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This is VAERS ID 292561

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 292561
VAERS Form:
Age:0.5
Gender:Male
Location:South Carolina
Vaccinated:2007-10-02
Onset:2007-10-05
Submitted:0000-00-00
Entered:2007-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B115CB / 2 LL / IM
FLU: INFLUENZA (FLUZONE) / SANOFI PASTEUR U2435AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF119AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B47300F / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0410U / 2 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Intussusception, Enema administration, Adenovirus infection, Abdominal X-ray, Rotavirus test negative

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abdominal Xray, Abdominal KUB 10/22/07-records received-KUB showed dilated loops of bowel with air fluid levels. Ultrasound diagnostic for intussusception.
CDC 'Split Type':

Write-up: intussusception confirmed by abdominal x ray, abdominal ultrasound at 10-5-07 10/22/07-records received for DOS 10/5-10/7/07-DC DX: Intussusception. Laparotomy, appendectomy. Operative reduction of intussusception. Hydrostatically irreducible. Three days"prior to admission C/O abdominal pain and emesis, HX of episodic pain, no bloody bowel movements.


Changed on 12/8/2009

VAERS ID: 292561 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:South Carolina
Vaccinated:2007-10-02
Onset:2007-10-05
Submitted:0000-00-00
Entered:2007-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B115CB / 2 LL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B115CB / 2 LL / IM
FLU: INFLUENZA (FLUZONE) INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2435AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF119AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B47300F / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0410U / 2 - / PO

Administered by: Private      Purchased by: Unknown Public
Symptoms: Intussusception, Urinary system X-ray, Enema administration, Ultrasound abdomen abnormal, Adenovirus infection, Abdominal X-ray, Rotavirus test negative

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abdominal Xray, Abdominal KUB 10/22/07-records received-KUB showed dilated loops of bowel with air fluid levels. Ultrasound diagnostic for intussusception. 11/15/07-records received-11/15/07-tissue slide report received: specimen appendix
CDC 'Split Type':

Write-up: intussusception confirmed by abdominal x ray, abdominal ultrasound at 10-5-07 10/22/07-records received for DOS 10/5-10/7/07-DC DX: Intussusception. Laparotomy, appendectomy. Operative reduction of intussusception. Hydrostatically irreducible. Three days"prior days prior to admission C/O abdominal pain and emesis, HX of episodic pain, no bloody bowel movements.


Changed on 3/2/2010

VAERS ID: 292561 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:South Carolina
Vaccinated:2007-10-02
Onset:2007-10-05
Submitted:0000-00-00
Entered:2007-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B115CB / 2 LL / IM
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2435AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF119AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B47300F / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0410U / 2 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Urinary system X-ray, Enema administration, Ultrasound abdomen abnormal, Adenovirus infection, Abdominal X-ray, Rotavirus test negative

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abdominal Xray, Abdominal KUB 10/22/07-records received-KUB showed dilated loops of bowel with air fluid levels. Ultrasound diagnostic for intussusception. 11/15/07-records received-11/15/07-tissue slide report received: specimen appendix
CDC 'Split Type':

Write-up: intussusception confirmed by abdominal x ray, abdominal ultrasound at 10-5-07 10/22/07-records received for DOS 10/5-10/7/07-DC DX: Intussusception. Laparotomy, appendectomy. Operative reduction of intussusception. Hydrostatically irreducible. Three days prior to admission C/O abdominal pain and emesis, HX of episodic pain, no bloody bowel movements.


Changed on 4/7/2010

VAERS ID: 292561 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:South Carolina
Vaccinated:2007-10-02
Onset:2007-10-05
Submitted:0000-00-00
Entered:2007-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B115CB / 2 LL / IM
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2435AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF119AA / 2 RL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B47300F / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0410U / 2 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Urinary system X-ray, Enema administration, Ultrasound abdomen abnormal, Adenovirus infection, Abdominal X-ray, Rotavirus test negative

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abdominal Xray, Abdominal KUB 10/22/07-records received-KUB showed dilated loops of bowel with air fluid levels. Ultrasound diagnostic for intussusception. 11/15/07-records received-11/15/07-tissue slide report received: specimen appendix
CDC 'Split Type':

Write-up: intussusception confirmed by abdominal x ray, abdominal ultrasound at 10-5-07 10/22/07-records received for DOS 10/5-10/7/07-DC DX: Intussusception. Laparotomy, appendectomy. Operative reduction of intussusception. Hydrostatically irreducible. Three days prior to admission C/O abdominal pain and emesis, HX of episodic pain, no bloody bowel movements.


Changed on 8/31/2010

VAERS ID: 292561 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:South Carolina
Vaccinated:2007-10-02
Onset:2007-10-05
Submitted:0000-00-00
Entered:2007-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B115CB / 2 LL / IM
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2435AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF119AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B47300F / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0410U / 2 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Urinary system X-ray, Enema administration, Ultrasound abdomen abnormal, Adenovirus infection, Abdominal X-ray, Rotavirus test negative

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abdominal Xray, Abdominal KUB 10/22/07-records received-KUB showed dilated loops of bowel with air fluid levels. Ultrasound diagnostic for intussusception. 11/15/07-records received-11/15/07-tissue slide report received: specimen appendix
CDC 'Split Type':

Write-up: intussusception confirmed by abdominal x ray, abdominal ultrasound at 10-5-07 10/22/07-records received for DOS 10/5-10/7/07-DC DX: Intussusception. Laparotomy, appendectomy. Operative reduction of intussusception. Hydrostatically irreducible. Three days prior to admission C/O abdominal pain and emesis, HX of episodic pain, no bloody bowel movements.


