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This is VAERS ID 272092

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 272092
VAERS Form:
Age:0.5
Gender:Male
Location:Nebraska
Vaccinated:2006-12-12
Onset:2007-01-10
Submitted:2007-02-02
Entered:2007-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / AVENTIS PASTEUR C2377A / 2 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0306R / 2 RL / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UE709AA / 2 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR Y0575 / 2 LA / SC
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08646H / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0389F / 2 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Barium double contrast, Haematochezia, Intussusception, Hospitalisation, Abdominal X-ray

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Vomiting and diarrhea x 1-2 days
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Abdominal X ray suspicious for intussusception. Abdominal ultrasound, right upper quadrant colonic intussusception. XR enema intussusception successfully reduced.
CDC 'Split Type':

Write-up: Developed intussusception on 10 Jan 2007. Reduced by XR enema.


Changed on 12/8/2009

VAERS ID: 272092 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Nebraska
Vaccinated:2006-12-12
Onset:2007-01-10
Submitted:2007-02-02
Entered:2007-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / AVENTIS PASTEUR C2377A / 2 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0306R / 2 RL / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UE709AA / 2 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR Y0575 / 2 LA / SC
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08646H / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0389F / 2 - / PO

Administered by: Private      Purchased by: Unknown Private
Symptoms: Barium double contrast, Haematochezia, Intussusception, Lethargy, Mucous stools, Ultrasound abdomen abnormal, Hospitalisation, Abdominal X-ray

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Vomiting and diarrhea x 1-2 days
Preexisting Conditions: NONE PMH: benign heart murmur
Allergies:
Diagnostic Lab Data: Abdominal X ray suspicious for intussusception. Abdominal ultrasound, right upper quadrant colonic intussusception. XR enema intussusception successfully reduced.
CDC 'Split Type':

Write-up: Developed intussusception on 10 Jan 2007. Reduced by XR enema. 2/20/07 Received medical records from PCP which reveal patient experienced recurrent ear infections, cough & cold symptoms, sinusitis, vomiting illness approx 6 days prior to vax, temp 100.1 on day of vax. On 12/19, seen for fever over past 2 days, decreased appetite, congestion & was dx w/left otitis media. Treated w/antibiotics. Received 2nd flu vax on 12/26. On 1/10 awoke w/green emesis & drawing legs up, blood noted in jelly like stool, lethargic. Seen in PCP office that day & sent to hospital for xrays which were reported as WNL. US of abdo showed possible mass in RUQ c/w IS. Air contrast enema done which reduced the IS & was kept overnight for observation. D/C home w/temp of 101.7, parent called PCP & was told to go to ER. On 1/18/07 had temp of 104 w/rash, diarrhea then constipation. Sent to hospital for labs which were reported as WNL. Continued to have fever & was stuffy & congested. Dx w/viral gastroenteritis. 3/29/07 Received medical records from hospital which reveal patinet experienced fussiness & drawing up of legs, vomiting & small bloody mucous stool on day of admit 1/10/07. PCP sent to ER where IS was confirmed & successfully reduced with air enema. Admitted for overnight observation. Progressed well & d/c home next am. Later that same day returned to ER with fever of 101.2. Treated w/fluids & antipyretic meds & d/c to home w/close observation by family. FINAL DX: RUQ colonic intussusception, reduced by contrast enema.


Changed on 3/2/2010

VAERS ID: 272092 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Nebraska
Vaccinated:2006-12-12
Onset:2007-01-10
Submitted:2007-02-02
Entered:2007-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / AVENTIS PASTEUR C2377A / 2 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0306R / 2 RL / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UE709AA / 2 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR Y0575 / 2 LA / SC
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / LEDERLE LABORATORIES B08646H / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0389F / 2 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Haematochezia, Intussusception, Lethargy, Mucous stools, Ultrasound abdomen abnormal, Hospitalisation, Abdominal X-ray

