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This is VAERS ID 284308

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 284308
VAERS Form:
Age:0.4
Gender:Male
Location:Pennsylvania
Vaccinated:2007-06-07
Onset:2007-06-30
Submitted:2007-07-08
Entered:2007-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2650AA / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0198F / - LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0547 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B0874A / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0578E / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Appendicectomy, Blood potassium decreased, Culture stool negative, Culture urine negative, Diarrhoea haemorrhagic

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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: VSD, Bronchitis, s/p repair pyloric stenosis records received 7/26/07- HX of pyloric stenosis surgically repaired 3/07-cardiac murmur small VSD.
Allergies:
Diagnostic Lab Data: None records received 7/26/07-Labs neut 71.1, lymph 25.7, mono 2.9. Potassium 2.0, sodium 147. Urine culture no growth. Stool culture normal flora. X-ray Upper GI with KUB:distended small bowel loops compatible with small bowel obstruction
CDC 'Split Type':

Write-up: Intussusception 7/26/07-records received for DOS 6/30-7/7/07-DC DX: Intussusception. Exploratory laparotomy and appendectomy on 7/2/07. On 6/30/06- C/O fever, nausea vomiting since night before. Sudden onset of vomiting became projectile. Bloody DiarrheaT"emp 100.5.

Changed on 12/8/2009

VAERS ID: 284308 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Pennsylvania
Vaccinated:2007-06-07
Onset:2007-06-30
Submitted:2007-07-08
Entered:2007-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2650AA / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0198F / - LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0547 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B0874A / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0578E / 1 - / PO

Administered by: Private      Purchased by: Unknown Public
Symptoms: Appendicectomy, Blood potassium decreased, Culture stool negative, Culture urine negative, Diarrhoea haemorrhagic, Gastrooesophageal reflux disease, Intussusception, Laparotomy, Lymphocyte count decreased, Monocyte count decreased, Nausea, Neutrophil count increased, Pyrexia, Small intestinal obstruction, Vomiting projectile, X-ray gastrointestinal tract abnormal

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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: VSD, Bronchitis, s/p repair pyloric stenosis records received 7/26/07- HX of pyloric stenosis surgically repaired 3/07-cardiac murmur small VSD.
Allergies:
Diagnostic Lab Data: None records received 7/26/07-Labs neut 71.1, lymph 25.7, mono 2.9. Potassium 2.0, sodium 147. Urine culture no growth. Stool culture normal flora. X-ray Upper GI with KUB:distended small bowel loops compatible with small bowel obstruction
CDC 'Split Type':

Write-up: Intussusception 7/26/07-records received for DOS 6/30-7/7/07-DC DX: Intussusception. Exploratory laparotomy and appendectomy on 7/2/07. On 6/30/06- C/O fever, nausea vomiting since night before. Sudden onset of vomiting became projectile. Bloody DiarrheaT"emp DiarrheaTemp 100.5.

Changed on 3/2/2010

VAERS ID: 284308 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Pennsylvania
Vaccinated:2007-06-07
Onset:2007-06-30
Submitted:2007-07-08
Entered:2007-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2650AA / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0198F / - LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0547 / 1 RL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B0874A / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0578E / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Appendicectomy, Blood potassium decreased, Culture stool negative, Culture urine negative, Diarrhoea haemorrhagic, Gastrooesophageal reflux disease, Intussusception, Laparotomy, Lymphocyte count decreased, Monocyte count decreased, Nausea, Neutrophil count increased, Pyrexia, Small intestinal obstruction, Vomiting projectile, X-ray gastrointestinal tract abnormal

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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: VSD, Bronchitis, s/p repair pyloric stenosis records received 7/26/07- HX of pyloric stenosis surgically repaired 3/07-cardiac murmur small VSD.
Allergies:
Diagnostic Lab Data: None records received 7/26/07-Labs neut 71.1, lymph 25.7, mono 2.9. Potassium 2.0, sodium 147. Urine culture no growth. Stool culture normal flora. X-ray Upper GI with KUB:distended small bowel loops compatible with small bowel obstruction
CDC 'Split Type':

Write-up: Intussusception 7/26/07-records received for DOS 6/30-7/7/07-DC DX: Intussusception. Exploratory laparotomy and appendectomy on 7/2/07. On 6/30/06- C/O fever, nausea vomiting since night before. Sudden onset of vomiting became projectile. Bloody DiarrheaTemp 100.5.

