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This is VAERS ID 319397

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 319397
VAERS Form:
Age:0.2
Sex:Male
Location:New York
Vaccinated:2008-04-08
Onset:2008-05-24
Submitted:2008-07-15
Entered:2008-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B074AA / 0 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR 356AB / 0 LL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0805 / 0 RL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C45887 / 0 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0015X / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Barium double contrast, Constipation, Full blood count, Intussusception, Decreased appetite

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: CBC; ultrasound, positive for intussusception 7/17/08-records received- WBC 13.7. Ultrasound positive for intussusception. Air contrast enema partiall successful with repeat attempt folllowing day successful reduction.
CDC 'Split Type':

Write-up: Blood per his rectum, fussy, lethargic. 7/17/08-records received with report for DOS 5/24-5/26/08-DC DX: Intussusception. Presented to Ed with history of bloood per rectum. Fussy. Appetitie decreased. Constipated. One hard stool day before and vomtiting o"nce.

Changed on 12/8/2009

VAERS ID: 319397 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:New York
Vaccinated:2008-04-08
Onset:2008-05-24
Submitted:2008-07-15
Entered:2008-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B074AA / 0 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR 356AB / 0 LL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0805 / 0 RL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C45887 / 0 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0015X / 0 - / PO

Administered by: Private      Purchased by: Unknown Private
Symptoms: Barium double contrast, Constipation, Full blood count, Intussusception, Irritability, Lethargy, Rectal haemorrhage, Vomiting, Ultrasound abdomen abnormal, Decreased appetite

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: CBC; ultrasound, positive for intussusception 7/17/08-records received- WBC 13.7. Ultrasound positive for intussusception. Air contrast enema partiall successful with repeat attempt folllowing day successful reduction.
CDC 'Split Type':

Write-up: Blood per his rectum, fussy, lethargic. 7/17/08-records received with report for DOS 5/24-5/26/08-DC DX: Intussusception. Presented to Ed with history of bloood per rectum. Fussy. Appetitie decreased. Constipated. One hard stool day before and vomtiting o"nce. once.

Changed on 3/2/2010

VAERS ID: 319397 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:New York
Vaccinated:2008-04-08
Onset:2008-05-24
Submitted:2008-07-15
Entered:2008-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B074AA / 0 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR 356AB / 0 LL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0805 / 0 RL / UN
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC C45887 / 0 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0015X / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Constipation, Full blood count, Intussusception, Irritability, Lethargy, Rectal haemorrhage, Vomiting, Ultrasound abdomen abnormal, Decreased appetite

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: CBC; ultrasound, positive for intussusception 7/17/08-records received- WBC 13.7. Ultrasound positive for intussusception. Air contrast enema partiall successful with repeat attempt folllowing day successful reduction.
CDC 'Split Type':

Write-up: Blood per his rectum, fussy, lethargic. 7/17/08-records received with report for DOS 5/24-5/26/08-DC DX: Intussusception. Presented to Ed with history of bloood per rectum. Fussy. Appetitie decreased. Constipated. One hard stool day before and vomtiting once.

Changed on 4/7/2010

VAERS ID: 319397 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:New York
Vaccinated:2008-04-08
Onset:2008-05-24
Submitted:2008-07-15
Entered:2008-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B074AA / 0 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR 356AB / 0 LL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0805 / 0 RL / UN
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C45887 / 0 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0015X / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Constipation, Full blood count, Intussusception, Irritability, Lethargy, Rectal haemorrhage, Vomiting, Ultrasound abdomen abnormal, Decreased appetite

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: CBC; ultrasound, positive for intussusception 7/17/08-records received- WBC 13.7. Ultrasound positive for intussusception. Air contrast enema partiall successful with repeat attempt folllowing day successful reduction.
CDC 'Split Type':

Write-up: Blood per his rectum, fussy, lethargic. 7/17/08-records received with report for DOS 5/24-5/26/08-DC DX: Intussusception. Presented to Ed with history of bloood per rectum. Fussy. Appetitie decreased. Constipated. One hard stool day before and vomtiting once.

Changed on 8/31/2010

VAERS ID: 319397 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:New York
Vaccinated:2008-04-08
Onset:2008-05-24
Submitted:2008-07-15
Entered:2008-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B074AA / 0 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR 356AB / 0 LL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0805 / 0 RL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH C45887 / 0 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0015X / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Constipation, Full blood count, Intussusception, Irritability, Lethargy, Rectal haemorrhage, Vomiting, Ultrasound abdomen abnormal, Decreased appetite

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: CBC; ultrasound, positive for intussusception 7/17/08-records received- WBC 13.7. Ultrasound positive for intussusception. Air contrast enema partiall successful with repeat attempt folllowing day successful reduction.
CDC 'Split Type':

Write-up: Blood per his rectum, fussy, lethargic. 7/17/08-records received with report for DOS 5/24-5/26/08-DC DX: Intussusception. Presented to Ed with history of bloood per rectum. Fussy. Appetitie decreased. Constipated. One hard stool day before and vomtiting once.

