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This is VAERS ID 306668

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 306668
VAERS Form:
Age:0.4
Sex:Male
Location:New Mexico
Vaccinated:2008-02-22
Onset:2008-03-03
Submitted:2008-03-07
Entered:2008-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR C2760AA / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0197F / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER A0125 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B5401SC / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 166SU / 1 - / PO

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

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none. Pt was recovering from a recent respiratory infection which was improving on abx.
Allergies:
Diagnostic Lab Data: Barium enema revealed intussusception. Labs and Diagnostics: KUB showed distended loop of small bowel, Upper GI WNL, Barium enema (+) for IS. CBC with WBCs 22.2, RBC 4.97, Hct 39.4
CDC 'Split Type':

Write-up: Patient received immunization 2/22/08. On 3/3/88 patient developed vomiting and diarrhea. Admitted to the hospital 3/5/08. Barium enema revealed intussusception. Unable to reduce in radiology, taken to the operating room for surgical laparoscopic redu"ction. 04/07/2008 MR received for DOS 3/5-7/2008 with D/C DX: Intussusception. Laparoscopic reduction of Intussusception. Infant presented to hospital with bilious vomiting and one bout of hematochezia, decreased activity and very sleepy. Pt was recov


Changed on 12/8/2009

VAERS ID: 306668 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:New Mexico
Vaccinated:2008-02-22
Onset:2008-03-03
Submitted:2008-03-07
Entered:2008-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR C2760AA / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0197F / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER A0125 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B5401SC / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 166SU / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal tenderness, Barium enema, Barium enema abnormal, Decreased activity, Dehydration, Diarrhoea, Full blood count, Haematochezia, Haematocrit increased, Intussusception, Irritability, Laparoscopy, Red blood cell count increased, Small intestinal intussusception reduction, Somnolence, Urinary system X-ray, Vomiting, White blood cell count increased, X-ray with contrast upper gastrointestinal tract

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none. Pt was recovering from a recent respiratory infection which was improving on abx.
Allergies:
Diagnostic Lab Data: Barium enema revealed intussusception. Labs and Diagnostics: KUB showed distended loop of small bowel, Upper GI WNL, Barium enema (+) for IS. CBC with WBCs 22.2, RBC 4.97, Hct 39.4
CDC 'Split Type':

Write-up: Patient received immunization 2/22/08. On 3/3/88 patient developed vomiting and diarrhea. Admitted to the hospital 3/5/08. Barium enema revealed intussusception. Unable to reduce in radiology, taken to the operating room for surgical laparoscopic redu"ction. reduction. 04/07/2008 MR received for DOS 3/5-7/2008 with D/C DX: Intussusception. Laparoscopic reduction of Intussusception. Infant presented to hospital with bilious vomiting and one bout of hematochezia, decreased activity and very sleepy. Pt was recov recovering from a recent respiratory infection which was improving on abx. PE(+) for palpable bowel loop in RLQ, (+) abd tenderness, mild to moderately dehydrated and fussy. Intussusception seen on Barium Enema but unable to reduce. Taken to OR for a Laparoscopic reduction of IS. A small serosal tear was identified on the terminal ileum. Tolerated surgery well and d/c on POD #2.


Changed on 3/2/2010

VAERS ID: 306668 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:New Mexico
Vaccinated:2008-02-22
Onset:2008-03-03
Submitted:2008-03-07
Entered:2008-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR C2760AA / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0197F / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER A0125 / 1 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B5401SC / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 166SU / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal tenderness, Barium enema, Barium enema abnormal, Decreased activity, Dehydration, Diarrhoea, Full blood count, Haematochezia, Haematocrit increased, Intussusception, Irritability, Laparoscopy, Red blood cell count increased, Small intestinal intussusception reduction, Somnolence, Urinary system X-ray, Vomiting, White blood cell count increased, X-ray with contrast upper gastrointestinal tract

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none. Pt was recovering from a recent respiratory infection which was improving on abx.
Allergies:
Diagnostic Lab Data: Barium enema revealed intussusception. Labs and Diagnostics: KUB showed distended loop of small bowel, Upper GI WNL, Barium enema (+) for IS. CBC with WBCs 22.2, RBC 4.97, Hct 39.4
CDC 'Split Type':

