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History of Changes from the VAERS Wayback Machine |
VAERS ID: | 292396 |
VAERS Form: | |
Age: | 0.2 |
Sex: | Male |
Location: | Kentucky |
Vaccinated: | 2007-08-24 |
Onset: | 2007-09-23 |
Submitted: | 2007-09-27 |
Entered: | 2007-10-08 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR | 02657AA / 0 | RL / IM |
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. | 0016U / 0 | LL / IM |
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR | 21009 / 0 | RA / IM |
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC | B53981B / 0 | LL / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0972U / 0 | - / PO |
Administered by: Private Purchased by: Unknown
Symptoms: Barium double contrast, Blood culture positive, Body temperature increased, Depressed level of consciousness, Enema administration
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4
Write-up: Vaccine given 8/24/07. Started vomiting 9/23/07, no fever, no diarrhea initially - diagnosed with viral gastroenteritis. On 9/25/07 had large bloody bowel movement - seen in local ER, transferred to another hospital where diagnosed with intussusception an"d underwent surgical correction/resection. Hospital records received from PCP for DOS 9/26-30/2007 for DX Incarcerated Intussusception. Infant presented with lethargy, mental status changes, decreased po intake and a large bloody bowel movement. PE sig
Vaccinated: | 2007-08-24 |
Onset: | 2007-09-23 |
Submitted: | 2007-09-27 |
Entered: | 2007-10-08 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR | 02657AA / 0 | RL / IM |
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. | 0016U / 0 | LL / IM |
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR | 21009 / 0 | RA / IM |
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC | B53981B / 0 | LL / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0972U / 0 | - / PO |
Administered by: Private Purchased by: Unknown Private
Symptoms: Barium double contrast, Blood culture positive, Body temperature increased, Depressed level of consciousness, Full blood count, Gastroenteritis viral, Haematochezia, Intussusception, Lethargy, Listless, Mucosal dryness, Small intestinal resection, Vomiting, White blood cell count decreased, Mental status changes, Enema administration, Explorative laparotomy, Oral intake reduced
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4
Write-up: Vaccine given 8/24/07. Started vomiting 9/23/07, no fever, no diarrhea initially - diagnosed with viral gastroenteritis. On 9/25/07 had large bloody bowel movement - seen in local ER, transferred to another hospital where diagnosed with intussusception an"d and underwent surgical correction/resection. Hospital records received from PCP for DOS 9/26-30/2007 for DX Incarcerated Intussusception. Infant presented with lethargy, mental status changes, decreased po intake and a large bloody bowel movement. PE sig significant for T=100.6''F, listness and acutely ill appearing, dry mucus membranes, minimal response to painful stimuli, rectal exam (+) for gross blood. Reduction failed by air contrast enema and infant taken to OR for Exploratory Lap with small bowel resection for IS. Pt tolerated advancing diet and was d/c home on 9/30/2007. 10/23/2007 Vax record received and correlates with VAERS submission. Per 60 day follow up: Patient underwent exploratory laparotomy with small bowel resection for incarcerated intussusception.
Vaccinated: | 2007-08-24 |
Onset: | 2007-09-23 |
Submitted: | 2007-09-27 |
Entered: | 2007-10-08 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR | 02657AA / 0 | RL / IM |
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. | 0016U / 0 | LL / IM |
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR | 21009 / 0 | RA / IM |
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC | B53981B / 0 | LL / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0972U / 0 | - / PO |
Administered by: Private Purchased by: Private
Symptoms: Barium double contrast, Blood culture positive, Body temperature increased, Depressed level of consciousness, Full blood count, Gastroenteritis viral, Haematochezia, Intussusception, Lethargy, Listless, Mucosal dryness, Small intestinal resection, Vomiting, White blood cell count decreased, Mental status changes, Enema administration, Explorative laparotomy, 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
Write-up: Vaccine given 8/24/07. Started vomiting 9/23/07, no fever, no diarrhea initially - diagnosed with viral gastroenteritis. On 9/25/07 had large bloody bowel movement - seen in local ER, transferred to another hospital where diagnosed with intussusception and underwent surgical correction/resection. Hospital records received from PCP for DOS 9/26-30/2007 for DX Incarcerated Intussusception. Infant presented with lethargy, mental status changes, decreased po intake and a large bloody bowel movement. PE significant for T=100.6''F, listness and acutely ill appearing, dry mucus membranes, minimal response to painful stimuli, rectal exam (+) for gross blood. Reduction failed by air contrast enema and infant taken to OR for Exploratory Lap with small bowel resection for IS. Pt tolerated advancing diet and was d/c home on 9/30/2007. 10/23/2007 Vax record received and correlates with VAERS submission. Per 60 day follow up: Patient underwent exploratory laparotomy with small bowel resection for incarcerated intussusception.
