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This is VAERS ID 314989

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 314989
VAERS Form:
Age:0.2
Sex:Male
Location:Florida
Vaccinated:2008-03-07
Onset:2008-03-26
Submitted:2008-06-05
Entered:2008-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS SKB AC21B133AA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR PMC UF343AD / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC WY C35170 / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. MSD 0975U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Blood culture positive, Haematochezia, Haematocrit decreased, Enema administration

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: CONGESTION
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 03/26/08 ULTRASOUND DONE AND 03/27/08 GASTROGRAFIN ENEMA DONE WHICH REVEALED AN INTUSSUSEPTION THAT COULD NOT BE REDUCED 6/19/08-records received-WBC 537, HGB 9.7, HCT 28.6, segs 69.3, lymphs 22.4. Urine 1+ protein, ketone 1+ and WBC 7-10,
CDC 'Split Type':

Write-up: 03/26/08 PRESENTED TO HOSPITAL W/ VOMITING, PALE IN COLOR, AND BRIGHT RED BLOOD IN DIAPER. LAB WORK AND IV''''S DONE PRIOR TO TRANSFER TO HOSPITAL. 6/19/08-records received for DOS 3/26/08-presented to ED with C/O blood in stool, low grade fever, vomiting."Assessment: abdominal pain, vomiting, rectal bleeding. Transferred. 6/24/08-records received for DOS 3/26-3/27/08- DX: Intussusception. Vomiting began day prior to admission. Surgery laparotomy reduction of intussusception.


Changed on 12/8/2009

VAERS ID: 314989 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Florida
Vaccinated:2008-03-07
Onset:2008-03-26
Submitted:2008-06-05
Entered:2008-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS SKB AC21B133AA / 0 RL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS SKB AC21B133AA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR PMC UF343AD / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC WY C35170 / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. MSD 0975U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Blood culture positive, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Laparotomy, Lymphocyte count decreased, Pallor, Pyrexia, Rectal haemorrhage, Vomiting, White blood cell count decreased, White blood cells urine positive, X-ray normal, Enema administration, Neutrophil percentage increased, Protein urine present, Urine ketone body present, Ultrasound scan abnormal, Occult blood positive

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: CONGESTION
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 03/26/08 ULTRASOUND DONE AND 03/27/08 GASTROGRAFIN ENEMA DONE WHICH REVEALED AN INTUSSUSEPTION THAT COULD NOT BE REDUCED 6/19/08-records received-WBC 537, HGB 9.7, HCT 28.6, segs 69.3, lymphs 22.4. Urine 1+ protein, ketone 1+ and WBC 7-10,
CDC 'Split Type':

Write-up: 03/26/08 PRESENTED TO HOSPITAL W/ VOMITING, PALE IN COLOR, AND BRIGHT RED BLOOD IN DIAPER. LAB WORK AND IV''''S IV''S DONE PRIOR TO TRANSFER TO HOSPITAL. 6/19/08-records received for DOS 3/26/08-presented to ED with C/O blood in stool, low grade fever, vomiting."Assessment: vomiting. Assessment: abdominal pain, vomiting, rectal bleeding. Transferred. 6/24/08-records received for DOS 3/26-3/27/08- DX: Intussusception. Vomiting began day prior to admission. Surgery laparotomy reduction of intussusception.


Changed on 3/2/2010

VAERS ID: 314989 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Florida
Vaccinated:2008-03-07
Onset:2008-03-26
Submitted:2008-06-05
Entered:2008-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS SKB AC21B133AA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR PMC UF343AD / 0 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC WY C35170 / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. MSD 0975U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Blood culture positive, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Laparotomy, Lymphocyte count decreased, Pallor, Pyrexia, Rectal haemorrhage, Vomiting, White blood cell count decreased, White blood cells urine positive, X-ray normal, Enema administration, Neutrophil percentage increased, Protein urine present, Urine ketone body present, Ultrasound scan abnormal, Occult blood positive

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: CONGESTION
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 03/26/08 ULTRASOUND DONE AND 03/27/08 GASTROGRAFIN ENEMA DONE WHICH REVEALED AN INTUSSUSEPTION THAT COULD NOT BE REDUCED 6/19/08-records received-WBC 537, HGB 9.7, HCT 28.6, segs 69.3, lymphs 22.4. Urine 1+ protein, ketone 1+ and WBC 7-10,
CDC 'Split Type':

Write-up: 03/26/08 PRESENTED TO HOSPITAL W/ VOMITING, PALE IN COLOR, AND BRIGHT RED BLOOD IN DIAPER. LAB WORK AND IV''S DONE PRIOR TO TRANSFER TO HOSPITAL. 6/19/08-records received for DOS 3/26/08-presented to ED with C/O blood in stool, low grade fever, vomiting. Assessment: abdominal pain, vomiting, rectal bleeding. Transferred. 6/24/08-records received for DOS 3/26-3/27/08- DX: Intussusception. Vomiting began day prior to admission. Surgery laparotomy reduction of intussusception.


