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This is VAERS ID 313034

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 313034
VAERS Form:
Age:0.2
Gender:Male
Location:Missouri
Vaccinated:2008-03-31
Onset:2008-04-26
Submitted:2008-05-22
Entered:2008-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF242AB / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC CS4763 / 0 LL / ID
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1839U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium double contrast, Barium enema, Abnormal behaviour, Abdominal X-ray

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NO
Preexisting Conditions: NO
Allergies:
Diagnostic Lab Data: Contrast enema-- intussusception. Then OR with Exploratory lap LABS: abdominal x-ray revealed distal IS
CDC 'Split Type':

Write-up: Presented to ER (April 26 th 2008)for fussiness, decreased appt and acting /"strange/" for several hours. In ER passed large bloody stool. BE showed intussusception. Despite multiple attempts, it could not be reduced. Flown to Hospital. Arrived early"April 27th. Exploratory Laparotomy after resuscitation ws performed by Dr. In OR, he had reduction of intussusception with right hemicolectomy and ileostomy. Total hospital stay was 10 days (D/C was May 7th). He was re-admitted 2 days later for vomiti


Changed on 12/8/2009

VAERS ID: 313034 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Missouri
Vaccinated:2008-03-31
Onset:2008-04-26
Submitted:2008-05-22
Entered:2008-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 0 RL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF242AB / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC CS4763 / 0 LL / ID
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1839U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium double contrast, Barium enema, Crying, Dehydration, Diarrhoea haemorrhagic, Ileostomy, Intussusception, Irritability, Resuscitation, Vomiting, X-ray abnormal, Explorative laparotomy, Abnormal behaviour, Decreased appetite, Abdominal X-ray, Colectomy, Oral intake reduced

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NO
Preexisting Conditions: NO
Allergies:
Diagnostic Lab Data: Contrast enema-- intussusception. Then OR with Exploratory lap LABS: abdominal x-ray revealed distal IS
CDC 'Split Type':

Write-up: Presented to ER (April 26 th 2008)for fussiness, decreased appt and acting /"strange/" "strange" for several hours. In ER passed large bloody stool. BE showed intussusception. Despite multiple attempts, it could not be reduced. Flown to Hospital. Arrived early"April early April 27th. Exploratory Laparotomy after resuscitation ws performed by Dr. In OR, he had reduction of intussusception with right hemicolectomy and ileostomy. Total hospital stay was 10 days (D/C was May 7th). He was re-admitted 2 days later for vomiti vomiting and dehydration. He is now home. 5/29/08 Reviewed hospital medical records for 4/27-5/7/2008. FINAL DX: Intussusception Records reveal patient experienced irritability, reduced oral intake, inconsolable crying, abdominal pain, emesis. Seen at outlying ER where BE revealed IS & initially reduced it. Had bloody diarrhea & bilious emesis in ER & transferred to higher level of care. Attempt to reduce w/air contrast enema unsuccessful & taken to OR. 8/8 Received operative report which reveals patient had exp lap, reduction of IS, right hemicolectomy w/ileostomy & central line placement.


Changed on 3/2/2010

VAERS ID: 313034 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Missouri
Vaccinated:2008-03-31
Onset:2008-04-26
Submitted:2008-05-22
Entered:2008-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF242AB / 0 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC CS4763 / 0 LL / ID
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1839U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium double contrast, Barium enema, Crying, Dehydration, Diarrhoea haemorrhagic, Ileostomy, Intussusception, Irritability, Resuscitation, Vomiting, X-ray abnormal, Explorative laparotomy, Abnormal behaviour, Decreased appetite, Abdominal X-ray, Colectomy, Oral intake reduced

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NO
Preexisting Conditions: NO
Allergies:
Diagnostic Lab Data: Contrast enema-- intussusception. Then OR with Exploratory lap LABS: abdominal x-ray revealed distal IS
CDC 'Split Type':

