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This is VAERS ID 278155

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 278155
VAERS Form:
Age:0.6
Gender:Male
Location:Tennessee
Vaccinated:2006-12-13
Onset:2007-04-15
Submitted:2007-05-03
Entered:2007-05-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (FLUZONE) / SANOFI PASTEUR 42174RA / 1 LA / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1034F / 2 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Abdominal pain, Abdominal pain upper, Barium enema, Blood chloride, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: WBC - 11.45, Hem - 11.5, HCT:34.2, and Platelets 431, CRP - 1.0, NA - 138, K+ - 4.4, chloride - 99, CO2 - 18, Glucose - 91, Bun - 10, creatinine - 04, LFTs - normal ABD. Films, KUB, Barium Enema
CDC 'Split Type':

Write-up: 4/16/07 acute vomiting, stomach pains - screaming seen in ETCH ER and fever and Diarrhea ? Paralytic Ileus GI consult - Bilious Emesis and concern for intussusception and flims/KUB normal s/p enema with good results.


Changed on 12/8/2009

VAERS ID: 278155 Before After
VAERS Form:
Age:0.6
Gender:Male
Location:Tennessee
Vaccinated:2006-12-13
Onset:2007-04-15
Submitted:2007-05-03
Entered:2007-05-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (FLUZONE) INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR 42174RA / 1 LA / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1034F / 2 - / PO

Administered by: Private      Purchased by: Unknown Private
Symptoms: Abdominal pain, Abdominal pain upper, Barium enema, Blood chloride, Blood creatinine, Blood glucose, Blood potassium, Blood urea, C-reactive protein increased, Carbon dioxide normal, Constipation, Diarrhoea, Ileus paralytic, Intussusception, Lethargy, Opisthotonus, Platelet count, Pyrexia, Screaming, Vomiting, White blood cell count, Enema administration, Laboratory test, Liver function test, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none none. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: WBC - 11.45, Hem - 11.5, HCT:34.2, and Platelets 431, CRP - 1.0, NA - 138, K+ - 4.4, chloride - 99, CO2 - 18, Glucose - 91, Bun - 10, creatinine - 04, LFTs - normal ABD. Films, KUB, Barium Enema Enema. Labs and Diagnostics: Abdominal X-rays x
CDC 'Split Type':

Write-up: 4/16/07 acute vomiting, stomach pains - screaming seen in ETCH ER and fever and Diarrhea ? Paralytic Ileus GI consult - Bilious Emesis and concern for intussusception and flims/KUB normal s/p enema with good results. 07/02/2007 MR received for hospital stay 4/19-21/2007. Infant developed intermittant, severe abdominal pain (evidenced by back arching and screaming) and emesis 5 days prior to admission. Seen in ER x 2 for above and progression to bilious vomiting and acting "lifeless". 2nd ER visit with DX of constipation and enema given with improvement initially. Symptoms reoccured and child was admitted. Barium enema succesfully reduced intussusception. Feeding, stooling, and voiding well post procedure. DX: c/w Intussusception.


Changed on 5/13/2013

VAERS ID: 278155 Before After
VAERS Form:
Age:0.6
Gender:Male
Location:Tennessee
Vaccinated:2006-12-13
Onset:2007-04-15
Submitted:2007-05-03
Entered:2007-05-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR 42174RA / 1 LA / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1034F / 2 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1034F / 2 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Abdominal pain upper, Barium enema, Blood chloride, Blood creatinine, Blood glucose, Blood potassium, Blood urea, C-reactive protein increased, Carbon dioxide normal, Constipation, Diarrhoea, Ileus paralytic, Intussusception, Lethargy, Opisthotonus, Platelet count, Pyrexia, Screaming, Vomiting, White blood cell count, Enema administration, Laboratory test, Liver function test, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: WBC - 11.45, Hem - 11.5, HCT:34.2, and Platelets 431, CRP - 1.0, NA - 138, K+ - 4.4, chloride - 99, CO2 - 18, Glucose - 91, Bun - 10, creatinine - 04, LFTs - normal ABD. Films, KUB, Barium Enema. Labs and Diagnostics: Abdominal X-rays x
CDC 'Split Type':

Write-up: 4/16/07 acute vomiting, stomach pains - screaming seen in ER and fever and Diarrhea ? Paralytic Ileus GI consult - Bilious Emesis and concern for intussusception and flims/KUB normal s/p enema with good results. 07/02/2007 MR received for hospital stay 4/19-21/2007. Infant developed intermittant, severe abdominal pain (evidenced by back arching and screaming) and emesis 5 days prior to admission. Seen in ER x 2 for above and progression to bilious vomiting and acting "lifeless". 2nd ER visit with DX of constipation and enema given with improvement initially. Symptoms reoccured and child was admitted. Barium enema succesfully reduced intussusception. Feeding, stooling, and voiding well post procedure. DX: c/w Intussusception.


