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VAERS ID: | 303025 |
VAERS Form: | |
Age: | 0.3 |
Sex: | Male |
Location: | Texas |
Vaccinated: | 2007-11-13 |
Onset: | 2007-11-27 |
Submitted: | 2008-01-18 |
Entered: | 2008-01-18 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B125BB / 1 | LL / IM |
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER | UF193AB / 1 | LL / UN |
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC | B54007F / 1 | RL / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1168U / 1 | - / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Abdominal pain, Appendicectomy, Diarrhoea, Haematochezia, Enema administration
Life Threatening? Yes
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: 1
Write-up: Infant on 11/27/07 began having small amount of diarrhea (non bloody)and vomiting. Later that evening there were no stools passed and worsening colicy abdominal pain and bilious vomiting. Discovered to have an intussuseption unreducible via air contrast"barium enema. Infant taken to OR immediately and intussuseption reduced surgically. 02/05/08-records received for DOS 11/27-11/28/07-DC DX: Intussusception, status post appendectomy and laparotomy with reduction of intussusception. Presented to ED with C/
Vaccinated: | 2007-11-13 |
Onset: | 2007-11-27 |
Submitted: | 2008-01-18 |
Entered: | 2008-01-18 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B125BB / 1 | LL / IM |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B125BB / 1 | LL / IM |
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER | UF193AB / 1 | LL / UN |
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC | B54007F / 1 | RL / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1168U / 1 | - / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Abdominal pain, Appendicectomy, Diarrhoea, Haematochezia, Intussusception, Laparotomy, Mucous stools, Vomiting, Enema administration, Ultrasound abdomen abnormal
Life Threatening? Yes
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: 1
Write-up: Infant on 11/27/07 began having small amount of diarrhea (non bloody)and vomiting. Later that evening there were no stools passed and worsening colicy abdominal pain and bilious vomiting. Discovered to have an intussuseption unreducible via air contrast"barium contrast barium enema. Infant taken to OR immediately and intussuseption reduced surgically. 02/05/08-records received for DOS 11/27-11/28/07-DC DX: Intussusception, status post appendectomy and laparotomy with reduction of intussusception. Presented to ED with C/ C/O abdominal pain and vomiting. PE: bloody mucous stool.
Vaccinated: | 2007-11-13 |
Onset: | 2007-11-27 |
Submitted: | 2008-01-18 |
Entered: | 2008-01-18 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B125BB / 1 | LL / IM |
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER | UF193AB / 1 | LL / UN |
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC | B54007F / 1 | RL / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1168U / 1 | - / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Abdominal pain, Appendicectomy, Diarrhoea, Haematochezia, Intussusception, Laparotomy, Mucous stools, Vomiting, Enema administration, Ultrasound abdomen abnormal
Life Threatening? Yes
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: 1
Write-up: Infant on 11/27/07 began having small amount of diarrhea (non bloody)and vomiting. Later that evening there were no stools passed and worsening colicy abdominal pain and bilious vomiting. Discovered to have an intussuseption unreducible via air contrast barium enema. Infant taken to OR immediately and intussuseption reduced surgically. 02/05/08-records received for DOS 11/27-11/28/07-DC DX: Intussusception, status post appendectomy and laparotomy with reduction of intussusception. Presented to ED with C/O abdominal pain and vomiting. PE: bloody mucous stool.
Vaccinated: | 2007-11-13 |
Onset: | 2007-11-27 |
Submitted: | 2008-01-18 |
Entered: | 2008-01-18 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B125BB / 1 | LL / IM |
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER | UF193AB / 1 | LL / UN |
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC | B54007F / 1 | RL / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1168U / 1 | - / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Abdominal pain, Appendicectomy, Diarrhoea, Haematochezia, Intussusception, Laparotomy, Mucous stools, Vomiting, Enema administration, Ultrasound abdomen abnormal
Life Threatening? Yes
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: 1
Write-up: Infant on 11/27/07 began having small amount of diarrhea (non bloody)and vomiting. Later that evening there were no stools passed and worsening colicy abdominal pain and bilious vomiting. Discovered to have an intussuseption unreducible via air contrast barium enema. Infant taken to OR immediately and intussuseption reduced surgically. 02/05/08-records received for DOS 11/27-11/28/07-DC DX: Intussusception, status post appendectomy and laparotomy with reduction of intussusception. Presented to ED with C/O abdominal pain and vomiting. PE: bloody mucous stool.
