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This is VAERS ID 293751

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 293751
VAERS Form:
Age:0.4
Gender:Male
Location:Illinois
Vaccinated:2007-08-13
Onset:2007-09-16
Submitted:2007-10-12
Entered:2007-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B137BA / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 02564 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08692D / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0694F / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Barium enema abnormal, Haematochezia, Intussusception, Irritability, Neutrophil percentage increased

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Rotateq vaccine given 8-13-07. Infant diagnosed and treated for intussusception 9/16/07.

Changed on 12/8/2009

VAERS ID: 293751 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Illinois
Vaccinated:2007-08-13
Onset:2007-09-16
Submitted:2007-10-12
Entered:2007-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B137BA / 1 RL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B137BA / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 02564 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08692D / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0694F / 1 - / PO

Administered by: Private      Purchased by: Unknown Public
Symptoms: Barium enema abnormal, Haematochezia, Intussusception, Irritability, Vomiting, X-ray with contrast upper gastrointestinal tract, Neutrophil percentage increased

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None 12/10/07-records received-Barium enema reduction of colo-colonic intussusception with reflux of contrast into the terminal ileum.UGI no evidence of malrotation. Neutrophils 55%.
CDC 'Split Type':

Write-up: Rotateq vaccine given 8-13-07. Infant diagnosed and treated for intussusception 9/16/07. 9/16/07.12/10/07-records received for DOS 9/16/07-DC DX: Intussusception. Barium enema reduction of colo-colonic intussusception with reflux of contrast into the terminal ileum. C/O vomiting and blood stools. Fussy.

Changed on 3/2/2010

VAERS ID: 293751 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Illinois
Vaccinated:2007-08-13
Onset:2007-09-16
Submitted:2007-10-12
Entered:2007-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B137BA / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 02564 / 1 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B08692D / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0694F / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema abnormal, Haematochezia, Intussusception, Irritability, Vomiting, X-ray with contrast upper gastrointestinal tract, Neutrophil percentage increased

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None 12/10/07-records received-Barium enema reduction of colo-colonic intussusception with reflux of contrast into the terminal ileum.UGI no evidence of malrotation. Neutrophils 55%.
CDC 'Split Type':

Write-up: Rotateq vaccine given 8-13-07. Infant diagnosed and treated for intussusception 9/16/07.12/10/07-records received for DOS 9/16/07-DC DX: Intussusception. Barium enema reduction of colo-colonic intussusception with reflux of contrast into the terminal ileum. C/O vomiting and blood stools. Fussy.

Changed on 4/7/2010

VAERS ID: 293751 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Illinois
Vaccinated:2007-08-13
Onset:2007-09-16
Submitted:2007-10-12
Entered:2007-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B137BA / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 02564 / 1 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08692D / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0694F / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema abnormal, Haematochezia, Intussusception, Irritability, Vomiting, X-ray with contrast upper gastrointestinal tract, Neutrophil percentage increased

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None 12/10/07-records received-Barium enema reduction of colo-colonic intussusception with reflux of contrast into the terminal ileum.UGI no evidence of malrotation. Neutrophils 55%.
CDC 'Split Type':

Write-up: Rotateq vaccine given 8-13-07. Infant diagnosed and treated for intussusception 9/16/07.12/10/07-records received for DOS 9/16/07-DC DX: Intussusception. Barium enema reduction of colo-colonic intussusception with reflux of contrast into the terminal ileum. C/O vomiting and blood stools. Fussy.

Changed on 8/31/2010

VAERS ID: 293751 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Illinois
Vaccinated:2007-08-13
Onset:2007-09-16
Submitted:2007-10-12
Entered:2007-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B137BA / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 02564 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B08692D / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0694F / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema abnormal, Haematochezia, Intussusception, Irritability, Vomiting, X-ray with contrast upper gastrointestinal tract, Neutrophil percentage increased

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None 12/10/07-records received-Barium enema reduction of colo-colonic intussusception with reflux of contrast into the terminal ileum.UGI no evidence of malrotation. Neutrophils 55%.
CDC 'Split Type':

Write-up: Rotateq vaccine given 8-13-07. Infant diagnosed and treated for intussusception 9/16/07.12/10/07-records received for DOS 9/16/07-DC DX: Intussusception. Barium enema reduction of colo-colonic intussusception with reflux of contrast into the terminal ileum. C/O vomiting and blood stools. Fussy.

