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This is VAERS ID 289161

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 289161
VAERS Form:
Age:0.2
Gender:Male
Location:Delaware
Vaccinated:2007-07-24
Onset:2007-08-19
Submitted:2007-08-23
Entered:2007-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2651AA / 0 RL / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 00404 / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF205AA / 0 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 21069 / 0 LL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B47442H / 0 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0551U / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Abdominal pain, Appendicectomy, Barium enema, Blood culture negative, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Xray of chest and abdomen
CDC 'Split Type':

Write-up: Pt. presented with vomiting and abdominal pain 8/19/07-taken to ER was later admitted to hospital-found to have a small bowel obstruction, not corrected by barium enema, needed to be taken to surgery (Dx: Intussusception) discharged on 8/22/07-all resolve"d


Changed on 12/8/2009

VAERS ID: 289161 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Delaware
Vaccinated:2007-07-24
Onset:2007-08-19
Submitted:2007-08-23
Entered:2007-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2651AA / 0 RL / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 00404 / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF205AA / 0 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 21069 / 0 LL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B47442H / 0 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0551U / 0 - / PO

Administered by: Private      Purchased by: Unknown Private
Symptoms: Abdominal pain, Appendicectomy, Barium enema, Blood culture negative, Chest X-ray, Culture urine positive, Intussusception, Small intestinal obstruction, Surgery, Vomiting, Citrobacter infection, Urine output decreased, Abdominal X-ray, Oral intake reduced

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None None. PMH: 35-36 wk premie with NICU stay for respiratory distress following birth. PE WNL at 2 months
Allergies:
Diagnostic Lab Data: Xray of chest and abdomen abdomen. Labs and Diagnostics: Abdominal X-ray concerning for SBO. Contrast enema (+) for intussusception which could not be fully reduced. Blood cultures (-). UC <10,000 Citrobacter koseri.
CDC 'Split Type':

Write-up: Pt. presented with vomiting and abdominal pain 8/19/07-taken to ER was later admitted to hospital-found to have a small bowel obstruction, not corrected by barium enema, needed to be taken to surgery (Dx: Intussusception) discharged on 8/22/07-all resolve"d resolved. 9/4/2007 MR rceived from PCP including vax record and hospital D/C summary and labs. Vax record c/w VAERS report. Infant presented 8/20/07 with 1 day hx of decreased feeding, decreased UO, and 3 episodes of NBNB emesis. Abdominal tenderness (+). Contrast enema showed IS but was could not be fully reduced. Taken to OR for Open reduction with incidental appendectomy. Discharged home on POD#2. Diagnosis: Intussusception.


Changed on 3/2/2010

VAERS ID: 289161 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Delaware
Vaccinated:2007-07-24
Onset:2007-08-19
Submitted:2007-08-23
Entered:2007-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2651AA / 0 RL / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 00404 / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF205AA / 0 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 21069 / 0 LL / UN
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B47442H / 0 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0551U / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Appendicectomy, Barium enema, Blood culture negative, Chest X-ray, Culture urine positive, Intussusception, Small intestinal obstruction, Surgery, Vomiting, Citrobacter infection, Urine output decreased, Abdominal X-ray, Oral intake reduced

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None. PMH: 35-36 wk premie with NICU stay for respiratory distress following birth. PE WNL at 2 months
Allergies:
Diagnostic Lab Data: Xray of chest and abdomen. Labs and Diagnostics: Abdominal X-ray concerning for SBO. Contrast enema (+) for intussusception which could not be fully reduced. Blood cultures (-). UC <10,000 Citrobacter koseri.
CDC 'Split Type':

Write-up: Pt. presented with vomiting and abdominal pain 8/19/07-taken to ER was later admitted to hospital-found to have a small bowel obstruction, not corrected by barium enema, needed to be taken to surgery (Dx: Intussusception) discharged on 8/22/07-all resolved. 9/4/2007 MR rceived from PCP including vax record and hospital D/C summary and labs. Vax record c/w VAERS report. Infant presented 8/20/07 with 1 day hx of decreased feeding, decreased UO, and 3 episodes of NBNB emesis. Abdominal tenderness (+). Contrast enema showed IS but was could not be fully reduced. Taken to OR for Open reduction with incidental appendectomy. Discharged home on POD#2. Diagnosis: Intussusception.


