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This is VAERS ID 292254

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 292254
VAERS Form:
Age:0.3
Sex:Male
Location:California
Vaccinated:2007-02-02
Onset:2007-03-30
Submitted:2007-09-26
Entered:2007-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084CA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1084F / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08683A / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0578F / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Abdominal pain, Appendicectomy, Dehydration, Haematochezia, Intussusception

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: 3     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 3/30/07 Came in for vomiting, dehydration 5 days hx of vomiting, Admitted to hospital - CT scan revealed reg scan - transferred for surgical evaluation. Had open reduction 4/3/07.

Changed on 12/8/2009

VAERS ID: 292254 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:California
Vaccinated:2007-02-02
Onset:2007-03-30
Submitted:2007-09-26
Entered:2007-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084CA / 1 LL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084CA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1084F / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08683A / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0578F / 1 - / PO

Administered by: Private      Purchased by: Unknown Private
Symptoms: Abdominal pain, Appendicectomy, Dehydration, Haematochezia, Intussusception, Mucous stools, Surgery, Vomiting

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: 3     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 3/30/07 Came in for vomiting, dehydration 5 days hx of vomiting, Admitted to hospital - CT scan revealed reg scan - transferred for surgical evaluation. Had open reduction 4/3/07. 10/26/07 Reviewed hospital medical records which reveal patient experienced abdominal pain, vomiting, x 6 days; irritability, bloody mucusy stool x 1 day. Admitted 4/2-4/5/2007. FINAL DX: Intussusception, surgically reduced; appendectomy. Records faxed to CDC.

Changed on 3/2/2010

VAERS ID: 292254 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:California
Vaccinated:2007-02-02
Onset:2007-03-30
Submitted:2007-09-26
Entered:2007-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084CA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1084F / 1 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B08683A / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0578F / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Appendicectomy, Dehydration, Haematochezia, Intussusception, Mucous stools, Surgery, Vomiting

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: 3     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 3/30/07 Came in for vomiting, dehydration 5 days hx of vomiting, Admitted to hospital - CT scan revealed reg scan - transferred for surgical evaluation. Had open reduction 4/3/07. 10/26/07 Reviewed hospital medical records which reveal patient experienced abdominal pain, vomiting, x 6 days; irritability, bloody mucusy stool x 1 day. Admitted 4/2-4/5/2007. FINAL DX: Intussusception, surgically reduced; appendectomy. Records faxed to CDC.

Changed on 4/7/2010

VAERS ID: 292254 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:California
Vaccinated:2007-02-02
Onset:2007-03-30
Submitted:2007-09-26
Entered:2007-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084CA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1084F / 1 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08683A / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0578F / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Appendicectomy, Dehydration, Haematochezia, Intussusception, Mucous stools, Surgery, Vomiting

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: 3     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 3/30/07 Came in for vomiting, dehydration 5 days hx of vomiting, Admitted to hospital - CT scan revealed reg scan - transferred for surgical evaluation. Had open reduction 4/3/07. 10/26/07 Reviewed hospital medical records which reveal patient experienced abdominal pain, vomiting, x 6 days; irritability, bloody mucusy stool x 1 day. Admitted 4/2-4/5/2007. FINAL DX: Intussusception, surgically reduced; appendectomy. Records faxed to CDC.

Changed on 8/31/2010

VAERS ID: 292254 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:California
Vaccinated:2007-02-02
Onset:2007-03-30
Submitted:2007-09-26
Entered:2007-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084CA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1084F / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B08683A / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0578F / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Appendicectomy, Dehydration, Haematochezia, Intussusception, Mucous stools, Surgery, Vomiting

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: 3     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 3/30/07 Came in for vomiting, dehydration 5 days hx of vomiting, Admitted to hospital - CT scan revealed reg scan - transferred for surgical evaluation. Had open reduction 4/3/07. 10/26/07 Reviewed hospital medical records which reveal patient experienced abdominal pain, vomiting, x 6 days; irritability, bloody mucusy stool x 1 day. Admitted 4/2-4/5/2007. FINAL DX: Intussusception, surgically reduced; appendectomy. Records faxed to CDC.

