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This is VAERS ID 486747

History of Changes from the VAERS Wayback Machine

First Appeared on 3/12/2013

VAERS ID: 486747
VAERS Form:
Age:0.3
Gender:Male
Location:New York
Vaccinated:2013-02-05
Onset:2013-03-07
Submitted:2013-03-12
Entered:2013-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B396B / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. H017030 / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F18876 / 1 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB322A / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Haematochezia, Intussusception, Ultrasound scan normal, Intestinal operation

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: 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: 3/7/13 - developed bloody stool, U/S negative, bloody stool increased, air enema diagnosis of intussusception but not successfully reduced. 3/8/13 - Brought to OR for reduction.


Changed on 5/13/2013

VAERS ID: 486747 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:New York
Vaccinated:2013-02-05
Onset:2013-03-07
Submitted:2013-03-12
Entered:2013-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B396B / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. H017030 / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F18876 / 1 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB322A / 1 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB322A / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Haematochezia, Intussusception, Ultrasound scan normal, Intestinal operation

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: 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: 3/7/13 - developed bloody stool, U/S negative, bloody stool increased, air enema diagnosis of intussusception but not successfully reduced. 3/8/13 - Brought to OR for reduction.


Changed on 9/17/2013

VAERS ID: 486747 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:New York
Vaccinated:2013-02-05
Onset:2013-03-07
Submitted:2013-03-12
Entered:2013-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B396B / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. H017030 / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F18876 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB322A / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal mass, Appendicectomy, Barium enema, Barium enema abnormal, Blood calcium decreased, Blood chloride increased, Blood glucose increased, Blood magnesium increased, Blood potassium decreased, Diarrhoea, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intensive care, Intussusception, Lethargy, Mean cell haemoglobin decreased, Mean cell volume decreased, Pallor, Red blood cell count decreased, Vomiting, White blood cell count increased, X-ray abnormal, Blood phosphorus decreased, Enema administration, Ultrasound abdomen abnormal, Neutrophil percentage decreased, Monocyte percentage increased, Gastrointestinal tube insertion, Explorative laparotomy, Central venous catheterisation, Laparoscopic surgery, Ultrasound scan normal, Abdominal X-ray, Intestinal operation

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: The following information was obtained through follow-up and/or provided by the government. 4/1/2013 hospital records received for DOS 3/7-11/2013. US abdomen, X-ray abdomen, air enema abnormal. Blood: WBC 17.2 K/mm3 (H), neutros 52.6% (L), monos 14.2% (H), RBC 3.62 M/mm3 (N), Hgb 8.8 g/dL (L), Hct 27.1% (L), MCV 74.9 fL (L), MCH 24.3 pg (L), K 2.9 mEq/L (L), glucose 121 mg/dL (H), Cl 115 mEq/L (H), Ca 8.1 mg/dL (L), PO4 3.3 mg/dL (L), Mg 2.4 mg/dL (H).
CDC 'Split Type':

Write-up: 3/7/13 - developed bloody stool, U/S negative, bloody stool increased, air enema diagnosis of intussusception but not successfully reduced. 3/8/13 - Brought to OR for reduction. The following information was obtained through follow-up and/or provided by the government. 4/1/2013 hospital records received for DOS 3/7-11/2013. D/c Dx: intussusception, s/p exploratory laparotomy w/ reduction of the intussusception, & s/p appendectomy. Pt transferred from outside facility w c/o 1 day hx bloody bright red stools per rectum. PE: pallor, lethargy, vomiting, diarrhea, bloody stools, abdominal mass. Seen previous day for same. Intussusception per US. Tx''t: air enema reduction attempted (unsuccessful), laparoscopic converted to open reduction, appendectomy, central line, PICU, NG tube, ABX. Feedings gradually started, tolerated w/o difficulty. D/c''d home in stable condition w/ care & f/u instructions.


Changed on 3/14/2015

VAERS ID: 486747 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:New York
Vaccinated:2013-02-05
Onset:2013-03-07
Submitted:2013-03-12
Entered:2013-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B396B / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. H017030 / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F18876 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB322A / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal mass, Appendicectomy, Barium enema, Barium enema abnormal, Blood calcium decreased, Blood chloride increased, Blood glucose increased, Blood magnesium increased, Blood potassium decreased, Diarrhoea, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intensive care, Intussusception, Lethargy, Mean cell haemoglobin decreased, Mean cell volume decreased, Pallor, Red blood cell count decreased, Vomiting, White blood cell count increased, X-ray abnormal, Blood phosphorus decreased, Enema administration, Ultrasound abdomen abnormal, Neutrophil percentage decreased, Monocyte percentage increased, Gastrointestinal tube insertion, Explorative laparotomy, Central venous catheterisation, Laparoscopic surgery, Ultrasound scan normal, Abdominal X-ray, Intestinal operation