Write-up: Patient received immunization 2/22/08. On 3/3/88 patient developed vomiting and diarrhea. Admitted to the hospital 3/5/08. Barium enema revealed intussusception. Unable to reduce in radiology, taken to the operating room for surgical laparoscopic reduction. 04/07/2008 MR received for DOS 3/5-7/2008 with D/C DX: Intussusception. Laparoscopic reduction of Intussusception. Infant presented to hospital with bilious vomiting and one bout of hematochezia, decreased activity and very sleepy. Pt was recovering from a recent respiratory infection which was improving on abx. PE(+) for palpable bowel loop in RLQ, (+) abd tenderness, mild to moderately dehydrated and fussy. Intussusception seen on Barium Enema but unable to reduce. Taken to OR for a Laparoscopic reduction of IS. A small serosal tear was identified on the terminal ileum. Tolerated surgery well and d/c on POD #2.


Changed on 4/7/2010

VAERS ID: 306668 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:New Mexico
Vaccinated:2008-02-22
Onset:2008-03-03
Submitted:2008-03-07
Entered:2008-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR C2760AA / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0197F / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER A0125 / 1 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B5401SC / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 166SU / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal tenderness, Barium enema, Barium enema abnormal, Decreased activity, Dehydration, Diarrhoea, Full blood count, Haematochezia, Haematocrit increased, Intussusception, Irritability, Laparoscopy, Red blood cell count increased, Small intestinal intussusception reduction, Somnolence, Urinary system X-ray, Vomiting, White blood cell count increased, X-ray with contrast upper gastrointestinal tract

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none. Pt was recovering from a recent respiratory infection which was improving on abx.
Allergies:
Diagnostic Lab Data: Barium enema revealed intussusception. Labs and Diagnostics: KUB showed distended loop of small bowel, Upper GI WNL, Barium enema (+) for IS. CBC with WBCs 22.2, RBC 4.97, Hct 39.4
CDC 'Split Type':

Write-up: Patient received immunization 2/22/08. On 3/3/88 patient developed vomiting and diarrhea. Admitted to the hospital 3/5/08. Barium enema revealed intussusception. Unable to reduce in radiology, taken to the operating room for surgical laparoscopic reduction. 04/07/2008 MR received for DOS 3/5-7/2008 with D/C DX: Intussusception. Laparoscopic reduction of Intussusception. Infant presented to hospital with bilious vomiting and one bout of hematochezia, decreased activity and very sleepy. Pt was recovering from a recent respiratory infection which was improving on abx. PE(+) for palpable bowel loop in RLQ, (+) abd tenderness, mild to moderately dehydrated and fussy. Intussusception seen on Barium Enema but unable to reduce. Taken to OR for a Laparoscopic reduction of IS. A small serosal tear was identified on the terminal ileum. Tolerated surgery well and d/c on POD #2.


Changed on 5/11/2010

VAERS ID: 306668 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:New Mexico
Vaccinated:2008-02-22
Onset:2008-03-03
Submitted:2008-03-07
Entered:2008-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR C2760AA / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0197F / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER A0125 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B5401SC B54015C / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 166SU 1665U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal tenderness, Barium enema, Barium enema abnormal, Decreased activity, Dehydration, Diarrhoea, Full blood count, Haematochezia, Haematocrit increased, Intussusception, Irritability, Laparoscopy, Red blood cell count increased, Small intestinal intussusception reduction, Somnolence, Urinary system X-ray, Vomiting, White blood cell count increased, X-ray with contrast upper gastrointestinal tract

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none. Pt was recovering from a recent respiratory infection which was improving on abx.
Allergies:
Diagnostic Lab Data: Barium enema revealed intussusception. Labs and Diagnostics: KUB showed distended loop of small bowel, Upper GI WNL, Barium enema (+) for IS. CBC with WBCs 22.2, RBC 4.97, Hct 39.4
CDC 'Split Type':

Write-up: Patient received immunization 2/22/08. On 3/3/88 patient developed vomiting and diarrhea. Admitted to the hospital 3/5/08. Barium enema revealed intussusception. Unable to reduce in radiology, taken to the operating room for surgical laparoscopic reduction. 04/07/2008 MR received for DOS 3/5-7/2008 with D/C DX: Intussusception. Laparoscopic reduction of Intussusception. Infant presented to hospital with bilious vomiting and one bout of hematochezia, decreased activity and very sleepy. Pt was recovering from a recent respiratory infection which was improving on abx. PE(+) for palpable bowel loop in RLQ, (+) abd tenderness, mild to moderately dehydrated and fussy. Intussusception seen on Barium Enema but unable to reduce. Taken to OR for a Laparoscopic reduction of IS. A small serosal tear was identified on the terminal ileum. Tolerated surgery well and d/c on POD #2.


