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This is VAERS ID 274629

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 274629
VAERS Form:
Age:0.2
Sex:Male
Location:D.C.
Vaccinated:2007-03-20
Onset:2007-03-22
Submitted:2007-03-23
Entered:2007-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070BA / 0 - / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08655E / 0 RA / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0779F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Colostomy, Gastrooesophageal reflux disease, Explorative laparotomy, Abdominal 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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: LASIX, DIGOXIN, ZANTAC, ASA
Current Illness: HYPOPLASTIC RIGHT HEART, D-TGA, TRICUSPIC VALVE STENOSIS, SUB-AORTIC STENOSIS, VSD, HYPOPLASTIC AORTIC ARCH, AORTA COARCTATION,
Preexisting Conditions: PER 18
Allergies:
Diagnostic Lab Data: ABD XR
CDC 'Split Type':

Write-up: INTUSSUSCEPTION, BOWEL PERFPRATION

Changed on 12/8/2009

VAERS ID: 274629 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:D.C.
Vaccinated:2007-03-20
Onset:2007-03-22
Submitted:2007-03-23
Entered:2007-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070BA / 0 - / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070BA / 0 - / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08655E / 0 RA / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0779F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Colostomy, Gastrooesophageal reflux disease, Haematochezia, Intestinal perforation, Intussusception, White blood cell count increased, X-ray abnormal, Ultrasound abdomen abnormal, Explorative laparotomy, Abdominal X-ray, Mechanical ventilation

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: LASIX, DIGOXIN, ZANTAC, ASA
Current Illness: HYPOPLASTIC RIGHT HEART, D-TGA, TRICUSPIC VALVE STENOSIS, SUB-AORTIC STENOSIS, VSD, HYPOPLASTIC AORTIC ARCH, AORTA COARCTATION,
Preexisting Conditions: PER 18 PMH: hypoplastic right ventricle, D-TGA, s/p Norwood w/BT shunt
Allergies:
Diagnostic Lab Data: ABD XR LABS: abdominal x-ray abnormal; US of abd c/w LLQ intussusception. Contrast enema given & patient had transverse colon bowel perforation. WBC increased
CDC 'Split Type':

Write-up: INTUSSUSCEPTION, BOWEL PERFPRATION 5/25/07 Received hospital medical records which reveal patient experienced bloody stools x 4 days prior to admit 3/22/07-4/6/07. Patient to OR after bowel perforation for exp lap & colostomy was done. ID consult done & started on multiple IV antibiotics. Initially vented but able to extubate quickly. To cath lab on 3/29 for dilation of coarctation. Transfused for low H/H. Tolerated oral feedings as well as NGT feedings. GI consult revealed GERD & delayed gastric emptying. Progressed well & was d/c to home w/close f/u by multiple specialties. FINAL DX: Intussception; bowel perforation secondary to BE; exp lap & colostomy.

Changed on 3/2/2010

VAERS ID: 274629 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:D.C.
Vaccinated:2007-03-20
Onset:2007-03-22
Submitted:2007-03-23
Entered:2007-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070BA / 0 - / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B08655E / 0 RA / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0779F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Colostomy, Gastrooesophageal reflux disease, Haematochezia, Intestinal perforation, Intussusception, White blood cell count increased, X-ray abnormal, Ultrasound abdomen abnormal, Explorative laparotomy, Abdominal X-ray, Mechanical ventilation

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: LASIX, DIGOXIN, ZANTAC, ASA
Current Illness: HYPOPLASTIC RIGHT HEART, D-TGA, TRICUSPIC VALVE STENOSIS, SUB-AORTIC STENOSIS, VSD, HYPOPLASTIC AORTIC ARCH, AORTA COARCTATION,
Preexisting Conditions: PER 18 PMH: hypoplastic right ventricle, D-TGA, s/p Norwood w/BT shunt
Allergies:
Diagnostic Lab Data: ABD XR LABS: abdominal x-ray abnormal; US of abd c/w LLQ intussusception. Contrast enema given & patient had transverse colon bowel perforation. WBC increased
CDC 'Split Type':

Write-up: INTUSSUSCEPTION, BOWEL PERFPRATION 5/25/07 Received hospital medical records which reveal patient experienced bloody stools x 4 days prior to admit 3/22/07-4/6/07. Patient to OR after bowel perforation for exp lap & colostomy was done. ID consult done & started on multiple IV antibiotics. Initially vented but able to extubate quickly. To cath lab on 3/29 for dilation of coarctation. Transfused for low H/H. Tolerated oral feedings as well as NGT feedings. GI consult revealed GERD & delayed gastric emptying. Progressed well & was d/c to home w/close f/u by multiple specialties. FINAL DX: Intussception; bowel perforation secondary to BE; exp lap & colostomy.