Write-up: Presented to ER (April 26 th 2008)for fussiness, decreased appt and acting "strange" for several hours. In ER passed large bloody stool. BE showed intussusception. Despite multiple attempts, it could not be reduced. Flown to Hospital. Arrived early April 27th. Exploratory Laparotomy after resuscitation ws performed by Dr. In OR, he had reduction of intussusception with right hemicolectomy and ileostomy. Total hospital stay was 10 days (D/C was May 7th). He was re-admitted 2 days later for vomiting and dehydration. He is now home. 5/29/08 Reviewed hospital medical records for 4/27-5/7/2008. FINAL DX: Intussusception Records reveal patient experienced irritability, reduced oral intake, inconsolable crying, abdominal pain, emesis. Seen at outlying ER where BE revealed IS & initially reduced it. Had bloody diarrhea & bilious emesis in ER & transferred to higher level of care. Attempt to reduce w/air contrast enema unsuccessful & taken to OR. 8/8 Received operative report which reveals patient had exp lap, reduction of IS, right hemicolectomy w/ileostomy & central line placement.


Changed on 4/7/2010

VAERS ID: 313034 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Missouri
Vaccinated:2008-03-31
Onset:2008-04-26
Submitted:2008-05-22
Entered:2008-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF242AB / 0 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC CS4763 / 0 LL / ID
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1839U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium double contrast, Barium enema, Crying, Dehydration, Diarrhoea haemorrhagic, Ileostomy, Intussusception, Irritability, Resuscitation, Vomiting, X-ray abnormal, Explorative laparotomy, Abnormal behaviour, Decreased appetite, Abdominal X-ray, Colectomy, Oral intake reduced

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NO
Preexisting Conditions: NO
Allergies:
Diagnostic Lab Data: Contrast enema-- intussusception. Then OR with Exploratory lap LABS: abdominal x-ray revealed distal IS
CDC 'Split Type':

Write-up: Presented to ER (April 26 th 2008)for fussiness, decreased appt and acting "strange" for several hours. In ER passed large bloody stool. BE showed intussusception. Despite multiple attempts, it could not be reduced. Flown to Hospital. Arrived early April 27th. Exploratory Laparotomy after resuscitation ws performed by Dr. In OR, he had reduction of intussusception with right hemicolectomy and ileostomy. Total hospital stay was 10 days (D/C was May 7th). He was re-admitted 2 days later for vomiting and dehydration. He is now home. 5/29/08 Reviewed hospital medical records for 4/27-5/7/2008. FINAL DX: Intussusception Records reveal patient experienced irritability, reduced oral intake, inconsolable crying, abdominal pain, emesis. Seen at outlying ER where BE revealed IS & initially reduced it. Had bloody diarrhea & bilious emesis in ER & transferred to higher level of care. Attempt to reduce w/air contrast enema unsuccessful & taken to OR. 8/8 Received operative report which reveals patient had exp lap, reduction of IS, right hemicolectomy w/ileostomy & central line placement.


Changed on 8/31/2010

VAERS ID: 313034 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Missouri
Vaccinated:2008-03-31
Onset:2008-04-26
Submitted:2008-05-22
Entered:2008-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF242AB / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH CS4763 / 0 LL / ID
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1839U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium double contrast, Barium enema, Crying, Dehydration, Diarrhoea haemorrhagic, Ileostomy, Intussusception, Irritability, Resuscitation, Vomiting, X-ray abnormal, Explorative laparotomy, Abnormal behaviour, Decreased appetite, Abdominal X-ray, Colectomy, Oral intake reduced

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NO
Preexisting Conditions: NO
Allergies:
Diagnostic Lab Data: Contrast enema-- intussusception. Then OR with Exploratory lap LABS: abdominal x-ray revealed distal IS
CDC 'Split Type':

