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This is VAERS ID 334086

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 334086
VAERS Form:
Age:0.4
Sex:Male
Location:Illinois
Vaccinated:2008-11-28
Onset:2008-12-03
Submitted:2008-12-05
Entered:2008-12-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIP: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C2870AA / 1 LL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D03125 / 1 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0407X / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Abdominal pain, Barium enema, Haematochezia, Enema administration, Decreased appetite

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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound abdomen LABS: Abdominal US (+) IS. Contrast BE reduced.
CDC 'Split Type':

Write-up: Developed intussusception on 12-3-08. Barium enema reduced it. 1/6/09 Reviewed hospital medical records of 12/3-12/4/08 FINAL DX: Intussusception Records reveal patient experienced colicky abdominal pain, sleep disturbance, decreased appetite, lethargy &"bloody stools. Admitted for overnight observation & d/c to home in AM.


Changed on 12/8/2009

VAERS ID: 334086 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:Illinois
Vaccinated:2008-11-28
Onset:2008-12-03
Submitted:2008-12-05
Entered:2008-12-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIP: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C2870AA / 1 LL / UN
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C2870AA / 1 LL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D03125 / 1 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0407X / 1 - / PO

Administered by: Private      Purchased by: Unknown Private
Symptoms: Abdominal pain, Barium enema, Haematochezia, Intussusception, Lethargy, Sleep disorder, Enema administration, Ultrasound abdomen abnormal, Decreased appetite

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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound abdomen LABS: Abdominal US (+) IS. Contrast BE reduced.
CDC 'Split Type':

Write-up: Developed intussusception on 12-3-08. Barium enema reduced it. 1/6/09 Reviewed hospital medical records of 12/3-12/4/08 FINAL DX: Intussusception Records reveal patient experienced colicky abdominal pain, sleep disturbance, decreased appetite, lethargy &"bloody & bloody stools. Admitted for overnight observation & d/c to home in AM.


Changed on 3/2/2010

VAERS ID: 334086 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:Illinois
Vaccinated:2008-11-28
Onset:2008-12-03
Submitted:2008-12-05
Entered:2008-12-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C2870AA / 1 LL / UN
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC D03125 / 1 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0407X / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Barium enema, Haematochezia, Intussusception, Lethargy, Sleep disorder, Enema administration, Ultrasound abdomen abnormal, Decreased appetite

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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound abdomen LABS: Abdominal US (+) IS. Contrast BE reduced.
CDC 'Split Type':

Write-up: Developed intussusception on 12-3-08. Barium enema reduced it. 1/6/09 Reviewed hospital medical records of 12/3-12/4/08 FINAL DX: Intussusception Records reveal patient experienced colicky abdominal pain, sleep disturbance, decreased appetite, lethargy & bloody stools. Admitted for overnight observation & d/c to home in AM.


Changed on 4/7/2010

VAERS ID: 334086 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:Illinois
Vaccinated:2008-11-28
Onset:2008-12-03
Submitted:2008-12-05
Entered:2008-12-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C2870AA / 1 LL / UN
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D03125 / 1 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0407X / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Barium enema, Haematochezia, Intussusception, Lethargy, Sleep disorder, Enema administration, Ultrasound abdomen abnormal, Decreased appetite

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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound abdomen LABS: Abdominal US (+) IS. Contrast BE reduced.
CDC 'Split Type':

Write-up: Developed intussusception on 12-3-08. Barium enema reduced it. 1/6/09 Reviewed hospital medical records of 12/3-12/4/08 FINAL DX: Intussusception Records reveal patient experienced colicky abdominal pain, sleep disturbance, decreased appetite, lethargy & bloody stools. Admitted for overnight observation & d/c to home in AM.


