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This is VAERS ID 301951

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 301951
VAERS Form:
Age:0.3
Gender:Male
Location:Ohio
Vaccinated:2007-12-13
Onset:2007-12-17
Submitted:2008-01-02
Entered:2008-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2797AA / 1 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF292AB / 1 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0298 / 1 UN / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B70143D / 1 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0904U / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Abdominal pain, Appendicectomy, Blood gases abnormal, Cyst, Enema administration

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None-but enteric duplication cyst dx''ed at time of intussusception
Allergies:
Diagnostic Lab Data: Abdominal ultrasound at hospital showed intussusception - non-reducible by air enema. 2/5/08-records received-Stool hemocult positive.Air enema incomplete recudtion of ileococlic intussusception with associated small bowel obstruction.Abdo
CDC 'Split Type':

Write-up: 4 days after vaccines, patient developed bilious emesis and rectal bleeding. Abdominal ultrasound at hospital showed intussusception - non reducible by air enema. Patient underwent exploratory laparotomy for reduction of intussusception and resection of"ileocecal enteric duplication cyst found at that time. 2/5/08-records received for DOS 12/17-12/19/07-DC DX: Intussusception. presented to ED with C/O vomiting greenish yellow 6 episodes. BRBRPR, no stool. Abdominal pain, increased sleepiness, decreased w


Changed on 12/8/2009

VAERS ID: 301951 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Ohio
Vaccinated:2007-12-13
Onset:2007-12-17
Submitted:2008-01-02
Entered:2008-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2797AA / 1 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF292AB / 1 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0298 / 1 UN / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B70143D / 1 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0904U / 1 - / PO

Administered by: Private      Purchased by: Unknown Private
Symptoms: Abdominal pain, Appendicectomy, Blood gases abnormal, Cyst, Intussusception, Rectal haemorrhage, Small intestinal obstruction, Somnolence, Vomiting, Enema administration, Ultrasound abdomen abnormal, Explorative laparotomy, Ileectomy, Occult blood positive

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None-but enteric duplication cyst dx''ed at time of intussusception
Allergies:
Diagnostic Lab Data: Abdominal ultrasound at hospital showed intussusception - non-reducible by air enema. 2/5/08-records received-Stool hemocult positive.Air enema incomplete recudtion of ileococlic intussusception with associated small bowel obstruction.Abdo
CDC 'Split Type':

Write-up: 4 days after vaccines, patient developed bilious emesis and rectal bleeding. Abdominal ultrasound at hospital showed intussusception - non reducible by air enema. Patient underwent exploratory laparotomy for reduction of intussusception and resection of"ileocecal of ileocecal enteric duplication cyst found at that time. 2/5/08-records received for DOS 12/17-12/19/07-DC DX: Intussusception. presented to ED with C/O vomiting greenish yellow 6 episodes. BRBRPR, no stool. Abdominal pain, increased sleepiness, decreased w wet diapers. Exploratory laparotomy, resection of ileocecal enteric duplication cyst. appendectomy.


Changed on 3/2/2010

VAERS ID: 301951 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Ohio
Vaccinated:2007-12-13
Onset:2007-12-17
Submitted:2008-01-02
Entered:2008-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2797AA / 1 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF292AB / 1 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0298 / 1 UN / UN
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B70143D / 1 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0904U / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Appendicectomy, Blood gases abnormal, Cyst, Intussusception, Rectal haemorrhage, Small intestinal obstruction, Somnolence, Vomiting, Enema administration, Ultrasound abdomen abnormal, Explorative laparotomy, Ileectomy, Occult blood positive

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None-but enteric duplication cyst dx''ed at time of intussusception
Allergies:
Diagnostic Lab Data: Abdominal ultrasound at hospital showed intussusception - non-reducible by air enema. 2/5/08-records received-Stool hemocult positive.Air enema incomplete recudtion of ileococlic intussusception with associated small bowel obstruction.Abdo
CDC 'Split Type':

Write-up: 4 days after vaccines, patient developed bilious emesis and rectal bleeding. Abdominal ultrasound at hospital showed intussusception - non reducible by air enema. Patient underwent exploratory laparotomy for reduction of intussusception and resection of ileocecal enteric duplication cyst found at that time. 2/5/08-records received for DOS 12/17-12/19/07-DC DX: Intussusception. presented to ED with C/O vomiting greenish yellow 6 episodes. BRBRPR, no stool. Abdominal pain, increased sleepiness, decreased wet diapers. Exploratory laparotomy, resection of ileocecal enteric duplication cyst. appendectomy.


