National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 306670

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 306670
VAERS Form:
Age:0.3
Sex:Male
Location:Indiana
Vaccinated:2007-12-20
Onset:2008-03-01
Submitted:2008-03-07
Entered:2008-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B12SCB / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0072U / 1 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B54015D / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1244U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Appendicectomy, Barium double contrast, Computerised tomogram abnormal, Constipation

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: no
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: labs and Diagnostics: Air contrast enema (+) for Ileocolic IS in the transverse colon. CT (+) for IS
CDC 'Split Type':

Write-up: intussusception requiring surgical reduction occurred 3/1/08. 03/14/2008 MR received for DOS 3/01-04/2008 with D/C DX: S/P Exploratory Laparotomy. Reduction of Intussusception. Appendectomy. Infant presented to local hospital with abdominal pain, vom"iting and bloody stools. Recent URI. Intussusception noted on abdominal CT and pt transfered to current facility for tx. Air enema unsuccessful at reduction and pt to OR for Ex Lap and reduction of IS. pt experience post-op fevers. Taking po on POD#2 an


Changed on 12/8/2009

VAERS ID: 306670 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Indiana
Vaccinated:2007-12-20
Onset:2008-03-01
Submitted:2008-03-07
Entered:2008-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B12SCB / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0072U / 1 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B54015D / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1244U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Appendicectomy, Barium double contrast, Computerised tomogram abnormal, Constipation, Haematochezia, Intussusception, Irritability, Large intestinal obstruction reduction, Pyrexia, Surgery, Vomiting, Enema administration, Explorative laparotomy

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: no
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: labs and Diagnostics: Air contrast enema (+) for Ileocolic IS in the transverse colon. CT (+) for IS
CDC 'Split Type':

Write-up: intussusception requiring surgical reduction occurred 3/1/08. 03/14/2008 MR received for DOS 3/01-04/2008 with D/C DX: S/P Exploratory Laparotomy. Reduction of Intussusception. Appendectomy. Infant presented to local hospital with abdominal pain, vom"iting vomiting and bloody stools. Recent URI. Intussusception noted on abdominal CT and pt transfered to current facility for tx. Air enema unsuccessful at reduction and pt to OR for Ex Lap and reduction of IS. pt experience post-op fevers. Taking po on POD#2 an and D/C home on POD#3. Seen again in ER 3/5/08 after no BM and fussiness. Glycerine supp given for constipation.


Changed on 3/2/2010

VAERS ID: 306670 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Indiana
Vaccinated:2007-12-20
Onset:2008-03-01
Submitted:2008-03-07
Entered:2008-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B12SCB / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0072U / 1 RL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B54015D / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1244U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Appendicectomy, Barium double contrast, Computerised tomogram abnormal, Constipation, Haematochezia, Intussusception, Irritability, Large intestinal obstruction reduction, Pyrexia, Surgery, Vomiting, Enema administration, Explorative laparotomy

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: no
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: labs and Diagnostics: Air contrast enema (+) for Ileocolic IS in the transverse colon. CT (+) for IS
CDC 'Split Type':

Write-up: intussusception requiring surgical reduction occurred 3/1/08. 03/14/2008 MR received for DOS 3/01-04/2008 with D/C DX: S/P Exploratory Laparotomy. Reduction of Intussusception. Appendectomy. Infant presented to local hospital with abdominal pain, vomiting and bloody stools. Recent URI. Intussusception noted on abdominal CT and pt transfered to current facility for tx. Air enema unsuccessful at reduction and pt to OR for Ex Lap and reduction of IS. pt experience post-op fevers. Taking po on POD#2 and D/C home on POD#3. Seen again in ER 3/5/08 after no BM and fussiness. Glycerine supp given for constipation.


