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This is VAERS ID 294236

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 294236
VAERS Form:
Age:0.5
Sex:Male
Location:Massachusetts
Vaccinated:2007-10-17
Onset:2007-10-17
Submitted:2007-10-22
Entered:2007-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B127AA / 2 RL / UN
FLU: INFLUENZA (FLUZONE) / SANOFI PASTEUR U245BA / 0 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF192AA / 2 LL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B47300F / 2 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0408U / 2 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Abdominal pain, Barium enema, Dehydration, Blood alkaline phosphatase increased, 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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Nasal congestion - No fever
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ba Enema
CDC 'Split Type':

Write-up: Intussusception

Changed on 12/8/2009

VAERS ID: 294236 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Massachusetts
Vaccinated:2007-10-17
Onset:2007-10-17
Submitted:2007-10-22
Entered:2007-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B127AA / 2 RL / UN
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B127AA / 2 RL / UN
FLU: INFLUENZA (FLUZONE) INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U245BA / 0 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF192AA / 2 LL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B47300F / 2 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0408U / 2 - / PO

Administered by: Private      Purchased by: Unknown Public
Symptoms: Abdominal pain, Barium enema, Dehydration, Diarrhoea, Intussusception, Irritability, Lymphocyte count decreased, Protein total normal, Pyrexia, Retching, Sleep disorder, Urinary system X-ray, Vomiting, Platelet count increased, Neutrophil percentage increased, Monocyte percentage increased, Blood alkaline phosphatase increased, Urine analysis normal, 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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Nasal congestion - No fever
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ba Enema LABS: Abdominal x-ray & KUB revealed colo-colic IS. Barium enema successful. LABS: KUB WNL. Platelets 512 (H), neutros 75% (H), lymphs 11% (L), monos 12% (H). Total protein 6.0. Alk phosphatase 254 (H). UA WNL.
CDC 'Split Type':

Write-up: Intussusception Intussusception. 11/02/07 Reviewed medical records from 2nd ER of 10/19/07 which reveal patient experienced pulling up of legs, vomiting & apparent abdominal pain. Seen in outlying ER & admitted overnight. Tx w/IVF & serial abdominal exams. D/c to home & had continued gagging, reduced oral intake, irritability, decreased sleep & uncomfortable abdomen. BE reduced IS & admitted overnight for observation s/p reduction. FINAL DX: Intussusception, enema reduced. Records faxed to CDC. 11/13/07 Reviewed hospital medical records which reveal patient experienced vomiting, fever & abdominal pain. Admitted 10/18-10/19/2007. Abdomen was diffusely tender. Tx w/IVF, antipyretic & antinausea meds. Improved & d/c to home. ER Diagnosis: dehydration, vomiting & abdominal pain. Seen at outlying hospital for persistent vomiting where IS was dx & reduced by BE. Admitted overnight for observation & d/c to home. Continued to run fever & had diarrhea & returned to ER. Temp 103 in ER. Tx w/antipyretic & d/c to home. Final ER dx: fever secondary to vaccines. Records faxed to CDC. 11/16/07 Received vax record from pcp which confirms RO dose & lot as reported. Record faxed to CDC.

Changed on 3/2/2010

VAERS ID: 294236 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Massachusetts
Vaccinated:2007-10-17
Onset:2007-10-17
Submitted:2007-10-22
Entered:2007-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B127AA / 2 RL / UN
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U245BA / 0 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF192AA / 2 LL / UN
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B47300F / 2 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0408U / 2 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal pain, Barium enema, Dehydration, Diarrhoea, Intussusception, Irritability, Lymphocyte count decreased, Protein total normal, Pyrexia, Retching, Sleep disorder, Urinary system X-ray, Vomiting, Platelet count increased, Neutrophil percentage increased, Monocyte percentage increased, Blood alkaline phosphatase increased, Urine analysis normal, 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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Nasal congestion - No fever
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ba Enema LABS: Abdominal x-ray & KUB revealed colo-colic IS. Barium enema successful. LABS: KUB WNL. Platelets 512 (H), neutros 75% (H), lymphs 11% (L), monos 12% (H). Total protein 6.0. Alk phosphatase 254 (H). UA WNL.
CDC 'Split Type':

