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This is VAERS ID 272200

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 272200
VAERS Form:
Age:0.3
Gender:Male
Location:Texas
Vaccinated:2006-12-19
Onset:2007-02-09
Submitted:2007-02-13
Entered:2007-02-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC2113089AA / 1 LL / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UE867AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08646F / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Appendicectomy, Barium enema, Blood creatinine decreased, Blood glucose increased

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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none Meds: Amoxicillin.
Current Illness: none
Preexisting Conditions: none PMH: Recent Otitis Media treated with Amoxicillin, otherwise none. Allergies: none.
Allergies:
Diagnostic Lab Data: Barium enema. Labs and Diagnostics: KUB revealed an obstructive appearing picture with opacity of gas in the lower abdomen. Bariun Enema revealed one severe ileocolic intussusception, initially encountered at the splenic flexure. Reduct
CDC 'Split Type':

Write-up: On 2/9/07 the child developed irritability, bilious vomiting, and bloody stool. The child was diagnosed with intussusception. Barium enema was able to partially reduce the intussusception. The child required laparotomy, manual reduction and bowel resec"tion of necrotic portion. The child is presently recovering in the hospital. 02/16/2007 Rotateq added to vaccine list. Provider stated to krk that an addendum with Lot # 0979F was submitted. 02/27/2007 MR received from treating hospital for admission


Changed on 12/8/2009

VAERS ID: 272200 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Texas
Vaccinated:2006-12-19
Onset:2007-02-09
Submitted:2007-02-13
Entered:2007-02-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC2113089AA / 1 LL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC2113089AA / 1 LL / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR SANOFI PASTEUR UE867AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES WYETH PHARMACEUTICALS, INC B08646F / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Appendicectomy, Barium enema, Blood creatinine decreased, Blood glucose increased, Bowel sounds abnormal, Culture stool negative, Full blood count, Gastrointestinal necrosis, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Irritability, Laboratory test abnormal, Laparotomy, Large intestinal obstruction reduction, Lethargy, Urinary system X-ray, Vomiting, Clostridium difficile toxin test, Urine analysis normal, Colectomy, Occult blood positive, Rotavirus test negative

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none Meds: Amoxicillin.
Current Illness: none
Preexisting Conditions: none PMH: Recent Otitis Media treated with Amoxicillin, otherwise none. Allergies: none.
Allergies:
Diagnostic Lab Data: Barium enema. Labs and Diagnostics: KUB revealed an obstructive appearing picture with opacity of gas in the lower abdomen. Bariun Enema revealed one severe ileocolic intussusception, initially encountered at the splenic flexure. Reduct
CDC 'Split Type':

Write-up: On 2/9/07 the child developed irritability, bilious vomiting, and bloody stool. The child was diagnosed with intussusception. Barium enema was able to partially reduce the intussusception. The child required laparotomy, manual reduction and bowel resec"tion resection of necrotic portion. The child is presently recovering in the hospital. 02/16/2007 Rotateq added to vaccine list. Provider stated to krk that an addendum with Lot # 0979F was submitted. 02/27/2007 MR received from treating hospital for admission for vomiting of dark green emesis, irritability, and lethargy. In the ER child had an episode of large, jelly-like bloody stool. PE showed a slightly distended abdomen with hyperactive bowel sounds. No palpable masses. Taken to OR for Exploratory Laparotomy, Reduction of Intussusception, Appendectomy. Limited right hemicolectomy. Post-operative DX: Intussusception. Final DX: Intussusception, with necrotic bowel.


Changed on 3/2/2010

VAERS ID: 272200 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Texas
Vaccinated:2006-12-19
Onset:2007-02-09
Submitted:2007-02-13
Entered:2007-02-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC2113089AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE867AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B08646F / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Appendicectomy, Barium enema, Blood creatinine decreased, Blood glucose increased, Bowel sounds abnormal, Culture stool negative, Full blood count, Gastrointestinal necrosis, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Irritability, Laboratory test abnormal, Laparotomy, Large intestinal obstruction reduction, Lethargy, Urinary system X-ray, Vomiting, Clostridium difficile toxin test, Urine analysis normal, Colectomy, Occult blood positive, Rotavirus 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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none Meds: Amoxicillin.
Current Illness: none
Preexisting Conditions: none PMH: Recent Otitis Media treated with Amoxicillin, otherwise none. Allergies: none.
Allergies:
Diagnostic Lab Data: Barium enema. Labs and Diagnostics: KUB revealed an obstructive appearing picture with opacity of gas in the lower abdomen. Bariun Enema revealed one severe ileocolic intussusception, initially encountered at the splenic flexure. Reduct
CDC 'Split Type':

Write-up: On 2/9/07 the child developed irritability, bilious vomiting, and bloody stool. The child was diagnosed with intussusception. Barium enema was able to partially reduce the intussusception. The child required laparotomy, manual reduction and bowel resection of necrotic portion. The child is presently recovering in the hospital. 02/16/2007 Rotateq added to vaccine list. Provider stated to krk that an addendum with Lot # 0979F was submitted. 02/27/2007 MR received from treating hospital for admission for vomiting of dark green emesis, irritability, and lethargy. In the ER child had an episode of large, jelly-like bloody stool. PE showed a slightly distended abdomen with hyperactive bowel sounds. No palpable masses. Taken to OR for Exploratory Laparotomy, Reduction of Intussusception, Appendectomy. Limited right hemicolectomy. Post-operative DX: Intussusception. Final DX: Intussusception, with necrotic bowel.


