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This is VAERS ID 326343

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 326343
VAERS Form:
Age:0.3
Gender:Male
Location:Maryland
Vaccinated:2008-07-17
Onset:2008-07-27
Submitted:0000-00-00
Entered:2008-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B82AA / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF225AA / 1 RL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC 1B70143E / 1 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0019X / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Abdominal pain, Barium enema, Culture stool positive, Decreased activity, 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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Thrush, Treatment - Diflucan PO
Preexisting Conditions: Thrush, mild pulmonary artery branch stenosis PMH: eczema, PABS murmur, colic.
Allergies:
Diagnostic Lab Data: (-) Stool culture (Rotavirus) LABS: Outlying air enema c/w IS & reduced it. Outlying BE c/w IS & reduced it. Hospital abdominal x-ray revealed nonspecific distended loops of bowel w/bowel wall thickening but no IS. US x2 WNL. Stool c
CDC 'Split Type':

Write-up: 7/17/08 PEDIARIX, ROTATEQ. Mucousy diarrhea (10-15 x/day) began 7/23. 7/27-clots of blood in stool/fussy, to ER, had successful reduction of intussusception via air-contrast enema. Admitted. Continued bloody stools/fussy, on Nutranigen, 7/24-transferred"to hosp. then diagnosed as milk protein allergy, bloody stools cleared on NEOCATE. Discharged 7/31/08. 11/14/08 Reviewed hospital medical records 7/29-7/31/2008. FINAL DX: abdominal pain & bloody stools s/p intussusception enema reduction Records reveal p


Changed on 12/8/2009

VAERS ID: 326343 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Maryland
Vaccinated:2008-07-17
Onset:2008-07-27
Submitted:0000-00-00
Entered:2008-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B82AA / 1 LL / UN
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B82AA / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF225AA / 1 RL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC 1B70143E / 1 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0019X / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Abdominal pain, Barium enema, Culture stool positive, Decreased activity, Diarrhoea, Haematochezia, Intussusception, Irritability, Milk allergy, Mucous stools, Salmonellosis, X-ray abnormal, Enema administration, Ultrasound abdomen normal, Abdominal X-ray, Hypophagia

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Thrush, Treatment - Diflucan PO
Preexisting Conditions: Thrush, mild pulmonary artery branch stenosis PMH: eczema, PABS murmur, colic.
Allergies:
Diagnostic Lab Data: (-) Stool culture (Rotavirus) LABS: Outlying air enema c/w IS & reduced it. Outlying BE c/w IS & reduced it. Hospital abdominal x-ray revealed nonspecific distended loops of bowel w/bowel wall thickening but no IS. US x2 WNL. Stool c
CDC 'Split Type':

Write-up: 7/17/08 PEDIARIX, ROTATEQ. Mucousy diarrhea (10-15 x/day) began 7/23. 7/27-clots of blood in stool/fussy, to ER, had successful reduction of intussusception via air-contrast enema. Admitted. Continued bloody stools/fussy, on Nutranigen, 7/24-transferred"to 7/24-transferred to hosp. then diagnosed as milk protein allergy, bloody stools cleared on NEOCATE. Discharged 7/31/08. 11/14/08 Reviewed hospital medical records 7/29-7/31/2008. FINAL DX: abdominal pain & bloody stools s/p intussusception enema reduction Records reveal p patient experienced irritability, diarrhea, bloody stools, mucous stools, decreased activity, oral intake reduced x 4 days. Evaluated in outlying ER/hospital. Had been admitted overnight for observation s/p enema reduction & developed recurrent symptoms. Barium enema done & reduced IS. Symptoms recurred again & family requested transfer. Surgery & GI consults done. Improved & d/c to home w/outpatient GI clinic f/u.


Changed on 3/2/2010

VAERS ID: 326343 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Maryland
Vaccinated:2008-07-17
Onset:2008-07-27
Submitted:0000-00-00
Entered:2008-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B82AA / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF225AA / 1 RL / -
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC 1B70143E / 1 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0019X / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Abdominal pain, Barium enema, Culture stool positive, Decreased activity, Diarrhoea, Haematochezia, Intussusception, Irritability, Milk allergy, Mucous stools, Salmonellosis, X-ray abnormal, Enema administration, Ultrasound abdomen normal, Abdominal X-ray, Hypophagia