Vaccinated: | 2007-08-24 |
Onset: | 2007-09-23 |
Submitted: | 2007-09-27 |
Entered: | 2007-10-08 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR | 02657AA / 0 | RL / IM |
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. | 0016U / 0 | LL / IM |
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR | 21009 / 0 | RA / IM |
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC | B53981B / 0 | LL / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0972U / 0 | - / PO |
Administered by: Private Purchased by: Private
Symptoms: Barium double contrast, Blood culture positive, Body temperature increased, Depressed level of consciousness, Full blood count, Gastroenteritis viral, Haematochezia, Intussusception, Lethargy, Listless, Mucosal dryness, Small intestinal resection, Vomiting, White blood cell count decreased, Mental status changes, Enema administration, Explorative laparotomy, 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
Write-up: Vaccine given 8/24/07. Started vomiting 9/23/07, no fever, no diarrhea initially - diagnosed with viral gastroenteritis. On 9/25/07 had large bloody bowel movement - seen in local ER, transferred to another hospital where diagnosed with intussusception and underwent surgical correction/resection. Hospital records received from PCP for DOS 9/26-30/2007 for DX Incarcerated Intussusception. Infant presented with lethargy, mental status changes, decreased po intake and a large bloody bowel movement. PE significant for T=100.6''F, listness and acutely ill appearing, dry mucus membranes, minimal response to painful stimuli, rectal exam (+) for gross blood. Reduction failed by air contrast enema and infant taken to OR for Exploratory Lap with small bowel resection for IS. Pt tolerated advancing diet and was d/c home on 9/30/2007. 10/23/2007 Vax record received and correlates with VAERS submission. Per 60 day follow up: Patient underwent exploratory laparotomy with small bowel resection for incarcerated intussusception.
Vaccinated: | 2007-08-24 |
Onset: | 2007-09-23 |
Submitted: | 2007-09-27 |
Entered: | 2007-10-08 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR | 02657AA / 0 | RL / IM |
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. | 0016U / 0 | LL / IM |
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR | 21009 / 0 | RA / IM |
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH | B53981B / 0 | LL / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0972U / 0 | - / PO |
Administered by: Private Purchased by: Private
Symptoms: Barium double contrast, Blood culture positive, Body temperature increased, Depressed level of consciousness, Full blood count, Gastroenteritis viral, Haematochezia, Intussusception, Lethargy, Listless, Mucosal dryness, Small intestinal resection, Vomiting, White blood cell count decreased, Mental status changes, Enema administration, Explorative laparotomy, 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
Write-up: Vaccine given 8/24/07. Started vomiting 9/23/07, no fever, no diarrhea initially - diagnosed with viral gastroenteritis. On 9/25/07 had large bloody bowel movement - seen in local ER, transferred to another hospital where diagnosed with intussusception and underwent surgical correction/resection. Hospital records received from PCP for DOS 9/26-30/2007 for DX Incarcerated Intussusception. Infant presented with lethargy, mental status changes, decreased po intake and a large bloody bowel movement. PE significant for T=100.6''F, listness and acutely ill appearing, dry mucus membranes, minimal response to painful stimuli, rectal exam (+) for gross blood. Reduction failed by air contrast enema and infant taken to OR for Exploratory Lap with small bowel resection for IS. Pt tolerated advancing diet and was d/c home on 9/30/2007. 10/23/2007 Vax record received and correlates with VAERS submission. Per 60 day follow up: Patient underwent exploratory laparotomy with small bowel resection for incarcerated intussusception.