Write-up: Intussusception. 11/02/07 Reviewed medical records from 2nd ER of 10/19/07 which reveal patient experienced pulling up of legs, vomiting & apparent abdominal pain. Seen in outlying ER & admitted overnight. Tx w/IVF & serial abdominal exams. D/c to home & had continued gagging, reduced oral intake, irritability, decreased sleep & uncomfortable abdomen. BE reduced IS & admitted overnight for observation s/p reduction. FINAL DX: Intussusception, enema reduced. Records faxed to CDC. 11/13/07 Reviewed hospital medical records which reveal patient experienced vomiting, fever & abdominal pain. Admitted 10/18-10/19/2007. Abdomen was diffusely tender. Tx w/IVF, antipyretic & antinausea meds. Improved & d/c to home. ER Diagnosis: dehydration, vomiting & abdominal pain. Seen at outlying hospital for persistent vomiting where IS was dx & reduced by BE. Admitted overnight for observation & d/c to home. Continued to run fever & had diarrhea & returned to ER. Temp 103 in ER. Tx w/antipyretic & d/c to home. Final ER dx: fever secondary to vaccines. Records faxed to CDC. 11/16/07 Received vax record from pcp which confirms RO dose & lot as reported. Record faxed to CDC.

Changed on 4/7/2010

VAERS ID: 294236 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Massachusetts
Vaccinated:2007-10-17
Onset:2007-10-17
Submitted:2007-10-22
Entered:2007-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B127AA / 2 RL / UN
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U245BA / 0 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF192AA / 2 LL / UN
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B47300F / 2 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0408U / 2 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal pain, Barium enema, Dehydration, Diarrhoea, Intussusception, Irritability, Lymphocyte count decreased, Protein total normal, Pyrexia, Retching, Sleep disorder, Urinary system X-ray, Vomiting, Platelet count increased, Neutrophil percentage increased, Monocyte percentage increased, Blood alkaline phosphatase increased, Urine analysis normal, 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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Nasal congestion - No fever
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ba Enema LABS: Abdominal x-ray & KUB revealed colo-colic IS. Barium enema successful. LABS: KUB WNL. Platelets 512 (H), neutros 75% (H), lymphs 11% (L), monos 12% (H). Total protein 6.0. Alk phosphatase 254 (H). UA WNL.
CDC 'Split Type':

Write-up: Intussusception. 11/02/07 Reviewed medical records from 2nd ER of 10/19/07 which reveal patient experienced pulling up of legs, vomiting & apparent abdominal pain. Seen in outlying ER & admitted overnight. Tx w/IVF & serial abdominal exams. D/c to home & had continued gagging, reduced oral intake, irritability, decreased sleep & uncomfortable abdomen. BE reduced IS & admitted overnight for observation s/p reduction. FINAL DX: Intussusception, enema reduced. Records faxed to CDC. 11/13/07 Reviewed hospital medical records which reveal patient experienced vomiting, fever & abdominal pain. Admitted 10/18-10/19/2007. Abdomen was diffusely tender. Tx w/IVF, antipyretic & antinausea meds. Improved & d/c to home. ER Diagnosis: dehydration, vomiting & abdominal pain. Seen at outlying hospital for persistent vomiting where IS was dx & reduced by BE. Admitted overnight for observation & d/c to home. Continued to run fever & had diarrhea & returned to ER. Temp 103 in ER. Tx w/antipyretic & d/c to home. Final ER dx: fever secondary to vaccines. Records faxed to CDC. 11/16/07 Received vax record from pcp which confirms RO dose & lot as reported. Record faxed to CDC.

