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This is VAERS ID 273140

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

273140
VAERS Form:
Age:0.5
Gender:Male
Location:Utah
Vaccinated:2007-01-08
Onset:2007-02-24
Submitted:2007-02-27
Entered:2007-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / AVENTIS PASTEUR C2521AA / 2 LL / IM
FLU: INFLUENZA (FLUZONE) / AVENTIS PASTEUR U2220BB / 0 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0412F / 2 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR Y1031 / 2 LL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B58845D / 2 RL / IM
ROT: ROTAVIRUS (NO BRAND NAME) / UNKNOWN MANUFACTURER 1111F / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Bowel sounds abnormal, Dehydration, Diarrhoea, Gastroenteritis

Life Threatening? No
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? No
Previous Vaccinations:
Other Medications: ZANTAC
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X RAY
CDC 'Split Type':

Write-up:INTUSSUSCEPTION


Changed on 12/8/2009

273140 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Utah
Vaccinated:2007-01-08
Onset:2007-02-24
Submitted:2007-02-27
Entered:2007-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / AVENTIS PASTEUR C2521AA / 2 LL / IM
FLU: INFLUENZA (FLUZONE) INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR U2220BB / 0 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0412F / 2 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR Y1031 / 2 LL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B58845D / 2 RL / IM
ROT: ROTAVIRUS (NO BRAND NAME) / UNKNOWN MANUFACTURER 1111F / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Bowel sounds abnormal, Dehydration, Diarrhoea, Gastroenteritis, Intussusception, Vomiting, X-ray

Life Threatening? No
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? No
Previous Vaccinations:
Other Medications: ZANTAC
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X RAY
CDC 'Split Type':

Write-up:INTUSSUSCEPTION 03/22/07-ER report and DC summary received for 2/26/07 Ileocolic intussusception. Successfully reduced into the distal ileum with air contrast enema. Status post dehydration, resolved. History of persistent vomiting since 2/24/07. Diarrhea last week for 3 days with no bloody stools. No stools since 2/23/07- PE WNL except for abdomen slight distended and increased bowel sounds. No palpable mass. 03/23/07-records received for DOS 2/25/07-DX:gastroenteritis, dehydration.


Changed on 3/2/2010

273140 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Utah
Vaccinated:2007-01-08
Onset:2007-02-24
Submitted:2007-02-27
Entered:2007-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / AVENTIS PASTEUR C2521AA / 2 LL / IM
FLU: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR U2220BB / 0 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0412F / 2 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR Y1031 / 2 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / LEDERLE LABORATORIES B58845D / 2 RL / IM
ROT: ROTAVIRUS (NO BRAND NAME) / UNKNOWN MANUFACTURER 1111F / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Bowel sounds abnormal, Dehydration, Diarrhoea, Gastroenteritis, Intussusception, Vomiting, X-ray

Life Threatening? No
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? No
Previous Vaccinations:
Other Medications: ZANTAC
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X RAY
CDC 'Split Type':

Write-up:INTUSSUSCEPTION 03/22/07-ER report and DC summary received for 2/26/07 Ileocolic intussusception. Successfully reduced into the distal ileum with air contrast enema. Status post dehydration, resolved. History of persistent vomiting since 2/24/07. Diarrhea last week for 3 days with no bloody stools. No stools since 2/23/07- PE WNL except for abdomen slight distended and increased bowel sounds. No palpable mass. 03/23/07-records received for DOS 2/25/07-DX:gastroenteritis, dehydration.


