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This is VAERS ID 279026

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 279026
VAERS Form:
Age:0.3
Gender:Male
Location:Alabama
Vaccinated:2007-05-08
Onset:2007-05-13
Submitted:2007-05-19
Entered:2007-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 0 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1125F / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08679D / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1165F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium double contrast, Barium enema, Abdominal X-ray, Colectomy

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: 4     Extended hospital stay? No
Previous Vaccinations: none~ ()~~0~In Patient|none~ ()~~0~In Sibling|none~ ()~~0~In Sibling
Other Medications: none
Current Illness: none
Preexisting Conditions: none Birth HX: 37 wk by c-section. birth wt 3565. Initially had respiratory depression which improved w/stimulation & CPAP. Normal growth & development since birth.
Allergies:
Diagnostic Lab Data: enema x-ray series, radiology reports, fecal occult sample Outlying hosp LABS: WBC 21,300, polys 80, lymphs 17 & 3 monos. plts 818,000. Chemistries WNL. Abdominal x-ray revealed dilated intestinal loops. Gastrograffin enema revealed IS
CDC 'Split Type': none Birth HX: 37 wk by c-section. birth wt 3565. Initially had respiratory depression which improved w/stimulation & CPAP. Normal growth & development since birth.

Write-up: Vomiting, Diaherria, intussusception 4-5 days post vaccination--tx surgery (has colostomy bag resulting in 2nd operation in 6-8 weeks). 5/22/07 Received medical records from hospital which reveal patient experienced emesis for 1 day, 3 loose stools w/blo"ody mucous & abdominal pain. On admit 5/14/07 was lethargic. FINAL DX: Intusussception, transferred to higher level of care for surgery. 5/29/07 Received hospital medical records which reveal patient was received from outlying hospital after vomiting, bl


Changed on 12/8/2009

VAERS ID: 279026 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Alabama
Vaccinated:2007-05-08
Onset:2007-05-13
Submitted:2007-05-19
Entered:2007-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 0 RL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 0 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1125F / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08679D / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1165F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium double contrast, Barium enema, Colostomy, Diarrhoea, Diarrhoea haemorrhagic, Intensive care, Intussusception, Lethargy, Pallor, Surgery, Urinary system X-ray, Vomiting, White blood cell count increased, X-ray, Enema administration, Platelet count increased, Explorative laparotomy, Laboratory test normal, Abdominal X-ray, Colectomy, Occult blood

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations: none~ ()~~0~In Patient|none~ ()~~0~In Sibling|none~ ()~~0~In Sibling ()~~0.00~Patient|none~ ()~~0.00~Sibling|none~ ()~~0.00~Sibling
Other Medications: none
Current Illness: none
Preexisting Conditions: none Birth HX: 37 wk by c-section. birth wt 3565. Initially had respiratory depression which improved w/stimulation & CPAP. Normal growth & development since birth.
Allergies:
Diagnostic Lab Data: enema x-ray series, radiology reports, fecal occult sample Outlying hosp LABS: WBC 21,300, polys 80, lymphs 17 & 3 monos. plts 818,000. Chemistries WNL. Abdominal x-ray revealed dilated intestinal loops. Gastrograffin enema revealed IS
CDC 'Split Type': none Birth HX: 37 wk by c-section. birth wt 3565. Initially had respiratory depression which improved w/stimulation & CPAP. Normal growth & development since birth. (blank)

Write-up: Vomiting, Diaherria, intussusception 4-5 days post vaccination--tx surgery (has colostomy bag resulting in 2nd operation in 6-8 weeks). 5/22/07 Received medical records from hospital which reveal patient experienced emesis for 1 day, 3 loose stools w/blo"ody w/bloody mucous & abdominal pain. On admit 5/14/07 was lethargic. FINAL DX: Intusussception, transferred to higher level of care for surgery. 5/29/07 Received hospital medical records which reveal patient was received from outlying hospital after vomiting, bl bloody diarrhea, pallor & lethargy. Admitted 5/14-5/18/07. Unable to reduce the IS & was taken to OR for exp lap & resection of sholecolonic IS, colostomy & placement of central line. 26 cm of colon was removed & patient was in ICU post op, intubated & on multiple IV antibiotics. Initially on TPN but was able to be extubated & diet advanced to oral FINAL DX: Cholecolonic intussusception; intussusception nonreducible, w/perforation. Follow-up: He will always have the risk of bowel obstruction and other bowel conditions due to the intensity of the surgeries.


Changed on 1/5/2010

VAERS ID: 279026 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Alabama
Vaccinated:2007-05-08
Onset:2007-05-13
Submitted:2007-05-19
Entered:2007-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 0 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1125F / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08679D / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1165F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium double contrast, Barium enema, Colostomy, Diarrhoea, Diarrhoea haemorrhagic, Intensive care, Intussusception, Lethargy, Pallor, Surgery, Urinary system X-ray, Vomiting, White blood cell count increased, X-ray, Enema administration, Platelet count increased, Explorative laparotomy, Laboratory test normal, Abdominal X-ray, Colectomy, Occult blood

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: 4     Extended hospital stay? No
Previous Vaccinations: none~ ()~~0.00~Patient|none~ ()~~0.00~Sibling|none~ ()~~0.00~Sibling
Other Medications: none
Current Illness: none
Preexisting Conditions: none Birth HX: 37 wk by c-section. birth wt 3565. Initially had respiratory depression which improved w/stimulation & CPAP. Normal growth & development since birth.
Allergies:
Diagnostic Lab Data: enema x-ray series, radiology reports, fecal occult sample Outlying hosp LABS: WBC 21,300, polys 80, lymphs 17 & 3 monos. plts 818,000. Chemistries WNL. Abdominal x-ray revealed dilated intestinal loops. Gastrograffin enema revealed IS
CDC 'Split Type':