Changed on 4/7/2010

VAERS ID: 284308 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Pennsylvania
Vaccinated:2007-06-07
Onset:2007-06-30
Submitted:2007-07-08
Entered:2007-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2650AA / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0198F / - LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0547 / 1 RL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B0874A / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0578E / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Appendicectomy, Blood potassium decreased, Culture stool negative, Culture urine negative, Diarrhoea haemorrhagic, Gastrooesophageal reflux disease, Intussusception, Laparotomy, Lymphocyte count decreased, Monocyte count decreased, Nausea, Neutrophil count increased, Pyrexia, Small intestinal obstruction, Vomiting projectile, X-ray gastrointestinal tract abnormal

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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: VSD, Bronchitis, s/p repair pyloric stenosis records received 7/26/07- HX of pyloric stenosis surgically repaired 3/07-cardiac murmur small VSD.
Allergies:
Diagnostic Lab Data: None records received 7/26/07-Labs neut 71.1, lymph 25.7, mono 2.9. Potassium 2.0, sodium 147. Urine culture no growth. Stool culture normal flora. X-ray Upper GI with KUB:distended small bowel loops compatible with small bowel obstruction
CDC 'Split Type':

Write-up: Intussusception 7/26/07-records received for DOS 6/30-7/7/07-DC DX: Intussusception. Exploratory laparotomy and appendectomy on 7/2/07. On 6/30/06- C/O fever, nausea vomiting since night before. Sudden onset of vomiting became projectile. Bloody DiarrheaTemp 100.5.

Changed on 8/31/2010

VAERS ID: 284308 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Pennsylvania
Vaccinated:2007-06-07
Onset:2007-06-30
Submitted:2007-07-08
Entered:2007-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2650AA / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0198F / - LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0547 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B0874A / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0578E / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Appendicectomy, Blood potassium decreased, Culture stool negative, Culture urine negative, Diarrhoea haemorrhagic, Gastrooesophageal reflux disease, Intussusception, Laparotomy, Lymphocyte count decreased, Monocyte count decreased, Nausea, Neutrophil count increased, Pyrexia, Small intestinal obstruction, Vomiting projectile, X-ray gastrointestinal tract abnormal

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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: VSD, Bronchitis, s/p repair pyloric stenosis records received 7/26/07- HX of pyloric stenosis surgically repaired 3/07-cardiac murmur small VSD.
Allergies:
Diagnostic Lab Data: None records received 7/26/07-Labs neut 71.1, lymph 25.7, mono 2.9. Potassium 2.0, sodium 147. Urine culture no growth. Stool culture normal flora. X-ray Upper GI with KUB:distended small bowel loops compatible with small bowel obstruction
CDC 'Split Type':

Write-up: Intussusception 7/26/07-records received for DOS 6/30-7/7/07-DC DX: Intussusception. Exploratory laparotomy and appendectomy on 7/2/07. On 6/30/06- C/O fever, nausea vomiting since night before. Sudden onset of vomiting became projectile. Bloody DiarrheaTemp 100.5.

Changed on 5/13/2013

VAERS ID: 284308 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Pennsylvania
Vaccinated:2007-06-07
Onset:2007-06-30
Submitted:2007-07-08
Entered:2007-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2650AA / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0198F / - LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0547 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B0874A / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0578E / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0578E / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Appendicectomy, Blood potassium decreased, Culture stool negative, Culture urine negative, Diarrhoea haemorrhagic, Gastrooesophageal reflux disease, Intussusception, Laparotomy, Lymphocyte count decreased, Monocyte count decreased, Nausea, Neutrophil count increased, Pyrexia, Small intestinal obstruction, Vomiting projectile, X-ray gastrointestinal tract abnormal

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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: VSD, Bronchitis, s/p repair pyloric stenosis records received 7/26/07- HX of pyloric stenosis surgically repaired 3/07-cardiac murmur small VSD.
Allergies:
Diagnostic Lab Data: None records received 7/26/07-Labs neut 71.1, lymph 25.7, mono 2.9. Potassium 2.0, sodium 147. Urine culture no growth. Stool culture normal flora. X-ray Upper GI with KUB:distended small bowel loops compatible with small bowel obstruction
CDC 'Split Type':

Write-up: Intussusception 7/26/07-records received for DOS 6/30-7/7/07-DC DX: Intussusception. Exploratory laparotomy and appendectomy on 7/2/07. On 6/30/06- C/O fever, nausea vomiting since night before. Sudden onset of vomiting became projectile. Bloody DiarrheaTemp 100.5.

