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History of Changes from the VAERS Wayback Machine |
VAERS ID: | 294705 |
VAERS Form: | |
Age: | 0.2 |
Sex: | Male |
Location: | California |
Vaccinated: | 2007-09-11 |
Onset: | 2007-10-24 |
Submitted: | 2007-10-29 |
Entered: | 2007-10-29 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B090AA / 0 | UN / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 0079U / 0 | UN / IM |
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC | B47440 / 0 | UN / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1167F / 0 | - / PO |
Administered by: Other Purchased by: Unknown
Symptoms: Haematochezia, Intussusception, Enema administration, 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
Write-up: Hospitalized with intussusception on 10/24/07.
Vaccinated: | 2007-09-11 |
Onset: | 2007-10-24 |
Submitted: | 2007-10-29 |
Entered: | 2007-10-29 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B090AA / 0 | UN / IM |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B090AA / 0 | UN / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 0079U / 0 | UN / IM |
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC | B47440 B474420 / 0 | UN / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1167F / 0 | - / PO |
Administered by: Other Purchased by: Unknown Public
Symptoms: Haematochezia, Intussusception, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, 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
Write-up: Hospitalized with intussusception on 10/24/07. 12/4/07 Reviewed vax record which confirms dose & lot numbers as reported. Records faxed to CDC. 12/7/07 Reviewed hospital medical records which reveal patient experienced vomiting & bloody stool. Had been seen at outlying ER & transferred to higher level of care. Admitted 10/24/2007 & d/c to home same day. FINAL DX: Intussusception, enema reduced. Records faxed to CDC.
Vaccinated: | 2007-09-11 |
Onset: | 2007-10-24 |
Submitted: | 2007-10-29 |
Entered: | 2007-10-29 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B090AA / 0 | UN / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 0079U / 0 | UN / IM |
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC | B474420 / 0 | UN / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1167F / 0 | - / PO |
Administered by: Other Purchased by: Public
Symptoms: Haematochezia, Intussusception, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, 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
Write-up: Hospitalized with intussusception on 10/24/07. 12/4/07 Reviewed vax record which confirms dose & lot numbers as reported. Records faxed to CDC. 12/7/07 Reviewed hospital medical records which reveal patient experienced vomiting & bloody stool. Had been seen at outlying ER & transferred to higher level of care. Admitted 10/24/2007 & d/c to home same day. FINAL DX: Intussusception, enema reduced. Records faxed to CDC.
Vaccinated: | 2007-09-11 |
Onset: | 2007-10-24 |
Submitted: | 2007-10-29 |
Entered: | 2007-10-29 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B090AA / 0 | UN / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 0079U / 0 | UN / IM |
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC | B474420 / 0 | UN / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1167F / 0 | - / PO |
Administered by: Other Purchased by: Public
Symptoms: Haematochezia, Intussusception, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, 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
Write-up: Hospitalized with intussusception on 10/24/07. 12/4/07 Reviewed vax record which confirms dose & lot numbers as reported. Records faxed to CDC. 12/7/07 Reviewed hospital medical records which reveal patient experienced vomiting & bloody stool. Had been seen at outlying ER & transferred to higher level of care. Admitted 10/24/2007 & d/c to home same day. FINAL DX: Intussusception, enema reduced. Records faxed to CDC.
Vaccinated: | 2007-09-11 |
Onset: | 2007-10-24 |
Submitted: | 2007-10-29 |
Entered: | 2007-10-29 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B090AA / 0 | UN / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 0079U / 0 | UN / IM |
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH | B474420 / 0 | UN / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1167F / 0 | - / PO |
Administered by: Other Purchased by: Public
Symptoms: Haematochezia, Intussusception, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, 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
Write-up: Hospitalized with intussusception on 10/24/07. 12/4/07 Reviewed vax record which confirms dose & lot numbers as reported. Records faxed to CDC. 12/7/07 Reviewed hospital medical records which reveal patient experienced vomiting & bloody stool. Had been seen at outlying ER & transferred to higher level of care. Admitted 10/24/2007 & d/c to home same day. FINAL DX: Intussusception, enema reduced. Records faxed to CDC.
