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This is VAERS ID 333395

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 333395
VAERS Form:
Age:0.3
Sex:Male
Location:California
Vaccinated:2008-09-26
Onset:2008-11-20
Submitted:2008-11-26
Entered:2008-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B156DA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF403AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C87339 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0302X / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal tenderness, Appendicectomy, Barium enema abnormal, Crying, Abdominal X-ray

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: RANITIDINE
Current Illness: NONE
Preexisting Conditions: GASTROESOPHAGEAL REFLUX DISEASE. PMH: GERD
Allergies:
Diagnostic Lab Data: surgical reduction of intussusception. Labs and Diagnostics: Abd X-ray (+) for decreased gas in distal colon/rectum. BE (+) for IS. CBC with 18.3 WBCs-82% segs, 15% lymphs, 3% monos.
CDC 'Split Type':

Write-up: Intussusception. 01/06/2009 MR received for DOS 11/20-23/2008 with D/C DX: Intussusception. Pt initially presented to PCP with c/o bilious emesis x3, refusing po, irritability and crying. Pale, mottled and lethargic. Sent to ER for transport to higher le"vel of care. PE (+) for decreased activity, back arching, abdominal tenderness, single macule on suprapubic skin. IS (+) on BE but unable to reduce. Taken to OR for Irreducible Ileocolic IS-laparoscopy. Reduction of IS. Appendectomy. Post-op uneventful


Changed on 12/8/2009

VAERS ID: 333395 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:California
Vaccinated:2008-09-26
Onset:2008-11-20
Submitted:2008-11-26
Entered:2008-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B156DA / 1 LL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B156DA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF403AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C87339 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0302X / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal tenderness, Appendicectomy, Barium enema abnormal, Crying, Full blood count, Intussusception, Irritability, Laparoscopy, Large intestinal obstruction reduction, Lethargy, Livedo reticularis, Opisthotonus, Pallor, Rash macular, Surgery, Vomiting, White blood cell count increased, X-ray abnormal, Enema administration, Platelet count increased, Neutrophil percentage increased, Lymphocyte percentage decreased, Monocyte percentage, Abdominal X-ray, Hypophagia

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: RANITIDINE
Current Illness: NONE
Preexisting Conditions: GASTROESOPHAGEAL REFLUX DISEASE. PMH: GERD
Allergies:
Diagnostic Lab Data: surgical reduction of intussusception. Labs and Diagnostics: Abd X-ray (+) for decreased gas in distal colon/rectum. BE (+) for IS. CBC with 18.3 WBCs-82% segs, 15% lymphs, 3% monos.
CDC 'Split Type':

Write-up: Intussusception. 01/06/2009 MR received for DOS 11/20-23/2008 with D/C DX: Intussusception. Pt initially presented to PCP with c/o bilious emesis x3, refusing po, irritability and crying. Pale, mottled and lethargic. Sent to ER for transport to higher le"vel level of care. PE (+) for decreased activity, back arching, abdominal tenderness, single macule on suprapubic skin. IS (+) on BE but unable to reduce. Taken to OR for Irreducible Ileocolic IS-laparoscopy. Reduction of IS. Appendectomy. Post-op uneventful and d/c home.


Changed on 3/2/2010

VAERS ID: 333395 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:California
Vaccinated:2008-09-26
Onset:2008-11-20
Submitted:2008-11-26
Entered:2008-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B156DA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF403AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC C87339 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0302X / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal tenderness, Appendicectomy, Barium enema abnormal, Crying, Full blood count, Intussusception, Irritability, Laparoscopy, Large intestinal obstruction reduction, Lethargy, Livedo reticularis, Opisthotonus, Pallor, Rash macular, Surgery, Vomiting, White blood cell count increased, X-ray abnormal, Enema administration, Platelet count increased, Neutrophil percentage increased, Lymphocyte percentage decreased, Monocyte percentage, Abdominal X-ray, Hypophagia