Write-up: Vomiting, Diaherria, intussusception 4-5 days post vaccination--tx surgery (has colostomy bag resulting in 2nd operation in 6-8 weeks). 5/22/07 Received medical records from hospital which reveal patient experienced emesis for 1 day, 3 loose stools w/bloody mucous & abdominal pain. On admit 5/14/07 was lethargic. FINAL DX: Intusussception, transferred to higher level of care for surgery. 5/29/07 Received hospital medical records which reveal patient was received from outlying hospital after vomiting, bloody diarrhea, pallor & lethargy. Admitted 5/14-5/18/07. Unable to reduce the IS & was taken to OR for exp lap & resection of sholecolonic IS, colostomy & placement of central line. 26 cm of colon was removed & patient was in ICU post op, intubated & on multiple IV antibiotics. Initially on TPN but was able to be extubated & diet advanced to oral FINAL DX: Cholecolonic intussusception; intussusception nonreducible, w/perforation. Follow-up: He will always have the risk of bowel obstruction and other bowel conditions due to the intensity of the surgeries.


Changed on 3/2/2010

VAERS ID: 279026 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Alabama
Vaccinated:2007-05-08
Onset:2007-05-13
Submitted:2007-05-19
Entered:2007-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 0 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1125F / 0 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B08679D / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1165F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Colostomy, Diarrhoea, Intussusception, Surgery, Vomiting, X-ray, Enema administration, Occult blood

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: 4     Extended hospital stay? No
Previous Vaccinations: none~ ()~~0.00~Patient|none~ ()~~0.00~Sibling|none~ ()~~0.00~Sibling
Other Medications: none
Current Illness: none
Preexisting Conditions: none Birth HX: 37 wk by c-section. birth wt 3565. Initially had respiratory depression which improved w/stimulation & CPAP. Normal growth & development since birth.
Allergies:
Diagnostic Lab Data: enema x-ray series, radiology reports, fecal occult sample Outlying hosp LABS: WBC 21,300, polys 80, lymphs 17 & 3 monos. plts 818,000. Chemistries WNL. Abdominal x-ray revealed dilated intestinal loops. Gastrograffin enema revealed IS
CDC 'Split Type':

Write-up: Vomiting, Diaherria, intussusception 4-5 days post vaccination--tx surgery (has colostomy bag resulting in 2nd operation in 6-8 weeks). 5/22/07 Received medical records from hospital which reveal patient experienced emesis for 1 day, 3 loose stools w/bloody mucous & abdominal pain. On admit 5/14/07 was lethargic. FINAL DX: Intusussception, transferred to higher level of care for surgery. 5/29/07 Received hospital medical records which reveal patient was received from outlying hospital after vomiting, bloody diarrhea, pallor & lethargy. Admitted 5/14-5/18/07. Unable to reduce the IS & was taken to OR for exp lap & resection of sholecolonic IS, colostomy & placement of central line. 26 cm of colon was removed & patient was in ICU post op, intubated & on multiple IV antibiotics. Initially on TPN but was able to be extubated & diet advanced to oral FINAL DX: Cholecolonic intussusception; intussusception nonreducible, w/perforation. Follow-up: He will always have the risk of bowel obstruction and other bowel conditions due to the intensity of the surgeries.


Changed on 4/7/2010

VAERS ID: 279026 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Alabama
Vaccinated:2007-05-08
Onset:2007-05-13
Submitted:2007-05-19
Entered:2007-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 0 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1125F / 0 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08679D / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1165F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Colostomy, Diarrhoea, Intussusception, Surgery, Vomiting, X-ray, Enema administration, Occult blood

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: 4     Extended hospital stay? No
Previous Vaccinations: none~ ()~~0.00~Patient|none~ ()~~0.00~Sibling|none~ ()~~0.00~Sibling
Other Medications: none
Current Illness: none
Preexisting Conditions: none Birth HX: 37 wk by c-section. birth wt 3565. Initially had respiratory depression which improved w/stimulation & CPAP. Normal growth & development since birth.
Allergies:
Diagnostic Lab Data: enema x-ray series, radiology reports, fecal occult sample Outlying hosp LABS: WBC 21,300, polys 80, lymphs 17 & 3 monos. plts 818,000. Chemistries WNL. Abdominal x-ray revealed dilated intestinal loops. Gastrograffin enema revealed IS
CDC 'Split Type':

Write-up: Vomiting, Diaherria, intussusception 4-5 days post vaccination--tx surgery (has colostomy bag resulting in 2nd operation in 6-8 weeks). 5/22/07 Received medical records from hospital which reveal patient experienced emesis for 1 day, 3 loose stools w/bloody mucous & abdominal pain. On admit 5/14/07 was lethargic. FINAL DX: Intusussception, transferred to higher level of care for surgery. 5/29/07 Received hospital medical records which reveal patient was received from outlying hospital after vomiting, bloody diarrhea, pallor & lethargy. Admitted 5/14-5/18/07. Unable to reduce the IS & was taken to OR for exp lap & resection of sholecolonic IS, colostomy & placement of central line. 26 cm of colon was removed & patient was in ICU post op, intubated & on multiple IV antibiotics. Initially on TPN but was able to be extubated & diet advanced to oral FINAL DX: Cholecolonic intussusception; intussusception nonreducible, w/perforation. Follow-up: He will always have the risk of bowel obstruction and other bowel conditions due to the intensity of the surgeries.


