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This is VAERS ID 291827

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 291827
VAERS Form:
Age:0.3
Gender:Male
Location:Michigan
Vaccinated:2007-07-23
Onset:2007-09-20
Submitted:2007-09-27
Entered:2007-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2605AA / 1 UN / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0408F / 1 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 20306 / 1 UN / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08679A / 1 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0025U / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Abdominal distension, Abdominal tenderness, Appendicectomy, Adenovirus infection, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd US (+) for IS. Abd X-ray: Small-bowel obstruction 2'''' to Intussusception. Barium enema unable to reduce the IS. Sugical pathology of Appendix Vermiformis: Lymphoid Hyperplasia and Adenovirus Infection.
CDC 'Split Type':

Write-up: Diarrhea, blood in stool and diagnosed w/intussusception emergency surgery done on 9-21-07 at hospital (possibly from Rotavirus vaccine)


Changed on 12/8/2009

VAERS ID: 291827 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Michigan
Vaccinated:2007-07-23
Onset:2007-09-20
Submitted:2007-09-27
Entered:2007-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2605AA / 1 UN / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0408F / 1 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 20306 / 1 UN / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08679A / 1 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0025U / 1 - / PO

Administered by: Private      Purchased by: Unknown Public
Symptoms: Abdominal distension, Abdominal tenderness, Appendicectomy, Barium enema, Diarrhoea, Haematochezia, Intussusception, Laparotomy, Nausea, Pyrexia, Small intestinal intussusception reduction, Small intestinal obstruction, Surgery, Lymphoid tissue hyperplasia, Ultrasound abdomen abnormal, Adenovirus infection, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd US (+) for IS. Abd X-ray: Small-bowel obstruction 2'''' 2'' to Intussusception. Barium enema unable to reduce the IS. Sugical pathology of Appendix Vermiformis: Lymphoid Hyperplasia and Adenovirus Infection.
CDC 'Split Type':

Write-up: Diarrhea, blood in stool and diagnosed w/intussusception emergency surgery done on 9-21-07 at hospital (possibly from Rotavirus vaccine) vaccine). 11/30/2007 MR received for DOS 9/21-23/2007 with discharge DX: Ileal-Ileal Ileocolic Intussusception. Child presented with 2 day hx of fever, nausea and vomiting with blood in stool. On PE, abdomen (+) distention and RLQ tenderness. Currant jelly stool in ER. Barium enema x 3 attempts-unable to reduce the IS so pt taken to OR for a Laparotomy with manuel reduction of Intussusception with Incidental Appendectomy. Pt did well post-op and D/cd home on POD 2. 12/10/2007 Vax record received from PC. Info the same as VAERS form submission. Doing well s/p surgery.


Changed on 3/2/2010

VAERS ID: 291827 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Michigan
Vaccinated:2007-07-23
Onset:2007-09-20
Submitted:2007-09-27
Entered:2007-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2605AA / 1 UN / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0408F / 1 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 20306 / 1 UN / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B08679A / 1 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0025U / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal distension, Abdominal tenderness, Appendicectomy, Barium enema, Diarrhoea, Haematochezia, Intussusception, Laparotomy, Nausea, Pyrexia, Small intestinal intussusception reduction, Small intestinal obstruction, Surgery, Lymphoid tissue hyperplasia, Ultrasound abdomen abnormal, Adenovirus infection, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd US (+) for IS. Abd X-ray: Small-bowel obstruction 2'' to Intussusception. Barium enema unable to reduce the IS. Sugical pathology of Appendix Vermiformis: Lymphoid Hyperplasia and Adenovirus Infection.
CDC 'Split Type':

Write-up: Diarrhea, blood in stool and diagnosed w/intussusception emergency surgery done on 9-21-07 at hospital (possibly from Rotavirus vaccine). 11/30/2007 MR received for DOS 9/21-23/2007 with discharge DX: Ileal-Ileal Ileocolic Intussusception. Child presented with 2 day hx of fever, nausea and vomiting with blood in stool. On PE, abdomen (+) distention and RLQ tenderness. Currant jelly stool in ER. Barium enema x 3 attempts-unable to reduce the IS so pt taken to OR for a Laparotomy with manuel reduction of Intussusception with Incidental Appendectomy. Pt did well post-op and D/cd home on POD 2. 12/10/2007 Vax record received from PC. Info the same as VAERS form submission. Doing well s/p surgery.


