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This is VAERS ID 299088

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 299088
VAERS Form:
Age:0.4
Gender:Male
Location:Florida
Vaccinated:2007-10-01
Onset:2007-12-01
Submitted:2007-12-04
Entered:2007-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPH: DTAP + HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC - / - UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0508U / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Computerised tomogram abnormal, Haematochezia, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: + Bloody stools; + ABD CAT Scan for intussusception
CDC 'Split Type':

Write-up: Intussusception


Changed on 12/8/2009

VAERS ID: 299088 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Florida
Vaccinated:2007-10-01
Onset:2007-12-01
Submitted:2007-12-04
Entered:2007-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2765AA / 1 LL / UN
DTAPH: DTAP + HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF168AA / 1 LL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0273 / 1 RL / UN
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC - B457300 / - 1 UN RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0508U / 1 - / PO

Administered by: Private      Purchased by: Unknown Private
Symptoms: Barium enema, Blood culture negative, C-reactive protein increased, Computerised tomogram abnormal, Culture stool negative, Culture urine negative, Haematochezia, Intensive care, Intussusception, Irritability, Lethargy, Pyrexia, Urinary system X-ray, White blood cell count increased, Enema administration, Respiratory tract infection, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: + Bloody stools; + ABD CAT Scan for intussusception LABS: CT of abdomen & KUB (+) IS. BE reduced IS. Repeat CT of abdomen WNL. WBC 17.5. CRP 1.4. Blood, urine & stool c/s neg.
CDC 'Split Type':

Write-up: Intussusception 12/11/07 Reviewed hospital medical records which reveal patient experienced irritability, decreased oral intake, lethargy & bloody stools. Had been on antibiotics & neb treatments prior to admission for respiratory s/s. Admitted 12/1-12/3/2007 to PICU for observation s/p IS reduction. Progressed well but had fever of 101. Scheduled to see pcp next day. FINAL DX: Intussusception, enema reduced.


Changed on 3/2/2010

VAERS ID: 299088 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Florida
Vaccinated:2007-10-01
Onset:2007-12-01
Submitted:2007-12-04
Entered:2007-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2765AA / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF168AA / 1 LL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0273 / 1 RL / UN
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B457300 / 1 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0508U / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Blood culture negative, C-reactive protein increased, Computerised tomogram abnormal, Culture stool negative, Culture urine negative, Haematochezia, Intensive care, Intussusception, Irritability, Lethargy, Pyrexia, Urinary system X-ray, White blood cell count increased, Enema administration, Respiratory tract infection, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: + Bloody stools; + ABD CAT Scan for intussusception LABS: CT of abdomen & KUB (+) IS. BE reduced IS. Repeat CT of abdomen WNL. WBC 17.5. CRP 1.4. Blood, urine & stool c/s neg.
CDC 'Split Type':

Write-up: Intussusception 12/11/07 Reviewed hospital medical records which reveal patient experienced irritability, decreased oral intake, lethargy & bloody stools. Had been on antibiotics & neb treatments prior to admission for respiratory s/s. Admitted 12/1-12/3/2007 to PICU for observation s/p IS reduction. Progressed well but had fever of 101. Scheduled to see pcp next day. FINAL DX: Intussusception, enema reduced.


Changed on 4/7/2010

VAERS ID: 299088 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Florida
Vaccinated:2007-10-01
Onset:2007-12-01
Submitted:2007-12-04
Entered:2007-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2765AA / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF168AA / 1 LL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0273 / 1 RL / UN
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B457300 / 1 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0508U / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Blood culture negative, C-reactive protein increased, Computerised tomogram abnormal, Culture stool negative, Culture urine negative, Haematochezia, Intensive care, Intussusception, Irritability, Lethargy, Pyrexia, Urinary system X-ray, White blood cell count increased, Enema administration, Respiratory tract infection, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: + Bloody stools; + ABD CAT Scan for intussusception LABS: CT of abdomen & KUB (+) IS. BE reduced IS. Repeat CT of abdomen WNL. WBC 17.5. CRP 1.4. Blood, urine & stool c/s neg.
CDC 'Split Type':

Write-up: Intussusception 12/11/07 Reviewed hospital medical records which reveal patient experienced irritability, decreased oral intake, lethargy & bloody stools. Had been on antibiotics & neb treatments prior to admission for respiratory s/s. Admitted 12/1-12/3/2007 to PICU for observation s/p IS reduction. Progressed well but had fever of 101. Scheduled to see pcp next day. FINAL DX: Intussusception, enema reduced.


