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This is VAERS ID 326995

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 326995
VAERS Form:
Age:0.5
Sex:Male
Location:Michigan
Vaccinated:2008-07-29
Onset:2008-09-22
Submitted:2008-10-03
Entered:2008-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B110AB / 2 UN / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C65935 / 2 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0019X / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Appendicectomy, Barium enema, Haematochezia, 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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: LABS: US revealed IS in RUQ. BE failed to reduce.
CDC 'Split Type':

Write-up: ON 09/22/08 PATIENT WAS SEEN IN HOSPITAL FOR REPEATED VOMITING AND BLOOD IN THE STOOL,WAS TAKEN TO GI FLOOR WHERE A BARIUM ENEMA WAS ATTEMPTED FOR REDUCTION OF INTUSSUSCEPTION AND WAS UNSUCCESSFUL AND EMERGENCY SURGERY WAS PERFORMED TO REDUCE THE INTUSSUS"CEPTION AND AN APPENDECTOMY WAS PERFORMED 10/17/08 Reviewed hospital medical records of 9/22-9/24/2008. FINAL DX: Intussusception, surgically reduced. Records reveal patient experienced vomiting, crampy abdominal pain & bloody stool. Emergent surgery to


Changed on 12/8/2009

VAERS ID: 326995 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Michigan
Vaccinated:2008-07-29
Onset:2008-09-22
Submitted:2008-10-03
Entered:2008-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B110AB / 2 UN / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B110AB / 2 UN / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C65935 / 2 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0019X / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Appendicectomy, Barium enema, Haematochezia, Intussusception, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: LABS: US revealed IS in RUQ. BE failed to reduce.
CDC 'Split Type':

Write-up: ON 09/22/08 PATIENT WAS SEEN IN HOSPITAL FOR REPEATED VOMITING AND BLOOD IN THE STOOL,WAS TAKEN TO GI FLOOR WHERE A BARIUM ENEMA WAS ATTEMPTED FOR REDUCTION OF INTUSSUSCEPTION AND WAS UNSUCCESSFUL AND EMERGENCY SURGERY WAS PERFORMED TO REDUCE THE INTUSSUS"CEPTION INTUSSUSCEPTION AND AN APPENDECTOMY WAS PERFORMED 10/17/08 Reviewed hospital medical records of 9/22-9/24/2008. FINAL DX: Intussusception, surgically reduced. Records reveal patient experienced vomiting, crampy abdominal pain & bloody stool. Emergent surgery to reduce IS & appendectomy. Progressed well & d/c to home w/PCP & surgery clinic f/u. 10/10/08 Reviewed PCP medical records of 2/21-10/06/2008. FINAL DX: Intussusception, surgically reduced Records reveal patient experienced good health on day of vaccination. Developed IS late 9/08. Did well postoperatively.


Changed on 3/2/2010

VAERS ID: 326995 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Michigan
Vaccinated:2008-07-29
Onset:2008-09-22
Submitted:2008-10-03
Entered:2008-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B110AB / 2 UN / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC C65935 / 2 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0019X / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Appendicectomy, Barium enema, Haematochezia, Intussusception, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: LABS: US revealed IS in RUQ. BE failed to reduce.
CDC 'Split Type':

Write-up: ON 09/22/08 PATIENT WAS SEEN IN HOSPITAL FOR REPEATED VOMITING AND BLOOD IN THE STOOL,WAS TAKEN TO GI FLOOR WHERE A BARIUM ENEMA WAS ATTEMPTED FOR REDUCTION OF INTUSSUSCEPTION AND WAS UNSUCCESSFUL AND EMERGENCY SURGERY WAS PERFORMED TO REDUCE THE INTUSSUSCEPTION AND AN APPENDECTOMY WAS PERFORMED 10/17/08 Reviewed hospital medical records of 9/22-9/24/2008. FINAL DX: Intussusception, surgically reduced. Records reveal patient experienced vomiting, crampy abdominal pain & bloody stool. Emergent surgery to reduce IS & appendectomy. Progressed well & d/c to home w/PCP & surgery clinic f/u. 10/10/08 Reviewed PCP medical records of 2/21-10/06/2008. FINAL DX: Intussusception, surgically reduced Records reveal patient experienced good health on day of vaccination. Developed IS late 9/08. Did well postoperatively.