Changed on 8/31/2010

VAERS ID: 294236 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Massachusetts
Vaccinated:2007-10-17
Onset:2007-10-17
Submitted:2007-10-22
Entered:2007-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B127AA / 2 RL / UN
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U245BA / 0 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF192AA / 2 LL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B47300F / 2 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0408U / 2 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal pain, Barium enema, Dehydration, Diarrhoea, Intussusception, Irritability, Lymphocyte count decreased, Protein total normal, Pyrexia, Retching, Sleep disorder, Urinary system X-ray, Vomiting, Platelet count increased, Neutrophil percentage increased, Monocyte percentage increased, Blood alkaline phosphatase increased, Urine analysis normal, 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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Nasal congestion - No fever
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ba Enema LABS: Abdominal x-ray & KUB revealed colo-colic IS. Barium enema successful. LABS: KUB WNL. Platelets 512 (H), neutros 75% (H), lymphs 11% (L), monos 12% (H). Total protein 6.0. Alk phosphatase 254 (H). UA WNL.
CDC 'Split Type':

Write-up: Intussusception. 11/02/07 Reviewed medical records from 2nd ER of 10/19/07 which reveal patient experienced pulling up of legs, vomiting & apparent abdominal pain. Seen in outlying ER & admitted overnight. Tx w/IVF & serial abdominal exams. D/c to home & had continued gagging, reduced oral intake, irritability, decreased sleep & uncomfortable abdomen. BE reduced IS & admitted overnight for observation s/p reduction. FINAL DX: Intussusception, enema reduced. Records faxed to CDC. 11/13/07 Reviewed hospital medical records which reveal patient experienced vomiting, fever & abdominal pain. Admitted 10/18-10/19/2007. Abdomen was diffusely tender. Tx w/IVF, antipyretic & antinausea meds. Improved & d/c to home. ER Diagnosis: dehydration, vomiting & abdominal pain. Seen at outlying hospital for persistent vomiting where IS was dx & reduced by BE. Admitted overnight for observation & d/c to home. Continued to run fever & had diarrhea & returned to ER. Temp 103 in ER. Tx w/antipyretic & d/c to home. Final ER dx: fever secondary to vaccines. Records faxed to CDC. 11/16/07 Received vax record from pcp which confirms RO dose & lot as reported. Record faxed to CDC.

Changed on 5/13/2013

VAERS ID: 294236 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Massachusetts
Vaccinated:2007-10-17
Onset:2007-10-17
Submitted:2007-10-22
Entered:2007-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B127AA / 2 RL / UN
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U245BA / 0 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF192AA / 2 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47300F / 2 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0408U / 2 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0408U / 2 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal pain, Barium enema, Dehydration, Diarrhoea, Intussusception, Irritability, Lymphocyte count decreased, Protein total normal, Pyrexia, Retching, Sleep disorder, Urinary system X-ray, Vomiting, Platelet count increased, Neutrophil percentage increased, Monocyte percentage increased, Blood alkaline phosphatase increased, Urine analysis normal, 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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Nasal congestion - No fever
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ba Enema LABS: Abdominal x-ray & KUB revealed colo-colic IS. Barium enema successful. LABS: KUB WNL. Platelets 512 (H), neutros 75% (H), lymphs 11% (L), monos 12% (H). Total protein 6.0. Alk phosphatase 254 (H). UA WNL.
CDC 'Split Type':

Write-up: Intussusception. 11/02/07 Reviewed medical records from 2nd ER of 10/19/07 which reveal patient experienced pulling up of legs, vomiting & apparent abdominal pain. Seen in outlying ER & admitted overnight. Tx w/IVF & serial abdominal exams. D/c to home & had continued gagging, reduced oral intake, irritability, decreased sleep & uncomfortable abdomen. BE reduced IS & admitted overnight for observation s/p reduction. FINAL DX: Intussusception, enema reduced. Records faxed to CDC. 11/13/07 Reviewed hospital medical records which reveal patient experienced vomiting, fever & abdominal pain. Admitted 10/18-10/19/2007. Abdomen was diffusely tender. Tx w/IVF, antipyretic & antinausea meds. Improved & d/c to home. ER Diagnosis: dehydration, vomiting & abdominal pain. Seen at outlying hospital for persistent vomiting where IS was dx & reduced by BE. Admitted overnight for observation & d/c to home. Continued to run fever & had diarrhea & returned to ER. Temp 103 in ER. Tx w/antipyretic & d/c to home. Final ER dx: fever secondary to vaccines. Records faxed to CDC. 11/16/07 Received vax record from pcp which confirms RO dose & lot as reported. Record faxed to CDC.