Vaccinated: | 2007-09-11 |
Onset: | 2007-10-24 |
Submitted: | 2007-10-29 |
Entered: | 2007-10-29 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B090AA / 0 | UN / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 0079U / 0 | UN / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B474420 / 0 | UN / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1167F / 0 | - / PO |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1167F / 0 | - / PO |
Administered by: Other Purchased by: Public
Symptoms: Haematochezia, Intussusception, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, 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
Write-up: Hospitalized with intussusception on 10/24/07. 12/4/07 Reviewed vax record which confirms dose & lot numbers as reported. Records faxed to CDC. 12/7/07 Reviewed hospital medical records which reveal patient experienced vomiting & bloody stool. Had been seen at outlying ER & transferred to higher level of care. Admitted 10/24/2007 & d/c to home same day. FINAL DX: Intussusception, enema reduced. Records faxed to CDC.
Vaccinated: | 2007-09-11 |
Onset: | 2007-10-24 |
Submitted: | 2007-10-29 |
Entered: | 2007-10-29 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B090AA / 0 | UN / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 0079U / 0 | UN / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B474420 / 0 | UN / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1167F / 0 | - / PO |
Administered by: Other Purchased by: Public
Symptoms: Haematochezia, Intussusception, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, 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
Write-up: Hospitalized with intussusception on 10/24/07. 12/4/07 Reviewed vax record which confirms dose & lot numbers as reported. Records faxed to CDC. 12/7/07 Reviewed hospital medical records which reveal patient experienced vomiting & bloody stool. Had been seen at outlying ER & transferred to higher level of care. Admitted 10/24/2007 & d/c to home same day. FINAL DX: Intussusception, enema reduced. Records faxed to CDC.
Vaccinated: | 2007-09-11 |
Onset: | 2007-10-24 |
Submitted: | 2007-10-29 |
Entered: | 2007-10-29 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B090AA / 0 1 | UN / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 0079U / 0 1 | UN / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B474420 / 0 1 | UN / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1167F / 0 1 | - MO / PO |
Administered by: Other 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: 2
Write-up: Hospitalized with intussusception on 10/24/07. 12/4/07 Reviewed vax record which confirms dose & lot numbers as reported. Records faxed to CDC. 12/7/07 Reviewed hospital medical records which reveal patient experienced vomiting & bloody stool. Had been seen at outlying ER & transferred to higher level of care. Admitted 10/24/2007 & d/c to home same day. FINAL DX: Intussusception, enema reduced. Records faxed to CDC.
Vaccinated: | 2007-09-11 |
Onset: | 2007-10-24 |
Submitted: | 2007-10-29 |
Entered: | 2007-10-29 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B090AA / 1 | UN / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 0079U / 1 | UN / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B474420 / 1 | UN / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1167F / 1 | MO / PO |
Administered by: Other 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: 2
Write-up: Hospitalized with intussusception on 10/24/07. 12/4/07 Reviewed vax record which confirms dose & lot numbers as reported. Records faxed to CDC. 12/7/07 Reviewed hospital medical records which reveal patient experienced vomiting & bloody stool. Had been seen at outlying ER & transferred to higher level of care. Admitted 10/24/2007 & d/c to home same day. FINAL DX: Intussusception, enema reduced. Records faxed to CDC.
Vaccinated: | 2007-09-11 |
Onset: | 2007-10-24 |
Submitted: | 2007-10-29 |
Entered: | 2007-10-29 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B090AA / 1 | UN / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 0079U / 1 | UN / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B474420 / 1 | UN / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1167F / 1 | MO / PO |
Administered by: Other 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: 2
Write-up: Hospitalized with intussusception on 10/24/07. 12/4/07 Reviewed vax record which confirms dose & lot numbers as reported. Records faxed to CDC. 12/7/07 Reviewed hospital medical records which reveal patient experienced vomiting & bloody stool. Had been seen at outlying ER & transferred to higher level of care. Admitted 10/24/2007 & d/c to home same day. FINAL DX: Intussusception, enema reduced. Records faxed to CDC.