Changed on 4/7/2010

VAERS ID: 274629 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:D.C.
Vaccinated:2007-03-20
Onset:2007-03-22
Submitted:2007-03-23
Entered:2007-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070BA / 0 - / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08655E / 0 RA / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0779F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Colostomy, Gastrooesophageal reflux disease, Haematochezia, Intestinal perforation, Intussusception, White blood cell count increased, X-ray abnormal, Ultrasound abdomen abnormal, Explorative laparotomy, Abdominal X-ray, Mechanical ventilation

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: LASIX, DIGOXIN, ZANTAC, ASA
Current Illness: HYPOPLASTIC RIGHT HEART, D-TGA, TRICUSPIC VALVE STENOSIS, SUB-AORTIC STENOSIS, VSD, HYPOPLASTIC AORTIC ARCH, AORTA COARCTATION,
Preexisting Conditions: PER 18 PMH: hypoplastic right ventricle, D-TGA, s/p Norwood w/BT shunt
Allergies:
Diagnostic Lab Data: ABD XR LABS: abdominal x-ray abnormal; US of abd c/w LLQ intussusception. Contrast enema given & patient had transverse colon bowel perforation. WBC increased
CDC 'Split Type':

Write-up: INTUSSUSCEPTION, BOWEL PERFPRATION 5/25/07 Received hospital medical records which reveal patient experienced bloody stools x 4 days prior to admit 3/22/07-4/6/07. Patient to OR after bowel perforation for exp lap & colostomy was done. ID consult done & started on multiple IV antibiotics. Initially vented but able to extubate quickly. To cath lab on 3/29 for dilation of coarctation. Transfused for low H/H. Tolerated oral feedings as well as NGT feedings. GI consult revealed GERD & delayed gastric emptying. Progressed well & was d/c to home w/close f/u by multiple specialties. FINAL DX: Intussception; bowel perforation secondary to BE; exp lap & colostomy.

Changed on 8/31/2010

VAERS ID: 274629 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:D.C.
Vaccinated:2007-03-20
Onset:2007-03-22
Submitted:2007-03-23
Entered:2007-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070BA / 0 - / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B08655E / 0 RA / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0779F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Colostomy, Gastrooesophageal reflux disease, Haematochezia, Intestinal perforation, Intussusception, White blood cell count increased, X-ray abnormal, Ultrasound abdomen abnormal, Explorative laparotomy, Abdominal X-ray, Mechanical ventilation

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: LASIX, DIGOXIN, ZANTAC, ASA
Current Illness: HYPOPLASTIC RIGHT HEART, D-TGA, TRICUSPIC VALVE STENOSIS, SUB-AORTIC STENOSIS, VSD, HYPOPLASTIC AORTIC ARCH, AORTA COARCTATION,
Preexisting Conditions: PER 18 PMH: hypoplastic right ventricle, D-TGA, s/p Norwood w/BT shunt
Allergies:
Diagnostic Lab Data: ABD XR LABS: abdominal x-ray abnormal; US of abd c/w LLQ intussusception. Contrast enema given & patient had transverse colon bowel perforation. WBC increased
CDC 'Split Type':

Write-up: INTUSSUSCEPTION, BOWEL PERFPRATION 5/25/07 Received hospital medical records which reveal patient experienced bloody stools x 4 days prior to admit 3/22/07-4/6/07. Patient to OR after bowel perforation for exp lap & colostomy was done. ID consult done & started on multiple IV antibiotics. Initially vented but able to extubate quickly. To cath lab on 3/29 for dilation of coarctation. Transfused for low H/H. Tolerated oral feedings as well as NGT feedings. GI consult revealed GERD & delayed gastric emptying. Progressed well & was d/c to home w/close f/u by multiple specialties. FINAL DX: Intussception; bowel perforation secondary to BE; exp lap & colostomy.