Changed on 4/7/2010

VAERS ID: 272200 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Texas
Vaccinated:2006-12-19
Onset:2007-02-09
Submitted:2007-02-13
Entered:2007-02-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC2113089AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE867AA / 1 RL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08646F / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Appendicectomy, Barium enema, Blood creatinine decreased, Blood glucose increased, Bowel sounds abnormal, Culture stool negative, Full blood count, Gastrointestinal necrosis, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Irritability, Laboratory test abnormal, Laparotomy, Large intestinal obstruction reduction, Lethargy, Urinary system X-ray, Vomiting, Clostridium difficile toxin test, Urine analysis normal, Colectomy, Occult blood positive, Rotavirus 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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none Meds: Amoxicillin.
Current Illness: none
Preexisting Conditions: none PMH: Recent Otitis Media treated with Amoxicillin, otherwise none. Allergies: none.
Allergies:
Diagnostic Lab Data: Barium enema. Labs and Diagnostics: KUB revealed an obstructive appearing picture with opacity of gas in the lower abdomen. Bariun Enema revealed one severe ileocolic intussusception, initially encountered at the splenic flexure. Reduct
CDC 'Split Type':

Write-up: On 2/9/07 the child developed irritability, bilious vomiting, and bloody stool. The child was diagnosed with intussusception. Barium enema was able to partially reduce the intussusception. The child required laparotomy, manual reduction and bowel resection of necrotic portion. The child is presently recovering in the hospital. 02/16/2007 Rotateq added to vaccine list. Provider stated to krk that an addendum with Lot # 0979F was submitted. 02/27/2007 MR received from treating hospital for admission for vomiting of dark green emesis, irritability, and lethargy. In the ER child had an episode of large, jelly-like bloody stool. PE showed a slightly distended abdomen with hyperactive bowel sounds. No palpable masses. Taken to OR for Exploratory Laparotomy, Reduction of Intussusception, Appendectomy. Limited right hemicolectomy. Post-operative DX: Intussusception. Final DX: Intussusception, with necrotic bowel.


Changed on 8/31/2010

VAERS ID: 272200 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Texas
Vaccinated:2006-12-19
Onset:2007-02-09
Submitted:2007-02-13
Entered:2007-02-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC2113089AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE867AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B08646F / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Appendicectomy, Barium enema, Blood creatinine decreased, Blood glucose increased, Bowel sounds abnormal, Culture stool negative, Full blood count, Gastrointestinal necrosis, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Irritability, Laboratory test abnormal, Laparotomy, Large intestinal obstruction reduction, Lethargy, Urinary system X-ray, Vomiting, Clostridium difficile toxin test, Urine analysis normal, Colectomy, Occult blood positive, Rotavirus 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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none Meds: Amoxicillin.
Current Illness: none
Preexisting Conditions: none PMH: Recent Otitis Media treated with Amoxicillin, otherwise none. Allergies: none.
Allergies:
Diagnostic Lab Data: Barium enema. Labs and Diagnostics: KUB revealed an obstructive appearing picture with opacity of gas in the lower abdomen. Bariun Enema revealed one severe ileocolic intussusception, initially encountered at the splenic flexure. Reduct
CDC 'Split Type':

Write-up: On 2/9/07 the child developed irritability, bilious vomiting, and bloody stool. The child was diagnosed with intussusception. Barium enema was able to partially reduce the intussusception. The child required laparotomy, manual reduction and bowel resection of necrotic portion. The child is presently recovering in the hospital. 02/16/2007 Rotateq added to vaccine list. Provider stated to krk that an addendum with Lot # 0979F was submitted. 02/27/2007 MR received from treating hospital for admission for vomiting of dark green emesis, irritability, and lethargy. In the ER child had an episode of large, jelly-like bloody stool. PE showed a slightly distended abdomen with hyperactive bowel sounds. No palpable masses. Taken to OR for Exploratory Laparotomy, Reduction of Intussusception, Appendectomy. Limited right hemicolectomy. Post-operative DX: Intussusception. Final DX: Intussusception, with necrotic bowel.