Changed on 4/7/2010

VAERS ID: 314989 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Florida
Vaccinated:2008-03-07
Onset:2008-03-26
Submitted:2008-06-05
Entered:2008-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS SKB AC21B133AA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR PMC UF343AD / 0 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC WY C35170 / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. MSD 0975U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Blood culture positive, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Laparotomy, Lymphocyte count decreased, Pallor, Pyrexia, Rectal haemorrhage, Vomiting, White blood cell count decreased, White blood cells urine positive, X-ray normal, Enema administration, Neutrophil percentage increased, Protein urine present, Urine ketone body present, Ultrasound scan abnormal, Occult blood positive

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: CONGESTION
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 03/26/08 ULTRASOUND DONE AND 03/27/08 GASTROGRAFIN ENEMA DONE WHICH REVEALED AN INTUSSUSEPTION THAT COULD NOT BE REDUCED 6/19/08-records received-WBC 537, HGB 9.7, HCT 28.6, segs 69.3, lymphs 22.4. Urine 1+ protein, ketone 1+ and WBC 7-10,
CDC 'Split Type':

Write-up: 03/26/08 PRESENTED TO HOSPITAL W/ VOMITING, PALE IN COLOR, AND BRIGHT RED BLOOD IN DIAPER. LAB WORK AND IV''S DONE PRIOR TO TRANSFER TO HOSPITAL. 6/19/08-records received for DOS 3/26/08-presented to ED with C/O blood in stool, low grade fever, vomiting. Assessment: abdominal pain, vomiting, rectal bleeding. Transferred. 6/24/08-records received for DOS 3/26-3/27/08- DX: Intussusception. Vomiting began day prior to admission. Surgery laparotomy reduction of intussusception.


Changed on 8/31/2010

VAERS ID: 314989 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Florida
Vaccinated:2008-03-07
Onset:2008-03-26
Submitted:2008-06-05
Entered:2008-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS SKB AC21B133AA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR PMC UF343AD / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH WY C35170 / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. MSD 0975U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Blood culture positive, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Laparotomy, Lymphocyte count decreased, Pallor, Pyrexia, Rectal haemorrhage, Vomiting, White blood cell count decreased, White blood cells urine positive, X-ray normal, Enema administration, Neutrophil percentage increased, Protein urine present, Urine ketone body present, Ultrasound scan abnormal, Occult blood positive

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: CONGESTION
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 03/26/08 ULTRASOUND DONE AND 03/27/08 GASTROGRAFIN ENEMA DONE WHICH REVEALED AN INTUSSUSEPTION THAT COULD NOT BE REDUCED 6/19/08-records received-WBC 537, HGB 9.7, HCT 28.6, segs 69.3, lymphs 22.4. Urine 1+ protein, ketone 1+ and WBC 7-10,
CDC 'Split Type':

Write-up: 03/26/08 PRESENTED TO HOSPITAL W/ VOMITING, PALE IN COLOR, AND BRIGHT RED BLOOD IN DIAPER. LAB WORK AND IV''S DONE PRIOR TO TRANSFER TO HOSPITAL. 6/19/08-records received for DOS 3/26/08-presented to ED with C/O blood in stool, low grade fever, vomiting. Assessment: abdominal pain, vomiting, rectal bleeding. Transferred. 6/24/08-records received for DOS 3/26-3/27/08- DX: Intussusception. Vomiting began day prior to admission. Surgery laparotomy reduction of intussusception.


