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This is VAERS ID 311224

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 311224
VAERS Form:
Age:0.6
Gender:Male
Location:Hawaii
Vaccinated:2007-11-28
Onset:2008-03-11
Submitted:2008-04-29
Entered:2008-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124DB / 2 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C45888 / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1391U / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Appendicectomy, Dehydration, Diarrhoea haemorrhagic

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: Intussusception~Rotavirus (Rotateq)~4~1~In Patient
Other Medications: None
Current Illness: None
Preexisting Conditions: torticollis
Allergies:
Diagnostic Lab Data: Abdominal Ultrasound- Highly Suggestive of Intussusception. Gastrografin Barium Enema- Findings consistent with intussusception at the proximal to mid transverse colon level. No extravasation of contrast material was demonstrated. 6/2/08-
CDC 'Split Type': torticollis

Write-up: Mother called the clinic on 3/12/08, baby started vomiting x 24 hours and just had a diarrhea stool that was bloody. She was instructed to bring him in to the clinic and arrived within the hour with more episodes of bloody stools. IV fluids were adminis"tered for treatment of dehydration. Child was admitted to the hospital for treatment after being diagnosed with Intussusception. Hydrostatic Reduction attempts were made but unsuccessful. Child was then taken to surgery for manual reduction of the intus


Changed on 12/8/2009

VAERS ID: 311224 Before After
VAERS Form:
Age:0.6
Gender:Male
Location:Hawaii
Vaccinated:2007-11-28
Onset:2008-03-11
Submitted:2008-04-29
Entered:2008-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124DB / 2 LL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124DB / 2 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C45888 / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1391U / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Appendicectomy, Dehydration, Diarrhoea haemorrhagic, Haematochezia, Intussusception, Listless, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal

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: Intussusception~Rotavirus (Rotateq)~4~1~In Patient
Other Medications: None
Current Illness: None
Preexisting Conditions: torticollis
Allergies:
Diagnostic Lab Data: Abdominal Ultrasound- Highly Suggestive of Intussusception. Gastrografin Barium Enema- Findings consistent with intussusception at the proximal to mid transverse colon level. No extravasation of contrast material was demonstrated. 6/2/08-
CDC 'Split Type': torticollis (blank)

Write-up: Mother called the clinic on 3/12/08, baby started vomiting x 24 hours and just had a diarrhea stool that was bloody. She was instructed to bring him in to the clinic and arrived within the hour with more episodes of bloody stools. IV fluids were adminis"tered administered for treatment of dehydration. Child was admitted to the hospital for treatment after being diagnosed with Intussusception. Hydrostatic Reduction attempts were made but unsuccessful. Child was then taken to surgery for manual reduction of the intus intussusception 5/2/08-ED records received-presented to ED with on and off abdominal pain times 1 week, vomiting with bouts of crying. DX: intussusception. Transferred. 6/2/08-records received for DOS 3/12-3/15/08-DC DX: Intussusception, status post manual reduction and incidental appendectomy. Gastrographin enema. 24 hour period of emesis starting on 3/11/08-became yellow green and developed intermittent colicky episodic abdominal pain with knees posterior to chest or stiffening. Listlessness. Bright red blood in diaper. On 2/27/08 fussy and x-ray of abdomen did not reveal foreign body.


Changed on 3/2/2010

VAERS ID: 311224 Before After
VAERS Form:
Age:0.6
Gender:Male
Location:Hawaii
Vaccinated:2007-11-28
Onset:2008-03-11
Submitted:2008-04-29
Entered:2008-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124DB / 2 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC C45888 / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1391U / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Appendicectomy, Dehydration, Diarrhoea haemorrhagic, Haematochezia, Intussusception, Listless, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal

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: Intussusception~Rotavirus (Rotateq)~4~1~In Patient
Other Medications: None
Current Illness: None
Preexisting Conditions: torticollis
Allergies:
Diagnostic Lab Data: Abdominal Ultrasound- Highly Suggestive of Intussusception. Gastrografin Barium Enema- Findings consistent with intussusception at the proximal to mid transverse colon level. No extravasation of contrast material was demonstrated. 6/2/08-
CDC 'Split Type':