Changed on 12/7/2010

VAERS ID: 272200 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Texas
Vaccinated:2006-12-19
Onset:2007-02-09
Submitted:2007-02-13
Entered:2007-02-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC2113089AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE867AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08646F / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Appendicectomy, Barium enema, Blood creatinine decreased, Blood glucose increased, Bowel sounds abnormal, Culture stool negative, Full blood count, Gastrointestinal necrosis, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Irritability, Laboratory test abnormal, Laparotomy, Large intestinal obstruction reduction, Lethargy, Urinary system X-ray, Vomiting, Urine analysis normal, Colectomy, Occult blood positive, Rotavirus 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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none Meds: Amoxicillin.
Current Illness: none
Preexisting Conditions: none PMH: Recent Otitis Media treated with Amoxicillin, otherwise none. Allergies: none.
Allergies:
Diagnostic Lab Data: Barium enema. Labs and Diagnostics: KUB revealed an obstructive appearing picture with opacity of gas in the lower abdomen. Bariun Enema revealed one severe ileocolic intussusception, initially encountered at the splenic flexure. Reduct Reduction was unsucessful. Serial CBCs show low H&H otherwise unremarkable. Chemistry with elevated glucose and low creatinine. UA unremarkable. Stool occult blood (+). Rotavirus Ag, Campylobacter Ag, and C. diff. toxins (-). Stool culture (-). Surgical pathology of small bowel resection showed hemorrhagic infarction and destruction of the mucosa.
CDC 'Split Type':

Write-up: On 2/9/07 the child developed irritability, bilious vomiting, and bloody stool. The child was diagnosed with intussusception. Barium enema was able to partially reduce the intussusception. The child required laparotomy, manual reduction and bowel resection of necrotic portion. The child is presently recovering in the hospital. 02/16/2007 Rotateq added to vaccine list. Provider stated to krk that an addendum with Lot # 0979F was submitted. 02/27/2007 MR received from treating hospital for admission for vomiting of dark green emesis, irritability, and lethargy. In the ER child had an episode of large, jelly-like bloody stool. PE showed a slightly distended abdomen with hyperactive bowel sounds. No palpable masses. Taken to OR for Exploratory Laparotomy, Reduction of Intussusception, Appendectomy. Limited right hemicolectomy. Post-operative DX: Intussusception. Final DX: Intussusception, with necrotic bowel.


Changed on 4/13/2011

VAERS ID: 272200 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Texas
Vaccinated:2006-12-19
Onset:2007-02-09
Submitted:2007-02-13
Entered:2007-02-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC2113089AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE867AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08646F / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Appendicectomy, Barium enema, Blood creatinine decreased, Blood glucose increased, Bowel sounds abnormal, Culture stool negative, Full blood count, Gastrointestinal necrosis, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Irritability, Laboratory test abnormal, Laparotomy, Large intestinal obstruction reduction, Lethargy, Urinary system X-ray, Vomiting, Clostridium difficile toxin test, Urine analysis normal, Colectomy, Occult blood positive, Rotavirus 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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none Meds: Amoxicillin.
Current Illness: none
Preexisting Conditions: none PMH: Recent Otitis Media treated with Amoxicillin, otherwise none. Allergies: none.
Allergies:
Diagnostic Lab Data: Barium enema. Labs and Diagnostics: KUB revealed an obstructive appearing picture with opacity of gas in the lower abdomen. Bariun Enema revealed one severe ileocolic intussusception, initially encountered at the splenic flexure. Reduction was unsucessful. Serial CBCs show low H&H otherwise unremarkable. Chemistry with elevated glucose and low creatinine. UA unremarkable. Stool occult blood (+). Rotavirus Ag, Campylobacter Ag, and C. diff. toxins (-). Stool culture (-). Surgical pathology of small bowel resection showed hemorrhagic infarction and destruction of the mucosa.
CDC 'Split Type':

Write-up: On 2/9/07 the child developed irritability, bilious vomiting, and bloody stool. The child was diagnosed with intussusception. Barium enema was able to partially reduce the intussusception. The child required laparotomy, manual reduction and bowel resection of necrotic portion. The child is presently recovering in the hospital. 02/16/2007 Rotateq added to vaccine list. Provider stated to krk that an addendum with Lot # 0979F was submitted. 02/27/2007 MR received from treating hospital for admission for vomiting of dark green emesis, irritability, and lethargy. In the ER child had an episode of large, jelly-like bloody stool. PE showed a slightly distended abdomen with hyperactive bowel sounds. No palpable masses. Taken to OR for Exploratory Laparotomy, Reduction of Intussusception, Appendectomy. Limited right hemicolectomy. Post-operative DX: Intussusception. Final DX: Intussusception, with necrotic bowel.