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: RANITIDINE
Current Illness: NONE
Preexisting Conditions: GASTROESOPHAGEAL REFLUX DISEASE. PMH: GERD
Allergies:
Diagnostic Lab Data: surgical reduction of intussusception. Labs and Diagnostics: Abd X-ray (+) for decreased gas in distal colon/rectum. BE (+) for IS. CBC with 18.3 WBCs-82% segs, 15% lymphs, 3% monos.
CDC 'Split Type':

Write-up: Intussusception. 01/06/2009 MR received for DOS 11/20-23/2008 with D/C DX: Intussusception. Pt initially presented to PCP with c/o bilious emesis x3, refusing po, irritability and crying. Pale, mottled and lethargic. Sent to ER for transport to higher level of care. PE (+) for decreased activity, back arching, abdominal tenderness, single macule on suprapubic skin. IS (+) on BE but unable to reduce. Taken to OR for Irreducible Ileocolic IS-laparoscopy. Reduction of IS. Appendectomy. Post-op uneventful and d/c home.


Changed on 4/7/2010

VAERS ID: 333395 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:California
Vaccinated:2008-09-26
Onset:2008-11-20
Submitted:2008-11-26
Entered:2008-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B156DA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF403AA / 1 RL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C87339 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0302X / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal tenderness, Appendicectomy, Barium enema abnormal, Crying, Full blood count, Intussusception, Irritability, Laparoscopy, Large intestinal obstruction reduction, Lethargy, Livedo reticularis, Opisthotonus, Pallor, Rash macular, Surgery, Vomiting, White blood cell count increased, X-ray abnormal, Enema administration, Platelet count increased, Neutrophil percentage increased, Lymphocyte percentage decreased, Monocyte percentage, Abdominal X-ray, Hypophagia

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: RANITIDINE
Current Illness: NONE
Preexisting Conditions: GASTROESOPHAGEAL REFLUX DISEASE. PMH: GERD
Allergies:
Diagnostic Lab Data: surgical reduction of intussusception. Labs and Diagnostics: Abd X-ray (+) for decreased gas in distal colon/rectum. BE (+) for IS. CBC with 18.3 WBCs-82% segs, 15% lymphs, 3% monos.
CDC 'Split Type':

Write-up: Intussusception. 01/06/2009 MR received for DOS 11/20-23/2008 with D/C DX: Intussusception. Pt initially presented to PCP with c/o bilious emesis x3, refusing po, irritability and crying. Pale, mottled and lethargic. Sent to ER for transport to higher level of care. PE (+) for decreased activity, back arching, abdominal tenderness, single macule on suprapubic skin. IS (+) on BE but unable to reduce. Taken to OR for Irreducible Ileocolic IS-laparoscopy. Reduction of IS. Appendectomy. Post-op uneventful and d/c home.


Changed on 8/31/2010

VAERS ID: 333395 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:California
Vaccinated:2008-09-26
Onset:2008-11-20
Submitted:2008-11-26
Entered:2008-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B156DA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF403AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH C87339 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0302X / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal tenderness, Appendicectomy, Barium enema abnormal, Crying, Full blood count, Intussusception, Irritability, Laparoscopy, Large intestinal obstruction reduction, Lethargy, Livedo reticularis, Opisthotonus, Pallor, Rash macular, Surgery, Vomiting, White blood cell count increased, X-ray abnormal, Enema administration, Platelet count increased, Neutrophil percentage increased, Lymphocyte percentage decreased, Monocyte percentage, Abdominal X-ray, Hypophagia

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: RANITIDINE
Current Illness: NONE
Preexisting Conditions: GASTROESOPHAGEAL REFLUX DISEASE. PMH: GERD
Allergies:
Diagnostic Lab Data: surgical reduction of intussusception. Labs and Diagnostics: Abd X-ray (+) for decreased gas in distal colon/rectum. BE (+) for IS. CBC with 18.3 WBCs-82% segs, 15% lymphs, 3% monos.
CDC 'Split Type':

Write-up: Intussusception. 01/06/2009 MR received for DOS 11/20-23/2008 with D/C DX: Intussusception. Pt initially presented to PCP with c/o bilious emesis x3, refusing po, irritability and crying. Pale, mottled and lethargic. Sent to ER for transport to higher level of care. PE (+) for decreased activity, back arching, abdominal tenderness, single macule on suprapubic skin. IS (+) on BE but unable to reduce. Taken to OR for Irreducible Ileocolic IS-laparoscopy. Reduction of IS. Appendectomy. Post-op uneventful and d/c home.


