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This is VAERS ID 303729

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 303729
VAERS Form:
Age:0.6
Gender:Male
Location:California
Vaccinated:2008-01-11
Onset:2008-01-12
Submitted:2008-01-21
Entered:2008-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B137AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C42993 / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1193U / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal tenderness, Appendicectomy, Barium enema, Barium enema abnormal

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: None
Current Illness: None
Preexisting Conditions: None. PMH: none except recent mild URI. NKDA.
Allergies:
Diagnostic Lab Data: surgery revealed intussusception. Labs and Diagnostics: KUB showed gas in the L colon and a soft tissue density in the R colon with distended bowel. Barium enema (+) for IS. CBC with WBC 15.8, Hgb 10.9, electrolytes WNL. CO2 20. Glucose
CDC 'Split Type':

Write-up: Child received immunizations 1/11/08. Went to ER on 1/12/08 - bloody stools - diagnosed with intussusception (surgical reduction required). 01/31/2008 MR received from CDC including vax record confirming vax as reported and hospital records from DOS 1/12"-15/2008 with DX: Ileocolic Intussusception. Infant presented to ER with progressive nausea, vomiting and bloody diarrhea. PO intake decreased. Surgical consult PE (+) for lethargy, abdominal tenderness and a RUQ density on deep palpation. IS was not re


Changed on 12/8/2009

VAERS ID: 303729 Before After
VAERS Form:
Age:0.6
Gender:Male
Location:California
Vaccinated:2008-01-11
Onset:2008-01-12
Submitted:2008-01-21
Entered:2008-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B137AA / 2 RL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B137AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C42993 / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1193U / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal tenderness, Appendicectomy, Barium enema, Barium enema abnormal, Blood glucose increased, Culture stool negative, Diarrhoea haemorrhagic, Full blood count, Haematochezia, Haemoglobin decreased, Intussusception, Large intestinal obstruction reduction, Lethargy, Nausea, Surgery, Urinary system X-ray, Vomiting, White blood cell count increased, White blood cells stool positive, Oral intake reduced, Carbon dioxide abnormal

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: None
Current Illness: None
Preexisting Conditions: None. PMH: none except recent mild URI. NKDA.
Allergies:
Diagnostic Lab Data: surgery revealed intussusception. Labs and Diagnostics: KUB showed gas in the L colon and a soft tissue density in the R colon with distended bowel. Barium enema (+) for IS. CBC with WBC 15.8, Hgb 10.9, electrolytes WNL. CO2 20. Glucose
CDC 'Split Type':

Write-up: Child received immunizations 1/11/08. Went to ER on 1/12/08 - bloody stools - diagnosed with intussusception (surgical reduction required). 01/31/2008 MR received from CDC including vax record confirming vax as reported and hospital records from DOS 1/12"-15/2008 1/12-15/2008 with DX: Ileocolic Intussusception. Infant presented to ER with progressive nausea, vomiting and bloody diarrhea. PO intake decreased. Surgical consult PE (+) for lethargy, abdominal tenderness and a RUQ density on deep palpation. IS was not re reducible by BE so pt had surgical reduction of IS and appendectomy.


Changed on 3/2/2010

VAERS ID: 303729 Before After
VAERS Form:
Age:0.6
Gender:Male
Location:California
Vaccinated:2008-01-11
Onset:2008-01-12
Submitted:2008-01-21
Entered:2008-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B137AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC C42993 / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1193U / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal tenderness, Appendicectomy, Barium enema, Barium enema abnormal, Blood glucose increased, Culture stool negative, Diarrhoea haemorrhagic, Full blood count, Haematochezia, Haemoglobin decreased, Intussusception, Large intestinal obstruction reduction, Lethargy, Nausea, Surgery, Urinary system X-ray, Vomiting, White blood cell count increased, White blood cells stool positive, Oral intake reduced, Carbon dioxide abnormal

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: None
Current Illness: None
Preexisting Conditions: None. PMH: none except recent mild URI. NKDA.
Allergies:
Diagnostic Lab Data: surgery revealed intussusception. Labs and Diagnostics: KUB showed gas in the L colon and a soft tissue density in the R colon with distended bowel. Barium enema (+) for IS. CBC with WBC 15.8, Hgb 10.9, electrolytes WNL. CO2 20. Glucose
CDC 'Split Type':

Write-up: Child received immunizations 1/11/08. Went to ER on 1/12/08 - bloody stools - diagnosed with intussusception (surgical reduction required). 01/31/2008 MR received from CDC including vax record confirming vax as reported and hospital records from DOS 1/12-15/2008 with DX: Ileocolic Intussusception. Infant presented to ER with progressive nausea, vomiting and bloody diarrhea. PO intake decreased. Surgical consult PE (+) for lethargy, abdominal tenderness and a RUQ density on deep palpation. IS was not reducible by BE so pt had surgical reduction of IS and appendectomy.