Changed on 7/31/2010

VAERS ID: 279026 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Alabama
Vaccinated:2007-05-08
Onset:2007-05-13
Submitted:2007-05-19
Entered:2007-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 0 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1125F / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08679D / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1165F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Colostomy, Diarrhoea, Intensive care, Intussusception, Lymphocyte count decreased, Mucous stools, Surgery, Vomiting, X-ray, Enema administration, Central venous catheterisation, Occult blood, Endotracheal intubation

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: 4     Extended hospital stay? No
Previous Vaccinations: none~ ()~~0.00~Patient|none~ ()~~0.00~Sibling|none~ ()~~0.00~Sibling
Other Medications: none
Current Illness: none
Preexisting Conditions: none Birth HX: 37 wk by c-section. birth wt 3565. Initially had respiratory depression which improved w/stimulation & CPAP. Normal growth & development since birth.
Allergies:
Diagnostic Lab Data: enema x-ray series, radiology reports, fecal occult sample Outlying hosp LABS: WBC 21,300, polys 80, lymphs 17 & 3 monos. plts 818,000. Chemistries WNL. Abdominal x-ray revealed dilated intestinal loops. Gastrograffin enema revealed IS
CDC 'Split Type':

Write-up: Vomiting, Diaherria, intussusception 4-5 days post vaccination--tx surgery (has colostomy bag resulting in 2nd operation in 6-8 weeks). 5/22/07 Received medical records from hospital which reveal patient experienced emesis for 1 day, 3 loose stools w/bloody mucous & abdominal pain. On admit 5/14/07 was lethargic. FINAL DX: Intusussception, transferred to higher level of care for surgery. 5/29/07 Received hospital medical records which reveal patient was received from outlying hospital after vomiting, bloody diarrhea, pallor & lethargy. Admitted 5/14-5/18/07. Unable to reduce the IS & was taken to OR for exp lap & resection of sholecolonic IS, colostomy & placement of central line. 26 cm of colon was removed & patient was in ICU post op, intubated & on multiple IV antibiotics. Initially on TPN but was able to be extubated & diet advanced to oral FINAL DX: Cholecolonic intussusception; intussusception nonreducible, w/perforation. Follow-up: He will always have the risk of bowel obstruction and other bowel conditions due to the intensity of the surgeries.


Changed on 8/31/2010

VAERS ID: 279026 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Alabama
Vaccinated:2007-05-08
Onset:2007-05-13
Submitted:2007-05-19
Entered:2007-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 0 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1125F / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B08679D / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1165F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Colostomy, Diarrhoea, Intensive care, Intussusception, Lymphocyte count decreased, Mucous stools, Surgery, Vomiting, X-ray, Enema administration, Explorative laparotomy, Central venous catheterisation, Occult blood, Endotracheal intubation

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: 4     Extended hospital stay? No
Previous Vaccinations: none~ ()~~0.00~Patient|none~ ()~~0.00~Sibling|none~ ()~~0.00~Sibling
Other Medications: none
Current Illness: none
Preexisting Conditions: none Birth HX: 37 wk by c-section. birth wt 3565. Initially had respiratory depression which improved w/stimulation & CPAP. Normal growth & development since birth.
Allergies:
Diagnostic Lab Data: enema x-ray series, radiology reports, fecal occult sample Outlying hosp LABS: WBC 21,300, polys 80, lymphs 17 & 3 monos. plts 818,000. Chemistries WNL. Abdominal x-ray revealed dilated intestinal loops. Gastrograffin enema revealed IS
CDC 'Split Type':

Write-up: Vomiting, Diaherria, intussusception 4-5 days post vaccination--tx surgery (has colostomy bag resulting in 2nd operation in 6-8 weeks). 5/22/07 Received medical records from hospital which reveal patient experienced emesis for 1 day, 3 loose stools w/bloody mucous & abdominal pain. On admit 5/14/07 was lethargic. FINAL DX: Intusussception, transferred to higher level of care for surgery. 5/29/07 Received hospital medical records which reveal patient was received from outlying hospital after vomiting, bloody diarrhea, pallor & lethargy. Admitted 5/14-5/18/07. Unable to reduce the IS & was taken to OR for exp lap & resection of sholecolonic IS, colostomy & placement of central line. 26 cm of colon was removed & patient was in ICU post op, intubated & on multiple IV antibiotics. Initially on TPN but was able to be extubated & diet advanced to oral FINAL DX: Cholecolonic intussusception; intussusception nonreducible, w/perforation. Follow-up: He will always have the risk of bowel obstruction and other bowel conditions due to the intensity of the surgeries.


Changed on 12/7/2010

VAERS ID: 279026 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Alabama
Vaccinated:2007-05-08
Onset:2007-05-13
Submitted:2007-05-19
Entered:2007-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 0 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1125F / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08679D / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1165F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Colostomy, Diarrhoea, Intensive care, Intussusception, Lymphocyte count decreased, Mucous stools, Surgery, Vomiting, X-ray, Enema administration, Explorative laparotomy, Central venous catheterisation, Occult blood, Endotracheal intubation

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: 4     Extended hospital stay? No
Previous Vaccinations: none~ ()~~0.00~Patient|none~ ()~~0.00~Sibling|none~ ()~~0.00~Sibling
Other Medications: none
Current Illness: none
Preexisting Conditions: none Birth HX: 37 wk by c-section. birth wt 3565. Initially had respiratory depression which improved w/stimulation & CPAP. Normal growth & development since birth.
Allergies:
Diagnostic Lab Data: enema x-ray series, radiology reports, fecal occult sample Outlying hosp LABS: WBC 21,300, polys 80, lymphs 17 & 3 monos. plts 818,000. Chemistries WNL. Abdominal x-ray revealed dilated intestinal loops. Gastrograffin enema revealed IS of descending colon LABS: KUB & gastrografin enema done at outlying hospital were c/w IS. Barium enema was repeated w/o resolution of IS. Air contrast done unsuccessful. Annual followup 01/4/2010 He always has a risk of bowel obstruction, as well as increased bowel movements causing him embarassment. There will always be emotional issues as well due to scaring.
CDC 'Split Type':

