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This is VAERS ID 315578

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 315578
VAERS Form:
Age:0.5
Sex:Male
Location:Illinois
Vaccinated:2007-10-22
Onset:2008-04-06
Submitted:2008-05-02
Entered:2008-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124DB / 2 LL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08702A / 2 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1053U / 2 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: Abdominal tenderness, Agitation, Barium enema abnormal, Crying, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None. PMH: intestinal d/o. NKDA.
Allergies:
Diagnostic Lab Data: Abd u/s and intussusception. Labs and Diagnostics: Abd X-ray concerning for IS. Abd US (+) for IS. Barium Enema (+) IS. Head CT (-).
CDC 'Split Type':

Write-up: Symptoms started in Feb. 29 08. Pt came in with emesis and loose stool. 3/17/08 again pt came in with emesis and diarrhea x5 days, no bloody stools. 4 8 08 h/o emesis, not tolerating liquids. 4/10/08 continues with vomiting not tolerating liquids, deh"ydrated went to ER. 07/02/2008 MR received for DOS 4/10-12/2008 with D/C DX: Intussusception. Infant presented to ER for 3rd time with c/o 4 day hx of emesis, abdominal tenderness and bloody stools. (+) URI sx-mild productive cough. PE WNL except crying


Changed on 12/8/2009

VAERS ID: 315578 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Illinois
Vaccinated:2007-10-22
Onset:2008-04-06 2008-04-08
Submitted:2008-05-02
Entered:2008-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124DB / 2 LL / UN
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124DB / 2 LL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08702A / 2 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1053U / 2 - / PO

Administered by: Public      Purchased by: Unknown Public
Symptoms: Abdominal tenderness, Agitation, Barium enema abnormal, Crying, Dehydration, Depressed level of consciousness, Diarrhoea, Haematochezia, Intussusception, Productive cough, Staring, Vomiting, Enema administration, Ultrasound abdomen abnormal, Upper respiratory tract congestion, Fluid intake reduced, Scan brain, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None. PMH: intestinal d/o. NKDA.
Allergies:
Diagnostic Lab Data: Abd u/s and intussusception. Labs and Diagnostics: Abd X-ray concerning for IS. Abd US (+) for IS. Barium Enema (+) IS. Head CT (-).
CDC 'Split Type':

Write-up: Symptoms started in Feb. 29 08. Pt came in with emesis and loose stool. 3/17/08 again pt came in with emesis and diarrhea x5 days, no bloody stools. 4 8 08 h/o emesis, not tolerating liquids. 4/10/08 continues with vomiting not tolerating liquids, deh"ydrated dehydrated went to ER. 07/02/2008 MR received for DOS 4/10-12/2008 with D/C DX: Intussusception. Infant presented to ER for 3rd time with c/o 4 day hx of emesis, abdominal tenderness and bloody stools. (+) URI sx-mild productive cough. PE WNL except crying and agitation and periods of staring and difficulty with arousal. Ileocolic Intussusception reduced by BE on 4/11/08.


Changed on 3/2/2010

VAERS ID: 315578 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Illinois
Vaccinated:2007-10-22
Onset:2008-04-08
Submitted:2008-05-02
Entered:2008-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124DB / 2 LL / UN
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B08702A / 2 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1053U / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Abdominal tenderness, Agitation, Barium enema abnormal, Crying, Dehydration, Depressed level of consciousness, Diarrhoea, Haematochezia, Intussusception, Productive cough, Staring, Vomiting, Enema administration, Ultrasound abdomen abnormal, Upper respiratory tract congestion, Fluid intake reduced, Scan brain, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None. PMH: intestinal d/o. NKDA.
Allergies:
Diagnostic Lab Data: Abd u/s and intussusception. Labs and Diagnostics: Abd X-ray concerning for IS. Abd US (+) for IS. Barium Enema (+) IS. Head CT (-).
CDC 'Split Type':

Write-up: Symptoms started in Feb. 29 08. Pt came in with emesis and loose stool. 3/17/08 again pt came in with emesis and diarrhea x5 days, no bloody stools. 4 8 08 h/o emesis, not tolerating liquids. 4/10/08 continues with vomiting not tolerating liquids, dehydrated went to ER. 07/02/2008 MR received for DOS 4/10-12/2008 with D/C DX: Intussusception. Infant presented to ER for 3rd time with c/o 4 day hx of emesis, abdominal tenderness and bloody stools. (+) URI sx-mild productive cough. PE WNL except crying and agitation and periods of staring and difficulty with arousal. Ileocolic Intussusception reduced by BE on 4/11/08.


