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This is VAERS ID 288089

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 288089
VAERS Form:
Age:0.3
Gender:Male
Location:Pennsylvania
Vaccinated:2007-05-25
Onset:2007-08-01
Submitted:2007-08-14
Entered:2007-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2651AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE921AA / 1 LL / ID
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0872 / 1 RL / ID
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08692F / 1 LA / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0236U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Appendicectomy, Barium enema, Diarrhoea, Intussusception, Explorative laparotomy

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A. PMH: URI 5 days ago, Varicella infection 2 weeks ago
Allergies:
Diagnostic Lab Data: exploratory laparotomy, reduction of intussusception, appendectomy. Labs and Diagnostics: Abdominal US (+) for IS. Air contrast barium enema which partially reduced the IS.
CDC 'Split Type':

Write-up: vomiting, diarrhea. D/C summary received for DOS 8/3-4/2007 for DX of Intussusception made at another facility. Infant had Air contrast barium enema which partially reduced the IS. Taken to OR for open reduction of intussusception and appendectomy. D/C"DX: Intussusception.


Changed on 12/8/2009

VAERS ID: 288089 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Pennsylvania
Vaccinated:2007-05-25
Onset:2007-08-01
Submitted:2007-08-14
Entered:2007-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2651AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE921AA / 1 LL / ID
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0872 / 1 RL / ID
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08692F / 1 LA / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0236U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Appendicectomy, Barium enema, Diarrhoea, Intussusception, Large intestinal obstruction reduction, Surgery, Vomiting, Ultrasound abdomen abnormal, Explorative laparotomy

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A. PMH: URI 5 days ago, Varicella infection 2 weeks ago
Allergies:
Diagnostic Lab Data: exploratory laparotomy, reduction of intussusception, appendectomy. Labs and Diagnostics: Abdominal US (+) for IS. Air contrast barium enema which partially reduced the IS.
CDC 'Split Type':

Write-up: vomiting, diarrhea. D/C summary received for DOS 8/3-4/2007 for DX of Intussusception made at another facility. Infant had Air contrast barium enema which partially reduced the IS. Taken to OR for open reduction of intussusception and appendectomy. D/C"DX: D/C DX: Intussusception.


Changed on 3/2/2010

VAERS ID: 288089 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Pennsylvania
Vaccinated:2007-05-25
Onset:2007-08-01
Submitted:2007-08-14
Entered:2007-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2651AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE921AA / 1 LL / ID
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0872 / 1 RL / ID
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B08692F / 1 LA / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0236U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Appendicectomy, Barium enema, Diarrhoea, Intussusception, Large intestinal obstruction reduction, Surgery, Vomiting, Ultrasound abdomen abnormal, Explorative laparotomy

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A. PMH: URI 5 days ago, Varicella infection 2 weeks ago
Allergies:
Diagnostic Lab Data: exploratory laparotomy, reduction of intussusception, appendectomy. Labs and Diagnostics: Abdominal US (+) for IS. Air contrast barium enema which partially reduced the IS.
CDC 'Split Type':

Write-up: vomiting, diarrhea. D/C summary received for DOS 8/3-4/2007 for DX of Intussusception made at another facility. Infant had Air contrast barium enema which partially reduced the IS. Taken to OR for open reduction of intussusception and appendectomy. D/C DX: Intussusception.


Changed on 4/7/2010

VAERS ID: 288089 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Pennsylvania
Vaccinated:2007-05-25
Onset:2007-08-01
Submitted:2007-08-14
Entered:2007-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2651AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE921AA / 1 LL / ID
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0872 / 1 RL / ID
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08692F / 1 LA / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0236U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Appendicectomy, Barium enema, Diarrhoea, Intussusception, Large intestinal obstruction reduction, Surgery, Vomiting, Ultrasound abdomen abnormal, Explorative laparotomy

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A. PMH: URI 5 days ago, Varicella infection 2 weeks ago
Allergies:
Diagnostic Lab Data: exploratory laparotomy, reduction of intussusception, appendectomy. Labs and Diagnostics: Abdominal US (+) for IS. Air contrast barium enema which partially reduced the IS.
CDC 'Split Type':

Write-up: vomiting, diarrhea. D/C summary received for DOS 8/3-4/2007 for DX of Intussusception made at another facility. Infant had Air contrast barium enema which partially reduced the IS. Taken to OR for open reduction of intussusception and appendectomy. D/C DX: Intussusception.


