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This is VAERS ID 316652

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 316652
VAERS Form:
Age:0.3
Sex:Male
Location:Texas
Vaccinated:2008-03-27
Onset:2008-04-30
Submitted:2008-06-19
Entered:2008-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ACZ1B139AA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF329AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C45893 / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1731U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Appendicectomy, Barium double contrast, Dehydration, Diarrhoea, Haematochezia

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: 3     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: 6/20/08-records received-PMH:mild gastroesophageal reflux disease
Allergies:
Diagnostic Lab Data: INTUSSUSCEPTION 6/20/08-records received-Air contrast enema showed intussusception but unsuccessful in reducing. 7/7/08-records received-KUB unremarkable moderate colonic stool, bloody stool, guaiac positive.
CDC 'Split Type':

Write-up: INTUSSUSCEPTION 6/20/08-records received for DOS 4/30-4/2/08-DC DX: Inussusception now resolved, status post surgical repair. Leukocytosis. Presented to ED with decreased activity, decreased oral intake, increased irritability and emesis. Bloody stool wit"h diarrhea, lethargy. Surgical laparotomy with appendectomy. 7/7/08-ER recs received for DOS 4/29/08-C/O vomiting, lethargic, . Dehydration, irritability.


Changed on 12/8/2009

VAERS ID: 316652 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Texas
Vaccinated:2008-03-27
Onset:2008-04-30
Submitted:2008-06-19
Entered:2008-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ACZ1B139AA / 0 RL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ACZ1B139AA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF329AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C45893 / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1731U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Appendicectomy, Barium double contrast, Dehydration, Diarrhoea, Haematochezia, Intussusception, Irritability, Laparotomy, Lethargy, Leukocytosis, Urinary system X-ray, Vomiting, Occult blood positive, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: 6/20/08-records received-PMH:mild gastroesophageal reflux disease
Allergies:
Diagnostic Lab Data: INTUSSUSCEPTION 6/20/08-records received-Air contrast enema showed intussusception but unsuccessful in reducing. 7/7/08-records received-KUB unremarkable moderate colonic stool, bloody stool, guaiac positive.
CDC 'Split Type':

Write-up: INTUSSUSCEPTION 6/20/08-records received for DOS 4/30-4/2/08-DC DX: Inussusception now resolved, status post surgical repair. Leukocytosis. Presented to ED with decreased activity, decreased oral intake, increased irritability and emesis. Bloody stool wit"h with diarrhea, lethargy. Surgical laparotomy with appendectomy. 7/7/08-ER recs received for DOS 4/29/08-C/O vomiting, lethargic, . Dehydration, irritability.


Changed on 3/2/2010

VAERS ID: 316652 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Texas
Vaccinated:2008-03-27
Onset:2008-04-30
Submitted:2008-06-19
Entered:2008-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ACZ1B139AA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF329AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC C45893 / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1731U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Appendicectomy, Barium double contrast, Dehydration, Diarrhoea, Haematochezia, Intussusception, Irritability, Laparotomy, Lethargy, Leukocytosis, Urinary system X-ray, Vomiting, Occult blood positive, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: 6/20/08-records received-PMH:mild gastroesophageal reflux disease
Allergies:
Diagnostic Lab Data: INTUSSUSCEPTION 6/20/08-records received-Air contrast enema showed intussusception but unsuccessful in reducing. 7/7/08-records received-KUB unremarkable moderate colonic stool, bloody stool, guaiac positive.
CDC 'Split Type':

Write-up: INTUSSUSCEPTION 6/20/08-records received for DOS 4/30-4/2/08-DC DX: Inussusception now resolved, status post surgical repair. Leukocytosis. Presented to ED with decreased activity, decreased oral intake, increased irritability and emesis. Bloody stool with diarrhea, lethargy. Surgical laparotomy with appendectomy. 7/7/08-ER recs received for DOS 4/29/08-C/O vomiting, lethargic, . Dehydration, irritability.