Changed on 5/13/2013

VAERS ID: 274629 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:D.C.
Vaccinated:2007-03-20
Onset:2007-03-22
Submitted:2007-03-23
Entered:2007-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070BA / 0 - / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08655E / 0 RA / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0779F / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0779F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Colostomy, Gastrooesophageal reflux disease, Haematochezia, Intestinal perforation, Intussusception, White blood cell count increased, X-ray abnormal, Ultrasound abdomen abnormal, Explorative laparotomy, Abdominal X-ray, Mechanical ventilation

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: LASIX, DIGOXIN, ZANTAC, ASA
Current Illness: HYPOPLASTIC RIGHT HEART, D-TGA, TRICUSPIC VALVE STENOSIS, SUB-AORTIC STENOSIS, VSD, HYPOPLASTIC AORTIC ARCH, AORTA COARCTATION,
Preexisting Conditions: PER 18 PMH: hypoplastic right ventricle, D-TGA, s/p Norwood w/BT shunt
Allergies:
Diagnostic Lab Data: ABD XR LABS: abdominal x-ray abnormal; US of abd c/w LLQ intussusception. Contrast enema given & patient had transverse colon bowel perforation. WBC increased
CDC 'Split Type':

Write-up: INTUSSUSCEPTION, BOWEL PERFPRATION 5/25/07 Received hospital medical records which reveal patient experienced bloody stools x 4 days prior to admit 3/22/07-4/6/07. Patient to OR after bowel perforation for exp lap & colostomy was done. ID consult done & started on multiple IV antibiotics. Initially vented but able to extubate quickly. To cath lab on 3/29 for dilation of coarctation. Transfused for low H/H. Tolerated oral feedings as well as NGT feedings. GI consult revealed GERD & delayed gastric emptying. Progressed well & was d/c to home w/close f/u by multiple specialties. FINAL DX: Intussception; bowel perforation secondary to BE; exp lap & colostomy.

Changed on 2/14/2017

VAERS ID: 274629 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:D.C.
Vaccinated:2007-03-20
Onset:2007-03-22
Submitted:2007-03-23
Entered:2007-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070BA / 0 - / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08655E / 0 RA / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0779F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Colostomy, Gastrooesophageal reflux disease, Haematochezia, Intestinal perforation, Intussusception, White blood cell count increased, X-ray abnormal, Ultrasound abdomen abnormal, Explorative laparotomy, Abdominal X-ray, Mechanical ventilation

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: LASIX, DIGOXIN, ZANTAC, ASA
Current Illness: HYPOPLASTIC RIGHT HEART, D-TGA, TRICUSPIC VALVE STENOSIS, SUB-AORTIC STENOSIS, VSD, HYPOPLASTIC AORTIC ARCH, AORTA COARCTATION, S/P NORWOOD I & BT SHUNT, FEEDING INTOLERANCE, S/P RECENT GASTRENTERITIS (ROTAZYME(-), STOOL Cx(-).
Preexisting Conditions: PER 18 PMH: hypoplastic right ventricle, D-TGA, s/p Norwood w/BT shunt
Allergies:
Diagnostic Lab Data: ABD XR LABS: abdominal x-ray abnormal; US of abd c/w LLQ intussusception. Contrast enema given & patient had transverse colon bowel perforation. WBC increased
CDC 'Split Type':

Write-up: INTUSSUSCEPTION, BOWEL PERFPRATION 5/25/07 Received hospital medical records which reveal patient experienced bloody stools x 4 days prior to admit 3/22/07-4/6/07. Patient to OR after bowel perforation for exp lap & colostomy was done. ID consult done & started on multiple IV antibiotics. Initially vented but able to extubate quickly. To cath lab on 3/29 for dilation of coarctation. Transfused for low H/H. Tolerated oral feedings as well as NGT feedings. GI consult revealed GERD & delayed gastric emptying. Progressed well & was d/c to home w/close f/u by multiple specialties. FINAL DX: Intussception; bowel perforation secondary to BE; exp lap & colostomy.

