abdominal Ultrasound revealed intussusception in the midtransverse colon. Abdominal x-ray revealed nonobstructive bowel gas pattern with midepigastric soft tissue density. S
CDC 'Split Type':

Write-up: Seen for lethargy - pallor. Glucose @ 110. Sent to ER for evaluation and was subsequently admitted for intussusception. 8/8/07-records received for DOS 7/5/07-DX: Intussusception. C/O lethargy and became pale. No nausea no vomiting no diarrhea or blood in stool. Successful reduction with air enema.


Changed on 7/31/2010

VAERS ID: 285725 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Missouri
Vaccinated:2007-07-03
Onset:2007-07-05
Submitted:2007-07-24
Entered:2007-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B132BA / 2 LL / IM
PPV: PNEUMO (PNU-IMUNE) / WYETH PHARMACEUTICALS, INC B58845H / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0503U / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Blood glucose, Inappropriate schedule of drug administration, Intussusception, Lethargy, Pallor, Enema administration, 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:
Other Medications: None
Current Illness: None
Preexisting Conditions: None records received 8/8/07-PMH: RSV.
Allergies:
Diagnostic Lab Data: Intussusception by abdominal ultrasound records received 8/8/07- Abdominal Ultrasound revealed intussusception in the midtransverse colon. Abdominal x-ray revealed nonobstructive bowel gas pattern with midepigastric soft tissue density. S
CDC 'Split Type':

Write-up: Seen for lethargy - pallor. Glucose @ 110. Sent to ER for evaluation and was subsequently admitted for intussusception. 8/8/07-records received for DOS 7/5/07-DX: Intussusception. C/O lethargy and became pale. No nausea no vomiting no diarrhea or blood in stool. Successful reduction with air enema.


Changed on 8/31/2010

VAERS ID: 285725 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Missouri
Vaccinated:2007-07-03
Onset:2007-07-05
Submitted:2007-07-24
Entered:2007-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B132BA / 2 LL / IM
PPV: PNEUMO (PNU-IMUNE) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B58845H / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0503U / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Blood glucose, Inappropriate schedule of drug administration, Intussusception, Lethargy, Pallor, Ultrasound abdomen abnormal

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: None
Current Illness: None
Preexisting Conditions: None records received 8/8/07-PMH: RSV.
Allergies:
Diagnostic Lab Data: Intussusception by abdominal ultrasound records received 8/8/07- Abdominal Ultrasound revealed intussusception in the midtransverse colon. Abdominal x-ray revealed nonobstructive bowel gas pattern with midepigastric soft tissue density. S
CDC 'Split Type':

Write-up: Seen for lethargy - pallor. Glucose @ 110. Sent to ER for evaluation and was subsequently admitted for intussusception. 8/8/07-records received for DOS 7/5/07-DX: Intussusception. C/O lethargy and became pale. No nausea no vomiting no diarrhea or blood in stool. Successful reduction with air enema.


Changed on 1/4/2011

VAERS ID: 285725 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Missouri
Vaccinated:2007-07-03
Onset:2007-07-05
Submitted:2007-07-24
Entered:2007-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B132BA / 2 LL / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH B58845H / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0503U / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Blood glucose, Inappropriate schedule of drug administration, Intussusception, Lethargy, Pallor, Ultrasound abdomen abnormal

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: None
Current Illness: None
Preexisting Conditions: None records received 8/8/07-PMH: RSV.
Allergies:
Diagnostic Lab Data: Intussusception by abdominal ultrasound records received 8/8/07- Abdominal Ultrasound revealed intussusception in the midtransverse colon. Abdominal x-ray revealed nonobstructive bowel gas pattern with midepigastric soft tissue density. S Successful reduction with air enema.Labs: WNL.
CDC 'Split Type':

Write-up: Seen for lethargy - pallor. Glucose @ 110. Sent to ER for evaluation and was subsequently admitted for intussusception. 8/8/07-records received for DOS 7/5/07-DX: Intussusception. C/O lethargy and became pale. No nausea no vomiting no diarrhea or blood in stool. Successful reduction with air enema.