Changed on 4/7/2010

VAERS ID: 315578 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Illinois
Vaccinated:2007-10-22
Onset:2008-04-08
Submitted:2008-05-02
Entered:2008-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124DB / 2 LL / UN
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08702A / 2 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1053U / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Abdominal tenderness, Agitation, Barium enema abnormal, Crying, Dehydration, Depressed level of consciousness, Diarrhoea, Haematochezia, Intussusception, Productive cough, Staring, Vomiting, Enema administration, Ultrasound abdomen abnormal, Upper respiratory tract congestion, Fluid intake reduced, Scan brain, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None. PMH: intestinal d/o. NKDA.
Allergies:
Diagnostic Lab Data: Abd u/s and intussusception. Labs and Diagnostics: Abd X-ray concerning for IS. Abd US (+) for IS. Barium Enema (+) IS. Head CT (-).
CDC 'Split Type':

Write-up: Symptoms started in Feb. 29 08. Pt came in with emesis and loose stool. 3/17/08 again pt came in with emesis and diarrhea x5 days, no bloody stools. 4 8 08 h/o emesis, not tolerating liquids. 4/10/08 continues with vomiting not tolerating liquids, dehydrated went to ER. 07/02/2008 MR received for DOS 4/10-12/2008 with D/C DX: Intussusception. Infant presented to ER for 3rd time with c/o 4 day hx of emesis, abdominal tenderness and bloody stools. (+) URI sx-mild productive cough. PE WNL except crying and agitation and periods of staring and difficulty with arousal. Ileocolic Intussusception reduced by BE on 4/11/08.


Changed on 8/31/2010

VAERS ID: 315578 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Illinois
Vaccinated:2007-10-22
Onset:2008-04-08
Submitted:2008-05-02
Entered:2008-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124DB / 2 LL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B08702A / 2 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1053U / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Abdominal tenderness, Agitation, Barium enema abnormal, Crying, Dehydration, Depressed level of consciousness, Diarrhoea, Haematochezia, Intussusception, Productive cough, Staring, Vomiting, Enema administration, Ultrasound abdomen abnormal, Upper respiratory tract congestion, Fluid intake reduced, Scan brain, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None. PMH: intestinal d/o. NKDA.
Allergies:
Diagnostic Lab Data: Abd u/s and intussusception. Labs and Diagnostics: Abd X-ray concerning for IS. Abd US (+) for IS. Barium Enema (+) IS. Head CT (-).
CDC 'Split Type':

Write-up: Symptoms started in Feb. 29 08. Pt came in with emesis and loose stool. 3/17/08 again pt came in with emesis and diarrhea x5 days, no bloody stools. 4 8 08 h/o emesis, not tolerating liquids. 4/10/08 continues with vomiting not tolerating liquids, dehydrated went to ER. 07/02/2008 MR received for DOS 4/10-12/2008 with D/C DX: Intussusception. Infant presented to ER for 3rd time with c/o 4 day hx of emesis, abdominal tenderness and bloody stools. (+) URI sx-mild productive cough. PE WNL except crying and agitation and periods of staring and difficulty with arousal. Ileocolic Intussusception reduced by BE on 4/11/08.


Changed on 5/13/2013

VAERS ID: 315578 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Illinois
Vaccinated:2007-10-22
Onset:2008-04-08
Submitted:2008-05-02
Entered:2008-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124DB / 2 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08702A / 2 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1053U / 2 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1053U / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Abdominal tenderness, Agitation, Barium enema abnormal, Crying, Dehydration, Depressed level of consciousness, Diarrhoea, Haematochezia, Intussusception, Productive cough, Staring, Vomiting, Enema administration, Ultrasound abdomen abnormal, Upper respiratory tract congestion, Fluid intake reduced, Scan brain, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None. PMH: intestinal d/o. NKDA.
Allergies:
Diagnostic Lab Data: Abd u/s and intussusception. Labs and Diagnostics: Abd X-ray concerning for IS. Abd US (+) for IS. Barium Enema (+) IS. Head CT (-).
CDC 'Split Type':

