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This is VAERS ID 333027

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 333027
VAERS Form:
Age:0.5
Sex:Male
Location:Hawaii
Vaccinated:2008-11-06
Onset:2008-11-11
Submitted:2008-11-21
Entered:2008-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC2IBI43AA / 2 LL / IM
HIBV: HIB (PROHIBIT) / SANOFI PASTEUR UF505AB / 2 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C2283 / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 047OX / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Barium enema abnormal, Cyanosis, Decreased appetite, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol HFA
Current Illness: diarrhea and emesis
Preexisting Conditions: reactive airway disease. PMH: none
Allergies:
Diagnostic Lab Data: see #7 Labs and Diagnsotics: Abd X-ray (+) for BO. Abd US (+) for IS. Barium enema (+) for IS.
CDC 'Split Type':

Write-up: Pt received Pediarix, Hib, PCV, and rotavirus vaccines on 11/6/08. On 11/17 he was admitted for intussusception. He was discharged 11/19 after successful reduction by barium enema. 11/26/2008 MR received for DOS 11/17-19/2008 with D/C DX: Intussuscepti"on. Diarrhea. Pt presented to ER with 5 day hx of diarrhea, irritabily, ear grabbing, fever and decreased appetite and 1 day hx of vomiting everything eaten. En route to ER vomited, turned blue and appeared to have stopped breathing, but quickly recovere


Changed on 12/8/2009

VAERS ID: 333027 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Hawaii
Vaccinated:2008-11-06
Onset:2008-11-11
Submitted:2008-11-21
Entered:2008-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC2IBI43AA / 2 LL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC2IBI43AA / 2 LL / IM
HIBV: HIB (PROHIBIT) / SANOFI PASTEUR UF505AB / 2 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C2283 / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 047OX / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Barium enema abnormal, Cyanosis, Dehydration, Intussusception, Irritability, Lethargy, Pyrexia, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Decreased appetite, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol HFA
Current Illness: diarrhea and emesis
Preexisting Conditions: reactive airway disease. PMH: none
Allergies:
Diagnostic Lab Data: see #7 Labs and Diagnsotics: Abd X-ray (+) for BO. Abd US (+) for IS. Barium enema (+) for IS.
CDC 'Split Type':

Write-up: Pt received Pediarix, Hib, PCV, and rotavirus vaccines on 11/6/08. On 11/17 he was admitted for intussusception. He was discharged 11/19 after successful reduction by barium enema. 11/26/2008 MR received for DOS 11/17-19/2008 with D/C DX: Intussuscepti"on. Intussusception. Diarrhea. Pt presented to ER with 5 day hx of diarrhea, irritabily, ear grabbing, fever and decreased appetite and 1 day hx of vomiting everything eaten. En route to ER vomited, turned blue and appeared to have stopped breathing, but quickly recovere recovered. Upon admission appeared dehydrated. initially thought to be AGE. Pt remained lethargic and unable to take po. IS dx by X-ray and US. Reduced by barium enema with immediate improvement in pt condition.


Changed on 3/2/2010

VAERS ID: 333027 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Hawaii
Vaccinated:2008-11-06
Onset:2008-11-11
Submitted:2008-11-21
Entered:2008-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC2IBI43AA / 2 LL / IM
HIBV: HIB (PROHIBIT) / SANOFI PASTEUR UF505AB / 2 RL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC C2283 / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 047OX / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Barium enema abnormal, Cyanosis, Dehydration, Intussusception, Irritability, Lethargy, Pyrexia, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Decreased appetite, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol HFA
Current Illness: diarrhea and emesis
Preexisting Conditions: reactive airway disease. PMH: none
Allergies:
Diagnostic Lab Data: see #7 Labs and Diagnsotics: Abd X-ray (+) for BO. Abd US (+) for IS. Barium enema (+) for IS.
CDC 'Split Type':