Changed on 7/7/2013

VAERS ID: 294236 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Massachusetts
Vaccinated:2007-10-17
Onset:2007-10-17
Submitted:2007-10-22
Entered:2007-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B127AA / 2 RL / UN
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U245BA / 0 RL / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U245BA / 0 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF192AA / 2 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47300F / 2 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0408U / 2 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal pain, Barium enema, Dehydration, Diarrhoea, Intussusception, Irritability, Lymphocyte count decreased, Protein total normal, Pyrexia, Retching, Sleep disorder, Urinary system X-ray, Vomiting, Platelet count increased, Neutrophil percentage increased, Monocyte percentage increased, Blood alkaline phosphatase increased, Urine analysis normal, 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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Nasal congestion - No fever
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ba Enema LABS: Abdominal x-ray & KUB revealed colo-colic IS. Barium enema successful. LABS: KUB WNL. Platelets 512 (H), neutros 75% (H), lymphs 11% (L), monos 12% (H). Total protein 6.0. Alk phosphatase 254 (H). UA WNL.
CDC 'Split Type':

Write-up: Intussusception. 11/02/07 Reviewed medical records from 2nd ER of 10/19/07 which reveal patient experienced pulling up of legs, vomiting & apparent abdominal pain. Seen in outlying ER & admitted overnight. Tx w/IVF & serial abdominal exams. D/c to home & had continued gagging, reduced oral intake, irritability, decreased sleep & uncomfortable abdomen. BE reduced IS & admitted overnight for observation s/p reduction. FINAL DX: Intussusception, enema reduced. Records faxed to CDC. 11/13/07 Reviewed hospital medical records which reveal patient experienced vomiting, fever & abdominal pain. Admitted 10/18-10/19/2007. Abdomen was diffusely tender. Tx w/IVF, antipyretic & antinausea meds. Improved & d/c to home. ER Diagnosis: dehydration, vomiting & abdominal pain. Seen at outlying hospital for persistent vomiting where IS was dx & reduced by BE. Admitted overnight for observation & d/c to home. Continued to run fever & had diarrhea & returned to ER. Temp 103 in ER. Tx w/antipyretic & d/c to home. Final ER dx: fever secondary to vaccines. Records faxed to CDC. 11/16/07 Received vax record from pcp which confirms RO dose & lot as reported. Record faxed to CDC.

Changed on 4/14/2017

VAERS ID: 294236 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Massachusetts
Vaccinated:2007-10-17
Onset:2007-10-17
Submitted:2007-10-22
Entered:2007-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B127AA / 2 RL / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U245BA / 0 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF192AA / 2 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47300F / 2 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0408U / 2 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal pain, Barium enema, Dehydration, Diarrhoea, Intussusception, Irritability, Lymphocyte count decreased, Protein total normal, Pyrexia, Retching, Sleep disorder, Urinary system X-ray, Vomiting, Platelet count increased, Neutrophil percentage increased, Monocyte percentage increased, Blood alkaline phosphatase increased, Urine analysis normal, 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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Nasal congestion - No fever
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ba Enema LABS: Abdominal x-ray & KUB revealed colo-colic IS. Barium enema successful. LABS: KUB WNL. Platelets 512 (H), neutros 75% (H), lymphs 11% (L), monos 12% (H). Total protein 6.0. Alk phosphatase 254 (H). UA WNL.
CDC 'Split Type':