Changed on 4/7/2010

VAERS ID: 289161 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Delaware
Vaccinated:2007-07-24
Onset:2007-08-19
Submitted:2007-08-23
Entered:2007-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2651AA / 0 RL / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 00404 / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF205AA / 0 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 21069 / 0 LL / UN
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B47442H / 0 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0551U / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Appendicectomy, Barium enema, Blood culture negative, Chest X-ray, Culture urine positive, Intussusception, Small intestinal obstruction, Surgery, Vomiting, Citrobacter infection, Urine output decreased, Abdominal X-ray, Oral intake reduced

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None. PMH: 35-36 wk premie with NICU stay for respiratory distress following birth. PE WNL at 2 months
Allergies:
Diagnostic Lab Data: Xray of chest and abdomen. Labs and Diagnostics: Abdominal X-ray concerning for SBO. Contrast enema (+) for intussusception which could not be fully reduced. Blood cultures (-). UC <10,000 Citrobacter koseri.
CDC 'Split Type':

Write-up: Pt. presented with vomiting and abdominal pain 8/19/07-taken to ER was later admitted to hospital-found to have a small bowel obstruction, not corrected by barium enema, needed to be taken to surgery (Dx: Intussusception) discharged on 8/22/07-all resolved. 9/4/2007 MR rceived from PCP including vax record and hospital D/C summary and labs. Vax record c/w VAERS report. Infant presented 8/20/07 with 1 day hx of decreased feeding, decreased UO, and 3 episodes of NBNB emesis. Abdominal tenderness (+). Contrast enema showed IS but was could not be fully reduced. Taken to OR for Open reduction with incidental appendectomy. Discharged home on POD#2. Diagnosis: Intussusception.


Changed on 8/31/2010

VAERS ID: 289161 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Delaware
Vaccinated:2007-07-24
Onset:2007-08-19
Submitted:2007-08-23
Entered:2007-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2651AA / 0 RL / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 00404 / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF205AA / 0 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 21069 / 0 LL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B47442H / 0 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0551U / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Appendicectomy, Barium enema, Blood culture negative, Chest X-ray, Culture urine positive, Intussusception, Small intestinal obstruction, Surgery, Vomiting, Citrobacter infection, Urine output decreased, Abdominal X-ray, Oral intake reduced

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None. PMH: 35-36 wk premie with NICU stay for respiratory distress following birth. PE WNL at 2 months
Allergies:
Diagnostic Lab Data: Xray of chest and abdomen. Labs and Diagnostics: Abdominal X-ray concerning for SBO. Contrast enema (+) for intussusception which could not be fully reduced. Blood cultures (-). UC <10,000 Citrobacter koseri.
CDC 'Split Type':

Write-up: Pt. presented with vomiting and abdominal pain 8/19/07-taken to ER was later admitted to hospital-found to have a small bowel obstruction, not corrected by barium enema, needed to be taken to surgery (Dx: Intussusception) discharged on 8/22/07-all resolved. 9/4/2007 MR rceived from PCP including vax record and hospital D/C summary and labs. Vax record c/w VAERS report. Infant presented 8/20/07 with 1 day hx of decreased feeding, decreased UO, and 3 episodes of NBNB emesis. Abdominal tenderness (+). Contrast enema showed IS but was could not be fully reduced. Taken to OR for Open reduction with incidental appendectomy. Discharged home on POD#2. Diagnosis: Intussusception.