Changed on 4/7/2010

VAERS ID: 301951 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Ohio
Vaccinated:2007-12-13
Onset:2007-12-17
Submitted:2008-01-02
Entered:2008-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2797AA / 1 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF292AB / 1 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0298 / 1 UN / UN
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B70143D / 1 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0904U / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Appendicectomy, Blood gases abnormal, Cyst, Intussusception, Rectal haemorrhage, Small intestinal obstruction, Somnolence, Vomiting, Enema administration, Ultrasound abdomen abnormal, Explorative laparotomy, Ileectomy, Occult blood positive

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None-but enteric duplication cyst dx''ed at time of intussusception
Allergies:
Diagnostic Lab Data: Abdominal ultrasound at hospital showed intussusception - non-reducible by air enema. 2/5/08-records received-Stool hemocult positive.Air enema incomplete recudtion of ileococlic intussusception with associated small bowel obstruction.Abdo
CDC 'Split Type':

Write-up: 4 days after vaccines, patient developed bilious emesis and rectal bleeding. Abdominal ultrasound at hospital showed intussusception - non reducible by air enema. Patient underwent exploratory laparotomy for reduction of intussusception and resection of ileocecal enteric duplication cyst found at that time. 2/5/08-records received for DOS 12/17-12/19/07-DC DX: Intussusception. presented to ED with C/O vomiting greenish yellow 6 episodes. BRBRPR, no stool. Abdominal pain, increased sleepiness, decreased wet diapers. Exploratory laparotomy, resection of ileocecal enteric duplication cyst. appendectomy.


Changed on 8/31/2010

VAERS ID: 301951 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Ohio
Vaccinated:2007-12-13
Onset:2007-12-17
Submitted:2008-01-02
Entered:2008-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2797AA / 1 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF292AB / 1 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0298 / 1 UN / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B70143D / 1 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0904U / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Appendicectomy, Blood gases abnormal, Cyst, Intussusception, Rectal haemorrhage, Small intestinal obstruction, Somnolence, Vomiting, Enema administration, Ultrasound abdomen abnormal, Explorative laparotomy, Ileectomy, Occult blood positive

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None-but enteric duplication cyst dx''ed at time of intussusception
Allergies:
Diagnostic Lab Data: Abdominal ultrasound at hospital showed intussusception - non-reducible by air enema. 2/5/08-records received-Stool hemocult positive.Air enema incomplete recudtion of ileococlic intussusception with associated small bowel obstruction.Abdo
CDC 'Split Type':

Write-up: 4 days after vaccines, patient developed bilious emesis and rectal bleeding. Abdominal ultrasound at hospital showed intussusception - non reducible by air enema. Patient underwent exploratory laparotomy for reduction of intussusception and resection of ileocecal enteric duplication cyst found at that time. 2/5/08-records received for DOS 12/17-12/19/07-DC DX: Intussusception. presented to ED with C/O vomiting greenish yellow 6 episodes. BRBRPR, no stool. Abdominal pain, increased sleepiness, decreased wet diapers. Exploratory laparotomy, resection of ileocecal enteric duplication cyst. appendectomy.


