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This is VAERS ID 293579

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 293579
VAERS Form:
Age:0.5
Gender:Male
Location:Arizona
Vaccinated:2007-07-17
Onset:2007-10-15
Submitted:2007-10-18
Entered:2007-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2605AA / 2 - / -
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER AHBVB437AA / 2 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UF101AB / 2 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0765U / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium enema, Blood culture, Enema administration

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: Tylenol infant drops
Current Illness: None
Preexisting Conditions: Plagiocephaly and mild gastroesophegeal reflux
Allergies:
Diagnostic Lab Data: Barium enema
CDC 'Split Type':

Write-up: Intussception at 9 months


Changed on 12/8/2009

VAERS ID: 293579 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Arizona
Vaccinated:2007-07-17
Onset:2007-10-15
Submitted:2007-10-18
Entered:2007-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2605AA / 2 - / -
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER AHBVB437AA / 2 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UF101AB / 2 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0765U / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium enema, Blood culture, Haematocrit decreased, Haemoglobin decreased, Intussusception, Irritability, Vomiting, White blood cell count increased, Enema administration, Ultrasound abdomen abnormal, Neutrophil percentage decreased, Laboratory test normal, Urine analysis normal

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: Tylenol infant drops
Current Illness: None
Preexisting Conditions: Plagiocephaly and mild gastroesophegeal reflux
Allergies:
Diagnostic Lab Data: Barium enema LABS: abdominal US c/w IS. BE c/w ileocolic IS. Air contrast enema successfully reduced IS. WBC 21.3, H/H 11.4/32.9, segs 54, lymphs 37, monos 6. Chemistry WNL. UA WNL. Blood culture done.
CDC 'Split Type':

Write-up: Intussception at 9 months months. 12/7/07 Reviewed hospital medical records which reveal patient experienced crampy abdominal pain, irritability, vomiting. Was on antibiotics for otitis media. Surgery consult done. Admitted 10/15-10/16/2007 for observation s/p enema reduction of IS. FINAL DX: Intussusception, enema reduced. Records faxed to CDC.


Changed on 5/13/2013

VAERS ID: 293579 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Arizona
Vaccinated:2007-07-17
Onset:2007-10-15
Submitted:2007-10-18
Entered:2007-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2605AA / 2 - / -
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER AHBVB437AA / 2 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UF101AB / 2 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0765U / 2 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0765U / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium enema, Blood culture, Haematocrit decreased, Haemoglobin decreased, Intussusception, Irritability, Vomiting, White blood cell count increased, Enema administration, Ultrasound abdomen abnormal, Neutrophil percentage decreased, Laboratory test normal, Urine analysis normal

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: Tylenol infant drops
Current Illness: None
Preexisting Conditions: Plagiocephaly and mild gastroesophegeal reflux
Allergies:
Diagnostic Lab Data: Barium enema LABS: abdominal US c/w IS. BE c/w ileocolic IS. Air contrast enema successfully reduced IS. WBC 21.3, H/H 11.4/32.9, segs 54, lymphs 37, monos 6. Chemistry WNL. UA WNL. Blood culture done.
CDC 'Split Type':

Write-up: Intussception at 9 months. 12/7/07 Reviewed hospital medical records which reveal patient experienced crampy abdominal pain, irritability, vomiting. Was on antibiotics for otitis media. Surgery consult done. Admitted 10/15-10/16/2007 for observation s/p enema reduction of IS. FINAL DX: Intussusception, enema reduced. Records faxed to CDC.


Changed on 9/14/2014

VAERS ID: 293579 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Arizona
Vaccinated:2007-07-17
Onset:2007-10-15
Submitted:2007-10-18
Entered:2007-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) DTAP (DAPTACEL) / UNKNOWN MANUFACTURER SANOFI PASTEUR C2605AA / 2 - / -
HEP: HEP B (NO BRAND NAME) HEP B (ENGERIX-B) / UNKNOWN MANUFACTURER GLAXOSMITHKLINE BIOLOGICALS AHBVB437AA / 2 - / -
HIBV: HIB (NO BRAND NAME) HIB (ACTHIB) / UNKNOWN MANUFACTURER SANOFI PASTEUR UF101AB / 2 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0765U / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium enema, Blood culture, Haematocrit decreased, Haemoglobin decreased, Intussusception, Irritability, Vomiting, White blood cell count increased, Enema administration, Ultrasound abdomen abnormal, Neutrophil percentage decreased, Laboratory test normal, Urine analysis normal