Changed on 8/31/2010

VAERS ID: 306668 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:New Mexico
Vaccinated:2008-02-22
Onset:2008-03-03
Submitted:2008-03-07
Entered:2008-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR C2760AA / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0197F / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER A0125 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B54015C / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1665U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Barium enema abnormal, Diarrhoea, Intussusception, Laparoscopy, Vomiting

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none. Pt was recovering from a recent respiratory infection which was improving on abx.
Allergies:
Diagnostic Lab Data: Barium enema revealed intussusception. Labs and Diagnostics: KUB showed distended loop of small bowel, Upper GI WNL, Barium enema (+) for IS. CBC with WBCs 22.2, RBC 4.97, Hct 39.4
CDC 'Split Type':

Write-up: Patient received immunization 2/22/08. On 3/3/88 patient developed vomiting and diarrhea. Admitted to the hospital 3/5/08. Barium enema revealed intussusception. Unable to reduce in radiology, taken to the operating room for surgical laparoscopic reduction. 04/07/2008 MR received for DOS 3/5-7/2008 with D/C DX: Intussusception. Laparoscopic reduction of Intussusception. Infant presented to hospital with bilious vomiting and one bout of hematochezia, decreased activity and very sleepy. Pt was recovering from a recent respiratory infection which was improving on abx. PE(+) for palpable bowel loop in RLQ, (+) abd tenderness, mild to moderately dehydrated and fussy. Intussusception seen on Barium Enema but unable to reduce. Taken to OR for a Laparoscopic reduction of IS. A small serosal tear was identified on the terminal ileum. Tolerated surgery well and d/c on POD #2.


Changed on 4/13/2011

VAERS ID: 306668 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:New Mexico
Vaccinated:2008-02-22
Onset:2008-03-03
Submitted:2008-03-07
Entered:2008-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR C2760AA / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0197F / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER A0125 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54015C / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1665U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal tenderness, Barium enema, Barium enema abnormal, Decreased activity, Dehydration, Diarrhoea, Full blood count, Haematochezia, Haematocrit increased, Intussusception, Irritability, Laparoscopy, Red blood cell count increased, Small intestinal intussusception reduction, Somnolence, Urinary system X-ray, Vomiting, White blood cell count increased, X-ray with contrast upper gastrointestinal tract

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none. Pt was recovering from a recent respiratory infection which was improving on abx.
Allergies:
Diagnostic Lab Data: Barium enema revealed intussusception. Labs and Diagnostics: KUB showed distended loop of small bowel, Upper GI WNL, Barium enema (+) for IS. CBC with WBCs 22.2, RBC 4.97, Hct 39.4
CDC 'Split Type':

Write-up: Patient received immunization 2/22/08. On 3/3/88 patient developed vomiting and diarrhea. Admitted to the hospital 3/5/08. Barium enema revealed intussusception. Unable to reduce in radiology, taken to the operating room for surgical laparoscopic reduction. 04/07/2008 MR received for DOS 3/5-7/2008 with D/C DX: Intussusception. Laparoscopic reduction of Intussusception. Infant presented to hospital with bilious vomiting and one bout of hematochezia, decreased activity and very sleepy. Pt was recovering from a recent respiratory infection which was improving on abx. PE(+) for palpable bowel loop in RLQ, (+) abd tenderness, mild to moderately dehydrated and fussy. Intussusception seen on Barium Enema but unable to reduce. Taken to OR for a Laparoscopic reduction of IS. A small serosal tear was identified on the terminal ileum. Tolerated surgery well and d/c on POD #2.


