National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 323228

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 323228
VAERS Form:
Age:0.2
Gender:Male
Location:Maryland
Vaccinated:2008-07-29
Onset:2008-08-17
Submitted:2008-08-23
Entered:2008-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2952BA / 0 LL / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1070U / 0 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF449AA / 0 LL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0491 / 0 LL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C65931 / 0 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0309X / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Abdominal rigidity, Barium double contrast, Barium enema abnormal, Crying, Frequent bowel movements

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: Fussy baby; ? formula intolerance/colic
Allergies:
Diagnostic Lab Data: Barium enema - intussusception noted in (L) colon which was reduced with contrast column. Reflux of barium was noted intermime ileum 8/22/08. 9/5/08-records received-Passed stool while in ED hemoccult positive. Success reduction of intussu
CDC 'Split Type':

Write-up: Pt had increase stooling 3 days prior to hospitalization. There was no bowel movement the next day but increased fussiness. By on night prior to admission baby refused pacifier and only liked upright position. Patient seen in our office and sent to hospit"al to r/o intussusception. KUB, labs normal but heme (+) stool noted. Patient admitted for observation and Ba enema done due to increased fussiness and intussusception diagnosed. Baby recovered well and discharged home 2 days later. 8/26/08-DC summary rec


Changed on 12/8/2009

VAERS ID: 323228 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Maryland
Vaccinated:2008-07-29
Onset:2008-08-17
Submitted:2008-08-23
Entered:2008-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2952BA / 0 LL / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1070U / 0 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF449AA / 0 LL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0491 / 0 LL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C65931 / 0 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0309X / 0 - / PO

Administered by: Private      Purchased by: Unknown Private
Symptoms: Abdominal rigidity, Barium double contrast, Barium enema abnormal, Crying, Frequent bowel movements, Haematochezia, Intussusception, Irritability, Urinary system X-ray, Occult blood positive, Gastrointestinal sounds 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: None
Preexisting Conditions: Fussy baby; ? formula intolerance/colic
Allergies:
Diagnostic Lab Data: Barium enema - intussusception noted in (L) colon which was reduced with contrast column. Reflux of barium was noted intermime ileum 8/22/08. 9/5/08-records received-Passed stool while in ED hemoccult positive. Success reduction of intussu
CDC 'Split Type':

Write-up: Pt had increase stooling 3 days prior to hospitalization. There was no bowel movement the next day but increased fussiness. By on night prior to admission baby refused pacifier and only liked upright position. Patient seen in our office and sent to hospit"al hospital to r/o intussusception. KUB, labs normal but heme (+) stool noted. Patient admitted for observation and Ba enema done due to increased fussiness and intussusception diagnosed. Baby recovered well and discharged home 2 days later. 8/26/08-DC summary rec received for DOS 8/22/08-DC DX: Intussusception. Admitted with C/O irritability. 9/5/08-records received for DOS 8/20-8/22/08-presented to ED with 3 day history of fussy, crying difficult to console, minimal stool output. Breastfeeding until 2 nights ago when rice cereal was introduced. Abdomen hard with poor bowel sounds.


Changed on 3/2/2010

VAERS ID: 323228 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Maryland
Vaccinated:2008-07-29
Onset:2008-08-17
Submitted:2008-08-23
Entered:2008-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2952BA / 0 LL / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1070U / 0 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF449AA / 0 LL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0491 / 0 LL / UN
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC C65931 / 0 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0309X / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal rigidity, Barium double contrast, Barium enema abnormal, Crying, Frequent bowel movements, Haematochezia, Intussusception, Irritability, Urinary system X-ray, Occult blood positive, Gastrointestinal sounds 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: None
Preexisting Conditions: Fussy baby; ? formula intolerance/colic
Allergies:
Diagnostic Lab Data: Barium enema - intussusception noted in (L) colon which was reduced with contrast column. Reflux of barium was noted intermime ileum 8/22/08. 9/5/08-records received-Passed stool while in ED hemoccult positive. Success reduction of intussu
CDC 'Split Type':

Write-up: Pt had increase stooling 3 days prior to hospitalization. There was no bowel movement the next day but increased fussiness. By on night prior to admission baby refused pacifier and only liked upright position. Patient seen in our office and sent to hospital to r/o intussusception. KUB, labs normal but heme (+) stool noted. Patient admitted for observation and Ba enema done due to increased fussiness and intussusception diagnosed. Baby recovered well and discharged home 2 days later. 8/26/08-DC summary received for DOS 8/22/08-DC DX: Intussusception. Admitted with C/O irritability. 9/5/08-records received for DOS 8/20-8/22/08-presented to ED with 3 day history of fussy, crying difficult to console, minimal stool output. Breastfeeding until 2 nights ago when rice cereal was introduced. Abdomen hard with poor bowel sounds.