Changed on 4/7/2010

VAERS ID: 306670 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Indiana
Vaccinated:2007-12-20
Onset:2008-03-01
Submitted:2008-03-07
Entered:2008-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B12SCB / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0072U / 1 RL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B54015D / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1244U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Appendicectomy, Barium double contrast, Computerised tomogram abnormal, Constipation, Haematochezia, Intussusception, Irritability, Large intestinal obstruction reduction, Pyrexia, Surgery, Vomiting, Enema administration, Explorative laparotomy

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: no
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: labs and Diagnostics: Air contrast enema (+) for Ileocolic IS in the transverse colon. CT (+) for IS
CDC 'Split Type':

Write-up: intussusception requiring surgical reduction occurred 3/1/08. 03/14/2008 MR received for DOS 3/01-04/2008 with D/C DX: S/P Exploratory Laparotomy. Reduction of Intussusception. Appendectomy. Infant presented to local hospital with abdominal pain, vomiting and bloody stools. Recent URI. Intussusception noted on abdominal CT and pt transfered to current facility for tx. Air enema unsuccessful at reduction and pt to OR for Ex Lap and reduction of IS. pt experience post-op fevers. Taking po on POD#2 and D/C home on POD#3. Seen again in ER 3/5/08 after no BM and fussiness. Glycerine supp given for constipation.


Changed on 8/31/2010

VAERS ID: 306670 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Indiana
Vaccinated:2007-12-20
Onset:2008-03-01
Submitted:2008-03-07
Entered:2008-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B12SCB / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0072U / 1 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B54015D / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1244U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Appendicectomy, Barium double contrast, Computerised tomogram abnormal, Constipation, Haematochezia, Intussusception, Irritability, Large intestinal obstruction reduction, Pyrexia, Surgery, Vomiting, Enema administration, Explorative laparotomy

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: no
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: labs and Diagnostics: Air contrast enema (+) for Ileocolic IS in the transverse colon. CT (+) for IS
CDC 'Split Type':

Write-up: intussusception requiring surgical reduction occurred 3/1/08. 03/14/2008 MR received for DOS 3/01-04/2008 with D/C DX: S/P Exploratory Laparotomy. Reduction of Intussusception. Appendectomy. Infant presented to local hospital with abdominal pain, vomiting and bloody stools. Recent URI. Intussusception noted on abdominal CT and pt transfered to current facility for tx. Air enema unsuccessful at reduction and pt to OR for Ex Lap and reduction of IS. pt experience post-op fevers. Taking po on POD#2 and D/C home on POD#3. Seen again in ER 3/5/08 after no BM and fussiness. Glycerine supp given for constipation.


Changed on 6/13/2012

VAERS ID: 306670 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Indiana
Vaccinated:2007-12-20
Onset:2008-03-01
Submitted:2008-03-07
Entered:2008-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B12SCB / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0072U / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54015D / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1244U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Appendicectomy, Barium double contrast, Computerised tomogram abnormal, Constipation, Haematochezia, Intussusception, Irritability, Large intestinal obstruction reduction, Pyrexia, Surgery, Vomiting, Enema administration, Explorative laparotomy

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: no
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: labs Labs and Diagnostics: Air contrast enema (+) for Ileocolic IS in the transverse colon. CT (+) for IS IS.
CDC 'Split Type':

Write-up: intussusception Intussusception requiring surgical reduction occurred 3/1/08. 03/14/2008 MR received for DOS 3/01-04/2008 with D/C DX: S/P Exploratory Laparotomy. Reduction of Intussusception. Appendectomy. Infant presented to local hospital with abdominal pain, vomiting and bloody stools. Recent URI. Intussusception noted on abdominal CT and pt transfered to current facility for tx. Air enema unsuccessful at reduction and pt to OR for Ex Lap and reduction of IS. pt experience post-op fevers. Taking po on POD#2 and D/C home on POD#3. Seen again in ER 3/5/08 after no BM and fussiness. Glycerine supp given for constipation.