Changed on 9/14/2017

VAERS ID: 274629 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:D.C.
Vaccinated:2007-03-20
Onset:2007-03-22
Submitted:2007-03-23
Entered:2007-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070BA / 0 1 - / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08655E / 0 1 RA / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0779F / 0 1 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intestinal perforation, Intussusception, Abdominal 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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: LASIX, DIGOXIN, ZANTAC, ASA
Current Illness: HYPOPLASTIC RIGHT HEART, D-TGA, TRICUSPIC VALVE STENOSIS, SUB-AORTIC STENOSIS, VSD, HYPOPLASTIC AORTIC ARCH, AORTA COARCTATION, S/P NORWOOD I & BT SHUNT, FEEDING INTOLERANCE, S/P RECENT GASTRENTERITIS (ROTAZYME(-), STOOL Cx(-).
Preexisting Conditions: PER 18 PMH: hypoplastic right ventricle, D-TGA, s/p Norwood w/BT shunt
Allergies:
Diagnostic Lab Data: ABD XR LABS: abdominal x-ray abnormal; US of abd c/w LLQ intussusception. Contrast enema given & patient had transverse colon bowel perforation. WBC increased
CDC 'Split Type':

Write-up: INTUSSUSCEPTION, BOWEL PERFPRATION 5/25/07 Received hospital medical records which reveal patient experienced bloody stools x 4 days prior to admit 3/22/07-4/6/07. Patient to OR after bowel perforation for exp lap & colostomy was done. ID consult done & started on multiple IV antibiotics. Initially vented but able to extubate quickly. To cath lab on 3/29 for dilation of coarctation. Transfused for low H/H. Tolerated oral feedings as well as NGT feedings. GI consult revealed GERD & delayed gastric emptying. Progressed well & was d/c to home w/close f/u by multiple specialties. FINAL DX: Intussception; bowel perforation secondary to BE; exp lap & colostomy.

Changed on 2/14/2018

VAERS ID: 274629 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:D.C.
Vaccinated:2007-03-20
Onset:2007-03-22
Submitted:2007-03-23
Entered:2007-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070BA / 1 - / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08655E / 1 RA / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0779F / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intestinal perforation, Intussusception, Abdominal 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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: LASIX, DIGOXIN, ZANTAC, ASA
Current Illness: HYPOPLASTIC RIGHT HEART, D-TGA, TRICUSPIC VALVE STENOSIS, SUB-AORTIC STENOSIS, VSD, HYPOPLASTIC AORTIC ARCH, AORTA COARCTATION, S/P NORWOOD I & BT SHUNT, FEEDING INTOLERANCE, S/P RECENT GASTRENTERITIS (ROTAZYME(-), STOOL Cx(-).
Preexisting Conditions: PER 18 PMH: hypoplastic right ventricle, D-TGA, s/p Norwood w/BT shunt
Allergies:
Diagnostic Lab Data: ABD XR LABS: abdominal x-ray abnormal; US of abd c/w LLQ intussusception. Contrast enema given & patient had transverse colon bowel perforation. WBC increased
CDC 'Split Type':

Write-up: INTUSSUSCEPTION, BOWEL PERFPRATION 5/25/07 Received hospital medical records which reveal patient experienced bloody stools x 4 days prior to admit 3/22/07-4/6/07. Patient to OR after bowel perforation for exp lap & colostomy was done. ID consult done & started on multiple IV antibiotics. Initially vented but able to extubate quickly. To cath lab on 3/29 for dilation of coarctation. Transfused for low H/H. Tolerated oral feedings as well as NGT feedings. GI consult revealed GERD & delayed gastric emptying. Progressed well & was d/c to home w/close f/u by multiple specialties. FINAL DX: Intussception; bowel perforation secondary to BE; exp lap & colostomy.

