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This is VAERS ID 311829

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 311829
VAERS Form:
Age:0.5
Sex:Male
Location:Massachusetts
Vaccinated:2007-12-17
Onset:2008-05-05
Submitted:2008-05-07
Entered:2008-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B128AB / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF192AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC 854013C / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1392U / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium double contrast, Crying, Enema administration, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none during visit, had been seen at ER 2 days prior with vomiting, but had resolved before visit.
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: see above. AXR and air-contrast enema. LABS: KUB & abdominal US c/w IS. Air contrast enema reduced IS.
CDC 'Split Type':

Write-up: on 5/5/08, patient seen in the ER with worsening intermittent abdominal pain for 1 day. Child would bring knees to his chest and cry inconsolably for up to 20 minutes. AXR showed intussuception, and patient was seen by surgery who successfully performed"an air-contrast enema. Patient was admitted to the hospital. 6/3/08 Reviewed hospital medical records for 5/5-5/7/2008. FINAL DX: intussusception, enema reduced. Records reveal patient experiencec worsening abdominal pain, crying inconsolably, vomiting,


Changed on 12/8/2009

VAERS ID: 311829 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Massachusetts
Vaccinated:2007-12-17
Onset:2008-05-05
Submitted:2008-05-07
Entered:2008-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B128AB / 2 LL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B128AB / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF192AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC 854013C / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1392U / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium double contrast, Crying, Intussusception, Irritability, Lethargy, Urinary system X-ray, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Abdominal X-ray, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none during visit, had been seen at ER 2 days prior with vomiting, but had resolved before visit.
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: see above. AXR and air-contrast enema. LABS: KUB & abdominal US c/w IS. Air contrast enema reduced IS.
CDC 'Split Type':

Write-up: on 5/5/08, patient seen in the ER with worsening intermittent abdominal pain for 1 day. Child would bring knees to his chest and cry inconsolably for up to 20 minutes. AXR showed intussuception, and patient was seen by surgery who successfully performed"an performed an air-contrast enema. Patient was admitted to the hospital. 6/3/08 Reviewed hospital medical records for 5/5-5/7/2008. FINAL DX: intussusception, enema reduced. Records reveal patient experiencec worsening abdominal pain, crying inconsolably, vomiting, reduced oral intake, lethargy, irritability. Admitted for observation s/p enema reduction of IS. Improved & d/c to home.


Changed on 3/2/2010

VAERS ID: 311829 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Massachusetts
Vaccinated:2007-12-17
Onset:2008-05-05
Submitted:2008-05-07
Entered:2008-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B128AB / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF192AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC 854013C / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1392U / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium double contrast, Crying, Intussusception, Irritability, Lethargy, Urinary system X-ray, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Abdominal X-ray, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none during visit, had been seen at ER 2 days prior with vomiting, but had resolved before visit.
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: see above. AXR and air-contrast enema. LABS: KUB & abdominal US c/w IS. Air contrast enema reduced IS.
CDC 'Split Type':

Write-up: on 5/5/08, patient seen in the ER with worsening intermittent abdominal pain for 1 day. Child would bring knees to his chest and cry inconsolably for up to 20 minutes. AXR showed intussuception, and patient was seen by surgery who successfully performed an air-contrast enema. Patient was admitted to the hospital. 6/3/08 Reviewed hospital medical records for 5/5-5/7/2008. FINAL DX: intussusception, enema reduced. Records reveal patient experiencec worsening abdominal pain, crying inconsolably, vomiting, reduced oral intake, lethargy, irritability. Admitted for observation s/p enema reduction of IS. Improved & d/c to home.