Write-up: Pt received Pediarix, Hib, PCV, and rotavirus vaccines on 11/6/08. On 11/17 he was admitted for intussusception. He was discharged 11/19 after successful reduction by barium enema. 11/26/2008 MR received for DOS 11/17-19/2008 with D/C DX: Intussusception. Diarrhea. Pt presented to ER with 5 day hx of diarrhea, irritabily, ear grabbing, fever and decreased appetite and 1 day hx of vomiting everything eaten. En route to ER vomited, turned blue and appeared to have stopped breathing, but quickly recovered. Upon admission appeared dehydrated. initially thought to be AGE. Pt remained lethargic and unable to take po. IS dx by X-ray and US. Reduced by barium enema with immediate improvement in pt condition.


Changed on 4/7/2010

VAERS ID: 333027 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Hawaii
Vaccinated:2008-11-06
Onset:2008-11-11
Submitted:2008-11-21
Entered:2008-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC2IBI43AA / 2 LL / IM
HIBV: HIB (PROHIBIT) / SANOFI PASTEUR UF505AB / 2 RL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C2283 / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 047OX / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Barium enema abnormal, Cyanosis, Dehydration, Intussusception, Irritability, Lethargy, Pyrexia, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Decreased appetite, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol HFA
Current Illness: diarrhea and emesis
Preexisting Conditions: reactive airway disease. PMH: none
Allergies:
Diagnostic Lab Data: see #7 Labs and Diagnsotics: Abd X-ray (+) for BO. Abd US (+) for IS. Barium enema (+) for IS.
CDC 'Split Type':

Write-up: Pt received Pediarix, Hib, PCV, and rotavirus vaccines on 11/6/08. On 11/17 he was admitted for intussusception. He was discharged 11/19 after successful reduction by barium enema. 11/26/2008 MR received for DOS 11/17-19/2008 with D/C DX: Intussusception. Diarrhea. Pt presented to ER with 5 day hx of diarrhea, irritabily, ear grabbing, fever and decreased appetite and 1 day hx of vomiting everything eaten. En route to ER vomited, turned blue and appeared to have stopped breathing, but quickly recovered. Upon admission appeared dehydrated. initially thought to be AGE. Pt remained lethargic and unable to take po. IS dx by X-ray and US. Reduced by barium enema with immediate improvement in pt condition.


Changed on 8/31/2010

VAERS ID: 333027 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Hawaii
Vaccinated:2008-11-06
Onset:2008-11-11
Submitted:2008-11-21
Entered:2008-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC2IBI43AA / 2 LL / IM
HIBV: HIB (PROHIBIT) / SANOFI PASTEUR UF505AB / 2 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH C2283 / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 047OX / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Barium enema abnormal, Cyanosis, Dehydration, Intussusception, Irritability, Lethargy, Pyrexia, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Decreased appetite, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol HFA
Current Illness: diarrhea and emesis
Preexisting Conditions: reactive airway disease. PMH: none
Allergies:
Diagnostic Lab Data: see #7 Labs and Diagnsotics: Abd X-ray (+) for BO. Abd US (+) for IS. Barium enema (+) for IS.
CDC 'Split Type':

Write-up: Pt received Pediarix, Hib, PCV, and rotavirus vaccines on 11/6/08. On 11/17 he was admitted for intussusception. He was discharged 11/19 after successful reduction by barium enema. 11/26/2008 MR received for DOS 11/17-19/2008 with D/C DX: Intussusception. Diarrhea. Pt presented to ER with 5 day hx of diarrhea, irritabily, ear grabbing, fever and decreased appetite and 1 day hx of vomiting everything eaten. En route to ER vomited, turned blue and appeared to have stopped breathing, but quickly recovered. Upon admission appeared dehydrated. initially thought to be AGE. Pt remained lethargic and unable to take po. IS dx by X-ray and US. Reduced by barium enema with immediate improvement in pt condition.