Changed on 6/14/2018

VAERS ID: 274629 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:D.C.
Vaccinated:2007-03-20
Onset:2007-03-22
Submitted:2007-03-23
Entered:2007-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070BA / 1 - / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08655E / 1 RA / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0779F / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intestinal perforation, Intussusception, Abdominal 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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: LASIX, DIGOXIN, ZANTAC, ASA
Current Illness: HYPOPLASTIC RIGHT HEART, D-TGA, TRICUSPIC VALVE STENOSIS, SUB-AORTIC STENOSIS, VSD, HYPOPLASTIC AORTIC ARCH, AORTA COARCTATION, S/P NORWOOD I & BT SHUNT, FEEDING INTOLERANCE, S/P RECENT GASTRENTERITIS (ROTAZYME(-), STOOL Cx(-).
Preexisting Conditions: PER 18 PMH: hypoplastic right ventricle, D-TGA, s/p Norwood w/BT shunt
Allergies:
Diagnostic Lab Data: ABD XR LABS: abdominal x-ray abnormal; US of abd c/w LLQ intussusception. Contrast enema given & patient had transverse colon bowel perforation. WBC increased
CDC 'Split Type':

Write-up: INTUSSUSCEPTION, BOWEL PERFPRATION 5/25/07 Received hospital medical records which reveal patient experienced bloody stools x 4 days prior to admit 3/22/07-4/6/07. Patient to OR after bowel perforation for exp lap & colostomy was done. ID consult done & started on multiple IV antibiotics. Initially vented but able to extubate quickly. To cath lab on 3/29 for dilation of coarctation. Transfused for low H/H. Tolerated oral feedings as well as NGT feedings. GI consult revealed GERD & delayed gastric emptying. Progressed well & was d/c to home w/close f/u by multiple specialties. FINAL DX: Intussception; bowel perforation secondary to BE; exp lap & colostomy.

Changed on 8/14/2018

VAERS ID: 274629 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:D.C.
Vaccinated:2007-03-20
Onset:2007-03-22
Submitted:2007-03-23
Entered:2007-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070BA / 1 - / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08655E / 1 RA / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0779F / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intestinal perforation, Intussusception, Abdominal 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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: LASIX, DIGOXIN, ZANTAC, ASA
Current Illness: HYPOPLASTIC RIGHT HEART, D-TGA, TRICUSPIC VALVE STENOSIS, SUB-AORTIC STENOSIS, VSD, HYPOPLASTIC AORTIC ARCH, AORTA COARCTATION, S/P NORWOOD I & BT SHUNT, FEEDING INTOLERANCE, S/P RECENT GASTRENTERITIS (ROTAZYME(-), STOOL Cx(-).
Preexisting Conditions: PER 18 PMH: hypoplastic right ventricle, D-TGA, s/p Norwood w/BT shunt
Allergies:
Diagnostic Lab Data: ABD XR LABS: abdominal x-ray abnormal; US of abd c/w LLQ intussusception. Contrast enema given & patient had transverse colon bowel perforation. WBC increased
CDC 'Split Type':

Write-up: INTUSSUSCEPTION, BOWEL PERFPRATION 5/25/07 Received hospital medical records which reveal patient experienced bloody stools x 4 days prior to admit 3/22/07-4/6/07. Patient to OR after bowel perforation for exp lap & colostomy was done. ID consult done & started on multiple IV antibiotics. Initially vented but able to extubate quickly. To cath lab on 3/29 for dilation of coarctation. Transfused for low H/H. Tolerated oral feedings as well as NGT feedings. GI consult revealed GERD & delayed gastric emptying. Progressed well & was d/c to home w/close f/u by multiple specialties. FINAL DX: Intussception; bowel perforation secondary to BE; exp lap & colostomy.

Changed on 9/14/2018

VAERS ID: 274629 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:D.C.
Vaccinated:2007-03-20
Onset:2007-03-22
Submitted:2007-03-23
Entered:2007-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070BA / 1 - / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08655E / 1 RA / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0779F / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intestinal perforation, Intussusception, Abdominal 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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: LASIX, DIGOXIN, ZANTAC, ASA
Current Illness: HYPOPLASTIC RIGHT HEART, D-TGA, TRICUSPIC VALVE STENOSIS, SUB-AORTIC STENOSIS, VSD, HYPOPLASTIC AORTIC ARCH, AORTA COARCTATION, S/P NORWOOD I & BT SHUNT, FEEDING INTOLERANCE, S/P RECENT GASTRENTERITIS (ROTAZYME(-), STOOL Cx(-).
Preexisting Conditions: PER 18 PMH: hypoplastic right ventricle, D-TGA, s/p Norwood w/BT shunt
Allergies:
Diagnostic Lab Data: ABD XR LABS: abdominal x-ray abnormal; US of abd c/w LLQ intussusception. Contrast enema given & patient had transverse colon bowel perforation. WBC increased
CDC 'Split Type':