Vaccinated: | 2007-11-13 |
Onset: | 2007-11-27 |
Submitted: | 2008-01-18 |
Entered: | 2008-01-18 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B125BB / 1 | LL / IM |
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER | UF193AB / 1 | LL / UN |
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH | B54007F / 1 | RL / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1168U / 1 | - / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Abdominal pain, Appendicectomy, Diarrhoea, Haematochezia, Intussusception, Laparotomy, Mucous stools, Vomiting, Enema administration, Ultrasound abdomen abnormal
Life Threatening? Yes
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: 1
Write-up: Infant on 11/27/07 began having small amount of diarrhea (non bloody)and vomiting. Later that evening there were no stools passed and worsening colicy abdominal pain and bilious vomiting. Discovered to have an intussuseption unreducible via air contrast barium enema. Infant taken to OR immediately and intussuseption reduced surgically. 02/05/08-records received for DOS 11/27-11/28/07-DC DX: Intussusception, status post appendectomy and laparotomy with reduction of intussusception. Presented to ED with C/O abdominal pain and vomiting. PE: bloody mucous stool.
Vaccinated: | 2007-11-13 |
Onset: | 2007-11-27 |
Submitted: | 2008-01-18 |
Entered: | 2008-01-18 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B125BB / 1 | LL / IM |
HIBV: HIB (NO BRAND NAME) HIB (ACTHIB) / UNKNOWN MANUFACTURER SANOFI PASTEUR | UF193AB / 1 | LL / UN IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B54007F / 1 | RL / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1168U / 1 | - / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Abdominal pain, Appendicectomy, Diarrhoea, Haematochezia, Intussusception, Laparotomy, Mucous stools, Vomiting, Enema administration, Ultrasound abdomen abnormal
Life Threatening? Yes
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: 1
Write-up: Infant on 11/27/07 began having small amount of diarrhea (non bloody)and vomiting. Later that evening there were no stools passed and worsening colicy abdominal pain and bilious vomiting. Discovered to have an intussuseption unreducible via air contrast barium enema. Infant taken to OR immediately and intussuseption reduced surgically. 02/05/08-records received for DOS 11/27-11/28/07-DC DX: Intussusception, status post appendectomy and laparotomy with reduction of intussusception. Presented to ED with C/O abdominal pain and vomiting. PE: bloody mucous stool.
Vaccinated: | 2007-11-13 |
Onset: | 2007-11-27 |
Submitted: | 2008-01-18 |
Entered: | 2008-01-18 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B125BB / 1 | LL / IM |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR | UF193AB / 1 | LL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B54007F / 1 | RL / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1168U / 1 | - / PO |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1168U / 1 | - / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Abdominal pain, Appendicectomy, Diarrhoea, Haematochezia, Intussusception, Laparotomy, Mucous stools, Vomiting, Enema administration, Ultrasound abdomen abnormal
Life Threatening? Yes
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: 1
Write-up: Infant on 11/27/07 began having small amount of diarrhea (non bloody)and vomiting. Later that evening there were no stools passed and worsening colicy abdominal pain and bilious vomiting. Discovered to have an intussuseption unreducible via air contrast barium enema. Infant taken to OR immediately and intussuseption reduced surgically. 02/05/08-records received for DOS 11/27-11/28/07-DC DX: Intussusception, status post appendectomy and laparotomy with reduction of intussusception. Presented to ED with C/O abdominal pain and vomiting. PE: bloody mucous stool.
Vaccinated: | 2007-11-13 |
Onset: | 2007-11-27 |
Submitted: | 2008-01-18 |
Entered: | 2008-01-18 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B125BB / 1 | LL / IM |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR | UF193AB / 1 | LL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B54007F / 1 | RL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1168U / 1 | - / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Abdominal pain, Appendicectomy, Diarrhoea, Haematochezia, Intussusception, Laparotomy, Mucous stools, Vomiting, Enema administration, Ultrasound abdomen abnormal
Life Threatening? Yes
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: 1
Write-up: Infant on 11/27/07 began having small amount of diarrhea (non bloody)and vomiting. Later that evening there were no stools passed and worsening colicy abdominal pain and bilious vomiting. Discovered to have an intussuseption unreducible via air contrast barium enema. Infant taken to OR immediately and intussuseption reduced surgically. 02/05/08-records received for DOS 11/27-11/28/07-DC DX: Intussusception, status post appendectomy and laparotomy with reduction of intussusception. Presented to ED with C/O abdominal pain and vomiting. PE: bloody mucous stool.