Write-up: Vomiting, Diaherria, intussusception 4-5 days post vaccination--tx surgery (has colostomy bag resulting in 2nd operation in 6-8 weeks). 5/22/07 Received medical records from hospital which reveal patient experienced emesis for 1 day, 3 loose stools w/bloody mucous & abdominal pain. On admit 5/14/07 was lethargic. FINAL DX: Intusussception, transferred to higher level of care for surgery. 5/29/07 Received hospital medical records which reveal patient was received from outlying hospital after vomiting, bloody diarrhea, pallor & lethargy. Admitted 5/14-5/18/07. Unable to reduce the IS & was taken to OR for exp lap & resection of sholecolonic IS, colostomy & placement of central line. 26 cm of colon was removed & patient was in ICU post op, intubated & on multiple IV antibiotics. Initially on TPN but was able to be extubated & diet advanced to oral FINAL DX: Cholecolonic intussusception; intussusception nonreducible, w/perforation. Follow-up: He will always have the risk of bowel obstruction and other bowel conditions due to the intensity of the surgeries.


Changed on 4/13/2011

VAERS ID: 279026 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Alabama
Vaccinated:2007-05-08
Onset:2007-05-13
Submitted:2007-05-19
Entered:2007-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 0 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1125F / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08679D / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1165F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium double contrast, Barium enema, Colostomy, Diarrhoea, Diarrhoea haemorrhagic, Intensive care, Intussusception, Lethargy, Lymphocyte count decreased, Mucous stools, Pallor, Surgery, Urinary system X-ray, Vomiting, White blood cell count increased, X-ray, Enema administration, Platelet count increased, Explorative laparotomy, Central venous catheterisation, Laboratory test normal, Abdominal X-ray, Colectomy, Occult blood, Endotracheal intubation

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: 4     Extended hospital stay? No
Previous Vaccinations: none~ ()~~0.00~Patient|none~ ()~~0.00~Sibling|none~ ()~~0.00~Sibling
Other Medications: none
Current Illness: none
Preexisting Conditions: none Birth HX: 37 wk by c-section. birth wt 3565. Initially had respiratory depression which improved w/stimulation & CPAP. Normal growth & development since birth.
Allergies:
Diagnostic Lab Data: enema x-ray series, radiology reports, fecal occult sample Outlying hosp LABS: WBC 21,300, polys 80, lymphs 17 & 3 monos. plts 818,000. Chemistries WNL. Abdominal x-ray revealed dilated intestinal loops. Gastrograffin enema revealed IS of descending colon LABS: KUB & gastrografin enema done at outlying hospital were c/w IS. Barium enema was repeated w/o resolution of IS. Air contrast done unsuccessful. Annual followup 01/4/2010 He always has a risk of bowel obstruction, as well as increased bowel movements causing him embarassment. There will always be emotional issues as well due to scaring.
CDC 'Split Type':

Write-up: Vomiting, Diaherria, intussusception 4-5 days post vaccination--tx surgery (has colostomy bag resulting in 2nd operation in 6-8 weeks). 5/22/07 Received medical records from hospital which reveal patient experienced emesis for 1 day, 3 loose stools w/bloody mucous & abdominal pain. On admit 5/14/07 was lethargic. FINAL DX: Intusussception, transferred to higher level of care for surgery. 5/29/07 Received hospital medical records which reveal patient was received from outlying hospital after vomiting, bloody diarrhea, pallor & lethargy. Admitted 5/14-5/18/07. Unable to reduce the IS & was taken to OR for exp lap & resection of sholecolonic IS, colostomy & placement of central line. 26 cm of colon was removed & patient was in ICU post op, intubated & on multiple IV antibiotics. Initially on TPN but was able to be extubated & diet advanced to oral FINAL DX: Cholecolonic intussusception; intussusception nonreducible, w/perforation. Follow-up: He will always have the risk of bowel obstruction and other bowel conditions due to the intensity of the surgeries.


Changed on 5/13/2011

VAERS ID: 279026 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Alabama
Vaccinated:2007-05-08
Onset:2007-05-13
Submitted:2007-05-19
Entered:2007-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 0 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1125F / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08679D / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1165F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium double contrast, Barium enema, Colostomy, Diarrhoea, Diarrhoea haemorrhagic, Intensive care, Intussusception, Lethargy, Lymphocyte count decreased, Mucous stools, Pallor, Surgery, Urinary system X-ray, Vomiting, White blood cell count increased, X-ray, Enema administration, Platelet count increased, Explorative laparotomy, Central venous catheterisation, Laboratory test normal, Abdominal X-ray, Colectomy, Occult blood, Endotracheal intubation

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: 4     Extended hospital stay? No
Previous Vaccinations: none~ ()~~0.00~Patient|none~ ()~~0.00~Sibling|none~ ()~~0.00~Sibling
Other Medications: none
Current Illness: none
Preexisting Conditions: none Birth HX: 37 wk by c-section. birth wt 3565. Initially had respiratory depression which improved w/stimulation & CPAP. Normal growth & development since birth.
Allergies:
Diagnostic Lab Data: enema x-ray series, radiology reports, fecal occult sample Outlying hosp LABS: WBC 21,300, polys 80, lymphs 17 & 3 monos. plts 818,000. Chemistries WNL. Abdominal x-ray revealed dilated intestinal loops. Gastrograffin enema revealed IS of descending colon LABS: KUB & gastrografin enema done at outlying hospital were c/w IS. Barium enema was repeated w/o resolution of IS. Air contrast done unsuccessful. Annual followup 01/4/2010 He always has a risk of bowel obstruction, as well as increased bowel movements causing him embarassment. There will always be emotional issues as well due to scaring.
CDC 'Split Type':

Write-up: Vomiting, Diaherria, intussusception 4-5 days post vaccination--tx surgery (has colostomy bag resulting in 2nd operation in 6-8 weeks). 5/22/07 Received medical records from hospital which reveal patient experienced emesis for 1 day, 3 loose stools w/bloody mucous & abdominal pain. On admit 5/14/07 was lethargic. FINAL DX: Intusussception, transferred to higher level of care for surgery. 5/29/07 Received hospital medical records which reveal patient was received from outlying hospital after vomiting, bloody diarrhea, pallor & lethargy. Admitted 5/14-5/18/07. Unable to reduce the IS & was taken to OR for exp lap & resection of sholecolonic IS, colostomy & placement of central line. 26 cm of colon was removed & patient was in ICU post op, intubated & on multiple IV antibiotics. Initially on TPN but was able to be extubated & diet advanced to oral FINAL DX: Cholecolonic intussusception; intussusception nonreducible, w/perforation. Follow-up: He will always have the risk of bowel obstruction and other bowel conditions due to the intensity of the surgeries.