Write-up: INTUSSUSCEPTION, BOWEL PERFPRATION 5/25/07 Received hospital medical records which reveal patient experienced bloody stools x 4 days prior to admit 3/22/07-4/6/07. Patient to OR after bowel perforation for exp lap & colostomy was done. ID consult done & started on multiple IV antibiotics. Initially vented but able to extubate quickly. To cath lab on 3/29 for dilation of coarctation. Transfused for low H/H. Tolerated oral feedings as well as NGT feedings. GI consult revealed GERD & delayed gastric emptying. Progressed well & was d/c to home w/close f/u by multiple specialties. FINAL DX: Intussception; bowel perforation secondary to BE; exp lap & colostomy.

Changed on 10/14/2018

VAERS ID: 274629 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:D.C.
Vaccinated:2007-03-20
Onset:2007-03-22
Submitted:2007-03-23
Entered:2007-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070BA / 1 - / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08655E / 1 RA / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0779F / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intestinal perforation, Intussusception, Abdominal 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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: LASIX, DIGOXIN, ZANTAC, ASA
Current Illness: HYPOPLASTIC RIGHT HEART, D-TGA, TRICUSPIC VALVE STENOSIS, SUB-AORTIC STENOSIS, VSD, HYPOPLASTIC AORTIC ARCH, AORTA COARCTATION, S/P NORWOOD I & BT SHUNT, FEEDING INTOLERANCE, S/P RECENT GASTRENTERITIS (ROTAZYME(-), STOOL Cx(-).
Preexisting Conditions: PER 18 PMH: hypoplastic right ventricle, D-TGA, s/p Norwood w/BT shunt
Allergies:
Diagnostic Lab Data: ABD XR LABS: abdominal x-ray abnormal; US of abd c/w LLQ intussusception. Contrast enema given & patient had transverse colon bowel perforation. WBC increased
CDC 'Split Type':

Write-up: INTUSSUSCEPTION, BOWEL PERFPRATION 5/25/07 Received hospital medical records which reveal patient experienced bloody stools x 4 days prior to admit 3/22/07-4/6/07. Patient to OR after bowel perforation for exp lap & colostomy was done. ID consult done & started on multiple IV antibiotics. Initially vented but able to extubate quickly. To cath lab on 3/29 for dilation of coarctation. Transfused for low H/H. Tolerated oral feedings as well as NGT feedings. GI consult revealed GERD & delayed gastric emptying. Progressed well & was d/c to home w/close f/u by multiple specialties. FINAL DX: Intussception; bowel perforation secondary to BE; exp lap & colostomy.

Changed on 12/10/2020

VAERS ID: 274629 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:D.C. Maryland
Vaccinated:2007-03-20
Onset:2007-03-22
Submitted:2007-03-23
Entered:2007-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070BA / 1 - / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08655E / 1 RA / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0779F / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intestinal perforation, Intussusception, Abdominal 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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: LASIX, DIGOXIN, ZANTAC, ASA
Current Illness: HYPOPLASTIC RIGHT HEART, D-TGA, TRICUSPIC VALVE STENOSIS, SUB-AORTIC STENOSIS, VSD, HYPOPLASTIC AORTIC ARCH, AORTA COARCTATION, S/P NORWOOD I & BT SHUNT, FEEDING INTOLERANCE, S/P RECENT GASTRENTERITIS (ROTAZYME(-), STOOL Cx(-).
Preexisting Conditions: PER 18 PMH: hypoplastic right ventricle, D-TGA, s/p Norwood w/BT shunt
Allergies:
Diagnostic Lab Data: ABD XR LABS: abdominal x-ray abnormal; US of abd c/w LLQ intussusception. Contrast enema given & patient had transverse colon bowel perforation. WBC increased
CDC 'Split Type':

