National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 289041

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 289041
VAERS Form:
Age:0.3
Gender:Male
Location:Michigan
Vaccinated:2007-06-14
Onset:2007-08-04
Submitted:2007-08-20
Entered:2007-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B114CA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1126F / 1 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08692H / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0236U / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Abdominal pain, Barium enema, Blood test normal, Decreased appetite

Life Threatening? Yes
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Confirmed by barium enema, Reduced by air enema
CDC 'Split Type':

Write-up: Intussusception - 1 day intermittent symptoms with colicky abdominal pain, blood tinged mucous stool --$g reduced by air enema


Changed on 12/8/2009

VAERS ID: 289041 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Michigan
Vaccinated:2007-06-14
Onset:2007-08-04
Submitted:2007-08-20
Entered:2007-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B114CA / 1 LL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B114CA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1126F / 1 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08692H / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0236U / 1 - / PO

Administered by: Private      Purchased by: Unknown Private
Symptoms: Abdominal pain, Barium enema, Haematochezia, Intussusception, Irritability, Listless, Lymphadenitis, Mucous stools, Vomiting, Enema administration, Blood test normal, Ultrasound abdomen abnormal, Decreased appetite

Life Threatening? Yes
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Confirmed by barium enema, Reduced by air enema LABS: Barium enema revealed IS in transverse colon. Air enema reduced. US of abdomen (+) IS recurrence, ileocolic IS & mesenteric adenitis. Blood work WNL.
CDC 'Split Type':

Write-up: Intussusception - 1 day intermittent symptoms with colicky abdominal pain, blood tinged mucous stool --$g reduced by air enema. 8/28/07 Received pcp medical records which included Hospital D/C summary & H&P. PCP records included vax records but no lot #s. T/C to pcp office, stated info on VAERS report correct & will not provide further info on lot #s. Office visit of 6/14 indicates patient was healthy on day of vax. F/U note of 8/07 indicates patient doing well post op. D/C Summary indicates paitent experienced mucousy emesis, decreased appetite, abdominal pain, fussy, listless & refusal to lie prone x 1 day & bloody mucously stool on day of admit. Admitted 8/4-8/5/07 for observation s/p IS reduction. Overnight, IS recurred as evidenced by (+) US. Then spontaneously resolved. FINAL DX: Intussusception, enema reduced. 9/17/07 Received lab & x-ray reports from hospital.


Changed on 3/2/2010

VAERS ID: 289041 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Michigan
Vaccinated:2007-06-14
Onset:2007-08-04
Submitted:2007-08-20
Entered:2007-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B114CA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1126F / 1 RL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B08692H / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0236U / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Barium enema, Haematochezia, Intussusception, Irritability, Listless, Lymphadenitis, Mucous stools, Vomiting, Enema administration, Blood test normal, Ultrasound abdomen abnormal, Decreased appetite

Life Threatening? Yes
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Confirmed by barium enema, Reduced by air enema LABS: Barium enema revealed IS in transverse colon. Air enema reduced. US of abdomen (+) IS recurrence, ileocolic IS & mesenteric adenitis. Blood work WNL.
CDC 'Split Type':

Write-up: Intussusception - 1 day intermittent symptoms with colicky abdominal pain, blood tinged mucous stool --$g reduced by air enema. 8/28/07 Received pcp medical records which included Hospital D/C summary & H&P. PCP records included vax records but no lot #s. T/C to pcp office, stated info on VAERS report correct & will not provide further info on lot #s. Office visit of 6/14 indicates patient was healthy on day of vax. F/U note of 8/07 indicates patient doing well post op. D/C Summary indicates paitent experienced mucousy emesis, decreased appetite, abdominal pain, fussy, listless & refusal to lie prone x 1 day & bloody mucously stool on day of admit. Admitted 8/4-8/5/07 for observation s/p IS reduction. Overnight, IS recurred as evidenced by (+) US. Then spontaneously resolved. FINAL DX: Intussusception, enema reduced. 9/17/07 Received lab & x-ray reports from hospital.


Changed on 4/7/2010

VAERS ID: 289041 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Michigan
Vaccinated:2007-06-14
Onset:2007-08-04
Submitted:2007-08-20
Entered:2007-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B114CA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1126F / 1 RL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08692H / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0236U / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Barium enema, Haematochezia, Intussusception, Irritability, Listless, Lymphadenitis, Mucous stools, Vomiting, Enema administration, Blood test normal, Ultrasound abdomen abnormal, Decreased appetite

Life Threatening? Yes
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Confirmed by barium enema, Reduced by air enema LABS: Barium enema revealed IS in transverse colon. Air enema reduced. US of abdomen (+) IS recurrence, ileocolic IS & mesenteric adenitis. Blood work WNL.
CDC 'Split Type':

Write-up: Intussusception - 1 day intermittent symptoms with colicky abdominal pain, blood tinged mucous stool --$g reduced by air enema. 8/28/07 Received pcp medical records which included Hospital D/C summary & H&P. PCP records included vax records but no lot #s. T/C to pcp office, stated info on VAERS report correct & will not provide further info on lot #s. Office visit of 6/14 indicates patient was healthy on day of vax. F/U note of 8/07 indicates patient doing well post op. D/C Summary indicates paitent experienced mucousy emesis, decreased appetite, abdominal pain, fussy, listless & refusal to lie prone x 1 day & bloody mucously stool on day of admit. Admitted 8/4-8/5/07 for observation s/p IS reduction. Overnight, IS recurred as evidenced by (+) US. Then spontaneously resolved. FINAL DX: Intussusception, enema reduced. 9/17/07 Received lab & x-ray reports from hospital.


