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This is VAERS ID 304268

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 304268
VAERS Form:
Age:0.3
Gender:Male
Location:Alabama
Vaccinated:2008-02-01
Onset:2008-02-02
Submitted:2008-02-04
Entered:2008-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B128AB / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF213AA / 0 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B54013F / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0969U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Culture stool positive, Diarrhoea, Diarrhoea haemorrhagic, Gastroenteritis, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: DRY PATCHES ON SKIN, SNEEZING
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal ultrasound, Barium enema, Stool culture, Stool O&P and Stool for rotavirus 2/25/08-records received-US demonstrated intussusception. Air contrast enema showed evidence of a resolved intussusception. Stool hemoccult positive. Stoo
CDC 'Split Type':

Write-up: Patient presented to ER on 2/2/08 with vomiting, bloody diarrhea; had Abdominal U/S which showed intussusception which was followed by a barium enema which showed resolution of intussusception,still in hospital as of today 2/4/2008 2/22/08-records receive"d for DOS 2/3-2/4/08-Gastroenteritis with hematochezia resolved intussusception. C/O diarrhea 2/2/08, watery stools. Vomiting and blood noted in stool. Fussy.


Changed on 12/8/2009

VAERS ID: 304268 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Alabama
Vaccinated:2008-02-01
Onset:2008-02-02
Submitted:2008-02-04
Entered:2008-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B128AB / 0 RL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B128AB / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF213AA / 0 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B54013F / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0969U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Culture stool positive, Diarrhoea, Diarrhoea haemorrhagic, Gastroenteritis, Haematochezia, Intussusception, Irritability, Salmonellosis, Vomiting, Enema administration, Ultrasound abdomen abnormal, Occult blood positive, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: DRY PATCHES ON SKIN, SNEEZING
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal ultrasound, Barium enema, Stool culture, Stool O&P and Stool for rotavirus 2/25/08-records received-US demonstrated intussusception. Air contrast enema showed evidence of a resolved intussusception. Stool hemoccult positive. Stoo
CDC 'Split Type':

Write-up: Patient presented to ER on 2/2/08 with vomiting, bloody diarrhea; had Abdominal U/S which showed intussusception which was followed by a barium enema which showed resolution of intussusception,still in hospital as of today 2/4/2008 2/22/08-records receive"d received for DOS 2/3-2/4/08-Gastroenteritis with hematochezia resolved intussusception. C/O diarrhea 2/2/08, watery stools. Vomiting and blood noted in stool. Fussy.


Changed on 1/5/2010

VAERS ID: 304268 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Alabama
Vaccinated:2008-02-01
Onset:2008-02-02
Submitted:2008-02-04
Entered:2008-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B128AB / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF213AA / 0 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B54013F / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0969U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Culture stool positive, Diarrhoea, Diarrhoea haemorrhagic, Gastroenteritis, Haematochezia, Intussusception, Irritability, Salmonellosis, Vomiting, Enema administration, Ultrasound abdomen abnormal, Occult blood positive, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: DRY PATCHES ON SKIN, SNEEZING
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal ultrasound, Barium enema, Stool culture, Stool O&P and Stool for rotavirus 2/25/08-records received-US demonstrated intussusception. Air contrast enema showed evidence of a resolved intussusception. Stool hemoccult positive. Stoo
CDC 'Split Type':

Write-up: Patient presented to ER on 2/2/08 with vomiting, bloody diarrhea; had Abdominal U/S which showed intussusception which was followed by a barium enema which showed resolution of intussusception,still in hospital as of today 2/4/2008 2/22/08-records received for DOS 2/3-2/4/08-Gastroenteritis with hematochezia resolved intussusception. C/O diarrhea 2/2/08, watery stools. Vomiting and blood noted in stool. Fussy.


