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This is VAERS ID 311012

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 311012
VAERS Form:
Age:0.1
Sex:Male
Location:Missouri
Vaccinated:2008-04-15
Onset:2008-04-20
Submitted:2008-04-23
Entered:2008-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF333AA / 0 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C63117 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0015X / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Barium enema abnormal, Diet refusal, Hypersomnia, Intussusception, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Upper GI. Labs and Diagnostics: Abd X-ray with abnormal bowel gas pattern. Upper GI/Barium Enema (+) for Ileocolic Intussusception
CDC 'Split Type':

Write-up: Child developed vomiting on 4/20/08 and was evaluated at hospital. An UGI showed intussusception. It was easily reduced with a Hypaque enema. 5/02/2008 MR received for ER visit 4/20/2008 with DX: Intussusception. Infant presented vomiting, refusal to eat", increased sleeping. Bilious green emesis in ER. IS noted on UGI and BE. Successfully reduced.


Changed on 12/8/2009

VAERS ID: 311012 Before After
VAERS Form:
Age:0.1
Sex:Male
Location:Missouri
Vaccinated:2008-04-15
Onset:2008-04-20
Submitted:2008-04-23
Entered:2008-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 0 LL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF333AA / 0 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C63117 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0015X / 0 - / PO

Administered by: Private      Purchased by: Unknown Public
Symptoms: Abdominal mass, Anisocytosis, Appendicectomy, Barium double contrast, Barium enema abnormal, Culture urine positive, Diet refusal, Haematochezia, Haemoglobin decreased, Hypersomnia, Intussusception, Laparotomy, Lymphadenitis, Mean cell haemoglobin, Mean cell volume decreased, Poikilocytosis, Vomiting, X-ray abnormal, X-ray with contrast upper gastrointestinal tract, Enema administration, Ultrasound abdomen abnormal, Red cell distribution width increased, Intestinal resection, Intestinal anastomosis, Urine ketone body present, Decreased appetite

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: 1 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Upper GI. Labs and Diagnostics: Abd X-ray with abnormal bowel gas pattern. Upper GI/Barium Enema (+) for Ileocolic Intussusception Intussusception. LABS and DIAGNOSTICS: CBC - Hgb 10.1 g/dL (L) MCV 69.7 fL (L) MCH 21.3 pg (L) RDW 14.8% (H) BAND 7% (H)
CDC 'Split Type':

Write-up: Child developed vomiting on 4/20/08 and was evaluated at hospital. An UGI showed intussusception. It was easily reduced with a Hypaque enema. 5/02/2008 MR received for ER visit 4/20/2008 with DX: Intussusception. Infant presented vomiting, refusal to eat", eat, increased sleeping. Bilious green emesis in ER. IS noted on UGI and BE. Successfully reduced. 7/31/09 Hospital records received DOS 7/2/09 to 7/9/09. First Admission 7/2/09 to 7/4/09. Assessment: Recurrent intussusception. Patient presented with vomiting. Reduction of intussusception by enema. Second Admission 7/5/09 to 7/9/09. Discharged Diagnosis: Recurrent intussusception status post ileocolic resection and ileotransverse colon renanastomosis. After several previous reductions of intussusception by enema. Patient presented with increased fussiness, gastric emesis, bilious emesis. Decreased appetite. Bloody stool. Palpable epigastric mass. Enema reduction unsuccessful. Exploratory laparotomy with ileocolic resection and ileotransverse colon renanastomosis. Appendectomy. Ileum was quite edematous and lymph nodes in the ileocolic mesentary were massive.


Changed on 3/2/2010

VAERS ID: 311012 Before After
VAERS Form:
Age:0.1
Sex:Male
Location:Missouri
Vaccinated:2008-04-15
Onset:2008-04-20
Submitted:2008-04-23
Entered:2008-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF333AA / 0 RL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC C63117 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0015X / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal mass, Anisocytosis, Appendicectomy, Barium double contrast, Barium enema abnormal, Culture urine positive, Diet refusal, Haematochezia, Haemoglobin decreased, Hypersomnia, Intussusception, Laparotomy, Lymphadenitis, Mean cell haemoglobin, Mean cell volume decreased, Poikilocytosis, Vomiting, X-ray abnormal, X-ray with contrast upper gastrointestinal tract, Enema administration, Ultrasound abdomen abnormal, Red cell distribution width increased, Intestinal resection, Intestinal anastomosis, Urine ketone body present, Decreased appetite

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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Upper GI. Labs and Diagnostics: Abd X-ray with abnormal bowel gas pattern. Upper GI/Barium Enema (+) for Ileocolic Intussusception. LABS and DIAGNOSTICS: CBC - Hgb 10.1 g/dL (L) MCV 69.7 fL (L) MCH 21.3 pg (L) RDW 14.8% (H) BAND 7% (H)
CDC 'Split Type':