Changed on 5/13/2011

VAERS ID: 306668 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:New Mexico
Vaccinated:2008-02-22
Onset:2008-03-03
Submitted:2008-03-07
Entered:2008-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR C2760AA / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0197F / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER A0125 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54015C / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1665U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal tenderness, Barium enema, Barium enema abnormal, Decreased activity, Dehydration, Diarrhoea, Full blood count, Haematochezia, Haematocrit increased, Intussusception, Irritability, Laparoscopy, Red blood cell count increased, Small intestinal intussusception reduction, Somnolence, Urinary system X-ray, Vomiting, White blood cell count increased, X-ray with contrast upper gastrointestinal tract

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none. Pt was recovering from a recent respiratory infection which was improving on abx.
Allergies:
Diagnostic Lab Data: Barium enema revealed intussusception. Labs and Diagnostics: KUB showed distended loop of small bowel, Upper GI WNL, Barium enema (+) for IS. CBC with WBCs 22.2, RBC 4.97, Hct 39.4
CDC 'Split Type':

Write-up: Patient received immunization 2/22/08. On 3/3/88 patient developed vomiting and diarrhea. Admitted to the hospital 3/5/08. Barium enema revealed intussusception. Unable to reduce in radiology, taken to the operating room for surgical laparoscopic reduction. 04/07/2008 MR received for DOS 3/5-7/2008 with D/C DX: Intussusception. Laparoscopic reduction of Intussusception. Infant presented to hospital with bilious vomiting and one bout of hematochezia, decreased activity and very sleepy. Pt was recovering from a recent respiratory infection which was improving on abx. PE(+) for palpable bowel loop in RLQ, (+) abd tenderness, mild to moderately dehydrated and fussy. Intussusception seen on Barium Enema but unable to reduce. Taken to OR for a Laparoscopic reduction of IS. A small serosal tear was identified on the terminal ileum. Tolerated surgery well and d/c on POD #2.


Changed on 6/11/2011

VAERS ID: 306668 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:New Mexico
Vaccinated:2008-02-22
Onset:2008-03-03
Submitted:2008-03-07
Entered:2008-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR C2760AA / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0197F / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER A0125 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54015C / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1665U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal tenderness, Barium enema, Barium enema abnormal, Decreased activity, Dehydration, Diarrhoea, Full blood count, Haematochezia, Haematocrit increased, Intussusception, Irritability, Laparoscopy, Red blood cell count increased, Small intestinal intussusception reduction, Somnolence, Urinary system X-ray, Vomiting, White blood cell count increased, X-ray with contrast upper gastrointestinal tract

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none. Pt was recovering from a recent respiratory infection which was improving on abx.
Allergies:
Diagnostic Lab Data: Barium enema revealed intussusception. Labs and Diagnostics: KUB showed distended loop of small bowel, Upper GI WNL, Barium enema (+) for IS. CBC with WBCs 22.2, RBC 4.97, Hct 39.4
CDC 'Split Type':

Write-up: Patient received immunization 2/22/08. On 3/3/88 patient developed vomiting and diarrhea. Admitted to the hospital 3/5/08. Barium enema revealed intussusception. Unable to reduce in radiology, taken to the operating room for surgical laparoscopic reduction. 04/07/2008 MR received for DOS 3/5-7/2008 with D/C DX: Intussusception. Laparoscopic reduction of Intussusception. Infant presented to hospital with bilious vomiting and one bout of hematochezia, decreased activity and very sleepy. Pt was recovering from a recent respiratory infection which was improving on abx. PE(+) for palpable bowel loop in RLQ, (+) abd tenderness, mild to moderately dehydrated and fussy. Intussusception seen on Barium Enema but unable to reduce. Taken to OR for a Laparoscopic reduction of IS. A small serosal tear was identified on the terminal ileum. Tolerated surgery well and d/c on POD #2.


Changed on 5/13/2013

VAERS ID: 306668 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:New Mexico
Vaccinated:2008-02-22
Onset:2008-03-03
Submitted:2008-03-07
Entered:2008-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR C2760AA / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0197F / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER A0125 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54015C / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1665U / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1665U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal tenderness, Barium enema, Barium enema abnormal, Decreased activity, Dehydration, Diarrhoea, Full blood count, Haematochezia, Haematocrit increased, Intussusception, Irritability, Laparoscopy, Red blood cell count increased, Small intestinal intussusception reduction, Somnolence, Urinary system X-ray, Vomiting, White blood cell count increased, X-ray with contrast upper gastrointestinal tract