Changed on 5/13/2013

VAERS ID: 333027 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Hawaii
Vaccinated:2008-11-06
Onset:2008-11-11
Submitted:2008-11-21
Entered:2008-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC2IBI43AA / 2 LL / IM
HIBV: HIB (PROHIBIT) / SANOFI PASTEUR UF505AB / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C2283 / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 047OX / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 047OX / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Barium enema abnormal, Cyanosis, Dehydration, Intussusception, Irritability, Lethargy, Pyrexia, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Decreased appetite, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol HFA
Current Illness: diarrhea and emesis
Preexisting Conditions: reactive airway disease. PMH: none
Allergies:
Diagnostic Lab Data: see #7 Labs and Diagnsotics: Abd X-ray (+) for BO. Abd US (+) for IS. Barium enema (+) for IS.
CDC 'Split Type':

Write-up: Pt received Pediarix, Hib, PCV, and rotavirus vaccines on 11/6/08. On 11/17 he was admitted for intussusception. He was discharged 11/19 after successful reduction by barium enema. 11/26/2008 MR received for DOS 11/17-19/2008 with D/C DX: Intussusception. Diarrhea. Pt presented to ER with 5 day hx of diarrhea, irritabily, ear grabbing, fever and decreased appetite and 1 day hx of vomiting everything eaten. En route to ER vomited, turned blue and appeared to have stopped breathing, but quickly recovered. Upon admission appeared dehydrated. initially thought to be AGE. Pt remained lethargic and unable to take po. IS dx by X-ray and US. Reduced by barium enema with immediate improvement in pt condition.


Changed on 4/14/2017

VAERS ID: 333027 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Hawaii
Vaccinated:2008-11-06
Onset:2008-11-11
Submitted:2008-11-21
Entered:2008-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC2IBI43AA / 2 LL / IM
HIBV: HIB (PROHIBIT) / SANOFI PASTEUR UF505AB / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C2283 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 047OX / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Barium enema abnormal, Cyanosis, Dehydration, Intussusception, Irritability, Lethargy, Pyrexia, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Decreased appetite, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol HFA
Current Illness: diarrhea and emesis
Preexisting Conditions: reactive airway disease. PMH: none
Allergies:
Diagnostic Lab Data: see #7 Labs and Diagnsotics: Abd X-ray (+) for BO. Abd US (+) for IS. Barium enema (+) for IS.
CDC 'Split Type':

Write-up: Pt received Pediarix, Hib, PCV, and rotavirus vaccines on 11/6/08. On 11/17 he was admitted for intussusception. He was discharged 11/19 after successful reduction by barium enema. 11/26/2008 MR received for DOS 11/17-19/2008 with D/C DX: Intussusception. Diarrhea. Pt presented to ER with 5 day hx of diarrhea, irritabily, ear grabbing, fever and decreased appetite and 1 day hx of vomiting everything eaten. En route to ER vomited, turned blue and appeared to have stopped breathing, but quickly recovered. Upon admission appeared dehydrated. initially thought to be AGE. Pt remained lethargic and unable to take po. IS dx by X-ray and US. Reduced by barium enema with immediate improvement in pt condition.


Changed on 9/14/2017

VAERS ID: 333027 Before After
VAERS Form:(blank) 1
Age:0.5
Sex:Male
Location:Hawaii
Vaccinated:2008-11-06
Onset:2008-11-11
Submitted:2008-11-21
Entered:2008-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC2IBI43AA / 2 3 LL / IM
HIBV: HIB (PROHIBIT) / SANOFI PASTEUR UF505AB / 2 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C2283 / 2 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 047OX / 0 1 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol HFA
Current Illness: diarrhea and emesis
Preexisting Conditions: reactive airway disease. PMH: none
Allergies:
Diagnostic Lab Data: see #7 Labs and Diagnsotics: Abd X-ray (+) for BO. Abd US (+) for IS. Barium enema (+) for IS.
CDC 'Split Type':