Write-up: Child developed vomiting on 4/20/08 and was evaluated at hospital. An UGI showed intussusception. It was easily reduced with a Hypaque enema. 5/02/2008 MR received for ER visit 4/20/2008 with DX: Intussusception. Infant presented vomiting, refusal to eat, increased sleeping. Bilious green emesis in ER. IS noted on UGI and BE. Successfully reduced. 7/31/09 Hospital records received DOS 7/2/09 to 7/9/09. First Admission 7/2/09 to 7/4/09. Assessment: Recurrent intussusception. Patient presented with vomiting. Reduction of intussusception by enema. Second Admission 7/5/09 to 7/9/09. Discharged Diagnosis: Recurrent intussusception status post ileocolic resection and ileotransverse colon renanastomosis. After several previous reductions of intussusception by enema. Patient presented with increased fussiness, gastric emesis, bilious emesis. Decreased appetite. Bloody stool. Palpable epigastric mass. Enema reduction unsuccessful. Exploratory laparotomy with ileocolic resection and ileotransverse colon renanastomosis. Appendectomy. Ileum was quite edematous and lymph nodes in the ileocolic mesentary were massive.


Changed on 4/7/2010

VAERS ID: 311012 Before After
VAERS Form:
Age:0.1
Sex:Male
Location:Missouri
Vaccinated:2008-04-15
Onset:2008-04-20
Submitted:2008-04-23
Entered:2008-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF333AA / 0 RL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C63117 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0015X / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal mass, Anisocytosis, Appendicectomy, Barium double contrast, Barium enema abnormal, Culture urine positive, Diet refusal, Haematochezia, Haemoglobin decreased, Hypersomnia, Intussusception, Laparotomy, Lymphadenitis, Mean cell haemoglobin, Mean cell volume decreased, Poikilocytosis, Vomiting, X-ray abnormal, X-ray with contrast upper gastrointestinal tract, Enema administration, Ultrasound abdomen abnormal, Red cell distribution width increased, Intestinal resection, Intestinal anastomosis, Urine ketone body present, Decreased appetite

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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Upper GI. Labs and Diagnostics: Abd X-ray with abnormal bowel gas pattern. Upper GI/Barium Enema (+) for Ileocolic Intussusception. LABS and DIAGNOSTICS: CBC - Hgb 10.1 g/dL (L) MCV 69.7 fL (L) MCH 21.3 pg (L) RDW 14.8% (H) BAND 7% (H)
CDC 'Split Type':

Write-up: Child developed vomiting on 4/20/08 and was evaluated at hospital. An UGI showed intussusception. It was easily reduced with a Hypaque enema. 5/02/2008 MR received for ER visit 4/20/2008 with DX: Intussusception. Infant presented vomiting, refusal to eat, increased sleeping. Bilious green emesis in ER. IS noted on UGI and BE. Successfully reduced. 7/31/09 Hospital records received DOS 7/2/09 to 7/9/09. First Admission 7/2/09 to 7/4/09. Assessment: Recurrent intussusception. Patient presented with vomiting. Reduction of intussusception by enema. Second Admission 7/5/09 to 7/9/09. Discharged Diagnosis: Recurrent intussusception status post ileocolic resection and ileotransverse colon renanastomosis. After several previous reductions of intussusception by enema. Patient presented with increased fussiness, gastric emesis, bilious emesis. Decreased appetite. Bloody stool. Palpable epigastric mass. Enema reduction unsuccessful. Exploratory laparotomy with ileocolic resection and ileotransverse colon renanastomosis. Appendectomy. Ileum was quite edematous and lymph nodes in the ileocolic mesentary were massive.


Changed on 8/31/2010

VAERS ID: 311012 Before After
VAERS Form:
Age:0.1
Sex:Male
Location:Missouri
Vaccinated:2008-04-15
Onset:2008-04-20
Submitted:2008-04-23
Entered:2008-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF333AA / 0 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH C63117 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0015X / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal mass, Anisocytosis, Appendicectomy, Barium double contrast, Barium enema abnormal, Culture urine positive, Diet refusal, Haematochezia, Haemoglobin decreased, Hypersomnia, Intussusception, Laparotomy, Lymphadenitis, Mean cell haemoglobin, Mean cell volume decreased, Poikilocytosis, Vomiting, X-ray abnormal, X-ray with contrast upper gastrointestinal tract, Enema administration, Ultrasound abdomen abnormal, Red cell distribution width increased, Intestinal resection, Intestinal anastomosis, Urine ketone body present, Decreased appetite