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Vomiting and diarrhea x 1-2 days
Preexisting Conditions: NONE PMH: benign heart murmur
Allergies:
Diagnostic Lab Data: Abdominal X ray suspicious for intussusception. Abdominal ultrasound, right upper quadrant colonic intussusception. XR enema intussusception successfully reduced.
CDC 'Split Type':

Write-up: Developed intussusception on 10 Jan 2007. Reduced by XR enema. 2/20/07 Received medical records from PCP which reveal patient experienced recurrent ear infections, cough & cold symptoms, sinusitis, vomiting illness approx 6 days prior to vax, temp 100.1 on day of vax. On 12/19, seen for fever over past 2 days, decreased appetite, congestion & was dx w/left otitis media. Treated w/antibiotics. Received 2nd flu vax on 12/26. On 1/10 awoke w/green emesis & drawing legs up, blood noted in jelly like stool, lethargic. Seen in PCP office that day & sent to hospital for xrays which were reported as WNL. US of abdo showed possible mass in RUQ c/w IS. Air contrast enema done which reduced the IS & was kept overnight for observation. D/C home w/temp of 101.7, parent called PCP & was told to go to ER. On 1/18/07 had temp of 104 w/rash, diarrhea then constipation. Sent to hospital for labs which were reported as WNL. Continued to have fever & was stuffy & congested. Dx w/viral gastroenteritis. 3/29/07 Received medical records from hospital which reveal patinet experienced fussiness & drawing up of legs, vomiting & small bloody mucous stool on day of admit 1/10/07. PCP sent to ER where IS was confirmed & successfully reduced with air enema. Admitted for overnight observation. Progressed well & d/c home next am. Later that same day returned to ER with fever of 101.2. Treated w/fluids & antipyretic meds & d/c to home w/close observation by family. FINAL DX: RUQ colonic intussusception, reduced by contrast enema.


Changed on 4/7/2010

VAERS ID: 272092 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Nebraska
Vaccinated:2006-12-12
Onset:2007-01-10
Submitted:2007-02-02
Entered:2007-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / AVENTIS PASTEUR C2377A / 2 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0306R / 2 RL / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UE709AA / 2 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR Y0575 / 2 LA / SC
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08646H / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0389F / 2 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Haematochezia, Intussusception, Lethargy, Mucous stools, Ultrasound abdomen abnormal, Hospitalisation, Abdominal X-ray

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Vomiting and diarrhea x 1-2 days
Preexisting Conditions: NONE PMH: benign heart murmur
Allergies:
Diagnostic Lab Data: Abdominal X ray suspicious for intussusception. Abdominal ultrasound, right upper quadrant colonic intussusception. XR enema intussusception successfully reduced.
CDC 'Split Type':

Write-up: Developed intussusception on 10 Jan 2007. Reduced by XR enema. 2/20/07 Received medical records from PCP which reveal patient experienced recurrent ear infections, cough & cold symptoms, sinusitis, vomiting illness approx 6 days prior to vax, temp 100.1 on day of vax. On 12/19, seen for fever over past 2 days, decreased appetite, congestion & was dx w/left otitis media. Treated w/antibiotics. Received 2nd flu vax on 12/26. On 1/10 awoke w/green emesis & drawing legs up, blood noted in jelly like stool, lethargic. Seen in PCP office that day & sent to hospital for xrays which were reported as WNL. US of abdo showed possible mass in RUQ c/w IS. Air contrast enema done which reduced the IS & was kept overnight for observation. D/C home w/temp of 101.7, parent called PCP & was told to go to ER. On 1/18/07 had temp of 104 w/rash, diarrhea then constipation. Sent to hospital for labs which were reported as WNL. Continued to have fever & was stuffy & congested. Dx w/viral gastroenteritis. 3/29/07 Received medical records from hospital which reveal patinet experienced fussiness & drawing up of legs, vomiting & small bloody mucous stool on day of admit 1/10/07. PCP sent to ER where IS was confirmed & successfully reduced with air enema. Admitted for overnight observation. Progressed well & d/c home next am. Later that same day returned to ER with fever of 101.2. Treated w/fluids & antipyretic meds & d/c to home w/close observation by family. FINAL DX: RUQ colonic intussusception, reduced by contrast enema.


