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This is VAERS ID 271927

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 271927
VAERS Form:
Age:0.5
Gender:Male
Location:Connecticut
Vaccinated:2007-01-29
Onset:2007-02-07
Submitted:2007-02-07
Entered:2007-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 2 UN / IM
FLU: INFLUENZA (FLUZONE) / AVENTIS PASTEUR UT2191KA / 0 UN / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08691A / 2 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0942F / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Body temperature increased, Cough, Dehydration, Diarrhoea

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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? Yes
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: recurrent wheezing, h/o RSV bronchiolitis (Nov 2006), eczema
Allergies:
Diagnostic Lab Data: Stool culture and viral studies to be done. Ultrasound showed ileocolic intussecptus and patient was transferred today. Outcome not known yet.
CDC 'Split Type':

Write-up: Patient developed explosive diarrhea and emesis shortly after vaccine given. On 2/6/07 he was admitted for worsening vomiting, and on the morning of 2/7/07 he was found to have intussusception.


Changed on 12/8/2009

VAERS ID: 271927 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Connecticut
Vaccinated:2007-01-29
Onset:2007-02-07
Submitted:2007-02-07
Entered:2007-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 2 UN / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 2 UN / IM
FLU: INFLUENZA (FLUZONE) INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR SANOFI PASTEUR UT2191KA / 0 UN / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES WYETH PHARMACEUTICALS, INC B08691A / 2 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0942F / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Body temperature increased, Cough, Dehydration, Diarrhoea, Haematochezia, Intussusception, Nasal congestion, Ultrasound scan, Vomiting, Ultrasound abdomen abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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? Yes
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: recurrent wheezing, h/o RSV bronchiolitis (Nov 2006), eczema PMH: flu like symptoms for approx 1 week prior to admit.
Allergies:
Diagnostic Lab Data: Stool culture and viral studies to be done. Ultrasound showed ileocolic intussecptus and patient was transferred today. Outcome not known yet. Initial hospital LABS: WBC 10.3, lymps 52, neutro 50.9, bands 1. CXR showed perihilar markings
CDC 'Split Type':

Write-up: Patient developed explosive diarrhea and emesis shortly after vaccine given. On 2/6/07 he was admitted for worsening vomiting, and on the morning of 2/7/07 he was found to have intussusception. 3/1/07 Received medical records from hospital which reveal patient experienced dehydration, vomiting & diarrhea, tactile temp at home, cough & nasal congestion. Seen in ER x2 then admitted. After admission, had large maroon stool & continued to have bile tinged emesis. After confirmation of IS, patient transferred to higher level of care. 3/15/07 Received medical records from transfer hospital which reveal patient admitted 2/7/07-2/8/07 s/p 48 hour history of abdominal pain, diarrhea & 1 week history of flu like symptoms w/bloody stools developing 24 hours prior to admit. IS successfully reduced w/air enema & kept overnight for observation. FINAL DX: Intussusception, reduced by air contrast enema.


Changed on 3/2/2010

VAERS ID: 271927 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Connecticut
Vaccinated:2007-01-29
Onset:2007-02-07
Submitted:2007-02-07
Entered:2007-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 2 UN / IM
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2191KA / 0 UN / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B08691A / 2 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0942F / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Body temperature increased, Cough, Dehydration, Diarrhoea, Haematochezia, Intussusception, Nasal congestion, Ultrasound scan, Vomiting, Ultrasound abdomen abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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? Yes
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: recurrent wheezing, h/o RSV bronchiolitis (Nov 2006), eczema PMH: flu like symptoms for approx 1 week prior to admit.
Allergies:
Diagnostic Lab Data: Stool culture and viral studies to be done. Ultrasound showed ileocolic intussecptus and patient was transferred today. Outcome not known yet. Initial hospital LABS: WBC 10.3, lymps 52, neutro 50.9, bands 1. CXR showed perihilar markings
CDC 'Split Type':