Changed on 4/7/2010

VAERS ID: 326995 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Michigan
Vaccinated:2008-07-29
Onset:2008-09-22
Submitted:2008-10-03
Entered:2008-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B110AB / 2 UN / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C65935 / 2 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0019X / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Appendicectomy, Barium enema, Haematochezia, Intussusception, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: LABS: US revealed IS in RUQ. BE failed to reduce.
CDC 'Split Type':

Write-up: ON 09/22/08 PATIENT WAS SEEN IN HOSPITAL FOR REPEATED VOMITING AND BLOOD IN THE STOOL,WAS TAKEN TO GI FLOOR WHERE A BARIUM ENEMA WAS ATTEMPTED FOR REDUCTION OF INTUSSUSCEPTION AND WAS UNSUCCESSFUL AND EMERGENCY SURGERY WAS PERFORMED TO REDUCE THE INTUSSUSCEPTION AND AN APPENDECTOMY WAS PERFORMED 10/17/08 Reviewed hospital medical records of 9/22-9/24/2008. FINAL DX: Intussusception, surgically reduced. Records reveal patient experienced vomiting, crampy abdominal pain & bloody stool. Emergent surgery to reduce IS & appendectomy. Progressed well & d/c to home w/PCP & surgery clinic f/u. 10/10/08 Reviewed PCP medical records of 2/21-10/06/2008. FINAL DX: Intussusception, surgically reduced Records reveal patient experienced good health on day of vaccination. Developed IS late 9/08. Did well postoperatively.


Changed on 8/31/2010

VAERS ID: 326995 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Michigan
Vaccinated:2008-07-29
Onset:2008-09-22
Submitted:2008-10-03
Entered:2008-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B110AB / 2 UN / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH C65935 / 2 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0019X / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Appendicectomy, Barium enema, Haematochezia, Intussusception, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: LABS: US revealed IS in RUQ. BE failed to reduce.
CDC 'Split Type':

Write-up: ON 09/22/08 PATIENT WAS SEEN IN HOSPITAL FOR REPEATED VOMITING AND BLOOD IN THE STOOL,WAS TAKEN TO GI FLOOR WHERE A BARIUM ENEMA WAS ATTEMPTED FOR REDUCTION OF INTUSSUSCEPTION AND WAS UNSUCCESSFUL AND EMERGENCY SURGERY WAS PERFORMED TO REDUCE THE INTUSSUSCEPTION AND AN APPENDECTOMY WAS PERFORMED 10/17/08 Reviewed hospital medical records of 9/22-9/24/2008. FINAL DX: Intussusception, surgically reduced. Records reveal patient experienced vomiting, crampy abdominal pain & bloody stool. Emergent surgery to reduce IS & appendectomy. Progressed well & d/c to home w/PCP & surgery clinic f/u. 10/10/08 Reviewed PCP medical records of 2/21-10/06/2008. FINAL DX: Intussusception, surgically reduced Records reveal patient experienced good health on day of vaccination. Developed IS late 9/08. Did well postoperatively.