Vaccinated: | 2007-08-24 |
Onset: | 2007-09-23 |
Submitted: | 2007-09-27 |
Entered: | 2007-10-08 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR | 02657AA / 0 | RL / IM |
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. | 0016U / 0 | LL / IM |
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR | 21009 / 0 | RA / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B53981B / 0 | LL / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0972U / 0 | - / PO |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0972U / 0 | - / PO |
Administered by: Private Purchased by: Private
Symptoms: Barium double contrast, Blood culture positive, Body temperature increased, Depressed level of consciousness, Full blood count, Gastroenteritis viral, Haematochezia, Intussusception, Lethargy, Listless, Mucosal dryness, Small intestinal resection, Vomiting, White blood cell count decreased, Mental status changes, Enema administration, Explorative laparotomy, 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
Write-up: Vaccine given 8/24/07. Started vomiting 9/23/07, no fever, no diarrhea initially - diagnosed with viral gastroenteritis. On 9/25/07 had large bloody bowel movement - seen in local ER, transferred to another hospital where diagnosed with intussusception and underwent surgical correction/resection. Hospital records received from PCP for DOS 9/26-30/2007 for DX Incarcerated Intussusception. Infant presented with lethargy, mental status changes, decreased po intake and a large bloody bowel movement. PE significant for T=100.6''F, listness and acutely ill appearing, dry mucus membranes, minimal response to painful stimuli, rectal exam (+) for gross blood. Reduction failed by air contrast enema and infant taken to OR for Exploratory Lap with small bowel resection for IS. Pt tolerated advancing diet and was d/c home on 9/30/2007. 10/23/2007 Vax record received and correlates with VAERS submission. Per 60 day follow up: Patient underwent exploratory laparotomy with small bowel resection for incarcerated intussusception.
Vaccinated: | 2007-08-24 |
Onset: | 2007-09-23 |
Submitted: | 2007-09-27 |
Entered: | 2007-10-08 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR | 02657AA / 0 | RL / IM |
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. | 0016U / 0 | LL / IM |
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR | 21009 / 0 | RA / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B53981B / 0 | LL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0972U / 0 | - / PO |
Administered by: Private Purchased by: Private
Symptoms: Barium double contrast, Blood culture positive, Body temperature increased, Depressed level of consciousness, Full blood count, Gastroenteritis viral, Haematochezia, Intussusception, Lethargy, Listless, Mucosal dryness, Small intestinal resection, Vomiting, White blood cell count decreased, Mental status changes, Enema administration, Explorative laparotomy, 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
Write-up: Vaccine given 8/24/07. Started vomiting 9/23/07, no fever, no diarrhea initially - diagnosed with viral gastroenteritis. On 9/25/07 had large bloody bowel movement - seen in local ER, transferred to another hospital where diagnosed with intussusception and underwent surgical correction/resection. Hospital records received from PCP for DOS 9/26-30/2007 for DX Incarcerated Intussusception. Infant presented with lethargy, mental status changes, decreased po intake and a large bloody bowel movement. PE significant for T=100.6''F, listness and acutely ill appearing, dry mucus membranes, minimal response to painful stimuli, rectal exam (+) for gross blood. Reduction failed by air contrast enema and infant taken to OR for Exploratory Lap with small bowel resection for IS. Pt tolerated advancing diet and was d/c home on 9/30/2007. 10/23/2007 Vax record received and correlates with VAERS submission. Per 60 day follow up: Patient underwent exploratory laparotomy with small bowel resection for incarcerated intussusception.