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none. Pt was recovering from a recent respiratory infection which was improving on abx.
Allergies:
Diagnostic Lab Data: Barium enema revealed intussusception. Labs and Diagnostics: KUB showed distended loop of small bowel, Upper GI WNL, Barium enema (+) for IS. CBC with WBCs 22.2, RBC 4.97, Hct 39.4
CDC 'Split Type':

Write-up: Patient received immunization 2/22/08. On 3/3/88 patient developed vomiting and diarrhea. Admitted to the hospital 3/5/08. Barium enema revealed intussusception. Unable to reduce in radiology, taken to the operating room for surgical laparoscopic reduction. 04/07/2008 MR received for DOS 3/5-7/2008 with D/C DX: Intussusception. Laparoscopic reduction of Intussusception. Infant presented to hospital with bilious vomiting and one bout of hematochezia, decreased activity and very sleepy. Pt was recovering from a recent respiratory infection which was improving on abx. PE(+) for palpable bowel loop in RLQ, (+) abd tenderness, mild to moderately dehydrated and fussy. Intussusception seen on Barium Enema but unable to reduce. Taken to OR for a Laparoscopic reduction of IS. A small serosal tear was identified on the terminal ileum. Tolerated surgery well and d/c on POD #2.


Changed on 6/14/2014

VAERS ID: 306668 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:New Mexico
Vaccinated:2008-02-22
Onset:2008-03-03
Submitted:2008-03-07
Entered:2008-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR C2760AA / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0197F / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER A0125 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54015C / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1665U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal tenderness, Barium enema, Barium enema abnormal, Decreased activity, Dehydration, Diarrhoea, Full blood count, Haematochezia, Haematocrit increased, Intussusception, Irritability, Laparoscopy, Red blood cell count increased, Small intestinal intussusception reduction, Somnolence, Urinary system X-ray, Vomiting, White blood cell count increased, X-ray with contrast upper gastrointestinal tract

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none. Pt was recovering from a recent respiratory infection which was improving on abx.
Allergies:
Diagnostic Lab Data: Barium enema revealed intussusception. Labs and Diagnostics: KUB showed distended loop of small bowel, Upper GI WNL, Barium enema (+) for IS. CBC with WBCs 22.2, RBC 4.97, Hct 39.4
CDC 'Split Type':

Write-up: Patient received immunization 2/22/08. On 3/3/88 patient developed vomiting and diarrhea. Admitted to the hospital 3/5/08. Barium enema revealed intussusception. Unable to reduce in radiology, taken to the operating room for surgical laparoscopic reduction. 04/07/2008 MR received for DOS 3/5-7/2008 with D/C DX: Intussusception. Laparoscopic reduction of Intussusception. Infant presented to hospital with bilious vomiting and one bout of hematochezia, decreased activity and very sleepy. Pt was recovering from a recent respiratory infection which was improving on abx. PE(+) for palpable bowel loop in RLQ, (+) abd tenderness, mild to moderately dehydrated and fussy. Intussusception seen on Barium Enema but unable to reduce. Taken to OR for a Laparoscopic reduction of IS. A small serosal tear was identified on the terminal ileum. Tolerated surgery well and d/c on POD #2.


Changed on 2/14/2017

VAERS ID: 306668 Before After
VAERS Form:
Age:0.4 0.36
Sex:Male
Location:New Mexico
Vaccinated:2008-02-22
Onset:2008-03-03
Submitted:2008-03-07
Entered:2008-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR C2760AA / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0197F / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER A0125 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54015C / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1665U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal tenderness, Barium enema, Barium enema abnormal, Decreased activity, Dehydration, Diarrhoea, Full blood count, Haematochezia, Haematocrit increased, Intussusception, Irritability, Laparoscopy, Red blood cell count increased, Small intestinal intussusception reduction, Somnolence, Urinary system X-ray, Vomiting, White blood cell count increased, X-ray with contrast upper gastrointestinal tract

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none. Pt was recovering from a recent respiratory infection which was improving on abx.
Allergies:
Diagnostic Lab Data: Barium enema revealed intussusception. Labs and Diagnostics: KUB showed distended loop of small bowel, Upper GI WNL, Barium enema (+) for IS. CBC with WBCs 22.2, RBC 4.97, Hct 39.4
CDC 'Split Type':