Changed on 5/13/2013

VAERS ID: 326995 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Michigan
Vaccinated:2008-07-29
Onset:2008-09-22
Submitted:2008-10-03
Entered:2008-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B110AB / 2 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65935 / 2 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0019X / 2 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0019X / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Appendicectomy, Barium enema, Haematochezia, Intussusception, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: LABS: US revealed IS in RUQ. BE failed to reduce.
CDC 'Split Type':

Write-up: ON 09/22/08 PATIENT WAS SEEN IN HOSPITAL FOR REPEATED VOMITING AND BLOOD IN THE STOOL,WAS TAKEN TO GI FLOOR WHERE A BARIUM ENEMA WAS ATTEMPTED FOR REDUCTION OF INTUSSUSCEPTION AND WAS UNSUCCESSFUL AND EMERGENCY SURGERY WAS PERFORMED TO REDUCE THE INTUSSUSCEPTION AND AN APPENDECTOMY WAS PERFORMED 10/17/08 Reviewed hospital medical records of 9/22-9/24/2008. FINAL DX: Intussusception, surgically reduced. Records reveal patient experienced vomiting, crampy abdominal pain & bloody stool. Emergent surgery to reduce IS & appendectomy. Progressed well & d/c to home w/PCP & surgery clinic f/u. 10/10/08 Reviewed PCP medical records of 2/21-10/06/2008. FINAL DX: Intussusception, surgically reduced Records reveal patient experienced good health on day of vaccination. Developed IS late 9/08. Did well postoperatively.


Changed on 4/14/2017

VAERS ID: 326995 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Michigan
Vaccinated:2008-07-29
Onset:2008-09-22
Submitted:2008-10-03
Entered:2008-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B110AB / 2 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65935 / 2 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0019X / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Appendicectomy, Barium enema, Haematochezia, Intussusception, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: LABS: US revealed IS in RUQ. BE failed to reduce.
CDC 'Split Type':

Write-up: ON 09/22/08 PATIENT WAS SEEN IN HOSPITAL FOR REPEATED VOMITING AND BLOOD IN THE STOOL,WAS TAKEN TO GI FLOOR WHERE A BARIUM ENEMA WAS ATTEMPTED FOR REDUCTION OF INTUSSUSCEPTION AND WAS UNSUCCESSFUL AND EMERGENCY SURGERY WAS PERFORMED TO REDUCE THE INTUSSUSCEPTION AND AN APPENDECTOMY WAS PERFORMED 10/17/08 Reviewed hospital medical records of 9/22-9/24/2008. FINAL DX: Intussusception, surgically reduced. Records reveal patient experienced vomiting, crampy abdominal pain & bloody stool. Emergent surgery to reduce IS & appendectomy. Progressed well & d/c to home w/PCP & surgery clinic f/u. 10/10/08 Reviewed PCP medical records of 2/21-10/06/2008. FINAL DX: Intussusception, surgically reduced Records reveal patient experienced good health on day of vaccination. Developed IS late 9/08. Did well postoperatively.


Changed on 9/14/2017

VAERS ID: 326995 Before After
VAERS Form:(blank) 1
Age:0.5
Sex:Male
Location:Michigan
Vaccinated:2008-07-29
Onset:2008-09-22
Submitted:2008-10-03
Entered:2008-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B110AB / 2 3 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65935 / 2 3 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0019X / 2 3 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Appendicectomy, Haematochezia, Intussusception, Surgery, Vomiting

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: LABS: US revealed IS in RUQ. BE failed to reduce.
CDC 'Split Type':

Write-up: ON 09/22/08 PATIENT WAS SEEN IN HOSPITAL FOR REPEATED VOMITING AND BLOOD IN THE STOOL,WAS TAKEN TO GI FLOOR WHERE A BARIUM ENEMA WAS ATTEMPTED FOR REDUCTION OF INTUSSUSCEPTION AND WAS UNSUCCESSFUL AND EMERGENCY SURGERY WAS PERFORMED TO REDUCE THE INTUSSUSCEPTION AND AN APPENDECTOMY WAS PERFORMED 10/17/08 Reviewed hospital medical records of 9/22-9/24/2008. FINAL DX: Intussusception, surgically reduced. Records reveal patient experienced vomiting, crampy abdominal pain & bloody stool. Emergent surgery to reduce IS & appendectomy. Progressed well & d/c to home w/PCP & surgery clinic f/u. 10/10/08 Reviewed PCP medical records of 2/21-10/06/2008. FINAL DX: Intussusception, surgically reduced Records reveal patient experienced good health on day of vaccination. Developed IS late 9/08. Did well postoperatively.