Changed on 8/31/2010

VAERS ID: 289041 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Michigan
Vaccinated:2007-06-14
Onset:2007-08-04
Submitted:2007-08-20
Entered:2007-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B114CA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1126F / 1 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B08692H / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0236U / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Barium enema, Haematochezia, Intussusception, Irritability, Listless, Lymphadenitis, Mucous stools, Vomiting, Enema administration, Blood test normal, Ultrasound abdomen abnormal, Decreased appetite

Life Threatening? Yes
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Confirmed by barium enema, Reduced by air enema LABS: Barium enema revealed IS in transverse colon. Air enema reduced. US of abdomen (+) IS recurrence, ileocolic IS & mesenteric adenitis. Blood work WNL.
CDC 'Split Type':

Write-up: Intussusception - 1 day intermittent symptoms with colicky abdominal pain, blood tinged mucous stool --$g reduced by air enema. 8/28/07 Received pcp medical records which included Hospital D/C summary & H&P. PCP records included vax records but no lot #s. T/C to pcp office, stated info on VAERS report correct & will not provide further info on lot #s. Office visit of 6/14 indicates patient was healthy on day of vax. F/U note of 8/07 indicates patient doing well post op. D/C Summary indicates paitent experienced mucousy emesis, decreased appetite, abdominal pain, fussy, listless & refusal to lie prone x 1 day & bloody mucously stool on day of admit. Admitted 8/4-8/5/07 for observation s/p IS reduction. Overnight, IS recurred as evidenced by (+) US. Then spontaneously resolved. FINAL DX: Intussusception, enema reduced. 9/17/07 Received lab & x-ray reports from hospital.


Changed on 5/13/2013

VAERS ID: 289041 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Michigan
Vaccinated:2007-06-14
Onset:2007-08-04
Submitted:2007-08-20
Entered:2007-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B114CA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1126F / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08692H / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0236U / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0236U / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Barium enema, Haematochezia, Intussusception, Irritability, Listless, Lymphadenitis, Mucous stools, Vomiting, Enema administration, Blood test normal, Ultrasound abdomen abnormal, Decreased appetite

Life Threatening? Yes
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Confirmed by barium enema, Reduced by air enema LABS: Barium enema revealed IS in transverse colon. Air enema reduced. US of abdomen (+) IS recurrence, ileocolic IS & mesenteric adenitis. Blood work WNL.
CDC 'Split Type':

Write-up: Intussusception - 1 day intermittent symptoms with colicky abdominal pain, blood tinged mucous stool --$g reduced by air enema. 8/28/07 Received pcp medical records which included Hospital D/C summary & H&P. PCP records included vax records but no lot #s. T/C to pcp office, stated info on VAERS report correct & will not provide further info on lot #s. Office visit of 6/14 indicates patient was healthy on day of vax. F/U note of 8/07 indicates patient doing well post op. D/C Summary indicates paitent experienced mucousy emesis, decreased appetite, abdominal pain, fussy, listless & refusal to lie prone x 1 day & bloody mucously stool on day of admit. Admitted 8/4-8/5/07 for observation s/p IS reduction. Overnight, IS recurred as evidenced by (+) US. Then spontaneously resolved. FINAL DX: Intussusception, enema reduced. 9/17/07 Received lab & x-ray reports from hospital.


Changed on 5/14/2017

VAERS ID: 289041 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Michigan
Vaccinated:2007-06-14
Onset:2007-08-04
Submitted:2007-08-20
Entered:2007-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B114CA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1126F / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08692H / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0236U / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Barium enema, Haematochezia, Intussusception, Irritability, Listless, Lymphadenitis, Mucous stools, Vomiting, Enema administration, Blood test normal, Ultrasound abdomen abnormal, Decreased appetite

Life Threatening? Yes
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Confirmed by barium enema, Reduced by air enema LABS: Barium enema revealed IS in transverse colon. Air enema reduced. US of abdomen (+) IS recurrence, ileocolic IS & mesenteric adenitis. Blood work WNL.
CDC 'Split Type':

Write-up: Intussusception - 1 day intermittent symptoms with colicky abdominal pain, blood tinged mucous stool --$g reduced by air enema. 8/28/07 Received pcp medical records which included Hospital D/C summary & H&P. PCP records included vax records but no lot #s. T/C to pcp office, stated info on VAERS report correct & will not provide further info on lot #s. Office visit of 6/14 indicates patient was healthy on day of vax. F/U note of 8/07 indicates patient doing well post op. D/C Summary indicates paitent experienced mucousy emesis, decreased appetite, abdominal pain, fussy, listless & refusal to lie prone x 1 day & bloody mucously stool on day of admit. Admitted 8/4-8/5/07 for observation s/p IS reduction. Overnight, IS recurred as evidenced by (+) US. Then spontaneously resolved. FINAL DX: Intussusception, enema reduced. 9/17/07 Received lab & x-ray reports from hospital.


