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This is VAERS ID 302822

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 302822
VAERS Form:
Age:0.3
Gender:Male
Location:Florida
Vaccinated:2007-11-12
Onset:2007-12-18
Submitted:2008-01-15
Entered:2008-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124CA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF168AB / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B70143C / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1460U / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Appendicectomy, Barium enema, Barium enema abnormal, Biopsy lymph gland, 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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Sonogram, Barium enema, Laparotomy, Biopsy of mesenteric lymph node. Labs and Diagnostics: Abdominal X-ray (+) dilated bowel loop. Barium enema showed high grade obstruction 2'''' to IS. CRP 1.64. Stool occult blood (+). Stool cx (-). blo
CDC 'Split Type':

Write-up: Pt began vomiting 12/18/07 PM to ER 12/19/07. Dx with intussuseption. A barium enema was attempted, but did not reduce. Surgical bowel reduction was successful. An appendectomy was also performed. 02/01/2008 MR received for DOS 12/19-21/2007 with DX: In"tussusception. Pt presented with 1 day hx of vomiting (16 episodes). Had bloody stool in ER. Attempted to reduce with Barium enema but unsuccessful. Pt had exploratory lap with reduction of ileocolic intussusception, appendectomy, and biopsy of mesenter


Changed on 12/8/2009

VAERS ID: 302822 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Florida
Vaccinated:2007-11-12
Onset:2007-12-18
Submitted:2008-01-15
Entered:2008-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124CA / 1 RL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124CA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF168AB / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B70143C / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1460U / 1 - / PO

Administered by: Private      Purchased by: Unknown Public
Symptoms: Appendicectomy, Barium enema, Barium enema abnormal, Biopsy lymph gland, Blood culture negative, C-reactive protein increased, Culture stool negative, Haematochezia, Intussusception, Large intestinal obstruction reduction, Surgery, Ultrasound scan, Vomiting, Explorative laparotomy, Abdominal X-ray, Occult blood positive

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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Sonogram, Barium enema, Laparotomy, Biopsy of mesenteric lymph node. Labs and Diagnostics: Abdominal X-ray (+) dilated bowel loop. Barium enema showed high grade obstruction 2'''' 2'' to IS. CRP 1.64. Stool occult blood (+). Stool cx (-). blo
CDC 'Split Type':

Write-up: Pt began vomiting 12/18/07 PM to ER 12/19/07. Dx with intussuseption. A barium enema was attempted, but did not reduce. Surgical bowel reduction was successful. An appendectomy was also performed. 02/01/2008 MR received for DOS 12/19-21/2007 with DX: In"tussusception. Intussusception. Pt presented with 1 day hx of vomiting (16 episodes). Had bloody stool in ER. Attempted to reduce with Barium enema but unsuccessful. Pt had exploratory lap with reduction of ileocolic intussusception, appendectomy, and biopsy of mesenter mesenteric lymph nodes. Mesenteric lymph nodes noted to be enlarged in OR. D/C on POD #2


Changed on 3/2/2010

VAERS ID: 302822 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Florida
Vaccinated:2007-11-12
Onset:2007-12-18
Submitted:2008-01-15
Entered:2008-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124CA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF168AB / 1 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B70143C / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1460U / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Appendicectomy, Barium enema, Barium enema abnormal, Biopsy lymph gland, Blood culture negative, C-reactive protein increased, Culture stool negative, Haematochezia, Intussusception, Large intestinal obstruction reduction, Surgery, Ultrasound scan, Vomiting, Explorative laparotomy, Abdominal X-ray, Occult blood positive

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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Sonogram, Barium enema, Laparotomy, Biopsy of mesenteric lymph node. Labs and Diagnostics: Abdominal X-ray (+) dilated bowel loop. Barium enema showed high grade obstruction 2'' to IS. CRP 1.64. Stool occult blood (+). Stool cx (-). blo
CDC 'Split Type':

Write-up: Pt began vomiting 12/18/07 PM to ER 12/19/07. Dx with intussuseption. A barium enema was attempted, but did not reduce. Surgical bowel reduction was successful. An appendectomy was also performed. 02/01/2008 MR received for DOS 12/19-21/2007 with DX: Intussusception. Pt presented with 1 day hx of vomiting (16 episodes). Had bloody stool in ER. Attempted to reduce with Barium enema but unsuccessful. Pt had exploratory lap with reduction of ileocolic intussusception, appendectomy, and biopsy of mesenteric lymph nodes. Mesenteric lymph nodes noted to be enlarged in OR. D/C on POD #2