Changed on 8/31/2010

VAERS ID: 288089 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Pennsylvania
Vaccinated:2007-05-25
Onset:2007-08-01
Submitted:2007-08-14
Entered:2007-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2651AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE921AA / 1 LL / ID
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0872 / 1 RL / ID
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B08692F / 1 LA / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0236U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Appendicectomy, Barium enema, Diarrhoea, Intussusception, Large intestinal obstruction reduction, Surgery, Vomiting, Ultrasound abdomen abnormal, Explorative laparotomy

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A. PMH: URI 5 days ago, Varicella infection 2 weeks ago
Allergies:
Diagnostic Lab Data: exploratory laparotomy, reduction of intussusception, appendectomy. Labs and Diagnostics: Abdominal US (+) for IS. Air contrast barium enema which partially reduced the IS.
CDC 'Split Type':

Write-up: vomiting, diarrhea. D/C summary received for DOS 8/3-4/2007 for DX of Intussusception made at another facility. Infant had Air contrast barium enema which partially reduced the IS. Taken to OR for open reduction of intussusception and appendectomy. D/C DX: Intussusception.


Changed on 5/13/2013

VAERS ID: 288089 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Pennsylvania
Vaccinated:2007-05-25
Onset:2007-08-01
Submitted:2007-08-14
Entered:2007-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2651AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE921AA / 1 LL / ID
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0872 / 1 RL / ID
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08692F / 1 LA / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0236U / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0236U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Appendicectomy, Barium enema, Diarrhoea, Intussusception, Large intestinal obstruction reduction, Surgery, Vomiting, Ultrasound abdomen abnormal, Explorative laparotomy

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A. PMH: URI 5 days ago, Varicella infection 2 weeks ago
Allergies:
Diagnostic Lab Data: exploratory laparotomy, reduction of intussusception, appendectomy. Labs and Diagnostics: Abdominal US (+) for IS. Air contrast barium enema which partially reduced the IS.
CDC 'Split Type':

Write-up: vomiting, diarrhea. D/C summary received for DOS 8/3-4/2007 for DX of Intussusception made at another facility. Infant had Air contrast barium enema which partially reduced the IS. Taken to OR for open reduction of intussusception and appendectomy. D/C DX: Intussusception.


Changed on 2/14/2017

VAERS ID: 288089 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Pennsylvania
Vaccinated:2007-05-25
Onset:2007-08-01
Submitted:2007-08-14
Entered:2007-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2651AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE921AA / 1 LL / ID
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0872 / 1 RL / ID
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08692F / 1 LA / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0236U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Appendicectomy, Barium enema, Diarrhoea, Intussusception, Large intestinal obstruction reduction, Surgery, Vomiting, Ultrasound abdomen abnormal, Explorative laparotomy

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A. PMH: URI 5 days ago, Varicella infection 2 weeks ago
Allergies:
Diagnostic Lab Data: exploratory laparotomy, reduction of intussusception, appendectomy. Labs and Diagnostics: Abdominal US (+) for IS. Air contrast barium enema which partially reduced the IS.
CDC 'Split Type':

Write-up: vomiting, diarrhea. D/C summary received for DOS 8/3-4/2007 for DX of Intussusception made at another facility. Infant had Air contrast barium enema which partially reduced the IS. Taken to OR for open reduction of intussusception and appendectomy. D/C DX: Intussusception.