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Thrush, Treatment - Diflucan PO
Preexisting Conditions: Thrush, mild pulmonary artery branch stenosis PMH: eczema, PABS murmur, colic.
Allergies:
Diagnostic Lab Data: (-) Stool culture (Rotavirus) LABS: Outlying air enema c/w IS & reduced it. Outlying BE c/w IS & reduced it. Hospital abdominal x-ray revealed nonspecific distended loops of bowel w/bowel wall thickening but no IS. US x2 WNL. Stool c
CDC 'Split Type':

Write-up: 7/17/08 PEDIARIX, ROTATEQ. Mucousy diarrhea (10-15 x/day) began 7/23. 7/27-clots of blood in stool/fussy, to ER, had successful reduction of intussusception via air-contrast enema. Admitted. Continued bloody stools/fussy, on Nutranigen, 7/24-transferred to hosp. then diagnosed as milk protein allergy, bloody stools cleared on NEOCATE. Discharged 7/31/08. 11/14/08 Reviewed hospital medical records 7/29-7/31/2008. FINAL DX: abdominal pain & bloody stools s/p intussusception enema reduction Records reveal patient experienced irritability, diarrhea, bloody stools, mucous stools, decreased activity, oral intake reduced x 4 days. Evaluated in outlying ER/hospital. Had been admitted overnight for observation s/p enema reduction & developed recurrent symptoms. Barium enema done & reduced IS. Symptoms recurred again & family requested transfer. Surgery & GI consults done. Improved & d/c to home w/outpatient GI clinic f/u.


Changed on 4/7/2010

VAERS ID: 326343 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Maryland
Vaccinated:2008-07-17
Onset:2008-07-27
Submitted:0000-00-00
Entered:2008-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B82AA / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF225AA / 1 RL / -
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC 1B70143E / 1 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0019X / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Abdominal pain, Barium enema, Culture stool positive, Decreased activity, Diarrhoea, Haematochezia, Intussusception, Irritability, Milk allergy, Mucous stools, Salmonellosis, X-ray abnormal, Enema administration, Ultrasound abdomen normal, Abdominal X-ray, Hypophagia

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Thrush, Treatment - Diflucan PO
Preexisting Conditions: Thrush, mild pulmonary artery branch stenosis PMH: eczema, PABS murmur, colic.
Allergies:
Diagnostic Lab Data: (-) Stool culture (Rotavirus) LABS: Outlying air enema c/w IS & reduced it. Outlying BE c/w IS & reduced it. Hospital abdominal x-ray revealed nonspecific distended loops of bowel w/bowel wall thickening but no IS. US x2 WNL. Stool c
CDC 'Split Type':

Write-up: 7/17/08 PEDIARIX, ROTATEQ. Mucousy diarrhea (10-15 x/day) began 7/23. 7/27-clots of blood in stool/fussy, to ER, had successful reduction of intussusception via air-contrast enema. Admitted. Continued bloody stools/fussy, on Nutranigen, 7/24-transferred to hosp. then diagnosed as milk protein allergy, bloody stools cleared on NEOCATE. Discharged 7/31/08. 11/14/08 Reviewed hospital medical records 7/29-7/31/2008. FINAL DX: abdominal pain & bloody stools s/p intussusception enema reduction Records reveal patient experienced irritability, diarrhea, bloody stools, mucous stools, decreased activity, oral intake reduced x 4 days. Evaluated in outlying ER/hospital. Had been admitted overnight for observation s/p enema reduction & developed recurrent symptoms. Barium enema done & reduced IS. Symptoms recurred again & family requested transfer. Surgery & GI consults done. Improved & d/c to home w/outpatient GI clinic f/u.


Changed on 8/31/2010

VAERS ID: 326343 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Maryland
Vaccinated:2008-07-17
Onset:2008-07-27
Submitted:0000-00-00
Entered:2008-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B82AA / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF225AA / 1 RL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 1B70143E / 1 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0019X / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Abdominal pain, Barium enema, Culture stool positive, Decreased activity, Diarrhoea, Haematochezia, Intussusception, Irritability, Milk allergy, Mucous stools, Salmonellosis, X-ray abnormal, Enema administration, Ultrasound abdomen normal, Abdominal X-ray, Hypophagia

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Thrush, Treatment - Diflucan PO
Preexisting Conditions: Thrush, mild pulmonary artery branch stenosis PMH: eczema, PABS murmur, colic.
Allergies:
Diagnostic Lab Data: (-) Stool culture (Rotavirus) LABS: Outlying air enema c/w IS & reduced it. Outlying BE c/w IS & reduced it. Hospital abdominal x-ray revealed nonspecific distended loops of bowel w/bowel wall thickening but no IS. US x2 WNL. Stool c
CDC 'Split Type':