Changed on 4/7/2010

VAERS ID: 291827 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Michigan
Vaccinated:2007-07-23
Onset:2007-09-20
Submitted:2007-09-27
Entered:2007-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2605AA / 1 UN / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0408F / 1 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 20306 / 1 UN / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08679A / 1 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0025U / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal distension, Abdominal tenderness, Appendicectomy, Barium enema, Diarrhoea, Haematochezia, Intussusception, Laparotomy, Nausea, Pyrexia, Small intestinal intussusception reduction, Small intestinal obstruction, Surgery, Lymphoid tissue hyperplasia, Ultrasound abdomen abnormal, Adenovirus infection, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd US (+) for IS. Abd X-ray: Small-bowel obstruction 2'' to Intussusception. Barium enema unable to reduce the IS. Sugical pathology of Appendix Vermiformis: Lymphoid Hyperplasia and Adenovirus Infection.
CDC 'Split Type':

Write-up: Diarrhea, blood in stool and diagnosed w/intussusception emergency surgery done on 9-21-07 at hospital (possibly from Rotavirus vaccine). 11/30/2007 MR received for DOS 9/21-23/2007 with discharge DX: Ileal-Ileal Ileocolic Intussusception. Child presented with 2 day hx of fever, nausea and vomiting with blood in stool. On PE, abdomen (+) distention and RLQ tenderness. Currant jelly stool in ER. Barium enema x 3 attempts-unable to reduce the IS so pt taken to OR for a Laparotomy with manuel reduction of Intussusception with Incidental Appendectomy. Pt did well post-op and D/cd home on POD 2. 12/10/2007 Vax record received from PC. Info the same as VAERS form submission. Doing well s/p surgery.


Changed on 8/31/2010

VAERS ID: 291827 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Michigan
Vaccinated:2007-07-23
Onset:2007-09-20
Submitted:2007-09-27
Entered:2007-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2605AA / 1 UN / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0408F / 1 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 20306 / 1 UN / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B08679A / 1 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0025U / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal distension, Abdominal tenderness, Appendicectomy, Barium enema, Diarrhoea, Haematochezia, Intussusception, Laparotomy, Nausea, Pyrexia, Small intestinal intussusception reduction, Small intestinal obstruction, Surgery, Lymphoid tissue hyperplasia, Ultrasound abdomen abnormal, Adenovirus infection, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd US (+) for IS. Abd X-ray: Small-bowel obstruction 2'' to Intussusception. Barium enema unable to reduce the IS. Sugical pathology of Appendix Vermiformis: Lymphoid Hyperplasia and Adenovirus Infection.
CDC 'Split Type':

Write-up: Diarrhea, blood in stool and diagnosed w/intussusception emergency surgery done on 9-21-07 at hospital (possibly from Rotavirus vaccine). 11/30/2007 MR received for DOS 9/21-23/2007 with discharge DX: Ileal-Ileal Ileocolic Intussusception. Child presented with 2 day hx of fever, nausea and vomiting with blood in stool. On PE, abdomen (+) distention and RLQ tenderness. Currant jelly stool in ER. Barium enema x 3 attempts-unable to reduce the IS so pt taken to OR for a Laparotomy with manuel reduction of Intussusception with Incidental Appendectomy. Pt did well post-op and D/cd home on POD 2. 12/10/2007 Vax record received from PC. Info the same as VAERS form submission. Doing well s/p surgery.


Changed on 5/13/2013

VAERS ID: 291827 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Michigan
Vaccinated:2007-07-23
Onset:2007-09-20
Submitted:2007-09-27
Entered:2007-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2605AA / 1 UN / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0408F / 1 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 20306 / 1 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08679A / 1 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0025U / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0025U / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal distension, Abdominal tenderness, Appendicectomy, Barium enema, Diarrhoea, Haematochezia, Intussusception, Laparotomy, Nausea, Pyrexia, Small intestinal intussusception reduction, Small intestinal obstruction, Surgery, Lymphoid tissue hyperplasia, Ultrasound abdomen abnormal, Adenovirus infection, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd US (+) for IS. Abd X-ray: Small-bowel obstruction 2'' to Intussusception. Barium enema unable to reduce the IS. Sugical pathology of Appendix Vermiformis: Lymphoid Hyperplasia and Adenovirus Infection.
CDC 'Split Type':

Write-up: Diarrhea, blood in stool and diagnosed w/intussusception emergency surgery done on 9-21-07 at hospital (possibly from Rotavirus vaccine). 11/30/2007 MR received for DOS 9/21-23/2007 with discharge DX: Ileal-Ileal Ileocolic Intussusception. Child presented with 2 day hx of fever, nausea and vomiting with blood in stool. On PE, abdomen (+) distention and RLQ tenderness. Currant jelly stool in ER. Barium enema x 3 attempts-unable to reduce the IS so pt taken to OR for a Laparotomy with manuel reduction of Intussusception with Incidental Appendectomy. Pt did well post-op and D/cd home on POD 2. 12/10/2007 Vax record received from PC. Info the same as VAERS form submission. Doing well s/p surgery.