Changed on 5/13/2013

VAERS ID: 333395 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:California
Vaccinated:2008-09-26
Onset:2008-11-20
Submitted:2008-11-26
Entered:2008-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B156DA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF403AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C87339 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0302X / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0302X / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal tenderness, Appendicectomy, Barium enema abnormal, Crying, Full blood count, Intussusception, Irritability, Laparoscopy, Large intestinal obstruction reduction, Lethargy, Livedo reticularis, Opisthotonus, Pallor, Rash macular, Surgery, Vomiting, White blood cell count increased, X-ray abnormal, Enema administration, Platelet count increased, Neutrophil percentage increased, Lymphocyte percentage decreased, Monocyte percentage, Abdominal X-ray, Hypophagia

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: RANITIDINE
Current Illness: NONE
Preexisting Conditions: GASTROESOPHAGEAL REFLUX DISEASE. PMH: GERD
Allergies:
Diagnostic Lab Data: surgical reduction of intussusception. Labs and Diagnostics: Abd X-ray (+) for decreased gas in distal colon/rectum. BE (+) for IS. CBC with 18.3 WBCs-82% segs, 15% lymphs, 3% monos.
CDC 'Split Type':

Write-up: Intussusception. 01/06/2009 MR received for DOS 11/20-23/2008 with D/C DX: Intussusception. Pt initially presented to PCP with c/o bilious emesis x3, refusing po, irritability and crying. Pale, mottled and lethargic. Sent to ER for transport to higher level of care. PE (+) for decreased activity, back arching, abdominal tenderness, single macule on suprapubic skin. IS (+) on BE but unable to reduce. Taken to OR for Irreducible Ileocolic IS-laparoscopy. Reduction of IS. Appendectomy. Post-op uneventful and d/c home.


Changed on 4/14/2017

VAERS ID: 333395 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:California
Vaccinated:2008-09-26
Onset:2008-11-20
Submitted:2008-11-26
Entered:2008-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B156DA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF403AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C87339 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0302X / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal tenderness, Appendicectomy, Barium enema abnormal, Crying, Full blood count, Intussusception, Irritability, Laparoscopy, Large intestinal obstruction reduction, Lethargy, Livedo reticularis, Opisthotonus, Pallor, Rash macular, Surgery, Vomiting, White blood cell count increased, X-ray abnormal, Enema administration, Platelet count increased, Neutrophil percentage increased, Lymphocyte percentage decreased, Monocyte percentage, Abdominal X-ray, Hypophagia

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: RANITIDINE
Current Illness: NONE
Preexisting Conditions: GASTROESOPHAGEAL REFLUX DISEASE. PMH: GERD
Allergies:
Diagnostic Lab Data: surgical reduction of intussusception. Labs and Diagnostics: Abd X-ray (+) for decreased gas in distal colon/rectum. BE (+) for IS. CBC with 18.3 WBCs-82% segs, 15% lymphs, 3% monos.
CDC 'Split Type':

Write-up: Intussusception. 01/06/2009 MR received for DOS 11/20-23/2008 with D/C DX: Intussusception. Pt initially presented to PCP with c/o bilious emesis x3, refusing po, irritability and crying. Pale, mottled and lethargic. Sent to ER for transport to higher level of care. PE (+) for decreased activity, back arching, abdominal tenderness, single macule on suprapubic skin. IS (+) on BE but unable to reduce. Taken to OR for Irreducible Ileocolic IS-laparoscopy. Reduction of IS. Appendectomy. Post-op uneventful and d/c home.