Changed on 2/14/2018

VAERS ID: 326995 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:Michigan
Vaccinated:2008-07-29
Onset:2008-09-22
Submitted:2008-10-03
Entered:2008-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B110AB / 3 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65935 / 3 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0019X / 3 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Appendicectomy, Haematochezia, Intussusception, Surgery, Vomiting

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: LABS: US revealed IS in RUQ. BE failed to reduce.
CDC 'Split Type':

Write-up: ON 09/22/08 PATIENT WAS SEEN IN HOSPITAL FOR REPEATED VOMITING AND BLOOD IN THE STOOL,WAS TAKEN TO GI FLOOR WHERE A BARIUM ENEMA WAS ATTEMPTED FOR REDUCTION OF INTUSSUSCEPTION AND WAS UNSUCCESSFUL AND EMERGENCY SURGERY WAS PERFORMED TO REDUCE THE INTUSSUSCEPTION AND AN APPENDECTOMY WAS PERFORMED 10/17/08 Reviewed hospital medical records of 9/22-9/24/2008. FINAL DX: Intussusception, surgically reduced. Records reveal patient experienced vomiting, crampy abdominal pain & bloody stool. Emergent surgery to reduce IS & appendectomy. Progressed well & d/c to home w/PCP & surgery clinic f/u. 10/10/08 Reviewed PCP medical records of 2/21-10/06/2008. FINAL DX: Intussusception, surgically reduced Records reveal patient experienced good health on day of vaccination. Developed IS late 9/08. Did well postoperatively.


Changed on 6/14/2018

VAERS ID: 326995 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:Michigan
Vaccinated:2008-07-29
Onset:2008-09-22
Submitted:2008-10-03
Entered:2008-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B110AB / 3 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65935 / 3 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0019X / 3 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Appendicectomy, Haematochezia, Intussusception, Surgery, Vomiting

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: LABS: US revealed IS in RUQ. BE failed to reduce.
CDC 'Split Type':

Write-up: ON 09/22/08 PATIENT WAS SEEN IN HOSPITAL FOR REPEATED VOMITING AND BLOOD IN THE STOOL,WAS TAKEN TO GI FLOOR WHERE A BARIUM ENEMA WAS ATTEMPTED FOR REDUCTION OF INTUSSUSCEPTION AND WAS UNSUCCESSFUL AND EMERGENCY SURGERY WAS PERFORMED TO REDUCE THE INTUSSUSCEPTION AND AN APPENDECTOMY WAS PERFORMED 10/17/08 Reviewed hospital medical records of 9/22-9/24/2008. FINAL DX: Intussusception, surgically reduced. Records reveal patient experienced vomiting, crampy abdominal pain & bloody stool. Emergent surgery to reduce IS & appendectomy. Progressed well & d/c to home w/PCP & surgery clinic f/u. 10/10/08 Reviewed PCP medical records of 2/21-10/06/2008. FINAL DX: Intussusception, surgically reduced Records reveal patient experienced good health on day of vaccination. Developed IS late 9/08. Did well postoperatively.


Changed on 8/14/2018

VAERS ID: 326995 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:Michigan
Vaccinated:2008-07-29
Onset:2008-09-22
Submitted:2008-10-03
Entered:2008-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B110AB / 3 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65935 / 3 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0019X / 3 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Appendicectomy, Haematochezia, Intussusception, Surgery, Vomiting

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: LABS: US revealed IS in RUQ. BE failed to reduce.
CDC 'Split Type':