Changed on 6/11/2011

VAERS ID: 279026 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Alabama
Vaccinated:2007-05-08
Onset:2007-05-13
Submitted:2007-05-19
Entered:2007-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 0 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1125F / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08679D / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1165F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium double contrast, Barium enema, Colostomy, Diarrhoea, Diarrhoea haemorrhagic, Intensive care, Intussusception, Lethargy, Lymphocyte count decreased, Mucous stools, Pallor, Surgery, Urinary system X-ray, Vomiting, White blood cell count increased, X-ray, Enema administration, Platelet count increased, Explorative laparotomy, Central venous catheterisation, Laboratory test normal, Abdominal X-ray, Colectomy, Occult blood, Endotracheal intubation

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: 4     Extended hospital stay? No
Previous Vaccinations: none~ ()~~0.00~Patient|none~ ()~~0.00~Sibling|none~ ()~~0.00~Sibling
Other Medications: none
Current Illness: none
Preexisting Conditions: none Birth HX: 37 wk by c-section. birth wt 3565. Initially had respiratory depression which improved w/stimulation & CPAP. Normal growth & development since birth.
Allergies:
Diagnostic Lab Data: enema x-ray series, radiology reports, fecal occult sample Outlying hosp LABS: WBC 21,300, polys 80, lymphs 17 & 3 monos. plts 818,000. Chemistries WNL. Abdominal x-ray revealed dilated intestinal loops. Gastrograffin enema revealed IS of descending colon LABS: KUB & gastrografin enema done at outlying hospital were c/w IS. Barium enema was repeated w/o resolution of IS. Air contrast done unsuccessful. Annual followup 01/4/2010 He always has a risk of bowel obstruction, as well as increased bowel movements causing him embarassment. There will always be emotional issues as well due to scaring.
CDC 'Split Type':

Write-up: Vomiting, Diaherria, intussusception 4-5 days post vaccination--tx surgery (has colostomy bag resulting in 2nd operation in 6-8 weeks). 5/22/07 Received medical records from hospital which reveal patient experienced emesis for 1 day, 3 loose stools w/bloody mucous & abdominal pain. On admit 5/14/07 was lethargic. FINAL DX: Intusussception, transferred to higher level of care for surgery. 5/29/07 Received hospital medical records which reveal patient was received from outlying hospital after vomiting, bloody diarrhea, pallor & lethargy. Admitted 5/14-5/18/07. Unable to reduce the IS & was taken to OR for exp lap & resection of sholecolonic IS, colostomy & placement of central line. 26 cm of colon was removed & patient was in ICU post op, intubated & on multiple IV antibiotics. Initially on TPN but was able to be extubated & diet advanced to oral FINAL DX: Cholecolonic intussusception; intussusception nonreducible, w/perforation. Follow-up: He will always have the risk of bowel obstruction and other bowel conditions due to the intensity of the surgeries.


Changed on 5/13/2013

VAERS ID: 279026 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Alabama
Vaccinated:2007-05-08
Onset:2007-05-13
Submitted:2007-05-19
Entered:2007-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 0 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1125F / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08679D / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1165F / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1165F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium double contrast, Barium enema, Colostomy, Diarrhoea, Diarrhoea haemorrhagic, Intensive care, Intussusception, Lethargy, Lymphocyte count decreased, Mucous stools, Pallor, Surgery, Urinary system X-ray, Vomiting, White blood cell count increased, X-ray, Enema administration, Platelet count increased, Explorative laparotomy, Central venous catheterisation, Laboratory test normal, Abdominal X-ray, Colectomy, Occult blood, Endotracheal intubation

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: 4     Extended hospital stay? No
Previous Vaccinations: none~ ()~~0.00~Patient|none~ ()~~0.00~Sibling|none~ ()~~0.00~Sibling
Other Medications: none
Current Illness: none
Preexisting Conditions: none Birth HX: 37 wk by c-section. birth wt 3565. Initially had respiratory depression which improved w/stimulation & CPAP. Normal growth & development since birth.
Allergies:
Diagnostic Lab Data: enema x-ray series, radiology reports, fecal occult sample Outlying hosp LABS: WBC 21,300, polys 80, lymphs 17 & 3 monos. plts 818,000. Chemistries WNL. Abdominal x-ray revealed dilated intestinal loops. Gastrograffin enema revealed IS of descending colon LABS: KUB & gastrografin enema done at outlying hospital were c/w IS. Barium enema was repeated w/o resolution of IS. Air contrast done unsuccessful. Annual followup 01/4/2010 He always has a risk of bowel obstruction, as well as increased bowel movements causing him embarassment. There will always be emotional issues as well due to scaring.
CDC 'Split Type':

Write-up: Vomiting, Diaherria, intussusception 4-5 days post vaccination--tx surgery (has colostomy bag resulting in 2nd operation in 6-8 weeks). 5/22/07 Received medical records from hospital which reveal patient experienced emesis for 1 day, 3 loose stools w/bloody mucous & abdominal pain. On admit 5/14/07 was lethargic. FINAL DX: Intusussception, transferred to higher level of care for surgery. 5/29/07 Received hospital medical records which reveal patient was received from outlying hospital after vomiting, bloody diarrhea, pallor & lethargy. Admitted 5/14-5/18/07. Unable to reduce the IS & was taken to OR for exp lap & resection of sholecolonic IS, colostomy & placement of central line. 26 cm of colon was removed & patient was in ICU post op, intubated & on multiple IV antibiotics. Initially on TPN but was able to be extubated & diet advanced to oral FINAL DX: Cholecolonic intussusception; intussusception nonreducible, w/perforation. Follow-up: He will always have the risk of bowel obstruction and other bowel conditions due to the intensity of the surgeries.