Write-up: Patient developed explosive diarrhea and emesis shortly after vaccine given. On 2/6/07 he was admitted for worsening vomiting, and on the morning of 2/7/07 he was found to have intussusception. 3/1/07 Received medical records from hospital which reveal patient experienced dehydration, vomiting & diarrhea, tactile temp at home, cough & nasal congestion. Seen in ER x2 then admitted. After admission, had large maroon stool & continued to have bile tinged emesis. After confirmation of IS, patient transferred to higher level of care. 3/15/07 Received medical records from transfer hospital which reveal patient admitted 2/7/07-2/8/07 s/p 48 hour history of abdominal pain, diarrhea & 1 week history of flu like symptoms w/bloody stools developing 24 hours prior to admit. IS successfully reduced w/air enema & kept overnight for observation. FINAL DX: Intussusception, reduced by air contrast enema.


Changed on 4/7/2010

VAERS ID: 271927 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Connecticut
Vaccinated:2007-01-29
Onset:2007-02-07
Submitted:2007-02-07
Entered:2007-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 2 UN / IM
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2191KA / 0 UN / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08691A / 2 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0942F / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Body temperature increased, Cough, Dehydration, Diarrhoea, Haematochezia, Intussusception, Nasal congestion, Ultrasound scan, Vomiting, Ultrasound abdomen abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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? Yes
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: recurrent wheezing, h/o RSV bronchiolitis (Nov 2006), eczema PMH: flu like symptoms for approx 1 week prior to admit.
Allergies:
Diagnostic Lab Data: Stool culture and viral studies to be done. Ultrasound showed ileocolic intussecptus and patient was transferred today. Outcome not known yet. Initial hospital LABS: WBC 10.3, lymps 52, neutro 50.9, bands 1. CXR showed perihilar markings
CDC 'Split Type':

Write-up: Patient developed explosive diarrhea and emesis shortly after vaccine given. On 2/6/07 he was admitted for worsening vomiting, and on the morning of 2/7/07 he was found to have intussusception. 3/1/07 Received medical records from hospital which reveal patient experienced dehydration, vomiting & diarrhea, tactile temp at home, cough & nasal congestion. Seen in ER x2 then admitted. After admission, had large maroon stool & continued to have bile tinged emesis. After confirmation of IS, patient transferred to higher level of care. 3/15/07 Received medical records from transfer hospital which reveal patient admitted 2/7/07-2/8/07 s/p 48 hour history of abdominal pain, diarrhea & 1 week history of flu like symptoms w/bloody stools developing 24 hours prior to admit. IS successfully reduced w/air enema & kept overnight for observation. FINAL DX: Intussusception, reduced by air contrast enema.


Changed on 8/31/2010

VAERS ID: 271927 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Connecticut
Vaccinated:2007-01-29
Onset:2007-02-07
Submitted:2007-02-07
Entered:2007-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 2 UN / IM
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2191KA / 0 UN / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B08691A / 2 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0942F / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Body temperature increased, Cough, Dehydration, Diarrhoea, Haematochezia, Intussusception, Nasal congestion, Ultrasound scan, Vomiting, Ultrasound abdomen abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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? Yes
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: recurrent wheezing, h/o RSV bronchiolitis (Nov 2006), eczema PMH: flu like symptoms for approx 1 week prior to admit.
Allergies:
Diagnostic Lab Data: Stool culture and viral studies to be done. Ultrasound showed ileocolic intussecptus and patient was transferred today. Outcome not known yet. Initial hospital LABS: WBC 10.3, lymps 52, neutro 50.9, bands 1. CXR showed perihilar markings
CDC 'Split Type':

