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This is VAERS ID 393611

History of Changes from the VAERS Wayback Machine

First Appeared on 7/31/2010

VAERS ID: 393611
VAERS Form:
Age:0.2
Gender:Male
Location:Colorado
Vaccinated:2010-07-14
Onset:2010-07-20
Submitted:2010-07-26
Entered:2010-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B249BA / 0 UN / SC
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1421Y / 0 UN / UN
PNC13: PNEUMO (PREVNAR13) / WYETH PHARMACEUTICALS, INC E60221 / 0 UN / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41BB088A/A41FB / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Barium enema, Computerised tomogram abnormal, Haematochezia, Intussusception, Small intestinal intussusception reduction

Life Threatening? Yes
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 6 days after vaccines developed crampy abdominal pain and bloody stools. CT showed ileocecal intussusception. Surgical reduction was performed after barium enema failed.


Changed on 8/31/2010

VAERS ID: 393611 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Colorado
Vaccinated:2010-07-14
Onset:2010-07-20
Submitted:2010-07-26
Entered:2010-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B249BA / 0 UN / SC
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1421Y / 0 UN / UN
PNC13: PNEUMO (PREVNAR13) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH E60221 / 0 UN / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41BB088A/A41FB / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Barium enema, Computerised tomogram abnormal, Haematochezia, Intussusception, Small intestinal intussusception reduction

Life Threatening? Yes
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 6 days after vaccines developed crampy abdominal pain and bloody stools. CT showed ileocecal intussusception. Surgical reduction was performed after barium enema failed.


Changed on 4/13/2011

VAERS ID: 393611 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Colorado
Vaccinated:2010-07-14
Onset:2010-07-20
Submitted:2010-07-26
Entered:2010-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B249BA / 0 UN / SC
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1421Y / 0 UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E60221 / 0 UN / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41BB088A/A41FB / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Barium enema, Barium enema abnormal, Computerised tomogram abnormal, Crying, Diarrhoea haemorrhagic, Haematochezia, Intestinal infarction, Intussusception, Irritability, Mucous stools, Small intestinal anastomosis, Small intestinal intussusception reduction, Urinary system X-ray, X-ray abnormal, Intestinal polyp, Enema administration, Ileectomy, Biopsy intestine abnormal, Laparoscopic surgery, Antibiotic resistant Staphylococcus test negative

Life Threatening? Yes
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 6 days after vaccines developed crampy abdominal pain and bloody stools. CT showed ileocecal intussusception. Surgical reduction was performed after barium enema failed.


Changed on 5/13/2011

VAERS ID: 393611 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Colorado
Vaccinated:2010-07-14
Onset:2010-07-20
Submitted:2010-07-26
Entered:2010-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B249BA / 0 UN / SC
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1421Y / 0 UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E60221 / 0 UN / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41BB088A/A41FB / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Barium enema, Barium enema abnormal, Computerised tomogram abnormal, Crying, Diarrhoea haemorrhagic, Haematochezia, Intestinal infarction, Intussusception, Irritability, Mucous stools, Small intestinal anastomosis, Small intestinal intussusception reduction, Urinary system X-ray, X-ray abnormal, Intestinal polyp, Enema administration, Ileectomy, Biopsy intestine abnormal, Laparoscopic surgery, Antibiotic resistant Staphylococcus test negative

Life Threatening? Yes
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 6 days after vaccines developed crampy abdominal pain and bloody stools. CT showed ileocecal intussusception. Surgical reduction was performed after barium enema failed.


Changed on 5/13/2013

VAERS ID: 393611 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Colorado
Vaccinated:2010-07-14
Onset:2010-07-20
Submitted:2010-07-26
Entered:2010-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B249BA / 0 UN / SC
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1421Y / 0 UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E60221 / 0 UN / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41BB088A/A41FB / 0 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41BB088A/A41FB / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Barium enema, Computerised tomogram abnormal, Haematochezia, Intussusception, Small intestinal intussusception reduction

Life Threatening? Yes
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 6 days after vaccines developed crampy abdominal pain and bloody stools. CT showed ileocecal intussusception. Surgical reduction was performed after barium enema failed.


Changed on 6/14/2014

VAERS ID: 393611 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Colorado
Vaccinated:2010-07-14
Onset:2010-07-20
Submitted:2010-07-26
Entered:2010-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B249BA / 0 UN / SC
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1421Y / 0 UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E60221 / 0 UN / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41BB088A/A41FB / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Barium enema, Computerised tomogram abnormal, Haematochezia, Intussusception, Small intestinal intussusception reduction

Life Threatening? Yes
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 6 days after vaccines developed crampy abdominal pain and bloody stools. CT showed ileocecal intussusception. Surgical reduction was performed after barium enema failed.


Changed on 2/14/2017

VAERS ID: 393611 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Colorado
Vaccinated:2010-07-14
Onset:2010-07-20
Submitted:2010-07-26
Entered:2010-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B249BA / 0 UN / SC
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1421Y / 0 UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E60221 / 0 UN / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41BB088A/A41FB / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Barium enema, Computerised tomogram abnormal, Haematochezia, Intussusception, Small intestinal intussusception reduction

Life Threatening? Yes
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 6 days after vaccines developed crampy abdominal pain and bloody stools. CT showed ileocecal intussusception. Surgical reduction was performed after barium enema failed.


Changed on 9/14/2017

VAERS ID: 393611 Before After
VAERS Form:(blank) 1
Age:0.2
Gender:Male
Location:Colorado
Vaccinated:2010-07-14
Onset:2010-07-20
Submitted:2010-07-26
Entered:2010-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B249BA / 0 1 UN / SC
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1421Y / 0 1 UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E60221 / 0 1 UN / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41BB088A/A41FB / 0 1 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Barium enema, Computerised tomogram abnormal, Haematochezia, Intussusception, Small intestinal intussusception reduction

Life Threatening? Yes
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 6 days after vaccines developed crampy abdominal pain and bloody stools. CT showed ileocecal intussusception. Surgical reduction was performed after barium enema failed.


Changed on 2/14/2018

VAERS ID: 393611 Before After
VAERS Form:1
Age:0.2
Gender:Male
Location:Colorado
Vaccinated:2010-07-14
Onset:2010-07-20
Submitted:2010-07-26
Entered:2010-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B249BA / 1 UN / SC
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1421Y / 1 UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E60221 / 1 UN / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41BB088A/A41FB / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Barium enema, Computerised tomogram abnormal, Haematochezia, Intussusception, Small intestinal intussusception reduction

Life Threatening? Yes
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 6 days after vaccines developed crampy abdominal pain and bloody stools. CT showed ileocecal intussusception. Surgical reduction was performed after barium enema failed.


Changed on 6/14/2018

VAERS ID: 393611 Before After
VAERS Form:1
Age:0.2
Gender:Male
Location:Colorado
Vaccinated:2010-07-14
Onset:2010-07-20
Submitted:2010-07-26
Entered:2010-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B249BA / 1 UN / SC
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1421Y / 1 UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E60221 / 1 UN / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41BB088A/A41FB / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Barium enema, Computerised tomogram abnormal, Haematochezia, Intussusception, Small intestinal intussusception reduction

Life Threatening? Yes
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 6 days after vaccines developed crampy abdominal pain and bloody stools. CT showed ileocecal intussusception. Surgical reduction was performed after barium enema failed.

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