Changed on 8/31/2010

VAERS ID: 299088 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Florida
Vaccinated:2007-10-01
Onset:2007-12-01
Submitted:2007-12-04
Entered:2007-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2765AA / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF168AA / 1 LL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0273 / 1 RL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B457300 / 1 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0508U / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Blood culture negative, C-reactive protein increased, Computerised tomogram abnormal, Culture stool negative, Culture urine negative, Haematochezia, Intensive care, Intussusception, Irritability, Lethargy, Pyrexia, Urinary system X-ray, White blood cell count increased, Enema administration, Respiratory tract infection, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: + Bloody stools; + ABD CAT Scan for intussusception LABS: CT of abdomen & KUB (+) IS. BE reduced IS. Repeat CT of abdomen WNL. WBC 17.5. CRP 1.4. Blood, urine & stool c/s neg.
CDC 'Split Type':

Write-up: Intussusception 12/11/07 Reviewed hospital medical records which reveal patient experienced irritability, decreased oral intake, lethargy & bloody stools. Had been on antibiotics & neb treatments prior to admission for respiratory s/s. Admitted 12/1-12/3/2007 to PICU for observation s/p IS reduction. Progressed well but had fever of 101. Scheduled to see pcp next day. FINAL DX: Intussusception, enema reduced.


Changed on 5/13/2013

VAERS ID: 299088 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Florida
Vaccinated:2007-10-01
Onset:2007-12-01
Submitted:2007-12-04
Entered:2007-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2765AA / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF168AA / 1 LL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0273 / 1 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B457300 / 1 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0508U / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0508U / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Blood culture negative, C-reactive protein increased, Computerised tomogram abnormal, Culture stool negative, Culture urine negative, Haematochezia, Intensive care, Intussusception, Irritability, Lethargy, Pyrexia, Urinary system X-ray, White blood cell count increased, Enema administration, Respiratory tract infection, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: + Bloody stools; + ABD CAT Scan for intussusception LABS: CT of abdomen & KUB (+) IS. BE reduced IS. Repeat CT of abdomen WNL. WBC 17.5. CRP 1.4. Blood, urine & stool c/s neg.
CDC 'Split Type':

Write-up: Intussusception 12/11/07 Reviewed hospital medical records which reveal patient experienced irritability, decreased oral intake, lethargy & bloody stools. Had been on antibiotics & neb treatments prior to admission for respiratory s/s. Admitted 12/1-12/3/2007 to PICU for observation s/p IS reduction. Progressed well but had fever of 101. Scheduled to see pcp next day. FINAL DX: Intussusception, enema reduced.


Changed on 2/14/2017

VAERS ID: 299088 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Florida
Vaccinated:2007-10-01
Onset:2007-12-01
Submitted:2007-12-04
Entered:2007-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2765AA / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF168AA / 1 LL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0273 / 1 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B457300 / 1 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0508U / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Blood culture negative, C-reactive protein increased, Computerised tomogram abnormal, Culture stool negative, Culture urine negative, Haematochezia, Intensive care, Intussusception, Irritability, Lethargy, Pyrexia, Urinary system X-ray, White blood cell count increased, Enema administration, Respiratory tract infection, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: + Bloody stools; + ABD CAT Scan for intussusception LABS: CT of abdomen & KUB (+) IS. BE reduced IS. Repeat CT of abdomen WNL. WBC 17.5. CRP 1.4. Blood, urine & stool c/s neg.
CDC 'Split Type':

Write-up: Intussusception 12/11/07 Reviewed hospital medical records which reveal patient experienced irritability, decreased oral intake, lethargy & bloody stools. Had been on antibiotics & neb treatments prior to admission for respiratory s/s. Admitted 12/1-12/3/2007 to PICU for observation s/p IS reduction. Progressed well but had fever of 101. Scheduled to see pcp next day. FINAL DX: Intussusception, enema reduced.


Changed on 9/14/2017

VAERS ID: 299088 Before After
VAERS Form:(blank) 1
Age:0.4
Gender:Male
Location:Florida
Vaccinated:2007-10-01
Onset:2007-12-01
Submitted:2007-12-04
Entered:2007-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2765AA / 1 2 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF168AA / 1 2 LL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0273 / 1 2 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B457300 / 1 2 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0508U / 1 2 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Computerised tomogram abnormal, Haematochezia, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: + Bloody stools; + ABD CAT Scan for intussusception LABS: CT of abdomen & KUB (+) IS. BE reduced IS. Repeat CT of abdomen WNL. WBC 17.5. CRP 1.4. Blood, urine & stool c/s neg.
CDC 'Split Type':

Write-up: Intussusception 12/11/07 Reviewed hospital medical records which reveal patient experienced irritability, decreased oral intake, lethargy & bloody stools. Had been on antibiotics & neb treatments prior to admission for respiratory s/s. Admitted 12/1-12/3/2007 to PICU for observation s/p IS reduction. Progressed well but had fever of 101. Scheduled to see pcp next day. FINAL DX: Intussusception, enema reduced.