Write-up: Patient developed explosive diarrhea and emesis shortly after vaccine given. On 2/6/07 he was admitted for worsening vomiting, and on the morning of 2/7/07 he was found to have intussusception. 3/1/07 Received medical records from hospital which reveal patient experienced dehydration, vomiting & diarrhea, tactile temp at home, cough & nasal congestion. Seen in ER x2 then admitted. After admission, had large maroon stool & continued to have bile tinged emesis. After confirmation of IS, patient transferred to higher level of care. 3/15/07 Received medical records from transfer hospital which reveal patient admitted 2/7/07-2/8/07 s/p 48 hour history of abdominal pain, diarrhea & 1 week history of flu like symptoms w/bloody stools developing 24 hours prior to admit. IS successfully reduced w/air enema & kept overnight for observation. FINAL DX: Intussusception, reduced by air contrast enema.


Changed on 5/13/2013

VAERS ID: 271927 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Connecticut
Vaccinated:2007-01-29
Onset:2007-02-07
Submitted:2007-02-07
Entered:2007-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 2 UN / IM
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2191KA / 0 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08691A / 2 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0942F / 2 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0942F / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Body temperature increased, Cough, Dehydration, Diarrhoea, Haematochezia, Intussusception, Nasal congestion, Ultrasound scan, Vomiting, Ultrasound abdomen abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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? Yes
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: recurrent wheezing, h/o RSV bronchiolitis (Nov 2006), eczema PMH: flu like symptoms for approx 1 week prior to admit.
Allergies:
Diagnostic Lab Data: Stool culture and viral studies to be done. Ultrasound showed ileocolic intussecptus and patient was transferred today. Outcome not known yet. Initial hospital LABS: WBC 10.3, lymps 52, neutro 50.9, bands 1. CXR showed perihilar markings
CDC 'Split Type':

Write-up: Patient developed explosive diarrhea and emesis shortly after vaccine given. On 2/6/07 he was admitted for worsening vomiting, and on the morning of 2/7/07 he was found to have intussusception. 3/1/07 Received medical records from hospital which reveal patient experienced dehydration, vomiting & diarrhea, tactile temp at home, cough & nasal congestion. Seen in ER x2 then admitted. After admission, had large maroon stool & continued to have bile tinged emesis. After confirmation of IS, patient transferred to higher level of care. 3/15/07 Received medical records from transfer hospital which reveal patient admitted 2/7/07-2/8/07 s/p 48 hour history of abdominal pain, diarrhea & 1 week history of flu like symptoms w/bloody stools developing 24 hours prior to admit. IS successfully reduced w/air enema & kept overnight for observation. FINAL DX: Intussusception, reduced by air contrast enema.


Changed on 7/7/2013

VAERS ID: 271927 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Connecticut
Vaccinated:2007-01-29
Onset:2007-02-07
Submitted:2007-02-07
Entered:2007-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 2 UN / IM
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2191KA / 0 UN / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2191KA / 0 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08691A / 2 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0942F / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Body temperature increased, Cough, Dehydration, Diarrhoea, Haematochezia, Intussusception, Nasal congestion, Ultrasound scan, Vomiting, Ultrasound abdomen abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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? Yes
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: recurrent wheezing, h/o RSV bronchiolitis (Nov 2006), eczema PMH: flu like symptoms for approx 1 week prior to admit.
Allergies:
Diagnostic Lab Data: Stool culture and viral studies to be done. Ultrasound showed ileocolic intussecptus and patient was transferred today. Outcome not known yet. Initial hospital LABS: WBC 10.3, lymps 52, neutro 50.9, bands 1. CXR showed perihilar markings
CDC 'Split Type':

Write-up: Patient developed explosive diarrhea and emesis shortly after vaccine given. On 2/6/07 he was admitted for worsening vomiting, and on the morning of 2/7/07 he was found to have intussusception. 3/1/07 Received medical records from hospital which reveal patient experienced dehydration, vomiting & diarrhea, tactile temp at home, cough & nasal congestion. Seen in ER x2 then admitted. After admission, had large maroon stool & continued to have bile tinged emesis. After confirmation of IS, patient transferred to higher level of care. 3/15/07 Received medical records from transfer hospital which reveal patient admitted 2/7/07-2/8/07 s/p 48 hour history of abdominal pain, diarrhea & 1 week history of flu like symptoms w/bloody stools developing 24 hours prior to admit. IS successfully reduced w/air enema & kept overnight for observation. FINAL DX: Intussusception, reduced by air contrast enema.