Changed on 4/7/2010

VAERS ID: 311829 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Massachusetts
Vaccinated:2007-12-17
Onset:2008-05-05
Submitted:2008-05-07
Entered:2008-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B128AB / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF192AA / 2 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC 854013C / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1392U / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium double contrast, Crying, Intussusception, Irritability, Lethargy, Urinary system X-ray, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Abdominal X-ray, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none during visit, had been seen at ER 2 days prior with vomiting, but had resolved before visit.
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: see above. AXR and air-contrast enema. LABS: KUB & abdominal US c/w IS. Air contrast enema reduced IS.
CDC 'Split Type':

Write-up: on 5/5/08, patient seen in the ER with worsening intermittent abdominal pain for 1 day. Child would bring knees to his chest and cry inconsolably for up to 20 minutes. AXR showed intussuception, and patient was seen by surgery who successfully performed an air-contrast enema. Patient was admitted to the hospital. 6/3/08 Reviewed hospital medical records for 5/5-5/7/2008. FINAL DX: intussusception, enema reduced. Records reveal patient experiencec worsening abdominal pain, crying inconsolably, vomiting, reduced oral intake, lethargy, irritability. Admitted for observation s/p enema reduction of IS. Improved & d/c to home.


Changed on 8/31/2010

VAERS ID: 311829 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Massachusetts
Vaccinated:2007-12-17
Onset:2008-05-05
Submitted:2008-05-07
Entered:2008-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B128AB / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF192AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 854013C / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1392U / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium double contrast, Crying, Intussusception, Irritability, Lethargy, Urinary system X-ray, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Abdominal X-ray, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none during visit, had been seen at ER 2 days prior with vomiting, but had resolved before visit.
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: see above. AXR and air-contrast enema. LABS: KUB & abdominal US c/w IS. Air contrast enema reduced IS.
CDC 'Split Type':

Write-up: on 5/5/08, patient seen in the ER with worsening intermittent abdominal pain for 1 day. Child would bring knees to his chest and cry inconsolably for up to 20 minutes. AXR showed intussuception, and patient was seen by surgery who successfully performed an air-contrast enema. Patient was admitted to the hospital. 6/3/08 Reviewed hospital medical records for 5/5-5/7/2008. FINAL DX: intussusception, enema reduced. Records reveal patient experiencec worsening abdominal pain, crying inconsolably, vomiting, reduced oral intake, lethargy, irritability. Admitted for observation s/p enema reduction of IS. Improved & d/c to home.


Changed on 5/13/2013

VAERS ID: 311829 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Massachusetts
Vaccinated:2007-12-17
Onset:2008-05-05
Submitted:2008-05-07
Entered:2008-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B128AB / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF192AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 854013C / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1392U / 2 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1392U / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium double contrast, Crying, Intussusception, Irritability, Lethargy, Urinary system X-ray, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Abdominal X-ray, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none during visit, had been seen at ER 2 days prior with vomiting, but had resolved before visit.
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: see above. AXR and air-contrast enema. LABS: KUB & abdominal US c/w IS. Air contrast enema reduced IS.
CDC 'Split Type':

Write-up: on 5/5/08, patient seen in the ER with worsening intermittent abdominal pain for 1 day. Child would bring knees to his chest and cry inconsolably for up to 20 minutes. AXR showed intussuception, and patient was seen by surgery who successfully performed an air-contrast enema. Patient was admitted to the hospital. 6/3/08 Reviewed hospital medical records for 5/5-5/7/2008. FINAL DX: intussusception, enema reduced. Records reveal patient experiencec worsening abdominal pain, crying inconsolably, vomiting, reduced oral intake, lethargy, irritability. Admitted for observation s/p enema reduction of IS. Improved & d/c to home.


Changed on 4/14/2017

VAERS ID: 311829 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Massachusetts
Vaccinated:2007-12-17
Onset:2008-05-05
Submitted:2008-05-07
Entered:2008-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B128AB / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF192AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 854013C / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1392U / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium double contrast, Crying, Intussusception, Irritability, Lethargy, Urinary system X-ray, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Abdominal X-ray, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none during visit, had been seen at ER 2 days prior with vomiting, but had resolved before visit.
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: see above. AXR and air-contrast enema. LABS: KUB & abdominal US c/w IS. Air contrast enema reduced IS.
CDC 'Split Type':

Write-up: on 5/5/08, patient seen in the ER with worsening intermittent abdominal pain for 1 day. Child would bring knees to his chest and cry inconsolably for up to 20 minutes. AXR showed intussuception, and patient was seen by surgery who successfully performed an air-contrast enema. Patient was admitted to the hospital. 6/3/08 Reviewed hospital medical records for 5/5-5/7/2008. FINAL DX: intussusception, enema reduced. Records reveal patient experiencec worsening abdominal pain, crying inconsolably, vomiting, reduced oral intake, lethargy, irritability. Admitted for observation s/p enema reduction of IS. Improved & d/c to home.