Write-up: Mother called the clinic on 3/12/08, baby started vomiting x 24 hours and just had a diarrhea stool that was bloody. She was instructed to bring him in to the clinic and arrived within the hour with more episodes of bloody stools. IV fluids were administered for treatment of dehydration. Child was admitted to the hospital for treatment after being diagnosed with Intussusception. Hydrostatic Reduction attempts were made but unsuccessful. Child was then taken to surgery for manual reduction of the intussusception 5/2/08-ED records received-presented to ED with on and off abdominal pain times 1 week, vomiting with bouts of crying. DX: intussusception. Transferred. 6/2/08-records received for DOS 3/12-3/15/08-DC DX: Intussusception, status post manual reduction and incidental appendectomy. Gastrographin enema. 24 hour period of emesis starting on 3/11/08-became yellow green and developed intermittent colicky episodic abdominal pain with knees posterior to chest or stiffening. Listlessness. Bright red blood in diaper. On 2/27/08 fussy and x-ray of abdomen did not reveal foreign body.


Changed on 4/7/2010

VAERS ID: 311224 Before After
VAERS Form:
Age:0.6
Gender:Male
Location:Hawaii
Vaccinated:2007-11-28
Onset:2008-03-11
Submitted:2008-04-29
Entered:2008-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124DB / 2 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C45888 / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1391U / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Appendicectomy, Dehydration, Diarrhoea haemorrhagic, Haematochezia, Intussusception, Listless, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal

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: Intussusception~Rotavirus (Rotateq)~4~1~In Patient
Other Medications: None
Current Illness: None
Preexisting Conditions: torticollis
Allergies:
Diagnostic Lab Data: Abdominal Ultrasound- Highly Suggestive of Intussusception. Gastrografin Barium Enema- Findings consistent with intussusception at the proximal to mid transverse colon level. No extravasation of contrast material was demonstrated. 6/2/08-
CDC 'Split Type':

Write-up: Mother called the clinic on 3/12/08, baby started vomiting x 24 hours and just had a diarrhea stool that was bloody. She was instructed to bring him in to the clinic and arrived within the hour with more episodes of bloody stools. IV fluids were administered for treatment of dehydration. Child was admitted to the hospital for treatment after being diagnosed with Intussusception. Hydrostatic Reduction attempts were made but unsuccessful. Child was then taken to surgery for manual reduction of the intussusception 5/2/08-ED records received-presented to ED with on and off abdominal pain times 1 week, vomiting with bouts of crying. DX: intussusception. Transferred. 6/2/08-records received for DOS 3/12-3/15/08-DC DX: Intussusception, status post manual reduction and incidental appendectomy. Gastrographin enema. 24 hour period of emesis starting on 3/11/08-became yellow green and developed intermittent colicky episodic abdominal pain with knees posterior to chest or stiffening. Listlessness. Bright red blood in diaper. On 2/27/08 fussy and x-ray of abdomen did not reveal foreign body.


Changed on 8/31/2010

VAERS ID: 311224 Before After
VAERS Form:
Age:0.6
Gender:Male
Location:Hawaii
Vaccinated:2007-11-28
Onset:2008-03-11
Submitted:2008-04-29
Entered:2008-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124DB / 2 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH C45888 / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1391U / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Appendicectomy, Dehydration, Diarrhoea haemorrhagic, Haematochezia, Intussusception, Listless, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal

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: Intussusception~Rotavirus (Rotateq)~4~1~In Patient
Other Medications: None
Current Illness: None
Preexisting Conditions: torticollis
Allergies:
Diagnostic Lab Data: Abdominal Ultrasound- Highly Suggestive of Intussusception. Gastrografin Barium Enema- Findings consistent with intussusception at the proximal to mid transverse colon level. No extravasation of contrast material was demonstrated. 6/2/08-
CDC 'Split Type':

Write-up: Mother called the clinic on 3/12/08, baby started vomiting x 24 hours and just had a diarrhea stool that was bloody. She was instructed to bring him in to the clinic and arrived within the hour with more episodes of bloody stools. IV fluids were administered for treatment of dehydration. Child was admitted to the hospital for treatment after being diagnosed with Intussusception. Hydrostatic Reduction attempts were made but unsuccessful. Child was then taken to surgery for manual reduction of the intussusception 5/2/08-ED records received-presented to ED with on and off abdominal pain times 1 week, vomiting with bouts of crying. DX: intussusception. Transferred. 6/2/08-records received for DOS 3/12-3/15/08-DC DX: Intussusception, status post manual reduction and incidental appendectomy. Gastrographin enema. 24 hour period of emesis starting on 3/11/08-became yellow green and developed intermittent colicky episodic abdominal pain with knees posterior to chest or stiffening. Listlessness. Bright red blood in diaper. On 2/27/08 fussy and x-ray of abdomen did not reveal foreign body.