Changed on 4/13/2011

VAERS ID: 289161 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Delaware
Vaccinated:2007-07-24
Onset:2007-08-19
Submitted:2007-08-23
Entered:2007-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2651AA / 0 RL / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 00404 / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF205AA / 0 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 21069 / 0 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47442H / 0 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0551U / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Appendicectomy, Barium enema, Blood culture negative, Chest X-ray, Culture urine positive, Intussusception, Small intestinal obstruction, Surgery, Vomiting, Citrobacter infection, Urine output decreased, Abdominal X-ray, Oral intake reduced

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None. PMH: 35-36 wk premie with NICU stay for respiratory distress following birth. PE WNL at 2 months
Allergies:
Diagnostic Lab Data: Xray of chest and abdomen. Labs and Diagnostics: Abdominal X-ray concerning for SBO. Contrast enema (+) for intussusception which could not be fully reduced. Blood cultures (-). UC <10,000 Citrobacter koseri.
CDC 'Split Type':

Write-up: Pt. presented with vomiting and abdominal pain 8/19/07-taken to ER was later admitted to hospital-found to have a small bowel obstruction, not corrected by barium enema, needed to be taken to surgery (Dx: Intussusception) discharged on 8/22/07-all resolved. 9/4/2007 MR rceived from PCP including vax record and hospital D/C summary and labs. Vax record c/w VAERS report. Infant presented 8/20/07 with 1 day hx of decreased feeding, decreased UO, and 3 episodes of NBNB emesis. Abdominal tenderness (+). Contrast enema showed IS but was could not be fully reduced. Taken to OR for Open reduction with incidental appendectomy. Discharged home on POD#2. Diagnosis: Intussusception.


Changed on 5/13/2011

VAERS ID: 289161 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Delaware
Vaccinated:2007-07-24
Onset:2007-08-19
Submitted:2007-08-23
Entered:2007-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2651AA / 0 RL / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 00404 / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF205AA / 0 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 21069 / 0 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47442H / 0 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0551U / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Appendicectomy, Barium enema, Blood culture negative, Chest X-ray, Culture urine positive, Intussusception, Small intestinal obstruction, Surgery, Vomiting, Citrobacter infection, Urine output decreased, Abdominal X-ray, Oral intake reduced

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None. PMH: 35-36 wk premie with NICU stay for respiratory distress following birth. PE WNL at 2 months
Allergies:
Diagnostic Lab Data: Xray of chest and abdomen. Labs and Diagnostics: Abdominal X-ray concerning for SBO. Contrast enema (+) for intussusception which could not be fully reduced. Blood cultures (-). UC <10,000 Citrobacter koseri.
CDC 'Split Type':

Write-up: Pt. presented with vomiting and abdominal pain 8/19/07-taken to ER was later admitted to hospital-found to have a small bowel obstruction, not corrected by barium enema, needed to be taken to surgery (Dx: Intussusception) discharged on 8/22/07-all resolved. 9/4/2007 MR rceived from PCP including vax record and hospital D/C summary and labs. Vax record c/w VAERS report. Infant presented 8/20/07 with 1 day hx of decreased feeding, decreased UO, and 3 episodes of NBNB emesis. Abdominal tenderness (+). Contrast enema showed IS but was could not be fully reduced. Taken to OR for Open reduction with incidental appendectomy. Discharged home on POD#2. Diagnosis: Intussusception.