Changed on 4/7/2010

VAERS ID: 323228 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Maryland
Vaccinated:2008-07-29
Onset:2008-08-17
Submitted:2008-08-23
Entered:2008-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2952BA / 0 LL / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1070U / 0 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF449AA / 0 LL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0491 / 0 LL / UN
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C65931 / 0 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0309X / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal rigidity, Barium double contrast, Barium enema abnormal, Crying, Frequent bowel movements, Haematochezia, Intussusception, Irritability, Urinary system X-ray, Occult blood positive, Gastrointestinal sounds 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: None
Preexisting Conditions: Fussy baby; ? formula intolerance/colic
Allergies:
Diagnostic Lab Data: Barium enema - intussusception noted in (L) colon which was reduced with contrast column. Reflux of barium was noted intermime ileum 8/22/08. 9/5/08-records received-Passed stool while in ED hemoccult positive. Success reduction of intussu
CDC 'Split Type':

Write-up: Pt had increase stooling 3 days prior to hospitalization. There was no bowel movement the next day but increased fussiness. By on night prior to admission baby refused pacifier and only liked upright position. Patient seen in our office and sent to hospital to r/o intussusception. KUB, labs normal but heme (+) stool noted. Patient admitted for observation and Ba enema done due to increased fussiness and intussusception diagnosed. Baby recovered well and discharged home 2 days later. 8/26/08-DC summary received for DOS 8/22/08-DC DX: Intussusception. Admitted with C/O irritability. 9/5/08-records received for DOS 8/20-8/22/08-presented to ED with 3 day history of fussy, crying difficult to console, minimal stool output. Breastfeeding until 2 nights ago when rice cereal was introduced. Abdomen hard with poor bowel sounds.


Changed on 8/31/2010

VAERS ID: 323228 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Maryland
Vaccinated:2008-07-29
Onset:2008-08-17
Submitted:2008-08-23
Entered:2008-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2952BA / 0 LL / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1070U / 0 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF449AA / 0 LL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0491 / 0 LL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH C65931 / 0 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0309X / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal rigidity, Barium double contrast, Barium enema abnormal, Crying, Frequent bowel movements, Haematochezia, Intussusception, Irritability, Urinary system X-ray, Occult blood positive, Gastrointestinal sounds 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: None
Preexisting Conditions: Fussy baby; ? formula intolerance/colic
Allergies:
Diagnostic Lab Data: Barium enema - intussusception noted in (L) colon which was reduced with contrast column. Reflux of barium was noted intermime ileum 8/22/08. 9/5/08-records received-Passed stool while in ED hemoccult positive. Success reduction of intussu
CDC 'Split Type':

Write-up: Pt had increase stooling 3 days prior to hospitalization. There was no bowel movement the next day but increased fussiness. By on night prior to admission baby refused pacifier and only liked upright position. Patient seen in our office and sent to hospital to r/o intussusception. KUB, labs normal but heme (+) stool noted. Patient admitted for observation and Ba enema done due to increased fussiness and intussusception diagnosed. Baby recovered well and discharged home 2 days later. 8/26/08-DC summary received for DOS 8/22/08-DC DX: Intussusception. Admitted with C/O irritability. 9/5/08-records received for DOS 8/20-8/22/08-presented to ED with 3 day history of fussy, crying difficult to console, minimal stool output. Breastfeeding until 2 nights ago when rice cereal was introduced. Abdomen hard with poor bowel sounds.