Changed on 4/13/2011

VAERS ID: 285725 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Missouri
Vaccinated:2007-07-03
Onset:2007-07-05
Submitted:2007-07-24
Entered:2007-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B132BA / 2 LL / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH B58845H / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0503U / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Blood glucose, Inappropriate schedule of drug administration, Intussusception, Lethargy, Pallor, Enema administration, 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:
Other Medications: None
Current Illness: None
Preexisting Conditions: None records received 8/8/07-PMH: RSV.
Allergies:
Diagnostic Lab Data: Intussusception by abdominal ultrasound records received 8/8/07- Abdominal Ultrasound revealed intussusception in the midtransverse colon. Abdominal x-ray revealed nonobstructive bowel gas pattern with midepigastric soft tissue density. Successful reduction with air enema.Labs: WNL.
CDC 'Split Type':

Write-up: Seen for lethargy - pallor. Glucose @ 110. Sent to ER for evaluation and was subsequently admitted for intussusception. 8/8/07-records received for DOS 7/5/07-DX: Intussusception. C/O lethargy and became pale. No nausea no vomiting no diarrhea or blood in stool. Successful reduction with air enema.


Changed on 5/13/2011

VAERS ID: 285725 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Missouri
Vaccinated:2007-07-03
Onset:2007-07-05
Submitted:2007-07-24
Entered:2007-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B132BA / 2 LL / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH B58845H / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0503U / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Blood glucose, Inappropriate schedule of drug administration, Intussusception, Lethargy, Pallor, Enema administration, 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:
Other Medications: None
Current Illness: None
Preexisting Conditions: None records received 8/8/07-PMH: RSV.
Allergies:
Diagnostic Lab Data: Intussusception by abdominal ultrasound records received 8/8/07- Abdominal Ultrasound revealed intussusception in the midtransverse colon. Abdominal x-ray revealed nonobstructive bowel gas pattern with midepigastric soft tissue density. Successful reduction with air enema.Labs: WNL.
CDC 'Split Type':

Write-up: Seen for lethargy - pallor. Glucose @ 110. Sent to ER for evaluation and was subsequently admitted for intussusception. 8/8/07-records received for DOS 7/5/07-DX: Intussusception. C/O lethargy and became pale. No nausea no vomiting no diarrhea or blood in stool. Successful reduction with air enema.


Changed on 6/11/2011

VAERS ID: 285725 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Missouri
Vaccinated:2007-07-03
Onset:2007-07-05
Submitted:2007-07-24
Entered:2007-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B132BA / 2 LL / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH B58845H / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0503U / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Blood glucose, Inappropriate schedule of drug administration, Intussusception, Lethargy, Pallor, Enema administration, 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:
Other Medications: None
Current Illness: None
Preexisting Conditions: None records received 8/8/07-PMH: RSV.
Allergies:
Diagnostic Lab Data: Intussusception by abdominal ultrasound records received 8/8/07- Abdominal Ultrasound revealed intussusception in the midtransverse colon. Abdominal x-ray revealed nonobstructive bowel gas pattern with midepigastric soft tissue density. Successful reduction with air enema.Labs: WNL.
CDC 'Split Type':

Write-up: Seen for lethargy - pallor. Glucose @ 110. Sent to ER for evaluation and was subsequently admitted for intussusception. 8/8/07-records received for DOS 7/5/07-DX: Intussusception. C/O lethargy and became pale. No nausea no vomiting no diarrhea or blood in stool. Successful reduction with air enema.