Vaccinated: | 2007-08-24 |
Onset: | 2007-09-23 |
Submitted: | 2007-09-27 |
Entered: | 2007-10-08 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR | 02657AA / 0 1 | RL / IM |
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. | 0016U / 0 1 | LL / IM |
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR | 21009 / 0 1 | RA / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B53981B / 0 1 | LL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0972U / 0 1 | - MO / PO |
Administered by: Private Purchased by: Private
Symptoms: Gastroenteritis viral, Haematochezia, Intussusception, Vomiting
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
Write-up: Vaccine given 8/24/07. Started vomiting 9/23/07, no fever, no diarrhea initially - diagnosed with viral gastroenteritis. On 9/25/07 had large bloody bowel movement - seen in local ER, transferred to another hospital where diagnosed with intussusception and underwent surgical correction/resection. Hospital records received from PCP for DOS 9/26-30/2007 for DX Incarcerated Intussusception. Infant presented with lethargy, mental status changes, decreased po intake and a large bloody bowel movement. PE significant for T=100.6''F, listness and acutely ill appearing, dry mucus membranes, minimal response to painful stimuli, rectal exam (+) for gross blood. Reduction failed by air contrast enema and infant taken to OR for Exploratory Lap with small bowel resection for IS. Pt tolerated advancing diet and was d/c home on 9/30/2007. 10/23/2007 Vax record received and correlates with VAERS submission. Per 60 day follow up: Patient underwent exploratory laparotomy with small bowel resection for incarcerated intussusception.
Vaccinated: | 2007-08-24 |
Onset: | 2007-09-23 |
Submitted: | 2007-09-27 |
Entered: | 2007-10-08 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR | 02657AA / 1 | RL / IM |
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. | 0016U / 1 | LL / IM |
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR | 21009 / 1 | RA / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B53981B / 1 | LL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0972U / 1 | MO / PO |
Administered by: Private Purchased by: Private
Symptoms: Gastroenteritis viral, Haematochezia, Intussusception, Vomiting
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
Write-up: Vaccine given 8/24/07. Started vomiting 9/23/07, no fever, no diarrhea initially - diagnosed with viral gastroenteritis. On 9/25/07 had large bloody bowel movement - seen in local ER, transferred to another hospital where diagnosed with intussusception and underwent surgical correction/resection. Hospital records received from PCP for DOS 9/26-30/2007 for DX Incarcerated Intussusception. Infant presented with lethargy, mental status changes, decreased po intake and a large bloody bowel movement. PE significant for T=100.6''F, listness and acutely ill appearing, dry mucus membranes, minimal response to painful stimuli, rectal exam (+) for gross blood. Reduction failed by air contrast enema and infant taken to OR for Exploratory Lap with small bowel resection for IS. Pt tolerated advancing diet and was d/c home on 9/30/2007. 10/23/2007 Vax record received and correlates with VAERS submission. Per 60 day follow up: Patient underwent exploratory laparotomy with small bowel resection for incarcerated intussusception.
Vaccinated: | 2007-08-24 |
Onset: | 2007-09-23 |
Submitted: | 2007-09-27 |
Entered: | 2007-10-08 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR | 02657AA / 1 | RL / IM |
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. | 0016U / 1 | LL / IM |
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR | 21009 / 1 | RA / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B53981B / 1 | LL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0972U / 1 | MO / PO |
Administered by: Private Purchased by: Private
Symptoms: Gastroenteritis viral, Haematochezia, Intussusception, Vomiting
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
Write-up: Vaccine given 8/24/07. Started vomiting 9/23/07, no fever, no diarrhea initially - diagnosed with viral gastroenteritis. On 9/25/07 had large bloody bowel movement - seen in local ER, transferred to another hospital where diagnosed with intussusception and underwent surgical correction/resection. Hospital records received from PCP for DOS 9/26-30/2007 for DX Incarcerated Intussusception. Infant presented with lethargy, mental status changes, decreased po intake and a large bloody bowel movement. PE significant for T=100.6''F, listness and acutely ill appearing, dry mucus membranes, minimal response to painful stimuli, rectal exam (+) for gross blood. Reduction failed by air contrast enema and infant taken to OR for Exploratory Lap with small bowel resection for IS. Pt tolerated advancing diet and was d/c home on 9/30/2007. 10/23/2007 Vax record received and correlates with VAERS submission. Per 60 day follow up: Patient underwent exploratory laparotomy with small bowel resection for incarcerated intussusception.