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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Upper GI. Labs and Diagnostics: Abd X-ray with abnormal bowel gas pattern. Upper GI/Barium Enema (+) for Ileocolic Intussusception. LABS and DIAGNOSTICS: CBC - Hgb 10.1 g/dL (L) MCV 69.7 fL (L) MCH 21.3 pg (L) RDW 14.8% (H) BAND 7% (H)
CDC 'Split Type':

Write-up: Child developed vomiting on 4/20/08 and was evaluated at hospital. An UGI showed intussusception. It was easily reduced with a Hypaque enema. 5/02/2008 MR received for ER visit 4/20/2008 with DX: Intussusception. Infant presented vomiting, refusal to eat, increased sleeping. Bilious green emesis in ER. IS noted on UGI and BE. Successfully reduced. 7/31/09 Hospital records received DOS 7/2/09 to 7/9/09. First Admission 7/2/09 to 7/4/09. Assessment: Recurrent intussusception. Patient presented with vomiting. Reduction of intussusception by enema. Second Admission 7/5/09 to 7/9/09. Discharged Diagnosis: Recurrent intussusception status post ileocolic resection and ileotransverse colon renanastomosis. After several previous reductions of intussusception by enema. Patient presented with increased fussiness, gastric emesis, bilious emesis. Decreased appetite. Bloody stool. Palpable epigastric mass. Enema reduction unsuccessful. Exploratory laparotomy with ileocolic resection and ileotransverse colon renanastomosis. Appendectomy. Ileum was quite edematous and lymph nodes in the ileocolic mesentary were massive.


Changed on 4/13/2011

VAERS ID: 311012 Before After
VAERS Form:
Age:0.1
Sex:Male
Location:Missouri
Vaccinated:2008-04-15
Onset:2008-04-20
Submitted:2008-04-23
Entered:2008-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF333AA / 0 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C63117 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0015X / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal mass, Anisocytosis, Appendicectomy, Barium double contrast, Barium enema abnormal, Culture urine positive, Diet refusal, Haematochezia, Haemoglobin decreased, Hypersomnia, Intussusception, Laparotomy, Lymphadenitis, Mean cell haemoglobin, Mean cell volume decreased, Poikilocytosis, Vomiting, X-ray abnormal, X-ray with contrast upper gastrointestinal tract, Enema administration, Ultrasound abdomen abnormal, Red cell distribution width increased, Intestinal resection, Intestinal anastomosis, Urine ketone body present, Decreased appetite

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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Upper GI. Labs and Diagnostics: Abd X-ray with abnormal bowel gas pattern. Upper GI/Barium Enema (+) for Ileocolic Intussusception. LABS and DIAGNOSTICS: CBC - Hgb 10.1 g/dL (L) MCV 69.7 fL (L) MCH 21.3 pg (L) RDW 14.8% (H) BAND 7% (H)
CDC 'Split Type':

Write-up: Child developed vomiting on 4/20/08 and was evaluated at hospital. An UGI showed intussusception. It was easily reduced with a Hypaque enema. 5/02/2008 MR received for ER visit 4/20/2008 with DX: Intussusception. Infant presented vomiting, refusal to eat, increased sleeping. Bilious green emesis in ER. IS noted on UGI and BE. Successfully reduced. 7/31/09 Hospital records received DOS 7/2/09 to 7/9/09. First Admission 7/2/09 to 7/4/09. Assessment: Recurrent intussusception. Patient presented with vomiting. Reduction of intussusception by enema. Second Admission 7/5/09 to 7/9/09. Discharged Diagnosis: Recurrent intussusception status post ileocolic resection and ileotransverse colon renanastomosis. After several previous reductions of intussusception by enema. Patient presented with increased fussiness, gastric emesis, bilious emesis. Decreased appetite. Bloody stool. Palpable epigastric mass. Enema reduction unsuccessful. Exploratory laparotomy with ileocolic resection and ileotransverse colon renanastomosis. Appendectomy. Ileum was quite edematous and lymph nodes in the ileocolic mesentary were massive.