Write-up: Patient received immunization 2/22/08. On 3/3/88 patient developed vomiting and diarrhea. Admitted to the hospital 3/5/08. Barium enema revealed intussusception. Unable to reduce in radiology, taken to the operating room for surgical laparoscopic reduction. 04/07/2008 MR received for DOS 3/5-7/2008 with D/C DX: Intussusception. Laparoscopic reduction of Intussusception. Infant presented to hospital with bilious vomiting and one bout of hematochezia, decreased activity and very sleepy. Pt was recovering from a recent respiratory infection which was improving on abx. PE(+) for palpable bowel loop in RLQ, (+) abd tenderness, mild to moderately dehydrated and fussy. Intussusception seen on Barium Enema but unable to reduce. Taken to OR for a Laparoscopic reduction of IS. A small serosal tear was identified on the terminal ileum. Tolerated surgery well and d/c on POD #2.


Changed on 4/14/2017

VAERS ID: 306668 Before After
VAERS Form:
Age:0.36
Sex:Male
Location:New Mexico
Vaccinated:2008-02-22
Onset:2008-03-03
Submitted:2008-03-07
Entered:2008-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR C2760AA / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0197F / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER A0125 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54015C / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1665U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal tenderness, Barium enema, Barium enema abnormal, Decreased activity, Dehydration, Diarrhoea, Full blood count, Haematochezia, Haematocrit increased, Intussusception, Irritability, Laparoscopy, Red blood cell count increased, Small intestinal intussusception reduction, Somnolence, Urinary system X-ray, Vomiting, White blood cell count increased, X-ray with contrast upper gastrointestinal tract

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none. Pt was recovering from a recent respiratory infection which was improving on abx.
Allergies:
Diagnostic Lab Data: Barium enema revealed intussusception. Labs and Diagnostics: KUB showed distended loop of small bowel, Upper GI WNL, Barium enema (+) for IS. CBC with WBCs 22.2, RBC 4.97, Hct 39.4
CDC 'Split Type':

Write-up: Patient received immunization 2/22/08. On 3/3/88 patient developed vomiting and diarrhea. Admitted to the hospital 3/5/08. Barium enema revealed intussusception. Unable to reduce in radiology, taken to the operating room for surgical laparoscopic reduction. 04/07/2008 MR received for DOS 3/5-7/2008 with D/C DX: Intussusception. Laparoscopic reduction of Intussusception. Infant presented to hospital with bilious vomiting and one bout of hematochezia, decreased activity and very sleepy. Pt was recovering from a recent respiratory infection which was improving on abx. PE(+) for palpable bowel loop in RLQ, (+) abd tenderness, mild to moderately dehydrated and fussy. Intussusception seen on Barium Enema but unable to reduce. Taken to OR for a Laparoscopic reduction of IS. A small serosal tear was identified on the terminal ileum. Tolerated surgery well and d/c on POD #2.


Changed on 9/14/2017

VAERS ID: 306668 Before After
VAERS Form:(blank) 1
Age:0.36
Sex:Male
Location:New Mexico
Vaccinated:2008-02-22
Onset:2008-03-03
Submitted:2008-03-07
Entered:2008-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR C2760AA / 1 2 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0197F / 1 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER A0125 / 1 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54015C / 1 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1665U / 1 2 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Barium enema abnormal, Diarrhoea, Intussusception, Laparoscopy, Vomiting

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none. Pt was recovering from a recent respiratory infection which was improving on abx.
Allergies:
Diagnostic Lab Data: Barium enema revealed intussusception. Labs and Diagnostics: KUB showed distended loop of small bowel, Upper GI WNL, Barium enema (+) for IS. CBC with WBCs 22.2, RBC 4.97, Hct 39.4
CDC 'Split Type':

Write-up: Patient received immunization 2/22/08. On 3/3/88 patient developed vomiting and diarrhea. Admitted to the hospital 3/5/08. Barium enema revealed intussusception. Unable to reduce in radiology, taken to the operating room for surgical laparoscopic reduction. 04/07/2008 MR received for DOS 3/5-7/2008 with D/C DX: Intussusception. Laparoscopic reduction of Intussusception. Infant presented to hospital with bilious vomiting and one bout of hematochezia, decreased activity and very sleepy. Pt was recovering from a recent respiratory infection which was improving on abx. PE(+) for palpable bowel loop in RLQ, (+) abd tenderness, mild to moderately dehydrated and fussy. Intussusception seen on Barium Enema but unable to reduce. Taken to OR for a Laparoscopic reduction of IS. A small serosal tear was identified on the terminal ileum. Tolerated surgery well and d/c on POD #2.