Changed on 7/13/2012

VAERS ID: 311224 Before After
VAERS Form:
Age:0.6
Gender:Male
Location:Hawaii
Vaccinated:2007-11-28
Onset:2008-03-11
Submitted:2008-04-29
Entered:2008-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124DB / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45888 / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1391U / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Appendicectomy, Dehydration, Diarrhoea haemorrhagic, Haematochezia, Intussusception, Listless, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal

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: Intussusception~Rotavirus (Rotateq)~4~1~In Patient (Rotateq)~4~0.80~Patient
Other Medications: None
Current Illness: None
Preexisting Conditions: torticollis Torticollis
Allergies:
Diagnostic Lab Data: Abdominal Ultrasound- Highly Suggestive of Intussusception. Gastrografin Barium Enema- Findings consistent with intussusception at the proximal to mid transverse colon level. No extravasation of contrast material was demonstrated. 6/2/08- 6/2/08-records received-CBC 15,000.US consistent with intussusception.
CDC 'Split Type':

Write-up: Mother called the clinic on 3/12/08, baby started vomiting x 24 hours and just had a diarrhea stool that was bloody. She was instructed to bring him in to the clinic and arrived within the hour with more episodes of bloody stools. IV fluids were administered for treatment of dehydration. Child was admitted to the hospital for treatment after being diagnosed with Intussusception. Hydrostatic Reduction attempts were made but unsuccessful. Child was then taken to surgery for manual reduction of the intussusception intussusception. 5/2/08-ED records received-presented to ED with on and off abdominal pain times 1 week, vomiting with bouts of crying. DX: intussusception. Transferred. 6/2/08-records received for DOS 3/12-3/15/08-DC DX: Intussusception, status post manual reduction and incidental appendectomy. Gastrographin enema. 24 hour period of emesis starting on 3/11/08-became yellow green and developed intermittent colicky episodic abdominal pain with knees posterior to chest or stiffening. Listlessness. Bright red blood in diaper. On 2/27/08 fussy and x-ray of abdomen did not reveal foreign body.


Changed on 5/13/2013

VAERS ID: 311224 Before After
VAERS Form:
Age:0.6
Gender:Male
Location:Hawaii
Vaccinated:2007-11-28
Onset:2008-03-11
Submitted:2008-04-29
Entered:2008-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124DB / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45888 / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1391U / 2 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1391U / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Appendicectomy, Dehydration, Diarrhoea haemorrhagic, Haematochezia, Intussusception, Listless, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal

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: Intussusception~Rotavirus (Rotateq)~4~0.80~Patient
Other Medications: None
Current Illness: None
Preexisting Conditions: Torticollis
Allergies:
Diagnostic Lab Data: Abdominal Ultrasound- Highly Suggestive of Intussusception. Gastrografin Barium Enema- Findings consistent with intussusception at the proximal to mid transverse colon level. No extravasation of contrast material was demonstrated. 6/2/08-records received-CBC 15,000.US consistent with intussusception.
CDC 'Split Type':

Write-up: Mother called the clinic on 3/12/08, baby started vomiting x 24 hours and just had a diarrhea stool that was bloody. She was instructed to bring him in to the clinic and arrived within the hour with more episodes of bloody stools. IV fluids were administered for treatment of dehydration. Child was admitted to the hospital for treatment after being diagnosed with Intussusception. Hydrostatic Reduction attempts were made but unsuccessful. Child was then taken to surgery for manual reduction of the intussusception. 5/2/08-ED records received-presented to ED with on and off abdominal pain times 1 week, vomiting with bouts of crying. DX: intussusception. Transferred. 6/2/08-records received for DOS 3/12-3/15/08-DC DX: Intussusception, status post manual reduction and incidental appendectomy. Gastrographin enema. 24 hour period of emesis starting on 3/11/08-became yellow green and developed intermittent colicky episodic abdominal pain with knees posterior to chest or stiffening. Listlessness. Bright red blood in diaper. On 2/27/08 fussy and x-ray of abdomen did not reveal foreign body.