Changed on 5/13/2011

VAERS ID: 272200 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Texas
Vaccinated:2006-12-19
Onset:2007-02-09
Submitted:2007-02-13
Entered:2007-02-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC2113089AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE867AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08646F / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Appendicectomy, Barium enema, Blood creatinine decreased, Blood glucose increased, Bowel sounds abnormal, Culture stool negative, Full blood count, Gastrointestinal necrosis, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Irritability, Laboratory test abnormal, Laparotomy, Large intestinal obstruction reduction, Lethargy, Urinary system X-ray, Vomiting, Clostridium difficile toxin test, Urine analysis normal, Colectomy, Occult blood positive, Rotavirus 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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none Meds: Amoxicillin.
Current Illness: none
Preexisting Conditions: none PMH: Recent Otitis Media treated with Amoxicillin, otherwise none. Allergies: none.
Allergies:
Diagnostic Lab Data: Barium enema. Labs and Diagnostics: KUB revealed an obstructive appearing picture with opacity of gas in the lower abdomen. Bariun Enema revealed one severe ileocolic intussusception, initially encountered at the splenic flexure. Reduction was unsucessful. Serial CBCs show low H&H otherwise unremarkable. Chemistry with elevated glucose and low creatinine. UA unremarkable. Stool occult blood (+). Rotavirus Ag, Campylobacter Ag, and C. diff. toxins (-). Stool culture (-). Surgical pathology of small bowel resection showed hemorrhagic infarction and destruction of the mucosa.
CDC 'Split Type':

Write-up: On 2/9/07 the child developed irritability, bilious vomiting, and bloody stool. The child was diagnosed with intussusception. Barium enema was able to partially reduce the intussusception. The child required laparotomy, manual reduction and bowel resection of necrotic portion. The child is presently recovering in the hospital. 02/16/2007 Rotateq added to vaccine list. Provider stated to krk that an addendum with Lot # 0979F was submitted. 02/27/2007 MR received from treating hospital for admission for vomiting of dark green emesis, irritability, and lethargy. In the ER child had an episode of large, jelly-like bloody stool. PE showed a slightly distended abdomen with hyperactive bowel sounds. No palpable masses. Taken to OR for Exploratory Laparotomy, Reduction of Intussusception, Appendectomy. Limited right hemicolectomy. Post-operative DX: Intussusception. Final DX: Intussusception, with necrotic bowel.


Changed on 6/11/2011

VAERS ID: 272200 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Texas
Vaccinated:2006-12-19
Onset:2007-02-09
Submitted:2007-02-13
Entered:2007-02-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC2113089AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE867AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08646F / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Appendicectomy, Barium enema, Blood creatinine decreased, Blood glucose increased, Bowel sounds abnormal, Culture stool negative, Full blood count, Gastrointestinal necrosis, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Irritability, Laboratory test abnormal, Laparotomy, Large intestinal obstruction reduction, Lethargy, Urinary system X-ray, Vomiting, Clostridium difficile toxin test, Urine analysis normal, Colectomy, Occult blood positive, Rotavirus 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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none Meds: Amoxicillin.
Current Illness: none
Preexisting Conditions: none PMH: Recent Otitis Media treated with Amoxicillin, otherwise none. Allergies: none.
Allergies:
Diagnostic Lab Data: Barium enema. Labs and Diagnostics: KUB revealed an obstructive appearing picture with opacity of gas in the lower abdomen. Bariun Enema revealed one severe ileocolic intussusception, initially encountered at the splenic flexure. Reduction was unsucessful. Serial CBCs show low H&H otherwise unremarkable. Chemistry with elevated glucose and low creatinine. UA unremarkable. Stool occult blood (+). Rotavirus Ag, Campylobacter Ag, and C. diff. toxins (-). Stool culture (-). Surgical pathology of small bowel resection showed hemorrhagic infarction and destruction of the mucosa.
CDC 'Split Type':

Write-up: On 2/9/07 the child developed irritability, bilious vomiting, and bloody stool. The child was diagnosed with intussusception. Barium enema was able to partially reduce the intussusception. The child required laparotomy, manual reduction and bowel resection of necrotic portion. The child is presently recovering in the hospital. 02/16/2007 Rotateq added to vaccine list. Provider stated to krk that an addendum with Lot # 0979F was submitted. 02/27/2007 MR received from treating hospital for admission for vomiting of dark green emesis, irritability, and lethargy. In the ER child had an episode of large, jelly-like bloody stool. PE showed a slightly distended abdomen with hyperactive bowel sounds. No palpable masses. Taken to OR for Exploratory Laparotomy, Reduction of Intussusception, Appendectomy. Limited right hemicolectomy. Post-operative DX: Intussusception. Final DX: Intussusception, with necrotic bowel.