Write-up: Symptoms started in Feb. 29 08. Pt came in with emesis and loose stool. 3/17/08 again pt came in with emesis and diarrhea x5 days, no bloody stools. 4 8 08 h/o emesis, not tolerating liquids. 4/10/08 continues with vomiting not tolerating liquids, dehydrated went to ER. 07/02/2008 MR received for DOS 4/10-12/2008 with D/C DX: Intussusception. Infant presented to ER for 3rd time with c/o 4 day hx of emesis, abdominal tenderness and bloody stools. (+) URI sx-mild productive cough. PE WNL except crying and agitation and periods of staring and difficulty with arousal. Ileocolic Intussusception reduced by BE on 4/11/08.


Changed on 2/14/2017

VAERS ID: 315578 Before After
VAERS Form:
Age:0.5 0.51
Sex:Male
Location:Illinois
Vaccinated:2007-10-22
Onset:2008-04-08
Submitted:2008-05-02
Entered:2008-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124DB / 2 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08702A / 2 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1053U / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Abdominal tenderness, Agitation, Barium enema abnormal, Crying, Dehydration, Depressed level of consciousness, Diarrhoea, Haematochezia, Intussusception, Productive cough, Staring, Vomiting, Enema administration, Ultrasound abdomen abnormal, Upper respiratory tract congestion, Fluid intake reduced, Scan brain, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None. PMH: intestinal d/o. NKDA.
Allergies:
Diagnostic Lab Data: Abd u/s and intussusception. Labs and Diagnostics: Abd X-ray concerning for IS. Abd US (+) for IS. Barium Enema (+) IS. Head CT (-).
CDC 'Split Type':

Write-up: Symptoms started in Feb. 29 08. Pt came in with emesis and loose stool. 3/17/08 again pt came in with emesis and diarrhea x5 days, no bloody stools. 4 8 08 h/o emesis, not tolerating liquids. 4/10/08 continues with vomiting not tolerating liquids, dehydrated went to ER. 07/02/2008 MR received for DOS 4/10-12/2008 with D/C DX: Intussusception. Infant presented to ER for 3rd time with c/o 4 day hx of emesis, abdominal tenderness and bloody stools. (+) URI sx-mild productive cough. PE WNL except crying and agitation and periods of staring and difficulty with arousal. Ileocolic Intussusception reduced by BE on 4/11/08.


Changed on 4/14/2017

VAERS ID: 315578 Before After
VAERS Form:
Age:0.51
Sex:Male
Location:Illinois
Vaccinated:2007-10-22
Onset:2008-04-08
Submitted:2008-05-02
Entered:2008-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124DB / 2 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08702A / 2 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1053U / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Abdominal tenderness, Agitation, Barium enema abnormal, Crying, Dehydration, Depressed level of consciousness, Diarrhoea, Haematochezia, Intussusception, Productive cough, Staring, Vomiting, Enema administration, Ultrasound abdomen abnormal, Upper respiratory tract congestion, Fluid intake reduced, Scan brain, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None. PMH: intestinal d/o. NKDA.
Allergies:
Diagnostic Lab Data: Abd u/s and intussusception. Labs and Diagnostics: Abd X-ray concerning for IS. Abd US (+) for IS. Barium Enema (+) IS. Head CT (-).
CDC 'Split Type':

Write-up: Symptoms started in Feb. 29 08. Pt came in with emesis and loose stool. 3/17/08 again pt came in with emesis and diarrhea x5 days, no bloody stools. 4 8 08 h/o emesis, not tolerating liquids. 4/10/08 continues with vomiting not tolerating liquids, dehydrated went to ER. 07/02/2008 MR received for DOS 4/10-12/2008 with D/C DX: Intussusception. Infant presented to ER for 3rd time with c/o 4 day hx of emesis, abdominal tenderness and bloody stools. (+) URI sx-mild productive cough. PE WNL except crying and agitation and periods of staring and difficulty with arousal. Ileocolic Intussusception reduced by BE on 4/11/08.


