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Derivative instruments (Locations and Effective Portions of Gain (Loss) Reclassified out of AOCI) (Details) - USD ($)
$ in Millions
3 Months Ended 9 Months Ended
Sep. 30, 2017
Sep. 30, 2016
Sep. 30, 2017
Sep. 30, 2016
Derivative Instruments Gain Loss [Line Items]        
Product sales $ 5,453 $ 5,516 $ 16,226 $ 16,229
Interest and other income, net 267 216 627 503
Interest expense, net (325) (325) (972) (932)
Income before income taxes 2,381 2,418 7,383 6,880
Accumulated net gain (loss) from cash flow hedges [Member] | Reclassification out of Accumulated Other Comprehensive Income [Member]        
Derivative Instruments Gain Loss [Line Items]        
Income before income taxes 140 65 601 98
Accumulated net gain (loss) from cash flow hedges [Member] | Reclassification out of Accumulated Other Comprehensive Income [Member] | Cash flow hedge [Member]        
Derivative Instruments Gain Loss [Line Items]        
Income before income taxes 140 65 601 98
Accumulated net gain (loss) from cash flow hedges [Member] | Reclassification out of Accumulated Other Comprehensive Income [Member] | Cash flow hedge [Member] | Foreign currency contracts [Member]        
Derivative Instruments Gain Loss [Line Items]        
Product sales (2) 67 88 242
Accumulated net gain (loss) from cash flow hedges [Member] | Reclassification out of Accumulated Other Comprehensive Income [Member] | Cash flow hedge [Member] | Cross currency swap contracts [Member]        
Derivative Instruments Gain Loss [Line Items]        
Interest and other income, net 143 (1) 514 (143)
Accumulated net gain (loss) from cash flow hedges [Member] | Reclassification out of Accumulated Other Comprehensive Income [Member] | Cash flow hedge [Member] | Forward interest rate contract [Member]        
Derivative Instruments Gain Loss [Line Items]        
Interest expense, net $ (1) $ (1) $ (1) $ (1)