Changed on 5/13/2011

VAERS ID: 311012 Before After
VAERS Form:
Age:0.1
Sex:Male
Location:Missouri
Vaccinated:2008-04-15
Onset:2008-04-20
Submitted:2008-04-23
Entered:2008-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF333AA / 0 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C63117 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0015X / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal mass, Anisocytosis, Appendicectomy, Barium double contrast, Barium enema abnormal, Culture urine positive, Diet refusal, Haematochezia, Haemoglobin decreased, Hypersomnia, Intussusception, Laparotomy, Lymphadenitis, Mean cell haemoglobin, Mean cell volume decreased, Poikilocytosis, Vomiting, X-ray abnormal, X-ray with contrast upper gastrointestinal tract, Enema administration, Ultrasound abdomen abnormal, Red cell distribution width increased, Intestinal resection, Intestinal anastomosis, Urine ketone body present, Decreased appetite

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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Upper GI. Labs and Diagnostics: Abd X-ray with abnormal bowel gas pattern. Upper GI/Barium Enema (+) for Ileocolic Intussusception. LABS and DIAGNOSTICS: CBC - Hgb 10.1 g/dL (L) MCV 69.7 fL (L) MCH 21.3 pg (L) RDW 14.8% (H) BAND 7% (H)
CDC 'Split Type':

Write-up: Child developed vomiting on 4/20/08 and was evaluated at hospital. An UGI showed intussusception. It was easily reduced with a Hypaque enema. 5/02/2008 MR received for ER visit 4/20/2008 with DX: Intussusception. Infant presented vomiting, refusal to eat, increased sleeping. Bilious green emesis in ER. IS noted on UGI and BE. Successfully reduced. 7/31/09 Hospital records received DOS 7/2/09 to 7/9/09. First Admission 7/2/09 to 7/4/09. Assessment: Recurrent intussusception. Patient presented with vomiting. Reduction of intussusception by enema. Second Admission 7/5/09 to 7/9/09. Discharged Diagnosis: Recurrent intussusception status post ileocolic resection and ileotransverse colon renanastomosis. After several previous reductions of intussusception by enema. Patient presented with increased fussiness, gastric emesis, bilious emesis. Decreased appetite. Bloody stool. Palpable epigastric mass. Enema reduction unsuccessful. Exploratory laparotomy with ileocolic resection and ileotransverse colon renanastomosis. Appendectomy. Ileum was quite edematous and lymph nodes in the ileocolic mesentary were massive.


Changed on 6/11/2011

VAERS ID: 311012 Before After
VAERS Form:
Age:0.1
Sex:Male
Location:Missouri
Vaccinated:2008-04-15
Onset:2008-04-20
Submitted:2008-04-23
Entered:2008-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF333AA / 0 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C63117 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0015X / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal mass, Anisocytosis, Appendicectomy, Barium double contrast, Barium enema abnormal, Culture urine positive, Diet refusal, Haematochezia, Haemoglobin decreased, Hypersomnia, Intussusception, Laparotomy, Lymphadenitis, Mean cell haemoglobin, Mean cell volume decreased, Poikilocytosis, Vomiting, X-ray abnormal, X-ray with contrast upper gastrointestinal tract, Enema administration, Ultrasound abdomen abnormal, Red cell distribution width increased, Intestinal resection, Intestinal anastomosis, Urine ketone body present, Decreased appetite

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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Upper GI. Labs and Diagnostics: Abd X-ray with abnormal bowel gas pattern. Upper GI/Barium Enema (+) for Ileocolic Intussusception. LABS and DIAGNOSTICS: CBC - Hgb 10.1 g/dL (L) MCV 69.7 fL (L) MCH 21.3 pg (L) RDW 14.8% (H) BAND 7% (H)
CDC 'Split Type':

Write-up: Child developed vomiting on 4/20/08 and was evaluated at hospital. An UGI showed intussusception. It was easily reduced with a Hypaque enema. 5/02/2008 MR received for ER visit 4/20/2008 with DX: Intussusception. Infant presented vomiting, refusal to eat, increased sleeping. Bilious green emesis in ER. IS noted on UGI and BE. Successfully reduced. 7/31/09 Hospital records received DOS 7/2/09 to 7/9/09. First Admission 7/2/09 to 7/4/09. Assessment: Recurrent intussusception. Patient presented with vomiting. Reduction of intussusception by enema. Second Admission 7/5/09 to 7/9/09. Discharged Diagnosis: Recurrent intussusception status post ileocolic resection and ileotransverse colon renanastomosis. After several previous reductions of intussusception by enema. Patient presented with increased fussiness, gastric emesis, bilious emesis. Decreased appetite. Bloody stool. Palpable epigastric mass. Enema reduction unsuccessful. Exploratory laparotomy with ileocolic resection and ileotransverse colon renanastomosis. Appendectomy. Ileum was quite edematous and lymph nodes in the ileocolic mesentary were massive.