Changed on 6/14/2014

VAERS ID: 311224 Before After
VAERS Form:
Age:0.6
Gender:Male
Location:Hawaii
Vaccinated:2007-11-28
Onset:2008-03-11
Submitted:2008-04-29
Entered:2008-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124DB / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45888 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1391U / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Appendicectomy, Dehydration, Diarrhoea haemorrhagic, Haematochezia, Intussusception, Listless, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal

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: Intussusception~Rotavirus (Rotateq)~4~0.80~Patient
Other Medications: None
Current Illness: None
Preexisting Conditions: Torticollis
Allergies:
Diagnostic Lab Data: Abdominal Ultrasound- Highly Suggestive of Intussusception. Gastrografin Barium Enema- Findings consistent with intussusception at the proximal to mid transverse colon level. No extravasation of contrast material was demonstrated. 6/2/08-records received-CBC 15,000.US consistent with intussusception.
CDC 'Split Type':

Write-up: Mother called the clinic on 3/12/08, baby started vomiting x 24 hours and just had a diarrhea stool that was bloody. She was instructed to bring him in to the clinic and arrived within the hour with more episodes of bloody stools. IV fluids were administered for treatment of dehydration. Child was admitted to the hospital for treatment after being diagnosed with Intussusception. Hydrostatic Reduction attempts were made but unsuccessful. Child was then taken to surgery for manual reduction of the intussusception. 5/2/08-ED records received-presented to ED with on and off abdominal pain times 1 week, vomiting with bouts of crying. DX: intussusception. Transferred. 6/2/08-records received for DOS 3/12-3/15/08-DC DX: Intussusception, status post manual reduction and incidental appendectomy. Gastrographin enema. 24 hour period of emesis starting on 3/11/08-became yellow green and developed intermittent colicky episodic abdominal pain with knees posterior to chest or stiffening. Listlessness. Bright red blood in diaper. On 2/27/08 fussy and x-ray of abdomen did not reveal foreign body.


Changed on 2/14/2017

VAERS ID: 311224 Before After
VAERS Form:
Age:0.6 0.56
Gender:Male
Location:Hawaii
Vaccinated:2007-11-28
Onset:2008-03-11
Submitted:2008-04-29
Entered:2008-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124DB / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45888 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1391U / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Appendicectomy, Dehydration, Diarrhoea haemorrhagic, Haematochezia, Intussusception, Listless, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal

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: Intussusception~Rotavirus (Rotateq)~4~0.80~Patient
Other Medications:
Current Illness: None
Preexisting Conditions: Torticollis
Allergies:
Diagnostic Lab Data: Abdominal Ultrasound- Highly Suggestive of Intussusception. Gastrografin Barium Enema- Findings consistent with intussusception at the proximal to mid transverse colon level. No extravasation of contrast material was demonstrated. 6/2/08-records received-CBC 15,000.US consistent with intussusception.
CDC 'Split Type':

Write-up: Mother called the clinic on 3/12/08, baby started vomiting x 24 hours and just had a diarrhea stool that was bloody. She was instructed to bring him in to the clinic and arrived within the hour with more episodes of bloody stools. IV fluids were administered for treatment of dehydration. Child was admitted to the hospital for treatment after being diagnosed with Intussusception. Hydrostatic Reduction attempts were made but unsuccessful. Child was then taken to surgery for manual reduction of the intussusception. 5/2/08-ED records received-presented to ED with on and off abdominal pain times 1 week, vomiting with bouts of crying. DX: intussusception. Transferred. 6/2/08-records received for DOS 3/12-3/15/08-DC DX: Intussusception, status post manual reduction and incidental appendectomy. Gastrographin enema. 24 hour period of emesis starting on 3/11/08-became yellow green and developed intermittent colicky episodic abdominal pain with knees posterior to chest or stiffening. Listlessness. Bright red blood in diaper. On 2/27/08 fussy and x-ray of abdomen did not reveal foreign body.