Changed on 6/14/2014

VAERS ID: 279026 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Alabama
Vaccinated:2007-05-08
Onset:2007-05-13
Submitted:2007-05-19
Entered:2007-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 0 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1125F / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08679D / 0 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1165F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium double contrast, Barium enema, Colostomy, Diarrhoea, Diarrhoea haemorrhagic, Intensive care, Intussusception, Lethargy, Lymphocyte count decreased, Mucous stools, Pallor, Surgery, Urinary system X-ray, Vomiting, White blood cell count increased, X-ray, Enema administration, Platelet count increased, Explorative laparotomy, Central venous catheterisation, Laboratory test normal, Abdominal X-ray, Colectomy, Occult blood, Endotracheal intubation

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: 4     Extended hospital stay? No
Previous Vaccinations: none~ ()~~0.00~Patient|none~ ()~~0.00~Sibling|none~ ()~~0.00~Sibling
Other Medications: none
Current Illness: none
Preexisting Conditions: none Birth HX: 37 wk by c-section. birth wt 3565. Initially had respiratory depression which improved w/stimulation & CPAP. Normal growth & development since birth.
Allergies:
Diagnostic Lab Data: enema x-ray series, radiology reports, fecal occult sample Outlying hosp LABS: WBC 21,300, polys 80, lymphs 17 & 3 monos. plts 818,000. Chemistries WNL. Abdominal x-ray revealed dilated intestinal loops. Gastrograffin enema revealed IS of descending colon LABS: KUB & gastrografin enema done at outlying hospital were c/w IS. Barium enema was repeated w/o resolution of IS. Air contrast done unsuccessful. Annual followup 01/4/2010 He always has a risk of bowel obstruction, as well as increased bowel movements causing him embarassment. There will always be emotional issues as well due to scaring.
CDC 'Split Type':

Write-up: Vomiting, Diaherria, intussusception 4-5 days post vaccination--tx surgery (has colostomy bag resulting in 2nd operation in 6-8 weeks). 5/22/07 Received medical records from hospital which reveal patient experienced emesis for 1 day, 3 loose stools w/bloody mucous & abdominal pain. On admit 5/14/07 was lethargic. FINAL DX: Intusussception, transferred to higher level of care for surgery. 5/29/07 Received hospital medical records which reveal patient was received from outlying hospital after vomiting, bloody diarrhea, pallor & lethargy. Admitted 5/14-5/18/07. Unable to reduce the IS & was taken to OR for exp lap & resection of sholecolonic IS, colostomy & placement of central line. 26 cm of colon was removed & patient was in ICU post op, intubated & on multiple IV antibiotics. Initially on TPN but was able to be extubated & diet advanced to oral FINAL DX: Cholecolonic intussusception; intussusception nonreducible, w/perforation. Follow-up: He will always have the risk of bowel obstruction and other bowel conditions due to the intensity of the surgeries.


Changed on 2/14/2017

VAERS ID: 279026 Before After
VAERS Form:
Age:0.3 0.27
Gender:Male
Location:Alabama
Vaccinated:2007-05-08
Onset:2007-05-13
Submitted:2007-05-19
Entered:2007-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 0 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1125F / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08679D / 0 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1165F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium double contrast, Barium enema, Colostomy, Diarrhoea, Diarrhoea haemorrhagic, Intensive care, Intussusception, Lethargy, Lymphocyte count decreased, Mucous stools, Pallor, Surgery, Urinary system X-ray, Vomiting, White blood cell count increased, X-ray, Enema administration, Platelet count increased, Explorative laparotomy, Central venous catheterisation, Laboratory test normal, Abdominal X-ray, Colectomy, Occult blood, Endotracheal intubation

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: 4     Extended hospital stay? No
Previous Vaccinations: none~ ()~~0.00~Patient|none~ ()~~0.00~Sibling|none~ ()~~0.00~Sibling
Other Medications:
Current Illness: none
Preexisting Conditions: none Birth HX: 37 wk by c-section. birth wt 3565. Initially had respiratory depression which improved w/stimulation & CPAP. Normal growth & development since birth.
Allergies:
Diagnostic Lab Data: enema x-ray series, radiology reports, fecal occult sample Outlying hosp LABS: WBC 21,300, polys 80, lymphs 17 & 3 monos. plts 818,000. Chemistries WNL. Abdominal x-ray revealed dilated intestinal loops. Gastrograffin enema revealed IS of descending colon LABS: KUB & gastrografin enema done at outlying hospital were c/w IS. Barium enema was repeated w/o resolution of IS. Air contrast done unsuccessful. Annual followup 01/4/2010 He always has a risk of bowel obstruction, as well as increased bowel movements causing him embarassment. There will always be emotional issues as well due to scaring.
CDC 'Split Type':

Write-up: Vomiting, Diaherria, intussusception 4-5 days post vaccination--tx surgery (has colostomy bag resulting in 2nd operation in 6-8 weeks). 5/22/07 Received medical records from hospital which reveal patient experienced emesis for 1 day, 3 loose stools w/bloody mucous & abdominal pain. On admit 5/14/07 was lethargic. FINAL DX: Intusussception, transferred to higher level of care for surgery. 5/29/07 Received hospital medical records which reveal patient was received from outlying hospital after vomiting, bloody diarrhea, pallor & lethargy. Admitted 5/14-5/18/07. Unable to reduce the IS & was taken to OR for exp lap & resection of sholecolonic IS, colostomy & placement of central line. 26 cm of colon was removed & patient was in ICU post op, intubated & on multiple IV antibiotics. Initially on TPN but was able to be extubated & diet advanced to oral FINAL DX: Cholecolonic intussusception; intussusception nonreducible, w/perforation. Follow-up: He will always have the risk of bowel obstruction and other bowel conditions due to the intensity of the surgeries.


