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This is VAERS ID 288297

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 288297
VAERS Form:
Age:0.4
Gender:Male
Location:New York
Vaccinated:2007-07-27
Onset:2007-08-09
Submitted:2007-08-16
Entered:2007-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B115AA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1274F / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B086908 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0508U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood culture negative, Crying, Full blood count, Enema administration, Abdominal X-ray

Life Threatening? Yes
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: cbc wbc 17.3 hgb 10.4 plts 414; nl chemistries, obstructive series (3 views) suspicious for ileocolic intussusception. Abd sono - ileocolic intussusception at transverse colon. air enema - reduced
CDC 'Split Type':

Write-up: On Aug 9th had crying and bloody stool noted by parent. Brought to emergency department, diagnosed with ileocolic intussusception. Reduced with air enema.


Changed on 12/8/2009

VAERS ID: 288297 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:New York
Vaccinated:2007-07-27
Onset:2007-08-09
Submitted:2007-08-16
Entered:2007-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B115AA / 1 LL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B115AA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1274F / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B086908 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0508U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood culture negative, Crying, Full blood count, Haematochezia, Haemoglobin normal, Intussusception, Irritability, Platelet count normal, White blood cell count increased, Enema administration, Abdominal X-ray

Life Threatening? Yes
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: cbc wbc 17.3 hgb 10.4 plts 414; nl chemistries, obstructive series (3 views) suspicious for ileocolic intussusception. Abd sono - ileocolic intussusception at transverse colon. air enema - reduced LABS: Blood c/s neg. Abdominal x-ray rev
CDC 'Split Type':

Write-up: On Aug 9th had crying and bloody stool noted by parent. Brought to emergency department, diagnosed with ileocolic intussusception. Reduced with air enema. 8/21/07 Received vax record from provider which confirms RO dose & lost # as reported. 10/16/07 Received hospital medical records which reveal patient experienced irritability & bloody stool x 1 day. Admitted 8/8-8/9/2007. FINAL DX: Ileocolic intussusception, enema reduced. Records faxed to CDC.


Changed on 3/2/2010

VAERS ID: 288297 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:New York
Vaccinated:2007-07-27
Onset:2007-08-09
Submitted:2007-08-16
Entered:2007-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B115AA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1274F / 1 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B086908 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0508U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood culture negative, Crying, Full blood count, Haematochezia, Haemoglobin normal, Intussusception, Irritability, Platelet count normal, White blood cell count increased, Enema administration, Abdominal X-ray

Life Threatening? Yes
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: cbc wbc 17.3 hgb 10.4 plts 414; nl chemistries, obstructive series (3 views) suspicious for ileocolic intussusception. Abd sono - ileocolic intussusception at transverse colon. air enema - reduced LABS: Blood c/s neg. Abdominal x-ray rev
CDC 'Split Type':

Write-up: On Aug 9th had crying and bloody stool noted by parent. Brought to emergency department, diagnosed with ileocolic intussusception. Reduced with air enema. 8/21/07 Received vax record from provider which confirms RO dose & lost # as reported. 10/16/07 Received hospital medical records which reveal patient experienced irritability & bloody stool x 1 day. Admitted 8/8-8/9/2007. FINAL DX: Ileocolic intussusception, enema reduced. Records faxed to CDC.


Changed on 4/7/2010

VAERS ID: 288297 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:New York
Vaccinated:2007-07-27
Onset:2007-08-09
Submitted:2007-08-16
Entered:2007-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B115AA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1274F / 1 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B086908 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0508U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood culture negative, Crying, Full blood count, Haematochezia, Haemoglobin normal, Intussusception, Irritability, Platelet count normal, White blood cell count increased, Enema administration, Abdominal X-ray

Life Threatening? Yes
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: cbc wbc 17.3 hgb 10.4 plts 414; nl chemistries, obstructive series (3 views) suspicious for ileocolic intussusception. Abd sono - ileocolic intussusception at transverse colon. air enema - reduced LABS: Blood c/s neg. Abdominal x-ray rev
CDC 'Split Type':

Write-up: On Aug 9th had crying and bloody stool noted by parent. Brought to emergency department, diagnosed with ileocolic intussusception. Reduced with air enema. 8/21/07 Received vax record from provider which confirms RO dose & lost # as reported. 10/16/07 Received hospital medical records which reveal patient experienced irritability & bloody stool x 1 day. Admitted 8/8-8/9/2007. FINAL DX: Ileocolic intussusception, enema reduced. Records faxed to CDC.


Changed on 8/31/2010

VAERS ID: 288297 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:New York
Vaccinated:2007-07-27
Onset:2007-08-09
Submitted:2007-08-16
Entered:2007-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B115AA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1274F / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B086908 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0508U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood culture negative, Crying, Full blood count, Haematochezia, Haemoglobin normal, Intussusception, Irritability, Platelet count normal, White blood cell count increased, Enema administration, Abdominal X-ray

Life Threatening? Yes
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: cbc wbc 17.3 hgb 10.4 plts 414; nl chemistries, obstructive series (3 views) suspicious for ileocolic intussusception. Abd sono - ileocolic intussusception at transverse colon. air enema - reduced LABS: Blood c/s neg. Abdominal x-ray rev
CDC 'Split Type':

Write-up: On Aug 9th had crying and bloody stool noted by parent. Brought to emergency department, diagnosed with ileocolic intussusception. Reduced with air enema. 8/21/07 Received vax record from provider which confirms RO dose & lost # as reported. 10/16/07 Received hospital medical records which reveal patient experienced irritability & bloody stool x 1 day. Admitted 8/8-8/9/2007. FINAL DX: Ileocolic intussusception, enema reduced. Records faxed to CDC.