Changed on 5/13/2013

VAERS ID: 323228 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Maryland
Vaccinated:2008-07-29
Onset:2008-08-17
Submitted:2008-08-23
Entered:2008-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2952BA / 0 LL / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1070U / 0 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF449AA / 0 LL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0491 / 0 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65931 / 0 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0309X / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0309X / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal rigidity, Barium double contrast, Barium enema abnormal, Crying, Frequent bowel movements, Haematochezia, Intussusception, Irritability, Urinary system X-ray, Occult blood positive, Gastrointestinal sounds 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: None
Preexisting Conditions: Fussy baby; ? formula intolerance/colic
Allergies:
Diagnostic Lab Data: Barium enema - intussusception noted in (L) colon which was reduced with contrast column. Reflux of barium was noted intermime ileum 8/22/08. 9/5/08-records received-Passed stool while in ED hemoccult positive. Success reduction of intussu
CDC 'Split Type':

Write-up: Pt had increase stooling 3 days prior to hospitalization. There was no bowel movement the next day but increased fussiness. By on night prior to admission baby refused pacifier and only liked upright position. Patient seen in our office and sent to hospital to r/o intussusception. KUB, labs normal but heme (+) stool noted. Patient admitted for observation and Ba enema done due to increased fussiness and intussusception diagnosed. Baby recovered well and discharged home 2 days later. 8/26/08-DC summary received for DOS 8/22/08-DC DX: Intussusception. Admitted with C/O irritability. 9/5/08-records received for DOS 8/20-8/22/08-presented to ED with 3 day history of fussy, crying difficult to console, minimal stool output. Breastfeeding until 2 nights ago when rice cereal was introduced. Abdomen hard with poor bowel sounds.


Changed on 4/14/2017

VAERS ID: 323228 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Maryland
Vaccinated:2008-07-29
Onset:2008-08-17
Submitted:2008-08-23
Entered:2008-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2952BA / 0 LL / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1070U / 0 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF449AA / 0 LL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0491 / 0 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65931 / 0 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0309X / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal rigidity, Barium double contrast, Barium enema abnormal, Crying, Frequent bowel movements, Haematochezia, Intussusception, Irritability, Urinary system X-ray, Occult blood positive, Gastrointestinal sounds 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: None
Preexisting Conditions: Fussy baby; ? formula intolerance/colic
Allergies:
Diagnostic Lab Data: Barium enema - intussusception noted in (L) colon which was reduced with contrast column. Reflux of barium was noted intermime ileum 8/22/08. 9/5/08-records received-Passed stool while in ED hemoccult positive. Success reduction of intussu intussusception with barium contrast enema.
CDC 'Split Type':

Write-up: Pt had increase stooling 3 days prior to hospitalization. There was no bowel movement the next day but increased fussiness. By on night prior to admission baby refused pacifier and only liked upright position. Patient seen in our office and sent to hospital to r/o intussusception. KUB, labs normal but heme (+) stool noted. Patient admitted for observation and Ba enema done due to increased fussiness and intussusception diagnosed. Baby recovered well and discharged home 2 days later. 8/26/08-DC summary received for DOS 8/22/08-DC DX: Intussusception. Admitted with C/O irritability. 9/5/08-records received for DOS 8/20-8/22/08-presented to ED with 3 day history of fussy, crying difficult to console, minimal stool output. Breastfeeding until 2 nights ago when rice cereal was introduced. Abdomen hard with poor bowel sounds.


Changed on 9/14/2017

VAERS ID: 323228 Before After
VAERS Form:(blank) 1
Age:0.2
Gender:Male
Location:Maryland
Vaccinated:2008-07-29
Onset:2008-08-17
Submitted:2008-08-23
Entered:2008-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2952BA / 0 1 LL / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1070U / 0 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF449AA / 0 1 LL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0491 / 0 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65931 / 0 1 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0309X / 0 1 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema abnormal, Frequent bowel movements, Haematochezia, Intussusception, Irritability, Urinary system X-ray, 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: None
Preexisting Conditions: Fussy baby; ? formula intolerance/colic
Allergies:
Diagnostic Lab Data: Barium enema - intussusception noted in (L) colon which was reduced with contrast column. Reflux of barium was noted intermime ileum 8/22/08. 9/5/08-records received-Passed stool while in ED hemoccult positive. Success reduction of intussusception with barium contrast enema.
CDC 'Split Type':

Write-up: Pt had increase stooling 3 days prior to hospitalization. There was no bowel movement the next day but increased fussiness. By on night prior to admission baby refused pacifier and only liked upright position. Patient seen in our office and sent to hospital to r/o intussusception. KUB, labs normal but heme (+) stool noted. Patient admitted for observation and Ba enema done due to increased fussiness and intussusception diagnosed. Baby recovered well and discharged home 2 days later. 8/26/08-DC summary received for DOS 8/22/08-DC DX: Intussusception. Admitted with C/O irritability. 9/5/08-records received for DOS 8/20-8/22/08-presented to ED with 3 day history of fussy, crying difficult to console, minimal stool output. Breastfeeding until 2 nights ago when rice cereal was introduced. Abdomen hard with poor bowel sounds.