Changed on 5/13/2013

VAERS ID: 272200 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Texas
Vaccinated:2006-12-19
Onset:2007-02-09
Submitted:2007-02-13
Entered:2007-02-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC2113089AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE867AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08646F / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / - - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Appendicectomy, Barium enema, Blood creatinine decreased, Blood glucose increased, Bowel sounds abnormal, Culture stool negative, Full blood count, Gastrointestinal necrosis, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Irritability, Laboratory test abnormal, Laparotomy, Large intestinal obstruction reduction, Lethargy, Urinary system X-ray, Vomiting, Clostridium difficile toxin test, Urine analysis normal, Colectomy, Occult blood positive, Rotavirus 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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none Meds: Amoxicillin.
Current Illness: none
Preexisting Conditions: none PMH: Recent Otitis Media treated with Amoxicillin, otherwise none. Allergies: none.
Allergies:
Diagnostic Lab Data: Barium enema. Labs and Diagnostics: KUB revealed an obstructive appearing picture with opacity of gas in the lower abdomen. Bariun Enema revealed one severe ileocolic intussusception, initially encountered at the splenic flexure. Reduction was unsucessful. Serial CBCs show low H&H otherwise unremarkable. Chemistry with elevated glucose and low creatinine. UA unremarkable. Stool occult blood (+). Rotavirus Ag, Campylobacter Ag, and C. diff. toxins (-). Stool culture (-). Surgical pathology of small bowel resection showed hemorrhagic infarction and destruction of the mucosa.
CDC 'Split Type':

Write-up: On 2/9/07 the child developed irritability, bilious vomiting, and bloody stool. The child was diagnosed with intussusception. Barium enema was able to partially reduce the intussusception. The child required laparotomy, manual reduction and bowel resection of necrotic portion. The child is presently recovering in the hospital. 02/16/2007 Rotateq added to vaccine list. Provider stated to krk that an addendum with Lot # 0979F was submitted. 02/27/2007 MR received from treating hospital for admission for vomiting of dark green emesis, irritability, and lethargy. In the ER child had an episode of large, jelly-like bloody stool. PE showed a slightly distended abdomen with hyperactive bowel sounds. No palpable masses. Taken to OR for Exploratory Laparotomy, Reduction of Intussusception, Appendectomy. Limited right hemicolectomy. Post-operative DX: Intussusception. Final DX: Intussusception, with necrotic bowel.


Changed on 6/14/2014

VAERS ID: 272200 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Texas
Vaccinated:2006-12-19
Onset:2007-02-09
Submitted:2007-02-13
Entered:2007-02-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC2113089AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE867AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08646F / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Appendicectomy, Barium enema, Blood creatinine decreased, Blood glucose increased, Bowel sounds abnormal, Culture stool negative, Full blood count, Gastrointestinal necrosis, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Irritability, Laboratory test abnormal, Laparotomy, Large intestinal obstruction reduction, Lethargy, Urinary system X-ray, Vomiting, Clostridium difficile toxin test, Urine analysis normal, Colectomy, Occult blood positive, Rotavirus 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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none Meds: Amoxicillin.
Current Illness: none
Preexisting Conditions: none PMH: Recent Otitis Media treated with Amoxicillin, otherwise none. Allergies: none.
Allergies:
Diagnostic Lab Data: Barium enema. Labs and Diagnostics: KUB revealed an obstructive appearing picture with opacity of gas in the lower abdomen. Bariun Enema revealed one severe ileocolic intussusception, initially encountered at the splenic flexure. Reduction was unsucessful. Serial CBCs show low H&H otherwise unremarkable. Chemistry with elevated glucose and low creatinine. UA unremarkable. Stool occult blood (+). Rotavirus Ag, Campylobacter Ag, and C. diff. toxins (-). Stool culture (-). Surgical pathology of small bowel resection showed hemorrhagic infarction and destruction of the mucosa.
CDC 'Split Type':

Write-up: On 2/9/07 the child developed irritability, bilious vomiting, and bloody stool. The child was diagnosed with intussusception. Barium enema was able to partially reduce the intussusception. The child required laparotomy, manual reduction and bowel resection of necrotic portion. The child is presently recovering in the hospital. 02/16/2007 Rotateq added to vaccine list. Provider stated to krk that an addendum with Lot # 0979F was submitted. 02/27/2007 MR received from treating hospital for admission for vomiting of dark green emesis, irritability, and lethargy. In the ER child had an episode of large, jelly-like bloody stool. PE showed a slightly distended abdomen with hyperactive bowel sounds. No palpable masses. Taken to OR for Exploratory Laparotomy, Reduction of Intussusception, Appendectomy. Limited right hemicolectomy. Post-operative DX: Intussusception. Final DX: Intussusception, with necrotic bowel.