Changed on 2/14/2018

VAERS ID: 299088 Before After
VAERS Form:1
Age:0.4
Gender:Male
Location:Florida
Vaccinated:2007-10-01
Onset:2007-12-01
Submitted:2007-12-04
Entered:2007-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2765AA / 2 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF168AA / 2 LL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0273 / 2 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B457300 / 2 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0508U / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Computerised tomogram abnormal, Haematochezia, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: + Bloody stools; + ABD CAT Scan for intussusception LABS: CT of abdomen & KUB (+) IS. BE reduced IS. Repeat CT of abdomen WNL. WBC 17.5. CRP 1.4. Blood, urine & stool c/s neg.
CDC 'Split Type':

Write-up: Intussusception 12/11/07 Reviewed hospital medical records which reveal patient experienced irritability, decreased oral intake, lethargy & bloody stools. Had been on antibiotics & neb treatments prior to admission for respiratory s/s. Admitted 12/1-12/3/2007 to PICU for observation s/p IS reduction. Progressed well but had fever of 101. Scheduled to see pcp next day. FINAL DX: Intussusception, enema reduced.


Changed on 6/14/2018

VAERS ID: 299088 Before After
VAERS Form:1
Age:0.4
Gender:Male
Location:Florida
Vaccinated:2007-10-01
Onset:2007-12-01
Submitted:2007-12-04
Entered:2007-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2765AA / 2 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF168AA / 2 LL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0273 / 2 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B457300 / 2 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0508U / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Computerised tomogram abnormal, Haematochezia, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: + Bloody stools; + ABD CAT Scan for intussusception LABS: CT of abdomen & KUB (+) IS. BE reduced IS. Repeat CT of abdomen WNL. WBC 17.5. CRP 1.4. Blood, urine & stool c/s neg.
CDC 'Split Type':

Write-up: Intussusception 12/11/07 Reviewed hospital medical records which reveal patient experienced irritability, decreased oral intake, lethargy & bloody stools. Had been on antibiotics & neb treatments prior to admission for respiratory s/s. Admitted 12/1-12/3/2007 to PICU for observation s/p IS reduction. Progressed well but had fever of 101. Scheduled to see pcp next day. FINAL DX: Intussusception, enema reduced.


Changed on 8/14/2018

VAERS ID: 299088 Before After
VAERS Form:1
Age:0.4
Gender:Male
Location:Florida
Vaccinated:2007-10-01
Onset:2007-12-01
Submitted:2007-12-04
Entered:2007-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2765AA / 2 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF168AA / 2 LL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0273 / 2 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B457300 / 2 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0508U / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Computerised tomogram abnormal, Haematochezia, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: + Bloody stools; + ABD CAT Scan for intussusception LABS: CT of abdomen & KUB (+) IS. BE reduced IS. Repeat CT of abdomen WNL. WBC 17.5. CRP 1.4. Blood, urine & stool c/s neg.
CDC 'Split Type':

Write-up: Intussusception 12/11/07 Reviewed hospital medical records which reveal patient experienced irritability, decreased oral intake, lethargy & bloody stools. Had been on antibiotics & neb treatments prior to admission for respiratory s/s. Admitted 12/1-12/3/2007 to PICU for observation s/p IS reduction. Progressed well but had fever of 101. Scheduled to see pcp next day. FINAL DX: Intussusception, enema reduced.


Changed on 9/14/2018

VAERS ID: 299088 Before After
VAERS Form:1
Age:0.4
Gender:Male
Location:Florida
Vaccinated:2007-10-01
Onset:2007-12-01
Submitted:2007-12-04
Entered:2007-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2765AA / 2 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF168AA / 2 LL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0273 / 2 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B457300 / 2 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0508U / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Computerised tomogram abnormal, Haematochezia, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: + Bloody stools; + ABD CAT Scan for intussusception LABS: CT of abdomen & KUB (+) IS. BE reduced IS. Repeat CT of abdomen WNL. WBC 17.5. CRP 1.4. Blood, urine & stool c/s neg.
CDC 'Split Type':

Write-up: Intussusception 12/11/07 Reviewed hospital medical records which reveal patient experienced irritability, decreased oral intake, lethargy & bloody stools. Had been on antibiotics & neb treatments prior to admission for respiratory s/s. Admitted 12/1-12/3/2007 to PICU for observation s/p IS reduction. Progressed well but had fever of 101. Scheduled to see pcp next day. FINAL DX: Intussusception, enema reduced.


Changed on 10/14/2018

VAERS ID: 299088 Before After
VAERS Form:1
Age:0.4
Gender:Male
Location:Florida
Vaccinated:2007-10-01
Onset:2007-12-01
Submitted:2007-12-04
Entered:2007-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2765AA / 2 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF168AA / 2 LL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0273 / 2 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B457300 / 2 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0508U / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Computerised tomogram abnormal, Haematochezia, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: + Bloody stools; + ABD CAT Scan for intussusception LABS: CT of abdomen & KUB (+) IS. BE reduced IS. Repeat CT of abdomen WNL. WBC 17.5. CRP 1.4. Blood, urine & stool c/s neg.
CDC 'Split Type':

Write-up: Intussusception 12/11/07 Reviewed hospital medical records which reveal patient experienced irritability, decreased oral intake, lethargy & bloody stools. Had been on antibiotics & neb treatments prior to admission for respiratory s/s. Admitted 12/1-12/3/2007 to PICU for observation s/p IS reduction. Progressed well but had fever of 101. Scheduled to see pcp next day. FINAL DX: Intussusception, enema reduced.

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