Changed on 5/13/2013

VAERS ID: 272092 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Nebraska
Vaccinated:2006-12-12
Onset:2007-01-10
Submitted:2007-02-02
Entered:2007-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / AVENTIS PASTEUR C2377A / 2 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0306R / 2 RL / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UE709AA / 2 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR Y0575 / 2 LA / SC
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08646H / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0389F / 2 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0389F / 2 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Haematochezia, Intussusception, Lethargy, Mucous stools, Ultrasound abdomen abnormal, Hospitalisation, Abdominal X-ray

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Vomiting and diarrhea x 1-2 days
Preexisting Conditions: NONE PMH: benign heart murmur
Allergies:
Diagnostic Lab Data: Abdominal X ray suspicious for intussusception. Abdominal ultrasound, right upper quadrant colonic intussusception. XR enema intussusception successfully reduced.
CDC 'Split Type':

Write-up: Developed intussusception on 10 Jan 2007. Reduced by XR enema. 2/20/07 Received medical records from PCP which reveal patient experienced recurrent ear infections, cough & cold symptoms, sinusitis, vomiting illness approx 6 days prior to vax, temp 100.1 on day of vax. On 12/19, seen for fever over past 2 days, decreased appetite, congestion & was dx w/left otitis media. Treated w/antibiotics. Received 2nd flu vax on 12/26. On 1/10 awoke w/green emesis & drawing legs up, blood noted in jelly like stool, lethargic. Seen in PCP office that day & sent to hospital for xrays which were reported as WNL. US of abdo showed possible mass in RUQ c/w IS. Air contrast enema done which reduced the IS & was kept overnight for observation. D/C home w/temp of 101.7, parent called PCP & was told to go to ER. On 1/18/07 had temp of 104 w/rash, diarrhea then constipation. Sent to hospital for labs which were reported as WNL. Continued to have fever & was stuffy & congested. Dx w/viral gastroenteritis. 3/29/07 Received medical records from hospital which reveal patinet experienced fussiness & drawing up of legs, vomiting & small bloody mucous stool on day of admit 1/10/07. PCP sent to ER where IS was confirmed & successfully reduced with air enema. Admitted for overnight observation. Progressed well & d/c home next am. Later that same day returned to ER with fever of 101.2. Treated w/fluids & antipyretic meds & d/c to home w/close observation by family. FINAL DX: RUQ colonic intussusception, reduced by contrast enema.


Changed on 2/14/2017

VAERS ID: 272092 Before After
VAERS Form:
Age:0.5 0.49
Gender:Male
Location:Nebraska
Vaccinated:2006-12-12
Onset:2007-01-10
Submitted:2007-02-02
Entered:2007-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / AVENTIS PASTEUR SANOFI PASTEUR C2377A / 2 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0306R / 2 RL / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR SANOFI PASTEUR UE709AA / 2 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR SANOFI PASTEUR Y0575 / 2 LA / SC
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES PFIZER/WYETH B08646H / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0389F / 2 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Haematochezia, Intussusception, Lethargy, Mucous stools, Ultrasound abdomen abnormal, Hospitalisation, Abdominal X-ray

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Vomiting and diarrhea x 1-2 days
Preexisting Conditions: NONE PMH: benign heart murmur
Allergies:
Diagnostic Lab Data: Abdominal X ray suspicious for intussusception. Abdominal ultrasound, right upper quadrant colonic intussusception. XR enema intussusception successfully reduced.
CDC 'Split Type':