Write-up: Presented to ER (April 26 th 2008)for fussiness, decreased appt and acting "strange" for several hours. In ER passed large bloody stool. BE showed intussusception. Despite multiple attempts, it could not be reduced. Flown to Hospital. Arrived early April 27th. Exploratory Laparotomy after resuscitation ws performed by Dr. In OR, he had reduction of intussusception with right hemicolectomy and ileostomy. Total hospital stay was 10 days (D/C was May 7th). He was re-admitted 2 days later for vomiting and dehydration. He is now home. 5/29/08 Reviewed hospital medical records for 4/27-5/7/2008. FINAL DX: Intussusception Records reveal patient experienced irritability, reduced oral intake, inconsolable crying, abdominal pain, emesis. Seen at outlying ER where BE revealed IS & initially reduced it. Had bloody diarrhea & bilious emesis in ER & transferred to higher level of care. Attempt to reduce w/air contrast enema unsuccessful & taken to OR. 8/8 Received operative report which reveals patient had exp lap, reduction of IS, right hemicolectomy w/ileostomy & central line placement.


Changed on 2/13/2013

VAERS ID: 313034 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Missouri
Vaccinated:2008-03-31
Onset:2008-04-26
Submitted:2008-05-22
Entered:2008-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF242AB / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH CS4763 / 0 LL / ID
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1839U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium double contrast, Barium enema, Crying, Dehydration, Diarrhoea haemorrhagic, Ileostomy, Intussusception, Irritability, Resuscitation, Vomiting, X-ray abnormal, Explorative laparotomy, Abnormal behaviour, Decreased appetite, Abdominal X-ray, Colectomy, Oral intake reduced

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NO
Preexisting Conditions: NO
Allergies:
Diagnostic Lab Data: Contrast enema-- intussusception. Then OR with Exploratory lap LABS: abdominal x-ray revealed distal IS
CDC 'Split Type':

Write-up: Presented to ER (April 26 th 2008)for 2008) for fussiness, decreased appt and acting "strange" for several hours. In ER passed large bloody stool. BE showed intussusception. Despite multiple attempts, it could not be reduced. Flown to Hospital. Arrived early April 27th. Exploratory Laparotomy after resuscitation ws performed by Dr. In OR, he had reduction of intussusception with right hemicolectomy and ileostomy. Total hospital stay was 10 days (D/C was May 7th). He was re-admitted 2 days later for vomiting and dehydration. He is now home. 5/29/08 Reviewed hospital medical records for 4/27-5/7/2008. FINAL DX: Intussusception Records reveal patient experienced irritability, reduced oral intake, inconsolable crying, abdominal pain, emesis. Seen at outlying ER where BE revealed IS & initially reduced it. Had bloody diarrhea & bilious emesis in ER & transferred to higher level of care. Attempt to reduce w/air contrast enema unsuccessful & taken to OR. 8/8 Received operative report which reveals patient had exp lap, reduction of IS, right hemicolectomy w/ileostomy & central line placement.


Changed on 5/13/2013

VAERS ID: 313034 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Missouri
Vaccinated:2008-03-31
Onset:2008-04-26
Submitted:2008-05-22
Entered:2008-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF242AB / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH CS4763 / 0 LL / ID
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1839U / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1839U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium double contrast, Barium enema, Crying, Dehydration, Diarrhoea haemorrhagic, Ileostomy, Intussusception, Irritability, Resuscitation, Vomiting, X-ray abnormal, Explorative laparotomy, Abnormal behaviour, Decreased appetite, Abdominal X-ray, Colectomy, Oral intake reduced

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NO
Preexisting Conditions: NO
Allergies:
Diagnostic Lab Data: Contrast enema-- intussusception. Then OR with Exploratory lap LABS: abdominal x-ray revealed distal IS
CDC 'Split Type':