Changed on 5/13/2013

VAERS ID: 319397 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:New York
Vaccinated:2008-04-08
Onset:2008-05-24
Submitted:2008-07-15
Entered:2008-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B074AA / 0 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR 356AB / 0 LL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0805 / 0 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45887 / 0 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0015X / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0015X / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Constipation, Full blood count, Intussusception, Irritability, Lethargy, Rectal haemorrhage, Vomiting, Ultrasound abdomen abnormal, Decreased appetite

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: CBC; ultrasound, positive for intussusception 7/17/08-records received- WBC 13.7. Ultrasound positive for intussusception. Air contrast enema partiall successful with repeat attempt folllowing day successful reduction.
CDC 'Split Type':

Write-up: Blood per his rectum, fussy, lethargic. 7/17/08-records received with report for DOS 5/24-5/26/08-DC DX: Intussusception. Presented to Ed with history of bloood per rectum. Fussy. Appetitie decreased. Constipated. One hard stool day before and vomtiting once.

Changed on 2/14/2017

VAERS ID: 319397 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:New York
Vaccinated:2008-04-08
Onset:2008-05-24
Submitted:2008-07-15
Entered:2008-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B074AA / 0 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR 356AB / 0 LL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0805 / 0 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45887 / 0 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0015X / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Constipation, Full blood count, Intussusception, Irritability, Lethargy, Rectal haemorrhage, Vomiting, Ultrasound abdomen abnormal, Decreased appetite

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: CBC; ultrasound, positive for intussusception 7/17/08-records received- WBC 13.7. Ultrasound positive for intussusception. Air contrast enema partiall successful with repeat attempt folllowing day successful reduction.
CDC 'Split Type':

Write-up: Blood per his rectum, fussy, lethargic. 7/17/08-records received with report for DOS 5/24-5/26/08-DC DX: Intussusception. Presented to Ed with history of bloood per rectum. Fussy. Appetitie decreased. Constipated. One hard stool day before and vomtiting once.

Changed on 9/14/2017

VAERS ID: 319397 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:New York
Vaccinated:2008-04-08
Onset:2008-05-24
Submitted:2008-07-15
Entered:2008-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B074AA / 0 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR 356AB / 0 1 LL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0805 / 0 1 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45887 / 0 1 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0015X / 0 1 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Full blood count, Intussusception, Irritability, Lethargy, Rectal haemorrhage, Ultrasound abdomen abnormal

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: CBC; ultrasound, positive for intussusception 7/17/08-records received- WBC 13.7. Ultrasound positive for intussusception. Air contrast enema partiall successful with repeat attempt folllowing day successful reduction.
CDC 'Split Type':

Write-up: Blood per his rectum, fussy, lethargic. 7/17/08-records received with report for DOS 5/24-5/26/08-DC DX: Intussusception. Presented to Ed with history of bloood per rectum. Fussy. Appetitie decreased. Constipated. One hard stool day before and vomtiting once.

Changed on 2/14/2018

VAERS ID: 319397 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:New York
Vaccinated:2008-04-08
Onset:2008-05-24
Submitted:2008-07-15
Entered:2008-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B074AA / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR 356AB / 1 LL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0805 / 1 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45887 / 1 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0015X / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Full blood count, Intussusception, Irritability, Lethargy, Rectal haemorrhage, Ultrasound abdomen abnormal

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: CBC; ultrasound, positive for intussusception 7/17/08-records received- WBC 13.7. Ultrasound positive for intussusception. Air contrast enema partiall successful with repeat attempt folllowing day successful reduction.
CDC 'Split Type':

Write-up: Blood per his rectum, fussy, lethargic. 7/17/08-records received with report for DOS 5/24-5/26/08-DC DX: Intussusception. Presented to Ed with history of bloood per rectum. Fussy. Appetitie decreased. Constipated. One hard stool day before and vomtiting once.

Changed on 6/14/2018

VAERS ID: 319397 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:New York
Vaccinated:2008-04-08
Onset:2008-05-24
Submitted:2008-07-15
Entered:2008-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B074AA / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR 356AB / 1 LL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0805 / 1 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45887 / 1 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0015X / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Full blood count, Intussusception, Irritability, Lethargy, Rectal haemorrhage, Ultrasound abdomen abnormal

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: CBC; ultrasound, positive for intussusception 7/17/08-records received- WBC 13.7. Ultrasound positive for intussusception. Air contrast enema partiall successful with repeat attempt folllowing day successful reduction.
CDC 'Split Type':

Write-up: Blood per his rectum, fussy, lethargic. 7/17/08-records received with report for DOS 5/24-5/26/08-DC DX: Intussusception. Presented to Ed with history of bloood per rectum. Fussy. Appetitie decreased. Constipated. One hard stool day before and vomtiting once.