Changed on 2/14/2017

VAERS ID: 272200 Before After
VAERS Form:
Age:0.3 0.34
Gender:Male
Location:Texas
Vaccinated:2006-12-19
Onset:2007-02-09
Submitted:2007-02-13
Entered:2007-02-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC2113089AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE867AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08646F / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Appendicectomy, Barium enema, Blood creatinine decreased, Blood glucose increased, Bowel sounds abnormal, Culture stool negative, Full blood count, Gastrointestinal necrosis, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Irritability, Laboratory test abnormal, Laparotomy, Large intestinal obstruction reduction, Lethargy, Urinary system X-ray, Vomiting, Clostridium difficile toxin test, Urine analysis normal, Colectomy, Occult blood positive, Rotavirus 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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none Meds: Amoxicillin.
Current Illness: none
Preexisting Conditions: none PMH: Recent Otitis Media treated with Amoxicillin, otherwise none. Allergies: none.
Allergies:
Diagnostic Lab Data: Barium enema. Labs and Diagnostics: KUB revealed an obstructive appearing picture with opacity of gas in the lower abdomen. Bariun Enema revealed one severe ileocolic intussusception, initially encountered at the splenic flexure. Reduction was unsucessful. Serial CBCs show low H&H otherwise unremarkable. Chemistry with elevated glucose and low creatinine. UA unremarkable. Stool occult blood (+). Rotavirus Ag, Campylobacter Ag, and C. diff. toxins (-). Stool culture (-). Surgical pathology of small bowel resection showed hemorrhagic infarction and destruction of the mucosa.
CDC 'Split Type':

Write-up: On 2/9/07 the child developed irritability, bilious vomiting, and bloody stool. The child was diagnosed with intussusception. Barium enema was able to partially reduce the intussusception. The child required laparotomy, manual reduction and bowel resection of necrotic portion. The child is presently recovering in the hospital. 02/16/2007 Rotateq added to vaccine list. Provider stated to krk that an addendum with Lot # 0979F was submitted. 02/27/2007 MR received from treating hospital for admission for vomiting of dark green emesis, irritability, and lethargy. In the ER child had an episode of large, jelly-like bloody stool. PE showed a slightly distended abdomen with hyperactive bowel sounds. No palpable masses. Taken to OR for Exploratory Laparotomy, Reduction of Intussusception, Appendectomy. Limited right hemicolectomy. Post-operative DX: Intussusception. Final DX: Intussusception, with necrotic bowel.


Changed on 9/14/2017

VAERS ID: 272200 Before After
VAERS Form:(blank) 1
Age:0.34
Gender:Male
Location:Texas
Vaccinated:2006-12-19
Onset:2007-02-09
Submitted:2007-02-13
Entered:2007-02-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC2113089AA / 1 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE867AA / 1 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08646F / 1 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / - UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Haematochezia, Intussusception, Irritability, Laparotomy, Vomiting

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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none Meds: Amoxicillin.
Current Illness: none
Preexisting Conditions: none PMH: Recent Otitis Media treated with Amoxicillin, otherwise none. Allergies: none.
Allergies:
Diagnostic Lab Data: Barium enema. Labs and Diagnostics: KUB revealed an obstructive appearing picture with opacity of gas in the lower abdomen. Bariun Enema revealed one severe ileocolic intussusception, initially encountered at the splenic flexure. Reduction was unsucessful. Serial CBCs show low H&H otherwise unremarkable. Chemistry with elevated glucose and low creatinine. UA unremarkable. Stool occult blood (+). Rotavirus Ag, Campylobacter Ag, and C. diff. toxins (-). Stool culture (-). Surgical pathology of small bowel resection showed hemorrhagic infarction and destruction of the mucosa.
CDC 'Split Type':

Write-up: On 2/9/07 the child developed irritability, bilious vomiting, and bloody stool. The child was diagnosed with intussusception. Barium enema was able to partially reduce the intussusception. The child required laparotomy, manual reduction and bowel resection of necrotic portion. The child is presently recovering in the hospital. 02/16/2007 Rotateq added to vaccine list. Provider stated to krk that an addendum with Lot # 0979F was submitted. 02/27/2007 MR received from treating hospital for admission for vomiting of dark green emesis, irritability, and lethargy. In the ER child had an episode of large, jelly-like bloody stool. PE showed a slightly distended abdomen with hyperactive bowel sounds. No palpable masses. Taken to OR for Exploratory Laparotomy, Reduction of Intussusception, Appendectomy. Limited right hemicolectomy. Post-operative DX: Intussusception. Final DX: Intussusception, with necrotic bowel.


Changed on 2/14/2018

VAERS ID: 272200 Before After
VAERS Form:1
Age:0.34
Gender:Male
Location:Texas
Vaccinated:2006-12-19
Onset:2007-02-09
Submitted:2007-02-13
Entered:2007-02-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC2113089AA / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE867AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08646F / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Haematochezia, Intussusception, Irritability, Laparotomy, Vomiting