Write-up: Presented to ER (April 26 th 2008) for fussiness, decreased appt and acting "strange" for several hours. In ER passed large bloody stool. BE showed intussusception. Despite multiple attempts, it could not be reduced. Flown to Hospital. Arrived early April 27th. Exploratory Laparotomy after resuscitation ws performed by Dr. In OR, he had reduction of intussusception with right hemicolectomy and ileostomy. Total hospital stay was 10 days (D/C was May 7th). He was re-admitted 2 days later for vomiting and dehydration. He is now home. 5/29/08 Reviewed hospital medical records for 4/27-5/7/2008. FINAL DX: Intussusception Records reveal patient experienced irritability, reduced oral intake, inconsolable crying, abdominal pain, emesis. Seen at outlying ER where BE revealed IS & initially reduced it. Had bloody diarrhea & bilious emesis in ER & transferred to higher level of care. Attempt to reduce w/air contrast enema unsuccessful & taken to OR. 8/8 Received operative report which reveals patient had exp lap, reduction of IS, right hemicolectomy w/ileostomy & central line placement.


Changed on 6/14/2014

VAERS ID: 313034 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Missouri
Vaccinated:2008-03-31
Onset:2008-04-26
Submitted:2008-05-22
Entered:2008-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF242AB / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH CS4763 / 0 LL / ID
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1839U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium double contrast, Barium enema, Crying, Dehydration, Diarrhoea haemorrhagic, Ileostomy, Intussusception, Irritability, Resuscitation, Vomiting, X-ray abnormal, Explorative laparotomy, Abnormal behaviour, Decreased appetite, Abdominal X-ray, Colectomy, Oral intake reduced

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NO
Preexisting Conditions: NO
Allergies:
Diagnostic Lab Data: Contrast enema-- intussusception. Then OR with Exploratory lap LABS: abdominal x-ray revealed distal IS
CDC 'Split Type':

Write-up: Presented to ER (April 26 th 2008) for fussiness, decreased appt and acting "strange" for several hours. In ER passed large bloody stool. BE showed intussusception. Despite multiple attempts, it could not be reduced. Flown to Hospital. Arrived early April 27th. Exploratory Laparotomy after resuscitation ws performed by Dr. In OR, he had reduction of intussusception with right hemicolectomy and ileostomy. Total hospital stay was 10 days (D/C was May 7th). He was re-admitted 2 days later for vomiting and dehydration. He is now home. 5/29/08 Reviewed hospital medical records for 4/27-5/7/2008. FINAL DX: Intussusception Records reveal patient experienced irritability, reduced oral intake, inconsolable crying, abdominal pain, emesis. Seen at outlying ER where BE revealed IS & initially reduced it. Had bloody diarrhea & bilious emesis in ER & transferred to higher level of care. Attempt to reduce w/air contrast enema unsuccessful & taken to OR. 8/8 Received operative report which reveals patient had exp lap, reduction of IS, right hemicolectomy w/ileostomy & central line placement.


Changed on 3/14/2015

VAERS ID: 313034 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Missouri
Vaccinated:2008-03-31
Onset:2008-04-26
Submitted:2008-05-22
Entered:2008-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF242AB / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH CS4763 / 0 LL / ID
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1839U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium double contrast, Barium enema, Crying, Dehydration, Diarrhoea haemorrhagic, Ileostomy, Intussusception, Irritability, Resuscitation, Vomiting, X-ray abnormal, Explorative laparotomy, Abnormal behaviour, Decreased appetite, Abdominal X-ray, Colectomy, Oral intake reduced

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NO
Preexisting Conditions: NO
Allergies:
Diagnostic Lab Data: Contrast enema-- intussusception. Then OR with Exploratory lap LABS: abdominal x-ray revealed distal IS
CDC 'Split Type':