Vaccinated: | 2007-11-13 |
Onset: | 2007-11-27 |
Submitted: | 2008-01-18 |
Entered: | 2008-01-18 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B125BB / 1 | LL / IM |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR | UF193AB / 1 | LL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B54007F / 1 | RL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1168U / 1 | - / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Abdominal pain, Appendicectomy, Diarrhoea, Haematochezia, Intussusception, Laparotomy, Mucous stools, Vomiting, Enema administration, Ultrasound abdomen abnormal
Life Threatening? Yes
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: 1
Write-up: Infant on 11/27/07 began having small amount of diarrhea (non bloody)and vomiting. Later that evening there were no stools passed and worsening colicy abdominal pain and bilious vomiting. Discovered to have an intussuseption unreducible via air contrast barium enema. Infant taken to OR immediately and intussuseption reduced surgically. 02/05/08-records received for DOS 11/27-11/28/07-DC DX: Intussusception, status post appendectomy and laparotomy with reduction of intussusception. Presented to ED with C/O abdominal pain and vomiting. PE: bloody mucous stool.
Vaccinated: | 2007-11-13 |
Onset: | 2007-11-27 |
Submitted: | 2008-01-18 |
Entered: | 2008-01-18 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B125BB / 1 | LL / IM |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR | UF193AB / 1 | LL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B54007F / 1 | RL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1168U / 1 | - / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Abdominal pain, Appendicectomy, Diarrhoea, Haematochezia, Intussusception, Laparotomy, Mucous stools, Vomiting, Enema administration, Ultrasound abdomen abnormal
Life Threatening? Yes
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: 1
Write-up: Infant on 11/27/07 began having small amount of diarrhea (non bloody)and vomiting. Later that evening there were no stools passed and worsening colicy abdominal pain and bilious vomiting. Discovered to have an intussuseption unreducible via air contrast barium enema. Infant taken to OR immediately and intussuseption reduced surgically. 02/05/08-records received for DOS 11/27-11/28/07-DC DX: Intussusception, status post appendectomy and laparotomy with reduction of intussusception. Presented to ED with C/O abdominal pain and vomiting. PE: bloody mucous stool.
Vaccinated: | 2007-11-13 |
Onset: | 2007-11-27 |
Submitted: | 2008-01-18 |
Entered: | 2008-01-18 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B125BB / 1 2 | LL / IM |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR | UF193AB / 1 2 | LL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B54007F / 1 2 | RL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1168U / 1 2 | - MO / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Abdominal pain, Diarrhoea, Intussusception, Vomiting, Enema administration
Life Threatening? Yes
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: 1
Write-up: Infant on 11/27/07 began having small amount of diarrhea (non bloody)and vomiting. Later that evening there were no stools passed and worsening colicy abdominal pain and bilious vomiting. Discovered to have an intussuseption unreducible via air contrast barium enema. Infant taken to OR immediately and intussuseption reduced surgically. 02/05/08-records received for DOS 11/27-11/28/07-DC DX: Intussusception, status post appendectomy and laparotomy with reduction of intussusception. Presented to ED with C/O abdominal pain and vomiting. PE: bloody mucous stool.
Vaccinated: | 2007-11-13 |
Onset: | 2007-11-27 |
Submitted: | 2008-01-18 |
Entered: | 2008-01-18 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B125BB / 2 | LL / IM |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR | UF193AB / 2 | LL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B54007F / 2 | RL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1168U / 2 | MO / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Abdominal pain, Diarrhoea, Intussusception, Vomiting, Enema administration
Life Threatening? Yes
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: 1
Write-up: Infant on 11/27/07 began having small amount of diarrhea (non bloody)and vomiting. Later that evening there were no stools passed and worsening colicy abdominal pain and bilious vomiting. Discovered to have an intussuseption unreducible via air contrast barium enema. Infant taken to OR immediately and intussuseption reduced surgically. 02/05/08-records received for DOS 11/27-11/28/07-DC DX: Intussusception, status post appendectomy and laparotomy with reduction of intussusception. Presented to ED with C/O abdominal pain and vomiting. PE: bloody mucous stool.
Vaccinated: | 2007-11-13 |
Onset: | 2007-11-27 |
Submitted: | 2008-01-18 |
Entered: | 2008-01-18 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B125BB / 2 | LL / IM |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR | UF193AB / 2 | LL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B54007F / 2 | RL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1168U / 2 | MO / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Abdominal pain, Diarrhoea, Intussusception, Vomiting, Enema administration
Life Threatening? Yes
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: 1
Write-up: Infant on 11/27/07 began having small amount of diarrhea (non bloody)and vomiting. Later that evening there were no stools passed and worsening colicy abdominal pain and bilious vomiting. Discovered to have an intussuseption unreducible via air contrast barium enema. Infant taken to OR immediately and intussuseption reduced surgically. 02/05/08-records received for DOS 11/27-11/28/07-DC DX: Intussusception, status post appendectomy and laparotomy with reduction of intussusception. Presented to ED with C/O abdominal pain and vomiting. PE: bloody mucous stool.