Write-up: 7/17/08 PEDIARIX, ROTATEQ. Mucousy diarrhea (10-15 x/day) began 7/23. 7/27-clots of blood in stool/fussy, to ER, had successful reduction of intussusception via air-contrast enema. Admitted. Continued bloody stools/fussy, on Nutranigen, 7/24-transferred to hosp. then diagnosed as milk protein allergy, bloody stools cleared on NEOCATE. Discharged 7/31/08. 11/14/08 Reviewed hospital medical records 7/29-7/31/2008. FINAL DX: abdominal pain & bloody stools s/p intussusception enema reduction Records reveal patient experienced irritability, diarrhea, bloody stools, mucous stools, decreased activity, oral intake reduced x 4 days. Evaluated in outlying ER/hospital. Had been admitted overnight for observation s/p enema reduction & developed recurrent symptoms. Barium enema done & reduced IS. Symptoms recurred again & family requested transfer. Surgery & GI consults done. Improved & d/c to home w/outpatient GI clinic f/u.


Changed on 5/13/2013

VAERS ID: 326343 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Maryland
Vaccinated:2008-07-17
Onset:2008-07-27
Submitted:0000-00-00
Entered:2008-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B82AA / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF225AA / 1 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 1B70143E / 1 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0019X / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0019X / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Abdominal pain, Barium enema, Culture stool positive, Decreased activity, Diarrhoea, Haematochezia, Intussusception, Irritability, Milk allergy, Mucous stools, Salmonellosis, X-ray abnormal, Enema administration, Ultrasound abdomen normal, Abdominal X-ray, Hypophagia

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Thrush, Treatment - Diflucan PO
Preexisting Conditions: Thrush, mild pulmonary artery branch stenosis PMH: eczema, PABS murmur, colic.
Allergies:
Diagnostic Lab Data: (-) Stool culture (Rotavirus) LABS: Outlying air enema c/w IS & reduced it. Outlying BE c/w IS & reduced it. Hospital abdominal x-ray revealed nonspecific distended loops of bowel w/bowel wall thickening but no IS. US x2 WNL. Stool c
CDC 'Split Type':

Write-up: 7/17/08 PEDIARIX, ROTATEQ. Mucousy diarrhea (10-15 x/day) began 7/23. 7/27-clots of blood in stool/fussy, to ER, had successful reduction of intussusception via air-contrast enema. Admitted. Continued bloody stools/fussy, on Nutranigen, 7/24-transferred to hosp. then diagnosed as milk protein allergy, bloody stools cleared on NEOCATE. Discharged 7/31/08. 11/14/08 Reviewed hospital medical records 7/29-7/31/2008. FINAL DX: abdominal pain & bloody stools s/p intussusception enema reduction Records reveal patient experienced irritability, diarrhea, bloody stools, mucous stools, decreased activity, oral intake reduced x 4 days. Evaluated in outlying ER/hospital. Had been admitted overnight for observation s/p enema reduction & developed recurrent symptoms. Barium enema done & reduced IS. Symptoms recurred again & family requested transfer. Surgery & GI consults done. Improved & d/c to home w/outpatient GI clinic f/u.


Changed on 2/14/2017

VAERS ID: 326343 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Maryland
Vaccinated:2008-07-17
Onset:2008-07-27
Submitted:0000-00-00
Entered:2008-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B82AA / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF225AA / 1 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 1B70143E / 1 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0019X / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Abdominal pain, Barium enema, Culture stool positive, Decreased activity, Diarrhoea, Haematochezia, Intussusception, Irritability, Milk allergy, Mucous stools, Salmonellosis, X-ray abnormal, Enema administration, Ultrasound abdomen normal, Abdominal X-ray, Hypophagia

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Thrush, Treatment - Diflucan PO
Preexisting Conditions: Thrush, mild pulmonary artery branch stenosis PMH: eczema, PABS murmur, colic.
Allergies:
Diagnostic Lab Data: (-) Stool culture (Rotavirus) LABS: Outlying air enema c/w IS & reduced it. Outlying BE c/w IS & reduced it. Hospital abdominal x-ray revealed nonspecific distended loops of bowel w/bowel wall thickening but no IS. US x2 WNL. Stool c c/s (+) salmonella
CDC 'Split Type':

