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This is VAERS ID 323278

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 323278
VAERS Form:
Age:0.4
Gender:Male
Location:Florida
Vaccinated:2008-06-17
Onset:2008-08-06
Submitted:2008-08-20
Entered:2008-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B182AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF447AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C45721F / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0141X / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Abdominal mass, Barium enema abnormal, Crying, Dehydration, Enema administration

Life Threatening? Yes
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? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None. PMH: none.
Allergies:
Diagnostic Lab Data: Barium Enema diagnostic and therapeutic. Labs and Diagnostics: KUB with abnormal gas pattern. Barium enema (+) for IS, also noted possible malrotation.
CDC 'Split Type':

Write-up: Intussusception. 09/05/2008 MR received for DOS 8/6/2008 with DX: Intussusception reduced, suspect malrotation. Infant presented with 7-8 hr hx of intermittant crying and pulling the legs to the abdomen, increased sleep and later blood/mucus in the diaper". (+) gagging but no vomiting. PE (+) for an abdominal mass left to the umbilicus and dehydration. IS identified and reduced by barium enema. Pt was stable and to be transfered for further eval of abnormal BE. 9/08/2008 No further diagnostic tests done.


Changed on 12/8/2009

VAERS ID: 323278 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Florida
Vaccinated:2008-06-17
Onset:2008-08-06
Submitted:2008-08-20
Entered:2008-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B182AA / 1 RL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B182AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF447AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C45721F / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0141X / 1 - / PO

Administered by: Private      Purchased by: Unknown Private
Symptoms: Abdominal mass, Barium enema abnormal, Crying, Dehydration, Haematochezia, Hypersomnia, Intussusception, Mucous stools, Retching, Urinary system X-ray, Enema administration

Life Threatening? Yes
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? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None. PMH: none.
Allergies:
Diagnostic Lab Data: Barium Enema diagnostic and therapeutic. Labs and Diagnostics: KUB with abnormal gas pattern. Barium enema (+) for IS, also noted possible malrotation.
CDC 'Split Type':

Write-up: Intussusception. 09/05/2008 MR received for DOS 8/6/2008 with DX: Intussusception reduced, suspect malrotation. Infant presented with 7-8 hr hx of intermittant crying and pulling the legs to the abdomen, increased sleep and later blood/mucus in the diaper". diaper. (+) gagging but no vomiting. PE (+) for an abdominal mass left to the umbilicus and dehydration. IS identified and reduced by barium enema. Pt was stable and to be transfered for further eval of abnormal BE. 9/08/2008 No further diagnostic tests done.


Changed on 3/2/2010

VAERS ID: 323278 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Florida
Vaccinated:2008-06-17
Onset:2008-08-06
Submitted:2008-08-20
Entered:2008-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B182AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF447AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC C45721F / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0141X / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal mass, Barium enema abnormal, Crying, Dehydration, Haematochezia, Hypersomnia, Intussusception, Mucous stools, Retching, Urinary system X-ray, Enema administration

Life Threatening? Yes
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? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None. PMH: none.
Allergies:
Diagnostic Lab Data: Barium Enema diagnostic and therapeutic. Labs and Diagnostics: KUB with abnormal gas pattern. Barium enema (+) for IS, also noted possible malrotation.
CDC 'Split Type':

Write-up: Intussusception. 09/05/2008 MR received for DOS 8/6/2008 with DX: Intussusception reduced, suspect malrotation. Infant presented with 7-8 hr hx of intermittant crying and pulling the legs to the abdomen, increased sleep and later blood/mucus in the diaper. (+) gagging but no vomiting. PE (+) for an abdominal mass left to the umbilicus and dehydration. IS identified and reduced by barium enema. Pt was stable and to be transfered for further eval of abnormal BE. 9/08/2008 No further diagnostic tests done.