Changed on 2/14/2017

VAERS ID: 271927 Before After
VAERS Form:
Age:0.5 0.54
Gender:Male
Location:Connecticut
Vaccinated:2007-01-29
Onset:2007-02-07
Submitted:2007-02-07
Entered:2007-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 2 UN / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2191KA / 0 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08691A / 2 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0942F / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Body temperature increased, Cough, Dehydration, Diarrhoea, Haematochezia, Intussusception, Nasal congestion, Ultrasound scan, Vomiting, Ultrasound abdomen abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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? Yes
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: recurrent wheezing, h/o RSV bronchiolitis (Nov 2006), eczema PMH: flu like symptoms for approx 1 week prior to admit.
Allergies:
Diagnostic Lab Data: Stool culture and viral studies to be done. Ultrasound showed ileocolic intussecptus and patient was transferred today. Outcome not known yet. Initial hospital LABS: WBC 10.3, lymps 52, neutro 50.9, bands 1. CXR showed perihilar markings c/w reactive inflammatory disease or viral pneumonia. KUB shoed dilated bowel. Abd US showed RUQ IS, likely ileocolic. Transfer hospital LABS: CBC 13.4, segs 30%, lymphs 61%, monos 7%, baso 1%. Abdominal US revealed IS in RUQ w/dilated small bowel loops proximally & small amount free fluid. Air contrast enema reduced w/o complication.
CDC 'Split Type':

Write-up: Patient developed explosive diarrhea and emesis shortly after vaccine given. On 2/6/07 he was admitted for worsening vomiting, and on the morning of 2/7/07 he was found to have intussusception. 3/1/07 Received medical records from hospital which reveal patient experienced dehydration, vomiting & diarrhea, tactile temp at home, cough & nasal congestion. Seen in ER x2 then admitted. After admission, had large maroon stool & continued to have bile tinged emesis. After confirmation of IS, patient transferred to higher level of care. 3/15/07 Received medical records from transfer hospital which reveal patient admitted 2/7/07-2/8/07 s/p 48 hour history of abdominal pain, diarrhea & 1 week history of flu like symptoms w/bloody stools developing 24 hours prior to admit. IS successfully reduced w/air enema & kept overnight for observation. FINAL DX: Intussusception, reduced by air contrast enema.


Changed on 9/14/2017

VAERS ID: 271927 Before After
VAERS Form:(blank) 1
Age:0.54
Gender:Male
Location:Connecticut
Vaccinated:2007-01-29
Onset:2007-02-07
Submitted:2007-02-07
Entered:2007-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 2 3 UN / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2191KA / 0 1 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08691A / 2 3 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0942F / 2 3 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diarrhoea, Intussusception, Ultrasound scan, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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? Yes
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: recurrent wheezing, h/o RSV bronchiolitis (Nov 2006), eczema PMH: flu like symptoms for approx 1 week prior to admit.
Allergies:
Diagnostic Lab Data: Stool culture and viral studies to be done. Ultrasound showed ileocolic intussecptus and patient was transferred today. Outcome not known yet. Initial hospital LABS: WBC 10.3, lymps 52, neutro 50.9, bands 1. CXR showed perihilar markings c/w reactive inflammatory disease or viral pneumonia. KUB shoed dilated bowel. Abd US showed RUQ IS, likely ileocolic. Transfer hospital LABS: CBC 13.4, segs 30%, lymphs 61%, monos 7%, baso 1%. Abdominal US revealed IS in RUQ w/dilated small bowel loops proximally & small amount free fluid. Air contrast enema reduced w/o complication.
CDC 'Split Type':