Changed on 3/2/2010

VAERS ID: 304268 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Alabama
Vaccinated:2008-02-01
Onset:2008-02-02
Submitted:2008-02-04
Entered:2008-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B128AB / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF213AA / 0 RL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B54013F / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0969U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diarrhoea haemorrhagic, Intussusception, Vomiting, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: DRY PATCHES ON SKIN, SNEEZING
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal ultrasound, Barium enema, Stool culture, Stool O&P and Stool for rotavirus 2/25/08-records received-US demonstrated intussusception. Air contrast enema showed evidence of a resolved intussusception. Stool hemoccult positive. Stoo
CDC 'Split Type':

Write-up: Patient presented to ER on 2/2/08 with vomiting, bloody diarrhea; had Abdominal U/S which showed intussusception which was followed by a barium enema which showed resolution of intussusception,still in hospital as of today 2/4/2008 2/22/08-records received for DOS 2/3-2/4/08-Gastroenteritis with hematochezia resolved intussusception. C/O diarrhea 2/2/08, watery stools. Vomiting and blood noted in stool. Fussy.


Changed on 4/7/2010

VAERS ID: 304268 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Alabama
Vaccinated:2008-02-01
Onset:2008-02-02
Submitted:2008-02-04
Entered:2008-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B128AB / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF213AA / 0 RL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B54013F / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0969U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diarrhoea haemorrhagic, Intussusception, Vomiting, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: DRY PATCHES ON SKIN, SNEEZING
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal ultrasound, Barium enema, Stool culture, Stool O&P and Stool for rotavirus 2/25/08-records received-US demonstrated intussusception. Air contrast enema showed evidence of a resolved intussusception. Stool hemoccult positive. Stoo
CDC 'Split Type':

Write-up: Patient presented to ER on 2/2/08 with vomiting, bloody diarrhea; had Abdominal U/S which showed intussusception which was followed by a barium enema which showed resolution of intussusception,still in hospital as of today 2/4/2008 2/22/08-records received for DOS 2/3-2/4/08-Gastroenteritis with hematochezia resolved intussusception. C/O diarrhea 2/2/08, watery stools. Vomiting and blood noted in stool. Fussy.


Changed on 8/31/2010

VAERS ID: 304268 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Alabama
Vaccinated:2008-02-01
Onset:2008-02-02
Submitted:2008-02-04
Entered:2008-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B128AB / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF213AA / 0 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B54013F / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0969U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diarrhoea haemorrhagic, Intussusception, Vomiting, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: DRY PATCHES ON SKIN, SNEEZING
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal ultrasound, Barium enema, Stool culture, Stool O&P and Stool for rotavirus 2/25/08-records received-US demonstrated intussusception. Air contrast enema showed evidence of a resolved intussusception. Stool hemoccult positive. Stoo
CDC 'Split Type':

Write-up: Patient presented to ER on 2/2/08 with vomiting, bloody diarrhea; had Abdominal U/S which showed intussusception which was followed by a barium enema which showed resolution of intussusception,still in hospital as of today 2/4/2008 2/22/08-records received for DOS 2/3-2/4/08-Gastroenteritis with hematochezia resolved intussusception. C/O diarrhea 2/2/08, watery stools. Vomiting and blood noted in stool. Fussy.


Changed on 1/4/2011

VAERS ID: 304268 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Alabama
Vaccinated:2008-02-01
Onset:2008-02-02
Submitted:2008-02-04
Entered:2008-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B128AB / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF213AA / 0 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54013F / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0969U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diarrhoea haemorrhagic, Intussusception, Vomiting, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: DRY PATCHES ON SKIN, SNEEZING
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal ultrasound, Barium enema, Stool culture, Stool O&P and Stool for rotavirus 2/25/08-records received-US demonstrated intussusception. Air contrast enema showed evidence of a resolved intussusception. Stool hemoccult positive. Stoo Stool positive for Salmonella group B.
CDC 'Split Type':

Write-up: Patient presented to ER on 2/2/08 with vomiting, bloody diarrhea; had Abdominal U/S which showed intussusception which was followed by a barium enema which showed resolution of intussusception,still in hospital as of today 2/4/2008 2/22/08-records received for DOS 2/3-2/4/08-Gastroenteritis with hematochezia resolved intussusception. C/O diarrhea 2/2/08, watery stools. Vomiting and blood noted in stool. Fussy.