Changed on 5/13/2013

VAERS ID: 311012 Before After
VAERS Form:
Age:0.1
Sex:Male
Location:Missouri
Vaccinated:2008-04-15
Onset:2008-04-20
Submitted:2008-04-23
Entered:2008-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF333AA / 0 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C63117 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0015X / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0015X / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal mass, Anisocytosis, Appendicectomy, Barium double contrast, Barium enema abnormal, Culture urine positive, Diet refusal, Haematochezia, Haemoglobin decreased, Hypersomnia, Intussusception, Laparotomy, Lymphadenitis, Mean cell haemoglobin, Mean cell volume decreased, Poikilocytosis, Vomiting, X-ray abnormal, X-ray with contrast upper gastrointestinal tract, Enema administration, Ultrasound abdomen abnormal, Red cell distribution width increased, Intestinal resection, Intestinal anastomosis, Urine ketone body present, Decreased appetite

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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Upper GI. Labs and Diagnostics: Abd X-ray with abnormal bowel gas pattern. Upper GI/Barium Enema (+) for Ileocolic Intussusception. LABS and DIAGNOSTICS: CBC - Hgb 10.1 g/dL (L) MCV 69.7 fL (L) MCH 21.3 pg (L) RDW 14.8% (H) BAND 7% (H)
CDC 'Split Type':

Write-up: Child developed vomiting on 4/20/08 and was evaluated at hospital. An UGI showed intussusception. It was easily reduced with a Hypaque enema. 5/02/2008 MR received for ER visit 4/20/2008 with DX: Intussusception. Infant presented vomiting, refusal to eat, increased sleeping. Bilious green emesis in ER. IS noted on UGI and BE. Successfully reduced. 7/31/09 Hospital records received DOS 7/2/09 to 7/9/09. First Admission 7/2/09 to 7/4/09. Assessment: Recurrent intussusception. Patient presented with vomiting. Reduction of intussusception by enema. Second Admission 7/5/09 to 7/9/09. Discharged Diagnosis: Recurrent intussusception status post ileocolic resection and ileotransverse colon renanastomosis. After several previous reductions of intussusception by enema. Patient presented with increased fussiness, gastric emesis, bilious emesis. Decreased appetite. Bloody stool. Palpable epigastric mass. Enema reduction unsuccessful. Exploratory laparotomy with ileocolic resection and ileotransverse colon renanastomosis. Appendectomy. Ileum was quite edematous and lymph nodes in the ileocolic mesentary were massive.


Changed on 4/14/2017

VAERS ID: 311012 Before After
VAERS Form:
Age:0.1
Sex:Male
Location:Missouri
Vaccinated:2008-04-15
Onset:2008-04-20
Submitted:2008-04-23
Entered:2008-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF333AA / 0 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C63117 / 0 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0015X / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal mass, Anisocytosis, Appendicectomy, Barium double contrast, Barium enema abnormal, Culture urine positive, Diet refusal, Haematochezia, Haemoglobin decreased, Hypersomnia, Intussusception, Laparotomy, Lymphadenitis, Mean cell haemoglobin, Mean cell volume decreased, Poikilocytosis, Vomiting, X-ray abnormal, X-ray with contrast upper gastrointestinal tract, Enema administration, Ultrasound abdomen abnormal, Red cell distribution width increased, Intestinal resection, Intestinal anastomosis, Urine ketone body present, Decreased appetite

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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Upper GI. Labs and Diagnostics: Abd X-ray with abnormal bowel gas pattern. Upper GI/Barium Enema (+) for Ileocolic Intussusception. LABS and DIAGNOSTICS: CBC - Hgb 10.1 g/dL (L) MCV 69.7 fL (L) MCH 21.3 pg (L) RDW 14.8% (H) BAND 7% (H) Atypical Lymph 12% (H) Anisocytosis slight Poikilocytosis slight. CHEM - CO2 19 mmol/L (L). Abdominal X-ray - bowel gas and soft tissue mass. Barium Air Contrast enema. Ultrasound Abdomen - consistant with intussusception. Urinalysis - Ketones 1+. Urine culture - Enterococcus species.
CDC 'Split Type':

Write-up: Child developed vomiting on 4/20/08 and was evaluated at hospital. An UGI showed intussusception. It was easily reduced with a Hypaque enema. 5/02/2008 MR received for ER visit 4/20/2008 with DX: Intussusception. Infant presented vomiting, refusal to eat, increased sleeping. Bilious green emesis in ER. IS noted on UGI and BE. Successfully reduced. 7/31/09 Hospital records received DOS 7/2/09 to 7/9/09. First Admission 7/2/09 to 7/4/09. Assessment: Recurrent intussusception. Patient presented with vomiting. Reduction of intussusception by enema. Second Admission 7/5/09 to 7/9/09. Discharged Diagnosis: Recurrent intussusception status post ileocolic resection and ileotransverse colon renanastomosis. After several previous reductions of intussusception by enema. Patient presented with increased fussiness, gastric emesis, bilious emesis. Decreased appetite. Bloody stool. Palpable epigastric mass. Enema reduction unsuccessful. Exploratory laparotomy with ileocolic resection and ileotransverse colon renanastomosis. Appendectomy. Ileum was quite edematous and lymph nodes in the ileocolic mesentary were massive.