Changed on 4/13/2011

VAERS ID: 301951 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Ohio
Vaccinated:2007-12-13
Onset:2007-12-17
Submitted:2008-01-02
Entered:2008-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2797AA / 1 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF292AB / 1 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0298 / 1 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70143D / 1 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0904U / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Appendicectomy, Blood gases abnormal, Cyst, Intussusception, Rectal haemorrhage, Small intestinal obstruction, Somnolence, Vomiting, Enema administration, Ultrasound abdomen abnormal, Explorative laparotomy, Ileectomy, Occult blood positive

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None-but enteric duplication cyst dx''ed at time of intussusception
Allergies:
Diagnostic Lab Data: Abdominal ultrasound at hospital showed intussusception - non-reducible by air enema. 2/5/08-records received-Stool hemocult positive.Air enema incomplete recudtion of ileococlic intussusception with associated small bowel obstruction.Abdo
CDC 'Split Type':

Write-up: 4 days after vaccines, patient developed bilious emesis and rectal bleeding. Abdominal ultrasound at hospital showed intussusception - non reducible by air enema. Patient underwent exploratory laparotomy for reduction of intussusception and resection of ileocecal enteric duplication cyst found at that time. 2/5/08-records received for DOS 12/17-12/19/07-DC DX: Intussusception. presented to ED with C/O vomiting greenish yellow 6 episodes. BRBRPR, no stool. Abdominal pain, increased sleepiness, decreased wet diapers. Exploratory laparotomy, resection of ileocecal enteric duplication cyst. appendectomy.


Changed on 5/13/2011

VAERS ID: 301951 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Ohio
Vaccinated:2007-12-13
Onset:2007-12-17
Submitted:2008-01-02
Entered:2008-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2797AA / 1 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF292AB / 1 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0298 / 1 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70143D / 1 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0904U / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Appendicectomy, Blood gases abnormal, Cyst, Intussusception, Rectal haemorrhage, Small intestinal obstruction, Somnolence, Vomiting, Enema administration, Ultrasound abdomen abnormal, Explorative laparotomy, Ileectomy, Occult blood positive

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None-but enteric duplication cyst dx''ed at time of intussusception
Allergies:
Diagnostic Lab Data: Abdominal ultrasound at hospital showed intussusception - non-reducible by air enema. 2/5/08-records received-Stool hemocult positive.Air enema incomplete recudtion of ileococlic intussusception with associated small bowel obstruction.Abdo
CDC 'Split Type':

Write-up: 4 days after vaccines, patient developed bilious emesis and rectal bleeding. Abdominal ultrasound at hospital showed intussusception - non reducible by air enema. Patient underwent exploratory laparotomy for reduction of intussusception and resection of ileocecal enteric duplication cyst found at that time. 2/5/08-records received for DOS 12/17-12/19/07-DC DX: Intussusception. presented to ED with C/O vomiting greenish yellow 6 episodes. BRBRPR, no stool. Abdominal pain, increased sleepiness, decreased wet diapers. Exploratory laparotomy, resection of ileocecal enteric duplication cyst. appendectomy.


Changed on 6/11/2011

VAERS ID: 301951 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Ohio
Vaccinated:2007-12-13
Onset:2007-12-17
Submitted:2008-01-02
Entered:2008-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2797AA / 1 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF292AB / 1 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0298 / 1 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70143D / 1 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0904U / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Appendicectomy, Blood gases abnormal, Cyst, Intussusception, Rectal haemorrhage, Small intestinal obstruction, Somnolence, Vomiting, Enema administration, Ultrasound abdomen abnormal, Explorative laparotomy, Ileectomy, Occult blood positive

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None-but enteric duplication cyst dx''ed at time of intussusception
Allergies:
Diagnostic Lab Data: Abdominal ultrasound at hospital showed intussusception - non-reducible by air enema. 2/5/08-records received-Stool hemocult positive.Air enema incomplete recudtion of ileococlic intussusception with associated small bowel obstruction.Abdo
CDC 'Split Type':

Write-up: 4 days after vaccines, patient developed bilious emesis and rectal bleeding. Abdominal ultrasound at hospital showed intussusception - non reducible by air enema. Patient underwent exploratory laparotomy for reduction of intussusception and resection of ileocecal enteric duplication cyst found at that time. 2/5/08-records received for DOS 12/17-12/19/07-DC DX: Intussusception. presented to ED with C/O vomiting greenish yellow 6 episodes. BRBRPR, no stool. Abdominal pain, increased sleepiness, decreased wet diapers. Exploratory laparotomy, resection of ileocecal enteric duplication cyst. appendectomy.