Changed on 4/14/2017

VAERS ID: 311224 Before After
VAERS Form:
Age:0.56
Gender:Male
Location:Hawaii
Vaccinated:2007-11-28
Onset:2008-03-11
Submitted:2008-04-29
Entered:2008-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124DB / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45888 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1391U / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Appendicectomy, Dehydration, Diarrhoea haemorrhagic, Haematochezia, Intussusception, Listless, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal

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: Intussusception~Rotavirus (Rotateq)~4~0.80~Patient
Other Medications: None
Current Illness: None
Preexisting Conditions: Torticollis
Allergies:
Diagnostic Lab Data: Abdominal Ultrasound- Highly Suggestive of Intussusception. Gastrografin Barium Enema- Findings consistent with intussusception at the proximal to mid transverse colon level. No extravasation of contrast material was demonstrated. 6/2/08-records received-CBC 15,000.US consistent with intussusception.
CDC 'Split Type':

Write-up: Mother called the clinic on 3/12/08, baby started vomiting x 24 hours and just had a diarrhea stool that was bloody. She was instructed to bring him in to the clinic and arrived within the hour with more episodes of bloody stools. IV fluids were administered for treatment of dehydration. Child was admitted to the hospital for treatment after being diagnosed with Intussusception. Hydrostatic Reduction attempts were made but unsuccessful. Child was then taken to surgery for manual reduction of the intussusception. 5/2/08-ED records received-presented to ED with on and off abdominal pain times 1 week, vomiting with bouts of crying. DX: intussusception. Transferred. 6/2/08-records received for DOS 3/12-3/15/08-DC DX: Intussusception, status post manual reduction and incidental appendectomy. Gastrographin enema. 24 hour period of emesis starting on 3/11/08-became yellow green and developed intermittent colicky episodic abdominal pain with knees posterior to chest or stiffening. Listlessness. Bright red blood in diaper. On 2/27/08 fussy and x-ray of abdomen did not reveal foreign body.


Changed on 9/14/2017

VAERS ID: 311224 Before After
VAERS Form:(blank) 1
Age:0.56
Gender:Male
Location:Hawaii
Vaccinated:2007-11-28
Onset:2008-03-11
Submitted:2008-04-29
Entered:2008-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124DB / 2 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45888 / 2 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1391U / 2 3 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Dehydration, Diarrhoea haemorrhagic, Haematochezia, Intussusception, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal

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: Intussusception~Rotavirus (Rotateq)~4~0.80~Patient
Other Medications: None
Current Illness: None
Preexisting Conditions: Torticollis
Allergies:
Diagnostic Lab Data: Abdominal Ultrasound- Highly Suggestive of Intussusception. Gastrografin Barium Enema- Findings consistent with intussusception at the proximal to mid transverse colon level. No extravasation of contrast material was demonstrated. 6/2/08-records received-CBC 15,000.US consistent with intussusception.
CDC 'Split Type':

Write-up: Mother called the clinic on 3/12/08, baby started vomiting x 24 hours and just had a diarrhea stool that was bloody. She was instructed to bring him in to the clinic and arrived within the hour with more episodes of bloody stools. IV fluids were administered for treatment of dehydration. Child was admitted to the hospital for treatment after being diagnosed with Intussusception. Hydrostatic Reduction attempts were made but unsuccessful. Child was then taken to surgery for manual reduction of the intussusception. 5/2/08-ED records received-presented to ED with on and off abdominal pain times 1 week, vomiting with bouts of crying. DX: intussusception. Transferred. 6/2/08-records received for DOS 3/12-3/15/08-DC DX: Intussusception, status post manual reduction and incidental appendectomy. Gastrographin enema. 24 hour period of emesis starting on 3/11/08-became yellow green and developed intermittent colicky episodic abdominal pain with knees posterior to chest or stiffening. Listlessness. Bright red blood in diaper. On 2/27/08 fussy and x-ray of abdomen did not reveal foreign body.


Changed on 2/14/2018

VAERS ID: 311224 Before After
VAERS Form:1
Age:0.56
Gender:Male
Location:Hawaii
Vaccinated:2007-11-28
Onset:2008-03-11
Submitted:2008-04-29
Entered:2008-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124DB / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45888 / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1391U / 3 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Dehydration, Diarrhoea haemorrhagic, Haematochezia, Intussusception, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal

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: Intussusception~Rotavirus (Rotateq)~4~0.80~Patient
Other Medications: None
Current Illness: None
Preexisting Conditions: Torticollis
Allergies:
Diagnostic Lab Data: Abdominal Ultrasound- Highly Suggestive of Intussusception. Gastrografin Barium Enema- Findings consistent with intussusception at the proximal to mid transverse colon level. No extravasation of contrast material was demonstrated. 6/2/08-records received-CBC 15,000.US consistent with intussusception.
CDC 'Split Type':