Changed on 9/14/2017

VAERS ID: 288089 Before After
VAERS Form:(blank) 1
Age:0.3
Gender:Male
Location:Pennsylvania
Vaccinated:2007-05-25
Onset:2007-08-01
Submitted:2007-08-14
Entered:2007-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2651AA / 1 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE921AA / 1 2 LL / ID
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0872 / 1 2 RL / ID
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08692F / 1 2 LA / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0236U / 1 2 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Appendicectomy, Diarrhoea, Intussusception, Vomiting, Explorative laparotomy

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A. PMH: URI 5 days ago, Varicella infection 2 weeks ago
Allergies:
Diagnostic Lab Data: exploratory laparotomy, reduction of intussusception, appendectomy. Labs and Diagnostics: Abdominal US (+) for IS. Air contrast barium enema which partially reduced the IS.
CDC 'Split Type':

Write-up: vomiting, diarrhea. D/C summary received for DOS 8/3-4/2007 for DX of Intussusception made at another facility. Infant had Air contrast barium enema which partially reduced the IS. Taken to OR for open reduction of intussusception and appendectomy. D/C DX: Intussusception.


Changed on 2/14/2018

VAERS ID: 288089 Before After
VAERS Form:1
Age:0.3
Gender:Male
Location:Pennsylvania
Vaccinated:2007-05-25
Onset:2007-08-01
Submitted:2007-08-14
Entered:2007-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2651AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE921AA / 2 LL / ID
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0872 / 2 RL / ID
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08692F / 2 LA / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0236U / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Appendicectomy, Diarrhoea, Intussusception, Vomiting, Explorative laparotomy

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A. PMH: URI 5 days ago, Varicella infection 2 weeks ago
Allergies:
Diagnostic Lab Data: exploratory laparotomy, reduction of intussusception, appendectomy. Labs and Diagnostics: Abdominal US (+) for IS. Air contrast barium enema which partially reduced the IS.
CDC 'Split Type':

Write-up: vomiting, diarrhea. D/C summary received for DOS 8/3-4/2007 for DX of Intussusception made at another facility. Infant had Air contrast barium enema which partially reduced the IS. Taken to OR for open reduction of intussusception and appendectomy. D/C DX: Intussusception.


Changed on 6/14/2018

VAERS ID: 288089 Before After
VAERS Form:1
Age:0.3
Gender:Male
Location:Pennsylvania
Vaccinated:2007-05-25
Onset:2007-08-01
Submitted:2007-08-14
Entered:2007-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2651AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE921AA / 2 LL / ID
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0872 / 2 RL / ID
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08692F / 2 LA / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0236U / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Appendicectomy, Diarrhoea, Intussusception, Vomiting, Explorative laparotomy

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A. PMH: URI 5 days ago, Varicella infection 2 weeks ago
Allergies:
Diagnostic Lab Data: exploratory laparotomy, reduction of intussusception, appendectomy. Labs and Diagnostics: Abdominal US (+) for IS. Air contrast barium enema which partially reduced the IS.
CDC 'Split Type':

Write-up: vomiting, diarrhea. D/C summary received for DOS 8/3-4/2007 for DX of Intussusception made at another facility. Infant had Air contrast barium enema which partially reduced the IS. Taken to OR for open reduction of intussusception and appendectomy. D/C DX: Intussusception.


Changed on 8/14/2018

VAERS ID: 288089 Before After
VAERS Form:1
Age:0.3
Gender:Male
Location:Pennsylvania
Vaccinated:2007-05-25
Onset:2007-08-01
Submitted:2007-08-14
Entered:2007-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2651AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE921AA / 2 LL / ID
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0872 / 2 RL / ID
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08692F / 2 LA / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0236U / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Appendicectomy, Diarrhoea, Intussusception, Vomiting, Explorative laparotomy

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A. PMH: URI 5 days ago, Varicella infection 2 weeks ago
Allergies:
Diagnostic Lab Data: exploratory laparotomy, reduction of intussusception, appendectomy. Labs and Diagnostics: Abdominal US (+) for IS. Air contrast barium enema which partially reduced the IS.
CDC 'Split Type':

Write-up: vomiting, diarrhea. D/C summary received for DOS 8/3-4/2007 for DX of Intussusception made at another facility. Infant had Air contrast barium enema which partially reduced the IS. Taken to OR for open reduction of intussusception and appendectomy. D/C DX: Intussusception.

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