Write-up: Presented to ER (April 26 th 2008) for fussiness, decreased appt and acting "strange" for several hours. In ER passed large bloody stool. BE showed intussusception. Despite multiple attempts, it could not be reduced. Flown to Hospital. Arrived early April 27th. Exploratory Laparotomy after resuscitation ws performed by Dr. In OR, he had reduction of intussusception with right hemicolectomy and ileostomy. Total hospital stay was 10 days (D/C was May 7th). He was re-admitted 2 days later for vomiting and dehydration. He is now home. 5/29/08 Reviewed hospital medical records for 4/27-5/7/2008. FINAL DX: Intussusception Records reveal patient experienced irritability, reduced oral intake, inconsolable crying, abdominal pain, emesis. Seen at outlying ER where BE revealed IS & initially reduced it. Had bloody diarrhea & bilious emesis in ER & transferred to higher level of care. Attempt to reduce w/air contrast enema unsuccessful & taken to OR. 8/8 Received operative report which reveals patient had exp lap, reduction of IS, right hemicolectomy w/ileostomy & central line placement.


Changed on 4/14/2017

VAERS ID: 313034 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Missouri
Vaccinated:2008-03-31
Onset:2008-04-26
Submitted:2008-05-22
Entered:2008-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF242AB / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH CS4763 / 0 LL / ID
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1839U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium double contrast, Barium enema, Crying, Dehydration, Diarrhoea haemorrhagic, Ileostomy, Intussusception, Irritability, Resuscitation, Vomiting, X-ray abnormal, Explorative laparotomy, Abnormal behaviour, Decreased appetite, Abdominal X-ray, Colectomy, Oral intake reduced

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NO
Preexisting Conditions: NO
Allergies:
Diagnostic Lab Data: Contrast enema-- intussusception. Then OR with Exploratory lap LABS: abdominal x-ray revealed distal IS
CDC 'Split Type':

Write-up: Presented to ER (April 26 th 2008) for fussiness, decreased appt and acting "strange" for several hours. In ER passed large bloody stool. BE showed intussusception. Despite multiple attempts, it could not be reduced. Flown to Hospital. Arrived early April 27th. Exploratory Laparotomy after resuscitation ws performed by Dr. In OR, he had reduction of intussusception with right hemicolectomy and ileostomy. Total hospital stay was 10 days (D/C was May 7th). He was re-admitted 2 days later for vomiting and dehydration. He is now home. 5/29/08 Reviewed hospital medical records for 4/27-5/7/2008. FINAL DX: Intussusception Records reveal patient experienced irritability, reduced oral intake, inconsolable crying, abdominal pain, emesis. Seen at outlying ER where BE revealed IS & initially reduced it. Had bloody diarrhea & bilious emesis in ER & transferred to higher level of care. Attempt to reduce w/air contrast enema unsuccessful & taken to OR. 8/8 Received operative report which reveals patient had exp lap, reduction of IS, right hemicolectomy w/ileostomy & central line placement.


Changed on 9/14/2017

VAERS ID: 313034 Before After
VAERS Form:(blank) 1
Age:0.2
Gender:Male
Location:Missouri
Vaccinated:2008-03-31
Onset:2008-04-26
Submitted:2008-05-22
Entered:2008-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 0 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF242AB / 0 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH CS4763 / 0 1 LL / ID
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1839U / 0 1 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Dehydration, Ileostomy, Intussusception, Irritability, Resuscitation, Vomiting, Explorative laparotomy, Abnormal behaviour, Decreased appetite, Colectomy

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NO
Preexisting Conditions: NO
Allergies:
Diagnostic Lab Data: Contrast enema-- intussusception. Then OR with Exploratory lap LABS: abdominal x-ray revealed distal IS
CDC 'Split Type':

Write-up: Presented to ER (April 26 th 2008) for fussiness, decreased appt and acting "strange" for several hours. In ER passed large bloody stool. BE showed intussusception. Despite multiple attempts, it could not be reduced. Flown to Hospital. Arrived early April 27th. Exploratory Laparotomy after resuscitation ws performed by Dr. In OR, he had reduction of intussusception with right hemicolectomy and ileostomy. Total hospital stay was 10 days (D/C was May 7th). He was re-admitted 2 days later for vomiting and dehydration. He is now home. 5/29/08 Reviewed hospital medical records for 4/27-5/7/2008. FINAL DX: Intussusception Records reveal patient experienced irritability, reduced oral intake, inconsolable crying, abdominal pain, emesis. Seen at outlying ER where BE revealed IS & initially reduced it. Had bloody diarrhea & bilious emesis in ER & transferred to higher level of care. Attempt to reduce w/air contrast enema unsuccessful & taken to OR. 8/8 Received operative report which reveals patient had exp lap, reduction of IS, right hemicolectomy w/ileostomy & central line placement.