Changed on 5/13/2013

VAERS ID: 314989 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Florida
Vaccinated:2008-03-07
Onset:2008-03-26
Submitted:2008-06-05
Entered:2008-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS SKB AC21B133AA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR PMC UF343AD / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH WY C35170 / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. MSD 0975U / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. MSD 0975U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Blood culture positive, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Laparotomy, Lymphocyte count decreased, Pallor, Pyrexia, Rectal haemorrhage, Vomiting, White blood cell count decreased, White blood cells urine positive, X-ray normal, Enema administration, Neutrophil percentage increased, Protein urine present, Urine ketone body present, Ultrasound scan abnormal, Occult blood positive

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: CONGESTION
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 03/26/08 ULTRASOUND DONE AND 03/27/08 GASTROGRAFIN ENEMA DONE WHICH REVEALED AN INTUSSUSEPTION THAT COULD NOT BE REDUCED 6/19/08-records received-WBC 537, HGB 9.7, HCT 28.6, segs 69.3, lymphs 22.4. Urine 1+ protein, ketone 1+ and WBC 7-10,
CDC 'Split Type':

Write-up: 03/26/08 PRESENTED TO HOSPITAL W/ VOMITING, PALE IN COLOR, AND BRIGHT RED BLOOD IN DIAPER. LAB WORK AND IV''S DONE PRIOR TO TRANSFER TO HOSPITAL. 6/19/08-records received for DOS 3/26/08-presented to ED with C/O blood in stool, low grade fever, vomiting. Assessment: abdominal pain, vomiting, rectal bleeding. Transferred. 6/24/08-records received for DOS 3/26-3/27/08- DX: Intussusception. Vomiting began day prior to admission. Surgery laparotomy reduction of intussusception.


Changed on 2/14/2017

VAERS ID: 314989 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Florida
Vaccinated:2008-03-07
Onset:2008-03-26
Submitted:2008-06-05
Entered:2008-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS SKB AC21B133AA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR PMC UF343AD / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH WY C35170 / 0 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. MSD 0975U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Blood culture positive, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Laparotomy, Lymphocyte count decreased, Pallor, Pyrexia, Rectal haemorrhage, Vomiting, White blood cell count decreased, White blood cells urine positive, X-ray normal, Enema administration, Neutrophil percentage increased, Protein urine present, Urine ketone body present, Ultrasound scan abnormal, Occult blood positive

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: CONGESTION
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 03/26/08 ULTRASOUND DONE AND 03/27/08 GASTROGRAFIN ENEMA DONE WHICH REVEALED AN INTUSSUSEPTION THAT COULD NOT BE REDUCED 6/19/08-records received-WBC 537, HGB 9.7, HCT 28.6, segs 69.3, lymphs 22.4. Urine 1+ protein, ketone 1+ and WBC 7-10, blood culture gram positive cocci. Stool guaiac positive. 6/24/08-records received-Ultrasound of abdomen negative. X-ray abdomen normal. Enema with contrast:intussusception, unsuccessful reduction attempt.
CDC 'Split Type':

Write-up: 03/26/08 PRESENTED TO HOSPITAL W/ VOMITING, PALE IN COLOR, AND BRIGHT RED BLOOD IN DIAPER. LAB WORK AND IV''S DONE PRIOR TO TRANSFER TO HOSPITAL. 6/19/08-records received for DOS 3/26/08-presented to ED with C/O blood in stool, low grade fever, vomiting. Assessment: abdominal pain, vomiting, rectal bleeding. Transferred. 6/24/08-records received for DOS 3/26-3/27/08- DX: Intussusception. Vomiting began day prior to admission. Surgery laparotomy reduction of intussusception.


Changed on 9/14/2017

VAERS ID: 314989 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:Florida
Vaccinated:2008-03-07
Onset:2008-03-26
Submitted:2008-06-05
Entered:2008-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS SKB AC21B133AA / 0 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR PMC UF343AD / 0 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH WY C35170 / 0 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. MSD 0975U / 0 1 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Haematochezia, Intussusception, Pallor, Vomiting, Enema administration, Ultrasound scan abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: CONGESTION
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 03/26/08 ULTRASOUND DONE AND 03/27/08 GASTROGRAFIN ENEMA DONE WHICH REVEALED AN INTUSSUSEPTION THAT COULD NOT BE REDUCED 6/19/08-records received-WBC 537, HGB 9.7, HCT 28.6, segs 69.3, lymphs 22.4. Urine 1+ protein, ketone 1+ and WBC 7-10, blood culture gram positive cocci. Stool guaiac positive. 6/24/08-records received-Ultrasound of abdomen negative. X-ray abdomen normal. Enema with contrast:intussusception, unsuccessful reduction attempt.
CDC 'Split Type':

Write-up: 03/26/08 PRESENTED TO HOSPITAL W/ VOMITING, PALE IN COLOR, AND BRIGHT RED BLOOD IN DIAPER. LAB WORK AND IV''S DONE PRIOR TO TRANSFER TO HOSPITAL. 6/19/08-records received for DOS 3/26/08-presented to ED with C/O blood in stool, low grade fever, vomiting. Assessment: abdominal pain, vomiting, rectal bleeding. Transferred. 6/24/08-records received for DOS 3/26-3/27/08- DX: Intussusception. Vomiting began day prior to admission. Surgery laparotomy reduction of intussusception.