Changed on 9/14/2017

VAERS ID: 311012 Before After
VAERS Form:(blank) 1
Age:0.1
Sex:Male
Location:Missouri
Vaccinated:2008-04-15
Onset:2008-04-20
Submitted:2008-04-23
Entered:2008-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 0 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF333AA / 0 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C63117 / 0 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0015X / 0 1 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Vomiting, X-ray with contrast upper gastrointestinal tract, 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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Upper GI. Labs and Diagnostics: Abd X-ray with abnormal bowel gas pattern. Upper GI/Barium Enema (+) for Ileocolic Intussusception. LABS and DIAGNOSTICS: CBC - Hgb 10.1 g/dL (L) MCV 69.7 fL (L) MCH 21.3 pg (L) RDW 14.8% (H) BAND 7% (H) Atypical Lymph 12% (H) Anisocytosis slight Poikilocytosis slight. CHEM - CO2 19 mmol/L (L). Abdominal X-ray - bowel gas and soft tissue mass. Barium Air Contrast enema. Ultrasound Abdomen - consistant with intussusception. Urinalysis - Ketones 1+. Urine culture - Enterococcus species.
CDC 'Split Type':

Write-up: Child developed vomiting on 4/20/08 and was evaluated at hospital. An UGI showed intussusception. It was easily reduced with a Hypaque enema. 5/02/2008 MR received for ER visit 4/20/2008 with DX: Intussusception. Infant presented vomiting, refusal to eat, increased sleeping. Bilious green emesis in ER. IS noted on UGI and BE. Successfully reduced. 7/31/09 Hospital records received DOS 7/2/09 to 7/9/09. First Admission 7/2/09 to 7/4/09. Assessment: Recurrent intussusception. Patient presented with vomiting. Reduction of intussusception by enema. Second Admission 7/5/09 to 7/9/09. Discharged Diagnosis: Recurrent intussusception status post ileocolic resection and ileotransverse colon renanastomosis. After several previous reductions of intussusception by enema. Patient presented with increased fussiness, gastric emesis, bilious emesis. Decreased appetite. Bloody stool. Palpable epigastric mass. Enema reduction unsuccessful. Exploratory laparotomy with ileocolic resection and ileotransverse colon renanastomosis. Appendectomy. Ileum was quite edematous and lymph nodes in the ileocolic mesentary were massive.


Changed on 2/14/2018

VAERS ID: 311012 Before After
VAERS Form:1
Age:0.1
Sex:Male
Location:Missouri
Vaccinated:2008-04-15
Onset:2008-04-20
Submitted:2008-04-23
Entered:2008-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF333AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C63117 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0015X / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Vomiting, X-ray with contrast upper gastrointestinal tract, 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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Upper GI. Labs and Diagnostics: Abd X-ray with abnormal bowel gas pattern. Upper GI/Barium Enema (+) for Ileocolic Intussusception. LABS and DIAGNOSTICS: CBC - Hgb 10.1 g/dL (L) MCV 69.7 fL (L) MCH 21.3 pg (L) RDW 14.8% (H) BAND 7% (H) Atypical Lymph 12% (H) Anisocytosis slight Poikilocytosis slight. CHEM - CO2 19 mmol/L (L). Abdominal X-ray - bowel gas and soft tissue mass. Barium Air Contrast enema. Ultrasound Abdomen - consistant with intussusception. Urinalysis - Ketones 1+. Urine culture - Enterococcus species.
CDC 'Split Type':

Write-up: Child developed vomiting on 4/20/08 and was evaluated at hospital. An UGI showed intussusception. It was easily reduced with a Hypaque enema. 5/02/2008 MR received for ER visit 4/20/2008 with DX: Intussusception. Infant presented vomiting, refusal to eat, increased sleeping. Bilious green emesis in ER. IS noted on UGI and BE. Successfully reduced. 7/31/09 Hospital records received DOS 7/2/09 to 7/9/09. First Admission 7/2/09 to 7/4/09. Assessment: Recurrent intussusception. Patient presented with vomiting. Reduction of intussusception by enema. Second Admission 7/5/09 to 7/9/09. Discharged Diagnosis: Recurrent intussusception status post ileocolic resection and ileotransverse colon renanastomosis. After several previous reductions of intussusception by enema. Patient presented with increased fussiness, gastric emesis, bilious emesis. Decreased appetite. Bloody stool. Palpable epigastric mass. Enema reduction unsuccessful. Exploratory laparotomy with ileocolic resection and ileotransverse colon renanastomosis. Appendectomy. Ileum was quite edematous and lymph nodes in the ileocolic mesentary were massive.