Changed on 5/14/2017

VAERS ID: 284308 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Pennsylvania
Vaccinated:2007-06-07
Onset:2007-06-30
Submitted:2007-07-08
Entered:2007-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2650AA / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0198F / - LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0547 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B0874A / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0578E / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Appendicectomy, Blood potassium decreased, Culture stool negative, Culture urine negative, Diarrhoea haemorrhagic, Gastrooesophageal reflux disease, Intussusception, Laparotomy, Lymphocyte count decreased, Monocyte count decreased, Nausea, Neutrophil count increased, Pyrexia, Small intestinal obstruction, Vomiting projectile, X-ray gastrointestinal tract abnormal

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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: VSD, Bronchitis, s/p repair pyloric stenosis records received 7/26/07- HX of pyloric stenosis surgically repaired 3/07-cardiac murmur small VSD.
Allergies:
Diagnostic Lab Data: None records received 7/26/07-Labs neut 71.1, lymph 25.7, mono 2.9. Potassium 2.0, sodium 147. Urine culture no growth. Stool culture normal flora. X-ray Upper GI with KUB:distended small bowel loops compatible with small bowel obstruction. Gastroesophageal reflux disease. CT abdomen: Small bowel obstruction presumably due to ileoileal or ileocecal intussusception in distal ileum
CDC 'Split Type':

Write-up: Intussusception 7/26/07-records received for DOS 6/30-7/7/07-DC DX: Intussusception. Exploratory laparotomy and appendectomy on 7/2/07. On 6/30/06- C/O fever, nausea vomiting since night before. Sudden onset of vomiting became projectile. Bloody DiarrheaTemp 100.5.

Changed on 9/14/2017

VAERS ID: 284308 Before After
VAERS Form:(blank) 1
Age:0.4
Gender:Male
Location:Pennsylvania
Vaccinated:2007-06-07
Onset:2007-06-30
Submitted:2007-07-08
Entered:2007-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2650AA / 1 2 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0198F / - UNK LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0547 / 1 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B0874A / 1 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0578E / 1 2 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception

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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: VSD, Bronchitis, s/p repair pyloric stenosis records received 7/26/07- HX of pyloric stenosis surgically repaired 3/07-cardiac murmur small VSD.
Allergies:
Diagnostic Lab Data: None records received 7/26/07-Labs neut 71.1, lymph 25.7, mono 2.9. Potassium 2.0, sodium 147. Urine culture no growth. Stool culture normal flora. X-ray Upper GI with KUB:distended small bowel loops compatible with small bowel obstruction. Gastroesophageal reflux disease. CT abdomen: Small bowel obstruction presumably due to ileoileal or ileocecal intussusception in distal ileum
CDC 'Split Type':

Write-up: Intussusception 7/26/07-records received for DOS 6/30-7/7/07-DC DX: Intussusception. Exploratory laparotomy and appendectomy on 7/2/07. On 6/30/06- C/O fever, nausea vomiting since night before. Sudden onset of vomiting became projectile. Bloody DiarrheaTemp 100.5.

Changed on 2/14/2018

VAERS ID: 284308 Before After
VAERS Form:1
Age:0.4
Gender:Male
Location:Pennsylvania
Vaccinated:2007-06-07
Onset:2007-06-30
Submitted:2007-07-08
Entered:2007-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2650AA / 2 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0198F / UNK LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0547 / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B0874A / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0578E / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception

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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: VSD, Bronchitis, s/p repair pyloric stenosis records received 7/26/07- HX of pyloric stenosis surgically repaired 3/07-cardiac murmur small VSD.
Allergies:
Diagnostic Lab Data: None records received 7/26/07-Labs neut 71.1, lymph 25.7, mono 2.9. Potassium 2.0, sodium 147. Urine culture no growth. Stool culture normal flora. X-ray Upper GI with KUB:distended small bowel loops compatible with small bowel obstruction. Gastroesophageal reflux disease. CT abdomen: Small bowel obstruction presumably due to ileoileal or ileocecal intussusception in distal ileum
CDC 'Split Type':

Write-up: Intussusception 7/26/07-records received for DOS 6/30-7/7/07-DC DX: Intussusception. Exploratory laparotomy and appendectomy on 7/2/07. On 6/30/06- C/O fever, nausea vomiting since night before. Sudden onset of vomiting became projectile. Bloody DiarrheaTemp 100.5.

Changed on 6/14/2018

VAERS ID: 284308 Before After
VAERS Form:1
Age:0.4
Gender:Male
Location:Pennsylvania
Vaccinated:2007-06-07
Onset:2007-06-30
Submitted:2007-07-08
Entered:2007-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2650AA / 2 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0198F / UNK LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0547 / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B0874A / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0578E / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception

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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: VSD, Bronchitis, s/p repair pyloric stenosis records received 7/26/07- HX of pyloric stenosis surgically repaired 3/07-cardiac murmur small VSD.
Allergies:
Diagnostic Lab Data: None records received 7/26/07-Labs neut 71.1, lymph 25.7, mono 2.9. Potassium 2.0, sodium 147. Urine culture no growth. Stool culture normal flora. X-ray Upper GI with KUB:distended small bowel loops compatible with small bowel obstruction. Gastroesophageal reflux disease. CT abdomen: Small bowel obstruction presumably due to ileoileal or ileocecal intussusception in distal ileum
CDC 'Split Type':

Write-up: Intussusception 7/26/07-records received for DOS 6/30-7/7/07-DC DX: Intussusception. Exploratory laparotomy and appendectomy on 7/2/07. On 6/30/06- C/O fever, nausea vomiting since night before. Sudden onset of vomiting became projectile. Bloody DiarrheaTemp 100.5.