Write-up: INTUSSUSCEPTION, BOWEL PERFPRATION 5/25/07 Received hospital medical records which reveal patient experienced bloody stools x 4 days prior to admit 3/22/07-4/6/07. Patient to OR after bowel perforation for exp lap & colostomy was done. ID consult done & started on multiple IV antibiotics. Initially vented but able to extubate quickly. To cath lab on 3/29 for dilation of coarctation. Transfused for low H/H. Tolerated oral feedings as well as NGT feedings. GI consult revealed GERD & delayed gastric emptying. Progressed well & was d/c to home w/close f/u by multiple specialties. FINAL DX: Intussception; bowel perforation secondary to BE; exp lap & colostomy.

Changed on 12/24/2020

VAERS ID: 274629 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Maryland
Vaccinated:2007-03-20
Onset:2007-03-22
Submitted:2007-03-23
Entered:2007-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070BA / 1 - / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08655E / 1 RA / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0779F / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intestinal perforation, Intussusception, Abdominal 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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: LASIX, DIGOXIN, ZANTAC, ASA
Current Illness: HYPOPLASTIC RIGHT HEART, D-TGA, TRICUSPIC VALVE STENOSIS, SUB-AORTIC STENOSIS, VSD, HYPOPLASTIC AORTIC ARCH, AORTA COARCTATION, S/P NORWOOD I & BT SHUNT, FEEDING INTOLERANCE, S/P RECENT GASTRENTERITIS (ROTAZYME(-), STOOL Cx(-).
Preexisting Conditions: PER 18 PMH: hypoplastic right ventricle, D-TGA, s/p Norwood w/BT shunt
Allergies:
Diagnostic Lab Data: ABD XR LABS: abdominal x-ray abnormal; US of abd c/w LLQ intussusception. Contrast enema given & patient had transverse colon bowel perforation. WBC increased
CDC 'Split Type':

Write-up: INTUSSUSCEPTION, BOWEL PERFPRATION 5/25/07 Received hospital medical records which reveal patient experienced bloody stools x 4 days prior to admit 3/22/07-4/6/07. Patient to OR after bowel perforation for exp lap & colostomy was done. ID consult done & started on multiple IV antibiotics. Initially vented but able to extubate quickly. To cath lab on 3/29 for dilation of coarctation. Transfused for low H/H. Tolerated oral feedings as well as NGT feedings. GI consult revealed GERD & delayed gastric emptying. Progressed well & was d/c to home w/close f/u by multiple specialties. FINAL DX: Intussception; bowel perforation secondary to BE; exp lap & colostomy.

Changed on 12/30/2020

VAERS ID: 274629 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Maryland
Vaccinated:2007-03-20
Onset:2007-03-22
Submitted:2007-03-23
Entered:2007-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070BA / 1 - / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08655E / 1 RA / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0779F / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intestinal perforation, Intussusception, Abdominal 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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: LASIX, DIGOXIN, ZANTAC, ASA
Current Illness: HYPOPLASTIC RIGHT HEART, D-TGA, TRICUSPIC VALVE STENOSIS, SUB-AORTIC STENOSIS, VSD, HYPOPLASTIC AORTIC ARCH, AORTA COARCTATION, S/P NORWOOD I & BT SHUNT, FEEDING INTOLERANCE, S/P RECENT GASTRENTERITIS (ROTAZYME(-), STOOL Cx(-).
Preexisting Conditions: PER 18 PMH: hypoplastic right ventricle, D-TGA, s/p Norwood w/BT shunt
Allergies:
Diagnostic Lab Data: ABD XR LABS: abdominal x-ray abnormal; US of abd c/w LLQ intussusception. Contrast enema given & patient had transverse colon bowel perforation. WBC increased
CDC 'Split Type':

Write-up: INTUSSUSCEPTION, BOWEL PERFPRATION 5/25/07 Received hospital medical records which reveal patient experienced bloody stools x 4 days prior to admit 3/22/07-4/6/07. Patient to OR after bowel perforation for exp lap & colostomy was done. ID consult done & started on multiple IV antibiotics. Initially vented but able to extubate quickly. To cath lab on 3/29 for dilation of coarctation. Transfused for low H/H. Tolerated oral feedings as well as NGT feedings. GI consult revealed GERD & delayed gastric emptying. Progressed well & was d/c to home w/close f/u by multiple specialties. FINAL DX: Intussception; bowel perforation secondary to BE; exp lap & colostomy.