Changed on 5/13/2013

VAERS ID: 293751 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Illinois
Vaccinated:2007-08-13
Onset:2007-09-16
Submitted:2007-10-12
Entered:2007-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B137BA / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 02564 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08692D / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0694F / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0694F / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema abnormal, Haematochezia, Intussusception, Irritability, Vomiting, X-ray with contrast upper gastrointestinal tract, Neutrophil percentage increased

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None 12/10/07-records received-Barium enema reduction of colo-colonic intussusception with reflux of contrast into the terminal ileum.UGI no evidence of malrotation. Neutrophils 55%.
CDC 'Split Type':

Write-up: Rotateq vaccine given 8-13-07. Infant diagnosed and treated for intussusception 9/16/07.12/10/07-records received for DOS 9/16/07-DC DX: Intussusception. Barium enema reduction of colo-colonic intussusception with reflux of contrast into the terminal ileum. C/O vomiting and blood stools. Fussy.

Changed on 4/14/2017

VAERS ID: 293751 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Illinois
Vaccinated:2007-08-13
Onset:2007-09-16
Submitted:2007-10-12
Entered:2007-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B137BA / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 02564 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08692D / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0694F / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema abnormal, Haematochezia, Intussusception, Irritability, Vomiting, X-ray with contrast upper gastrointestinal tract, Neutrophil percentage increased

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None 12/10/07-records received-Barium enema reduction of colo-colonic intussusception with reflux of contrast into the terminal ileum.UGI no evidence of malrotation. Neutrophils 55%.
CDC 'Split Type':

Write-up: Rotateq vaccine given 8-13-07. Infant diagnosed and treated for intussusception 9/16/07.12/10/07-records received for DOS 9/16/07-DC DX: Intussusception. Barium enema reduction of colo-colonic intussusception with reflux of contrast into the terminal ileum. C/O vomiting and blood stools. Fussy.

Changed on 9/14/2017

VAERS ID: 293751 Before After
VAERS Form:(blank) 1
Age:0.4
Gender:Male
Location:Illinois
Vaccinated:2007-08-13
Onset:2007-09-16
Submitted:2007-10-12
Entered:2007-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B137BA / 1 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 02564 / 1 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08692D / 1 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0694F / 1 2 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None 12/10/07-records received-Barium enema reduction of colo-colonic intussusception with reflux of contrast into the terminal ileum.UGI no evidence of malrotation. Neutrophils 55%.
CDC 'Split Type':

Write-up: Rotateq vaccine given 8-13-07. Infant diagnosed and treated for intussusception 9/16/07.12/10/07-records received for DOS 9/16/07-DC DX: Intussusception. Barium enema reduction of colo-colonic intussusception with reflux of contrast into the terminal ileum. C/O vomiting and blood stools. Fussy.

Changed on 2/14/2018

VAERS ID: 293751 Before After
VAERS Form:1
Age:0.4
Gender:Male
Location:Illinois
Vaccinated:2007-08-13
Onset:2007-09-16
Submitted:2007-10-12
Entered:2007-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B137BA / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 02564 / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08692D / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0694F / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None 12/10/07-records received-Barium enema reduction of colo-colonic intussusception with reflux of contrast into the terminal ileum.UGI no evidence of malrotation. Neutrophils 55%.
CDC 'Split Type':

Write-up: Rotateq vaccine given 8-13-07. Infant diagnosed and treated for intussusception 9/16/07.12/10/07-records received for DOS 9/16/07-DC DX: Intussusception. Barium enema reduction of colo-colonic intussusception with reflux of contrast into the terminal ileum. C/O vomiting and blood stools. Fussy.

Changed on 6/14/2018

VAERS ID: 293751 Before After
VAERS Form:1
Age:0.4
Gender:Male
Location:Illinois
Vaccinated:2007-08-13
Onset:2007-09-16
Submitted:2007-10-12
Entered:2007-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B137BA / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 02564 / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08692D / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0694F / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None 12/10/07-records received-Barium enema reduction of colo-colonic intussusception with reflux of contrast into the terminal ileum.UGI no evidence of malrotation. Neutrophils 55%.
CDC 'Split Type':

Write-up: Rotateq vaccine given 8-13-07. Infant diagnosed and treated for intussusception 9/16/07.12/10/07-records received for DOS 9/16/07-DC DX: Intussusception. Barium enema reduction of colo-colonic intussusception with reflux of contrast into the terminal ileum. C/O vomiting and blood stools. Fussy.

Changed on 8/14/2018

VAERS ID: 293751 Before After
VAERS Form:1
Age:0.4
Gender:Male
Location:Illinois
Vaccinated:2007-08-13
Onset:2007-09-16
Submitted:2007-10-12
Entered:2007-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B137BA / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 02564 / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08692D / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0694F / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None 12/10/07-records received-Barium enema reduction of colo-colonic intussusception with reflux of contrast into the terminal ileum.UGI no evidence of malrotation. Neutrophils 55%.
CDC 'Split Type':

Write-up: Rotateq vaccine given 8-13-07. Infant diagnosed and treated for intussusception 9/16/07.12/10/07-records received for DOS 9/16/07-DC DX: Intussusception. Barium enema reduction of colo-colonic intussusception with reflux of contrast into the terminal ileum. C/O vomiting and blood stools. Fussy.

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