Write-up: Intussusception. 11/02/07 Reviewed medical records from 2nd ER of 10/19/07 which reveal patient experienced pulling up of legs, vomiting & apparent abdominal pain. Seen in outlying ER & admitted overnight. Tx w/IVF & serial abdominal exams. D/c to home & had continued gagging, reduced oral intake, irritability, decreased sleep & uncomfortable abdomen. BE reduced IS & admitted overnight for observation s/p reduction. FINAL DX: Intussusception, enema reduced. Records faxed to CDC. 11/13/07 Reviewed hospital medical records which reveal patient experienced vomiting, fever & abdominal pain. Admitted 10/18-10/19/2007. Abdomen was diffusely tender. Tx w/IVF, antipyretic & antinausea meds. Improved & d/c to home. ER Diagnosis: dehydration, vomiting & abdominal pain. Seen at outlying hospital for persistent vomiting where IS was dx & reduced by BE. Admitted overnight for observation & d/c to home. Continued to run fever & had diarrhea & returned to ER. Temp 103 in ER. Tx w/antipyretic & d/c to home. Final ER dx: fever secondary to vaccines. Records faxed to CDC. 11/16/07 Received vax record from pcp which confirms RO dose & lot as reported. Record faxed to CDC.

Changed on 9/14/2017

VAERS ID: 294236 Before After
VAERS Form:(blank) 1
Age:0.5
Sex:Male
Location:Massachusetts
Vaccinated:2007-10-17
Onset:2007-10-17
Submitted:2007-10-22
Entered:2007-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B127AA / 2 3 RL / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U245BA / 0 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF192AA / 2 3 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47300F / 2 3 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0408U / 2 3 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Nasal congestion - No fever
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ba Enema LABS: Abdominal x-ray & KUB revealed colo-colic IS. Barium enema successful. LABS: KUB WNL. Platelets 512 (H), neutros 75% (H), lymphs 11% (L), monos 12% (H). Total protein 6.0. Alk phosphatase 254 (H). UA WNL.
CDC 'Split Type':

Write-up: Intussusception. 11/02/07 Reviewed medical records from 2nd ER of 10/19/07 which reveal patient experienced pulling up of legs, vomiting & apparent abdominal pain. Seen in outlying ER & admitted overnight. Tx w/IVF & serial abdominal exams. D/c to home & had continued gagging, reduced oral intake, irritability, decreased sleep & uncomfortable abdomen. BE reduced IS & admitted overnight for observation s/p reduction. FINAL DX: Intussusception, enema reduced. Records faxed to CDC. 11/13/07 Reviewed hospital medical records which reveal patient experienced vomiting, fever & abdominal pain. Admitted 10/18-10/19/2007. Abdomen was diffusely tender. Tx w/IVF, antipyretic & antinausea meds. Improved & d/c to home. ER Diagnosis: dehydration, vomiting & abdominal pain. Seen at outlying hospital for persistent vomiting where IS was dx & reduced by BE. Admitted overnight for observation & d/c to home. Continued to run fever & had diarrhea & returned to ER. Temp 103 in ER. Tx w/antipyretic & d/c to home. Final ER dx: fever secondary to vaccines. Records faxed to CDC. 11/16/07 Received vax record from pcp which confirms RO dose & lot as reported. Record faxed to CDC.

Changed on 2/14/2018

VAERS ID: 294236 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:Massachusetts
Vaccinated:2007-10-17
Onset:2007-10-17
Submitted:2007-10-22
Entered:2007-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B127AA / 3 RL / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U245BA / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF192AA / 3 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47300F / 3 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0408U / 3 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Nasal congestion - No fever
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ba Enema LABS: Abdominal x-ray & KUB revealed colo-colic IS. Barium enema successful. LABS: KUB WNL. Platelets 512 (H), neutros 75% (H), lymphs 11% (L), monos 12% (H). Total protein 6.0. Alk phosphatase 254 (H). UA WNL.
CDC 'Split Type':

Write-up: Intussusception. 11/02/07 Reviewed medical records from 2nd ER of 10/19/07 which reveal patient experienced pulling up of legs, vomiting & apparent abdominal pain. Seen in outlying ER & admitted overnight. Tx w/IVF & serial abdominal exams. D/c to home & had continued gagging, reduced oral intake, irritability, decreased sleep & uncomfortable abdomen. BE reduced IS & admitted overnight for observation s/p reduction. FINAL DX: Intussusception, enema reduced. Records faxed to CDC. 11/13/07 Reviewed hospital medical records which reveal patient experienced vomiting, fever & abdominal pain. Admitted 10/18-10/19/2007. Abdomen was diffusely tender. Tx w/IVF, antipyretic & antinausea meds. Improved & d/c to home. ER Diagnosis: dehydration, vomiting & abdominal pain. Seen at outlying hospital for persistent vomiting where IS was dx & reduced by BE. Admitted overnight for observation & d/c to home. Continued to run fever & had diarrhea & returned to ER. Temp 103 in ER. Tx w/antipyretic & d/c to home. Final ER dx: fever secondary to vaccines. Records faxed to CDC. 11/16/07 Received vax record from pcp which confirms RO dose & lot as reported. Record faxed to CDC.