Write-up: 7/17/08 PEDIARIX, ROTATEQ. Mucousy diarrhea (10-15 x/day) began 7/23. 7/27-clots of blood in stool/fussy, to ER, had successful reduction of intussusception via air-contrast enema. Admitted. Continued bloody stools/fussy, on Nutranigen, 7/24-transferred to hosp. then diagnosed as milk protein allergy, bloody stools cleared on NEOCATE. Discharged 7/31/08. 11/14/08 Reviewed hospital medical records 7/29-7/31/2008. FINAL DX: abdominal pain & bloody stools s/p intussusception enema reduction Records reveal patient experienced irritability, diarrhea, bloody stools, mucous stools, decreased activity, oral intake reduced x 4 days. Evaluated in outlying ER/hospital. Had been admitted overnight for observation s/p enema reduction & developed recurrent symptoms. Barium enema done & reduced IS. Symptoms recurred again & family requested transfer. Surgery & GI consults done. Improved & d/c to home w/outpatient GI clinic f/u.


Changed on 9/14/2017

VAERS ID: 326343 Before After
VAERS Form:(blank) 1
Age:0.3
Gender:Male
Location:Maryland
Vaccinated:2008-07-17
Onset:2008-07-27
Submitted:0000-00-00
Entered:2008-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B82AA / 1 2 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF225AA / 1 2 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 1B70143E / 1 2 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0019X / 1 2 - MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Diarrhoea, Intussusception, Irritability, Milk allergy, Mucous stools, Enema administration

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Thrush, Treatment - Diflucan PO
Preexisting Conditions: Thrush, mild pulmonary artery branch stenosis PMH: eczema, PABS murmur, colic.
Allergies:
Diagnostic Lab Data: (-) Stool culture (Rotavirus) LABS: Outlying air enema c/w IS & reduced it. Outlying BE c/w IS & reduced it. Hospital abdominal x-ray revealed nonspecific distended loops of bowel w/bowel wall thickening but no IS. US x2 WNL. Stool c/s (+) salmonella
CDC 'Split Type':

Write-up: 7/17/08 PEDIARIX, ROTATEQ. Mucousy diarrhea (10-15 x/day) began 7/23. 7/27-clots of blood in stool/fussy, to ER, had successful reduction of intussusception via air-contrast enema. Admitted. Continued bloody stools/fussy, on Nutranigen, 7/24-transferred to hosp. then diagnosed as milk protein allergy, bloody stools cleared on NEOCATE. Discharged 7/31/08. 11/14/08 Reviewed hospital medical records 7/29-7/31/2008. FINAL DX: abdominal pain & bloody stools s/p intussusception enema reduction Records reveal patient experienced irritability, diarrhea, bloody stools, mucous stools, decreased activity, oral intake reduced x 4 days. Evaluated in outlying ER/hospital. Had been admitted overnight for observation s/p enema reduction & developed recurrent symptoms. Barium enema done & reduced IS. Symptoms recurred again & family requested transfer. Surgery & GI consults done. Improved & d/c to home w/outpatient GI clinic f/u.


Changed on 2/14/2018

VAERS ID: 326343 Before After
VAERS Form:1
Age:0.3
Gender:Male
Location:Maryland
Vaccinated:2008-07-17
Onset:2008-07-27
Submitted:0000-00-00
Entered:2008-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B82AA / 2 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF225AA / 2 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 1B70143E / 2 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0019X / 2 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Diarrhoea, Intussusception, Irritability, Milk allergy, Mucous stools, Enema administration

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Thrush, Treatment - Diflucan PO
Preexisting Conditions: Thrush, mild pulmonary artery branch stenosis PMH: eczema, PABS murmur, colic.
Allergies:
Diagnostic Lab Data: (-) Stool culture (Rotavirus) LABS: Outlying air enema c/w IS & reduced it. Outlying BE c/w IS & reduced it. Hospital abdominal x-ray revealed nonspecific distended loops of bowel w/bowel wall thickening but no IS. US x2 WNL. Stool c/s (+) salmonella
CDC 'Split Type':