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: Tylenol infant drops
Current Illness: None
Preexisting Conditions: Plagiocephaly and mild gastroesophegeal reflux
Allergies:
Diagnostic Lab Data: Barium enema LABS: abdominal US c/w IS. BE c/w ileocolic IS. Air contrast enema successfully reduced IS. WBC 21.3, H/H 11.4/32.9, segs 54, lymphs 37, monos 6. Chemistry WNL. UA WNL. Blood culture done.
CDC 'Split Type':

Write-up: Intussception at 9 months. 12/7/07 Reviewed hospital medical records which reveal patient experienced crampy abdominal pain, irritability, vomiting. Was on antibiotics for otitis media. Surgery consult done. Admitted 10/15-10/16/2007 for observation s/p enema reduction of IS. FINAL DX: Intussusception, enema reduced. Records faxed to CDC.


Changed on 2/14/2017

VAERS ID: 293579 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Arizona
Vaccinated:2007-07-17
Onset:2007-10-15
Submitted:2007-10-18
Entered:2007-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2605AA / 2 - / -
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB437AA / 2 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF101AB / 2 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0765U / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium enema, Blood culture, Haematocrit decreased, Haemoglobin decreased, Intussusception, Irritability, Vomiting, White blood cell count increased, Enema administration, Ultrasound abdomen abnormal, Neutrophil percentage decreased, Laboratory test normal, Urine analysis normal

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: Tylenol infant drops
Current Illness: None
Preexisting Conditions: Plagiocephaly and mild gastroesophegeal reflux
Allergies:
Diagnostic Lab Data: Barium enema LABS: abdominal US c/w IS. BE c/w ileocolic IS. Air contrast enema successfully reduced IS. WBC 21.3, H/H 11.4/32.9, segs 54, lymphs 37, monos 6. Chemistry WNL. UA WNL. Blood culture done.
CDC 'Split Type':

Write-up: Intussception at 9 months. 12/7/07 Reviewed hospital medical records which reveal patient experienced crampy abdominal pain, irritability, vomiting. Was on antibiotics for otitis media. Surgery consult done. Admitted 10/15-10/16/2007 for observation s/p enema reduction of IS. FINAL DX: Intussusception, enema reduced. Records faxed to CDC.


Changed on 9/14/2017

VAERS ID: 293579 Before After
VAERS Form:(blank) 1
Age:0.5
Gender:Male
Location:Arizona
Vaccinated:2007-07-17
Onset:2007-10-15
Submitted:2007-10-18
Entered:2007-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2605AA / 2 3 - / -
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB437AA / 2 3 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF101AB / 2 3 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0765U / 2 3 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Intussusception, Enema administration

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: Tylenol infant drops
Current Illness: None
Preexisting Conditions: Plagiocephaly and mild gastroesophegeal reflux
Allergies:
Diagnostic Lab Data: Barium enema LABS: abdominal US c/w IS. BE c/w ileocolic IS. Air contrast enema successfully reduced IS. WBC 21.3, H/H 11.4/32.9, segs 54, lymphs 37, monos 6. Chemistry WNL. UA WNL. Blood culture done.
CDC 'Split Type':

Write-up: Intussception at 9 months. 12/7/07 Reviewed hospital medical records which reveal patient experienced crampy abdominal pain, irritability, vomiting. Was on antibiotics for otitis media. Surgery consult done. Admitted 10/15-10/16/2007 for observation s/p enema reduction of IS. FINAL DX: Intussusception, enema reduced. Records faxed to CDC.


Changed on 2/14/2018

VAERS ID: 293579 Before After
VAERS Form:1
Age:0.5
Gender:Male
Location:Arizona
Vaccinated:2007-07-17
Onset:2007-10-15
Submitted:2007-10-18
Entered:2007-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2605AA / 3 - / -
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB437AA / 3 - / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF101AB / 3 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0765U / 3 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Intussusception, Enema administration

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: Tylenol infant drops
Current Illness: None
Preexisting Conditions: Plagiocephaly and mild gastroesophegeal reflux
Allergies:
Diagnostic Lab Data: Barium enema LABS: abdominal US c/w IS. BE c/w ileocolic IS. Air contrast enema successfully reduced IS. WBC 21.3, H/H 11.4/32.9, segs 54, lymphs 37, monos 6. Chemistry WNL. UA WNL. Blood culture done.
CDC 'Split Type':

Write-up: Intussception at 9 months. 12/7/07 Reviewed hospital medical records which reveal patient experienced crampy abdominal pain, irritability, vomiting. Was on antibiotics for otitis media. Surgery consult done. Admitted 10/15-10/16/2007 for observation s/p enema reduction of IS. FINAL DX: Intussusception, enema reduced. Records faxed to CDC.


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