Changed on 5/13/2013

VAERS ID: 292561 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:South Carolina
Vaccinated:2007-10-02
Onset:2007-10-05
Submitted:0000-00-00
Entered:2007-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B115CB / 2 LL / IM
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2435AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF119AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47300F / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0410U / 2 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0410U / 2 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Urinary system X-ray, Enema administration, Ultrasound abdomen abnormal, Adenovirus infection, Abdominal X-ray, Rotavirus test negative

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abdominal Xray, Abdominal KUB 10/22/07-records received-KUB showed dilated loops of bowel with air fluid levels. Ultrasound diagnostic for intussusception. 11/15/07-records received-11/15/07-tissue slide report received: specimen appendix
CDC 'Split Type':

Write-up: intussusception confirmed by abdominal x ray, abdominal ultrasound at 10-5-07 10/22/07-records received for DOS 10/5-10/7/07-DC DX: Intussusception. Laparotomy, appendectomy. Operative reduction of intussusception. Hydrostatically irreducible. Three days prior to admission C/O abdominal pain and emesis, HX of episodic pain, no bloody bowel movements.


Changed on 7/7/2013

VAERS ID: 292561 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:South Carolina
Vaccinated:2007-10-02
Onset:2007-10-05
Submitted:0000-00-00
Entered:2007-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B115CB / 2 LL / IM
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2435AA / 0 LL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2435AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF119AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47300F / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0410U / 2 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Urinary system X-ray, Enema administration, Ultrasound abdomen abnormal, Adenovirus infection, Abdominal X-ray, Rotavirus test negative

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abdominal Xray, Abdominal KUB 10/22/07-records received-KUB showed dilated loops of bowel with air fluid levels. Ultrasound diagnostic for intussusception. 11/15/07-records received-11/15/07-tissue slide report received: specimen appendix
CDC 'Split Type':

Write-up: intussusception confirmed by abdominal x ray, abdominal ultrasound at 10-5-07 10/22/07-records received for DOS 10/5-10/7/07-DC DX: Intussusception. Laparotomy, appendectomy. Operative reduction of intussusception. Hydrostatically irreducible. Three days prior to admission C/O abdominal pain and emesis, HX of episodic pain, no bloody bowel movements.


Changed on 4/14/2017

VAERS ID: 292561 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:South Carolina
Vaccinated:2007-10-02
Onset:2007-10-05
Submitted:0000-00-00
Entered:2007-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B115CB / 2 LL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2435AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF119AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47300F / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0410U / 2 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Urinary system X-ray, Enema administration, Ultrasound abdomen abnormal, Adenovirus infection, Abdominal X-ray, Rotavirus test negative

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abdominal Xray, Abdominal KUB 10/22/07-records received-KUB showed dilated loops of bowel with air fluid levels. Ultrasound diagnostic for intussusception. 11/15/07-records received-11/15/07-tissue slide report received: specimen appendix appendix.IHC for adenovirus positive. IHC for Rotavirus A negative.
CDC 'Split Type':

Write-up: intussusception confirmed by abdominal x ray, abdominal ultrasound at 10-5-07 10/22/07-records received for DOS 10/5-10/7/07-DC DX: Intussusception. Laparotomy, appendectomy. Operative reduction of intussusception. Hydrostatically irreducible. Three days prior to admission C/O abdominal pain and emesis, HX of episodic pain, no bloody bowel movements.


Changed on 9/14/2017

VAERS ID: 292561 Before After
VAERS Form:(blank) 1
Age:0.5
Gender:Male
Location:South Carolina
Vaccinated:2007-10-02
Onset:2007-10-05
Submitted:0000-00-00
Entered:2007-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B115CB / 2 3 LL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2435AA / 0 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF119AA / 2 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47300F / 2 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0410U / 2 3 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Urinary system X-ray, 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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abdominal Xray, Abdominal KUB 10/22/07-records received-KUB showed dilated loops of bowel with air fluid levels. Ultrasound diagnostic for intussusception. 11/15/07-records received-11/15/07-tissue slide report received: specimen appendix.IHC for adenovirus positive. IHC for Rotavirus A negative.
CDC 'Split Type':

Write-up: intussusception confirmed by abdominal x ray, abdominal ultrasound at 10-5-07 10/22/07-records received for DOS 10/5-10/7/07-DC DX: Intussusception. Laparotomy, appendectomy. Operative reduction of intussusception. Hydrostatically irreducible. Three days prior to admission C/O abdominal pain and emesis, HX of episodic pain, no bloody bowel movements.


Changed on 2/14/2018

VAERS ID: 292561 Before After
VAERS Form:1
Age:0.5
Gender:Male
Location:South Carolina
Vaccinated:2007-10-02
Onset:2007-10-05
Submitted:0000-00-00
Entered:2007-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B115CB / 3 LL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2435AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF119AA / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47300F / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0410U / 3 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Urinary system X-ray, 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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abdominal Xray, Abdominal KUB 10/22/07-records received-KUB showed dilated loops of bowel with air fluid levels. Ultrasound diagnostic for intussusception. 11/15/07-records received-11/15/07-tissue slide report received: specimen appendix.IHC for adenovirus positive. IHC for Rotavirus A negative.
CDC 'Split Type':

Write-up: intussusception confirmed by abdominal x ray, abdominal ultrasound at 10-5-07 10/22/07-records received for DOS 10/5-10/7/07-DC DX: Intussusception. Laparotomy, appendectomy. Operative reduction of intussusception. Hydrostatically irreducible. Three days prior to admission C/O abdominal pain and emesis, HX of episodic pain, no bloody bowel movements.


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