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This is VAERS ID 315579

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 315579
VAERS Form:
Age:0.5
Gender:Male
Location:North Carolina
Vaccinated:2008-05-30
Onset:2008-06-03
Submitted:2008-06-04
Entered:2008-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF350AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C65929 / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0211X / 2 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Appendicectomy, Intussusception, Laparoscopy

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: 1     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: TYLENOL
Current Illness: hematochezia
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Intussusception, surgical intervention. 7/23/08-follow up visit for DOS 6/18/08-seen for routine follow up after laparoscopic reduction of intussusception and appendectomy. Presented with nonreducible intussusception with uneventful recovery.


Changed on 12/8/2009

VAERS ID: 315579 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:North Carolina
Vaccinated:2008-05-30
Onset:2008-06-03
Submitted:2008-06-04
Entered:2008-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 2 RL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF350AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C65929 / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0211X / 2 - / PO

Administered by: Private      Purchased by: Unknown Private
Symptoms: Appendicectomy, Intussusception, Laparoscopy

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: 1     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: TYLENOL
Current Illness: hematochezia
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Intussusception, surgical intervention. 7/23/08-follow up visit for DOS 6/18/08-seen for routine follow up after laparoscopic reduction of intussusception and appendectomy. Presented with nonreducible intussusception with uneventful recovery.


Changed on 3/2/2010

VAERS ID: 315579 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:North Carolina
Vaccinated:2008-05-30
Onset:2008-06-03
Submitted:2008-06-04
Entered:2008-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF350AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC C65929 / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0211X / 2 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Appendicectomy, Intussusception, Laparoscopy

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: 1     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: TYLENOL
Current Illness: hematochezia
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Intussusception, surgical intervention. 7/23/08-follow up visit for DOS 6/18/08-seen for routine follow up after laparoscopic reduction of intussusception and appendectomy. Presented with nonreducible intussusception with uneventful recovery.


Changed on 4/7/2010

VAERS ID: 315579 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:North Carolina
Vaccinated:2008-05-30
Onset:2008-06-03
Submitted:2008-06-04
Entered:2008-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF350AA / 2 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C65929 / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0211X / 2 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Appendicectomy, Intussusception, Laparoscopy

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: 1     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: TYLENOL
Current Illness: hematochezia
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Intussusception, surgical intervention. 7/23/08-follow up visit for DOS 6/18/08-seen for routine follow up after laparoscopic reduction of intussusception and appendectomy. Presented with nonreducible intussusception with uneventful recovery.


Changed on 8/31/2010

VAERS ID: 315579 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:North Carolina
Vaccinated:2008-05-30
Onset:2008-06-03
Submitted:2008-06-04
Entered:2008-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF350AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH C65929 / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0211X / 2 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Appendicectomy, Intussusception, Laparoscopy

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: 1     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: TYLENOL
Current Illness: hematochezia
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Intussusception, surgical intervention. 7/23/08-follow up visit for DOS 6/18/08-seen for routine follow up after laparoscopic reduction of intussusception and appendectomy. Presented with nonreducible intussusception with uneventful recovery.


Changed on 5/13/2013

VAERS ID: 315579 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:North Carolina
Vaccinated:2008-05-30
Onset:2008-06-03
Submitted:2008-06-04
Entered:2008-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF350AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65929 / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0211X / 2 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0211X / 2 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Appendicectomy, Intussusception, Laparoscopy

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: 1     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: TYLENOL
Current Illness: hematochezia
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Intussusception, surgical intervention. 7/23/08-follow up visit for DOS 6/18/08-seen for routine follow up after laparoscopic reduction of intussusception and appendectomy. Presented with nonreducible intussusception with uneventful recovery.


Changed on 4/14/2017

VAERS ID: 315579 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:North Carolina
Vaccinated:2008-05-30
Onset:2008-06-03
Submitted:2008-06-04
Entered:2008-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF350AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65929 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0211X / 2 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Appendicectomy, Intussusception, Laparoscopy

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: 1     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: TYLENOL
Current Illness: hematochezia
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Intussusception, surgical intervention. 7/23/08-follow up visit for DOS 6/18/08-seen for routine follow up after laparoscopic reduction of intussusception and appendectomy. Presented with nonreducible intussusception with uneventful recovery.