Vaccinated: | 2007-08-24 |
Onset: | 2007-09-23 |
Submitted: | 2007-09-27 |
Entered: | 2007-10-08 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR | 02657AA / 1 | RL / IM |
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. | 0016U / 1 | LL / IM |
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR | 21009 / 1 | RA / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B53981B / 1 | LL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0972U / 1 | MO / PO |
Administered by: Private Purchased by: Private
Symptoms: Gastroenteritis viral, Haematochezia, Intussusception, Vomiting
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
Write-up: Vaccine given 8/24/07. Started vomiting 9/23/07, no fever, no diarrhea initially - diagnosed with viral gastroenteritis. On 9/25/07 had large bloody bowel movement - seen in local ER, transferred to another hospital where diagnosed with intussusception and underwent surgical correction/resection. Hospital records received from PCP for DOS 9/26-30/2007 for DX Incarcerated Intussusception. Infant presented with lethargy, mental status changes, decreased po intake and a large bloody bowel movement. PE significant for T=100.6''F, listness and acutely ill appearing, dry mucus membranes, minimal response to painful stimuli, rectal exam (+) for gross blood. Reduction failed by air contrast enema and infant taken to OR for Exploratory Lap with small bowel resection for IS. Pt tolerated advancing diet and was d/c home on 9/30/2007. 10/23/2007 Vax record received and correlates with VAERS submission. Per 60 day follow up: Patient underwent exploratory laparotomy with small bowel resection for incarcerated intussusception.
Vaccinated: | 2007-08-24 |
Onset: | 2007-09-23 |
Submitted: | 2007-09-27 |
Entered: | 2007-10-08 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR | 02657AA / 1 | RL / IM |
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. | 0016U / 1 | LL / IM |
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR | 21009 / 1 | RA / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B53981B / 1 | LL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0972U / 1 | MO / PO |
Administered by: Private Purchased by: Private
Symptoms: Gastroenteritis viral, Haematochezia, Intussusception, Vomiting
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
Write-up: Vaccine given 8/24/07. Started vomiting 9/23/07, no fever, no diarrhea initially - diagnosed with viral gastroenteritis. On 9/25/07 had large bloody bowel movement - seen in local ER, transferred to another hospital where diagnosed with intussusception and underwent surgical correction/resection. Hospital records received from PCP for DOS 9/26-30/2007 for DX Incarcerated Intussusception. Infant presented with lethargy, mental status changes, decreased po intake and a large bloody bowel movement. PE significant for T=100.6''F, listness and acutely ill appearing, dry mucus membranes, minimal response to painful stimuli, rectal exam (+) for gross blood. Reduction failed by air contrast enema and infant taken to OR for Exploratory Lap with small bowel resection for IS. Pt tolerated advancing diet and was d/c home on 9/30/2007. 10/23/2007 Vax record received and correlates with VAERS submission. Per 60 day follow up: Patient underwent exploratory laparotomy with small bowel resection for incarcerated intussusception.