Write-up: 7/17/08 PEDIARIX, ROTATEQ. Mucousy diarrhea (10-15 x/day) began 7/23. 7/27-clots of blood in stool/fussy, to ER, had successful reduction of intussusception via air-contrast enema. Admitted. Continued bloody stools/fussy, on Nutranigen, 7/24-transferred to hosp. then diagnosed as milk protein allergy, bloody stools cleared on NEOCATE. Discharged 7/31/08. 11/14/08 Reviewed hospital medical records 7/29-7/31/2008. FINAL DX: abdominal pain & bloody stools s/p intussusception enema reduction Records reveal patient experienced irritability, diarrhea, bloody stools, mucous stools, decreased activity, oral intake reduced x 4 days. Evaluated in outlying ER/hospital. Had been admitted overnight for observation s/p enema reduction & developed recurrent symptoms. Barium enema done & reduced IS. Symptoms recurred again & family requested transfer. Surgery & GI consults done. Improved & d/c to home w/outpatient GI clinic f/u.


Changed on 6/14/2018

VAERS ID: 326343 Before After
VAERS Form:1
Age:0.3
Gender:Male
Location:Maryland
Vaccinated:2008-07-17
Onset:2008-07-27
Submitted:0000-00-00
Entered:2008-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B82AA / 2 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF225AA / 2 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 1B70143E / 2 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0019X / 2 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Diarrhoea, Intussusception, Irritability, Milk allergy, Mucous stools, Enema administration

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Thrush, Treatment - Diflucan PO
Preexisting Conditions: Thrush, mild pulmonary artery branch stenosis PMH: eczema, PABS murmur, colic.
Allergies:
Diagnostic Lab Data: (-) Stool culture (Rotavirus) LABS: Outlying air enema c/w IS & reduced it. Outlying BE c/w IS & reduced it. Hospital abdominal x-ray revealed nonspecific distended loops of bowel w/bowel wall thickening but no IS. US x2 WNL. Stool c/s (+) salmonella
CDC 'Split Type':

Write-up: 7/17/08 PEDIARIX, ROTATEQ. Mucousy diarrhea (10-15 x/day) began 7/23. 7/27-clots of blood in stool/fussy, to ER, had successful reduction of intussusception via air-contrast enema. Admitted. Continued bloody stools/fussy, on Nutranigen, 7/24-transferred to hosp. then diagnosed as milk protein allergy, bloody stools cleared on NEOCATE. Discharged 7/31/08. 11/14/08 Reviewed hospital medical records 7/29-7/31/2008. FINAL DX: abdominal pain & bloody stools s/p intussusception enema reduction Records reveal patient experienced irritability, diarrhea, bloody stools, mucous stools, decreased activity, oral intake reduced x 4 days. Evaluated in outlying ER/hospital. Had been admitted overnight for observation s/p enema reduction & developed recurrent symptoms. Barium enema done & reduced IS. Symptoms recurred again & family requested transfer. Surgery & GI consults done. Improved & d/c to home w/outpatient GI clinic f/u.


Changed on 8/14/2018

VAERS ID: 326343 Before After
VAERS Form:1
Age:0.3
Gender:Male
Location:Maryland
Vaccinated:2008-07-17
Onset:2008-07-27
Submitted:0000-00-00
Entered:2008-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B82AA / 2 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF225AA / 2 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 1B70143E / 2 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0019X / 2 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Diarrhoea, Intussusception, Irritability, Milk allergy, Mucous stools, Enema administration

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Thrush, Treatment - Diflucan PO
Preexisting Conditions: Thrush, mild pulmonary artery branch stenosis PMH: eczema, PABS murmur, colic.
Allergies:
Diagnostic Lab Data: (-) Stool culture (Rotavirus) LABS: Outlying air enema c/w IS & reduced it. Outlying BE c/w IS & reduced it. Hospital abdominal x-ray revealed nonspecific distended loops of bowel w/bowel wall thickening but no IS. US x2 WNL. Stool c/s (+) salmonella
CDC 'Split Type':

Write-up: 7/17/08 PEDIARIX, ROTATEQ. Mucousy diarrhea (10-15 x/day) began 7/23. 7/27-clots of blood in stool/fussy, to ER, had successful reduction of intussusception via air-contrast enema. Admitted. Continued bloody stools/fussy, on Nutranigen, 7/24-transferred to hosp. then diagnosed as milk protein allergy, bloody stools cleared on NEOCATE. Discharged 7/31/08. 11/14/08 Reviewed hospital medical records 7/29-7/31/2008. FINAL DX: abdominal pain & bloody stools s/p intussusception enema reduction Records reveal patient experienced irritability, diarrhea, bloody stools, mucous stools, decreased activity, oral intake reduced x 4 days. Evaluated in outlying ER/hospital. Had been admitted overnight for observation s/p enema reduction & developed recurrent symptoms. Barium enema done & reduced IS. Symptoms recurred again & family requested transfer. Surgery & GI consults done. Improved & d/c to home w/outpatient GI clinic f/u.