Changed on 4/7/2010

VAERS ID: 323278 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Florida
Vaccinated:2008-06-17
Onset:2008-08-06
Submitted:2008-08-20
Entered:2008-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B182AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF447AA / 1 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C45721F / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0141X / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal mass, Barium enema abnormal, Crying, Dehydration, Haematochezia, Hypersomnia, Intussusception, Mucous stools, Retching, Urinary system X-ray, Enema administration

Life Threatening? Yes
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? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None. PMH: none.
Allergies:
Diagnostic Lab Data: Barium Enema diagnostic and therapeutic. Labs and Diagnostics: KUB with abnormal gas pattern. Barium enema (+) for IS, also noted possible malrotation.
CDC 'Split Type':

Write-up: Intussusception. 09/05/2008 MR received for DOS 8/6/2008 with DX: Intussusception reduced, suspect malrotation. Infant presented with 7-8 hr hx of intermittant crying and pulling the legs to the abdomen, increased sleep and later blood/mucus in the diaper. (+) gagging but no vomiting. PE (+) for an abdominal mass left to the umbilicus and dehydration. IS identified and reduced by barium enema. Pt was stable and to be transfered for further eval of abnormal BE. 9/08/2008 No further diagnostic tests done.


Changed on 8/31/2010

VAERS ID: 323278 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Florida
Vaccinated:2008-06-17
Onset:2008-08-06
Submitted:2008-08-20
Entered:2008-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B182AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF447AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH C45721F / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0141X / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal mass, Barium enema abnormal, Crying, Dehydration, Haematochezia, Hypersomnia, Intussusception, Mucous stools, Retching, Urinary system X-ray, Enema administration

Life Threatening? Yes
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? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None. PMH: none.
Allergies:
Diagnostic Lab Data: Barium Enema diagnostic and therapeutic. Labs and Diagnostics: KUB with abnormal gas pattern. Barium enema (+) for IS, also noted possible malrotation.
CDC 'Split Type':

Write-up: Intussusception. 09/05/2008 MR received for DOS 8/6/2008 with DX: Intussusception reduced, suspect malrotation. Infant presented with 7-8 hr hx of intermittant crying and pulling the legs to the abdomen, increased sleep and later blood/mucus in the diaper. (+) gagging but no vomiting. PE (+) for an abdominal mass left to the umbilicus and dehydration. IS identified and reduced by barium enema. Pt was stable and to be transfered for further eval of abnormal BE. 9/08/2008 No further diagnostic tests done.


Changed on 5/13/2013

VAERS ID: 323278 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Florida
Vaccinated:2008-06-17
Onset:2008-08-06
Submitted:2008-08-20
Entered:2008-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B182AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF447AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45721F / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0141X / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0141X / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal mass, Barium enema abnormal, Crying, Dehydration, Haematochezia, Hypersomnia, Intussusception, Mucous stools, Retching, Urinary system X-ray, Enema administration

Life Threatening? Yes
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? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None. PMH: none.
Allergies:
Diagnostic Lab Data: Barium Enema diagnostic and therapeutic. Labs and Diagnostics: KUB with abnormal gas pattern. Barium enema (+) for IS, also noted possible malrotation.
CDC 'Split Type':

Write-up: Intussusception. 09/05/2008 MR received for DOS 8/6/2008 with DX: Intussusception reduced, suspect malrotation. Infant presented with 7-8 hr hx of intermittant crying and pulling the legs to the abdomen, increased sleep and later blood/mucus in the diaper. (+) gagging but no vomiting. PE (+) for an abdominal mass left to the umbilicus and dehydration. IS identified and reduced by barium enema. Pt was stable and to be transfered for further eval of abnormal BE. 9/08/2008 No further diagnostic tests done.