Changed on 6/11/2011

VAERS ID: 289161 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Delaware
Vaccinated:2007-07-24
Onset:2007-08-19
Submitted:2007-08-23
Entered:2007-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2651AA / 0 RL / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 00404 / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF205AA / 0 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 21069 / 0 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47442H / 0 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0551U / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Appendicectomy, Barium enema, Blood culture negative, Chest X-ray, Culture urine positive, Intussusception, Small intestinal obstruction, Surgery, Vomiting, Citrobacter infection, Urine output decreased, Abdominal X-ray, Oral intake reduced

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None. PMH: 35-36 wk premie with NICU stay for respiratory distress following birth. PE WNL at 2 months
Allergies:
Diagnostic Lab Data: Xray of chest and abdomen. Labs and Diagnostics: Abdominal X-ray concerning for SBO. Contrast enema (+) for intussusception which could not be fully reduced. Blood cultures (-). UC <10,000 Citrobacter koseri.
CDC 'Split Type':

Write-up: Pt. presented with vomiting and abdominal pain 8/19/07-taken to ER was later admitted to hospital-found to have a small bowel obstruction, not corrected by barium enema, needed to be taken to surgery (Dx: Intussusception) discharged on 8/22/07-all resolved. 9/4/2007 MR rceived from PCP including vax record and hospital D/C summary and labs. Vax record c/w VAERS report. Infant presented 8/20/07 with 1 day hx of decreased feeding, decreased UO, and 3 episodes of NBNB emesis. Abdominal tenderness (+). Contrast enema showed IS but was could not be fully reduced. Taken to OR for Open reduction with incidental appendectomy. Discharged home on POD#2. Diagnosis: Intussusception.


Changed on 5/13/2013

VAERS ID: 289161 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Delaware
Vaccinated:2007-07-24
Onset:2007-08-19
Submitted:2007-08-23
Entered:2007-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2651AA / 0 RL / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 00404 / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF205AA / 0 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 21069 / 0 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47442H / 0 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0551U / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0551U / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Appendicectomy, Barium enema, Blood culture negative, Chest X-ray, Culture urine positive, Intussusception, Small intestinal obstruction, Surgery, Vomiting, Citrobacter infection, Urine output decreased, Abdominal X-ray, Oral intake reduced

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None. PMH: 35-36 wk premie with NICU stay for respiratory distress following birth. PE WNL at 2 months
Allergies:
Diagnostic Lab Data: Xray of chest and abdomen. Labs and Diagnostics: Abdominal X-ray concerning for SBO. Contrast enema (+) for intussusception which could not be fully reduced. Blood cultures (-). UC <10,000 Citrobacter koseri.
CDC 'Split Type':

Write-up: Pt. presented with vomiting and abdominal pain 8/19/07-taken to ER was later admitted to hospital-found to have a small bowel obstruction, not corrected by barium enema, needed to be taken to surgery (Dx: Intussusception) discharged on 8/22/07-all resolved. 9/4/2007 MR rceived from PCP including vax record and hospital D/C summary and labs. Vax record c/w VAERS report. Infant presented 8/20/07 with 1 day hx of decreased feeding, decreased UO, and 3 episodes of NBNB emesis. Abdominal tenderness (+). Contrast enema showed IS but was could not be fully reduced. Taken to OR for Open reduction with incidental appendectomy. Discharged home on POD#2. Diagnosis: Intussusception.


Changed on 2/14/2017

VAERS ID: 289161 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Delaware
Vaccinated:2007-07-24
Onset:2007-08-19
Submitted:2007-08-23
Entered:2007-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2651AA / 0 RL / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 00404 / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF205AA / 0 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 21069 / 0 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47442H / 0 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0551U / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Appendicectomy, Barium enema, Blood culture negative, Chest X-ray, Culture urine positive, Intussusception, Small intestinal obstruction, Surgery, Vomiting, Citrobacter infection, Urine output decreased, Abdominal X-ray, Oral intake reduced

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None. PMH: 35-36 wk premie with NICU stay for respiratory distress following birth. PE WNL at 2 months
Allergies:
Diagnostic Lab Data: Xray of chest and abdomen. Labs and Diagnostics: Abdominal X-ray concerning for SBO. Contrast enema (+) for intussusception which could not be fully reduced. Blood cultures (-). UC <10,000 Citrobacter koseri.
CDC 'Split Type':