Changed on 5/13/2013

VAERS ID: 306670 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Indiana
Vaccinated:2007-12-20
Onset:2008-03-01
Submitted:2008-03-07
Entered:2008-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B12SCB / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0072U / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54015D / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1244U / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1244U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Appendicectomy, Barium double contrast, Computerised tomogram abnormal, Constipation, Haematochezia, Intussusception, Irritability, Large intestinal obstruction reduction, Pyrexia, Surgery, Vomiting, Enema administration, Explorative laparotomy

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: no
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Air contrast enema (+) for Ileocolic IS in the transverse colon. CT (+) for IS.
CDC 'Split Type':

Write-up: Intussusception requiring surgical reduction occurred 3/1/08. 03/14/2008 MR received for DOS 3/01-04/2008 with D/C DX: S/P Exploratory Laparotomy. Reduction of Intussusception. Appendectomy. Infant presented to local hospital with abdominal pain, vomiting and bloody stools. Recent URI. Intussusception noted on abdominal CT and pt transfered to current facility for tx. Air enema unsuccessful at reduction and pt to OR for Ex Lap and reduction of IS. pt experience post-op fevers. Taking po on POD#2 and D/C home on POD#3. Seen again in ER 3/5/08 after no BM and fussiness. Glycerine supp given for constipation.


Changed on 6/14/2014

VAERS ID: 306670 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Indiana
Vaccinated:2007-12-20
Onset:2008-03-01
Submitted:2008-03-07
Entered:2008-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B12SCB / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0072U / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54015D / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1244U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Appendicectomy, Barium double contrast, Computerised tomogram abnormal, Constipation, Haematochezia, Intussusception, Irritability, Large intestinal obstruction reduction, Pyrexia, Surgery, Vomiting, Enema administration, Explorative laparotomy

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: no
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Air contrast enema (+) for Ileocolic IS in the transverse colon. CT (+) for IS.
CDC 'Split Type':

Write-up: Intussusception requiring surgical reduction occurred 3/1/08. 03/14/2008 MR received for DOS 3/01-04/2008 with D/C DX: S/P Exploratory Laparotomy. Reduction of Intussusception. Appendectomy. Infant presented to local hospital with abdominal pain, vomiting and bloody stools. Recent URI. Intussusception noted on abdominal CT and pt transfered to current facility for tx. Air enema unsuccessful at reduction and pt to OR for Ex Lap and reduction of IS. pt experience post-op fevers. Taking po on POD#2 and D/C home on POD#3. Seen again in ER 3/5/08 after no BM and fussiness. Glycerine supp given for constipation.


Changed on 2/14/2017

VAERS ID: 306670 Before After
VAERS Form:
Age:0.3 0.33
Sex:Male
Location:Indiana
Vaccinated:2007-12-20
Onset:2008-03-01
Submitted:2008-03-07
Entered:2008-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B12SCB / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0072U / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54015D / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1244U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Appendicectomy, Barium double contrast, Computerised tomogram abnormal, Constipation, Haematochezia, Intussusception, Irritability, Large intestinal obstruction reduction, Pyrexia, Surgery, Vomiting, Enema administration, Explorative laparotomy

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Air contrast enema (+) for Ileocolic IS in the transverse colon. CT (+) for IS.
CDC 'Split Type':

Write-up: Intussusception requiring surgical reduction occurred 3/1/08. 03/14/2008 MR received for DOS 3/01-04/2008 with D/C DX: S/P Exploratory Laparotomy. Reduction of Intussusception. Appendectomy. Infant presented to local hospital with abdominal pain, vomiting and bloody stools. Recent URI. Intussusception noted on abdominal CT and pt transfered to current facility for tx. Air enema unsuccessful at reduction and pt to OR for Ex Lap and reduction of IS. pt experience post-op fevers. Taking po on POD#2 and D/C home on POD#3. Seen again in ER 3/5/08 after no BM and fussiness. Glycerine supp given for constipation.