Changed on 4/13/2011

VAERS ID: 304268 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Alabama
Vaccinated:2008-02-01
Onset:2008-02-02
Submitted:2008-02-04
Entered:2008-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B128AB / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF213AA / 0 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54013F / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0969U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Culture stool positive, Diarrhoea, Diarrhoea haemorrhagic, Gastroenteritis, Haematochezia, Intussusception, Irritability, Salmonellosis, Vomiting, Enema administration, Ultrasound abdomen abnormal, Occult blood positive, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: DRY PATCHES ON SKIN, SNEEZING
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal ultrasound, Barium enema, Stool culture, Stool O&P and Stool for rotavirus 2/25/08-records received-US demonstrated intussusception. Air contrast enema showed evidence of a resolved intussusception. Stool hemoccult positive. Stool positive for Salmonella group B.
CDC 'Split Type':

Write-up: Patient presented to ER on 2/2/08 with vomiting, bloody diarrhea; had Abdominal U/S which showed intussusception which was followed by a barium enema which showed resolution of intussusception,still in hospital as of today 2/4/2008 2/22/08-records received for DOS 2/3-2/4/08-Gastroenteritis with hematochezia resolved intussusception. C/O diarrhea 2/2/08, watery stools. Vomiting and blood noted in stool. Fussy.


Changed on 5/13/2011

VAERS ID: 304268 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Alabama
Vaccinated:2008-02-01
Onset:2008-02-02
Submitted:2008-02-04
Entered:2008-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B128AB / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF213AA / 0 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54013F / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0969U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Culture stool positive, Diarrhoea, Diarrhoea haemorrhagic, Gastroenteritis, Haematochezia, Intussusception, Irritability, Salmonellosis, Vomiting, Enema administration, Ultrasound abdomen abnormal, Occult blood positive, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: DRY PATCHES ON SKIN, SNEEZING
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal ultrasound, Barium enema, Stool culture, Stool O&P and Stool for rotavirus 2/25/08-records received-US demonstrated intussusception. Air contrast enema showed evidence of a resolved intussusception. Stool hemoccult positive. Stool positive for Salmonella group B.
CDC 'Split Type':

Write-up: Patient presented to ER on 2/2/08 with vomiting, bloody diarrhea; had Abdominal U/S which showed intussusception which was followed by a barium enema which showed resolution of intussusception,still in hospital as of today 2/4/2008 2/22/08-records received for DOS 2/3-2/4/08-Gastroenteritis with hematochezia resolved intussusception. C/O diarrhea 2/2/08, watery stools. Vomiting and blood noted in stool. Fussy.


Changed on 6/11/2011

VAERS ID: 304268 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Alabama
Vaccinated:2008-02-01
Onset:2008-02-02
Submitted:2008-02-04
Entered:2008-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B128AB / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF213AA / 0 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54013F / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0969U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Culture stool positive, Diarrhoea, Diarrhoea haemorrhagic, Gastroenteritis, Haematochezia, Intussusception, Irritability, Salmonellosis, Vomiting, Enema administration, Ultrasound abdomen abnormal, Occult blood positive, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: DRY PATCHES ON SKIN, SNEEZING
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal ultrasound, Barium enema, Stool culture, Stool O&P and Stool for rotavirus 2/25/08-records received-US demonstrated intussusception. Air contrast enema showed evidence of a resolved intussusception. Stool hemoccult positive. Stool positive for Salmonella group B.
CDC 'Split Type':

Write-up: Patient presented to ER on 2/2/08 with vomiting, bloody diarrhea; had Abdominal U/S which showed intussusception which was followed by a barium enema which showed resolution of intussusception,still in hospital as of today 2/4/2008 2/22/08-records received for DOS 2/3-2/4/08-Gastroenteritis with hematochezia resolved intussusception. C/O diarrhea 2/2/08, watery stools. Vomiting and blood noted in stool. Fussy.