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: The following information was obtained through follow-up and/or provided by the government. 4/1/2013 hospital records received for DOS 3/7-11/2013. US abdomen, X-ray abdomen, air enema abnormal. Blood: WBC 17.2 K/mm3 (H), neutros 52.6% (L), monos 14.2% (H), RBC 3.62 M/mm3 (N), Hgb 8.8 g/dL (L), Hct 27.1% (L), MCV 74.9 fL (L), MCH 24.3 pg (L), K 2.9 mEq/L (L), glucose 121 mg/dL (H), Cl 115 mEq/L (H), Ca 8.1 mg/dL (L), PO4 3.3 mg/dL (L), Mg 2.4 mg/dL (H).
CDC 'Split Type':

Write-up: 3/7/13 - developed bloody stool, U/S negative, bloody stool increased, air enema diagnosis of intussusception but not successfully reduced. 3/8/13 - Brought to OR for reduction. The following information was obtained through follow-up and/or provided by the government. 4/1/2013 hospital records received for DOS 3/7-11/2013. D/c Dx: intussusception, s/p exploratory laparotomy w/ reduction of the intussusception, & s/p appendectomy. Pt transferred from outside facility w c/o 1 day hx bloody bright red stools per rectum. PE: pallor, lethargy, vomiting, diarrhea, bloody stools, abdominal mass. Seen previous day for same. Intussusception per US. Tx''t: air enema reduction attempted (unsuccessful), laparoscopic converted to open reduction, appendectomy, central line, PICU, NG tube, ABX. Feedings gradually started, tolerated w/o difficulty. D/c''d home in stable condition w/ care & f/u instructions.


Changed on 2/14/2017

VAERS ID: 486747 Before After
VAERS Form:
Age:0.3 0.34
Gender:Male
Location:New York
Vaccinated:2013-02-05
Onset:2013-03-07
Submitted:2013-03-12
Entered:2013-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B396B / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. H017030 / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F18876 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB322A / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Haematochezia, Intussusception, Ultrasound scan normal, Intestinal operation

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: 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: 3/7/13 - developed bloody stool, U/S negative, bloody stool increased, air enema diagnosis of intussusception but not successfully reduced. 3/8/13 - Brought to OR for reduction.


Changed on 9/14/2017

VAERS ID: 486747 Before After
VAERS Form:(blank) 1
Age:0.34
Gender:Male
Location:New York
Vaccinated:2013-02-05
Onset:2013-03-07
Submitted:2013-03-12
Entered:2013-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B396B / 1 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. H017030 / 1 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F18876 / 1 2 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB322A / 1 2 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Haematochezia, Intussusception, Ultrasound scan normal, Intestinal operation

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: 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: 3/7/13 - developed bloody stool, U/S negative, bloody stool increased, air enema diagnosis of intussusception but not successfully reduced. 3/8/13 - Brought to OR for reduction.


Changed on 2/14/2018

VAERS ID: 486747 Before After
VAERS Form:1
Age:0.34
Gender:Male
Location:New York
Vaccinated:2013-02-05
Onset:2013-03-07
Submitted:2013-03-12
Entered:2013-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B396B / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. H017030 / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F18876 / 2 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB322A / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Haematochezia, Intussusception, Ultrasound scan normal, Intestinal operation

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: 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: 3/7/13 - developed bloody stool, U/S negative, bloody stool increased, air enema diagnosis of intussusception but not successfully reduced. 3/8/13 - Brought to OR for reduction.


Changed on 6/14/2018

VAERS ID: 486747 Before After
VAERS Form:1
Age:0.34
Gender:Male
Location:New York
Vaccinated:2013-02-05
Onset:2013-03-07
Submitted:2013-03-12
Entered:2013-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B396B / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. H017030 / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F18876 / 2 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB322A / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Haematochezia, Intussusception, Ultrasound scan normal, Intestinal operation

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: 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: 3/7/13 - developed bloody stool, U/S negative, bloody stool increased, air enema diagnosis of intussusception but not successfully reduced. 3/8/13 - Brought to OR for reduction.


Changed on 8/14/2018

VAERS ID: 486747 Before After
VAERS Form:1
Age:0.34
Gender:Male
Location:New York
Vaccinated:2013-02-05
Onset:2013-03-07
Submitted:2013-03-12
Entered:2013-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B396B / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. H017030 / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F18876 / 2 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB322A / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Haematochezia, Intussusception, Ultrasound scan normal, Intestinal operation

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: 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: 3/7/13 - developed bloody stool, U/S negative, bloody stool increased, air enema diagnosis of intussusception but not successfully reduced. 3/8/13 - Brought to OR for reduction.


Changed on 9/14/2018

VAERS ID: 486747 Before After
VAERS Form:1
Age:0.34
Gender:Male
Location:New York
Vaccinated:2013-02-05
Onset:2013-03-07
Submitted:2013-03-12
Entered:2013-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B396B / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. H017030 / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F18876 / 2 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB322A / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Haematochezia, Intussusception, Ultrasound scan normal, Intestinal operation

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: 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: 3/7/13 - developed bloody stool, U/S negative, bloody stool increased, air enema diagnosis of intussusception but not successfully reduced. 3/8/13 - Brought to OR for reduction.

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