Changed on 2/14/2018

VAERS ID: 323228 Before After
VAERS Form:1
Age:0.2
Gender:Male
Location:Maryland
Vaccinated:2008-07-29
Onset:2008-08-17
Submitted:2008-08-23
Entered:2008-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2952BA / 1 LL / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1070U / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF449AA / 1 LL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0491 / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65931 / 1 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0309X / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema abnormal, Frequent bowel movements, Haematochezia, Intussusception, Irritability, Urinary system X-ray, 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: None
Preexisting Conditions: Fussy baby; ? formula intolerance/colic
Allergies:
Diagnostic Lab Data: Barium enema - intussusception noted in (L) colon which was reduced with contrast column. Reflux of barium was noted intermime ileum 8/22/08. 9/5/08-records received-Passed stool while in ED hemoccult positive. Success reduction of intussusception with barium contrast enema.
CDC 'Split Type':

Write-up: Pt had increase stooling 3 days prior to hospitalization. There was no bowel movement the next day but increased fussiness. By on night prior to admission baby refused pacifier and only liked upright position. Patient seen in our office and sent to hospital to r/o intussusception. KUB, labs normal but heme (+) stool noted. Patient admitted for observation and Ba enema done due to increased fussiness and intussusception diagnosed. Baby recovered well and discharged home 2 days later. 8/26/08-DC summary received for DOS 8/22/08-DC DX: Intussusception. Admitted with C/O irritability. 9/5/08-records received for DOS 8/20-8/22/08-presented to ED with 3 day history of fussy, crying difficult to console, minimal stool output. Breastfeeding until 2 nights ago when rice cereal was introduced. Abdomen hard with poor bowel sounds.


Changed on 6/14/2018

VAERS ID: 323228 Before After
VAERS Form:1
Age:0.2
Gender:Male
Location:Maryland
Vaccinated:2008-07-29
Onset:2008-08-17
Submitted:2008-08-23
Entered:2008-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2952BA / 1 LL / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1070U / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF449AA / 1 LL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0491 / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65931 / 1 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0309X / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema abnormal, Frequent bowel movements, Haematochezia, Intussusception, Irritability, Urinary system X-ray, 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: None
Preexisting Conditions: Fussy baby; ? formula intolerance/colic
Allergies:
Diagnostic Lab Data: Barium enema - intussusception noted in (L) colon which was reduced with contrast column. Reflux of barium was noted intermime ileum 8/22/08. 9/5/08-records received-Passed stool while in ED hemoccult positive. Success reduction of intussusception with barium contrast enema.
CDC 'Split Type':

Write-up: Pt had increase stooling 3 days prior to hospitalization. There was no bowel movement the next day but increased fussiness. By on night prior to admission baby refused pacifier and only liked upright position. Patient seen in our office and sent to hospital to r/o intussusception. KUB, labs normal but heme (+) stool noted. Patient admitted for observation and Ba enema done due to increased fussiness and intussusception diagnosed. Baby recovered well and discharged home 2 days later. 8/26/08-DC summary received for DOS 8/22/08-DC DX: Intussusception. Admitted with C/O irritability. 9/5/08-records received for DOS 8/20-8/22/08-presented to ED with 3 day history of fussy, crying difficult to console, minimal stool output. Breastfeeding until 2 nights ago when rice cereal was introduced. Abdomen hard with poor bowel sounds.


Changed on 8/14/2018

VAERS ID: 323228 Before After
VAERS Form:1
Age:0.2
Gender:Male
Location:Maryland
Vaccinated:2008-07-29
Onset:2008-08-17
Submitted:2008-08-23
Entered:2008-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2952BA / 1 LL / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1070U / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF449AA / 1 LL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0491 / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65931 / 1 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0309X / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema abnormal, Frequent bowel movements, Haematochezia, Intussusception, Irritability, Urinary system X-ray, 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: None
Preexisting Conditions: Fussy baby; ? formula intolerance/colic
Allergies:
Diagnostic Lab Data: Barium enema - intussusception noted in (L) colon which was reduced with contrast column. Reflux of barium was noted intermime ileum 8/22/08. 9/5/08-records received-Passed stool while in ED hemoccult positive. Success reduction of intussusception with barium contrast enema.
CDC 'Split Type':