Write-up: Pt. presented with vomiting and abdominal pain 8/19/07-taken to ER was later admitted to hospital-found to have a small bowel obstruction, not corrected by barium enema, needed to be taken to surgery (Dx: Intussusception) discharged on 8/22/07-all resolved. 9/4/2007 MR rceived from PCP including vax record and hospital D/C summary and labs. Vax record c/w VAERS report. Infant presented 8/20/07 with 1 day hx of decreased feeding, decreased UO, and 3 episodes of NBNB emesis. Abdominal tenderness (+). Contrast enema showed IS but was could not be fully reduced. Taken to OR for Open reduction with incidental appendectomy. Discharged home on POD#2. Diagnosis: Intussusception.


Changed on 9/14/2017

VAERS ID: 289161 Before After
VAERS Form:(blank) 1
Age:0.2
Gender:Male
Location:Delaware
Vaccinated:2007-07-24
Onset:2007-08-19
Submitted:2007-08-23
Entered:2007-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2651AA / 0 1 RL / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 00404 / 1 2 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF205AA / 0 1 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 21069 / 0 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47442H / 0 1 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0551U / 0 1 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Barium enema, Chest X-ray, Intussusception, Small intestinal obstruction, Surgery, Vomiting, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None. PMH: 35-36 wk premie with NICU stay for respiratory distress following birth. PE WNL at 2 months
Allergies:
Diagnostic Lab Data: Xray of chest and abdomen. Labs and Diagnostics: Abdominal X-ray concerning for SBO. Contrast enema (+) for intussusception which could not be fully reduced. Blood cultures (-). UC <10,000 Citrobacter koseri.
CDC 'Split Type':

Write-up: Pt. presented with vomiting and abdominal pain 8/19/07-taken to ER was later admitted to hospital-found to have a small bowel obstruction, not corrected by barium enema, needed to be taken to surgery (Dx: Intussusception) discharged on 8/22/07-all resolved. 9/4/2007 MR rceived from PCP including vax record and hospital D/C summary and labs. Vax record c/w VAERS report. Infant presented 8/20/07 with 1 day hx of decreased feeding, decreased UO, and 3 episodes of NBNB emesis. Abdominal tenderness (+). Contrast enema showed IS but was could not be fully reduced. Taken to OR for Open reduction with incidental appendectomy. Discharged home on POD#2. Diagnosis: Intussusception.


Changed on 2/14/2018

VAERS ID: 289161 Before After
VAERS Form:1
Age:0.2
Gender:Male
Location:Delaware
Vaccinated:2007-07-24
Onset:2007-08-19
Submitted:2007-08-23
Entered:2007-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2651AA / 1 RL / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 00404 / 2 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF205AA / 1 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 21069 / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47442H / 1 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0551U / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Barium enema, Chest X-ray, Intussusception, Small intestinal obstruction, Surgery, Vomiting, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None. PMH: 35-36 wk premie with NICU stay for respiratory distress following birth. PE WNL at 2 months
Allergies:
Diagnostic Lab Data: Xray of chest and abdomen. Labs and Diagnostics: Abdominal X-ray concerning for SBO. Contrast enema (+) for intussusception which could not be fully reduced. Blood cultures (-). UC <10,000 Citrobacter koseri.
CDC 'Split Type':

Write-up: Pt. presented with vomiting and abdominal pain 8/19/07-taken to ER was later admitted to hospital-found to have a small bowel obstruction, not corrected by barium enema, needed to be taken to surgery (Dx: Intussusception) discharged on 8/22/07-all resolved. 9/4/2007 MR rceived from PCP including vax record and hospital D/C summary and labs. Vax record c/w VAERS report. Infant presented 8/20/07 with 1 day hx of decreased feeding, decreased UO, and 3 episodes of NBNB emesis. Abdominal tenderness (+). Contrast enema showed IS but was could not be fully reduced. Taken to OR for Open reduction with incidental appendectomy. Discharged home on POD#2. Diagnosis: Intussusception.


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