Vaccinated: | 2007-09-11 |
Onset: | 2007-10-24 |
Submitted: | 2007-10-29 |
Entered: | 2007-10-29 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B090AA / 1 | UN / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 0079U / 1 | UN / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B474420 / 1 | UN / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1167F / 1 | MO / PO |
Administered by: Other 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: 2
Write-up: Hospitalized with intussusception on 10/24/07. 12/4/07 Reviewed vax record which confirms dose & lot numbers as reported. Records faxed to CDC. 12/7/07 Reviewed hospital medical records which reveal patient experienced vomiting & bloody stool. Had been seen at outlying ER & transferred to higher level of care. Admitted 10/24/2007 & d/c to home same day. FINAL DX: Intussusception, enema reduced. Records faxed to CDC.
Vaccinated: | 2007-09-11 |
Onset: | 2007-10-24 |
Submitted: | 2007-10-29 |
Entered: | 2007-10-29 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B090AA / 1 | UN / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 0079U / 1 | UN / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B474420 / 1 | UN / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1167F / 1 | MO / PO |
Administered by: Other 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: 2
Write-up: Hospitalized with intussusception on 10/24/07. 12/4/07 Reviewed vax record which confirms dose & lot numbers as reported. Records faxed to CDC. 12/7/07 Reviewed hospital medical records which reveal patient experienced vomiting & bloody stool. Had been seen at outlying ER & transferred to higher level of care. Admitted 10/24/2007 & d/c to home same day. FINAL DX: Intussusception, enema reduced. Records faxed to CDC.
Vaccinated: | 2007-09-11 |
Onset: | 2007-10-24 |
Submitted: | 2007-10-29 |
Entered: | 2007-10-29 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B090AA / 1 | UN / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 0079U / 1 | UN / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B474420 / 1 | UN / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1167F / 1 | MO / PO |
Administered by: Other 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: 2
Write-up: Hospitalized with intussusception on 10/24/07. 12/4/07 Reviewed vax record which confirms dose & lot numbers as reported. Records faxed to CDC. 12/7/07 Reviewed hospital medical records which reveal patient experienced vomiting & bloody stool. Had been seen at outlying ER & transferred to higher level of care. Admitted 10/24/2007 & d/c to home same day. FINAL DX: Intussusception, enema reduced. Records faxed to CDC.
Vaccinated: | 2007-09-11 |
Onset: | 2007-10-24 |
Submitted: | 2007-10-29 |
Entered: | 2007-10-29 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B090AA / 1 | UN / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 0079U / 1 | UN / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B474420 / 1 | UN / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1167F / 1 | MO / PO |
Administered by: Other 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: 2
Write-up: Hospitalized with intussusception on 10/24/07. 12/4/07 Reviewed vax record which confirms dose & lot numbers as reported. Records faxed to CDC. 12/7/07 Reviewed hospital medical records which reveal patient experienced vomiting & bloody stool. Had been seen at outlying ER & transferred to higher level of care. Admitted 10/24/2007 & d/c to home same day. FINAL DX: Intussusception, enema reduced. Records faxed to CDC.
Vaccinated: | 2007-09-11 |
Onset: | 2007-10-24 |
Submitted: | 2007-10-29 |
Entered: | 2007-10-29 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B090AA / 1 | UN / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 0079U / 1 | UN / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B474420 / 1 | UN / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1167F / 1 | MO / PO |
Administered by: Other 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: 2
Write-up: Hospitalized with intussusception on 10/24/07. 12/4/07 Reviewed vax record which confirms dose & lot numbers as reported. Records faxed to CDC. 12/7/07 Reviewed hospital medical records which reveal patient experienced vomiting & bloody stool. Had been seen at outlying ER & transferred to higher level of care. Admitted 10/24/2007 & d/c to home same day. FINAL DX: Intussusception, enema reduced. Records faxed to CDC.
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