Changed on 5/13/2013

VAERS ID: 301951 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Ohio
Vaccinated:2007-12-13
Onset:2007-12-17
Submitted:2008-01-02
Entered:2008-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2797AA / 1 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF292AB / 1 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0298 / 1 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70143D / 1 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0904U / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0904U / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Appendicectomy, Blood gases abnormal, Cyst, Intussusception, Rectal haemorrhage, Small intestinal obstruction, Somnolence, Vomiting, Enema administration, Ultrasound abdomen abnormal, Explorative laparotomy, Ileectomy, Occult blood positive

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None-but enteric duplication cyst dx''ed at time of intussusception
Allergies:
Diagnostic Lab Data: Abdominal ultrasound at hospital showed intussusception - non-reducible by air enema. 2/5/08-records received-Stool hemocult positive.Air enema incomplete recudtion of ileococlic intussusception with associated small bowel obstruction.Abdo
CDC 'Split Type':

Write-up: 4 days after vaccines, patient developed bilious emesis and rectal bleeding. Abdominal ultrasound at hospital showed intussusception - non reducible by air enema. Patient underwent exploratory laparotomy for reduction of intussusception and resection of ileocecal enteric duplication cyst found at that time. 2/5/08-records received for DOS 12/17-12/19/07-DC DX: Intussusception. presented to ED with C/O vomiting greenish yellow 6 episodes. BRBRPR, no stool. Abdominal pain, increased sleepiness, decreased wet diapers. Exploratory laparotomy, resection of ileocecal enteric duplication cyst. appendectomy.


Changed on 4/14/2017

VAERS ID: 301951 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Ohio
Vaccinated:2007-12-13
Onset:2007-12-17
Submitted:2008-01-02
Entered:2008-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2797AA / 1 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF292AB / 1 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0298 / 1 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70143D / 1 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0904U / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Appendicectomy, Blood gases abnormal, Cyst, Intussusception, Rectal haemorrhage, Small intestinal obstruction, Somnolence, Vomiting, Enema administration, Ultrasound abdomen abnormal, Explorative laparotomy, Ileectomy, Occult blood positive

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None-but enteric duplication cyst dx''ed at time of intussusception
Allergies:
Diagnostic Lab Data: Abdominal ultrasound at hospital showed intussusception - non-reducible by air enema. 2/5/08-records received-Stool hemocult positive.Air enema incomplete recudtion of ileococlic intussusception with associated small bowel obstruction.Abdo obstruction.Abdominal x-ray small bowel obstruction. US intussusception right upper quadrant.
CDC 'Split Type':

Write-up: 4 days after vaccines, patient developed bilious emesis and rectal bleeding. Abdominal ultrasound at hospital showed intussusception - non reducible by air enema. Patient underwent exploratory laparotomy for reduction of intussusception and resection of ileocecal enteric duplication cyst found at that time. 2/5/08-records received for DOS 12/17-12/19/07-DC DX: Intussusception. presented to ED with C/O vomiting greenish yellow 6 episodes. BRBRPR, no stool. Abdominal pain, increased sleepiness, decreased wet diapers. Exploratory laparotomy, resection of ileocecal enteric duplication cyst. appendectomy.


Changed on 9/14/2017

VAERS ID: 301951 Before After
VAERS Form:(blank) 1
Age:0.3
Gender:Male
Location:Ohio
Vaccinated:2007-12-13
Onset:2007-12-17
Submitted:2008-01-02
Entered:2008-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2797AA / 1 2 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF292AB / 1 2 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0298 / 1 2 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70143D / 1 2 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0904U / 1 2 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Cyst, Intussusception, Rectal haemorrhage, Vomiting, Ultrasound abdomen abnormal, Explorative laparotomy, Ileectomy