Changed on 4/7/2010

273140 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Utah
Vaccinated:2007-01-08
Onset:2007-02-24
Submitted:2007-02-27
Entered:2007-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / AVENTIS PASTEUR C2521AA / 2 LL / IM
FLU: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR U2220BB / 0 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0412F / 2 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR Y1031 / 2 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / LEDERLE LABORATORIES B58845D / 2 RL / IM
ROT: ROTAVIRUS (NO BRAND NAME) / UNKNOWN MANUFACTURER 1111F / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Bowel sounds abnormal, Dehydration, Diarrhoea, Gastroenteritis, Intussusception, Vomiting, X-ray

Life Threatening? No
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? No
Previous Vaccinations:
Other Medications: ZANTAC
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X RAY
CDC 'Split Type':

Write-up:INTUSSUSCEPTION 03/22/07-ER report and DC summary received for 2/26/07 Ileocolic intussusception. Successfully reduced into the distal ileum with air contrast enema. Status post dehydration, resolved. History of persistent vomiting since 2/24/07. Diarrhea last week for 3 days with no bloody stools. No stools since 2/23/07- PE WNL except for abdomen slight distended and increased bowel sounds. No palpable mass. 03/23/07-records received for DOS 2/25/07-DX:gastroenteritis, dehydration.


Changed on 8/31/2010

273140 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Utah
Vaccinated:2007-01-08
Onset:2007-02-24
Submitted:2007-02-27
Entered:2007-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / AVENTIS PASTEUR SANOFI PASTEUR C2521AA / 2 LL / IM
FLU: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR SANOFI PASTEUR U2220BB / 0 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0412F / 2 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR SANOFI PASTEUR Y1031 / 2 LL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES PFIZER/WYETH B58845D / 2 RL / IM
ROT: ROTAVIRUS (NO BRAND NAME) / UNKNOWN MANUFACTURER 1111F / 1 - / PO
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1111F / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Bowel sounds abnormal, Dehydration, Diarrhoea, Gastroenteritis, Intussusception, Vomiting, X-ray

Life Threatening? No
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? No
Previous Vaccinations:
Other Medications: ZANTAC
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X RAY
CDC 'Split Type':

Write-up:INTUSSUSCEPTION 03/22/07-ER report and DC summary received for 2/26/07 Ileocolic intussusception. Successfully reduced into the distal ileum with air contrast enema. Status post dehydration, resolved. History of persistent vomiting since 2/24/07. Diarrhea last week for 3 days with no bloody stools. No stools since 2/23/07- PE WNL except for abdomen slight distended and increased bowel sounds. No palpable mass. 03/23/07-records received for DOS 2/25/07-DX:gastroenteritis, dehydration.


Changed on 4/13/2011

273140 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Utah
Vaccinated:2007-01-08
Onset:2007-02-24
Submitted:2007-02-27
Entered:2007-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2521AA / 2 LL / IM
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2220BB / 0 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0412F / 2 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1031 / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B58845D / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1111F / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Bowel sounds abnormal, Dehydration, Diarrhoea, Gastroenteritis, Intussusception, Vomiting, X-ray

Life Threatening? No
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? No
Previous Vaccinations:
Other Medications: ZANTAC
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X RAY
CDC 'Split Type':

Write-up:INTUSSUSCEPTION 03/22/07-ER report and DC summary received for 2/26/07 Ileocolic intussusception. Successfully reduced into the distal ileum with air contrast enema. Status post dehydration, resolved. History of persistent vomiting since 2/24/07. Diarrhea last week for 3 days with no bloody stools. No stools since 2/23/07- PE WNL except for abdomen slight distended and increased bowel sounds. No palpable mass. 03/23/07-records received for DOS 2/25/07-DX:gastroenteritis, dehydration.


Changed on 5/13/2011

273140 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Utah
Vaccinated:2007-01-08
Onset:2007-02-24
Submitted:2007-02-27
Entered:2007-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2521AA / 2 LL / IM
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2220BB / 0 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0412F / 2 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1031 / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B58845D / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1111F / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Bowel sounds abnormal, Dehydration, Diarrhoea, Gastroenteritis, Intussusception, Vomiting, X-ray

Life Threatening? No
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? No
Previous Vaccinations:
Other Medications: ZANTAC
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X RAY
CDC 'Split Type':

Write-up:INTUSSUSCEPTION 03/22/07-ER report and DC summary received for 2/26/07 Ileocolic intussusception. Successfully reduced into the distal ileum with air contrast enema. Status post dehydration, resolved. History of persistent vomiting since 2/24/07. Diarrhea last week for 3 days with no bloody stools. No stools since 2/23/07- PE WNL except for abdomen slight distended and increased bowel sounds. No palpable mass. 03/23/07-records received for DOS 2/25/07-DX:gastroenteritis, dehydration.