Changed on 9/14/2017

VAERS ID: 333395 Before After
VAERS Form:(blank) 1
Age:0.3
Sex:Male
Location:California
Vaccinated:2008-09-26
Onset:2008-11-20
Submitted:2008-11-26
Entered:2008-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B156DA / 1 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF403AA / 1 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C87339 / 1 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0302X / 1 2 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception, Surgery

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: RANITIDINE
Current Illness: NONE
Preexisting Conditions: GASTROESOPHAGEAL REFLUX DISEASE. PMH: GERD
Allergies:
Diagnostic Lab Data: surgical reduction of intussusception. Labs and Diagnostics: Abd X-ray (+) for decreased gas in distal colon/rectum. BE (+) for IS. CBC with 18.3 WBCs-82% segs, 15% lymphs, 3% monos.
CDC 'Split Type':

Write-up: Intussusception. 01/06/2009 MR received for DOS 11/20-23/2008 with D/C DX: Intussusception. Pt initially presented to PCP with c/o bilious emesis x3, refusing po, irritability and crying. Pale, mottled and lethargic. Sent to ER for transport to higher level of care. PE (+) for decreased activity, back arching, abdominal tenderness, single macule on suprapubic skin. IS (+) on BE but unable to reduce. Taken to OR for Irreducible Ileocolic IS-laparoscopy. Reduction of IS. Appendectomy. Post-op uneventful and d/c home.


Changed on 2/14/2018

VAERS ID: 333395 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:California
Vaccinated:2008-09-26
Onset:2008-11-20
Submitted:2008-11-26
Entered:2008-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B156DA / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF403AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C87339 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0302X / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception, Surgery

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: RANITIDINE
Current Illness: NONE
Preexisting Conditions: GASTROESOPHAGEAL REFLUX DISEASE. PMH: GERD
Allergies:
Diagnostic Lab Data: surgical reduction of intussusception. Labs and Diagnostics: Abd X-ray (+) for decreased gas in distal colon/rectum. BE (+) for IS. CBC with 18.3 WBCs-82% segs, 15% lymphs, 3% monos.
CDC 'Split Type':

Write-up: Intussusception. 01/06/2009 MR received for DOS 11/20-23/2008 with D/C DX: Intussusception. Pt initially presented to PCP with c/o bilious emesis x3, refusing po, irritability and crying. Pale, mottled and lethargic. Sent to ER for transport to higher level of care. PE (+) for decreased activity, back arching, abdominal tenderness, single macule on suprapubic skin. IS (+) on BE but unable to reduce. Taken to OR for Irreducible Ileocolic IS-laparoscopy. Reduction of IS. Appendectomy. Post-op uneventful and d/c home.


Changed on 6/14/2018

VAERS ID: 333395 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:California
Vaccinated:2008-09-26
Onset:2008-11-20
Submitted:2008-11-26
Entered:2008-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B156DA / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF403AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C87339 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0302X / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception, Surgery

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: RANITIDINE
Current Illness: NONE
Preexisting Conditions: GASTROESOPHAGEAL REFLUX DISEASE. PMH: GERD
Allergies:
Diagnostic Lab Data: surgical reduction of intussusception. Labs and Diagnostics: Abd X-ray (+) for decreased gas in distal colon/rectum. BE (+) for IS. CBC with 18.3 WBCs-82% segs, 15% lymphs, 3% monos.
CDC 'Split Type':

Write-up: Intussusception. 01/06/2009 MR received for DOS 11/20-23/2008 with D/C DX: Intussusception. Pt initially presented to PCP with c/o bilious emesis x3, refusing po, irritability and crying. Pale, mottled and lethargic. Sent to ER for transport to higher level of care. PE (+) for decreased activity, back arching, abdominal tenderness, single macule on suprapubic skin. IS (+) on BE but unable to reduce. Taken to OR for Irreducible Ileocolic IS-laparoscopy. Reduction of IS. Appendectomy. Post-op uneventful and d/c home.