Changed on 4/7/2010

VAERS ID: 316652 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Texas
Vaccinated:2008-03-27
Onset:2008-04-30
Submitted:2008-06-19
Entered:2008-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ACZ1B139AA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF329AA / 0 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C45893 / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1731U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Appendicectomy, Barium double contrast, Dehydration, Diarrhoea, Haematochezia, Intussusception, Irritability, Laparotomy, Lethargy, Leukocytosis, Urinary system X-ray, Vomiting, Occult blood positive, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: 6/20/08-records received-PMH:mild gastroesophageal reflux disease
Allergies:
Diagnostic Lab Data: INTUSSUSCEPTION 6/20/08-records received-Air contrast enema showed intussusception but unsuccessful in reducing. 7/7/08-records received-KUB unremarkable moderate colonic stool, bloody stool, guaiac positive.
CDC 'Split Type':

Write-up: INTUSSUSCEPTION 6/20/08-records received for DOS 4/30-4/2/08-DC DX: Inussusception now resolved, status post surgical repair. Leukocytosis. Presented to ED with decreased activity, decreased oral intake, increased irritability and emesis. Bloody stool with diarrhea, lethargy. Surgical laparotomy with appendectomy. 7/7/08-ER recs received for DOS 4/29/08-C/O vomiting, lethargic, . Dehydration, irritability.


Changed on 8/31/2010

VAERS ID: 316652 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Texas
Vaccinated:2008-03-27
Onset:2008-04-30
Submitted:2008-06-19
Entered:2008-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ACZ1B139AA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF329AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH C45893 / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1731U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Appendicectomy, Barium double contrast, Dehydration, Diarrhoea, Haematochezia, Intussusception, Irritability, Laparotomy, Lethargy, Leukocytosis, Urinary system X-ray, Vomiting, Occult blood positive, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: 6/20/08-records received-PMH:mild gastroesophageal reflux disease
Allergies:
Diagnostic Lab Data: INTUSSUSCEPTION 6/20/08-records received-Air contrast enema showed intussusception but unsuccessful in reducing. 7/7/08-records received-KUB unremarkable moderate colonic stool, bloody stool, guaiac positive.
CDC 'Split Type':

Write-up: INTUSSUSCEPTION 6/20/08-records received for DOS 4/30-4/2/08-DC DX: Inussusception now resolved, status post surgical repair. Leukocytosis. Presented to ED with decreased activity, decreased oral intake, increased irritability and emesis. Bloody stool with diarrhea, lethargy. Surgical laparotomy with appendectomy. 7/7/08-ER recs received for DOS 4/29/08-C/O vomiting, lethargic, . Dehydration, irritability.


Changed on 5/13/2013

VAERS ID: 316652 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Texas
Vaccinated:2008-03-27
Onset:2008-04-30
Submitted:2008-06-19
Entered:2008-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ACZ1B139AA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF329AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45893 / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1731U / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1731U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Appendicectomy, Barium double contrast, Dehydration, Diarrhoea, Haematochezia, Intussusception, Irritability, Laparotomy, Lethargy, Leukocytosis, Urinary system X-ray, Vomiting, Occult blood positive, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: 6/20/08-records received-PMH:mild gastroesophageal reflux disease
Allergies:
Diagnostic Lab Data: INTUSSUSCEPTION 6/20/08-records received-Air contrast enema showed intussusception but unsuccessful in reducing. 7/7/08-records received-KUB unremarkable moderate colonic stool, bloody stool, guaiac positive.
CDC 'Split Type':

Write-up: INTUSSUSCEPTION 6/20/08-records received for DOS 4/30-4/2/08-DC DX: Inussusception now resolved, status post surgical repair. Leukocytosis. Presented to ED with decreased activity, decreased oral intake, increased irritability and emesis. Bloody stool with diarrhea, lethargy. Surgical laparotomy with appendectomy. 7/7/08-ER recs received for DOS 4/29/08-C/O vomiting, lethargic, . Dehydration, irritability.