Vaccinated: | 2007-08-24 |
Onset: | 2007-09-23 |
Submitted: | 2007-09-27 |
Entered: | 2007-10-08 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR | 02657AA / 1 | RL / IM |
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. | 0016U / 1 | LL / IM |
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR | 21009 / 1 | RA / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B53981B / 1 | LL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0972U / 1 | MO / PO |
Administered by: Private Purchased by: Private
Symptoms: Gastroenteritis viral, Haematochezia, Intussusception, Vomiting
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
Write-up: Vaccine given 8/24/07. Started vomiting 9/23/07, no fever, no diarrhea initially - diagnosed with viral gastroenteritis. On 9/25/07 had large bloody bowel movement - seen in local ER, transferred to another hospital where diagnosed with intussusception and underwent surgical correction/resection. Hospital records received from PCP for DOS 9/26-30/2007 for DX Incarcerated Intussusception. Infant presented with lethargy, mental status changes, decreased po intake and a large bloody bowel movement. PE significant for T=100.6''F, listness and acutely ill appearing, dry mucus membranes, minimal response to painful stimuli, rectal exam (+) for gross blood. Reduction failed by air contrast enema and infant taken to OR for Exploratory Lap with small bowel resection for IS. Pt tolerated advancing diet and was d/c home on 9/30/2007. 10/23/2007 Vax record received and correlates with VAERS submission. Per 60 day follow up: Patient underwent exploratory laparotomy with small bowel resection for incarcerated intussusception.
Vaccinated: | 2007-08-24 |
Onset: | 2007-09-23 |
Submitted: | 2007-09-27 |
Entered: | 2007-10-08 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR | 02657AA / 1 | RL / IM |
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. | 0016U / 1 | LL / IM |
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR | 21009 / 1 | RA / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B53981B / 1 | LL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0972U / 1 | MO / PO |
Administered by: Private Purchased by: Private
Symptoms: Gastroenteritis viral, Haematochezia, Intussusception, Vomiting
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
Write-up: Vaccine given 8/24/07. Started vomiting 9/23/07, no fever, no diarrhea initially - diagnosed with viral gastroenteritis. On 9/25/07 had large bloody bowel movement - seen in local ER, transferred to another hospital where diagnosed with intussusception and underwent surgical correction/resection. Hospital records received from PCP for DOS 9/26-30/2007 for DX Incarcerated Intussusception. Infant presented with lethargy, mental status changes, decreased po intake and a large bloody bowel movement. PE significant for T=100.6''F, listness and acutely ill appearing, dry mucus membranes, minimal response to painful stimuli, rectal exam (+) for gross blood. Reduction failed by air contrast enema and infant taken to OR for Exploratory Lap with small bowel resection for IS. Pt tolerated advancing diet and was d/c home on 9/30/2007. 10/23/2007 Vax record received and correlates with VAERS submission. Per 60 day follow up: Patient underwent exploratory laparotomy with small bowel resection for incarcerated intussusception.
Vaccinated: | 2007-08-24 |
Onset: | 2007-09-23 |
Submitted: | 2007-09-27 |
Entered: | 2007-10-08 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR | 02657AA / 1 | RL / IM |
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. | 0016U / 1 | LL / IM |
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR | 21009 / 1 | RA / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B53981B / 1 | LL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0972U / 1 | MO / PO |
Administered by: Private Purchased by: Private
Symptoms: Gastroenteritis viral, Haematochezia, Intussusception, Vomiting
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
Write-up: Vaccine given 8/24/07. Started vomiting 9/23/07, no fever, no diarrhea initially - diagnosed with viral gastroenteritis. On 9/25/07 had large bloody bowel movement - seen in local ER, transferred to another hospital where diagnosed with intussusception and underwent surgical correction/resection. Hospital records received from PCP for DOS 9/26-30/2007 for DX Incarcerated Intussusception. Infant presented with lethargy, mental status changes, decreased po intake and a large bloody bowel movement. PE significant for T=100.6''F, listness and acutely ill appearing, dry mucus membranes, minimal response to painful stimuli, rectal exam (+) for gross blood. Reduction failed by air contrast enema and infant taken to OR for Exploratory Lap with small bowel resection for IS. Pt tolerated advancing diet and was d/c home on 9/30/2007. 10/23/2007 Vax record received and correlates with VAERS submission. Per 60 day follow up: Patient underwent exploratory laparotomy with small bowel resection for incarcerated intussusception.
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