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This is VAERS ID 306766

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 306766
VAERS Form:
Age:0.5
Sex:Male
Location:New York
Vaccinated:2008-03-04
Onset:2008-03-06
Submitted:2008-03-10
Entered:2008-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 2 UN / UN
FLU: INFLUENZA (FLUZONE) / SANOFI PASTEUR - / 0 UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR - / 2 UN / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC - / - UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 2 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Crying, Haematochezia, Intussusception, Irritability, Enema administration

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Irritability
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: x-ray consistent w/intussusception. Air enema 5/6/08-records received- Air enema reduction unsusscessful. KUB possible intussusception. Stool guaic positive.
CDC 'Split Type':

Write-up: Intussusception-melena, pain, crankiness and current jelly stool s/p Air enema x2 which failed and required surgical reduction. 5/6/08-records received for DOS 3/6-3/8/08-DC DX: Intussusception. Presented with projectile vomiting since 3/5/08-bloody stool"s followed that same evening. Well until evening prior to 6 month check up when he was crying an abnormal amount and fever 102.8 2 nights after vaccines. Oral intake decreased.Surgical laparotomy with reduction of intussusception.


Changed on 12/8/2009

VAERS ID: 306766 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:New York
Vaccinated:2008-03-04
Onset:2008-03-06
Submitted:2008-03-10
Entered:2008-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 2 UN / UN
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 2 UN / UN
FLU: INFLUENZA (FLUZONE) INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR - / 0 UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR - / 2 UN / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC - / - UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 2 - / PO

Administered by: Private      Purchased by: Unknown Other
Symptoms: Crying, Haematochezia, Intussusception, Irritability, Laparotomy, Melaena, Pain, Pyrexia, Surgery, Vomiting projectile, X-ray abnormal, Enema administration, Occult blood positive, Oral intake reduced

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: Irritability
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: x-ray consistent w/intussusception. Air enema 5/6/08-records received- Air enema reduction unsusscessful. KUB possible intussusception. Stool guaic positive.
CDC 'Split Type':

Write-up: Intussusception-melena, pain, crankiness and current jelly stool s/p Air enema x2 which failed and required surgical reduction. 5/6/08-records received for DOS 3/6-3/8/08-DC DX: Intussusception. Presented with projectile vomiting since 3/5/08-bloody stool"s stools followed that same evening. Well until evening prior to 6 month check up when he was crying an abnormal amount and fever 102.8 2 nights after vaccines. Oral intake decreased.Surgical laparotomy with reduction of intussusception.


Changed on 3/2/2010

VAERS ID: 306766 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:New York
Vaccinated:2008-03-04
Onset:2008-03-06
Submitted:2008-03-10
Entered:2008-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 2 UN / UN
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR - / 0 UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR - / 2 UN / UN
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC - / - UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 2 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Crying, Haematochezia, Intussusception, Irritability, Laparotomy, Melaena, Pain, Pyrexia, Surgery, Vomiting projectile, X-ray abnormal, Enema administration, Occult blood positive, Oral intake reduced

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: Irritability
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: x-ray consistent w/intussusception. Air enema 5/6/08-records received- Air enema reduction unsusscessful. KUB possible intussusception. Stool guaic positive.
CDC 'Split Type':

Write-up: Intussusception-melena, pain, crankiness and current jelly stool s/p Air enema x2 which failed and required surgical reduction. 5/6/08-records received for DOS 3/6-3/8/08-DC DX: Intussusception. Presented with projectile vomiting since 3/5/08-bloody stools followed that same evening. Well until evening prior to 6 month check up when he was crying an abnormal amount and fever 102.8 2 nights after vaccines. Oral intake decreased.Surgical laparotomy with reduction of intussusception.