Changed on 4/14/2017

VAERS ID: 323278 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Florida
Vaccinated:2008-06-17
Onset:2008-08-06
Submitted:2008-08-20
Entered:2008-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B182AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF447AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45721F / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0141X / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal mass, Barium enema abnormal, Crying, Dehydration, Haematochezia, Hypersomnia, Intussusception, Mucous stools, Retching, Urinary system X-ray, Enema administration

Life Threatening? Yes
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? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None. PMH: none.
Allergies:
Diagnostic Lab Data: Barium Enema diagnostic and therapeutic. Labs and Diagnostics: KUB with abnormal gas pattern. Barium enema (+) for IS, also noted possible malrotation.
CDC 'Split Type':

Write-up: Intussusception. 09/05/2008 MR received for DOS 8/6/2008 with DX: Intussusception reduced, suspect malrotation. Infant presented with 7-8 hr hx of intermittant crying and pulling the legs to the abdomen, increased sleep and later blood/mucus in the diaper. (+) gagging but no vomiting. PE (+) for an abdominal mass left to the umbilicus and dehydration. IS identified and reduced by barium enema. Pt was stable and to be transfered for further eval of abnormal BE. 9/08/2008 No further diagnostic tests done.


Changed on 9/14/2017

VAERS ID: 323278 Before After
VAERS Form:(blank) 1
Age:0.4
Gender:Male
Location:Florida
Vaccinated:2008-06-17
Onset:2008-08-06
Submitted:2008-08-20
Entered:2008-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B182AA / 1 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF447AA / 1 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45721F / 1 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0141X / 1 2 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception

Life Threatening? Yes
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? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None. PMH: none.
Allergies:
Diagnostic Lab Data: Barium Enema diagnostic and therapeutic. Labs and Diagnostics: KUB with abnormal gas pattern. Barium enema (+) for IS, also noted possible malrotation.
CDC 'Split Type':

Write-up: Intussusception. 09/05/2008 MR received for DOS 8/6/2008 with DX: Intussusception reduced, suspect malrotation. Infant presented with 7-8 hr hx of intermittant crying and pulling the legs to the abdomen, increased sleep and later blood/mucus in the diaper. (+) gagging but no vomiting. PE (+) for an abdominal mass left to the umbilicus and dehydration. IS identified and reduced by barium enema. Pt was stable and to be transfered for further eval of abnormal BE. 9/08/2008 No further diagnostic tests done.


Changed on 2/14/2018

VAERS ID: 323278 Before After
VAERS Form:1
Age:0.4
Gender:Male
Location:Florida
Vaccinated:2008-06-17
Onset:2008-08-06
Submitted:2008-08-20
Entered:2008-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B182AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF447AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45721F / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0141X / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception

Life Threatening? Yes
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? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None. PMH: none.
Allergies:
Diagnostic Lab Data: Barium Enema diagnostic and therapeutic. Labs and Diagnostics: KUB with abnormal gas pattern. Barium enema (+) for IS, also noted possible malrotation.
CDC 'Split Type':

Write-up: Intussusception. 09/05/2008 MR received for DOS 8/6/2008 with DX: Intussusception reduced, suspect malrotation. Infant presented with 7-8 hr hx of intermittant crying and pulling the legs to the abdomen, increased sleep and later blood/mucus in the diaper. (+) gagging but no vomiting. PE (+) for an abdominal mass left to the umbilicus and dehydration. IS identified and reduced by barium enema. Pt was stable and to be transfered for further eval of abnormal BE. 9/08/2008 No further diagnostic tests done.


Changed on 6/14/2018

VAERS ID: 323278 Before After
VAERS Form:1
Age:0.4
Gender:Male
Location:Florida
Vaccinated:2008-06-17
Onset:2008-08-06
Submitted:2008-08-20
Entered:2008-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B182AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF447AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45721F / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0141X / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception

Life Threatening? Yes
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? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None. PMH: none.
Allergies:
Diagnostic Lab Data: Barium Enema diagnostic and therapeutic. Labs and Diagnostics: KUB with abnormal gas pattern. Barium enema (+) for IS, also noted possible malrotation.
CDC 'Split Type':

Write-up: Intussusception. 09/05/2008 MR received for DOS 8/6/2008 with DX: Intussusception reduced, suspect malrotation. Infant presented with 7-8 hr hx of intermittant crying and pulling the legs to the abdomen, increased sleep and later blood/mucus in the diaper. (+) gagging but no vomiting. PE (+) for an abdominal mass left to the umbilicus and dehydration. IS identified and reduced by barium enema. Pt was stable and to be transfered for further eval of abnormal BE. 9/08/2008 No further diagnostic tests done.