Vaccinated: | 2007-11-13 |
Onset: | 2007-11-27 |
Submitted: | 2008-01-18 |
Entered: | 2008-01-18 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B125BB / 2 | LL / IM |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR | UF193AB / 2 | LL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B54007F / 2 | RL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1168U / 2 | MO / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Abdominal pain, Diarrhoea, Intussusception, Vomiting, Enema administration
Life Threatening? Yes
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: 1
Write-up: Infant on 11/27/07 began having small amount of diarrhea (non bloody)and vomiting. Later that evening there were no stools passed and worsening colicy abdominal pain and bilious vomiting. Discovered to have an intussuseption unreducible via air contrast barium enema. Infant taken to OR immediately and intussuseption reduced surgically. 02/05/08-records received for DOS 11/27-11/28/07-DC DX: Intussusception, status post appendectomy and laparotomy with reduction of intussusception. Presented to ED with C/O abdominal pain and vomiting. PE: bloody mucous stool.
Vaccinated: | 2007-11-13 |
Onset: | 2007-11-27 |
Submitted: | 2008-01-18 |
Entered: | 2008-01-18 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B125BB / 2 | LL / IM |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR | UF193AB / 2 | LL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B54007F / 2 | RL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1168U / 2 | MO / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Abdominal pain, Diarrhoea, Intussusception, Vomiting, Enema administration
Life Threatening? Yes
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: 1
Write-up: Infant on 11/27/07 began having small amount of diarrhea (non bloody)and vomiting. Later that evening there were no stools passed and worsening colicy abdominal pain and bilious vomiting. Discovered to have an intussuseption unreducible via air contrast barium enema. Infant taken to OR immediately and intussuseption reduced surgically. 02/05/08-records received for DOS 11/27-11/28/07-DC DX: Intussusception, status post appendectomy and laparotomy with reduction of intussusception. Presented to ED with C/O abdominal pain and vomiting. PE: bloody mucous stool.
Vaccinated: | 2007-11-13 |
Onset: | 2007-11-27 |
Submitted: | 2008-01-18 |
Entered: | 2008-01-18 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B125BB / 2 | LL / IM |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR | UF193AB / 2 | LL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B54007F / 2 | RL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1168U / 2 | MO / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Abdominal pain, Diarrhoea, Intussusception, Vomiting, Enema administration
Life Threatening? Yes
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: 1
Write-up: Infant on 11/27/07 began having small amount of diarrhea (non bloody)and vomiting. Later that evening there were no stools passed and worsening colicy abdominal pain and bilious vomiting. Discovered to have an intussuseption unreducible via air contrast barium enema. Infant taken to OR immediately and intussuseption reduced surgically. 02/05/08-records received for DOS 11/27-11/28/07-DC DX: Intussusception, status post appendectomy and laparotomy with reduction of intussusception. Presented to ED with C/O abdominal pain and vomiting. PE: bloody mucous stool.
Vaccinated: | 2007-11-13 |
Onset: | 2007-11-27 |
Submitted: | 2008-01-18 |
Entered: | 2008-01-18 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B125BB / 2 | LL / IM |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR | UF193AB / 2 | LL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B54007F / 2 | RL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1168U / 2 | MO / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Abdominal pain, Diarrhoea, Intussusception, Vomiting, Enema administration
Life Threatening? Yes
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: 1
Write-up: Infant on 11/27/07 began having small amount of diarrhea (non bloody)and vomiting. Later that evening there were no stools passed and worsening colicy abdominal pain and bilious vomiting. Discovered to have an intussuseption unreducible via air contrast barium enema. Infant taken to OR immediately and intussuseption reduced surgically. 02/05/08-records received for DOS 11/27-11/28/07-DC DX: Intussusception, status post appendectomy and laparotomy with reduction of intussusception. Presented to ED with C/O abdominal pain and vomiting. PE: bloody mucous stool.
Vaccinated: | 2007-11-13 |
Onset: | 2007-11-27 |
Submitted: | 2008-01-18 |
Entered: | 2008-01-18 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B125BB / 2 | LL / IM |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR | UF193AB / 2 | LL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B54007F / 2 | RL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1168U / 2 | MO / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Abdominal pain, Diarrhoea, Intussusception, Vomiting, Enema administration
Life Threatening? Yes
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: 1
Write-up: Infant on 11/27/07 began having small amount of diarrhea (non bloody)and vomiting. Later that evening there were no stools passed and worsening colicy abdominal pain and bilious vomiting. Discovered to have an intussuseption unreducible via air contrast barium enema. Infant taken to OR immediately and intussuseption reduced surgically. 02/05/08-records received for DOS 11/27-11/28/07-DC DX: Intussusception, status post appendectomy and laparotomy with reduction of intussusception. Presented to ED with C/O abdominal pain and vomiting. PE: bloody mucous stool.
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