Changed on 4/7/2010

VAERS ID: 306766 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:New York
Vaccinated:2008-03-04
Onset:2008-03-06
Submitted:2008-03-10
Entered:2008-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 2 UN / UN
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR - / 0 UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR - / 2 UN / UN
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC - / - UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 2 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Crying, Haematochezia, Intussusception, Irritability, Laparotomy, Melaena, Pain, Pyrexia, Surgery, Vomiting projectile, X-ray abnormal, Enema administration, Occult blood positive, Oral intake reduced

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: Irritability
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: x-ray consistent w/intussusception. Air enema 5/6/08-records received- Air enema reduction unsusscessful. KUB possible intussusception. Stool guaic positive.
CDC 'Split Type':

Write-up: Intussusception-melena, pain, crankiness and current jelly stool s/p Air enema x2 which failed and required surgical reduction. 5/6/08-records received for DOS 3/6-3/8/08-DC DX: Intussusception. Presented with projectile vomiting since 3/5/08-bloody stools followed that same evening. Well until evening prior to 6 month check up when he was crying an abnormal amount and fever 102.8 2 nights after vaccines. Oral intake decreased.Surgical laparotomy with reduction of intussusception.


Changed on 8/31/2010

VAERS ID: 306766 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:New York
Vaccinated:2008-03-04
Onset:2008-03-06
Submitted:2008-03-10
Entered:2008-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 2 UN / UN
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR - / 0 UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR - / 2 UN / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH - / - UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 2 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Crying, Haematochezia, Intussusception, Irritability, Laparotomy, Melaena, Pain, Pyrexia, Surgery, Vomiting projectile, X-ray abnormal, Enema administration, Occult blood positive, Oral intake reduced

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: Irritability
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: x-ray consistent w/intussusception. Air enema 5/6/08-records received- Air enema reduction unsusscessful. KUB possible intussusception. Stool guaic positive.
CDC 'Split Type':

Write-up: Intussusception-melena, pain, crankiness and current jelly stool s/p Air enema x2 which failed and required surgical reduction. 5/6/08-records received for DOS 3/6-3/8/08-DC DX: Intussusception. Presented with projectile vomiting since 3/5/08-bloody stools followed that same evening. Well until evening prior to 6 month check up when he was crying an abnormal amount and fever 102.8 2 nights after vaccines. Oral intake decreased.Surgical laparotomy with reduction of intussusception.


Changed on 5/13/2013

VAERS ID: 306766 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:New York
Vaccinated:2008-03-04
Onset:2008-03-06
Submitted:2008-03-10
Entered:2008-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 2 UN / UN
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR - / 0 UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR - / 2 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / - UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 2 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 2 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Crying, Haematochezia, Intussusception, Irritability, Laparotomy, Melaena, Pain, Pyrexia, Surgery, Vomiting projectile, X-ray abnormal, Enema administration, Occult blood positive, Oral intake reduced

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: Irritability
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: x-ray consistent w/intussusception. Air enema 5/6/08-records received- Air enema reduction unsusscessful. KUB possible intussusception. Stool guaic positive.
CDC 'Split Type':

Write-up: Intussusception-melena, pain, crankiness and current jelly stool s/p Air enema x2 which failed and required surgical reduction. 5/6/08-records received for DOS 3/6-3/8/08-DC DX: Intussusception. Presented with projectile vomiting since 3/5/08-bloody stools followed that same evening. Well until evening prior to 6 month check up when he was crying an abnormal amount and fever 102.8 2 nights after vaccines. Oral intake decreased.Surgical laparotomy with reduction of intussusception.


Changed on 7/7/2013

VAERS ID: 306766 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:New York
Vaccinated:2008-03-04
Onset:2008-03-06
Submitted:2008-03-10
Entered:2008-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 2 UN / UN
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR - / 0 UN / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR - / 0 UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR - / 2 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / - UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 2 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Crying, Haematochezia, Intussusception, Irritability, Laparotomy, Melaena, Pain, Pyrexia, Surgery, Vomiting projectile, X-ray abnormal, Enema administration, Occult blood positive, Oral intake reduced

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: Irritability
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: x-ray consistent w/intussusception. Air enema 5/6/08-records received- Air enema reduction unsusscessful. KUB possible intussusception. Stool guaic positive.
CDC 'Split Type':

Write-up: Intussusception-melena, pain, crankiness and current jelly stool s/p Air enema x2 which failed and required surgical reduction. 5/6/08-records received for DOS 3/6-3/8/08-DC DX: Intussusception. Presented with projectile vomiting since 3/5/08-bloody stools followed that same evening. Well until evening prior to 6 month check up when he was crying an abnormal amount and fever 102.8 2 nights after vaccines. Oral intake decreased.Surgical laparotomy with reduction of intussusception.