Changed on 5/13/2013

VAERS ID: 292254 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:California
Vaccinated:2007-02-02
Onset:2007-03-30
Submitted:2007-09-26
Entered:2007-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084CA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1084F / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08683A / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0578F / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0578F / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Appendicectomy, Dehydration, Haematochezia, Intussusception, Mucous stools, Surgery, Vomiting

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: 3     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 3/30/07 Came in for vomiting, dehydration 5 days hx of vomiting, Admitted to hospital - CT scan revealed reg scan - transferred for surgical evaluation. Had open reduction 4/3/07. 10/26/07 Reviewed hospital medical records which reveal patient experienced abdominal pain, vomiting, x 6 days; irritability, bloody mucusy stool x 1 day. Admitted 4/2-4/5/2007. FINAL DX: Intussusception, surgically reduced; appendectomy. Records faxed to CDC.

Changed on 2/14/2017

VAERS ID: 292254 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:California
Vaccinated:2007-02-02
Onset:2007-03-30
Submitted:2007-09-26
Entered:2007-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084CA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1084F / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08683A / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0578F / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Appendicectomy, Dehydration, Haematochezia, Intussusception, Mucous stools, Surgery, Vomiting

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: 3     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 3/30/07 Came in for vomiting, dehydration 5 days hx of vomiting, Admitted to hospital - CT scan revealed reg scan - transferred for surgical evaluation. Had open reduction 4/3/07. 10/26/07 Reviewed hospital medical records which reveal patient experienced abdominal pain, vomiting, x 6 days; irritability, bloody mucusy stool x 1 day. Admitted 4/2-4/5/2007. FINAL DX: Intussusception, surgically reduced; appendectomy. Records faxed to CDC.

Changed on 9/14/2017

VAERS ID: 292254 Before After
VAERS Form:(blank) 1
Age:0.3
Sex:Male
Location:California
Vaccinated:2007-02-02
Onset:2007-03-30
Submitted:2007-09-26
Entered:2007-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084CA / 1 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1084F / 1 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08683A / 1 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0578F / 1 2 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Dehydration, Intussusception, Vomiting

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: 3     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 3/30/07 Came in for vomiting, dehydration 5 days hx of vomiting, Admitted to hospital - CT scan revealed reg scan - transferred for surgical evaluation. Had open reduction 4/3/07. 10/26/07 Reviewed hospital medical records which reveal patient experienced abdominal pain, vomiting, x 6 days; irritability, bloody mucusy stool x 1 day. Admitted 4/2-4/5/2007. FINAL DX: Intussusception, surgically reduced; appendectomy. Records faxed to CDC.

Changed on 2/14/2018

VAERS ID: 292254 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:California
Vaccinated:2007-02-02
Onset:2007-03-30
Submitted:2007-09-26
Entered:2007-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084CA / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1084F / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08683A / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0578F / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Dehydration, Intussusception, Vomiting

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: 3     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 3/30/07 Came in for vomiting, dehydration 5 days hx of vomiting, Admitted to hospital - CT scan revealed reg scan - transferred for surgical evaluation. Had open reduction 4/3/07. 10/26/07 Reviewed hospital medical records which reveal patient experienced abdominal pain, vomiting, x 6 days; irritability, bloody mucusy stool x 1 day. Admitted 4/2-4/5/2007. FINAL DX: Intussusception, surgically reduced; appendectomy. Records faxed to CDC.

Changed on 6/14/2018

VAERS ID: 292254 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:California
Vaccinated:2007-02-02
Onset:2007-03-30
Submitted:2007-09-26
Entered:2007-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084CA / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1084F / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08683A / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0578F / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Dehydration, Intussusception, Vomiting

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: 3     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 3/30/07 Came in for vomiting, dehydration 5 days hx of vomiting, Admitted to hospital - CT scan revealed reg scan - transferred for surgical evaluation. Had open reduction 4/3/07. 10/26/07 Reviewed hospital medical records which reveal patient experienced abdominal pain, vomiting, x 6 days; irritability, bloody mucusy stool x 1 day. Admitted 4/2-4/5/2007. FINAL DX: Intussusception, surgically reduced; appendectomy. Records faxed to CDC.