Changed on 8/14/2018

VAERS ID: 284308 Before After
VAERS Form:1
Age:0.4
Gender:Male
Location:Pennsylvania
Vaccinated:2007-06-07
Onset:2007-06-30
Submitted:2007-07-08
Entered:2007-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2650AA / 2 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0198F / UNK LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0547 / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B0874A / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0578E / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception

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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: VSD, Bronchitis, s/p repair pyloric stenosis records received 7/26/07- HX of pyloric stenosis surgically repaired 3/07-cardiac murmur small VSD.
Allergies:
Diagnostic Lab Data: None records received 7/26/07-Labs neut 71.1, lymph 25.7, mono 2.9. Potassium 2.0, sodium 147. Urine culture no growth. Stool culture normal flora. X-ray Upper GI with KUB:distended small bowel loops compatible with small bowel obstruction. Gastroesophageal reflux disease. CT abdomen: Small bowel obstruction presumably due to ileoileal or ileocecal intussusception in distal ileum
CDC 'Split Type':

Write-up: Intussusception 7/26/07-records received for DOS 6/30-7/7/07-DC DX: Intussusception. Exploratory laparotomy and appendectomy on 7/2/07. On 6/30/06- C/O fever, nausea vomiting since night before. Sudden onset of vomiting became projectile. Bloody DiarrheaTemp 100.5.

Changed on 9/14/2018

VAERS ID: 284308 Before After
VAERS Form:1
Age:0.4
Gender:Male
Location:Pennsylvania
Vaccinated:2007-06-07
Onset:2007-06-30
Submitted:2007-07-08
Entered:2007-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2650AA / 2 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0198F / UNK LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0547 / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B0874A / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0578E / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception

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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: VSD, Bronchitis, s/p repair pyloric stenosis records received 7/26/07- HX of pyloric stenosis surgically repaired 3/07-cardiac murmur small VSD.
Allergies:
Diagnostic Lab Data: None records received 7/26/07-Labs neut 71.1, lymph 25.7, mono 2.9. Potassium 2.0, sodium 147. Urine culture no growth. Stool culture normal flora. X-ray Upper GI with KUB:distended small bowel loops compatible with small bowel obstruction. Gastroesophageal reflux disease. CT abdomen: Small bowel obstruction presumably due to ileoileal or ileocecal intussusception in distal ileum
CDC 'Split Type':

Write-up: Intussusception 7/26/07-records received for DOS 6/30-7/7/07-DC DX: Intussusception. Exploratory laparotomy and appendectomy on 7/2/07. On 6/30/06- C/O fever, nausea vomiting since night before. Sudden onset of vomiting became projectile. Bloody DiarrheaTemp 100.5.

Changed on 10/14/2018

VAERS ID: 284308 Before After
VAERS Form:1
Age:0.4
Gender:Male
Location:Pennsylvania
Vaccinated:2007-06-07
Onset:2007-06-30
Submitted:2007-07-08
Entered:2007-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2650AA / 2 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0198F / UNK LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0547 / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B0874A / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0578E / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception

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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: VSD, Bronchitis, s/p repair pyloric stenosis records received 7/26/07- HX of pyloric stenosis surgically repaired 3/07-cardiac murmur small VSD.
Allergies:
Diagnostic Lab Data: None records received 7/26/07-Labs neut 71.1, lymph 25.7, mono 2.9. Potassium 2.0, sodium 147. Urine culture no growth. Stool culture normal flora. X-ray Upper GI with KUB:distended small bowel loops compatible with small bowel obstruction. Gastroesophageal reflux disease. CT abdomen: Small bowel obstruction presumably due to ileoileal or ileocecal intussusception in distal ileum
CDC 'Split Type':

Write-up: Intussusception 7/26/07-records received for DOS 6/30-7/7/07-DC DX: Intussusception. Exploratory laparotomy and appendectomy on 7/2/07. On 6/30/06- C/O fever, nausea vomiting since night before. Sudden onset of vomiting became projectile. Bloody DiarrheaTemp 100.5.

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