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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none Meds: Amoxicillin.
Current Illness: none
Preexisting Conditions: none PMH: Recent Otitis Media treated with Amoxicillin, otherwise none. Allergies: none.
Allergies:
Diagnostic Lab Data: Barium enema. Labs and Diagnostics: KUB revealed an obstructive appearing picture with opacity of gas in the lower abdomen. Bariun Enema revealed one severe ileocolic intussusception, initially encountered at the splenic flexure. Reduction was unsucessful. Serial CBCs show low H&H otherwise unremarkable. Chemistry with elevated glucose and low creatinine. UA unremarkable. Stool occult blood (+). Rotavirus Ag, Campylobacter Ag, and C. diff. toxins (-). Stool culture (-). Surgical pathology of small bowel resection showed hemorrhagic infarction and destruction of the mucosa.
CDC 'Split Type':

Write-up: On 2/9/07 the child developed irritability, bilious vomiting, and bloody stool. The child was diagnosed with intussusception. Barium enema was able to partially reduce the intussusception. The child required laparotomy, manual reduction and bowel resection of necrotic portion. The child is presently recovering in the hospital. 02/16/2007 Rotateq added to vaccine list. Provider stated to krk that an addendum with Lot # 0979F was submitted. 02/27/2007 MR received from treating hospital for admission for vomiting of dark green emesis, irritability, and lethargy. In the ER child had an episode of large, jelly-like bloody stool. PE showed a slightly distended abdomen with hyperactive bowel sounds. No palpable masses. Taken to OR for Exploratory Laparotomy, Reduction of Intussusception, Appendectomy. Limited right hemicolectomy. Post-operative DX: Intussusception. Final DX: Intussusception, with necrotic bowel.


Changed on 6/14/2018

VAERS ID: 272200 Before After
VAERS Form:1
Age:0.34
Gender:Male
Location:Texas
Vaccinated:2006-12-19
Onset:2007-02-09
Submitted:2007-02-13
Entered:2007-02-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC2113089AA / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE867AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08646F / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Haematochezia, Intussusception, Irritability, Laparotomy, Vomiting

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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none Meds: Amoxicillin.
Current Illness: none
Preexisting Conditions: none PMH: Recent Otitis Media treated with Amoxicillin, otherwise none. Allergies: none.
Allergies:
Diagnostic Lab Data: Barium enema. Labs and Diagnostics: KUB revealed an obstructive appearing picture with opacity of gas in the lower abdomen. Bariun Enema revealed one severe ileocolic intussusception, initially encountered at the splenic flexure. Reduction was unsucessful. Serial CBCs show low H&H otherwise unremarkable. Chemistry with elevated glucose and low creatinine. UA unremarkable. Stool occult blood (+). Rotavirus Ag, Campylobacter Ag, and C. diff. toxins (-). Stool culture (-). Surgical pathology of small bowel resection showed hemorrhagic infarction and destruction of the mucosa.
CDC 'Split Type':

Write-up: On 2/9/07 the child developed irritability, bilious vomiting, and bloody stool. The child was diagnosed with intussusception. Barium enema was able to partially reduce the intussusception. The child required laparotomy, manual reduction and bowel resection of necrotic portion. The child is presently recovering in the hospital. 02/16/2007 Rotateq added to vaccine list. Provider stated to krk that an addendum with Lot # 0979F was submitted. 02/27/2007 MR received from treating hospital for admission for vomiting of dark green emesis, irritability, and lethargy. In the ER child had an episode of large, jelly-like bloody stool. PE showed a slightly distended abdomen with hyperactive bowel sounds. No palpable masses. Taken to OR for Exploratory Laparotomy, Reduction of Intussusception, Appendectomy. Limited right hemicolectomy. Post-operative DX: Intussusception. Final DX: Intussusception, with necrotic bowel.


Changed on 8/14/2018

VAERS ID: 272200 Before After
VAERS Form:1
Age:0.34
Gender:Male
Location:Texas
Vaccinated:2006-12-19
Onset:2007-02-09
Submitted:2007-02-13
Entered:2007-02-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC2113089AA / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE867AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08646F / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Haematochezia, Intussusception, Irritability, Laparotomy, Vomiting

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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none Meds: Amoxicillin.
Current Illness: none
Preexisting Conditions: none PMH: Recent Otitis Media treated with Amoxicillin, otherwise none. Allergies: none.
Allergies:
Diagnostic Lab Data: Barium enema. Labs and Diagnostics: KUB revealed an obstructive appearing picture with opacity of gas in the lower abdomen. Bariun Enema revealed one severe ileocolic intussusception, initially encountered at the splenic flexure. Reduction was unsucessful. Serial CBCs show low H&H otherwise unremarkable. Chemistry with elevated glucose and low creatinine. UA unremarkable. Stool occult blood (+). Rotavirus Ag, Campylobacter Ag, and C. diff. toxins (-). Stool culture (-). Surgical pathology of small bowel resection showed hemorrhagic infarction and destruction of the mucosa.
CDC 'Split Type':

Write-up: On 2/9/07 the child developed irritability, bilious vomiting, and bloody stool. The child was diagnosed with intussusception. Barium enema was able to partially reduce the intussusception. The child required laparotomy, manual reduction and bowel resection of necrotic portion. The child is presently recovering in the hospital. 02/16/2007 Rotateq added to vaccine list. Provider stated to krk that an addendum with Lot # 0979F was submitted. 02/27/2007 MR received from treating hospital for admission for vomiting of dark green emesis, irritability, and lethargy. In the ER child had an episode of large, jelly-like bloody stool. PE showed a slightly distended abdomen with hyperactive bowel sounds. No palpable masses. Taken to OR for Exploratory Laparotomy, Reduction of Intussusception, Appendectomy. Limited right hemicolectomy. Post-operative DX: Intussusception. Final DX: Intussusception, with necrotic bowel.