Changed on 6/11/2011

273140 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Utah
Vaccinated:2007-01-08
Onset:2007-02-24
Submitted:2007-02-27
Entered:2007-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2521AA / 2 LL / IM
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2220BB / 0 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0412F / 2 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1031 / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B58845D / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1111F / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Bowel sounds abnormal, Dehydration, Diarrhoea, Gastroenteritis, Intussusception, Vomiting, X-ray

Life Threatening? No
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? No
Previous Vaccinations:
Other Medications: ZANTAC
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X RAY
CDC 'Split Type':

Write-up:INTUSSUSCEPTION 03/22/07-ER report and DC summary received for 2/26/07 Ileocolic intussusception. Successfully reduced into the distal ileum with air contrast enema. Status post dehydration, resolved. History of persistent vomiting since 2/24/07. Diarrhea last week for 3 days with no bloody stools. No stools since 2/23/07- PE WNL except for abdomen slight distended and increased bowel sounds. No palpable mass. 03/23/07-records received for DOS 2/25/07-DX:gastroenteritis, dehydration.


Changed on 5/13/2013

273140 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Utah
Vaccinated:2007-01-08
Onset:2007-02-24
Submitted:2007-02-27
Entered:2007-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2521AA / 2 LL / IM
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2220BB / 0 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0412F / 2 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1031 / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B58845D / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1111F / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1111F / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Bowel sounds abnormal, Dehydration, Diarrhoea, Gastroenteritis, Intussusception, Vomiting, X-ray

Life Threatening? No
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? No
Previous Vaccinations:
Other Medications: ZANTAC
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X RAY
CDC 'Split Type':

Write-up:INTUSSUSCEPTION 03/22/07-ER report and DC summary received for 2/26/07 Ileocolic intussusception. Successfully reduced into the distal ileum with air contrast enema. Status post dehydration, resolved. History of persistent vomiting since 2/24/07. Diarrhea last week for 3 days with no bloody stools. No stools since 2/23/07- PE WNL except for abdomen slight distended and increased bowel sounds. No palpable mass. 03/23/07-records received for DOS 2/25/07-DX:gastroenteritis, dehydration.


Changed on 7/7/2013

273140 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Utah
Vaccinated:2007-01-08
Onset:2007-02-24
Submitted:2007-02-27
Entered:2007-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2521AA / 2 LL / IM
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2220BB / 0 LL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2220BB / 0 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0412F / 2 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1031 / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B58845D / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1111F / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Bowel sounds abnormal, Dehydration, Diarrhoea, Gastroenteritis, Intussusception, Vomiting, X-ray

Life Threatening? No
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? No
Previous Vaccinations:
Other Medications: ZANTAC
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X RAY
CDC 'Split Type':

Write-up:INTUSSUSCEPTION 03/22/07-ER report and DC summary received for 2/26/07 Ileocolic intussusception. Successfully reduced into the distal ileum with air contrast enema. Status post dehydration, resolved. History of persistent vomiting since 2/24/07. Diarrhea last week for 3 days with no bloody stools. No stools since 2/23/07- PE WNL except for abdomen slight distended and increased bowel sounds. No palpable mass. 03/23/07-records received for DOS 2/25/07-DX:gastroenteritis, dehydration.