Changed on 8/14/2018

VAERS ID: 323278 Before After
VAERS Form:1
Age:0.4
Gender:Male
Location:Florida
Vaccinated:2008-06-17
Onset:2008-08-06
Submitted:2008-08-20
Entered:2008-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B182AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF447AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45721F / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0141X / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception

Life Threatening? Yes
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? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None. PMH: none.
Allergies:
Diagnostic Lab Data: Barium Enema diagnostic and therapeutic. Labs and Diagnostics: KUB with abnormal gas pattern. Barium enema (+) for IS, also noted possible malrotation.
CDC 'Split Type':

Write-up: Intussusception. 09/05/2008 MR received for DOS 8/6/2008 with DX: Intussusception reduced, suspect malrotation. Infant presented with 7-8 hr hx of intermittant crying and pulling the legs to the abdomen, increased sleep and later blood/mucus in the diaper. (+) gagging but no vomiting. PE (+) for an abdominal mass left to the umbilicus and dehydration. IS identified and reduced by barium enema. Pt was stable and to be transfered for further eval of abnormal BE. 9/08/2008 No further diagnostic tests done.


Changed on 9/14/2018

VAERS ID: 323278 Before After
VAERS Form:1
Age:0.4
Gender:Male
Location:Florida
Vaccinated:2008-06-17
Onset:2008-08-06
Submitted:2008-08-20
Entered:2008-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B182AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF447AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45721F / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0141X / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception

Life Threatening? Yes
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? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None. PMH: none.
Allergies:
Diagnostic Lab Data: Barium Enema diagnostic and therapeutic. Labs and Diagnostics: KUB with abnormal gas pattern. Barium enema (+) for IS, also noted possible malrotation.
CDC 'Split Type':

Write-up: Intussusception. 09/05/2008 MR received for DOS 8/6/2008 with DX: Intussusception reduced, suspect malrotation. Infant presented with 7-8 hr hx of intermittant crying and pulling the legs to the abdomen, increased sleep and later blood/mucus in the diaper. (+) gagging but no vomiting. PE (+) for an abdominal mass left to the umbilicus and dehydration. IS identified and reduced by barium enema. Pt was stable and to be transfered for further eval of abnormal BE. 9/08/2008 No further diagnostic tests done.


Changed on 10/14/2018

VAERS ID: 323278 Before After
VAERS Form:1
Age:0.4
Gender:Male
Location:Florida
Vaccinated:2008-06-17
Onset:2008-08-06
Submitted:2008-08-20
Entered:2008-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B182AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF447AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45721F / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0141X / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception

Life Threatening? Yes
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? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None. PMH: none.
Allergies:
Diagnostic Lab Data: Barium Enema diagnostic and therapeutic. Labs and Diagnostics: KUB with abnormal gas pattern. Barium enema (+) for IS, also noted possible malrotation.
CDC 'Split Type':

Write-up: Intussusception. 09/05/2008 MR received for DOS 8/6/2008 with DX: Intussusception reduced, suspect malrotation. Infant presented with 7-8 hr hx of intermittant crying and pulling the legs to the abdomen, increased sleep and later blood/mucus in the diaper. (+) gagging but no vomiting. PE (+) for an abdominal mass left to the umbilicus and dehydration. IS identified and reduced by barium enema. Pt was stable and to be transfered for further eval of abnormal BE. 9/08/2008 No further diagnostic tests done.

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