Changed on 2/14/2017

VAERS ID: 316652 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Texas
Vaccinated:2008-03-27
Onset:2008-04-30
Submitted:2008-06-19
Entered:2008-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ACZ1B139AA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF329AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45893 / 0 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1731U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Appendicectomy, Barium double contrast, Dehydration, Diarrhoea, Haematochezia, Intussusception, Irritability, Laparotomy, Lethargy, Leukocytosis, Urinary system X-ray, Vomiting, Occult blood positive, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: 6/20/08-records received-PMH:mild gastroesophageal reflux disease
Allergies:
Diagnostic Lab Data: INTUSSUSCEPTION 6/20/08-records received-Air contrast enema showed intussusception but unsuccessful in reducing. 7/7/08-records received-KUB unremarkable moderate colonic stool, bloody stool, guaiac positive.
CDC 'Split Type':

Write-up: INTUSSUSCEPTION 6/20/08-records received for DOS 4/30-4/2/08-DC DX: Inussusception now resolved, status post surgical repair. Leukocytosis. Presented to ED with decreased activity, decreased oral intake, increased irritability and emesis. Bloody stool with diarrhea, lethargy. Surgical laparotomy with appendectomy. 7/7/08-ER recs received for DOS 4/29/08-C/O vomiting, lethargic, . Dehydration, irritability.


Changed on 9/14/2017

VAERS ID: 316652 Before After
VAERS Form:(blank) 1
Age:0.3
Sex:Male
Location:Texas
Vaccinated:2008-03-27
Onset:2008-04-30
Submitted:2008-06-19
Entered:2008-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ACZ1B139AA / 0 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF329AA / 0 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45893 / 0 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1731U / 0 1 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception

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: 3     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: 6/20/08-records received-PMH:mild gastroesophageal reflux disease
Allergies:
Diagnostic Lab Data: INTUSSUSCEPTION 6/20/08-records received-Air contrast enema showed intussusception but unsuccessful in reducing. 7/7/08-records received-KUB unremarkable moderate colonic stool, bloody stool, guaiac positive.
CDC 'Split Type':

Write-up: INTUSSUSCEPTION 6/20/08-records received for DOS 4/30-4/2/08-DC DX: Inussusception now resolved, status post surgical repair. Leukocytosis. Presented to ED with decreased activity, decreased oral intake, increased irritability and emesis. Bloody stool with diarrhea, lethargy. Surgical laparotomy with appendectomy. 7/7/08-ER recs received for DOS 4/29/08-C/O vomiting, lethargic, . Dehydration, irritability.


Changed on 2/14/2018

VAERS ID: 316652 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Texas
Vaccinated:2008-03-27
Onset:2008-04-30
Submitted:2008-06-19
Entered:2008-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ACZ1B139AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF329AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45893 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1731U / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception

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: 3     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: 6/20/08-records received-PMH:mild gastroesophageal reflux disease
Allergies:
Diagnostic Lab Data: INTUSSUSCEPTION 6/20/08-records received-Air contrast enema showed intussusception but unsuccessful in reducing. 7/7/08-records received-KUB unremarkable moderate colonic stool, bloody stool, guaiac positive.
CDC 'Split Type':

Write-up: INTUSSUSCEPTION 6/20/08-records received for DOS 4/30-4/2/08-DC DX: Inussusception now resolved, status post surgical repair. Leukocytosis. Presented to ED with decreased activity, decreased oral intake, increased irritability and emesis. Bloody stool with diarrhea, lethargy. Surgical laparotomy with appendectomy. 7/7/08-ER recs received for DOS 4/29/08-C/O vomiting, lethargic, . Dehydration, irritability.