Changed on 7/7/2013

VAERS ID: 278155 Before After
VAERS Form:
Age:0.6
Gender:Male
Location:Tennessee
Vaccinated:2006-12-13
Onset:2007-04-15
Submitted:2007-05-03
Entered:2007-05-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR 42174RA / 1 LA / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR 42174RA / 1 LA / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1034F / 2 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Abdominal pain upper, Barium enema, Blood chloride, Blood creatinine, Blood glucose, Blood potassium, Blood urea, C-reactive protein increased, Carbon dioxide normal, Constipation, Diarrhoea, Ileus paralytic, Intussusception, Lethargy, Opisthotonus, Platelet count, Pyrexia, Screaming, Vomiting, White blood cell count, Enema administration, Laboratory test, Liver function test, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: WBC - 11.45, Hem - 11.5, HCT:34.2, and Platelets 431, CRP - 1.0, NA - 138, K+ - 4.4, chloride - 99, CO2 - 18, Glucose - 91, Bun - 10, creatinine - 04, LFTs - normal ABD. Films, KUB, Barium Enema. Labs and Diagnostics: Abdominal X-rays x
CDC 'Split Type':

Write-up: 4/16/07 acute vomiting, stomach pains - screaming seen in ER and fever and Diarrhea ? Paralytic Ileus GI consult - Bilious Emesis and concern for intussusception and flims/KUB normal s/p enema with good results. 07/02/2007 MR received for hospital stay 4/19-21/2007. Infant developed intermittant, severe abdominal pain (evidenced by back arching and screaming) and emesis 5 days prior to admission. Seen in ER x 2 for above and progression to bilious vomiting and acting "lifeless". 2nd ER visit with DX of constipation and enema given with improvement initially. Symptoms reoccured and child was admitted. Barium enema succesfully reduced intussusception. Feeding, stooling, and voiding well post procedure. DX: c/w Intussusception.


Changed on 2/14/2017

VAERS ID: 278155 Before After
VAERS Form:
Age:0.6
Gender:Male
Location:Tennessee
Vaccinated:2006-12-13
Onset:2007-04-15
Submitted:2007-05-03
Entered:2007-05-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR 42174RA / 1 LA / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1034F / 2 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Abdominal pain upper, Barium enema, Blood chloride, Blood creatinine, Blood glucose, Blood potassium, Blood urea, C-reactive protein increased, Carbon dioxide normal, Constipation, Diarrhoea, Ileus paralytic, Intussusception, Lethargy, Opisthotonus, Platelet count, Pyrexia, Screaming, Vomiting, White blood cell count, Enema administration, Laboratory test, Liver function test, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: WBC - 11.45, Hem - 11.5, HCT:34.2, and Platelets 431, CRP - 1.0, NA - 138, K+ - 4.4, chloride - 99, CO2 - 18, Glucose - 91, Bun - 10, creatinine - 04, LFTs - normal ABD. Films, KUB, Barium Enema. Labs and Diagnostics: Abdominal X-rays x 3-normal. Barium enema which showed a filling defect at hepatic flexure c/w intussusception.
CDC 'Split Type':

Write-up: 4/16/07 acute vomiting, stomach pains - screaming seen in ER and fever and Diarrhea ? Paralytic Ileus GI consult - Bilious Emesis and concern for intussusception and flims/KUB normal s/p enema with good results. 07/02/2007 MR received for hospital stay 4/19-21/2007. Infant developed intermittant, severe abdominal pain (evidenced by back arching and screaming) and emesis 5 days prior to admission. Seen in ER x 2 for above and progression to bilious vomiting and acting "lifeless". 2nd ER visit with DX of constipation and enema given with improvement initially. Symptoms reoccured and child was admitted. Barium enema succesfully reduced intussusception. Feeding, stooling, and voiding well post procedure. DX: c/w Intussusception.


Changed on 9/14/2017

VAERS ID: 278155 Before After
VAERS Form:(blank) 1
Age:0.6
Gender:Male
Location:Tennessee
Vaccinated:2006-12-13
Onset:2007-04-15
Submitted:2007-05-03
Entered:2007-05-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR 42174RA / 1 2 LA / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1034F / 2 3 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain upper, Barium enema, Blood chloride, Blood creatinine, Blood glucose, Blood potassium, Blood urea, C-reactive protein increased, Carbon dioxide normal, Diarrhoea, Ileus paralytic, Intussusception, Platelet count, Pyrexia, Screaming, Vomiting, White blood cell count, Laboratory test, Liver function test, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: WBC - 11.45, Hem - 11.5, HCT:34.2, and Platelets 431, CRP - 1.0, NA - 138, K+ - 4.4, chloride - 99, CO2 - 18, Glucose - 91, Bun - 10, creatinine - 04, LFTs - normal ABD. Films, KUB, Barium Enema. Labs and Diagnostics: Abdominal X-rays x 3-normal. Barium enema which showed a filling defect at hepatic flexure c/w intussusception.
CDC 'Split Type':