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None-but enteric duplication cyst dx''ed at time of intussusception
Allergies:
Diagnostic Lab Data: Abdominal ultrasound at hospital showed intussusception - non-reducible by air enema. 2/5/08-records received-Stool hemocult positive.Air enema incomplete recudtion of ileococlic intussusception with associated small bowel obstruction.Abdominal x-ray small bowel obstruction. US intussusception right upper quadrant.
CDC 'Split Type':

Write-up: 4 days after vaccines, patient developed bilious emesis and rectal bleeding. Abdominal ultrasound at hospital showed intussusception - non reducible by air enema. Patient underwent exploratory laparotomy for reduction of intussusception and resection of ileocecal enteric duplication cyst found at that time. 2/5/08-records received for DOS 12/17-12/19/07-DC DX: Intussusception. presented to ED with C/O vomiting greenish yellow 6 episodes. BRBRPR, no stool. Abdominal pain, increased sleepiness, decreased wet diapers. Exploratory laparotomy, resection of ileocecal enteric duplication cyst. appendectomy.


Changed on 2/14/2018

VAERS ID: 301951 Before After
VAERS Form:1
Age:0.3
Gender:Male
Location:Ohio
Vaccinated:2007-12-13
Onset:2007-12-17
Submitted:2008-01-02
Entered:2008-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2797AA / 2 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF292AB / 2 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0298 / 2 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70143D / 2 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0904U / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Cyst, Intussusception, Rectal haemorrhage, Vomiting, Ultrasound abdomen abnormal, Explorative laparotomy, Ileectomy

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None-but enteric duplication cyst dx''ed at time of intussusception
Allergies:
Diagnostic Lab Data: Abdominal ultrasound at hospital showed intussusception - non-reducible by air enema. 2/5/08-records received-Stool hemocult positive.Air enema incomplete recudtion of ileococlic intussusception with associated small bowel obstruction.Abdominal x-ray small bowel obstruction. US intussusception right upper quadrant.
CDC 'Split Type':

Write-up: 4 days after vaccines, patient developed bilious emesis and rectal bleeding. Abdominal ultrasound at hospital showed intussusception - non reducible by air enema. Patient underwent exploratory laparotomy for reduction of intussusception and resection of ileocecal enteric duplication cyst found at that time. 2/5/08-records received for DOS 12/17-12/19/07-DC DX: Intussusception. presented to ED with C/O vomiting greenish yellow 6 episodes. BRBRPR, no stool. Abdominal pain, increased sleepiness, decreased wet diapers. Exploratory laparotomy, resection of ileocecal enteric duplication cyst. appendectomy.


Changed on 6/14/2018

VAERS ID: 301951 Before After
VAERS Form:1
Age:0.3
Gender:Male
Location:Ohio
Vaccinated:2007-12-13
Onset:2007-12-17
Submitted:2008-01-02
Entered:2008-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2797AA / 2 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF292AB / 2 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0298 / 2 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70143D / 2 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0904U / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Cyst, Intussusception, Rectal haemorrhage, Vomiting, Ultrasound abdomen abnormal, Explorative laparotomy, Ileectomy

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None-but enteric duplication cyst dx''ed at time of intussusception
Allergies:
Diagnostic Lab Data: Abdominal ultrasound at hospital showed intussusception - non-reducible by air enema. 2/5/08-records received-Stool hemocult positive.Air enema incomplete recudtion of ileococlic intussusception with associated small bowel obstruction.Abdominal x-ray small bowel obstruction. US intussusception right upper quadrant.
CDC 'Split Type':

Write-up: 4 days after vaccines, patient developed bilious emesis and rectal bleeding. Abdominal ultrasound at hospital showed intussusception - non reducible by air enema. Patient underwent exploratory laparotomy for reduction of intussusception and resection of ileocecal enteric duplication cyst found at that time. 2/5/08-records received for DOS 12/17-12/19/07-DC DX: Intussusception. presented to ED with C/O vomiting greenish yellow 6 episodes. BRBRPR, no stool. Abdominal pain, increased sleepiness, decreased wet diapers. Exploratory laparotomy, resection of ileocecal enteric duplication cyst. appendectomy.

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