Changed on 4/7/2010

VAERS ID: 302822 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Florida
Vaccinated:2007-11-12
Onset:2007-12-18
Submitted:2008-01-15
Entered:2008-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124CA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF168AB / 1 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B70143C / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1460U / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Appendicectomy, Barium enema, Barium enema abnormal, Biopsy lymph gland, Blood culture negative, C-reactive protein increased, Culture stool negative, Haematochezia, Intussusception, Large intestinal obstruction reduction, Surgery, Ultrasound scan, Vomiting, Explorative laparotomy, Abdominal X-ray, Occult blood positive

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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Sonogram, Barium enema, Laparotomy, Biopsy of mesenteric lymph node. Labs and Diagnostics: Abdominal X-ray (+) dilated bowel loop. Barium enema showed high grade obstruction 2'' to IS. CRP 1.64. Stool occult blood (+). Stool cx (-). blo
CDC 'Split Type':

Write-up: Pt began vomiting 12/18/07 PM to ER 12/19/07. Dx with intussuseption. A barium enema was attempted, but did not reduce. Surgical bowel reduction was successful. An appendectomy was also performed. 02/01/2008 MR received for DOS 12/19-21/2007 with DX: Intussusception. Pt presented with 1 day hx of vomiting (16 episodes). Had bloody stool in ER. Attempted to reduce with Barium enema but unsuccessful. Pt had exploratory lap with reduction of ileocolic intussusception, appendectomy, and biopsy of mesenteric lymph nodes. Mesenteric lymph nodes noted to be enlarged in OR. D/C on POD #2


Changed on 8/31/2010

VAERS ID: 302822 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Florida
Vaccinated:2007-11-12
Onset:2007-12-18
Submitted:2008-01-15
Entered:2008-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124CA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF168AB / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B70143C / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1460U / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Appendicectomy, Barium enema, Barium enema abnormal, Biopsy lymph gland, Blood culture negative, C-reactive protein increased, Culture stool negative, Haematochezia, Intussusception, Large intestinal obstruction reduction, Surgery, Ultrasound scan, Vomiting, Explorative laparotomy, Abdominal X-ray, Occult blood positive

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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Sonogram, Barium enema, Laparotomy, Biopsy of mesenteric lymph node. Labs and Diagnostics: Abdominal X-ray (+) dilated bowel loop. Barium enema showed high grade obstruction 2'' to IS. CRP 1.64. Stool occult blood (+). Stool cx (-). blo
CDC 'Split Type':

Write-up: Pt began vomiting 12/18/07 PM to ER 12/19/07. Dx with intussuseption. A barium enema was attempted, but did not reduce. Surgical bowel reduction was successful. An appendectomy was also performed. 02/01/2008 MR received for DOS 12/19-21/2007 with DX: Intussusception. Pt presented with 1 day hx of vomiting (16 episodes). Had bloody stool in ER. Attempted to reduce with Barium enema but unsuccessful. Pt had exploratory lap with reduction of ileocolic intussusception, appendectomy, and biopsy of mesenteric lymph nodes. Mesenteric lymph nodes noted to be enlarged in OR. D/C on POD #2


Changed on 5/13/2013

VAERS ID: 302822 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Florida
Vaccinated:2007-11-12
Onset:2007-12-18
Submitted:2008-01-15
Entered:2008-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124CA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF168AB / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70143C / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1460U / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1460U / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Appendicectomy, Barium enema, Barium enema abnormal, Biopsy lymph gland, Blood culture negative, C-reactive protein increased, Culture stool negative, Haematochezia, Intussusception, Large intestinal obstruction reduction, Surgery, Ultrasound scan, Vomiting, Explorative laparotomy, Abdominal X-ray, Occult blood positive

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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Sonogram, Barium enema, Laparotomy, Biopsy of mesenteric lymph node. Labs and Diagnostics: Abdominal X-ray (+) dilated bowel loop. Barium enema showed high grade obstruction 2'' to IS. CRP 1.64. Stool occult blood (+). Stool cx (-). blo
CDC 'Split Type':

Write-up: Pt began vomiting 12/18/07 PM to ER 12/19/07. Dx with intussuseption. A barium enema was attempted, but did not reduce. Surgical bowel reduction was successful. An appendectomy was also performed. 02/01/2008 MR received for DOS 12/19-21/2007 with DX: Intussusception. Pt presented with 1 day hx of vomiting (16 episodes). Had bloody stool in ER. Attempted to reduce with Barium enema but unsuccessful. Pt had exploratory lap with reduction of ileocolic intussusception, appendectomy, and biopsy of mesenteric lymph nodes. Mesenteric lymph nodes noted to be enlarged in OR. D/C on POD #2