Write-up: Pt had increase stooling 3 days prior to hospitalization. There was no bowel movement the next day but increased fussiness. By on night prior to admission baby refused pacifier and only liked upright position. Patient seen in our office and sent to hospital to r/o intussusception. KUB, labs normal but heme (+) stool noted. Patient admitted for observation and Ba enema done due to increased fussiness and intussusception diagnosed. Baby recovered well and discharged home 2 days later. 8/26/08-DC summary received for DOS 8/22/08-DC DX: Intussusception. Admitted with C/O irritability. 9/5/08-records received for DOS 8/20-8/22/08-presented to ED with 3 day history of fussy, crying difficult to console, minimal stool output. Breastfeeding until 2 nights ago when rice cereal was introduced. Abdomen hard with poor bowel sounds.


Changed on 9/14/2018

VAERS ID: 323228 Before After
VAERS Form:1
Age:0.2
Gender:Male
Location:Maryland
Vaccinated:2008-07-29
Onset:2008-08-17
Submitted:2008-08-23
Entered:2008-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2952BA / 1 LL / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1070U / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF449AA / 1 LL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0491 / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65931 / 1 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0309X / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema abnormal, Frequent bowel movements, Haematochezia, Intussusception, Irritability, Urinary system X-ray, 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: None
Preexisting Conditions: Fussy baby; ? formula intolerance/colic
Allergies:
Diagnostic Lab Data: Barium enema - intussusception noted in (L) colon which was reduced with contrast column. Reflux of barium was noted intermime ileum 8/22/08. 9/5/08-records received-Passed stool while in ED hemoccult positive. Success reduction of intussusception with barium contrast enema.
CDC 'Split Type':

Write-up: Pt had increase stooling 3 days prior to hospitalization. There was no bowel movement the next day but increased fussiness. By on night prior to admission baby refused pacifier and only liked upright position. Patient seen in our office and sent to hospital to r/o intussusception. KUB, labs normal but heme (+) stool noted. Patient admitted for observation and Ba enema done due to increased fussiness and intussusception diagnosed. Baby recovered well and discharged home 2 days later. 8/26/08-DC summary received for DOS 8/22/08-DC DX: Intussusception. Admitted with C/O irritability. 9/5/08-records received for DOS 8/20-8/22/08-presented to ED with 3 day history of fussy, crying difficult to console, minimal stool output. Breastfeeding until 2 nights ago when rice cereal was introduced. Abdomen hard with poor bowel sounds.


Changed on 10/14/2018

VAERS ID: 323228 Before After
VAERS Form:1
Age:0.2
Gender:Male
Location:Maryland
Vaccinated:2008-07-29
Onset:2008-08-17
Submitted:2008-08-23
Entered:2008-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2952BA / 1 LL / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1070U / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF449AA / 1 LL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0491 / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65931 / 1 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0309X / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema abnormal, Frequent bowel movements, Haematochezia, Intussusception, Irritability, Urinary system X-ray, 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: None
Preexisting Conditions: Fussy baby; ? formula intolerance/colic
Allergies:
Diagnostic Lab Data: Barium enema - intussusception noted in (L) colon which was reduced with contrast column. Reflux of barium was noted intermime ileum 8/22/08. 9/5/08-records received-Passed stool while in ED hemoccult positive. Success reduction of intussusception with barium contrast enema.
CDC 'Split Type':

Write-up: Pt had increase stooling 3 days prior to hospitalization. There was no bowel movement the next day but increased fussiness. By on night prior to admission baby refused pacifier and only liked upright position. Patient seen in our office and sent to hospital to r/o intussusception. KUB, labs normal but heme (+) stool noted. Patient admitted for observation and Ba enema done due to increased fussiness and intussusception diagnosed. Baby recovered well and discharged home 2 days later. 8/26/08-DC summary received for DOS 8/22/08-DC DX: Intussusception. Admitted with C/O irritability. 9/5/08-records received for DOS 8/20-8/22/08-presented to ED with 3 day history of fussy, crying difficult to console, minimal stool output. Breastfeeding until 2 nights ago when rice cereal was introduced. Abdomen hard with poor bowel sounds.

New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=323228&WAYBACKHISTORY=ON


Copyright © 2019 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166