Changed on 9/14/2017

VAERS ID: 315579 Before After
VAERS Form:(blank) 1
Age:0.5
Gender:Male
Location:North Carolina
Vaccinated:2008-05-30
Onset:2008-06-03
Submitted:2008-06-04
Entered:2008-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 2 3 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF350AA / 2 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65929 / 2 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0211X / 2 3 - MO / PO

Administered by: Private      Purchased by: Private
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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: TYLENOL
Current Illness: hematochezia
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Intussusception, surgical intervention. 7/23/08-follow up visit for DOS 6/18/08-seen for routine follow up after laparoscopic reduction of intussusception and appendectomy. Presented with nonreducible intussusception with uneventful recovery.


Changed on 2/14/2018

VAERS ID: 315579 Before After
VAERS Form:1
Age:0.5
Gender:Male
Location:North Carolina
Vaccinated:2008-05-30
Onset:2008-06-03
Submitted:2008-06-04
Entered:2008-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 3 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF350AA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65929 / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0211X / 3 MO / PO

Administered by: Private      Purchased by: Private
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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: TYLENOL
Current Illness: hematochezia
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Intussusception, surgical intervention. 7/23/08-follow up visit for DOS 6/18/08-seen for routine follow up after laparoscopic reduction of intussusception and appendectomy. Presented with nonreducible intussusception with uneventful recovery.


Changed on 6/14/2018

VAERS ID: 315579 Before After
VAERS Form:1
Age:0.5
Gender:Male
Location:North Carolina
Vaccinated:2008-05-30
Onset:2008-06-03
Submitted:2008-06-04
Entered:2008-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 3 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF350AA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65929 / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0211X / 3 MO / PO

Administered by: Private      Purchased by: Private
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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: TYLENOL
Current Illness: hematochezia
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Intussusception, surgical intervention. 7/23/08-follow up visit for DOS 6/18/08-seen for routine follow up after laparoscopic reduction of intussusception and appendectomy. Presented with nonreducible intussusception with uneventful recovery.


Changed on 8/14/2018

VAERS ID: 315579 Before After
VAERS Form:1
Age:0.5
Gender:Male
Location:North Carolina
Vaccinated:2008-05-30
Onset:2008-06-03
Submitted:2008-06-04
Entered:2008-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 3 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF350AA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65929 / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0211X / 3 MO / PO

Administered by: Private      Purchased by: Private
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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: TYLENOL
Current Illness: hematochezia
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Intussusception, surgical intervention. 7/23/08-follow up visit for DOS 6/18/08-seen for routine follow up after laparoscopic reduction of intussusception and appendectomy. Presented with nonreducible intussusception with uneventful recovery.


Changed on 9/14/2018

VAERS ID: 315579 Before After
VAERS Form:1
Age:0.5
Gender:Male
Location:North Carolina
Vaccinated:2008-05-30
Onset:2008-06-03
Submitted:2008-06-04
Entered:2008-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 3 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF350AA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65929 / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0211X / 3 MO / PO

Administered by: Private      Purchased by: Private
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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: TYLENOL
Current Illness: hematochezia
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Intussusception, surgical intervention. 7/23/08-follow up visit for DOS 6/18/08-seen for routine follow up after laparoscopic reduction of intussusception and appendectomy. Presented with nonreducible intussusception with uneventful recovery.


Changed on 10/14/2018

VAERS ID: 315579 Before After
VAERS Form:1
Age:0.5
Gender:Male
Location:North Carolina
Vaccinated:2008-05-30
Onset:2008-06-03
Submitted:2008-06-04
Entered:2008-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 3 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF350AA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65929 / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0211X / 3 MO / PO

Administered by: Private      Purchased by: Private
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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: TYLENOL
Current Illness: hematochezia
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Intussusception, surgical intervention. 7/23/08-follow up visit for DOS 6/18/08-seen for routine follow up after laparoscopic reduction of intussusception and appendectomy. Presented with nonreducible intussusception with uneventful recovery.

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