Changed on 4/7/2010

VAERS ID: 303729 Before After
VAERS Form:
Age:0.6
Gender:Male
Location:California
Vaccinated:2008-01-11
Onset:2008-01-12
Submitted:2008-01-21
Entered:2008-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B137AA / 2 RL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C42993 / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1193U / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal tenderness, Appendicectomy, Barium enema, Barium enema abnormal, Blood glucose increased, Culture stool negative, Diarrhoea haemorrhagic, Full blood count, Haematochezia, Haemoglobin decreased, Intussusception, Large intestinal obstruction reduction, Lethargy, Nausea, Surgery, Urinary system X-ray, Vomiting, White blood cell count increased, White blood cells stool positive, Oral intake reduced, Carbon dioxide abnormal

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: None
Current Illness: None
Preexisting Conditions: None. PMH: none except recent mild URI. NKDA.
Allergies:
Diagnostic Lab Data: surgery revealed intussusception. Labs and Diagnostics: KUB showed gas in the L colon and a soft tissue density in the R colon with distended bowel. Barium enema (+) for IS. CBC with WBC 15.8, Hgb 10.9, electrolytes WNL. CO2 20. Glucose
CDC 'Split Type':

Write-up: Child received immunizations 1/11/08. Went to ER on 1/12/08 - bloody stools - diagnosed with intussusception (surgical reduction required). 01/31/2008 MR received from CDC including vax record confirming vax as reported and hospital records from DOS 1/12-15/2008 with DX: Ileocolic Intussusception. Infant presented to ER with progressive nausea, vomiting and bloody diarrhea. PO intake decreased. Surgical consult PE (+) for lethargy, abdominal tenderness and a RUQ density on deep palpation. IS was not reducible by BE so pt had surgical reduction of IS and appendectomy.


Changed on 8/31/2010

VAERS ID: 303729 Before After
VAERS Form:
Age:0.6
Gender:Male
Location:California
Vaccinated:2008-01-11
Onset:2008-01-12
Submitted:2008-01-21
Entered:2008-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B137AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH C42993 / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1193U / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal tenderness, Appendicectomy, Barium enema, Barium enema abnormal, Blood glucose increased, Culture stool negative, Diarrhoea haemorrhagic, Full blood count, Haematochezia, Haemoglobin decreased, Intussusception, Large intestinal obstruction reduction, Lethargy, Nausea, Surgery, Urinary system X-ray, Vomiting, White blood cell count increased, White blood cells stool positive, Oral intake reduced, Carbon dioxide abnormal

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: None
Current Illness: None
Preexisting Conditions: None. PMH: none except recent mild URI. NKDA.
Allergies:
Diagnostic Lab Data: surgery revealed intussusception. Labs and Diagnostics: KUB showed gas in the L colon and a soft tissue density in the R colon with distended bowel. Barium enema (+) for IS. CBC with WBC 15.8, Hgb 10.9, electrolytes WNL. CO2 20. Glucose
CDC 'Split Type':

Write-up: Child received immunizations 1/11/08. Went to ER on 1/12/08 - bloody stools - diagnosed with intussusception (surgical reduction required). 01/31/2008 MR received from CDC including vax record confirming vax as reported and hospital records from DOS 1/12-15/2008 with DX: Ileocolic Intussusception. Infant presented to ER with progressive nausea, vomiting and bloody diarrhea. PO intake decreased. Surgical consult PE (+) for lethargy, abdominal tenderness and a RUQ density on deep palpation. IS was not reducible by BE so pt had surgical reduction of IS and appendectomy.