Changed on 2/14/2017

VAERS ID: 291827 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Michigan
Vaccinated:2007-07-23
Onset:2007-09-20
Submitted:2007-09-27
Entered:2007-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2605AA / 1 UN / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0408F / 1 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 20306 / 1 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08679A / 1 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0025U / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal distension, Abdominal tenderness, Appendicectomy, Barium enema, Diarrhoea, Haematochezia, Intussusception, Laparotomy, Nausea, Pyrexia, Small intestinal intussusception reduction, Small intestinal obstruction, Surgery, Lymphoid tissue hyperplasia, Ultrasound abdomen abnormal, Adenovirus infection, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd US (+) for IS. Abd X-ray: Small-bowel obstruction 2'' to Intussusception. Barium enema unable to reduce the IS. Sugical pathology of Appendix Vermiformis: Lymphoid Hyperplasia and Adenovirus Infection.
CDC 'Split Type':

Write-up: Diarrhea, blood in stool and diagnosed w/intussusception emergency surgery done on 9-21-07 at hospital (possibly from Rotavirus vaccine). 11/30/2007 MR received for DOS 9/21-23/2007 with discharge DX: Ileal-Ileal Ileocolic Intussusception. Child presented with 2 day hx of fever, nausea and vomiting with blood in stool. On PE, abdomen (+) distention and RLQ tenderness. Currant jelly stool in ER. Barium enema x 3 attempts-unable to reduce the IS so pt taken to OR for a Laparotomy with manuel reduction of Intussusception with Incidental Appendectomy. Pt did well post-op and D/cd home on POD 2. 12/10/2007 Vax record received from PC. Info the same as VAERS form submission. Doing well s/p surgery.


Changed on 9/14/2017

VAERS ID: 291827 Before After
VAERS Form:(blank) 1
Age:0.3
Gender:Male
Location:Michigan
Vaccinated:2007-07-23
Onset:2007-09-20
Submitted:2007-09-27
Entered:2007-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2605AA / 1 2 UN / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0408F / 1 2 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 20306 / 1 2 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08679A / 1 2 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0025U / 1 2 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Diarrhoea, Haematochezia, Intussusception, Surgery

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd US (+) for IS. Abd X-ray: Small-bowel obstruction 2'' to Intussusception. Barium enema unable to reduce the IS. Sugical pathology of Appendix Vermiformis: Lymphoid Hyperplasia and Adenovirus Infection.
CDC 'Split Type':

Write-up: Diarrhea, blood in stool and diagnosed w/intussusception emergency surgery done on 9-21-07 at hospital (possibly from Rotavirus vaccine). 11/30/2007 MR received for DOS 9/21-23/2007 with discharge DX: Ileal-Ileal Ileocolic Intussusception. Child presented with 2 day hx of fever, nausea and vomiting with blood in stool. On PE, abdomen (+) distention and RLQ tenderness. Currant jelly stool in ER. Barium enema x 3 attempts-unable to reduce the IS so pt taken to OR for a Laparotomy with manuel reduction of Intussusception with Incidental Appendectomy. Pt did well post-op and D/cd home on POD 2. 12/10/2007 Vax record received from PC. Info the same as VAERS form submission. Doing well s/p surgery.


Changed on 2/14/2018

VAERS ID: 291827 Before After
VAERS Form:1
Age:0.3
Gender:Male
Location:Michigan
Vaccinated:2007-07-23
Onset:2007-09-20
Submitted:2007-09-27
Entered:2007-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2605AA / 2 UN / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0408F / 2 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 20306 / 2 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08679A / 2 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0025U / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Diarrhoea, Haematochezia, Intussusception, Surgery

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd US (+) for IS. Abd X-ray: Small-bowel obstruction 2'' to Intussusception. Barium enema unable to reduce the IS. Sugical pathology of Appendix Vermiformis: Lymphoid Hyperplasia and Adenovirus Infection.
CDC 'Split Type':

Write-up: Diarrhea, blood in stool and diagnosed w/intussusception emergency surgery done on 9-21-07 at hospital (possibly from Rotavirus vaccine). 11/30/2007 MR received for DOS 9/21-23/2007 with discharge DX: Ileal-Ileal Ileocolic Intussusception. Child presented with 2 day hx of fever, nausea and vomiting with blood in stool. On PE, abdomen (+) distention and RLQ tenderness. Currant jelly stool in ER. Barium enema x 3 attempts-unable to reduce the IS so pt taken to OR for a Laparotomy with manuel reduction of Intussusception with Incidental Appendectomy. Pt did well post-op and D/cd home on POD 2. 12/10/2007 Vax record received from PC. Info the same as VAERS form submission. Doing well s/p surgery.


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