Write-up: Patient developed explosive diarrhea and emesis shortly after vaccine given. On 2/6/07 he was admitted for worsening vomiting, and on the morning of 2/7/07 he was found to have intussusception. 3/1/07 Received medical records from hospital which reveal patient experienced dehydration, vomiting & diarrhea, tactile temp at home, cough & nasal congestion. Seen in ER x2 then admitted. After admission, had large maroon stool & continued to have bile tinged emesis. After confirmation of IS, patient transferred to higher level of care. 3/15/07 Received medical records from transfer hospital which reveal patient admitted 2/7/07-2/8/07 s/p 48 hour history of abdominal pain, diarrhea & 1 week history of flu like symptoms w/bloody stools developing 24 hours prior to admit. IS successfully reduced w/air enema & kept overnight for observation. FINAL DX: Intussusception, reduced by air contrast enema.


Changed on 2/14/2018

VAERS ID: 271927 Before After
VAERS Form:1
Age:0.54
Gender:Male
Location:Connecticut
Vaccinated:2007-01-29
Onset:2007-02-07
Submitted:2007-02-07
Entered:2007-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 3 UN / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2191KA / 1 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08691A / 3 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0942F / 3 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diarrhoea, Intussusception, Ultrasound scan, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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? Yes
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: recurrent wheezing, h/o RSV bronchiolitis (Nov 2006), eczema PMH: flu like symptoms for approx 1 week prior to admit.
Allergies:
Diagnostic Lab Data: Stool culture and viral studies to be done. Ultrasound showed ileocolic intussecptus and patient was transferred today. Outcome not known yet. Initial hospital LABS: WBC 10.3, lymps 52, neutro 50.9, bands 1. CXR showed perihilar markings c/w reactive inflammatory disease or viral pneumonia. KUB shoed dilated bowel. Abd US showed RUQ IS, likely ileocolic. Transfer hospital LABS: CBC 13.4, segs 30%, lymphs 61%, monos 7%, baso 1%. Abdominal US revealed IS in RUQ w/dilated small bowel loops proximally & small amount free fluid. Air contrast enema reduced w/o complication.
CDC 'Split Type':

Write-up: Patient developed explosive diarrhea and emesis shortly after vaccine given. On 2/6/07 he was admitted for worsening vomiting, and on the morning of 2/7/07 he was found to have intussusception. 3/1/07 Received medical records from hospital which reveal patient experienced dehydration, vomiting & diarrhea, tactile temp at home, cough & nasal congestion. Seen in ER x2 then admitted. After admission, had large maroon stool & continued to have bile tinged emesis. After confirmation of IS, patient transferred to higher level of care. 3/15/07 Received medical records from transfer hospital which reveal patient admitted 2/7/07-2/8/07 s/p 48 hour history of abdominal pain, diarrhea & 1 week history of flu like symptoms w/bloody stools developing 24 hours prior to admit. IS successfully reduced w/air enema & kept overnight for observation. FINAL DX: Intussusception, reduced by air contrast enema.


Changed on 6/14/2018

VAERS ID: 271927 Before After
VAERS Form:1
Age:0.54
Gender:Male
Location:Connecticut
Vaccinated:2007-01-29
Onset:2007-02-07
Submitted:2007-02-07
Entered:2007-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 3 UN / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2191KA / 1 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08691A / 3 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0942F / 3 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diarrhoea, Intussusception, Ultrasound scan, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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? Yes
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: recurrent wheezing, h/o RSV bronchiolitis (Nov 2006), eczema PMH: flu like symptoms for approx 1 week prior to admit.
Allergies:
Diagnostic Lab Data: Stool culture and viral studies to be done. Ultrasound showed ileocolic intussecptus and patient was transferred today. Outcome not known yet. Initial hospital LABS: WBC 10.3, lymps 52, neutro 50.9, bands 1. CXR showed perihilar markings c/w reactive inflammatory disease or viral pneumonia. KUB shoed dilated bowel. Abd US showed RUQ IS, likely ileocolic. Transfer hospital LABS: CBC 13.4, segs 30%, lymphs 61%, monos 7%, baso 1%. Abdominal US revealed IS in RUQ w/dilated small bowel loops proximally & small amount free fluid. Air contrast enema reduced w/o complication.
CDC 'Split Type':