Changed on 6/14/2018

VAERS ID: 311012 Before After
VAERS Form:1
Age:0.1
Sex:Male
Location:Missouri
Vaccinated:2008-04-15
Onset:2008-04-20
Submitted:2008-04-23
Entered:2008-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF333AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C63117 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0015X / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Vomiting, X-ray with contrast upper gastrointestinal tract, 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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Upper GI. Labs and Diagnostics: Abd X-ray with abnormal bowel gas pattern. Upper GI/Barium Enema (+) for Ileocolic Intussusception. LABS and DIAGNOSTICS: CBC - Hgb 10.1 g/dL (L) MCV 69.7 fL (L) MCH 21.3 pg (L) RDW 14.8% (H) BAND 7% (H) Atypical Lymph 12% (H) Anisocytosis slight Poikilocytosis slight. CHEM - CO2 19 mmol/L (L). Abdominal X-ray - bowel gas and soft tissue mass. Barium Air Contrast enema. Ultrasound Abdomen - consistant with intussusception. Urinalysis - Ketones 1+. Urine culture - Enterococcus species.
CDC 'Split Type':

Write-up: Child developed vomiting on 4/20/08 and was evaluated at hospital. An UGI showed intussusception. It was easily reduced with a Hypaque enema. 5/02/2008 MR received for ER visit 4/20/2008 with DX: Intussusception. Infant presented vomiting, refusal to eat, increased sleeping. Bilious green emesis in ER. IS noted on UGI and BE. Successfully reduced. 7/31/09 Hospital records received DOS 7/2/09 to 7/9/09. First Admission 7/2/09 to 7/4/09. Assessment: Recurrent intussusception. Patient presented with vomiting. Reduction of intussusception by enema. Second Admission 7/5/09 to 7/9/09. Discharged Diagnosis: Recurrent intussusception status post ileocolic resection and ileotransverse colon renanastomosis. After several previous reductions of intussusception by enema. Patient presented with increased fussiness, gastric emesis, bilious emesis. Decreased appetite. Bloody stool. Palpable epigastric mass. Enema reduction unsuccessful. Exploratory laparotomy with ileocolic resection and ileotransverse colon renanastomosis. Appendectomy. Ileum was quite edematous and lymph nodes in the ileocolic mesentary were massive.


Changed on 8/14/2018

VAERS ID: 311012 Before After
VAERS Form:1
Age:0.1
Sex:Male
Location:Missouri
Vaccinated:2008-04-15
Onset:2008-04-20
Submitted:2008-04-23
Entered:2008-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF333AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C63117 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0015X / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Vomiting, X-ray with contrast upper gastrointestinal tract, 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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Upper GI. Labs and Diagnostics: Abd X-ray with abnormal bowel gas pattern. Upper GI/Barium Enema (+) for Ileocolic Intussusception. LABS and DIAGNOSTICS: CBC - Hgb 10.1 g/dL (L) MCV 69.7 fL (L) MCH 21.3 pg (L) RDW 14.8% (H) BAND 7% (H) Atypical Lymph 12% (H) Anisocytosis slight Poikilocytosis slight. CHEM - CO2 19 mmol/L (L). Abdominal X-ray - bowel gas and soft tissue mass. Barium Air Contrast enema. Ultrasound Abdomen - consistant with intussusception. Urinalysis - Ketones 1+. Urine culture - Enterococcus species.
CDC 'Split Type':

Write-up: Child developed vomiting on 4/20/08 and was evaluated at hospital. An UGI showed intussusception. It was easily reduced with a Hypaque enema. 5/02/2008 MR received for ER visit 4/20/2008 with DX: Intussusception. Infant presented vomiting, refusal to eat, increased sleeping. Bilious green emesis in ER. IS noted on UGI and BE. Successfully reduced. 7/31/09 Hospital records received DOS 7/2/09 to 7/9/09. First Admission 7/2/09 to 7/4/09. Assessment: Recurrent intussusception. Patient presented with vomiting. Reduction of intussusception by enema. Second Admission 7/5/09 to 7/9/09. Discharged Diagnosis: Recurrent intussusception status post ileocolic resection and ileotransverse colon renanastomosis. After several previous reductions of intussusception by enema. Patient presented with increased fussiness, gastric emesis, bilious emesis. Decreased appetite. Bloody stool. Palpable epigastric mass. Enema reduction unsuccessful. Exploratory laparotomy with ileocolic resection and ileotransverse colon renanastomosis. Appendectomy. Ileum was quite edematous and lymph nodes in the ileocolic mesentary were massive.