Changed on 4/14/2017

VAERS ID: 306670 Before After
VAERS Form:
Age:0.33
Sex:Male
Location:Indiana
Vaccinated:2007-12-20
Onset:2008-03-01
Submitted:2008-03-07
Entered:2008-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B12SCB / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0072U / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54015D / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1244U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Appendicectomy, Barium double contrast, Computerised tomogram abnormal, Constipation, Haematochezia, Intussusception, Irritability, Large intestinal obstruction reduction, Pyrexia, Surgery, Vomiting, Enema administration, Explorative laparotomy

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: no
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Air contrast enema (+) for Ileocolic IS in the transverse colon. CT (+) for IS.
CDC 'Split Type':

Write-up: Intussusception requiring surgical reduction occurred 3/1/08. 03/14/2008 MR received for DOS 3/01-04/2008 with D/C DX: S/P Exploratory Laparotomy. Reduction of Intussusception. Appendectomy. Infant presented to local hospital with abdominal pain, vomiting and bloody stools. Recent URI. Intussusception noted on abdominal CT and pt transfered to current facility for tx. Air enema unsuccessful at reduction and pt to OR for Ex Lap and reduction of IS. pt experience post-op fevers. Taking po on POD#2 and D/C home on POD#3. Seen again in ER 3/5/08 after no BM and fussiness. Glycerine supp given for constipation.


Changed on 9/14/2017

VAERS ID: 306670 Before After
VAERS Form:(blank) 1
Age:0.33
Sex:Male
Location:Indiana
Vaccinated:2007-12-20
Onset:2008-03-01
Submitted:2008-03-07
Entered:2008-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B12SCB / 1 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0072U / 1 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54015D / 1 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1244U / 1 2 - MO / PO

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

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: no
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Air contrast enema (+) for Ileocolic IS in the transverse colon. CT (+) for IS.
CDC 'Split Type':

Write-up: Intussusception requiring surgical reduction occurred 3/1/08. 03/14/2008 MR received for DOS 3/01-04/2008 with D/C DX: S/P Exploratory Laparotomy. Reduction of Intussusception. Appendectomy. Infant presented to local hospital with abdominal pain, vomiting and bloody stools. Recent URI. Intussusception noted on abdominal CT and pt transfered to current facility for tx. Air enema unsuccessful at reduction and pt to OR for Ex Lap and reduction of IS. pt experience post-op fevers. Taking po on POD#2 and D/C home on POD#3. Seen again in ER 3/5/08 after no BM and fussiness. Glycerine supp given for constipation.


Changed on 2/14/2018

VAERS ID: 306670 Before After
VAERS Form:1
Age:0.33
Sex:Male
Location:Indiana
Vaccinated:2007-12-20
Onset:2008-03-01
Submitted:2008-03-07
Entered:2008-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B12SCB / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0072U / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54015D / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1244U / 2 MO / PO

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

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: no
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Air contrast enema (+) for Ileocolic IS in the transverse colon. CT (+) for IS.
CDC 'Split Type':

Write-up: Intussusception requiring surgical reduction occurred 3/1/08. 03/14/2008 MR received for DOS 3/01-04/2008 with D/C DX: S/P Exploratory Laparotomy. Reduction of Intussusception. Appendectomy. Infant presented to local hospital with abdominal pain, vomiting and bloody stools. Recent URI. Intussusception noted on abdominal CT and pt transfered to current facility for tx. Air enema unsuccessful at reduction and pt to OR for Ex Lap and reduction of IS. pt experience post-op fevers. Taking po on POD#2 and D/C home on POD#3. Seen again in ER 3/5/08 after no BM and fussiness. Glycerine supp given for constipation.


Changed on 6/14/2018

VAERS ID: 306670 Before After
VAERS Form:1
Age:0.33
Sex:Male
Location:Indiana
Vaccinated:2007-12-20
Onset:2008-03-01
Submitted:2008-03-07
Entered:2008-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B12SCB / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0072U / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54015D / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1244U / 2 MO / PO

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

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: no
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Air contrast enema (+) for Ileocolic IS in the transverse colon. CT (+) for IS.
CDC 'Split Type':

Write-up: Intussusception requiring surgical reduction occurred 3/1/08. 03/14/2008 MR received for DOS 3/01-04/2008 with D/C DX: S/P Exploratory Laparotomy. Reduction of Intussusception. Appendectomy. Infant presented to local hospital with abdominal pain, vomiting and bloody stools. Recent URI. Intussusception noted on abdominal CT and pt transfered to current facility for tx. Air enema unsuccessful at reduction and pt to OR for Ex Lap and reduction of IS. pt experience post-op fevers. Taking po on POD#2 and D/C home on POD#3. Seen again in ER 3/5/08 after no BM and fussiness. Glycerine supp given for constipation.