Write-up: Patient developed explosive diarrhea and emesis shortly after vaccine given. On 2/6/07 he was admitted for worsening vomiting, and on the morning of 2/7/07 he was found to have intussusception. 3/1/07 Received medical records from hospital which reveal patient experienced dehydration, vomiting & diarrhea, tactile temp at home, cough & nasal congestion. Seen in ER x2 then admitted. After admission, had large maroon stool & continued to have bile tinged emesis. After confirmation of IS, patient transferred to higher level of care. 3/15/07 Received medical records from transfer hospital which reveal patient admitted 2/7/07-2/8/07 s/p 48 hour history of abdominal pain, diarrhea & 1 week history of flu like symptoms w/bloody stools developing 24 hours prior to admit. IS successfully reduced w/air enema & kept overnight for observation. FINAL DX: Intussusception, reduced by air contrast enema.


Changed on 8/14/2018

VAERS ID: 271927 Before After
VAERS Form:1
Age:0.54
Gender:Male
Location:Connecticut
Vaccinated:2007-01-29
Onset:2007-02-07
Submitted:2007-02-07
Entered:2007-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 3 UN / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2191KA / 1 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08691A / 3 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0942F / 3 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diarrhoea, Intussusception, Ultrasound scan, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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? Yes
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: recurrent wheezing, h/o RSV bronchiolitis (Nov 2006), eczema PMH: flu like symptoms for approx 1 week prior to admit.
Allergies:
Diagnostic Lab Data: Stool culture and viral studies to be done. Ultrasound showed ileocolic intussecptus and patient was transferred today. Outcome not known yet. Initial hospital LABS: WBC 10.3, lymps 52, neutro 50.9, bands 1. CXR showed perihilar markings c/w reactive inflammatory disease or viral pneumonia. KUB shoed dilated bowel. Abd US showed RUQ IS, likely ileocolic. Transfer hospital LABS: CBC 13.4, segs 30%, lymphs 61%, monos 7%, baso 1%. Abdominal US revealed IS in RUQ w/dilated small bowel loops proximally & small amount free fluid. Air contrast enema reduced w/o complication.
CDC 'Split Type':

Write-up: Patient developed explosive diarrhea and emesis shortly after vaccine given. On 2/6/07 he was admitted for worsening vomiting, and on the morning of 2/7/07 he was found to have intussusception. 3/1/07 Received medical records from hospital which reveal patient experienced dehydration, vomiting & diarrhea, tactile temp at home, cough & nasal congestion. Seen in ER x2 then admitted. After admission, had large maroon stool & continued to have bile tinged emesis. After confirmation of IS, patient transferred to higher level of care. 3/15/07 Received medical records from transfer hospital which reveal patient admitted 2/7/07-2/8/07 s/p 48 hour history of abdominal pain, diarrhea & 1 week history of flu like symptoms w/bloody stools developing 24 hours prior to admit. IS successfully reduced w/air enema & kept overnight for observation. FINAL DX: Intussusception, reduced by air contrast enema.