Changed on 4/14/2017

VAERS ID: 306766 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:New York
Vaccinated:2008-03-04
Onset:2008-03-06
Submitted:2008-03-10
Entered:2008-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 2 UN / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR - / 0 UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR - / 2 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / - UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 2 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Crying, Haematochezia, Intussusception, Irritability, Laparotomy, Melaena, Pain, Pyrexia, Surgery, Vomiting projectile, X-ray abnormal, Enema administration, Occult blood positive, Oral intake reduced

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: Irritability
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: x-ray consistent w/intussusception. Air enema 5/6/08-records received- Air enema reduction unsusscessful. KUB possible intussusception. Stool guaic positive.
CDC 'Split Type':

Write-up: Intussusception-melena, pain, crankiness and current jelly stool s/p Air enema x2 which failed and required surgical reduction. 5/6/08-records received for DOS 3/6-3/8/08-DC DX: Intussusception. Presented with projectile vomiting since 3/5/08-bloody stools followed that same evening. Well until evening prior to 6 month check up when he was crying an abnormal amount and fever 102.8 2 nights after vaccines. Oral intake decreased.Surgical laparotomy with reduction of intussusception.


Changed on 9/14/2017

VAERS ID: 306766 Before After
VAERS Form:(blank) 1
Age:0.5
Sex:Male
Location:New York
Vaccinated:2008-03-04
Onset:2008-03-06
Submitted:2008-03-10
Entered:2008-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 2 3 UN / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR - / 0 1 UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR - / 2 3 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / - UNK UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 2 3 - MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Intussusception, Irritability, Melaena, Pain, Surgery, X-ray abnormal, Enema administration

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Irritability
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: x-ray consistent w/intussusception. Air enema 5/6/08-records received- Air enema reduction unsusscessful. KUB possible intussusception. Stool guaic positive.
CDC 'Split Type':

Write-up: Intussusception-melena, pain, crankiness and current jelly stool s/p Air enema x2 which failed and required surgical reduction. 5/6/08-records received for DOS 3/6-3/8/08-DC DX: Intussusception. Presented with projectile vomiting since 3/5/08-bloody stools followed that same evening. Well until evening prior to 6 month check up when he was crying an abnormal amount and fever 102.8 2 nights after vaccines. Oral intake decreased.Surgical laparotomy with reduction of intussusception.


Changed on 2/14/2018

VAERS ID: 306766 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:New York
Vaccinated:2008-03-04
Onset:2008-03-06
Submitted:2008-03-10
Entered:2008-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 3 UN / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR - / 1 UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR - / 3 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 3 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Intussusception, Irritability, Melaena, Pain, Surgery, X-ray abnormal, Enema administration

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Irritability
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: x-ray consistent w/intussusception. Air enema 5/6/08-records received- Air enema reduction unsusscessful. KUB possible intussusception. Stool guaic positive.
CDC 'Split Type':

Write-up: Intussusception-melena, pain, crankiness and current jelly stool s/p Air enema x2 which failed and required surgical reduction. 5/6/08-records received for DOS 3/6-3/8/08-DC DX: Intussusception. Presented with projectile vomiting since 3/5/08-bloody stools followed that same evening. Well until evening prior to 6 month check up when he was crying an abnormal amount and fever 102.8 2 nights after vaccines. Oral intake decreased.Surgical laparotomy with reduction of intussusception.