Changed on 5/12/2012

VAERS ID: 304268 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Alabama
Vaccinated:2008-02-01
Onset:2008-02-02
Submitted:2008-02-04
Entered:2008-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B128AB / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF213AA / 0 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54013F / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0969U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Culture stool positive, Diarrhoea, Diarrhoea haemorrhagic, Gastroenteritis, Haematochezia, Intussusception, Irritability, Salmonellosis, Vomiting, Enema administration, Ultrasound abdomen abnormal, Occult blood positive, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: DRY PATCHES ON SKIN, SNEEZING
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal ultrasound, Barium enema, Stool culture, Stool O&P and Stool for rotavirus 2/25/08-records received-US demonstrated intussusception. Air contrast enema showed evidence of a resolved intussusception. Stool hemoccult positive. Stool positive for Salmonella group B.
CDC 'Split Type':

Write-up: Patient presented to ER on 2/2/08 with vomiting, bloody diarrhea; had Abdominal U/S which showed intussusception which was followed by a barium enema which showed resolution of intussusception,still intussusception, still in hospital as of today 2/4/2008 2/4/2008. 2/22/08-records received for DOS 2/3-2/4/08-Gastroenteritis with hematochezia resolved intussusception. C/O diarrhea 2/2/08, watery stools. Vomiting and blood noted in stool. Fussy.


Changed on 5/13/2013

VAERS ID: 304268 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Alabama
Vaccinated:2008-02-01
Onset:2008-02-02
Submitted:2008-02-04
Entered:2008-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B128AB / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF213AA / 0 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54013F / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0969U / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0969U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Culture stool positive, Diarrhoea, Diarrhoea haemorrhagic, Gastroenteritis, Haematochezia, Intussusception, Irritability, Salmonellosis, Vomiting, Enema administration, Ultrasound abdomen abnormal, Occult blood positive, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: DRY PATCHES ON SKIN, SNEEZING
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal ultrasound, Barium enema, Stool culture, Stool O&P and Stool for rotavirus 2/25/08-records received-US demonstrated intussusception. Air contrast enema showed evidence of a resolved intussusception. Stool hemoccult positive. Stool positive for Salmonella group B.
CDC 'Split Type':

Write-up: Patient presented to ER on 2/2/08 with vomiting, bloody diarrhea; had Abdominal U/S which showed intussusception which was followed by a barium enema which showed resolution of intussusception, still in hospital as of today 2/4/2008. 2/22/08-records received for DOS 2/3-2/4/08-Gastroenteritis with hematochezia resolved intussusception. C/O diarrhea 2/2/08, watery stools. Vomiting and blood noted in stool. Fussy.


Changed on 2/14/2017

VAERS ID: 304268 Before After
VAERS Form:
Age:0.3 0.31
Gender:Male
Location:Alabama
Vaccinated:2008-02-01
Onset:2008-02-02
Submitted:2008-02-04
Entered:2008-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B128AB / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF213AA / 0 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54013F / 0 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0969U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Culture stool positive, Diarrhoea, Diarrhoea haemorrhagic, Gastroenteritis, Haematochezia, Intussusception, Irritability, Salmonellosis, Vomiting, Enema administration, Ultrasound abdomen abnormal, Occult blood positive, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: DRY PATCHES ON SKIN, SNEEZING
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal ultrasound, Barium enema, Stool culture, Stool O&P and Stool for rotavirus 2/25/08-records received-US demonstrated intussusception. Air contrast enema showed evidence of a resolved intussusception. Stool hemoccult positive. Stool positive for Salmonella group B.
CDC 'Split Type':

Write-up: Patient presented to ER on 2/2/08 with vomiting, bloody diarrhea; had Abdominal U/S which showed intussusception which was followed by a barium enema which showed resolution of intussusception, still in hospital as of today 2/4/2008. 2/22/08-records received for DOS 2/3-2/4/08-Gastroenteritis with hematochezia resolved intussusception. C/O diarrhea 2/2/08, watery stools. Vomiting and blood noted in stool. Fussy.