Changed on 2/14/2018

VAERS ID: 314989 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Florida
Vaccinated:2008-03-07
Onset:2008-03-26
Submitted:2008-06-05
Entered:2008-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS SKB AC21B133AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR PMC UF343AD / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH WY C35170 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. MSD 0975U / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Haematochezia, Intussusception, Pallor, Vomiting, Enema administration, Ultrasound scan abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: CONGESTION
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 03/26/08 ULTRASOUND DONE AND 03/27/08 GASTROGRAFIN ENEMA DONE WHICH REVEALED AN INTUSSUSEPTION THAT COULD NOT BE REDUCED 6/19/08-records received-WBC 537, HGB 9.7, HCT 28.6, segs 69.3, lymphs 22.4. Urine 1+ protein, ketone 1+ and WBC 7-10, blood culture gram positive cocci. Stool guaiac positive. 6/24/08-records received-Ultrasound of abdomen negative. X-ray abdomen normal. Enema with contrast:intussusception, unsuccessful reduction attempt.
CDC 'Split Type':

Write-up: 03/26/08 PRESENTED TO HOSPITAL W/ VOMITING, PALE IN COLOR, AND BRIGHT RED BLOOD IN DIAPER. LAB WORK AND IV''S DONE PRIOR TO TRANSFER TO HOSPITAL. 6/19/08-records received for DOS 3/26/08-presented to ED with C/O blood in stool, low grade fever, vomiting. Assessment: abdominal pain, vomiting, rectal bleeding. Transferred. 6/24/08-records received for DOS 3/26-3/27/08- DX: Intussusception. Vomiting began day prior to admission. Surgery laparotomy reduction of intussusception.


Changed on 6/14/2018

VAERS ID: 314989 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Florida
Vaccinated:2008-03-07
Onset:2008-03-26
Submitted:2008-06-05
Entered:2008-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS SKB AC21B133AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR PMC UF343AD / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH WY C35170 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. MSD 0975U / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Haematochezia, Intussusception, Pallor, Vomiting, Enema administration, Ultrasound scan abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: CONGESTION
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 03/26/08 ULTRASOUND DONE AND 03/27/08 GASTROGRAFIN ENEMA DONE WHICH REVEALED AN INTUSSUSEPTION THAT COULD NOT BE REDUCED 6/19/08-records received-WBC 537, HGB 9.7, HCT 28.6, segs 69.3, lymphs 22.4. Urine 1+ protein, ketone 1+ and WBC 7-10, blood culture gram positive cocci. Stool guaiac positive. 6/24/08-records received-Ultrasound of abdomen negative. X-ray abdomen normal. Enema with contrast:intussusception, unsuccessful reduction attempt.
CDC 'Split Type':

Write-up: 03/26/08 PRESENTED TO HOSPITAL W/ VOMITING, PALE IN COLOR, AND BRIGHT RED BLOOD IN DIAPER. LAB WORK AND IV''S DONE PRIOR TO TRANSFER TO HOSPITAL. 6/19/08-records received for DOS 3/26/08-presented to ED with C/O blood in stool, low grade fever, vomiting. Assessment: abdominal pain, vomiting, rectal bleeding. Transferred. 6/24/08-records received for DOS 3/26-3/27/08- DX: Intussusception. Vomiting began day prior to admission. Surgery laparotomy reduction of intussusception.


