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This is VAERS ID 317989

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 317989
VAERS Form:
Age:0.2
Sex:Male
Location:D.C.
Vaccinated:2008-03-04
Onset:2008-05-08
Submitted:2008-06-27
Entered:2008-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 - / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC - / 0 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1388U / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Barium double contrast, Haematochezia, Intussusception, Somnolence, Oral intake reduced

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? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Air contrast enema 9/8/08-records received-Successful reduction with fluoroscopy guided barium edema.
CDC 'Split Type':

Write-up: Intussusception 5-8-08 reduced by air enema on second attempt. 9/8/08-records received for DOS 05/05/08-DC DX: Intussusception. Presented to ED with C/O drowsiness starting morning of ED visit. Poor oral intake and decreased urinary output and no BM today". Observed grabbing at left ear. In ED passed currant jelly stool followed by bloody stool. Observed for 23 hours and discharged.


Changed on 12/8/2009

VAERS ID: 317989 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:D.C.
Vaccinated:2008-03-04
Onset:2008-05-08
Submitted:2008-06-27
Entered:2008-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 - / -
DTAPHEPBIP: DTAP + HEPB + IPV (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 - / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC - / 0 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1388U / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Barium double contrast, Haematochezia, Intussusception, Somnolence, Urine output decreased, Oral intake reduced

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? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Air contrast enema 9/8/08-records received-Successful reduction with fluoroscopy guided barium edema.
CDC 'Split Type':

Write-up: Intussusception 5-8-08 reduced by air enema on second attempt. 9/8/08-records received for DOS 05/05/08-DC DX: Intussusception. Presented to ED with C/O drowsiness starting morning of ED visit. Poor oral intake and decreased urinary output and no BM today". today. Observed grabbing at left ear. In ED passed currant jelly stool followed by bloody stool. Observed for 23 hours and discharged.


Changed on 3/2/2010

VAERS ID: 317989 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:D.C.
Vaccinated:2008-03-04
Onset:2008-05-08
Submitted:2008-06-27
Entered:2008-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 - / -
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC - / 0 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1388U / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Barium double contrast, Haematochezia, Intussusception, Somnolence, Urine output decreased, Oral intake reduced

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? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Air contrast enema 9/8/08-records received-Successful reduction with fluoroscopy guided barium edema.
CDC 'Split Type':

Write-up: Intussusception 5-8-08 reduced by air enema on second attempt. 9/8/08-records received for DOS 05/05/08-DC DX: Intussusception. Presented to ED with C/O drowsiness starting morning of ED visit. Poor oral intake and decreased urinary output and no BM today. Observed grabbing at left ear. In ED passed currant jelly stool followed by bloody stool. Observed for 23 hours and discharged.


Changed on 4/7/2010

VAERS ID: 317989 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:D.C.
Vaccinated:2008-03-04
Onset:2008-05-08
Submitted:2008-06-27
Entered:2008-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 - / -
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC - / 0 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1388U / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Barium double contrast, Haematochezia, Intussusception, Somnolence, Urine output decreased, Oral intake reduced

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? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Air contrast enema 9/8/08-records received-Successful reduction with fluoroscopy guided barium edema.
CDC 'Split Type':

Write-up: Intussusception 5-8-08 reduced by air enema on second attempt. 9/8/08-records received for DOS 05/05/08-DC DX: Intussusception. Presented to ED with C/O drowsiness starting morning of ED visit. Poor oral intake and decreased urinary output and no BM today. Observed grabbing at left ear. In ED passed currant jelly stool followed by bloody stool. Observed for 23 hours and discharged.


Changed on 8/31/2010

VAERS ID: 317989 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:D.C.
Vaccinated:2008-03-04
Onset:2008-05-08
Submitted:2008-06-27
Entered:2008-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 - / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH - / 0 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1388U / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Barium double contrast, Haematochezia, Intussusception, Somnolence, Urine output decreased, Oral intake reduced

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? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Air contrast enema 9/8/08-records received-Successful reduction with fluoroscopy guided barium edema.
CDC 'Split Type':

Write-up: Intussusception 5-8-08 reduced by air enema on second attempt. 9/8/08-records received for DOS 05/05/08-DC DX: Intussusception. Presented to ED with C/O drowsiness starting morning of ED visit. Poor oral intake and decreased urinary output and no BM today. Observed grabbing at left ear. In ED passed currant jelly stool followed by bloody stool. Observed for 23 hours and discharged.


Changed on 5/13/2013

VAERS ID: 317989 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:D.C.
Vaccinated:2008-03-04
Onset:2008-05-08
Submitted:2008-06-27
Entered:2008-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / 0 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1388U / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1388U / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Barium double contrast, Haematochezia, Intussusception, Somnolence, Urine output decreased, Oral intake reduced

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? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Air contrast enema 9/8/08-records received-Successful reduction with fluoroscopy guided barium edema.
CDC 'Split Type':

Write-up: Intussusception 5-8-08 reduced by air enema on second attempt. 9/8/08-records received for DOS 05/05/08-DC DX: Intussusception. Presented to ED with C/O drowsiness starting morning of ED visit. Poor oral intake and decreased urinary output and no BM today. Observed grabbing at left ear. In ED passed currant jelly stool followed by bloody stool. Observed for 23 hours and discharged.