Changed on 9/14/2017

VAERS ID: 311829 Before After
VAERS Form:(blank) 1
Age:0.5
Sex:Male
Location:Massachusetts
Vaccinated:2007-12-17
Onset:2008-05-05
Submitted:2008-05-07
Entered:2008-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B128AB / 2 3 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF192AA / 2 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 854013C / 2 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1392U / 2 3 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium double contrast, Crying, Intussusception, X-ray abnormal, Enema administration, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none during visit, had been seen at ER 2 days prior with vomiting, but had resolved before visit.
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: see above. AXR and air-contrast enema. LABS: KUB & abdominal US c/w IS. Air contrast enema reduced IS.
CDC 'Split Type':

Write-up: on 5/5/08, patient seen in the ER with worsening intermittent abdominal pain for 1 day. Child would bring knees to his chest and cry inconsolably for up to 20 minutes. AXR showed intussuception, and patient was seen by surgery who successfully performed an air-contrast enema. Patient was admitted to the hospital. 6/3/08 Reviewed hospital medical records for 5/5-5/7/2008. FINAL DX: intussusception, enema reduced. Records reveal patient experiencec worsening abdominal pain, crying inconsolably, vomiting, reduced oral intake, lethargy, irritability. Admitted for observation s/p enema reduction of IS. Improved & d/c to home.


Changed on 2/14/2018

VAERS ID: 311829 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:Massachusetts
Vaccinated:2007-12-17
Onset:2008-05-05
Submitted:2008-05-07
Entered:2008-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B128AB / 3 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF192AA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 854013C / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1392U / 3 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium double contrast, Crying, Intussusception, X-ray abnormal, Enema administration, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none during visit, had been seen at ER 2 days prior with vomiting, but had resolved before visit.
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: see above. AXR and air-contrast enema. LABS: KUB & abdominal US c/w IS. Air contrast enema reduced IS.
CDC 'Split Type':

Write-up: on 5/5/08, patient seen in the ER with worsening intermittent abdominal pain for 1 day. Child would bring knees to his chest and cry inconsolably for up to 20 minutes. AXR showed intussuception, and patient was seen by surgery who successfully performed an air-contrast enema. Patient was admitted to the hospital. 6/3/08 Reviewed hospital medical records for 5/5-5/7/2008. FINAL DX: intussusception, enema reduced. Records reveal patient experiencec worsening abdominal pain, crying inconsolably, vomiting, reduced oral intake, lethargy, irritability. Admitted for observation s/p enema reduction of IS. Improved & d/c to home.


Changed on 6/14/2018

VAERS ID: 311829 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:Massachusetts
Vaccinated:2007-12-17
Onset:2008-05-05
Submitted:2008-05-07
Entered:2008-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B128AB / 3 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF192AA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 854013C / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1392U / 3 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium double contrast, Crying, Intussusception, X-ray abnormal, Enema administration, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none during visit, had been seen at ER 2 days prior with vomiting, but had resolved before visit.
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: see above. AXR and air-contrast enema. LABS: KUB & abdominal US c/w IS. Air contrast enema reduced IS.
CDC 'Split Type':

Write-up: on 5/5/08, patient seen in the ER with worsening intermittent abdominal pain for 1 day. Child would bring knees to his chest and cry inconsolably for up to 20 minutes. AXR showed intussuception, and patient was seen by surgery who successfully performed an air-contrast enema. Patient was admitted to the hospital. 6/3/08 Reviewed hospital medical records for 5/5-5/7/2008. FINAL DX: intussusception, enema reduced. Records reveal patient experiencec worsening abdominal pain, crying inconsolably, vomiting, reduced oral intake, lethargy, irritability. Admitted for observation s/p enema reduction of IS. Improved & d/c to home.