Changed on 9/14/2018

VAERS ID: 271927 Before After
VAERS Form:1
Age:0.54
Gender:Male
Location:Connecticut
Vaccinated:2007-01-29
Onset:2007-02-07
Submitted:2007-02-07
Entered:2007-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 3 UN / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2191KA / 1 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08691A / 3 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0942F / 3 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diarrhoea, Intussusception, Ultrasound scan, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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? Yes
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: recurrent wheezing, h/o RSV bronchiolitis (Nov 2006), eczema PMH: flu like symptoms for approx 1 week prior to admit.
Allergies:
Diagnostic Lab Data: Stool culture and viral studies to be done. Ultrasound showed ileocolic intussecptus and patient was transferred today. Outcome not known yet. Initial hospital LABS: WBC 10.3, lymps 52, neutro 50.9, bands 1. CXR showed perihilar markings c/w reactive inflammatory disease or viral pneumonia. KUB shoed dilated bowel. Abd US showed RUQ IS, likely ileocolic. Transfer hospital LABS: CBC 13.4, segs 30%, lymphs 61%, monos 7%, baso 1%. Abdominal US revealed IS in RUQ w/dilated small bowel loops proximally & small amount free fluid. Air contrast enema reduced w/o complication.
CDC 'Split Type':

Write-up: Patient developed explosive diarrhea and emesis shortly after vaccine given. On 2/6/07 he was admitted for worsening vomiting, and on the morning of 2/7/07 he was found to have intussusception. 3/1/07 Received medical records from hospital which reveal patient experienced dehydration, vomiting & diarrhea, tactile temp at home, cough & nasal congestion. Seen in ER x2 then admitted. After admission, had large maroon stool & continued to have bile tinged emesis. After confirmation of IS, patient transferred to higher level of care. 3/15/07 Received medical records from transfer hospital which reveal patient admitted 2/7/07-2/8/07 s/p 48 hour history of abdominal pain, diarrhea & 1 week history of flu like symptoms w/bloody stools developing 24 hours prior to admit. IS successfully reduced w/air enema & kept overnight for observation. FINAL DX: Intussusception, reduced by air contrast enema.


Changed on 10/14/2018

VAERS ID: 271927 Before After
VAERS Form:1
Age:0.54
Gender:Male
Location:Connecticut
Vaccinated:2007-01-29
Onset:2007-02-07
Submitted:2007-02-07
Entered:2007-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 3 UN / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2191KA / 1 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08691A / 3 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0942F / 3 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diarrhoea, Intussusception, Ultrasound scan, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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? Yes
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: recurrent wheezing, h/o RSV bronchiolitis (Nov 2006), eczema PMH: flu like symptoms for approx 1 week prior to admit.
Allergies:
Diagnostic Lab Data: Stool culture and viral studies to be done. Ultrasound showed ileocolic intussecptus and patient was transferred today. Outcome not known yet. Initial hospital LABS: WBC 10.3, lymps 52, neutro 50.9, bands 1. CXR showed perihilar markings c/w reactive inflammatory disease or viral pneumonia. KUB shoed dilated bowel. Abd US showed RUQ IS, likely ileocolic. Transfer hospital LABS: CBC 13.4, segs 30%, lymphs 61%, monos 7%, baso 1%. Abdominal US revealed IS in RUQ w/dilated small bowel loops proximally & small amount free fluid. Air contrast enema reduced w/o complication.
CDC 'Split Type':

Write-up: Patient developed explosive diarrhea and emesis shortly after vaccine given. On 2/6/07 he was admitted for worsening vomiting, and on the morning of 2/7/07 he was found to have intussusception. 3/1/07 Received medical records from hospital which reveal patient experienced dehydration, vomiting & diarrhea, tactile temp at home, cough & nasal congestion. Seen in ER x2 then admitted. After admission, had large maroon stool & continued to have bile tinged emesis. After confirmation of IS, patient transferred to higher level of care. 3/15/07 Received medical records from transfer hospital which reveal patient admitted 2/7/07-2/8/07 s/p 48 hour history of abdominal pain, diarrhea & 1 week history of flu like symptoms w/bloody stools developing 24 hours prior to admit. IS successfully reduced w/air enema & kept overnight for observation. FINAL DX: Intussusception, reduced by air contrast enema.

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