Changed on 2/14/2018

VAERS ID: 313034 Before After
VAERS Form:1
Age:0.2
Gender:Male
Location:Missouri
Vaccinated:2008-03-31
Onset:2008-04-26
Submitted:2008-05-22
Entered:2008-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF242AB / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH CS4763 / 1 LL / ID
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1839U / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Dehydration, Ileostomy, Intussusception, Irritability, Resuscitation, Vomiting, Explorative laparotomy, Abnormal behaviour, Decreased appetite, Colectomy

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NO
Preexisting Conditions: NO
Allergies:
Diagnostic Lab Data: Contrast enema-- intussusception. Then OR with Exploratory lap LABS: abdominal x-ray revealed distal IS
CDC 'Split Type':

Write-up: Presented to ER (April 26 th 2008) for fussiness, decreased appt and acting "strange" for several hours. In ER passed large bloody stool. BE showed intussusception. Despite multiple attempts, it could not be reduced. Flown to Hospital. Arrived early April 27th. Exploratory Laparotomy after resuscitation ws performed by Dr. In OR, he had reduction of intussusception with right hemicolectomy and ileostomy. Total hospital stay was 10 days (D/C was May 7th). He was re-admitted 2 days later for vomiting and dehydration. He is now home. 5/29/08 Reviewed hospital medical records for 4/27-5/7/2008. FINAL DX: Intussusception Records reveal patient experienced irritability, reduced oral intake, inconsolable crying, abdominal pain, emesis. Seen at outlying ER where BE revealed IS & initially reduced it. Had bloody diarrhea & bilious emesis in ER & transferred to higher level of care. Attempt to reduce w/air contrast enema unsuccessful & taken to OR. 8/8 Received operative report which reveals patient had exp lap, reduction of IS, right hemicolectomy w/ileostomy & central line placement.


Changed on 6/14/2018

VAERS ID: 313034 Before After
VAERS Form:1
Age:0.2
Gender:Male
Location:Missouri
Vaccinated:2008-03-31
Onset:2008-04-26
Submitted:2008-05-22
Entered:2008-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF242AB / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH CS4763 / 1 LL / ID
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1839U / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Dehydration, Ileostomy, Intussusception, Irritability, Resuscitation, Vomiting, Explorative laparotomy, Abnormal behaviour, Decreased appetite, Colectomy

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NO
Preexisting Conditions: NO
Allergies:
Diagnostic Lab Data: Contrast enema-- intussusception. Then OR with Exploratory lap LABS: abdominal x-ray revealed distal IS
CDC 'Split Type':

Write-up: Presented to ER (April 26 th 2008) for fussiness, decreased appt and acting "strange" for several hours. In ER passed large bloody stool. BE showed intussusception. Despite multiple attempts, it could not be reduced. Flown to Hospital. Arrived early April 27th. Exploratory Laparotomy after resuscitation ws performed by Dr. In OR, he had reduction of intussusception with right hemicolectomy and ileostomy. Total hospital stay was 10 days (D/C was May 7th). He was re-admitted 2 days later for vomiting and dehydration. He is now home. 5/29/08 Reviewed hospital medical records for 4/27-5/7/2008. FINAL DX: Intussusception Records reveal patient experienced irritability, reduced oral intake, inconsolable crying, abdominal pain, emesis. Seen at outlying ER where BE revealed IS & initially reduced it. Had bloody diarrhea & bilious emesis in ER & transferred to higher level of care. Attempt to reduce w/air contrast enema unsuccessful & taken to OR. 8/8 Received operative report which reveals patient had exp lap, reduction of IS, right hemicolectomy w/ileostomy & central line placement.