Changed on 5/13/2013

VAERS ID: 285725 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Missouri
Vaccinated:2007-07-03
Onset:2007-07-05
Submitted:2007-07-24
Entered:2007-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B132BA / 2 LL / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH B58845H / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0503U / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0503U / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Blood glucose, Inappropriate schedule of drug administration, Intussusception, Lethargy, Pallor, Enema administration, 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:
Other Medications: None
Current Illness: None
Preexisting Conditions: None records received 8/8/07-PMH: RSV.
Allergies:
Diagnostic Lab Data: Intussusception by abdominal ultrasound records received 8/8/07- Abdominal Ultrasound revealed intussusception in the midtransverse colon. Abdominal x-ray revealed nonobstructive bowel gas pattern with midepigastric soft tissue density. Successful reduction with air enema.Labs: WNL.
CDC 'Split Type':

Write-up: Seen for lethargy - pallor. Glucose @ 110. Sent to ER for evaluation and was subsequently admitted for intussusception. 8/8/07-records received for DOS 7/5/07-DX: Intussusception. C/O lethargy and became pale. No nausea no vomiting no diarrhea or blood in stool. Successful reduction with air enema.


Changed on 6/14/2014

VAERS ID: 285725 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Missouri
Vaccinated:2007-07-03
Onset:2007-07-05
Submitted:2007-07-24
Entered:2007-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B132BA / 2 LL / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH B58845H / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0503U / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Blood glucose, Inappropriate schedule of drug administration, Intussusception, Lethargy, Pallor, Enema administration, 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:
Other Medications: None
Current Illness: None
Preexisting Conditions: None records received 8/8/07-PMH: RSV.
Allergies:
Diagnostic Lab Data: Intussusception by abdominal ultrasound records received 8/8/07- Abdominal Ultrasound revealed intussusception in the midtransverse colon. Abdominal x-ray revealed nonobstructive bowel gas pattern with midepigastric soft tissue density. Successful reduction with air enema.Labs: WNL.
CDC 'Split Type':

Write-up: Seen for lethargy - pallor. Glucose @ 110. Sent to ER for evaluation and was subsequently admitted for intussusception. 8/8/07-records received for DOS 7/5/07-DX: Intussusception. C/O lethargy and became pale. No nausea no vomiting no diarrhea or blood in stool. Successful reduction with air enema.


Changed on 2/14/2017

VAERS ID: 285725 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Missouri
Vaccinated:2007-07-03
Onset:2007-07-05
Submitted:2007-07-24
Entered:2007-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B132BA / 2 LL / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH B58845H / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0503U / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Blood glucose, Inappropriate schedule of drug administration, Intussusception, Lethargy, Pallor, Enema administration, 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:
Other Medications: None
Current Illness: None
Preexisting Conditions: None records received 8/8/07-PMH: RSV.
Allergies:
Diagnostic Lab Data: Intussusception by abdominal ultrasound records received 8/8/07- Abdominal Ultrasound revealed intussusception in the midtransverse colon. Abdominal x-ray revealed nonobstructive bowel gas pattern with midepigastric soft tissue density. Successful reduction with air enema.Labs: WNL.
CDC 'Split Type':

Write-up: Seen for lethargy - pallor. Glucose @ 110. Sent to ER for evaluation and was subsequently admitted for intussusception. 8/8/07-records received for DOS 7/5/07-DX: Intussusception. C/O lethargy and became pale. No nausea no vomiting no diarrhea or blood in stool. Successful reduction with air enema.


Changed on 9/14/2017

VAERS ID: 285725 Before After
VAERS Form:(blank) 1
Age:0.5
Gender:Male
Location:Missouri
Vaccinated:2007-07-03
Onset:2007-07-05
Submitted:2007-07-24
Entered:2007-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B132BA / 2 3 LL / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH B58845H / 2 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0503U / 0 1 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Blood glucose, Inappropriate schedule of drug administration, Intussusception, Lethargy, Pallor, Ultrasound abdomen abnormal

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: None
Current Illness: None
Preexisting Conditions: None records received 8/8/07-PMH: RSV.
Allergies:
Diagnostic Lab Data: Intussusception by abdominal ultrasound records received 8/8/07- Abdominal Ultrasound revealed intussusception in the midtransverse colon. Abdominal x-ray revealed nonobstructive bowel gas pattern with midepigastric soft tissue density. Successful reduction with air enema.Labs: WNL.
CDC 'Split Type':

Write-up: Seen for lethargy - pallor. Glucose @ 110. Sent to ER for evaluation and was subsequently admitted for intussusception. 8/8/07-records received for DOS 7/5/07-DX: Intussusception. C/O lethargy and became pale. No nausea no vomiting no diarrhea or blood in stool. Successful reduction with air enema.