Changed on 5/13/2013

VAERS ID: 288297 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:New York
Vaccinated:2007-07-27
Onset:2007-08-09
Submitted:2007-08-16
Entered:2007-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B115AA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1274F / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B086908 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0508U / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0508U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood culture negative, Crying, Full blood count, Haematochezia, Haemoglobin normal, Intussusception, Irritability, Platelet count normal, White blood cell count increased, Enema administration, Abdominal X-ray

Life Threatening? Yes
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: cbc wbc 17.3 hgb 10.4 plts 414; nl chemistries, obstructive series (3 views) suspicious for ileocolic intussusception. Abd sono - ileocolic intussusception at transverse colon. air enema - reduced LABS: Blood c/s neg. Abdominal x-ray rev
CDC 'Split Type':

Write-up: On Aug 9th had crying and bloody stool noted by parent. Brought to emergency department, diagnosed with ileocolic intussusception. Reduced with air enema. 8/21/07 Received vax record from provider which confirms RO dose & lost # as reported. 10/16/07 Received hospital medical records which reveal patient experienced irritability & bloody stool x 1 day. Admitted 8/8-8/9/2007. FINAL DX: Ileocolic intussusception, enema reduced. Records faxed to CDC.


Changed on 2/14/2017

VAERS ID: 288297 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:New York
Vaccinated:2007-07-27
Onset:2007-08-09
Submitted:2007-08-16
Entered:2007-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B115AA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1274F / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B086908 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0508U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood culture negative, Crying, Full blood count, Haematochezia, Haemoglobin normal, Intussusception, Irritability, Platelet count normal, White blood cell count increased, Enema administration, Abdominal X-ray

Life Threatening? Yes
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: cbc wbc 17.3 hgb 10.4 plts 414; nl chemistries, obstructive series (3 views) suspicious for ileocolic intussusception. Abd sono - ileocolic intussusception at transverse colon. air enema - reduced LABS: Blood c/s neg. Abdominal x-ray rev revealed IS. Barium enema w/air contrast
CDC 'Split Type':

Write-up: On Aug 9th had crying and bloody stool noted by parent. Brought to emergency department, diagnosed with ileocolic intussusception. Reduced with air enema. 8/21/07 Received vax record from provider which confirms RO dose & lost # as reported. 10/16/07 Received hospital medical records which reveal patient experienced irritability & bloody stool x 1 day. Admitted 8/8-8/9/2007. FINAL DX: Ileocolic intussusception, enema reduced. Records faxed to CDC.


Changed on 9/14/2017

VAERS ID: 288297 Before After
VAERS Form:(blank) 1
Age:0.4
Gender:Male
Location:New York
Vaccinated:2007-07-27
Onset:2007-08-09
Submitted:2007-08-16
Entered:2007-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B115AA / 1 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1274F / 1 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B086908 / 1 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0508U / 1 2 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Crying, Full blood count, Haematochezia, Haemoglobin normal, Intussusception, Platelet count normal, White blood cell count increased, Enema administration

Life Threatening? Yes
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: cbc wbc 17.3 hgb 10.4 plts 414; nl chemistries, obstructive series (3 views) suspicious for ileocolic intussusception. Abd sono - ileocolic intussusception at transverse colon. air enema - reduced LABS: Blood c/s neg. Abdominal x-ray revealed IS. Barium enema w/air contrast
CDC 'Split Type':

Write-up: On Aug 9th had crying and bloody stool noted by parent. Brought to emergency department, diagnosed with ileocolic intussusception. Reduced with air enema. 8/21/07 Received vax record from provider which confirms RO dose & lost # as reported. 10/16/07 Received hospital medical records which reveal patient experienced irritability & bloody stool x 1 day. Admitted 8/8-8/9/2007. FINAL DX: Ileocolic intussusception, enema reduced. Records faxed to CDC.


Changed on 2/14/2018

VAERS ID: 288297 Before After
VAERS Form:1
Age:0.4
Gender:Male
Location:New York
Vaccinated:2007-07-27
Onset:2007-08-09
Submitted:2007-08-16
Entered:2007-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B115AA / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1274F / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B086908 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0508U / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Crying, Full blood count, Haematochezia, Haemoglobin normal, Intussusception, Platelet count normal, White blood cell count increased, Enema administration

Life Threatening? Yes
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: cbc wbc 17.3 hgb 10.4 plts 414; nl chemistries, obstructive series (3 views) suspicious for ileocolic intussusception. Abd sono - ileocolic intussusception at transverse colon. air enema - reduced LABS: Blood c/s neg. Abdominal x-ray revealed IS. Barium enema w/air contrast
CDC 'Split Type':

Write-up: On Aug 9th had crying and bloody stool noted by parent. Brought to emergency department, diagnosed with ileocolic intussusception. Reduced with air enema. 8/21/07 Received vax record from provider which confirms RO dose & lost # as reported. 10/16/07 Received hospital medical records which reveal patient experienced irritability & bloody stool x 1 day. Admitted 8/8-8/9/2007. FINAL DX: Ileocolic intussusception, enema reduced. Records faxed to CDC.


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