Changed on 8/14/2018

VAERS ID: 313034 Before After
VAERS Form:1
Age:0.2
Gender:Male
Location:Missouri
Vaccinated:2008-03-31
Onset:2008-04-26
Submitted:2008-05-22
Entered:2008-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF242AB / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH CS4763 / 1 LL / ID
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1839U / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Dehydration, Ileostomy, Intussusception, Irritability, Resuscitation, Vomiting, Explorative laparotomy, Abnormal behaviour, Decreased appetite, Colectomy

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NO
Preexisting Conditions: NO
Allergies:
Diagnostic Lab Data: Contrast enema-- intussusception. Then OR with Exploratory lap LABS: abdominal x-ray revealed distal IS
CDC 'Split Type':

Write-up: Presented to ER (April 26 th 2008) for fussiness, decreased appt and acting "strange" for several hours. In ER passed large bloody stool. BE showed intussusception. Despite multiple attempts, it could not be reduced. Flown to Hospital. Arrived early April 27th. Exploratory Laparotomy after resuscitation ws performed by Dr. In OR, he had reduction of intussusception with right hemicolectomy and ileostomy. Total hospital stay was 10 days (D/C was May 7th). He was re-admitted 2 days later for vomiting and dehydration. He is now home. 5/29/08 Reviewed hospital medical records for 4/27-5/7/2008. FINAL DX: Intussusception Records reveal patient experienced irritability, reduced oral intake, inconsolable crying, abdominal pain, emesis. Seen at outlying ER where BE revealed IS & initially reduced it. Had bloody diarrhea & bilious emesis in ER & transferred to higher level of care. Attempt to reduce w/air contrast enema unsuccessful & taken to OR. 8/8 Received operative report which reveals patient had exp lap, reduction of IS, right hemicolectomy w/ileostomy & central line placement.


Changed on 9/14/2018

VAERS ID: 313034 Before After
VAERS Form:1
Age:0.2
Gender:Male
Location:Missouri
Vaccinated:2008-03-31
Onset:2008-04-26
Submitted:2008-05-22
Entered:2008-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF242AB / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH CS4763 / 1 LL / ID
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1839U / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Dehydration, Ileostomy, Intussusception, Irritability, Resuscitation, Vomiting, Explorative laparotomy, Abnormal behaviour, Decreased appetite, Colectomy

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NO
Preexisting Conditions: NO
Allergies:
Diagnostic Lab Data: Contrast enema-- intussusception. Then OR with Exploratory lap LABS: abdominal x-ray revealed distal IS
CDC 'Split Type':

Write-up: Presented to ER (April 26 th 2008) for fussiness, decreased appt and acting "strange" for several hours. In ER passed large bloody stool. BE showed intussusception. Despite multiple attempts, it could not be reduced. Flown to Hospital. Arrived early April 27th. Exploratory Laparotomy after resuscitation ws performed by Dr. In OR, he had reduction of intussusception with right hemicolectomy and ileostomy. Total hospital stay was 10 days (D/C was May 7th). He was re-admitted 2 days later for vomiting and dehydration. He is now home. 5/29/08 Reviewed hospital medical records for 4/27-5/7/2008. FINAL DX: Intussusception Records reveal patient experienced irritability, reduced oral intake, inconsolable crying, abdominal pain, emesis. Seen at outlying ER where BE revealed IS & initially reduced it. Had bloody diarrhea & bilious emesis in ER & transferred to higher level of care. Attempt to reduce w/air contrast enema unsuccessful & taken to OR. 8/8 Received operative report which reveals patient had exp lap, reduction of IS, right hemicolectomy w/ileostomy & central line placement.

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