Changed on 8/14/2018

VAERS ID: 306670 Before After
VAERS Form:1
Age:0.33
Sex:Male
Location:Indiana
Vaccinated:2007-12-20
Onset:2008-03-01
Submitted:2008-03-07
Entered:2008-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B12SCB / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0072U / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54015D / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1244U / 2 MO / PO

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

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: no
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Air contrast enema (+) for Ileocolic IS in the transverse colon. CT (+) for IS.
CDC 'Split Type':

Write-up: Intussusception requiring surgical reduction occurred 3/1/08. 03/14/2008 MR received for DOS 3/01-04/2008 with D/C DX: S/P Exploratory Laparotomy. Reduction of Intussusception. Appendectomy. Infant presented to local hospital with abdominal pain, vomiting and bloody stools. Recent URI. Intussusception noted on abdominal CT and pt transfered to current facility for tx. Air enema unsuccessful at reduction and pt to OR for Ex Lap and reduction of IS. pt experience post-op fevers. Taking po on POD#2 and D/C home on POD#3. Seen again in ER 3/5/08 after no BM and fussiness. Glycerine supp given for constipation.


Changed on 9/14/2018

VAERS ID: 306670 Before After
VAERS Form:1
Age:0.33
Sex:Male
Location:Indiana
Vaccinated:2007-12-20
Onset:2008-03-01
Submitted:2008-03-07
Entered:2008-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B12SCB / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0072U / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54015D / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1244U / 2 MO / PO

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

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: no
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Air contrast enema (+) for Ileocolic IS in the transverse colon. CT (+) for IS.
CDC 'Split Type':

Write-up: Intussusception requiring surgical reduction occurred 3/1/08. 03/14/2008 MR received for DOS 3/01-04/2008 with D/C DX: S/P Exploratory Laparotomy. Reduction of Intussusception. Appendectomy. Infant presented to local hospital with abdominal pain, vomiting and bloody stools. Recent URI. Intussusception noted on abdominal CT and pt transfered to current facility for tx. Air enema unsuccessful at reduction and pt to OR for Ex Lap and reduction of IS. pt experience post-op fevers. Taking po on POD#2 and D/C home on POD#3. Seen again in ER 3/5/08 after no BM and fussiness. Glycerine supp given for constipation.


Changed on 10/14/2018

VAERS ID: 306670 Before After
VAERS Form:1
Age:0.33
Sex:Male
Location:Indiana
Vaccinated:2007-12-20
Onset:2008-03-01
Submitted:2008-03-07
Entered:2008-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B12SCB / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0072U / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54015D / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1244U / 2 MO / PO

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

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: no
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Air contrast enema (+) for Ileocolic IS in the transverse colon. CT (+) for IS.
CDC 'Split Type':

Write-up: Intussusception requiring surgical reduction occurred 3/1/08. 03/14/2008 MR received for DOS 3/01-04/2008 with D/C DX: S/P Exploratory Laparotomy. Reduction of Intussusception. Appendectomy. Infant presented to local hospital with abdominal pain, vomiting and bloody stools. Recent URI. Intussusception noted on abdominal CT and pt transfered to current facility for tx. Air enema unsuccessful at reduction and pt to OR for Ex Lap and reduction of IS. pt experience post-op fevers. Taking po on POD#2 and D/C home on POD#3. Seen again in ER 3/5/08 after no BM and fussiness. Glycerine supp given for constipation.

New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=306670&WAYBACKHISTORY=ON


Copyright © 2020 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166