Changed on 5/14/2017

VAERS ID: 279026 Before After
VAERS Form:
Age:0.27
Gender:Male
Location:Alabama
Vaccinated:2007-05-08
Onset:2007-05-13
Submitted:2007-05-19
Entered:2007-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 0 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1125F / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08679D / 0 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1165F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium double contrast, Barium enema, Colostomy, Diarrhoea, Diarrhoea haemorrhagic, Intensive care, Intussusception, Lethargy, Lymphocyte count decreased, Mucous stools, Pallor, Surgery, Urinary system X-ray, Vomiting, White blood cell count increased, X-ray, Enema administration, Platelet count increased, Explorative laparotomy, Central venous catheterisation, Laboratory test normal, Abdominal X-ray, Colectomy, Occult blood, Endotracheal intubation

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: 4     Extended hospital stay? No
Previous Vaccinations: none~ ()~~0.00~Patient|none~ ()~~0.00~Sibling|none~ ()~~0.00~Sibling
Other Medications: none
Current Illness: none
Preexisting Conditions: none Birth HX: 37 wk by c-section. birth wt 3565. Initially had respiratory depression which improved w/stimulation & CPAP. Normal growth & development since birth.
Allergies:
Diagnostic Lab Data: enema x-ray series, radiology reports, fecal occult sample Outlying hosp LABS: WBC 21,300, polys 80, lymphs 17 & 3 monos. plts 818,000. Chemistries WNL. Abdominal x-ray revealed dilated intestinal loops. Gastrograffin enema revealed IS of descending colon LABS: KUB & gastrografin enema done at outlying hospital were c/w IS. Barium enema was repeated w/o resolution of IS. Air contrast done unsuccessful. Annual followup 01/4/2010 He always has a risk of bowel obstruction, as well as increased bowel movements causing him embarassment. There will always be emotional issues as well due to scaring.
CDC 'Split Type':

Write-up: Vomiting, Diaherria, intussusception 4-5 days post vaccination--tx surgery (has colostomy bag resulting in 2nd operation in 6-8 weeks). 5/22/07 Received medical records from hospital which reveal patient experienced emesis for 1 day, 3 loose stools w/bloody mucous & abdominal pain. On admit 5/14/07 was lethargic. FINAL DX: Intusussception, transferred to higher level of care for surgery. 5/29/07 Received hospital medical records which reveal patient was received from outlying hospital after vomiting, bloody diarrhea, pallor & lethargy. Admitted 5/14-5/18/07. Unable to reduce the IS & was taken to OR for exp lap & resection of sholecolonic IS, colostomy & placement of central line. 26 cm of colon was removed & patient was in ICU post op, intubated & on multiple IV antibiotics. Initially on TPN but was able to be extubated & diet advanced to oral FINAL DX: Cholecolonic intussusception; intussusception nonreducible, w/perforation. Follow-up: He will always have the risk of bowel obstruction and other bowel conditions due to the intensity of the surgeries.


Changed on 9/14/2017

VAERS ID: 279026 Before After
VAERS Form:(blank) 1
Age:0.27
Gender:Male
Location:Alabama
Vaccinated:2007-05-08
Onset:2007-05-13
Submitted:2007-05-19
Entered:2007-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 0 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1125F / 0 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08679D / 0 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1165F / 0 1 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Colostomy, Diarrhoea, Intensive care, Intussusception, Lymphocyte count decreased, Mucous stools, Surgery, Vomiting, X-ray, Enema administration, Central venous catheterisation, Occult blood, Endotracheal intubation

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: 4     Extended hospital stay? No
Previous Vaccinations: none~ ()~~0.00~Patient|none~ ()~~0.00~Sibling|none~ ()~~0.00~Sibling
Other Medications: none
Current Illness: none
Preexisting Conditions: none Birth HX: 37 wk by c-section. birth wt 3565. Initially had respiratory depression which improved w/stimulation & CPAP. Normal growth & development since birth.
Allergies:
Diagnostic Lab Data: enema x-ray series, radiology reports, fecal occult sample Outlying hosp LABS: WBC 21,300, polys 80, lymphs 17 & 3 monos. plts 818,000. Chemistries WNL. Abdominal x-ray revealed dilated intestinal loops. Gastrograffin enema revealed IS of descending colon LABS: KUB & gastrografin enema done at outlying hospital were c/w IS. Barium enema was repeated w/o resolution of IS. Air contrast done unsuccessful. Annual followup 01/4/2010 He always has a risk of bowel obstruction, as well as increased bowel movements causing him embarassment. There will always be emotional issues as well due to scaring.
CDC 'Split Type':

Write-up: Vomiting, Diaherria, intussusception 4-5 days post vaccination--tx surgery (has colostomy bag resulting in 2nd operation in 6-8 weeks). 5/22/07 Received medical records from hospital which reveal patient experienced emesis for 1 day, 3 loose stools w/bloody mucous & abdominal pain. On admit 5/14/07 was lethargic. FINAL DX: Intusussception, transferred to higher level of care for surgery. 5/29/07 Received hospital medical records which reveal patient was received from outlying hospital after vomiting, bloody diarrhea, pallor & lethargy. Admitted 5/14-5/18/07. Unable to reduce the IS & was taken to OR for exp lap & resection of sholecolonic IS, colostomy & placement of central line. 26 cm of colon was removed & patient was in ICU post op, intubated & on multiple IV antibiotics. Initially on TPN but was able to be extubated & diet advanced to oral FINAL DX: Cholecolonic intussusception; intussusception nonreducible, w/perforation. Follow-up: He will always have the risk of bowel obstruction and other bowel conditions due to the intensity of the surgeries.