Changed on 6/14/2018

VAERS ID: 316652 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Texas
Vaccinated:2008-03-27
Onset:2008-04-30
Submitted:2008-06-19
Entered:2008-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ACZ1B139AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF329AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45893 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1731U / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception

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: 3     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: 6/20/08-records received-PMH:mild gastroesophageal reflux disease
Allergies:
Diagnostic Lab Data: INTUSSUSCEPTION 6/20/08-records received-Air contrast enema showed intussusception but unsuccessful in reducing. 7/7/08-records received-KUB unremarkable moderate colonic stool, bloody stool, guaiac positive.
CDC 'Split Type':

Write-up: INTUSSUSCEPTION 6/20/08-records received for DOS 4/30-4/2/08-DC DX: Inussusception now resolved, status post surgical repair. Leukocytosis. Presented to ED with decreased activity, decreased oral intake, increased irritability and emesis. Bloody stool with diarrhea, lethargy. Surgical laparotomy with appendectomy. 7/7/08-ER recs received for DOS 4/29/08-C/O vomiting, lethargic, . Dehydration, irritability.


Changed on 8/14/2018

VAERS ID: 316652 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Texas
Vaccinated:2008-03-27
Onset:2008-04-30
Submitted:2008-06-19
Entered:2008-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ACZ1B139AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF329AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45893 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1731U / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception

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: 3     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: 6/20/08-records received-PMH:mild gastroesophageal reflux disease
Allergies:
Diagnostic Lab Data: INTUSSUSCEPTION 6/20/08-records received-Air contrast enema showed intussusception but unsuccessful in reducing. 7/7/08-records received-KUB unremarkable moderate colonic stool, bloody stool, guaiac positive.
CDC 'Split Type':

Write-up: INTUSSUSCEPTION 6/20/08-records received for DOS 4/30-4/2/08-DC DX: Inussusception now resolved, status post surgical repair. Leukocytosis. Presented to ED with decreased activity, decreased oral intake, increased irritability and emesis. Bloody stool with diarrhea, lethargy. Surgical laparotomy with appendectomy. 7/7/08-ER recs received for DOS 4/29/08-C/O vomiting, lethargic, . Dehydration, irritability.


Changed on 9/14/2018

VAERS ID: 316652 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Texas
Vaccinated:2008-03-27
Onset:2008-04-30
Submitted:2008-06-19
Entered:2008-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ACZ1B139AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF329AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45893 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1731U / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception

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: 3     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: 6/20/08-records received-PMH:mild gastroesophageal reflux disease
Allergies:
Diagnostic Lab Data: INTUSSUSCEPTION 6/20/08-records received-Air contrast enema showed intussusception but unsuccessful in reducing. 7/7/08-records received-KUB unremarkable moderate colonic stool, bloody stool, guaiac positive.
CDC 'Split Type':

Write-up: INTUSSUSCEPTION 6/20/08-records received for DOS 4/30-4/2/08-DC DX: Inussusception now resolved, status post surgical repair. Leukocytosis. Presented to ED with decreased activity, decreased oral intake, increased irritability and emesis. Bloody stool with diarrhea, lethargy. Surgical laparotomy with appendectomy. 7/7/08-ER recs received for DOS 4/29/08-C/O vomiting, lethargic, . Dehydration, irritability.


Changed on 10/14/2018

VAERS ID: 316652 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Texas
Vaccinated:2008-03-27
Onset:2008-04-30
Submitted:2008-06-19
Entered:2008-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ACZ1B139AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF329AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45893 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1731U / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception

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: 3     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: 6/20/08-records received-PMH:mild gastroesophageal reflux disease
Allergies:
Diagnostic Lab Data: INTUSSUSCEPTION 6/20/08-records received-Air contrast enema showed intussusception but unsuccessful in reducing. 7/7/08-records received-KUB unremarkable moderate colonic stool, bloody stool, guaiac positive.
CDC 'Split Type':

Write-up: INTUSSUSCEPTION 6/20/08-records received for DOS 4/30-4/2/08-DC DX: Inussusception now resolved, status post surgical repair. Leukocytosis. Presented to ED with decreased activity, decreased oral intake, increased irritability and emesis. Bloody stool with diarrhea, lethargy. Surgical laparotomy with appendectomy. 7/7/08-ER recs received for DOS 4/29/08-C/O vomiting, lethargic, . Dehydration, irritability.

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