Write-up: ON 09/22/08 PATIENT WAS SEEN IN HOSPITAL FOR REPEATED VOMITING AND BLOOD IN THE STOOL,WAS TAKEN TO GI FLOOR WHERE A BARIUM ENEMA WAS ATTEMPTED FOR REDUCTION OF INTUSSUSCEPTION AND WAS UNSUCCESSFUL AND EMERGENCY SURGERY WAS PERFORMED TO REDUCE THE INTUSSUSCEPTION AND AN APPENDECTOMY WAS PERFORMED 10/17/08 Reviewed hospital medical records of 9/22-9/24/2008. FINAL DX: Intussusception, surgically reduced. Records reveal patient experienced vomiting, crampy abdominal pain & bloody stool. Emergent surgery to reduce IS & appendectomy. Progressed well & d/c to home w/PCP & surgery clinic f/u. 10/10/08 Reviewed PCP medical records of 2/21-10/06/2008. FINAL DX: Intussusception, surgically reduced Records reveal patient experienced good health on day of vaccination. Developed IS late 9/08. Did well postoperatively.


Changed on 9/14/2018

VAERS ID: 326995 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:Michigan
Vaccinated:2008-07-29
Onset:2008-09-22
Submitted:2008-10-03
Entered:2008-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B110AB / 3 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65935 / 3 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0019X / 3 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Appendicectomy, Haematochezia, Intussusception, Surgery, Vomiting

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: LABS: US revealed IS in RUQ. BE failed to reduce.
CDC 'Split Type':

Write-up: ON 09/22/08 PATIENT WAS SEEN IN HOSPITAL FOR REPEATED VOMITING AND BLOOD IN THE STOOL,WAS TAKEN TO GI FLOOR WHERE A BARIUM ENEMA WAS ATTEMPTED FOR REDUCTION OF INTUSSUSCEPTION AND WAS UNSUCCESSFUL AND EMERGENCY SURGERY WAS PERFORMED TO REDUCE THE INTUSSUSCEPTION AND AN APPENDECTOMY WAS PERFORMED 10/17/08 Reviewed hospital medical records of 9/22-9/24/2008. FINAL DX: Intussusception, surgically reduced. Records reveal patient experienced vomiting, crampy abdominal pain & bloody stool. Emergent surgery to reduce IS & appendectomy. Progressed well & d/c to home w/PCP & surgery clinic f/u. 10/10/08 Reviewed PCP medical records of 2/21-10/06/2008. FINAL DX: Intussusception, surgically reduced Records reveal patient experienced good health on day of vaccination. Developed IS late 9/08. Did well postoperatively.


Changed on 10/14/2018

VAERS ID: 326995 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:Michigan
Vaccinated:2008-07-29
Onset:2008-09-22
Submitted:2008-10-03
Entered:2008-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B110AB / 3 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65935 / 3 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0019X / 3 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Appendicectomy, Haematochezia, Intussusception, Surgery, Vomiting

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: LABS: US revealed IS in RUQ. BE failed to reduce.
CDC 'Split Type':

Write-up: ON 09/22/08 PATIENT WAS SEEN IN HOSPITAL FOR REPEATED VOMITING AND BLOOD IN THE STOOL,WAS TAKEN TO GI FLOOR WHERE A BARIUM ENEMA WAS ATTEMPTED FOR REDUCTION OF INTUSSUSCEPTION AND WAS UNSUCCESSFUL AND EMERGENCY SURGERY WAS PERFORMED TO REDUCE THE INTUSSUSCEPTION AND AN APPENDECTOMY WAS PERFORMED 10/17/08 Reviewed hospital medical records of 9/22-9/24/2008. FINAL DX: Intussusception, surgically reduced. Records reveal patient experienced vomiting, crampy abdominal pain & bloody stool. Emergent surgery to reduce IS & appendectomy. Progressed well & d/c to home w/PCP & surgery clinic f/u. 10/10/08 Reviewed PCP medical records of 2/21-10/06/2008. FINAL DX: Intussusception, surgically reduced Records reveal patient experienced good health on day of vaccination. Developed IS late 9/08. Did well postoperatively.

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