Changed on 4/14/2017

VAERS ID: 317989 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:D.C.
Vaccinated:2008-03-04
Onset:2008-05-08
Submitted:2008-06-27
Entered:2008-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / 0 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1388U / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Barium double contrast, Haematochezia, Intussusception, Somnolence, Urine output decreased, Oral intake reduced

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? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Air contrast enema 9/8/08-records received-Successful reduction with fluoroscopy guided barium edema.
CDC 'Split Type':

Write-up: Intussusception 5-8-08 reduced by air enema on second attempt. 9/8/08-records received for DOS 05/05/08-DC DX: Intussusception. Presented to ED with C/O drowsiness starting morning of ED visit. Poor oral intake and decreased urinary output and no BM today. Observed grabbing at left ear. In ED passed currant jelly stool followed by bloody stool. Observed for 23 hours and discharged.


Changed on 9/14/2017

VAERS ID: 317989 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:D.C.
Vaccinated:2008-03-04
Onset:2008-05-08
Submitted:2008-06-27
Entered:2008-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 1 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 1 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / 0 1 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1388U / 0 1 - MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Barium double contrast, 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? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Air contrast enema 9/8/08-records received-Successful reduction with fluoroscopy guided barium edema.
CDC 'Split Type':

Write-up: Intussusception 5-8-08 reduced by air enema on second attempt. 9/8/08-records received for DOS 05/05/08-DC DX: Intussusception. Presented to ED with C/O drowsiness starting morning of ED visit. Poor oral intake and decreased urinary output and no BM today. Observed grabbing at left ear. In ED passed currant jelly stool followed by bloody stool. Observed for 23 hours and discharged.


Changed on 2/14/2018

VAERS ID: 317989 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:D.C.
Vaccinated:2008-03-04
Onset:2008-05-08
Submitted:2008-06-27
Entered:2008-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / 1 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1388U / 1 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Barium double contrast, 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? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Air contrast enema 9/8/08-records received-Successful reduction with fluoroscopy guided barium edema.
CDC 'Split Type':

Write-up: Intussusception 5-8-08 reduced by air enema on second attempt. 9/8/08-records received for DOS 05/05/08-DC DX: Intussusception. Presented to ED with C/O drowsiness starting morning of ED visit. Poor oral intake and decreased urinary output and no BM today. Observed grabbing at left ear. In ED passed currant jelly stool followed by bloody stool. Observed for 23 hours and discharged.


Changed on 6/14/2018

VAERS ID: 317989 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:D.C.
Vaccinated:2008-03-04
Onset:2008-05-08
Submitted:2008-06-27
Entered:2008-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / 1 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1388U / 1 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Barium double contrast, 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? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Air contrast enema 9/8/08-records received-Successful reduction with fluoroscopy guided barium edema.
CDC 'Split Type':

Write-up: Intussusception 5-8-08 reduced by air enema on second attempt. 9/8/08-records received for DOS 05/05/08-DC DX: Intussusception. Presented to ED with C/O drowsiness starting morning of ED visit. Poor oral intake and decreased urinary output and no BM today. Observed grabbing at left ear. In ED passed currant jelly stool followed by bloody stool. Observed for 23 hours and discharged.


Changed on 8/14/2018

VAERS ID: 317989 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:D.C.
Vaccinated:2008-03-04
Onset:2008-05-08
Submitted:2008-06-27
Entered:2008-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / 1 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1388U / 1 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Barium double contrast, 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? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Air contrast enema 9/8/08-records received-Successful reduction with fluoroscopy guided barium edema.
CDC 'Split Type':

Write-up: Intussusception 5-8-08 reduced by air enema on second attempt. 9/8/08-records received for DOS 05/05/08-DC DX: Intussusception. Presented to ED with C/O drowsiness starting morning of ED visit. Poor oral intake and decreased urinary output and no BM today. Observed grabbing at left ear. In ED passed currant jelly stool followed by bloody stool. Observed for 23 hours and discharged.


Changed on 9/14/2018

VAERS ID: 317989 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:D.C.
Vaccinated:2008-03-04
Onset:2008-05-08
Submitted:2008-06-27
Entered:2008-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / 1 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1388U / 1 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Barium double contrast, 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? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Air contrast enema 9/8/08-records received-Successful reduction with fluoroscopy guided barium edema.
CDC 'Split Type':

Write-up: Intussusception 5-8-08 reduced by air enema on second attempt. 9/8/08-records received for DOS 05/05/08-DC DX: Intussusception. Presented to ED with C/O drowsiness starting morning of ED visit. Poor oral intake and decreased urinary output and no BM today. Observed grabbing at left ear. In ED passed currant jelly stool followed by bloody stool. Observed for 23 hours and discharged.


Changed on 10/14/2018

VAERS ID: 317989 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:D.C.
Vaccinated:2008-03-04
Onset:2008-05-08
Submitted:2008-06-27
Entered:2008-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / 1 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1388U / 1 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Barium double contrast, 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? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Air contrast enema 9/8/08-records received-Successful reduction with fluoroscopy guided barium edema.
CDC 'Split Type':

Write-up: Intussusception 5-8-08 reduced by air enema on second attempt. 9/8/08-records received for DOS 05/05/08-DC DX: Intussusception. Presented to ED with C/O drowsiness starting morning of ED visit. Poor oral intake and decreased urinary output and no BM today. Observed grabbing at left ear. In ED passed currant jelly stool followed by bloody stool. Observed for 23 hours and discharged.

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