Changed on 5/13/2013

VAERS ID: 303729 Before After
VAERS Form:
Age:0.6
Gender:Male
Location:California
Vaccinated:2008-01-11
Onset:2008-01-12
Submitted:2008-01-21
Entered:2008-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B137AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C42993 / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1193U / 2 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1193U / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal tenderness, Appendicectomy, Barium enema, Barium enema abnormal, Blood glucose increased, Culture stool negative, Diarrhoea haemorrhagic, Full blood count, Haematochezia, Haemoglobin decreased, Intussusception, Large intestinal obstruction reduction, Lethargy, Nausea, Surgery, Urinary system X-ray, Vomiting, White blood cell count increased, White blood cells stool positive, Oral intake reduced, Carbon dioxide abnormal

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: None
Current Illness: None
Preexisting Conditions: None. PMH: none except recent mild URI. NKDA.
Allergies:
Diagnostic Lab Data: surgery revealed intussusception. Labs and Diagnostics: KUB showed gas in the L colon and a soft tissue density in the R colon with distended bowel. Barium enema (+) for IS. CBC with WBC 15.8, Hgb 10.9, electrolytes WNL. CO2 20. Glucose
CDC 'Split Type':

Write-up: Child received immunizations 1/11/08. Went to ER on 1/12/08 - bloody stools - diagnosed with intussusception (surgical reduction required). 01/31/2008 MR received from CDC including vax record confirming vax as reported and hospital records from DOS 1/12-15/2008 with DX: Ileocolic Intussusception. Infant presented to ER with progressive nausea, vomiting and bloody diarrhea. PO intake decreased. Surgical consult PE (+) for lethargy, abdominal tenderness and a RUQ density on deep palpation. IS was not reducible by BE so pt had surgical reduction of IS and appendectomy.


Changed on 2/14/2017

VAERS ID: 303729 Before After
VAERS Form:
Age:0.6
Gender:Male
Location:California
Vaccinated:2008-01-11
Onset:2008-01-12
Submitted:2008-01-21
Entered:2008-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B137AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C42993 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1193U / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal tenderness, Appendicectomy, Barium enema, Barium enema abnormal, Blood glucose increased, Culture stool negative, Diarrhoea haemorrhagic, Full blood count, Haematochezia, Haemoglobin decreased, Intussusception, Large intestinal obstruction reduction, Lethargy, Nausea, Surgery, Urinary system X-ray, Vomiting, White blood cell count increased, White blood cells stool positive, Oral intake reduced, Carbon dioxide abnormal

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: None
Current Illness: None
Preexisting Conditions: None. PMH: none except recent mild URI. NKDA.
Allergies:
Diagnostic Lab Data: surgery revealed intussusception. Labs and Diagnostics: KUB showed gas in the L colon and a soft tissue density in the R colon with distended bowel. Barium enema (+) for IS. CBC with WBC 15.8, Hgb 10.9, electrolytes WNL. CO2 20. Glucose 111. Stool 1+ WBCs. Stool cx (-).
CDC 'Split Type':

Write-up: Child received immunizations 1/11/08. Went to ER on 1/12/08 - bloody stools - diagnosed with intussusception (surgical reduction required). 01/31/2008 MR received from CDC including vax record confirming vax as reported and hospital records from DOS 1/12-15/2008 with DX: Ileocolic Intussusception. Infant presented to ER with progressive nausea, vomiting and bloody diarrhea. PO intake decreased. Surgical consult PE (+) for lethargy, abdominal tenderness and a RUQ density on deep palpation. IS was not reducible by BE so pt had surgical reduction of IS and appendectomy.


Changed on 9/14/2017

VAERS ID: 303729 Before After
VAERS Form:(blank) 1
Age:0.6
Gender:Male
Location:California
Vaccinated:2008-01-11
Onset:2008-01-12
Submitted:2008-01-21
Entered:2008-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B137AA / 2 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C42993 / 2 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1193U / 2 3 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Haematochezia, Intussusception, Surgery

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: None
Current Illness: None
Preexisting Conditions: None. PMH: none except recent mild URI. NKDA.
Allergies:
Diagnostic Lab Data: surgery revealed intussusception. Labs and Diagnostics: KUB showed gas in the L colon and a soft tissue density in the R colon with distended bowel. Barium enema (+) for IS. CBC with WBC 15.8, Hgb 10.9, electrolytes WNL. CO2 20. Glucose 111. Stool 1+ WBCs. Stool cx (-).
CDC 'Split Type':

Write-up: Child received immunizations 1/11/08. Went to ER on 1/12/08 - bloody stools - diagnosed with intussusception (surgical reduction required). 01/31/2008 MR received from CDC including vax record confirming vax as reported and hospital records from DOS 1/12-15/2008 with DX: Ileocolic Intussusception. Infant presented to ER with progressive nausea, vomiting and bloody diarrhea. PO intake decreased. Surgical consult PE (+) for lethargy, abdominal tenderness and a RUQ density on deep palpation. IS was not reducible by BE so pt had surgical reduction of IS and appendectomy.