Write-up: Pt received Pediarix, Hib, PCV, and rotavirus vaccines on 11/6/08. On 11/17 he was admitted for intussusception. He was discharged 11/19 after successful reduction by barium enema. 11/26/2008 MR received for DOS 11/17-19/2008 with D/C DX: Intussusception. Diarrhea. Pt presented to ER with 5 day hx of diarrhea, irritabily, ear grabbing, fever and decreased appetite and 1 day hx of vomiting everything eaten. En route to ER vomited, turned blue and appeared to have stopped breathing, but quickly recovered. Upon admission appeared dehydrated. initially thought to be AGE. Pt remained lethargic and unable to take po. IS dx by X-ray and US. Reduced by barium enema with immediate improvement in pt condition.


Changed on 2/14/2018

VAERS ID: 333027 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:Hawaii
Vaccinated:2008-11-06
Onset:2008-11-11
Submitted:2008-11-21
Entered:2008-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC2IBI43AA / 3 LL / IM
HIBV: HIB (PROHIBIT) / SANOFI PASTEUR UF505AB / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C2283 / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 047OX / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol HFA
Current Illness: diarrhea and emesis
Preexisting Conditions: reactive airway disease. PMH: none
Allergies:
Diagnostic Lab Data: see #7 Labs and Diagnsotics: Abd X-ray (+) for BO. Abd US (+) for IS. Barium enema (+) for IS.
CDC 'Split Type':

Write-up: Pt received Pediarix, Hib, PCV, and rotavirus vaccines on 11/6/08. On 11/17 he was admitted for intussusception. He was discharged 11/19 after successful reduction by barium enema. 11/26/2008 MR received for DOS 11/17-19/2008 with D/C DX: Intussusception. Diarrhea. Pt presented to ER with 5 day hx of diarrhea, irritabily, ear grabbing, fever and decreased appetite and 1 day hx of vomiting everything eaten. En route to ER vomited, turned blue and appeared to have stopped breathing, but quickly recovered. Upon admission appeared dehydrated. initially thought to be AGE. Pt remained lethargic and unable to take po. IS dx by X-ray and US. Reduced by barium enema with immediate improvement in pt condition.


Changed on 6/14/2018

VAERS ID: 333027 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:Hawaii
Vaccinated:2008-11-06
Onset:2008-11-11
Submitted:2008-11-21
Entered:2008-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC2IBI43AA / 3 LL / IM
HIBV: HIB (PROHIBIT) / SANOFI PASTEUR UF505AB / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C2283 / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 047OX / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol HFA
Current Illness: diarrhea and emesis
Preexisting Conditions: reactive airway disease. PMH: none
Allergies:
Diagnostic Lab Data: see #7 Labs and Diagnsotics: Abd X-ray (+) for BO. Abd US (+) for IS. Barium enema (+) for IS.
CDC 'Split Type':

Write-up: Pt received Pediarix, Hib, PCV, and rotavirus vaccines on 11/6/08. On 11/17 he was admitted for intussusception. He was discharged 11/19 after successful reduction by barium enema. 11/26/2008 MR received for DOS 11/17-19/2008 with D/C DX: Intussusception. Diarrhea. Pt presented to ER with 5 day hx of diarrhea, irritabily, ear grabbing, fever and decreased appetite and 1 day hx of vomiting everything eaten. En route to ER vomited, turned blue and appeared to have stopped breathing, but quickly recovered. Upon admission appeared dehydrated. initially thought to be AGE. Pt remained lethargic and unable to take po. IS dx by X-ray and US. Reduced by barium enema with immediate improvement in pt condition.