Write-up: Developed intussusception on 10 Jan 2007. Reduced by XR enema. 2/20/07 Received medical records from PCP which reveal patient experienced recurrent ear infections, cough & cold symptoms, sinusitis, vomiting illness approx 6 days prior to vax, temp 100.1 on day of vax. On 12/19, seen for fever over past 2 days, decreased appetite, congestion & was dx w/left otitis media. Treated w/antibiotics. Received 2nd flu vax on 12/26. On 1/10 awoke w/green emesis & drawing legs up, blood noted in jelly like stool, lethargic. Seen in PCP office that day & sent to hospital for xrays which were reported as WNL. US of abdo showed possible mass in RUQ c/w IS. Air contrast enema done which reduced the IS & was kept overnight for observation. D/C home w/temp of 101.7, parent called PCP & was told to go to ER. On 1/18/07 had temp of 104 w/rash, diarrhea then constipation. Sent to hospital for labs which were reported as WNL. Continued to have fever & was stuffy & congested. Dx w/viral gastroenteritis. 3/29/07 Received medical records from hospital which reveal patinet experienced fussiness & drawing up of legs, vomiting & small bloody mucous stool on day of admit 1/10/07. PCP sent to ER where IS was confirmed & successfully reduced with air enema. Admitted for overnight observation. Progressed well & d/c home next am. Later that same day returned to ER with fever of 101.2. Treated w/fluids & antipyretic meds & d/c to home w/close observation by family. FINAL DX: RUQ colonic intussusception, reduced by contrast enema.


Changed on 9/14/2017

VAERS ID: 272092 Before After
VAERS Form:(blank) 1
Age:0.49
Gender:Male
Location:Nebraska
Vaccinated:2006-12-12
Onset:2007-01-10
Submitted:2007-02-02
Entered:2007-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2377A / 2 3 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0306R / 2 3 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE709AA / 2 3 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y0575 / 2 3 LA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08646H / 2 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0389F / 2 3 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception, Ultrasound abdomen abnormal, Abdominal X-ray

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Vomiting and diarrhea x 1-2 days
Preexisting Conditions: NONE PMH: benign heart murmur
Allergies:
Diagnostic Lab Data: Abdominal X ray suspicious for intussusception. Abdominal ultrasound, right upper quadrant colonic intussusception. XR enema intussusception successfully reduced.
CDC 'Split Type':

Write-up: Developed intussusception on 10 Jan 2007. Reduced by XR enema. 2/20/07 Received medical records from PCP which reveal patient experienced recurrent ear infections, cough & cold symptoms, sinusitis, vomiting illness approx 6 days prior to vax, temp 100.1 on day of vax. On 12/19, seen for fever over past 2 days, decreased appetite, congestion & was dx w/left otitis media. Treated w/antibiotics. Received 2nd flu vax on 12/26. On 1/10 awoke w/green emesis & drawing legs up, blood noted in jelly like stool, lethargic. Seen in PCP office that day & sent to hospital for xrays which were reported as WNL. US of abdo showed possible mass in RUQ c/w IS. Air contrast enema done which reduced the IS & was kept overnight for observation. D/C home w/temp of 101.7, parent called PCP & was told to go to ER. On 1/18/07 had temp of 104 w/rash, diarrhea then constipation. Sent to hospital for labs which were reported as WNL. Continued to have fever & was stuffy & congested. Dx w/viral gastroenteritis. 3/29/07 Received medical records from hospital which reveal patinet experienced fussiness & drawing up of legs, vomiting & small bloody mucous stool on day of admit 1/10/07. PCP sent to ER where IS was confirmed & successfully reduced with air enema. Admitted for overnight observation. Progressed well & d/c home next am. Later that same day returned to ER with fever of 101.2. Treated w/fluids & antipyretic meds & d/c to home w/close observation by family. FINAL DX: RUQ colonic intussusception, reduced by contrast enema.


Changed on 2/14/2018

VAERS ID: 272092 Before After
VAERS Form:1
Age:0.49
Gender:Male
Location:Nebraska
Vaccinated:2006-12-12
Onset:2007-01-10
Submitted:2007-02-02
Entered:2007-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2377A / 3 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0306R / 3 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE709AA / 3 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y0575 / 3 LA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08646H / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0389F / 3 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception, Ultrasound abdomen abnormal, Abdominal X-ray