Changed on 4/14/2017

VAERS ID: 304268 Before After
VAERS Form:
Age:0.31
Gender:Male
Location:Alabama
Vaccinated:2008-02-01
Onset:2008-02-02
Submitted:2008-02-04
Entered:2008-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B128AB / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF213AA / 0 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54013F / 0 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0969U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Culture stool positive, Diarrhoea, Diarrhoea haemorrhagic, Gastroenteritis, Haematochezia, Intussusception, Irritability, Salmonellosis, Vomiting, Enema administration, Ultrasound abdomen abnormal, Occult blood positive, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: DRY PATCHES ON SKIN, SNEEZING
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal ultrasound, Barium enema, Stool culture, Stool O&P and Stool for rotavirus 2/25/08-records received-US demonstrated intussusception. Air contrast enema showed evidence of a resolved intussusception. Stool hemoccult positive. Stool positive for Salmonella group B.
CDC 'Split Type':

Write-up: Patient presented to ER on 2/2/08 with vomiting, bloody diarrhea; had Abdominal U/S which showed intussusception which was followed by a barium enema which showed resolution of intussusception, still in hospital as of today 2/4/2008. 2/22/08-records received for DOS 2/3-2/4/08-Gastroenteritis with hematochezia resolved intussusception. C/O diarrhea 2/2/08, watery stools. Vomiting and blood noted in stool. Fussy.


Changed on 9/14/2017

VAERS ID: 304268 Before After
VAERS Form:(blank) 1
Age:0.31
Gender:Male
Location:Alabama
Vaccinated:2008-02-01
Onset:2008-02-02
Submitted:2008-02-04
Entered:2008-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B128AB / 0 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF213AA / 0 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54013F / 0 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0969U / 0 1 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diarrhoea haemorrhagic, Intussusception, Vomiting, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: DRY PATCHES ON SKIN, SNEEZING
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal ultrasound, Barium enema, Stool culture, Stool O&P and Stool for rotavirus 2/25/08-records received-US demonstrated intussusception. Air contrast enema showed evidence of a resolved intussusception. Stool hemoccult positive. Stool positive for Salmonella group B.
CDC 'Split Type':

Write-up: Patient presented to ER on 2/2/08 with vomiting, bloody diarrhea; had Abdominal U/S which showed intussusception which was followed by a barium enema which showed resolution of intussusception, still in hospital as of today 2/4/2008. 2/22/08-records received for DOS 2/3-2/4/08-Gastroenteritis with hematochezia resolved intussusception. C/O diarrhea 2/2/08, watery stools. Vomiting and blood noted in stool. Fussy.


Changed on 2/14/2018

VAERS ID: 304268 Before After
VAERS Form:1
Age:0.31
Gender:Male
Location:Alabama
Vaccinated:2008-02-01
Onset:2008-02-02
Submitted:2008-02-04
Entered:2008-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B128AB / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF213AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54013F / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0969U / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diarrhoea haemorrhagic, Intussusception, Vomiting, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: DRY PATCHES ON SKIN, SNEEZING
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal ultrasound, Barium enema, Stool culture, Stool O&P and Stool for rotavirus 2/25/08-records received-US demonstrated intussusception. Air contrast enema showed evidence of a resolved intussusception. Stool hemoccult positive. Stool positive for Salmonella group B.
CDC 'Split Type':

Write-up: Patient presented to ER on 2/2/08 with vomiting, bloody diarrhea; had Abdominal U/S which showed intussusception which was followed by a barium enema which showed resolution of intussusception, still in hospital as of today 2/4/2008. 2/22/08-records received for DOS 2/3-2/4/08-Gastroenteritis with hematochezia resolved intussusception. C/O diarrhea 2/2/08, watery stools. Vomiting and blood noted in stool. Fussy.


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