Changed on 9/14/2018

VAERS ID: 311012 Before After
VAERS Form:1
Age:0.1
Sex:Male
Location:Missouri
Vaccinated:2008-04-15
Onset:2008-04-20
Submitted:2008-04-23
Entered:2008-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF333AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C63117 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0015X / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Vomiting, X-ray with contrast upper gastrointestinal tract, 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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Upper GI. Labs and Diagnostics: Abd X-ray with abnormal bowel gas pattern. Upper GI/Barium Enema (+) for Ileocolic Intussusception. LABS and DIAGNOSTICS: CBC - Hgb 10.1 g/dL (L) MCV 69.7 fL (L) MCH 21.3 pg (L) RDW 14.8% (H) BAND 7% (H) Atypical Lymph 12% (H) Anisocytosis slight Poikilocytosis slight. CHEM - CO2 19 mmol/L (L). Abdominal X-ray - bowel gas and soft tissue mass. Barium Air Contrast enema. Ultrasound Abdomen - consistant with intussusception. Urinalysis - Ketones 1+. Urine culture - Enterococcus species.
CDC 'Split Type':

Write-up: Child developed vomiting on 4/20/08 and was evaluated at hospital. An UGI showed intussusception. It was easily reduced with a Hypaque enema. 5/02/2008 MR received for ER visit 4/20/2008 with DX: Intussusception. Infant presented vomiting, refusal to eat, increased sleeping. Bilious green emesis in ER. IS noted on UGI and BE. Successfully reduced. 7/31/09 Hospital records received DOS 7/2/09 to 7/9/09. First Admission 7/2/09 to 7/4/09. Assessment: Recurrent intussusception. Patient presented with vomiting. Reduction of intussusception by enema. Second Admission 7/5/09 to 7/9/09. Discharged Diagnosis: Recurrent intussusception status post ileocolic resection and ileotransverse colon renanastomosis. After several previous reductions of intussusception by enema. Patient presented with increased fussiness, gastric emesis, bilious emesis. Decreased appetite. Bloody stool. Palpable epigastric mass. Enema reduction unsuccessful. Exploratory laparotomy with ileocolic resection and ileotransverse colon renanastomosis. Appendectomy. Ileum was quite edematous and lymph nodes in the ileocolic mesentary were massive.


Changed on 10/14/2018

VAERS ID: 311012 Before After
VAERS Form:1
Age:0.1
Sex:Male
Location:Missouri
Vaccinated:2008-04-15
Onset:2008-04-20
Submitted:2008-04-23
Entered:2008-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF333AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C63117 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0015X / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Vomiting, X-ray with contrast upper gastrointestinal tract, 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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Upper GI. Labs and Diagnostics: Abd X-ray with abnormal bowel gas pattern. Upper GI/Barium Enema (+) for Ileocolic Intussusception. LABS and DIAGNOSTICS: CBC - Hgb 10.1 g/dL (L) MCV 69.7 fL (L) MCH 21.3 pg (L) RDW 14.8% (H) BAND 7% (H) Atypical Lymph 12% (H) Anisocytosis slight Poikilocytosis slight. CHEM - CO2 19 mmol/L (L). Abdominal X-ray - bowel gas and soft tissue mass. Barium Air Contrast enema. Ultrasound Abdomen - consistant with intussusception. Urinalysis - Ketones 1+. Urine culture - Enterococcus species.
CDC 'Split Type':

Write-up: Child developed vomiting on 4/20/08 and was evaluated at hospital. An UGI showed intussusception. It was easily reduced with a Hypaque enema. 5/02/2008 MR received for ER visit 4/20/2008 with DX: Intussusception. Infant presented vomiting, refusal to eat, increased sleeping. Bilious green emesis in ER. IS noted on UGI and BE. Successfully reduced. 7/31/09 Hospital records received DOS 7/2/09 to 7/9/09. First Admission 7/2/09 to 7/4/09. Assessment: Recurrent intussusception. Patient presented with vomiting. Reduction of intussusception by enema. Second Admission 7/5/09 to 7/9/09. Discharged Diagnosis: Recurrent intussusception status post ileocolic resection and ileotransverse colon renanastomosis. After several previous reductions of intussusception by enema. Patient presented with increased fussiness, gastric emesis, bilious emesis. Decreased appetite. Bloody stool. Palpable epigastric mass. Enema reduction unsuccessful. Exploratory laparotomy with ileocolic resection and ileotransverse colon renanastomosis. Appendectomy. Ileum was quite edematous and lymph nodes in the ileocolic mesentary were massive.

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