Changed on 6/14/2014

273140 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Utah
Vaccinated:2007-01-08
Onset:2007-02-24
Submitted:2007-02-27
Entered:2007-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2521AA / 2 LL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2220BB / 0 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0412F / 2 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1031 / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B58845D / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1111F / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Bowel sounds abnormal, Dehydration, Diarrhoea, Gastroenteritis, Intussusception, Vomiting, X-ray

Life Threatening? No
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? No
Previous Vaccinations:
Other Medications: ZANTAC
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X RAY
CDC 'Split Type':

Write-up:INTUSSUSCEPTION 03/22/07-ER report and DC summary received for 2/26/07 Ileocolic intussusception. Successfully reduced into the distal ileum with air contrast enema. Status post dehydration, resolved. History of persistent vomiting since 2/24/07. Diarrhea last week for 3 days with no bloody stools. No stools since 2/23/07- PE WNL except for abdomen slight distended and increased bowel sounds. No palpable mass. 03/23/07-records received for DOS 2/25/07-DX:gastroenteritis, dehydration.


Changed on 2/14/2017

273140 Before After
VAERS Form:
Age:0.5 0.53
Gender:Male
Location:Utah
Vaccinated:2007-01-08
Onset:2007-02-24
Submitted:2007-02-27
Entered:2007-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2521AA / 2 LL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2220BB / 0 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0412F / 2 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1031 / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B58845D / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1111F / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Bowel sounds abnormal, Dehydration, Diarrhoea, Gastroenteritis, Intussusception, Vomiting, X-ray

Life Threatening? No
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? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X RAY
CDC 'Split Type':

Write-up:INTUSSUSCEPTION 03/22/07-ER report and DC summary received for 2/26/07 Ileocolic intussusception. Successfully reduced into the distal ileum with air contrast enema. Status post dehydration, resolved. History of persistent vomiting since 2/24/07. Diarrhea last week for 3 days with no bloody stools. No stools since 2/23/07- PE WNL except for abdomen slight distended and increased bowel sounds. No palpable mass. 03/23/07-records received for DOS 2/25/07-DX:gastroenteritis, dehydration.


Changed on 5/14/2017

273140 Before After
VAERS Form:
Age:0.53
Gender:Male
Location:Utah
Vaccinated:2007-01-08
Onset:2007-02-24
Submitted:2007-02-27
Entered:2007-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2521AA / 2 LL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2220BB / 0 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0412F / 2 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1031 / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B58845D / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1111F / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Bowel sounds abnormal, Dehydration, Diarrhoea, Gastroenteritis, Intussusception, Vomiting, X-ray

Life Threatening? No
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? No
Previous Vaccinations:
Other Medications: ZANTAC
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X RAY
CDC 'Split Type':

Write-up:INTUSSUSCEPTION 03/22/07-ER report and DC summary received for 2/26/07 Ileocolic intussusception. Successfully reduced into the distal ileum with air contrast enema. Status post dehydration, resolved. History of persistent vomiting since 2/24/07. Diarrhea last week for 3 days with no bloody stools. No stools since 2/23/07- PE WNL except for abdomen slight distended and increased bowel sounds. No palpable mass. 03/23/07-records received for DOS 2/25/07-DX:gastroenteritis, dehydration.


Changed on 9/14/2017

273140 Before After
VAERS Form:(blank) 1
Age:0.53
Gender:Male
Location:Utah
Vaccinated:2007-01-08
Onset:2007-02-24
Submitted:2007-02-27
Entered:2007-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2521AA / 2 3 LL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2220BB / 0 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0412F / 2 3 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1031 / 2 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B58845D / 2 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1111F / 1 2 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception, X-ray

Life Threatening? No
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? No
Previous Vaccinations:
Other Medications: ZANTAC
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X RAY
CDC 'Split Type':

Write-up:INTUSSUSCEPTION 03/22/07-ER report and DC summary received for 2/26/07 Ileocolic intussusception. Successfully reduced into the distal ileum with air contrast enema. Status post dehydration, resolved. History of persistent vomiting since 2/24/07. Diarrhea last week for 3 days with no bloody stools. No stools since 2/23/07- PE WNL except for abdomen slight distended and increased bowel sounds. No palpable mass. 03/23/07-records received for DOS 2/25/07-DX:gastroenteritis, dehydration.


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