Changed on 9/14/2018

VAERS ID: 326343 Before After
VAERS Form:1
Age:0.3
Gender:Male
Location:Maryland
Vaccinated:2008-07-17
Onset:2008-07-27
Submitted:0000-00-00
Entered:2008-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B82AA / 2 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF225AA / 2 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 1B70143E / 2 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0019X / 2 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Diarrhoea, Intussusception, Irritability, Milk allergy, Mucous stools, Enema administration

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Thrush, Treatment - Diflucan PO
Preexisting Conditions: Thrush, mild pulmonary artery branch stenosis PMH: eczema, PABS murmur, colic.
Allergies:
Diagnostic Lab Data: (-) Stool culture (Rotavirus) LABS: Outlying air enema c/w IS & reduced it. Outlying BE c/w IS & reduced it. Hospital abdominal x-ray revealed nonspecific distended loops of bowel w/bowel wall thickening but no IS. US x2 WNL. Stool c/s (+) salmonella
CDC 'Split Type':

Write-up: 7/17/08 PEDIARIX, ROTATEQ. Mucousy diarrhea (10-15 x/day) began 7/23. 7/27-clots of blood in stool/fussy, to ER, had successful reduction of intussusception via air-contrast enema. Admitted. Continued bloody stools/fussy, on Nutranigen, 7/24-transferred to hosp. then diagnosed as milk protein allergy, bloody stools cleared on NEOCATE. Discharged 7/31/08. 11/14/08 Reviewed hospital medical records 7/29-7/31/2008. FINAL DX: abdominal pain & bloody stools s/p intussusception enema reduction Records reveal patient experienced irritability, diarrhea, bloody stools, mucous stools, decreased activity, oral intake reduced x 4 days. Evaluated in outlying ER/hospital. Had been admitted overnight for observation s/p enema reduction & developed recurrent symptoms. Barium enema done & reduced IS. Symptoms recurred again & family requested transfer. Surgery & GI consults done. Improved & d/c to home w/outpatient GI clinic f/u.


Changed on 10/14/2018

VAERS ID: 326343 Before After
VAERS Form:1
Age:0.3
Gender:Male
Location:Maryland
Vaccinated:2008-07-17
Onset:2008-07-27
Submitted:0000-00-00
Entered:2008-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B82AA / 2 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF225AA / 2 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 1B70143E / 2 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0019X / 2 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Diarrhoea, Intussusception, Irritability, Milk allergy, Mucous stools, Enema administration

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Thrush, Treatment - Diflucan PO
Preexisting Conditions: Thrush, mild pulmonary artery branch stenosis PMH: eczema, PABS murmur, colic.
Allergies:
Diagnostic Lab Data: (-) Stool culture (Rotavirus) LABS: Outlying air enema c/w IS & reduced it. Outlying BE c/w IS & reduced it. Hospital abdominal x-ray revealed nonspecific distended loops of bowel w/bowel wall thickening but no IS. US x2 WNL. Stool c/s (+) salmonella
CDC 'Split Type':

Write-up: 7/17/08 PEDIARIX, ROTATEQ. Mucousy diarrhea (10-15 x/day) began 7/23. 7/27-clots of blood in stool/fussy, to ER, had successful reduction of intussusception via air-contrast enema. Admitted. Continued bloody stools/fussy, on Nutranigen, 7/24-transferred to hosp. then diagnosed as milk protein allergy, bloody stools cleared on NEOCATE. Discharged 7/31/08. 11/14/08 Reviewed hospital medical records 7/29-7/31/2008. FINAL DX: abdominal pain & bloody stools s/p intussusception enema reduction Records reveal patient experienced irritability, diarrhea, bloody stools, mucous stools, decreased activity, oral intake reduced x 4 days. Evaluated in outlying ER/hospital. Had been admitted overnight for observation s/p enema reduction & developed recurrent symptoms. Barium enema done & reduced IS. Symptoms recurred again & family requested transfer. Surgery & GI consults done. Improved & d/c to home w/outpatient GI clinic f/u.

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