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Vomiting and diarrhea x 1-2 days
Preexisting Conditions: NONE PMH: benign heart murmur
Allergies:
Diagnostic Lab Data: Abdominal X ray suspicious for intussusception. Abdominal ultrasound, right upper quadrant colonic intussusception. XR enema intussusception successfully reduced.
CDC 'Split Type':

Write-up: Developed intussusception on 10 Jan 2007. Reduced by XR enema. 2/20/07 Received medical records from PCP which reveal patient experienced recurrent ear infections, cough & cold symptoms, sinusitis, vomiting illness approx 6 days prior to vax, temp 100.1 on day of vax. On 12/19, seen for fever over past 2 days, decreased appetite, congestion & was dx w/left otitis media. Treated w/antibiotics. Received 2nd flu vax on 12/26. On 1/10 awoke w/green emesis & drawing legs up, blood noted in jelly like stool, lethargic. Seen in PCP office that day & sent to hospital for xrays which were reported as WNL. US of abdo showed possible mass in RUQ c/w IS. Air contrast enema done which reduced the IS & was kept overnight for observation. D/C home w/temp of 101.7, parent called PCP & was told to go to ER. On 1/18/07 had temp of 104 w/rash, diarrhea then constipation. Sent to hospital for labs which were reported as WNL. Continued to have fever & was stuffy & congested. Dx w/viral gastroenteritis. 3/29/07 Received medical records from hospital which reveal patinet experienced fussiness & drawing up of legs, vomiting & small bloody mucous stool on day of admit 1/10/07. PCP sent to ER where IS was confirmed & successfully reduced with air enema. Admitted for overnight observation. Progressed well & d/c home next am. Later that same day returned to ER with fever of 101.2. Treated w/fluids & antipyretic meds & d/c to home w/close observation by family. FINAL DX: RUQ colonic intussusception, reduced by contrast enema.


Changed on 6/14/2018

VAERS ID: 272092 Before After
VAERS Form:1
Age:0.49
Gender:Male
Location:Nebraska
Vaccinated:2006-12-12
Onset:2007-01-10
Submitted:2007-02-02
Entered:2007-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2377A / 3 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0306R / 3 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE709AA / 3 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y0575 / 3 LA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08646H / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0389F / 3 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception, Ultrasound abdomen abnormal, Abdominal X-ray

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Vomiting and diarrhea x 1-2 days
Preexisting Conditions: NONE PMH: benign heart murmur
Allergies:
Diagnostic Lab Data: Abdominal X ray suspicious for intussusception. Abdominal ultrasound, right upper quadrant colonic intussusception. XR enema intussusception successfully reduced.
CDC 'Split Type':

Write-up: Developed intussusception on 10 Jan 2007. Reduced by XR enema. 2/20/07 Received medical records from PCP which reveal patient experienced recurrent ear infections, cough & cold symptoms, sinusitis, vomiting illness approx 6 days prior to vax, temp 100.1 on day of vax. On 12/19, seen for fever over past 2 days, decreased appetite, congestion & was dx w/left otitis media. Treated w/antibiotics. Received 2nd flu vax on 12/26. On 1/10 awoke w/green emesis & drawing legs up, blood noted in jelly like stool, lethargic. Seen in PCP office that day & sent to hospital for xrays which were reported as WNL. US of abdo showed possible mass in RUQ c/w IS. Air contrast enema done which reduced the IS & was kept overnight for observation. D/C home w/temp of 101.7, parent called PCP & was told to go to ER. On 1/18/07 had temp of 104 w/rash, diarrhea then constipation. Sent to hospital for labs which were reported as WNL. Continued to have fever & was stuffy & congested. Dx w/viral gastroenteritis. 3/29/07 Received medical records from hospital which reveal patinet experienced fussiness & drawing up of legs, vomiting & small bloody mucous stool on day of admit 1/10/07. PCP sent to ER where IS was confirmed & successfully reduced with air enema. Admitted for overnight observation. Progressed well & d/c home next am. Later that same day returned to ER with fever of 101.2. Treated w/fluids & antipyretic meds & d/c to home w/close observation by family. FINAL DX: RUQ colonic intussusception, reduced by contrast enema.

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