Changed on 5/7/2021

VAERS ID: 274629 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Maryland
Vaccinated:2007-03-20
Onset:2007-03-22
Submitted:2007-03-23
Entered:2007-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070BA / 1 - / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08655E / 1 RA / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0779F / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intestinal perforation, Intussusception, Abdominal 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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: LASIX, DIGOXIN, ZANTAC, ASA
Current Illness: HYPOPLASTIC RIGHT HEART, D-TGA, TRICUSPIC VALVE STENOSIS, SUB-AORTIC STENOSIS, VSD, HYPOPLASTIC AORTIC ARCH, AORTA COARCTATION, S/P NORWOOD I & BT SHUNT, FEEDING INTOLERANCE, S/P RECENT GASTRENTERITIS (ROTAZYME(-), STOOL Cx(-).
Preexisting Conditions: PER 18 PMH: hypoplastic right ventricle, D-TGA, s/p Norwood w/BT shunt
Allergies:
Diagnostic Lab Data: ABD XR LABS: abdominal x-ray abnormal; US of abd c/w LLQ intussusception. Contrast enema given & patient had transverse colon bowel perforation. WBC increased
CDC 'Split Type':

Write-up: INTUSSUSCEPTION, BOWEL PERFPRATION 5/25/07 Received hospital medical records which reveal patient experienced bloody stools x 4 days prior to admit 3/22/07-4/6/07. Patient to OR after bowel perforation for exp lap & colostomy was done. ID consult done & started on multiple IV antibiotics. Initially vented but able to extubate quickly. To cath lab on 3/29 for dilation of coarctation. Transfused for low H/H. Tolerated oral feedings as well as NGT feedings. GI consult revealed GERD & delayed gastric emptying. Progressed well & was d/c to home w/close f/u by multiple specialties. FINAL DX: Intussception; bowel perforation secondary to BE; exp lap & colostomy.

Changed on 5/14/2021

VAERS ID: 274629 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Maryland
Vaccinated:2007-03-20
Onset:2007-03-22
Submitted:2007-03-23
Entered:2007-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070BA / 1 - / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08655E / 1 RA / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0779F / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intestinal perforation, Intussusception, Abdominal 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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: LASIX, DIGOXIN, ZANTAC, ASA
Current Illness: HYPOPLASTIC RIGHT HEART, D-TGA, TRICUSPIC VALVE STENOSIS, SUB-AORTIC STENOSIS, VSD, HYPOPLASTIC AORTIC ARCH, AORTA COARCTATION, S/P NORWOOD I & BT SHUNT, FEEDING INTOLERANCE, S/P RECENT GASTRENTERITIS (ROTAZYME(-), STOOL Cx(-).
Preexisting Conditions: PER 18 PMH: hypoplastic right ventricle, D-TGA, s/p Norwood w/BT shunt
Allergies:
Diagnostic Lab Data: ABD XR LABS: abdominal x-ray abnormal; US of abd c/w LLQ intussusception. Contrast enema given & patient had transverse colon bowel perforation. WBC increased
CDC 'Split Type':

Write-up: INTUSSUSCEPTION, BOWEL PERFPRATION 5/25/07 Received hospital medical records which reveal patient experienced bloody stools x 4 days prior to admit 3/22/07-4/6/07. Patient to OR after bowel perforation for exp lap & colostomy was done. ID consult done & started on multiple IV antibiotics. Initially vented but able to extubate quickly. To cath lab on 3/29 for dilation of coarctation. Transfused for low H/H. Tolerated oral feedings as well as NGT feedings. GI consult revealed GERD & delayed gastric emptying. Progressed well & was d/c to home w/close f/u by multiple specialties. FINAL DX: Intussception; bowel perforation secondary to BE; exp lap & colostomy.

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