Changed on 9/14/2017

VAERS ID: 289041 Before After
VAERS Form:(blank) 1
Age:0.3
Gender:Male
Location:Michigan
Vaccinated:2007-06-14
Onset:2007-08-04
Submitted:2007-08-20
Entered:2007-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B114CA / 1 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1126F / 1 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08692H / 1 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0236U / 1 2 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Barium enema, Haematochezia, Intussusception, Mucous stools, Enema administration

Life Threatening? Yes
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Confirmed by barium enema, Reduced by air enema LABS: Barium enema revealed IS in transverse colon. Air enema reduced. US of abdomen (+) IS recurrence, ileocolic IS & mesenteric adenitis. Blood work WNL.
CDC 'Split Type':

Write-up: Intussusception - 1 day intermittent symptoms with colicky abdominal pain, blood tinged mucous stool --$g reduced by air enema. 8/28/07 Received pcp medical records which included Hospital D/C summary & H&P. PCP records included vax records but no lot #s. T/C to pcp office, stated info on VAERS report correct & will not provide further info on lot #s. Office visit of 6/14 indicates patient was healthy on day of vax. F/U note of 8/07 indicates patient doing well post op. D/C Summary indicates paitent experienced mucousy emesis, decreased appetite, abdominal pain, fussy, listless & refusal to lie prone x 1 day & bloody mucously stool on day of admit. Admitted 8/4-8/5/07 for observation s/p IS reduction. Overnight, IS recurred as evidenced by (+) US. Then spontaneously resolved. FINAL DX: Intussusception, enema reduced. 9/17/07 Received lab & x-ray reports from hospital.


Changed on 2/14/2018

VAERS ID: 289041 Before After
VAERS Form:1
Age:0.3
Gender:Male
Location:Michigan
Vaccinated:2007-06-14
Onset:2007-08-04
Submitted:2007-08-20
Entered:2007-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B114CA / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1126F / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08692H / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0236U / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Barium enema, Haematochezia, Intussusception, Mucous stools, Enema administration

Life Threatening? Yes
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Confirmed by barium enema, Reduced by air enema LABS: Barium enema revealed IS in transverse colon. Air enema reduced. US of abdomen (+) IS recurrence, ileocolic IS & mesenteric adenitis. Blood work WNL.
CDC 'Split Type':

Write-up: Intussusception - 1 day intermittent symptoms with colicky abdominal pain, blood tinged mucous stool --$g reduced by air enema. 8/28/07 Received pcp medical records which included Hospital D/C summary & H&P. PCP records included vax records but no lot #s. T/C to pcp office, stated info on VAERS report correct & will not provide further info on lot #s. Office visit of 6/14 indicates patient was healthy on day of vax. F/U note of 8/07 indicates patient doing well post op. D/C Summary indicates paitent experienced mucousy emesis, decreased appetite, abdominal pain, fussy, listless & refusal to lie prone x 1 day & bloody mucously stool on day of admit. Admitted 8/4-8/5/07 for observation s/p IS reduction. Overnight, IS recurred as evidenced by (+) US. Then spontaneously resolved. FINAL DX: Intussusception, enema reduced. 9/17/07 Received lab & x-ray reports from hospital.


Changed on 6/14/2018

VAERS ID: 289041 Before After
VAERS Form:1
Age:0.3
Gender:Male
Location:Michigan
Vaccinated:2007-06-14
Onset:2007-08-04
Submitted:2007-08-20
Entered:2007-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B114CA / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1126F / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08692H / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0236U / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Barium enema, Haematochezia, Intussusception, Mucous stools, Enema administration

Life Threatening? Yes
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Confirmed by barium enema, Reduced by air enema LABS: Barium enema revealed IS in transverse colon. Air enema reduced. US of abdomen (+) IS recurrence, ileocolic IS & mesenteric adenitis. Blood work WNL.
CDC 'Split Type':

Write-up: Intussusception - 1 day intermittent symptoms with colicky abdominal pain, blood tinged mucous stool --$g reduced by air enema. 8/28/07 Received pcp medical records which included Hospital D/C summary & H&P. PCP records included vax records but no lot #s. T/C to pcp office, stated info on VAERS report correct & will not provide further info on lot #s. Office visit of 6/14 indicates patient was healthy on day of vax. F/U note of 8/07 indicates patient doing well post op. D/C Summary indicates paitent experienced mucousy emesis, decreased appetite, abdominal pain, fussy, listless & refusal to lie prone x 1 day & bloody mucously stool on day of admit. Admitted 8/4-8/5/07 for observation s/p IS reduction. Overnight, IS recurred as evidenced by (+) US. Then spontaneously resolved. FINAL DX: Intussusception, enema reduced. 9/17/07 Received lab & x-ray reports from hospital.

New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=289041&WAYBACKHISTORY=ON


Copyright © 2018 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166