Changed on 2/14/2018

VAERS ID: 279026 Before After
VAERS Form:1
Age:0.27
Gender:Male
Location:Alabama
Vaccinated:2007-05-08
Onset:2007-05-13
Submitted:2007-05-19
Entered:2007-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1125F / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08679D / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1165F / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Colostomy, Diarrhoea, Intensive care, Intussusception, Lymphocyte count decreased, Mucous stools, Surgery, Vomiting, X-ray, Enema administration, Central venous catheterisation, Occult blood, Endotracheal intubation

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: 4     Extended hospital stay? No
Previous Vaccinations: none~ ()~~0.00~Patient|none~ ()~~0.00~Sibling|none~ ()~~0.00~Sibling
Other Medications: none
Current Illness: none
Preexisting Conditions: none Birth HX: 37 wk by c-section. birth wt 3565. Initially had respiratory depression which improved w/stimulation & CPAP. Normal growth & development since birth.
Allergies:
Diagnostic Lab Data: enema x-ray series, radiology reports, fecal occult sample Outlying hosp LABS: WBC 21,300, polys 80, lymphs 17 & 3 monos. plts 818,000. Chemistries WNL. Abdominal x-ray revealed dilated intestinal loops. Gastrograffin enema revealed IS of descending colon LABS: KUB & gastrografin enema done at outlying hospital were c/w IS. Barium enema was repeated w/o resolution of IS. Air contrast done unsuccessful. Annual followup 01/4/2010 He always has a risk of bowel obstruction, as well as increased bowel movements causing him embarassment. There will always be emotional issues as well due to scaring.
CDC 'Split Type':

Write-up: Vomiting, Diaherria, intussusception 4-5 days post vaccination--tx surgery (has colostomy bag resulting in 2nd operation in 6-8 weeks). 5/22/07 Received medical records from hospital which reveal patient experienced emesis for 1 day, 3 loose stools w/bloody mucous & abdominal pain. On admit 5/14/07 was lethargic. FINAL DX: Intusussception, transferred to higher level of care for surgery. 5/29/07 Received hospital medical records which reveal patient was received from outlying hospital after vomiting, bloody diarrhea, pallor & lethargy. Admitted 5/14-5/18/07. Unable to reduce the IS & was taken to OR for exp lap & resection of sholecolonic IS, colostomy & placement of central line. 26 cm of colon was removed & patient was in ICU post op, intubated & on multiple IV antibiotics. Initially on TPN but was able to be extubated & diet advanced to oral FINAL DX: Cholecolonic intussusception; intussusception nonreducible, w/perforation. Follow-up: He will always have the risk of bowel obstruction and other bowel conditions due to the intensity of the surgeries.


Changed on 6/14/2018

VAERS ID: 279026 Before After
VAERS Form:1
Age:0.27
Gender:Male
Location:Alabama
Vaccinated:2007-05-08
Onset:2007-05-13
Submitted:2007-05-19
Entered:2007-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1125F / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08679D / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1165F / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Colostomy, Diarrhoea, Intensive care, Intussusception, Lymphocyte count decreased, Mucous stools, Surgery, Vomiting, X-ray, Enema administration, Central venous catheterisation, Occult blood, Endotracheal intubation

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: 4     Extended hospital stay? No
Previous Vaccinations: none~ ()~~0.00~Patient|none~ ()~~0.00~Sibling|none~ ()~~0.00~Sibling
Other Medications: none
Current Illness: none
Preexisting Conditions: none Birth HX: 37 wk by c-section. birth wt 3565. Initially had respiratory depression which improved w/stimulation & CPAP. Normal growth & development since birth.
Allergies:
Diagnostic Lab Data: enema x-ray series, radiology reports, fecal occult sample Outlying hosp LABS: WBC 21,300, polys 80, lymphs 17 & 3 monos. plts 818,000. Chemistries WNL. Abdominal x-ray revealed dilated intestinal loops. Gastrograffin enema revealed IS of descending colon LABS: KUB & gastrografin enema done at outlying hospital were c/w IS. Barium enema was repeated w/o resolution of IS. Air contrast done unsuccessful. Annual followup 01/4/2010 He always has a risk of bowel obstruction, as well as increased bowel movements causing him embarassment. There will always be emotional issues as well due to scaring.
CDC 'Split Type':

Write-up: Vomiting, Diaherria, intussusception 4-5 days post vaccination--tx surgery (has colostomy bag resulting in 2nd operation in 6-8 weeks). 5/22/07 Received medical records from hospital which reveal patient experienced emesis for 1 day, 3 loose stools w/bloody mucous & abdominal pain. On admit 5/14/07 was lethargic. FINAL DX: Intusussception, transferred to higher level of care for surgery. 5/29/07 Received hospital medical records which reveal patient was received from outlying hospital after vomiting, bloody diarrhea, pallor & lethargy. Admitted 5/14-5/18/07. Unable to reduce the IS & was taken to OR for exp lap & resection of sholecolonic IS, colostomy & placement of central line. 26 cm of colon was removed & patient was in ICU post op, intubated & on multiple IV antibiotics. Initially on TPN but was able to be extubated & diet advanced to oral FINAL DX: Cholecolonic intussusception; intussusception nonreducible, w/perforation. Follow-up: He will always have the risk of bowel obstruction and other bowel conditions due to the intensity of the surgeries.

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