Changed on 8/14/2018

VAERS ID: 314989 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Florida
Vaccinated:2008-03-07
Onset:2008-03-26
Submitted:2008-06-05
Entered:2008-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS SKB AC21B133AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR PMC UF343AD / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH WY C35170 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. MSD 0975U / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Haematochezia, Intussusception, Pallor, Vomiting, Enema administration, Ultrasound scan abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: CONGESTION
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 03/26/08 ULTRASOUND DONE AND 03/27/08 GASTROGRAFIN ENEMA DONE WHICH REVEALED AN INTUSSUSEPTION THAT COULD NOT BE REDUCED 6/19/08-records received-WBC 537, HGB 9.7, HCT 28.6, segs 69.3, lymphs 22.4. Urine 1+ protein, ketone 1+ and WBC 7-10, blood culture gram positive cocci. Stool guaiac positive. 6/24/08-records received-Ultrasound of abdomen negative. X-ray abdomen normal. Enema with contrast:intussusception, unsuccessful reduction attempt.
CDC 'Split Type':

Write-up: 03/26/08 PRESENTED TO HOSPITAL W/ VOMITING, PALE IN COLOR, AND BRIGHT RED BLOOD IN DIAPER. LAB WORK AND IV''S DONE PRIOR TO TRANSFER TO HOSPITAL. 6/19/08-records received for DOS 3/26/08-presented to ED with C/O blood in stool, low grade fever, vomiting. Assessment: abdominal pain, vomiting, rectal bleeding. Transferred. 6/24/08-records received for DOS 3/26-3/27/08- DX: Intussusception. Vomiting began day prior to admission. Surgery laparotomy reduction of intussusception.


Changed on 9/14/2018

VAERS ID: 314989 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Florida
Vaccinated:2008-03-07
Onset:2008-03-26
Submitted:2008-06-05
Entered:2008-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS SKB AC21B133AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR PMC UF343AD / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH WY C35170 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. MSD 0975U / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Haematochezia, Intussusception, Pallor, Vomiting, Enema administration, Ultrasound scan abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: CONGESTION
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 03/26/08 ULTRASOUND DONE AND 03/27/08 GASTROGRAFIN ENEMA DONE WHICH REVEALED AN INTUSSUSEPTION THAT COULD NOT BE REDUCED 6/19/08-records received-WBC 537, HGB 9.7, HCT 28.6, segs 69.3, lymphs 22.4. Urine 1+ protein, ketone 1+ and WBC 7-10, blood culture gram positive cocci. Stool guaiac positive. 6/24/08-records received-Ultrasound of abdomen negative. X-ray abdomen normal. Enema with contrast:intussusception, unsuccessful reduction attempt.
CDC 'Split Type':

Write-up: 03/26/08 PRESENTED TO HOSPITAL W/ VOMITING, PALE IN COLOR, AND BRIGHT RED BLOOD IN DIAPER. LAB WORK AND IV''S DONE PRIOR TO TRANSFER TO HOSPITAL. 6/19/08-records received for DOS 3/26/08-presented to ED with C/O blood in stool, low grade fever, vomiting. Assessment: abdominal pain, vomiting, rectal bleeding. Transferred. 6/24/08-records received for DOS 3/26-3/27/08- DX: Intussusception. Vomiting began day prior to admission. Surgery laparotomy reduction of intussusception.


Changed on 10/14/2018

VAERS ID: 314989 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Florida
Vaccinated:2008-03-07
Onset:2008-03-26
Submitted:2008-06-05
Entered:2008-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS SKB AC21B133AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR PMC UF343AD / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH WY C35170 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. MSD 0975U / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Haematochezia, Intussusception, Pallor, Vomiting, Enema administration, Ultrasound scan abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: CONGESTION
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 03/26/08 ULTRASOUND DONE AND 03/27/08 GASTROGRAFIN ENEMA DONE WHICH REVEALED AN INTUSSUSEPTION THAT COULD NOT BE REDUCED 6/19/08-records received-WBC 537, HGB 9.7, HCT 28.6, segs 69.3, lymphs 22.4. Urine 1+ protein, ketone 1+ and WBC 7-10, blood culture gram positive cocci. Stool guaiac positive. 6/24/08-records received-Ultrasound of abdomen negative. X-ray abdomen normal. Enema with contrast:intussusception, unsuccessful reduction attempt.
CDC 'Split Type':

Write-up: 03/26/08 PRESENTED TO HOSPITAL W/ VOMITING, PALE IN COLOR, AND BRIGHT RED BLOOD IN DIAPER. LAB WORK AND IV''S DONE PRIOR TO TRANSFER TO HOSPITAL. 6/19/08-records received for DOS 3/26/08-presented to ED with C/O blood in stool, low grade fever, vomiting. Assessment: abdominal pain, vomiting, rectal bleeding. Transferred. 6/24/08-records received for DOS 3/26-3/27/08- DX: Intussusception. Vomiting began day prior to admission. Surgery laparotomy reduction of intussusception.

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