Changed on 2/14/2018

VAERS ID: 306668 Before After
VAERS Form:1
Age:0.36
Sex:Male
Location:New Mexico
Vaccinated:2008-02-22
Onset:2008-03-03
Submitted:2008-03-07
Entered:2008-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR C2760AA / 2 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0197F / 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER A0125 / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54015C / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1665U / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Barium enema abnormal, Diarrhoea, Intussusception, Laparoscopy, Vomiting

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none. Pt was recovering from a recent respiratory infection which was improving on abx.
Allergies:
Diagnostic Lab Data: Barium enema revealed intussusception. Labs and Diagnostics: KUB showed distended loop of small bowel, Upper GI WNL, Barium enema (+) for IS. CBC with WBCs 22.2, RBC 4.97, Hct 39.4
CDC 'Split Type':

Write-up: Patient received immunization 2/22/08. On 3/3/88 patient developed vomiting and diarrhea. Admitted to the hospital 3/5/08. Barium enema revealed intussusception. Unable to reduce in radiology, taken to the operating room for surgical laparoscopic reduction. 04/07/2008 MR received for DOS 3/5-7/2008 with D/C DX: Intussusception. Laparoscopic reduction of Intussusception. Infant presented to hospital with bilious vomiting and one bout of hematochezia, decreased activity and very sleepy. Pt was recovering from a recent respiratory infection which was improving on abx. PE(+) for palpable bowel loop in RLQ, (+) abd tenderness, mild to moderately dehydrated and fussy. Intussusception seen on Barium Enema but unable to reduce. Taken to OR for a Laparoscopic reduction of IS. A small serosal tear was identified on the terminal ileum. Tolerated surgery well and d/c on POD #2.


Changed on 6/14/2018

VAERS ID: 306668 Before After
VAERS Form:1
Age:0.36
Sex:Male
Location:New Mexico
Vaccinated:2008-02-22
Onset:2008-03-03
Submitted:2008-03-07
Entered:2008-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR C2760AA / 2 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0197F / 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER A0125 / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54015C / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1665U / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Barium enema abnormal, Diarrhoea, Intussusception, Laparoscopy, Vomiting

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none. Pt was recovering from a recent respiratory infection which was improving on abx.
Allergies:
Diagnostic Lab Data: Barium enema revealed intussusception. Labs and Diagnostics: KUB showed distended loop of small bowel, Upper GI WNL, Barium enema (+) for IS. CBC with WBCs 22.2, RBC 4.97, Hct 39.4
CDC 'Split Type':

Write-up: Patient received immunization 2/22/08. On 3/3/88 patient developed vomiting and diarrhea. Admitted to the hospital 3/5/08. Barium enema revealed intussusception. Unable to reduce in radiology, taken to the operating room for surgical laparoscopic reduction. 04/07/2008 MR received for DOS 3/5-7/2008 with D/C DX: Intussusception. Laparoscopic reduction of Intussusception. Infant presented to hospital with bilious vomiting and one bout of hematochezia, decreased activity and very sleepy. Pt was recovering from a recent respiratory infection which was improving on abx. PE(+) for palpable bowel loop in RLQ, (+) abd tenderness, mild to moderately dehydrated and fussy. Intussusception seen on Barium Enema but unable to reduce. Taken to OR for a Laparoscopic reduction of IS. A small serosal tear was identified on the terminal ileum. Tolerated surgery well and d/c on POD #2.


Changed on 8/14/2018

VAERS ID: 306668 Before After
VAERS Form:1
Age:0.36
Sex:Male
Location:New Mexico
Vaccinated:2008-02-22
Onset:2008-03-03
Submitted:2008-03-07
Entered:2008-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR C2760AA / 2 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0197F / 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER A0125 / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54015C / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1665U / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Barium enema abnormal, Diarrhoea, Intussusception, Laparoscopy, Vomiting

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none. Pt was recovering from a recent respiratory infection which was improving on abx.
Allergies:
Diagnostic Lab Data: Barium enema revealed intussusception. Labs and Diagnostics: KUB showed distended loop of small bowel, Upper GI WNL, Barium enema (+) for IS. CBC with WBCs 22.2, RBC 4.97, Hct 39.4
CDC 'Split Type':