Write-up: 4/16/07 acute vomiting, stomach pains - screaming seen in ER and fever and Diarrhea ? Paralytic Ileus GI consult - Bilious Emesis and concern for intussusception and flims/KUB normal s/p enema with good results. 07/02/2007 MR received for hospital stay 4/19-21/2007. Infant developed intermittant, severe abdominal pain (evidenced by back arching and screaming) and emesis 5 days prior to admission. Seen in ER x 2 for above and progression to bilious vomiting and acting "lifeless". 2nd ER visit with DX of constipation and enema given with improvement initially. Symptoms reoccured and child was admitted. Barium enema succesfully reduced intussusception. Feeding, stooling, and voiding well post procedure. DX: c/w Intussusception.


Changed on 2/14/2018

VAERS ID: 278155 Before After
VAERS Form:1
Age:0.6
Gender:Male
Location:Tennessee
Vaccinated:2006-12-13
Onset:2007-04-15
Submitted:2007-05-03
Entered:2007-05-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR 42174RA / 2 LA / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1034F / 3 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain upper, Barium enema, Blood chloride, Blood creatinine, Blood glucose, Blood potassium, Blood urea, C-reactive protein increased, Carbon dioxide normal, Diarrhoea, Ileus paralytic, Intussusception, Platelet count, Pyrexia, Screaming, Vomiting, White blood cell count, Laboratory test, Liver function test, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: WBC - 11.45, Hem - 11.5, HCT:34.2, and Platelets 431, CRP - 1.0, NA - 138, K+ - 4.4, chloride - 99, CO2 - 18, Glucose - 91, Bun - 10, creatinine - 04, LFTs - normal ABD. Films, KUB, Barium Enema. Labs and Diagnostics: Abdominal X-rays x 3-normal. Barium enema which showed a filling defect at hepatic flexure c/w intussusception.
CDC 'Split Type':

Write-up: 4/16/07 acute vomiting, stomach pains - screaming seen in ER and fever and Diarrhea ? Paralytic Ileus GI consult - Bilious Emesis and concern for intussusception and flims/KUB normal s/p enema with good results. 07/02/2007 MR received for hospital stay 4/19-21/2007. Infant developed intermittant, severe abdominal pain (evidenced by back arching and screaming) and emesis 5 days prior to admission. Seen in ER x 2 for above and progression to bilious vomiting and acting "lifeless". 2nd ER visit with DX of constipation and enema given with improvement initially. Symptoms reoccured and child was admitted. Barium enema succesfully reduced intussusception. Feeding, stooling, and voiding well post procedure. DX: c/w Intussusception.


Changed on 6/14/2018

VAERS ID: 278155 Before After
VAERS Form:1
Age:0.6
Gender:Male
Location:Tennessee
Vaccinated:2006-12-13
Onset:2007-04-15
Submitted:2007-05-03
Entered:2007-05-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR 42174RA / 2 LA / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1034F / 3 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain upper, Barium enema, Blood chloride, Blood creatinine, Blood glucose, Blood potassium, Blood urea, C-reactive protein increased, Carbon dioxide normal, Diarrhoea, Ileus paralytic, Intussusception, Platelet count, Pyrexia, Screaming, Vomiting, White blood cell count, Laboratory test, Liver function test, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: WBC - 11.45, Hem - 11.5, HCT:34.2, and Platelets 431, CRP - 1.0, NA - 138, K+ - 4.4, chloride - 99, CO2 - 18, Glucose - 91, Bun - 10, creatinine - 04, LFTs - normal ABD. Films, KUB, Barium Enema. Labs and Diagnostics: Abdominal X-rays x 3-normal. Barium enema which showed a filling defect at hepatic flexure c/w intussusception.
CDC 'Split Type':

Write-up: 4/16/07 acute vomiting, stomach pains - screaming seen in ER and fever and Diarrhea ? Paralytic Ileus GI consult - Bilious Emesis and concern for intussusception and flims/KUB normal s/p enema with good results. 07/02/2007 MR received for hospital stay 4/19-21/2007. Infant developed intermittant, severe abdominal pain (evidenced by back arching and screaming) and emesis 5 days prior to admission. Seen in ER x 2 for above and progression to bilious vomiting and acting "lifeless". 2nd ER visit with DX of constipation and enema given with improvement initially. Symptoms reoccured and child was admitted. Barium enema succesfully reduced intussusception. Feeding, stooling, and voiding well post procedure. DX: c/w Intussusception.

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