Changed on 6/14/2018

VAERS ID: 294236 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:Massachusetts
Vaccinated:2007-10-17
Onset:2007-10-17
Submitted:2007-10-22
Entered:2007-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B127AA / 3 RL / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U245BA / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF192AA / 3 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47300F / 3 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0408U / 3 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Nasal congestion - No fever
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ba Enema LABS: Abdominal x-ray & KUB revealed colo-colic IS. Barium enema successful. LABS: KUB WNL. Platelets 512 (H), neutros 75% (H), lymphs 11% (L), monos 12% (H). Total protein 6.0. Alk phosphatase 254 (H). UA WNL.
CDC 'Split Type':

Write-up: Intussusception. 11/02/07 Reviewed medical records from 2nd ER of 10/19/07 which reveal patient experienced pulling up of legs, vomiting & apparent abdominal pain. Seen in outlying ER & admitted overnight. Tx w/IVF & serial abdominal exams. D/c to home & had continued gagging, reduced oral intake, irritability, decreased sleep & uncomfortable abdomen. BE reduced IS & admitted overnight for observation s/p reduction. FINAL DX: Intussusception, enema reduced. Records faxed to CDC. 11/13/07 Reviewed hospital medical records which reveal patient experienced vomiting, fever & abdominal pain. Admitted 10/18-10/19/2007. Abdomen was diffusely tender. Tx w/IVF, antipyretic & antinausea meds. Improved & d/c to home. ER Diagnosis: dehydration, vomiting & abdominal pain. Seen at outlying hospital for persistent vomiting where IS was dx & reduced by BE. Admitted overnight for observation & d/c to home. Continued to run fever & had diarrhea & returned to ER. Temp 103 in ER. Tx w/antipyretic & d/c to home. Final ER dx: fever secondary to vaccines. Records faxed to CDC. 11/16/07 Received vax record from pcp which confirms RO dose & lot as reported. Record faxed to CDC.

Changed on 8/14/2018

VAERS ID: 294236 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:Massachusetts
Vaccinated:2007-10-17
Onset:2007-10-17
Submitted:2007-10-22
Entered:2007-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B127AA / 3 RL / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U245BA / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF192AA / 3 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47300F / 3 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0408U / 3 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Nasal congestion - No fever
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ba Enema LABS: Abdominal x-ray & KUB revealed colo-colic IS. Barium enema successful. LABS: KUB WNL. Platelets 512 (H), neutros 75% (H), lymphs 11% (L), monos 12% (H). Total protein 6.0. Alk phosphatase 254 (H). UA WNL.
CDC 'Split Type':

Write-up: Intussusception. 11/02/07 Reviewed medical records from 2nd ER of 10/19/07 which reveal patient experienced pulling up of legs, vomiting & apparent abdominal pain. Seen in outlying ER & admitted overnight. Tx w/IVF & serial abdominal exams. D/c to home & had continued gagging, reduced oral intake, irritability, decreased sleep & uncomfortable abdomen. BE reduced IS & admitted overnight for observation s/p reduction. FINAL DX: Intussusception, enema reduced. Records faxed to CDC. 11/13/07 Reviewed hospital medical records which reveal patient experienced vomiting, fever & abdominal pain. Admitted 10/18-10/19/2007. Abdomen was diffusely tender. Tx w/IVF, antipyretic & antinausea meds. Improved & d/c to home. ER Diagnosis: dehydration, vomiting & abdominal pain. Seen at outlying hospital for persistent vomiting where IS was dx & reduced by BE. Admitted overnight for observation & d/c to home. Continued to run fever & had diarrhea & returned to ER. Temp 103 in ER. Tx w/antipyretic & d/c to home. Final ER dx: fever secondary to vaccines. Records faxed to CDC. 11/16/07 Received vax record from pcp which confirms RO dose & lot as reported. Record faxed to CDC.