Changed on 2/14/2018

VAERS ID: 303729 Before After
VAERS Form:1
Age:0.6
Gender:Male
Location:California
Vaccinated:2008-01-11
Onset:2008-01-12
Submitted:2008-01-21
Entered:2008-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B137AA / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C42993 / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1193U / 3 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Haematochezia, Intussusception, Surgery

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: None
Current Illness: None
Preexisting Conditions: None. PMH: none except recent mild URI. NKDA.
Allergies:
Diagnostic Lab Data: surgery revealed intussusception. Labs and Diagnostics: KUB showed gas in the L colon and a soft tissue density in the R colon with distended bowel. Barium enema (+) for IS. CBC with WBC 15.8, Hgb 10.9, electrolytes WNL. CO2 20. Glucose 111. Stool 1+ WBCs. Stool cx (-).
CDC 'Split Type':

Write-up: Child received immunizations 1/11/08. Went to ER on 1/12/08 - bloody stools - diagnosed with intussusception (surgical reduction required). 01/31/2008 MR received from CDC including vax record confirming vax as reported and hospital records from DOS 1/12-15/2008 with DX: Ileocolic Intussusception. Infant presented to ER with progressive nausea, vomiting and bloody diarrhea. PO intake decreased. Surgical consult PE (+) for lethargy, abdominal tenderness and a RUQ density on deep palpation. IS was not reducible by BE so pt had surgical reduction of IS and appendectomy.


Changed on 6/14/2018

VAERS ID: 303729 Before After
VAERS Form:1
Age:0.6
Gender:Male
Location:California
Vaccinated:2008-01-11
Onset:2008-01-12
Submitted:2008-01-21
Entered:2008-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B137AA / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C42993 / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1193U / 3 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Haematochezia, Intussusception, Surgery

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: None
Current Illness: None
Preexisting Conditions: None. PMH: none except recent mild URI. NKDA.
Allergies:
Diagnostic Lab Data: surgery revealed intussusception. Labs and Diagnostics: KUB showed gas in the L colon and a soft tissue density in the R colon with distended bowel. Barium enema (+) for IS. CBC with WBC 15.8, Hgb 10.9, electrolytes WNL. CO2 20. Glucose 111. Stool 1+ WBCs. Stool cx (-).
CDC 'Split Type':

Write-up: Child received immunizations 1/11/08. Went to ER on 1/12/08 - bloody stools - diagnosed with intussusception (surgical reduction required). 01/31/2008 MR received from CDC including vax record confirming vax as reported and hospital records from DOS 1/12-15/2008 with DX: Ileocolic Intussusception. Infant presented to ER with progressive nausea, vomiting and bloody diarrhea. PO intake decreased. Surgical consult PE (+) for lethargy, abdominal tenderness and a RUQ density on deep palpation. IS was not reducible by BE so pt had surgical reduction of IS and appendectomy.


Changed on 8/14/2018

VAERS ID: 303729 Before After
VAERS Form:1
Age:0.6
Gender:Male
Location:California
Vaccinated:2008-01-11
Onset:2008-01-12
Submitted:2008-01-21
Entered:2008-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B137AA / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C42993 / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1193U / 3 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Haematochezia, Intussusception, Surgery

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: None
Current Illness: None
Preexisting Conditions: None. PMH: none except recent mild URI. NKDA.
Allergies:
Diagnostic Lab Data: surgery revealed intussusception. Labs and Diagnostics: KUB showed gas in the L colon and a soft tissue density in the R colon with distended bowel. Barium enema (+) for IS. CBC with WBC 15.8, Hgb 10.9, electrolytes WNL. CO2 20. Glucose 111. Stool 1+ WBCs. Stool cx (-).
CDC 'Split Type':

Write-up: Child received immunizations 1/11/08. Went to ER on 1/12/08 - bloody stools - diagnosed with intussusception (surgical reduction required). 01/31/2008 MR received from CDC including vax record confirming vax as reported and hospital records from DOS 1/12-15/2008 with DX: Ileocolic Intussusception. Infant presented to ER with progressive nausea, vomiting and bloody diarrhea. PO intake decreased. Surgical consult PE (+) for lethargy, abdominal tenderness and a RUQ density on deep palpation. IS was not reducible by BE so pt had surgical reduction of IS and appendectomy.

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