Changed on 9/14/2018

VAERS ID: 272200 Before After
VAERS Form:1
Age:0.34
Gender:Male
Location:Texas
Vaccinated:2006-12-19
Onset:2007-02-09
Submitted:2007-02-13
Entered:2007-02-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC2113089AA / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE867AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08646F / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Haematochezia, Intussusception, Irritability, Laparotomy, Vomiting

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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none Meds: Amoxicillin.
Current Illness: none
Preexisting Conditions: none PMH: Recent Otitis Media treated with Amoxicillin, otherwise none. Allergies: none.
Allergies:
Diagnostic Lab Data: Barium enema. Labs and Diagnostics: KUB revealed an obstructive appearing picture with opacity of gas in the lower abdomen. Bariun Enema revealed one severe ileocolic intussusception, initially encountered at the splenic flexure. Reduction was unsucessful. Serial CBCs show low H&H otherwise unremarkable. Chemistry with elevated glucose and low creatinine. UA unremarkable. Stool occult blood (+). Rotavirus Ag, Campylobacter Ag, and C. diff. toxins (-). Stool culture (-). Surgical pathology of small bowel resection showed hemorrhagic infarction and destruction of the mucosa.
CDC 'Split Type':

Write-up: On 2/9/07 the child developed irritability, bilious vomiting, and bloody stool. The child was diagnosed with intussusception. Barium enema was able to partially reduce the intussusception. The child required laparotomy, manual reduction and bowel resection of necrotic portion. The child is presently recovering in the hospital. 02/16/2007 Rotateq added to vaccine list. Provider stated to krk that an addendum with Lot # 0979F was submitted. 02/27/2007 MR received from treating hospital for admission for vomiting of dark green emesis, irritability, and lethargy. In the ER child had an episode of large, jelly-like bloody stool. PE showed a slightly distended abdomen with hyperactive bowel sounds. No palpable masses. Taken to OR for Exploratory Laparotomy, Reduction of Intussusception, Appendectomy. Limited right hemicolectomy. Post-operative DX: Intussusception. Final DX: Intussusception, with necrotic bowel.


Changed on 10/14/2018

VAERS ID: 272200 Before After
VAERS Form:1
Age:0.34
Gender:Male
Location:Texas
Vaccinated:2006-12-19
Onset:2007-02-09
Submitted:2007-02-13
Entered:2007-02-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC2113089AA / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE867AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08646F / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Haematochezia, Intussusception, Irritability, Laparotomy, Vomiting

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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none Meds: Amoxicillin.
Current Illness: none
Preexisting Conditions: none PMH: Recent Otitis Media treated with Amoxicillin, otherwise none. Allergies: none.
Allergies:
Diagnostic Lab Data: Barium enema. Labs and Diagnostics: KUB revealed an obstructive appearing picture with opacity of gas in the lower abdomen. Bariun Enema revealed one severe ileocolic intussusception, initially encountered at the splenic flexure. Reduction was unsucessful. Serial CBCs show low H&H otherwise unremarkable. Chemistry with elevated glucose and low creatinine. UA unremarkable. Stool occult blood (+). Rotavirus Ag, Campylobacter Ag, and C. diff. toxins (-). Stool culture (-). Surgical pathology of small bowel resection showed hemorrhagic infarction and destruction of the mucosa.
CDC 'Split Type':

Write-up: On 2/9/07 the child developed irritability, bilious vomiting, and bloody stool. The child was diagnosed with intussusception. Barium enema was able to partially reduce the intussusception. The child required laparotomy, manual reduction and bowel resection of necrotic portion. The child is presently recovering in the hospital. 02/16/2007 Rotateq added to vaccine list. Provider stated to krk that an addendum with Lot # 0979F was submitted. 02/27/2007 MR received from treating hospital for admission for vomiting of dark green emesis, irritability, and lethargy. In the ER child had an episode of large, jelly-like bloody stool. PE showed a slightly distended abdomen with hyperactive bowel sounds. No palpable masses. Taken to OR for Exploratory Laparotomy, Reduction of Intussusception, Appendectomy. Limited right hemicolectomy. Post-operative DX: Intussusception. Final DX: Intussusception, with necrotic bowel.

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