Changed on 8/14/2018

VAERS ID: 292254 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:California
Vaccinated:2007-02-02
Onset:2007-03-30
Submitted:2007-09-26
Entered:2007-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084CA / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1084F / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08683A / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0578F / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Dehydration, Intussusception, Vomiting

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: 3     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 3/30/07 Came in for vomiting, dehydration 5 days hx of vomiting, Admitted to hospital - CT scan revealed reg scan - transferred for surgical evaluation. Had open reduction 4/3/07. 10/26/07 Reviewed hospital medical records which reveal patient experienced abdominal pain, vomiting, x 6 days; irritability, bloody mucusy stool x 1 day. Admitted 4/2-4/5/2007. FINAL DX: Intussusception, surgically reduced; appendectomy. Records faxed to CDC.

Changed on 9/14/2018

VAERS ID: 292254 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:California
Vaccinated:2007-02-02
Onset:2007-03-30
Submitted:2007-09-26
Entered:2007-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084CA / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1084F / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08683A / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0578F / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Dehydration, Intussusception, Vomiting

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: 3     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 3/30/07 Came in for vomiting, dehydration 5 days hx of vomiting, Admitted to hospital - CT scan revealed reg scan - transferred for surgical evaluation. Had open reduction 4/3/07. 10/26/07 Reviewed hospital medical records which reveal patient experienced abdominal pain, vomiting, x 6 days; irritability, bloody mucusy stool x 1 day. Admitted 4/2-4/5/2007. FINAL DX: Intussusception, surgically reduced; appendectomy. Records faxed to CDC.

Changed on 10/14/2018

VAERS ID: 292254 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:California
Vaccinated:2007-02-02
Onset:2007-03-30
Submitted:2007-09-26
Entered:2007-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084CA / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1084F / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08683A / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0578F / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Dehydration, Intussusception, Vomiting

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: 3     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 3/30/07 Came in for vomiting, dehydration 5 days hx of vomiting, Admitted to hospital - CT scan revealed reg scan - transferred for surgical evaluation. Had open reduction 4/3/07. 10/26/07 Reviewed hospital medical records which reveal patient experienced abdominal pain, vomiting, x 6 days; irritability, bloody mucusy stool x 1 day. Admitted 4/2-4/5/2007. FINAL DX: Intussusception, surgically reduced; appendectomy. Records faxed to CDC.

Changed on 12/24/2020

VAERS ID: 292254 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:California
Vaccinated:2007-02-02
Onset:2007-03-30
Submitted:2007-09-26
Entered:2007-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084CA / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1084F / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08683A / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0578F / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Dehydration, Intussusception, Vomiting

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: 3     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 3/30/07 Came in for vomiting, dehydration 5 days hx of vomiting, Admitted to hospital - CT scan revealed reg scan - transferred for surgical evaluation. Had open reduction 4/3/07. 10/26/07 Reviewed hospital medical records which reveal patient experienced abdominal pain, vomiting, x 6 days; irritability, bloody mucusy stool x 1 day. Admitted 4/2-4/5/2007. FINAL DX: Intussusception, surgically reduced; appendectomy. Records faxed to CDC.

Changed on 12/30/2020

VAERS ID: 292254 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:California
Vaccinated:2007-02-02
Onset:2007-03-30
Submitted:2007-09-26
Entered:2007-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084CA / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1084F / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08683A / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0578F / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Dehydration, Intussusception, Vomiting

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: 3     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
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Write-up: 3/30/07 Came in for vomiting, dehydration 5 days hx of vomiting, Admitted to hospital - CT scan revealed reg scan - transferred for surgical evaluation. Had open reduction 4/3/07. 10/26/07 Reviewed hospital medical records which reveal patient experienced abdominal pain, vomiting, x 6 days; irritability, bloody mucusy stool x 1 day. Admitted 4/2-4/5/2007. FINAL DX: Intussusception, surgically reduced; appendectomy. Records faxed to CDC.

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