Changed on 8/14/2018

VAERS ID: 333027 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:Hawaii
Vaccinated:2008-11-06
Onset:2008-11-11
Submitted:2008-11-21
Entered:2008-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC2IBI43AA / 3 LL / IM
HIBV: HIB (PROHIBIT) / SANOFI PASTEUR UF505AB / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C2283 / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 047OX / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol HFA
Current Illness: diarrhea and emesis
Preexisting Conditions: reactive airway disease. PMH: none
Allergies:
Diagnostic Lab Data: see #7 Labs and Diagnsotics: Abd X-ray (+) for BO. Abd US (+) for IS. Barium enema (+) for IS.
CDC 'Split Type':

Write-up: Pt received Pediarix, Hib, PCV, and rotavirus vaccines on 11/6/08. On 11/17 he was admitted for intussusception. He was discharged 11/19 after successful reduction by barium enema. 11/26/2008 MR received for DOS 11/17-19/2008 with D/C DX: Intussusception. Diarrhea. Pt presented to ER with 5 day hx of diarrhea, irritabily, ear grabbing, fever and decreased appetite and 1 day hx of vomiting everything eaten. En route to ER vomited, turned blue and appeared to have stopped breathing, but quickly recovered. Upon admission appeared dehydrated. initially thought to be AGE. Pt remained lethargic and unable to take po. IS dx by X-ray and US. Reduced by barium enema with immediate improvement in pt condition.


Changed on 9/14/2018

VAERS ID: 333027 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:Hawaii
Vaccinated:2008-11-06
Onset:2008-11-11
Submitted:2008-11-21
Entered:2008-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC2IBI43AA / 3 LL / IM
HIBV: HIB (PROHIBIT) / SANOFI PASTEUR UF505AB / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C2283 / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 047OX / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol HFA
Current Illness: diarrhea and emesis
Preexisting Conditions: reactive airway disease. PMH: none
Allergies:
Diagnostic Lab Data: see #7 Labs and Diagnsotics: Abd X-ray (+) for BO. Abd US (+) for IS. Barium enema (+) for IS.
CDC 'Split Type':

Write-up: Pt received Pediarix, Hib, PCV, and rotavirus vaccines on 11/6/08. On 11/17 he was admitted for intussusception. He was discharged 11/19 after successful reduction by barium enema. 11/26/2008 MR received for DOS 11/17-19/2008 with D/C DX: Intussusception. Diarrhea. Pt presented to ER with 5 day hx of diarrhea, irritabily, ear grabbing, fever and decreased appetite and 1 day hx of vomiting everything eaten. En route to ER vomited, turned blue and appeared to have stopped breathing, but quickly recovered. Upon admission appeared dehydrated. initially thought to be AGE. Pt remained lethargic and unable to take po. IS dx by X-ray and US. Reduced by barium enema with immediate improvement in pt condition.


Changed on 10/14/2018

VAERS ID: 333027 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:Hawaii
Vaccinated:2008-11-06
Onset:2008-11-11
Submitted:2008-11-21
Entered:2008-11-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC2IBI43AA / 3 LL / IM
HIBV: HIB (PROHIBIT) / SANOFI PASTEUR UF505AB / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C2283 / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 047OX / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol HFA
Current Illness: diarrhea and emesis
Preexisting Conditions: reactive airway disease. PMH: none
Allergies:
Diagnostic Lab Data: see #7 Labs and Diagnsotics: Abd X-ray (+) for BO. Abd US (+) for IS. Barium enema (+) for IS.
CDC 'Split Type':

Write-up: Pt received Pediarix, Hib, PCV, and rotavirus vaccines on 11/6/08. On 11/17 he was admitted for intussusception. He was discharged 11/19 after successful reduction by barium enema. 11/26/2008 MR received for DOS 11/17-19/2008 with D/C DX: Intussusception. Diarrhea. Pt presented to ER with 5 day hx of diarrhea, irritabily, ear grabbing, fever and decreased appetite and 1 day hx of vomiting everything eaten. En route to ER vomited, turned blue and appeared to have stopped breathing, but quickly recovered. Upon admission appeared dehydrated. initially thought to be AGE. Pt remained lethargic and unable to take po. IS dx by X-ray and US. Reduced by barium enema with immediate improvement in pt condition.

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