Changed on 4/14/2017

VAERS ID: 302822 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Florida
Vaccinated:2007-11-12
Onset:2007-12-18
Submitted:2008-01-15
Entered:2008-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124CA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF168AB / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70143C / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1460U / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Appendicectomy, Barium enema, Barium enema abnormal, Biopsy lymph gland, Blood culture negative, C-reactive protein increased, Culture stool negative, Haematochezia, Intussusception, Large intestinal obstruction reduction, Surgery, Ultrasound scan, Vomiting, Explorative laparotomy, Abdominal X-ray, Occult blood positive

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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Sonogram, Barium enema, Laparotomy, Biopsy of mesenteric lymph node. Labs and Diagnostics: Abdominal X-ray (+) dilated bowel loop. Barium enema showed high grade obstruction 2'' to IS. CRP 1.64. Stool occult blood (+). Stool cx (-). blo blood cx (-).
CDC 'Split Type':

Write-up: Pt began vomiting 12/18/07 PM to ER 12/19/07. Dx with intussuseption. A barium enema was attempted, but did not reduce. Surgical bowel reduction was successful. An appendectomy was also performed. 02/01/2008 MR received for DOS 12/19-21/2007 with DX: Intussusception. Pt presented with 1 day hx of vomiting (16 episodes). Had bloody stool in ER. Attempted to reduce with Barium enema but unsuccessful. Pt had exploratory lap with reduction of ileocolic intussusception, appendectomy, and biopsy of mesenteric lymph nodes. Mesenteric lymph nodes noted to be enlarged in OR. D/C on POD #2


Changed on 9/14/2017

VAERS ID: 302822 Before After
VAERS Form:(blank) 1
Age:0.3
Gender:Male
Location:Florida
Vaccinated:2007-11-12
Onset:2007-12-18
Submitted:2008-01-15
Entered:2008-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124CA / 1 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF168AB / 1 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70143C / 1 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1460U / 1 2 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Appendicectomy, Barium enema, Biopsy lymph gland, Intussusception, Surgery, Ultrasound scan, Vomiting

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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Sonogram, Barium enema, Laparotomy, Biopsy of mesenteric lymph node. Labs and Diagnostics: Abdominal X-ray (+) dilated bowel loop. Barium enema showed high grade obstruction 2'' to IS. CRP 1.64. Stool occult blood (+). Stool cx (-). blood cx (-).
CDC 'Split Type':

Write-up: Pt began vomiting 12/18/07 PM to ER 12/19/07. Dx with intussuseption. A barium enema was attempted, but did not reduce. Surgical bowel reduction was successful. An appendectomy was also performed. 02/01/2008 MR received for DOS 12/19-21/2007 with DX: Intussusception. Pt presented with 1 day hx of vomiting (16 episodes). Had bloody stool in ER. Attempted to reduce with Barium enema but unsuccessful. Pt had exploratory lap with reduction of ileocolic intussusception, appendectomy, and biopsy of mesenteric lymph nodes. Mesenteric lymph nodes noted to be enlarged in OR. D/C on POD #2


Changed on 2/14/2018

VAERS ID: 302822 Before After
VAERS Form:1
Age:0.3
Gender:Male
Location:Florida
Vaccinated:2007-11-12
Onset:2007-12-18
Submitted:2008-01-15
Entered:2008-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124CA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF168AB / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70143C / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1460U / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Appendicectomy, Barium enema, Biopsy lymph gland, Intussusception, Surgery, Ultrasound scan, Vomiting

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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Sonogram, Barium enema, Laparotomy, Biopsy of mesenteric lymph node. Labs and Diagnostics: Abdominal X-ray (+) dilated bowel loop. Barium enema showed high grade obstruction 2'' to IS. CRP 1.64. Stool occult blood (+). Stool cx (-). blood cx (-).
CDC 'Split Type':

Write-up: Pt began vomiting 12/18/07 PM to ER 12/19/07. Dx with intussuseption. A barium enema was attempted, but did not reduce. Surgical bowel reduction was successful. An appendectomy was also performed. 02/01/2008 MR received for DOS 12/19-21/2007 with DX: Intussusception. Pt presented with 1 day hx of vomiting (16 episodes). Had bloody stool in ER. Attempted to reduce with Barium enema but unsuccessful. Pt had exploratory lap with reduction of ileocolic intussusception, appendectomy, and biopsy of mesenteric lymph nodes. Mesenteric lymph nodes noted to be enlarged in OR. D/C on POD #2


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