Changed on 6/14/2018

VAERS ID: 306766 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:New York
Vaccinated:2008-03-04
Onset:2008-03-06
Submitted:2008-03-10
Entered:2008-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 3 UN / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR - / 1 UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR - / 3 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 3 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Intussusception, Irritability, Melaena, Pain, Surgery, X-ray abnormal, Enema administration

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Irritability
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: x-ray consistent w/intussusception. Air enema 5/6/08-records received- Air enema reduction unsusscessful. KUB possible intussusception. Stool guaic positive.
CDC 'Split Type':

Write-up: Intussusception-melena, pain, crankiness and current jelly stool s/p Air enema x2 which failed and required surgical reduction. 5/6/08-records received for DOS 3/6-3/8/08-DC DX: Intussusception. Presented with projectile vomiting since 3/5/08-bloody stools followed that same evening. Well until evening prior to 6 month check up when he was crying an abnormal amount and fever 102.8 2 nights after vaccines. Oral intake decreased.Surgical laparotomy with reduction of intussusception.


Changed on 8/14/2018

VAERS ID: 306766 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:New York
Vaccinated:2008-03-04
Onset:2008-03-06
Submitted:2008-03-10
Entered:2008-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 3 UN / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR - / 1 UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR - / 3 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 3 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Intussusception, Irritability, Melaena, Pain, Surgery, X-ray abnormal, Enema administration

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Irritability
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: x-ray consistent w/intussusception. Air enema 5/6/08-records received- Air enema reduction unsusscessful. KUB possible intussusception. Stool guaic positive.
CDC 'Split Type':

Write-up: Intussusception-melena, pain, crankiness and current jelly stool s/p Air enema x2 which failed and required surgical reduction. 5/6/08-records received for DOS 3/6-3/8/08-DC DX: Intussusception. Presented with projectile vomiting since 3/5/08-bloody stools followed that same evening. Well until evening prior to 6 month check up when he was crying an abnormal amount and fever 102.8 2 nights after vaccines. Oral intake decreased.Surgical laparotomy with reduction of intussusception.


Changed on 9/14/2018

VAERS ID: 306766 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:New York
Vaccinated:2008-03-04
Onset:2008-03-06
Submitted:2008-03-10
Entered:2008-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 3 UN / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR - / 1 UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR - / 3 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 3 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Intussusception, Irritability, Melaena, Pain, Surgery, X-ray abnormal, Enema administration

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Irritability
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: x-ray consistent w/intussusception. Air enema 5/6/08-records received- Air enema reduction unsusscessful. KUB possible intussusception. Stool guaic positive.
CDC 'Split Type':

Write-up: Intussusception-melena, pain, crankiness and current jelly stool s/p Air enema x2 which failed and required surgical reduction. 5/6/08-records received for DOS 3/6-3/8/08-DC DX: Intussusception. Presented with projectile vomiting since 3/5/08-bloody stools followed that same evening. Well until evening prior to 6 month check up when he was crying an abnormal amount and fever 102.8 2 nights after vaccines. Oral intake decreased.Surgical laparotomy with reduction of intussusception.


Changed on 10/14/2018

VAERS ID: 306766 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:New York
Vaccinated:2008-03-04
Onset:2008-03-06
Submitted:2008-03-10
Entered:2008-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 3 UN / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR - / 1 UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR - / 3 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 3 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Intussusception, Irritability, Melaena, Pain, Surgery, X-ray abnormal, Enema administration

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Irritability
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: x-ray consistent w/intussusception. Air enema 5/6/08-records received- Air enema reduction unsusscessful. KUB possible intussusception. Stool guaic positive.
CDC 'Split Type':

Write-up: Intussusception-melena, pain, crankiness and current jelly stool s/p Air enema x2 which failed and required surgical reduction. 5/6/08-records received for DOS 3/6-3/8/08-DC DX: Intussusception. Presented with projectile vomiting since 3/5/08-bloody stools followed that same evening. Well until evening prior to 6 month check up when he was crying an abnormal amount and fever 102.8 2 nights after vaccines. Oral intake decreased.Surgical laparotomy with reduction of intussusception.

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