Write-up: Mother called the clinic on 3/12/08, baby started vomiting x 24 hours and just had a diarrhea stool that was bloody. She was instructed to bring him in to the clinic and arrived within the hour with more episodes of bloody stools. IV fluids were administered for treatment of dehydration. Child was admitted to the hospital for treatment after being diagnosed with Intussusception. Hydrostatic Reduction attempts were made but unsuccessful. Child was then taken to surgery for manual reduction of the intussusception. 5/2/08-ED records received-presented to ED with on and off abdominal pain times 1 week, vomiting with bouts of crying. DX: intussusception. Transferred. 6/2/08-records received for DOS 3/12-3/15/08-DC DX: Intussusception, status post manual reduction and incidental appendectomy. Gastrographin enema. 24 hour period of emesis starting on 3/11/08-became yellow green and developed intermittent colicky episodic abdominal pain with knees posterior to chest or stiffening. Listlessness. Bright red blood in diaper. On 2/27/08 fussy and x-ray of abdomen did not reveal foreign body.


Changed on 6/14/2018

VAERS ID: 311224 Before After
VAERS Form:1
Age:0.56
Gender:Male
Location:Hawaii
Vaccinated:2007-11-28
Onset:2008-03-11
Submitted:2008-04-29
Entered:2008-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124DB / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45888 / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1391U / 3 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Dehydration, Diarrhoea haemorrhagic, Haematochezia, Intussusception, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal

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: Intussusception~Rotavirus (Rotateq)~4~0.80~Patient
Other Medications: None
Current Illness: None
Preexisting Conditions: Torticollis
Allergies:
Diagnostic Lab Data: Abdominal Ultrasound- Highly Suggestive of Intussusception. Gastrografin Barium Enema- Findings consistent with intussusception at the proximal to mid transverse colon level. No extravasation of contrast material was demonstrated. 6/2/08-records received-CBC 15,000.US consistent with intussusception.
CDC 'Split Type':

Write-up: Mother called the clinic on 3/12/08, baby started vomiting x 24 hours and just had a diarrhea stool that was bloody. She was instructed to bring him in to the clinic and arrived within the hour with more episodes of bloody stools. IV fluids were administered for treatment of dehydration. Child was admitted to the hospital for treatment after being diagnosed with Intussusception. Hydrostatic Reduction attempts were made but unsuccessful. Child was then taken to surgery for manual reduction of the intussusception. 5/2/08-ED records received-presented to ED with on and off abdominal pain times 1 week, vomiting with bouts of crying. DX: intussusception. Transferred. 6/2/08-records received for DOS 3/12-3/15/08-DC DX: Intussusception, status post manual reduction and incidental appendectomy. Gastrographin enema. 24 hour period of emesis starting on 3/11/08-became yellow green and developed intermittent colicky episodic abdominal pain with knees posterior to chest or stiffening. Listlessness. Bright red blood in diaper. On 2/27/08 fussy and x-ray of abdomen did not reveal foreign body.


Changed on 8/14/2018

VAERS ID: 311224 Before After
VAERS Form:1
Age:0.56
Gender:Male
Location:Hawaii
Vaccinated:2007-11-28
Onset:2008-03-11
Submitted:2008-04-29
Entered:2008-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124DB / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45888 / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1391U / 3 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Dehydration, Diarrhoea haemorrhagic, Haematochezia, Intussusception, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal

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: Intussusception~Rotavirus (Rotateq)~4~0.80~Patient
Other Medications: None
Current Illness: None
Preexisting Conditions: Torticollis
Allergies:
Diagnostic Lab Data: Abdominal Ultrasound- Highly Suggestive of Intussusception. Gastrografin Barium Enema- Findings consistent with intussusception at the proximal to mid transverse colon level. No extravasation of contrast material was demonstrated. 6/2/08-records received-CBC 15,000.US consistent with intussusception.
CDC 'Split Type':

Write-up: Mother called the clinic on 3/12/08, baby started vomiting x 24 hours and just had a diarrhea stool that was bloody. She was instructed to bring him in to the clinic and arrived within the hour with more episodes of bloody stools. IV fluids were administered for treatment of dehydration. Child was admitted to the hospital for treatment after being diagnosed with Intussusception. Hydrostatic Reduction attempts were made but unsuccessful. Child was then taken to surgery for manual reduction of the intussusception. 5/2/08-ED records received-presented to ED with on and off abdominal pain times 1 week, vomiting with bouts of crying. DX: intussusception. Transferred. 6/2/08-records received for DOS 3/12-3/15/08-DC DX: Intussusception, status post manual reduction and incidental appendectomy. Gastrographin enema. 24 hour period of emesis starting on 3/11/08-became yellow green and developed intermittent colicky episodic abdominal pain with knees posterior to chest or stiffening. Listlessness. Bright red blood in diaper. On 2/27/08 fussy and x-ray of abdomen did not reveal foreign body.