Changed on 9/14/2017

VAERS ID: 315578 Before After
VAERS Form:(blank) 1
Age:0.51
Sex:Male
Location:Illinois
Vaccinated:2007-10-22
Onset:2008-04-08
Submitted:2008-05-02
Entered:2008-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124DB / 2 3 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08702A / 2 3 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1053U / 2 3 - MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Dehydration, Diarrhoea, Intussusception, Vomiting, Ultrasound abdomen abnormal, Fluid 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None. PMH: intestinal d/o. NKDA.
Allergies:
Diagnostic Lab Data: Abd u/s and intussusception. Labs and Diagnostics: Abd X-ray concerning for IS. Abd US (+) for IS. Barium Enema (+) IS. Head CT (-).
CDC 'Split Type':

Write-up: Symptoms started in Feb. 29 08. Pt came in with emesis and loose stool. 3/17/08 again pt came in with emesis and diarrhea x5 days, no bloody stools. 4 8 08 h/o emesis, not tolerating liquids. 4/10/08 continues with vomiting not tolerating liquids, dehydrated went to ER. 07/02/2008 MR received for DOS 4/10-12/2008 with D/C DX: Intussusception. Infant presented to ER for 3rd time with c/o 4 day hx of emesis, abdominal tenderness and bloody stools. (+) URI sx-mild productive cough. PE WNL except crying and agitation and periods of staring and difficulty with arousal. Ileocolic Intussusception reduced by BE on 4/11/08.


Changed on 2/14/2018

VAERS ID: 315578 Before After
VAERS Form:1
Age:0.51
Sex:Male
Location:Illinois
Vaccinated:2007-10-22
Onset:2008-04-08
Submitted:2008-05-02
Entered:2008-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124DB / 3 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08702A / 3 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1053U / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Dehydration, Diarrhoea, Intussusception, Vomiting, Ultrasound abdomen abnormal, Fluid 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None. PMH: intestinal d/o. NKDA.
Allergies:
Diagnostic Lab Data: Abd u/s and intussusception. Labs and Diagnostics: Abd X-ray concerning for IS. Abd US (+) for IS. Barium Enema (+) IS. Head CT (-).
CDC 'Split Type':

Write-up: Symptoms started in Feb. 29 08. Pt came in with emesis and loose stool. 3/17/08 again pt came in with emesis and diarrhea x5 days, no bloody stools. 4 8 08 h/o emesis, not tolerating liquids. 4/10/08 continues with vomiting not tolerating liquids, dehydrated went to ER. 07/02/2008 MR received for DOS 4/10-12/2008 with D/C DX: Intussusception. Infant presented to ER for 3rd time with c/o 4 day hx of emesis, abdominal tenderness and bloody stools. (+) URI sx-mild productive cough. PE WNL except crying and agitation and periods of staring and difficulty with arousal. Ileocolic Intussusception reduced by BE on 4/11/08.


Changed on 6/14/2018

VAERS ID: 315578 Before After
VAERS Form:1
Age:0.51
Sex:Male
Location:Illinois
Vaccinated:2007-10-22
Onset:2008-04-08
Submitted:2008-05-02
Entered:2008-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124DB / 3 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08702A / 3 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1053U / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Dehydration, Diarrhoea, Intussusception, Vomiting, Ultrasound abdomen abnormal, Fluid 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None. PMH: intestinal d/o. NKDA.
Allergies:
Diagnostic Lab Data: Abd u/s and intussusception. Labs and Diagnostics: Abd X-ray concerning for IS. Abd US (+) for IS. Barium Enema (+) IS. Head CT (-).
CDC 'Split Type':

Write-up: Symptoms started in Feb. 29 08. Pt came in with emesis and loose stool. 3/17/08 again pt came in with emesis and diarrhea x5 days, no bloody stools. 4 8 08 h/o emesis, not tolerating liquids. 4/10/08 continues with vomiting not tolerating liquids, dehydrated went to ER. 07/02/2008 MR received for DOS 4/10-12/2008 with D/C DX: Intussusception. Infant presented to ER for 3rd time with c/o 4 day hx of emesis, abdominal tenderness and bloody stools. (+) URI sx-mild productive cough. PE WNL except crying and agitation and periods of staring and difficulty with arousal. Ileocolic Intussusception reduced by BE on 4/11/08.