Changed on 8/14/2018

VAERS ID: 319397 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:New York
Vaccinated:2008-04-08
Onset:2008-05-24
Submitted:2008-07-15
Entered:2008-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B074AA / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR 356AB / 1 LL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0805 / 1 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45887 / 1 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0015X / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Full blood count, Intussusception, Irritability, Lethargy, Rectal haemorrhage, Ultrasound abdomen abnormal

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: CBC; ultrasound, positive for intussusception 7/17/08-records received- WBC 13.7. Ultrasound positive for intussusception. Air contrast enema partiall successful with repeat attempt folllowing day successful reduction.
CDC 'Split Type':

Write-up: Blood per his rectum, fussy, lethargic. 7/17/08-records received with report for DOS 5/24-5/26/08-DC DX: Intussusception. Presented to Ed with history of bloood per rectum. Fussy. Appetitie decreased. Constipated. One hard stool day before and vomtiting once.

Changed on 9/14/2018

VAERS ID: 319397 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:New York
Vaccinated:2008-04-08
Onset:2008-05-24
Submitted:2008-07-15
Entered:2008-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B074AA / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR 356AB / 1 LL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0805 / 1 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45887 / 1 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0015X / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Full blood count, Intussusception, Irritability, Lethargy, Rectal haemorrhage, Ultrasound abdomen abnormal

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: CBC; ultrasound, positive for intussusception 7/17/08-records received- WBC 13.7. Ultrasound positive for intussusception. Air contrast enema partiall successful with repeat attempt folllowing day successful reduction.
CDC 'Split Type':

Write-up: Blood per his rectum, fussy, lethargic. 7/17/08-records received with report for DOS 5/24-5/26/08-DC DX: Intussusception. Presented to Ed with history of bloood per rectum. Fussy. Appetitie decreased. Constipated. One hard stool day before and vomtiting once.

Changed on 10/14/2018

VAERS ID: 319397 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:New York
Vaccinated:2008-04-08
Onset:2008-05-24
Submitted:2008-07-15
Entered:2008-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B074AA / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR 356AB / 1 LL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0805 / 1 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45887 / 1 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0015X / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Full blood count, Intussusception, Irritability, Lethargy, Rectal haemorrhage, Ultrasound abdomen abnormal

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: CBC; ultrasound, positive for intussusception 7/17/08-records received- WBC 13.7. Ultrasound positive for intussusception. Air contrast enema partiall successful with repeat attempt folllowing day successful reduction.
CDC 'Split Type':

Write-up: Blood per his rectum, fussy, lethargic. 7/17/08-records received with report for DOS 5/24-5/26/08-DC DX: Intussusception. Presented to Ed with history of bloood per rectum. Fussy. Appetitie decreased. Constipated. One hard stool day before and vomtiting once.

Changed on 12/24/2020

VAERS ID: 319397 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:New York
Vaccinated:2008-04-08
Onset:2008-05-24
Submitted:2008-07-15
Entered:2008-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B074AA / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR 356AB / 1 LL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0805 / 1 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45887 / 1 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0015X / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Full blood count, Intussusception, Irritability, Lethargy, Rectal haemorrhage, Ultrasound abdomen abnormal

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: CBC; ultrasound, positive for intussusception 7/17/08-records received- WBC 13.7. Ultrasound positive for intussusception. Air contrast enema partiall successful with repeat attempt folllowing day successful reduction.
CDC 'Split Type':

Write-up: Blood per his rectum, fussy, lethargic. 7/17/08-records received with report for DOS 5/24-5/26/08-DC DX: Intussusception. Presented to Ed with history of bloood per rectum. Fussy. Appetitie decreased. Constipated. One hard stool day before and vomtiting once.

Changed on 12/30/2020

VAERS ID: 319397 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:New York
Vaccinated:2008-04-08
Onset:2008-05-24
Submitted:2008-07-15
Entered:2008-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B074AA / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR 356AB / 1 LL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0805 / 1 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45887 / 1 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0015X / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Full blood count, Intussusception, Irritability, Lethargy, Rectal haemorrhage, Ultrasound abdomen abnormal

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: CBC; ultrasound, positive for intussusception 7/17/08-records received- WBC 13.7. Ultrasound positive for intussusception. Air contrast enema partiall successful with repeat attempt folllowing day successful reduction.
CDC 'Split Type':

Write-up: Blood per his rectum, fussy, lethargic. 7/17/08-records received with report for DOS 5/24-5/26/08-DC DX: Intussusception. Presented to Ed with history of bloood per rectum. Fussy. Appetitie decreased. Constipated. One hard stool day before and vomtiting once.

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