Write-up: Patient received immunization 2/22/08. On 3/3/88 patient developed vomiting and diarrhea. Admitted to the hospital 3/5/08. Barium enema revealed intussusception. Unable to reduce in radiology, taken to the operating room for surgical laparoscopic reduction. 04/07/2008 MR received for DOS 3/5-7/2008 with D/C DX: Intussusception. Laparoscopic reduction of Intussusception. Infant presented to hospital with bilious vomiting and one bout of hematochezia, decreased activity and very sleepy. Pt was recovering from a recent respiratory infection which was improving on abx. PE(+) for palpable bowel loop in RLQ, (+) abd tenderness, mild to moderately dehydrated and fussy. Intussusception seen on Barium Enema but unable to reduce. Taken to OR for a Laparoscopic reduction of IS. A small serosal tear was identified on the terminal ileum. Tolerated surgery well and d/c on POD #2.


Changed on 9/14/2018

VAERS ID: 306668 Before After
VAERS Form:1
Age:0.36
Sex:Male
Location:New Mexico
Vaccinated:2008-02-22
Onset:2008-03-03
Submitted:2008-03-07
Entered:2008-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR C2760AA / 2 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0197F / 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER A0125 / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54015C / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1665U / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Barium enema abnormal, Diarrhoea, Intussusception, Laparoscopy, Vomiting

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none. Pt was recovering from a recent respiratory infection which was improving on abx.
Allergies:
Diagnostic Lab Data: Barium enema revealed intussusception. Labs and Diagnostics: KUB showed distended loop of small bowel, Upper GI WNL, Barium enema (+) for IS. CBC with WBCs 22.2, RBC 4.97, Hct 39.4
CDC 'Split Type':

Write-up: Patient received immunization 2/22/08. On 3/3/88 patient developed vomiting and diarrhea. Admitted to the hospital 3/5/08. Barium enema revealed intussusception. Unable to reduce in radiology, taken to the operating room for surgical laparoscopic reduction. 04/07/2008 MR received for DOS 3/5-7/2008 with D/C DX: Intussusception. Laparoscopic reduction of Intussusception. Infant presented to hospital with bilious vomiting and one bout of hematochezia, decreased activity and very sleepy. Pt was recovering from a recent respiratory infection which was improving on abx. PE(+) for palpable bowel loop in RLQ, (+) abd tenderness, mild to moderately dehydrated and fussy. Intussusception seen on Barium Enema but unable to reduce. Taken to OR for a Laparoscopic reduction of IS. A small serosal tear was identified on the terminal ileum. Tolerated surgery well and d/c on POD #2.


Changed on 10/14/2018

VAERS ID: 306668 Before After
VAERS Form:1
Age:0.36
Sex:Male
Location:New Mexico
Vaccinated:2008-02-22
Onset:2008-03-03
Submitted:2008-03-07
Entered:2008-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR C2760AA / 2 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0197F / 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER A0125 / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54015C / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1665U / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Barium enema abnormal, Diarrhoea, Intussusception, Laparoscopy, Vomiting

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none. Pt was recovering from a recent respiratory infection which was improving on abx.
Allergies:
Diagnostic Lab Data: Barium enema revealed intussusception. Labs and Diagnostics: KUB showed distended loop of small bowel, Upper GI WNL, Barium enema (+) for IS. CBC with WBCs 22.2, RBC 4.97, Hct 39.4
CDC 'Split Type':

Write-up: Patient received immunization 2/22/08. On 3/3/88 patient developed vomiting and diarrhea. Admitted to the hospital 3/5/08. Barium enema revealed intussusception. Unable to reduce in radiology, taken to the operating room for surgical laparoscopic reduction. 04/07/2008 MR received for DOS 3/5-7/2008 with D/C DX: Intussusception. Laparoscopic reduction of Intussusception. Infant presented to hospital with bilious vomiting and one bout of hematochezia, decreased activity and very sleepy. Pt was recovering from a recent respiratory infection which was improving on abx. PE(+) for palpable bowel loop in RLQ, (+) abd tenderness, mild to moderately dehydrated and fussy. Intussusception seen on Barium Enema but unable to reduce. Taken to OR for a Laparoscopic reduction of IS. A small serosal tear was identified on the terminal ileum. Tolerated surgery well and d/c on POD #2.

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