Changed on 8/14/2018

VAERS ID: 333395 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:California
Vaccinated:2008-09-26
Onset:2008-11-20
Submitted:2008-11-26
Entered:2008-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B156DA / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF403AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C87339 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0302X / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception, Surgery

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: RANITIDINE
Current Illness: NONE
Preexisting Conditions: GASTROESOPHAGEAL REFLUX DISEASE. PMH: GERD
Allergies:
Diagnostic Lab Data: surgical reduction of intussusception. Labs and Diagnostics: Abd X-ray (+) for decreased gas in distal colon/rectum. BE (+) for IS. CBC with 18.3 WBCs-82% segs, 15% lymphs, 3% monos.
CDC 'Split Type':

Write-up: Intussusception. 01/06/2009 MR received for DOS 11/20-23/2008 with D/C DX: Intussusception. Pt initially presented to PCP with c/o bilious emesis x3, refusing po, irritability and crying. Pale, mottled and lethargic. Sent to ER for transport to higher level of care. PE (+) for decreased activity, back arching, abdominal tenderness, single macule on suprapubic skin. IS (+) on BE but unable to reduce. Taken to OR for Irreducible Ileocolic IS-laparoscopy. Reduction of IS. Appendectomy. Post-op uneventful and d/c home.


Changed on 9/14/2018

VAERS ID: 333395 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:California
Vaccinated:2008-09-26
Onset:2008-11-20
Submitted:2008-11-26
Entered:2008-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B156DA / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF403AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C87339 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0302X / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception, Surgery

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: RANITIDINE
Current Illness: NONE
Preexisting Conditions: GASTROESOPHAGEAL REFLUX DISEASE. PMH: GERD
Allergies:
Diagnostic Lab Data: surgical reduction of intussusception. Labs and Diagnostics: Abd X-ray (+) for decreased gas in distal colon/rectum. BE (+) for IS. CBC with 18.3 WBCs-82% segs, 15% lymphs, 3% monos.
CDC 'Split Type':

Write-up: Intussusception. 01/06/2009 MR received for DOS 11/20-23/2008 with D/C DX: Intussusception. Pt initially presented to PCP with c/o bilious emesis x3, refusing po, irritability and crying. Pale, mottled and lethargic. Sent to ER for transport to higher level of care. PE (+) for decreased activity, back arching, abdominal tenderness, single macule on suprapubic skin. IS (+) on BE but unable to reduce. Taken to OR for Irreducible Ileocolic IS-laparoscopy. Reduction of IS. Appendectomy. Post-op uneventful and d/c home.


Changed on 10/14/2018

VAERS ID: 333395 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:California
Vaccinated:2008-09-26
Onset:2008-11-20
Submitted:2008-11-26
Entered:2008-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B156DA / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF403AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C87339 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0302X / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception, Surgery

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: RANITIDINE
Current Illness: NONE
Preexisting Conditions: GASTROESOPHAGEAL REFLUX DISEASE. PMH: GERD
Allergies:
Diagnostic Lab Data: surgical reduction of intussusception. Labs and Diagnostics: Abd X-ray (+) for decreased gas in distal colon/rectum. BE (+) for IS. CBC with 18.3 WBCs-82% segs, 15% lymphs, 3% monos.
CDC 'Split Type':

Write-up: Intussusception. 01/06/2009 MR received for DOS 11/20-23/2008 with D/C DX: Intussusception. Pt initially presented to PCP with c/o bilious emesis x3, refusing po, irritability and crying. Pale, mottled and lethargic. Sent to ER for transport to higher level of care. PE (+) for decreased activity, back arching, abdominal tenderness, single macule on suprapubic skin. IS (+) on BE but unable to reduce. Taken to OR for Irreducible Ileocolic IS-laparoscopy. Reduction of IS. Appendectomy. Post-op uneventful and d/c home.

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