Changed on 8/14/2018

VAERS ID: 315578 Before After
VAERS Form:1
Age:0.51
Sex:Male
Location:Illinois
Vaccinated:2007-10-22
Onset:2008-04-08
Submitted:2008-05-02
Entered:2008-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124DB / 3 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08702A / 3 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1053U / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Dehydration, Diarrhoea, Intussusception, Vomiting, Ultrasound abdomen abnormal, Fluid 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None. PMH: intestinal d/o. NKDA.
Allergies:
Diagnostic Lab Data: Abd u/s and intussusception. Labs and Diagnostics: Abd X-ray concerning for IS. Abd US (+) for IS. Barium Enema (+) IS. Head CT (-).
CDC 'Split Type':

Write-up: Symptoms started in Feb. 29 08. Pt came in with emesis and loose stool. 3/17/08 again pt came in with emesis and diarrhea x5 days, no bloody stools. 4 8 08 h/o emesis, not tolerating liquids. 4/10/08 continues with vomiting not tolerating liquids, dehydrated went to ER. 07/02/2008 MR received for DOS 4/10-12/2008 with D/C DX: Intussusception. Infant presented to ER for 3rd time with c/o 4 day hx of emesis, abdominal tenderness and bloody stools. (+) URI sx-mild productive cough. PE WNL except crying and agitation and periods of staring and difficulty with arousal. Ileocolic Intussusception reduced by BE on 4/11/08.


Changed on 9/14/2018

VAERS ID: 315578 Before After
VAERS Form:1
Age:0.51
Sex:Male
Location:Illinois
Vaccinated:2007-10-22
Onset:2008-04-08
Submitted:2008-05-02
Entered:2008-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124DB / 3 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08702A / 3 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1053U / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Dehydration, Diarrhoea, Intussusception, Vomiting, Ultrasound abdomen abnormal, Fluid 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None. PMH: intestinal d/o. NKDA.
Allergies:
Diagnostic Lab Data: Abd u/s and intussusception. Labs and Diagnostics: Abd X-ray concerning for IS. Abd US (+) for IS. Barium Enema (+) IS. Head CT (-).
CDC 'Split Type':

Write-up: Symptoms started in Feb. 29 08. Pt came in with emesis and loose stool. 3/17/08 again pt came in with emesis and diarrhea x5 days, no bloody stools. 4 8 08 h/o emesis, not tolerating liquids. 4/10/08 continues with vomiting not tolerating liquids, dehydrated went to ER. 07/02/2008 MR received for DOS 4/10-12/2008 with D/C DX: Intussusception. Infant presented to ER for 3rd time with c/o 4 day hx of emesis, abdominal tenderness and bloody stools. (+) URI sx-mild productive cough. PE WNL except crying and agitation and periods of staring and difficulty with arousal. Ileocolic Intussusception reduced by BE on 4/11/08.


Changed on 10/14/2018

VAERS ID: 315578 Before After
VAERS Form:1
Age:0.51
Sex:Male
Location:Illinois
Vaccinated:2007-10-22
Onset:2008-04-08
Submitted:2008-05-02
Entered:2008-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124DB / 3 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08702A / 3 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1053U / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Dehydration, Diarrhoea, Intussusception, Vomiting, Ultrasound abdomen abnormal, Fluid 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None. PMH: intestinal d/o. NKDA.
Allergies:
Diagnostic Lab Data: Abd u/s and intussusception. Labs and Diagnostics: Abd X-ray concerning for IS. Abd US (+) for IS. Barium Enema (+) IS. Head CT (-).
CDC 'Split Type':

Write-up: Symptoms started in Feb. 29 08. Pt came in with emesis and loose stool. 3/17/08 again pt came in with emesis and diarrhea x5 days, no bloody stools. 4 8 08 h/o emesis, not tolerating liquids. 4/10/08 continues with vomiting not tolerating liquids, dehydrated went to ER. 07/02/2008 MR received for DOS 4/10-12/2008 with D/C DX: Intussusception. Infant presented to ER for 3rd time with c/o 4 day hx of emesis, abdominal tenderness and bloody stools. (+) URI sx-mild productive cough. PE WNL except crying and agitation and periods of staring and difficulty with arousal. Ileocolic Intussusception reduced by BE on 4/11/08.

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