Changed on 2/14/2018

VAERS ID: 285725 Before After
VAERS Form:1
Age:0.5
Gender:Male
Location:Missouri
Vaccinated:2007-07-03
Onset:2007-07-05
Submitted:2007-07-24
Entered:2007-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B132BA / 3 LL / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH B58845H / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0503U / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Blood glucose, Inappropriate schedule of drug administration, Intussusception, Lethargy, Pallor, Ultrasound abdomen abnormal

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: None
Current Illness: None
Preexisting Conditions: None records received 8/8/07-PMH: RSV.
Allergies:
Diagnostic Lab Data: Intussusception by abdominal ultrasound records received 8/8/07- Abdominal Ultrasound revealed intussusception in the midtransverse colon. Abdominal x-ray revealed nonobstructive bowel gas pattern with midepigastric soft tissue density. Successful reduction with air enema.Labs: WNL.
CDC 'Split Type':

Write-up: Seen for lethargy - pallor. Glucose @ 110. Sent to ER for evaluation and was subsequently admitted for intussusception. 8/8/07-records received for DOS 7/5/07-DX: Intussusception. C/O lethargy and became pale. No nausea no vomiting no diarrhea or blood in stool. Successful reduction with air enema.


Changed on 6/14/2018

VAERS ID: 285725 Before After
VAERS Form:1
Age:0.5
Gender:Male
Location:Missouri
Vaccinated:2007-07-03
Onset:2007-07-05
Submitted:2007-07-24
Entered:2007-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B132BA / 3 LL / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH B58845H / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0503U / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Blood glucose, Inappropriate schedule of drug administration, Intussusception, Lethargy, Pallor, Ultrasound abdomen abnormal

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: None
Current Illness: None
Preexisting Conditions: None records received 8/8/07-PMH: RSV.
Allergies:
Diagnostic Lab Data: Intussusception by abdominal ultrasound records received 8/8/07- Abdominal Ultrasound revealed intussusception in the midtransverse colon. Abdominal x-ray revealed nonobstructive bowel gas pattern with midepigastric soft tissue density. Successful reduction with air enema.Labs: WNL.
CDC 'Split Type':

Write-up: Seen for lethargy - pallor. Glucose @ 110. Sent to ER for evaluation and was subsequently admitted for intussusception. 8/8/07-records received for DOS 7/5/07-DX: Intussusception. C/O lethargy and became pale. No nausea no vomiting no diarrhea or blood in stool. Successful reduction with air enema.


Changed on 8/14/2018

VAERS ID: 285725 Before After
VAERS Form:1
Age:0.5
Gender:Male
Location:Missouri
Vaccinated:2007-07-03
Onset:2007-07-05
Submitted:2007-07-24
Entered:2007-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B132BA / 3 LL / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH B58845H / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0503U / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Blood glucose, Inappropriate schedule of drug administration, Intussusception, Lethargy, Pallor, Ultrasound abdomen abnormal

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: None
Current Illness: None
Preexisting Conditions: None records received 8/8/07-PMH: RSV.
Allergies:
Diagnostic Lab Data: Intussusception by abdominal ultrasound records received 8/8/07- Abdominal Ultrasound revealed intussusception in the midtransverse colon. Abdominal x-ray revealed nonobstructive bowel gas pattern with midepigastric soft tissue density. Successful reduction with air enema.Labs: WNL.
CDC 'Split Type':

Write-up: Seen for lethargy - pallor. Glucose @ 110. Sent to ER for evaluation and was subsequently admitted for intussusception. 8/8/07-records received for DOS 7/5/07-DX: Intussusception. C/O lethargy and became pale. No nausea no vomiting no diarrhea or blood in stool. Successful reduction with air enema.

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