Changed on 9/14/2018

VAERS ID: 311224 Before After
VAERS Form:1
Age:0.56
Gender:Male
Location:Hawaii
Vaccinated:2007-11-28
Onset:2008-03-11
Submitted:2008-04-29
Entered:2008-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124DB / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45888 / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1391U / 3 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Dehydration, Diarrhoea haemorrhagic, Haematochezia, Intussusception, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal

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: Intussusception~Rotavirus (Rotateq)~4~0.80~Patient
Other Medications: None
Current Illness: None
Preexisting Conditions: Torticollis
Allergies:
Diagnostic Lab Data: Abdominal Ultrasound- Highly Suggestive of Intussusception. Gastrografin Barium Enema- Findings consistent with intussusception at the proximal to mid transverse colon level. No extravasation of contrast material was demonstrated. 6/2/08-records received-CBC 15,000.US consistent with intussusception.
CDC 'Split Type':

Write-up: Mother called the clinic on 3/12/08, baby started vomiting x 24 hours and just had a diarrhea stool that was bloody. She was instructed to bring him in to the clinic and arrived within the hour with more episodes of bloody stools. IV fluids were administered for treatment of dehydration. Child was admitted to the hospital for treatment after being diagnosed with Intussusception. Hydrostatic Reduction attempts were made but unsuccessful. Child was then taken to surgery for manual reduction of the intussusception. 5/2/08-ED records received-presented to ED with on and off abdominal pain times 1 week, vomiting with bouts of crying. DX: intussusception. Transferred. 6/2/08-records received for DOS 3/12-3/15/08-DC DX: Intussusception, status post manual reduction and incidental appendectomy. Gastrographin enema. 24 hour period of emesis starting on 3/11/08-became yellow green and developed intermittent colicky episodic abdominal pain with knees posterior to chest or stiffening. Listlessness. Bright red blood in diaper. On 2/27/08 fussy and x-ray of abdomen did not reveal foreign body.


Changed on 10/14/2018

VAERS ID: 311224 Before After
VAERS Form:1
Age:0.56
Gender:Male
Location:Hawaii
Vaccinated:2007-11-28
Onset:2008-03-11
Submitted:2008-04-29
Entered:2008-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124DB / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45888 / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1391U / 3 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Dehydration, Diarrhoea haemorrhagic, Haematochezia, Intussusception, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal

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: Intussusception~Rotavirus (Rotateq)~4~0.80~Patient
Other Medications: None
Current Illness: None
Preexisting Conditions: Torticollis
Allergies:
Diagnostic Lab Data: Abdominal Ultrasound- Highly Suggestive of Intussusception. Gastrografin Barium Enema- Findings consistent with intussusception at the proximal to mid transverse colon level. No extravasation of contrast material was demonstrated. 6/2/08-records received-CBC 15,000.US consistent with intussusception.
CDC 'Split Type':

Write-up: Mother called the clinic on 3/12/08, baby started vomiting x 24 hours and just had a diarrhea stool that was bloody. She was instructed to bring him in to the clinic and arrived within the hour with more episodes of bloody stools. IV fluids were administered for treatment of dehydration. Child was admitted to the hospital for treatment after being diagnosed with Intussusception. Hydrostatic Reduction attempts were made but unsuccessful. Child was then taken to surgery for manual reduction of the intussusception. 5/2/08-ED records received-presented to ED with on and off abdominal pain times 1 week, vomiting with bouts of crying. DX: intussusception. Transferred. 6/2/08-records received for DOS 3/12-3/15/08-DC DX: Intussusception, status post manual reduction and incidental appendectomy. Gastrographin enema. 24 hour period of emesis starting on 3/11/08-became yellow green and developed intermittent colicky episodic abdominal pain with knees posterior to chest or stiffening. Listlessness. Bright red blood in diaper. On 2/27/08 fussy and x-ray of abdomen did not reveal foreign body.

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