Changed on 9/14/2018

VAERS ID: 294236 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:Massachusetts
Vaccinated:2007-10-17
Onset:2007-10-17
Submitted:2007-10-22
Entered:2007-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B127AA / 3 RL / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U245BA / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF192AA / 3 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47300F / 3 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0408U / 3 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Nasal congestion - No fever
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ba Enema LABS: Abdominal x-ray & KUB revealed colo-colic IS. Barium enema successful. LABS: KUB WNL. Platelets 512 (H), neutros 75% (H), lymphs 11% (L), monos 12% (H). Total protein 6.0. Alk phosphatase 254 (H). UA WNL.
CDC 'Split Type':

Write-up: Intussusception. 11/02/07 Reviewed medical records from 2nd ER of 10/19/07 which reveal patient experienced pulling up of legs, vomiting & apparent abdominal pain. Seen in outlying ER & admitted overnight. Tx w/IVF & serial abdominal exams. D/c to home & had continued gagging, reduced oral intake, irritability, decreased sleep & uncomfortable abdomen. BE reduced IS & admitted overnight for observation s/p reduction. FINAL DX: Intussusception, enema reduced. Records faxed to CDC. 11/13/07 Reviewed hospital medical records which reveal patient experienced vomiting, fever & abdominal pain. Admitted 10/18-10/19/2007. Abdomen was diffusely tender. Tx w/IVF, antipyretic & antinausea meds. Improved & d/c to home. ER Diagnosis: dehydration, vomiting & abdominal pain. Seen at outlying hospital for persistent vomiting where IS was dx & reduced by BE. Admitted overnight for observation & d/c to home. Continued to run fever & had diarrhea & returned to ER. Temp 103 in ER. Tx w/antipyretic & d/c to home. Final ER dx: fever secondary to vaccines. Records faxed to CDC. 11/16/07 Received vax record from pcp which confirms RO dose & lot as reported. Record faxed to CDC.

Changed on 10/14/2018

VAERS ID: 294236 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:Massachusetts
Vaccinated:2007-10-17
Onset:2007-10-17
Submitted:2007-10-22
Entered:2007-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B127AA / 3 RL / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U245BA / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF192AA / 3 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47300F / 3 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0408U / 3 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Nasal congestion - No fever
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ba Enema LABS: Abdominal x-ray & KUB revealed colo-colic IS. Barium enema successful. LABS: KUB WNL. Platelets 512 (H), neutros 75% (H), lymphs 11% (L), monos 12% (H). Total protein 6.0. Alk phosphatase 254 (H). UA WNL.
CDC 'Split Type':

Write-up: Intussusception. 11/02/07 Reviewed medical records from 2nd ER of 10/19/07 which reveal patient experienced pulling up of legs, vomiting & apparent abdominal pain. Seen in outlying ER & admitted overnight. Tx w/IVF & serial abdominal exams. D/c to home & had continued gagging, reduced oral intake, irritability, decreased sleep & uncomfortable abdomen. BE reduced IS & admitted overnight for observation s/p reduction. FINAL DX: Intussusception, enema reduced. Records faxed to CDC. 11/13/07 Reviewed hospital medical records which reveal patient experienced vomiting, fever & abdominal pain. Admitted 10/18-10/19/2007. Abdomen was diffusely tender. Tx w/IVF, antipyretic & antinausea meds. Improved & d/c to home. ER Diagnosis: dehydration, vomiting & abdominal pain. Seen at outlying hospital for persistent vomiting where IS was dx & reduced by BE. Admitted overnight for observation & d/c to home. Continued to run fever & had diarrhea & returned to ER. Temp 103 in ER. Tx w/antipyretic & d/c to home. Final ER dx: fever secondary to vaccines. Records faxed to CDC. 11/16/07 Received vax record from pcp which confirms RO dose & lot as reported. Record faxed to CDC.

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