Changed on 8/14/2018

VAERS ID: 311829 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:Massachusetts
Vaccinated:2007-12-17
Onset:2008-05-05
Submitted:2008-05-07
Entered:2008-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B128AB / 3 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF192AA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 854013C / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1392U / 3 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium double contrast, Crying, Intussusception, X-ray abnormal, Enema administration, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none during visit, had been seen at ER 2 days prior with vomiting, but had resolved before visit.
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: see above. AXR and air-contrast enema. LABS: KUB & abdominal US c/w IS. Air contrast enema reduced IS.
CDC 'Split Type':

Write-up: on 5/5/08, patient seen in the ER with worsening intermittent abdominal pain for 1 day. Child would bring knees to his chest and cry inconsolably for up to 20 minutes. AXR showed intussuception, and patient was seen by surgery who successfully performed an air-contrast enema. Patient was admitted to the hospital. 6/3/08 Reviewed hospital medical records for 5/5-5/7/2008. FINAL DX: intussusception, enema reduced. Records reveal patient experiencec worsening abdominal pain, crying inconsolably, vomiting, reduced oral intake, lethargy, irritability. Admitted for observation s/p enema reduction of IS. Improved & d/c to home.


Changed on 9/14/2018

VAERS ID: 311829 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:Massachusetts
Vaccinated:2007-12-17
Onset:2008-05-05
Submitted:2008-05-07
Entered:2008-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B128AB / 3 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF192AA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 854013C / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1392U / 3 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium double contrast, Crying, Intussusception, X-ray abnormal, Enema administration, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none during visit, had been seen at ER 2 days prior with vomiting, but had resolved before visit.
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: see above. AXR and air-contrast enema. LABS: KUB & abdominal US c/w IS. Air contrast enema reduced IS.
CDC 'Split Type':

Write-up: on 5/5/08, patient seen in the ER with worsening intermittent abdominal pain for 1 day. Child would bring knees to his chest and cry inconsolably for up to 20 minutes. AXR showed intussuception, and patient was seen by surgery who successfully performed an air-contrast enema. Patient was admitted to the hospital. 6/3/08 Reviewed hospital medical records for 5/5-5/7/2008. FINAL DX: intussusception, enema reduced. Records reveal patient experiencec worsening abdominal pain, crying inconsolably, vomiting, reduced oral intake, lethargy, irritability. Admitted for observation s/p enema reduction of IS. Improved & d/c to home.


Changed on 10/14/2018

VAERS ID: 311829 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:Massachusetts
Vaccinated:2007-12-17
Onset:2008-05-05
Submitted:2008-05-07
Entered:2008-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B128AB / 3 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF192AA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 854013C / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1392U / 3 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium double contrast, Crying, Intussusception, X-ray abnormal, Enema administration, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none during visit, had been seen at ER 2 days prior with vomiting, but had resolved before visit.
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: see above. AXR and air-contrast enema. LABS: KUB & abdominal US c/w IS. Air contrast enema reduced IS.
CDC 'Split Type':

Write-up: on 5/5/08, patient seen in the ER with worsening intermittent abdominal pain for 1 day. Child would bring knees to his chest and cry inconsolably for up to 20 minutes. AXR showed intussuception, and patient was seen by surgery who successfully performed an air-contrast enema. Patient was admitted to the hospital. 6/3/08 Reviewed hospital medical records for 5/5-5/7/2008. FINAL DX: intussusception, enema reduced. Records reveal patient experiencec worsening abdominal pain, crying inconsolably, vomiting, reduced oral intake, lethargy, irritability. Admitted for observation s/p enema reduction of IS. Improved & d/c to home.

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