Changed on 8/31/2010

VAERS ID: 334086 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:Illinois
Vaccinated:2008-11-28
Onset:2008-12-03
Submitted:2008-12-05
Entered:2008-12-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C2870AA / 1 LL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH D03125 / 1 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0407X / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Barium enema, Haematochezia, Intussusception, Lethargy, Sleep disorder, Enema administration, Ultrasound abdomen abnormal, Decreased appetite

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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound abdomen LABS: Abdominal US (+) IS. Contrast BE reduced.
CDC 'Split Type':

Write-up: Developed intussusception on 12-3-08. Barium enema reduced it. 1/6/09 Reviewed hospital medical records of 12/3-12/4/08 FINAL DX: Intussusception Records reveal patient experienced colicky abdominal pain, sleep disturbance, decreased appetite, lethargy & bloody stools. Admitted for overnight observation & d/c to home in AM.


Changed on 5/13/2013

VAERS ID: 334086 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:Illinois
Vaccinated:2008-11-28
Onset:2008-12-03
Submitted:2008-12-05
Entered:2008-12-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C2870AA / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D03125 / 1 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0407X / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0407X / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Barium enema, Haematochezia, Intussusception, Lethargy, Sleep disorder, Enema administration, Ultrasound abdomen abnormal, Decreased appetite

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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound abdomen LABS: Abdominal US (+) IS. Contrast BE reduced.
CDC 'Split Type':

Write-up: Developed intussusception on 12-3-08. Barium enema reduced it. 1/6/09 Reviewed hospital medical records of 12/3-12/4/08 FINAL DX: Intussusception Records reveal patient experienced colicky abdominal pain, sleep disturbance, decreased appetite, lethargy & bloody stools. Admitted for overnight observation & d/c to home in AM.


Changed on 6/14/2014

VAERS ID: 334086 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:Illinois
Vaccinated:2008-11-28
Onset:2008-12-03
Submitted:2008-12-05
Entered:2008-12-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C2870AA / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D03125 / 1 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0407X / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Barium enema, Haematochezia, Intussusception, Lethargy, Sleep disorder, Enema administration, Ultrasound abdomen abnormal, Decreased appetite

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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound abdomen LABS: Abdominal US (+) IS. Contrast BE reduced.
CDC 'Split Type':

Write-up: Developed intussusception on 12-3-08. Barium enema reduced it. 1/6/09 Reviewed hospital medical records of 12/3-12/4/08 FINAL DX: Intussusception Records reveal patient experienced colicky abdominal pain, sleep disturbance, decreased appetite, lethargy & bloody stools. Admitted for overnight observation & d/c to home in AM.


Changed on 3/14/2015

VAERS ID: 334086 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:Illinois
Vaccinated:2008-11-28
Onset:2008-12-03
Submitted:2008-12-05
Entered:2008-12-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C2870AA / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D03125 / 1 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0407X / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Barium enema, Haematochezia, Intussusception, Lethargy, Sleep disorder, Enema administration, Ultrasound abdomen abnormal, Decreased appetite

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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound abdomen LABS: Abdominal US (+) IS. Contrast BE reduced.
CDC 'Split Type':

Write-up: Developed intussusception on 12-3-08. Barium enema reduced it. 1/6/09 Reviewed hospital medical records of 12/3-12/4/08 FINAL DX: Intussusception Records reveal patient experienced colicky abdominal pain, sleep disturbance, decreased appetite, lethargy & bloody stools. Admitted for overnight observation & d/c to home in AM.


Changed on 2/14/2017

VAERS ID: 334086 Before After
VAERS Form:
Age:0.4 0.36
Sex:Male
Location:Illinois
Vaccinated:2008-11-28
Onset:2008-12-03
Submitted:2008-12-05
Entered:2008-12-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C2870AA / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D03125 / 1 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0407X / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Barium enema, Haematochezia, Intussusception, Lethargy, Sleep disorder, Enema administration, Ultrasound abdomen abnormal, Decreased appetite

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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound abdomen LABS: Abdominal US (+) IS. Contrast BE reduced.
CDC 'Split Type':

Write-up: Developed intussusception on 12-3-08. Barium enema reduced it. 1/6/09 Reviewed hospital medical records of 12/3-12/4/08 FINAL DX: Intussusception Records reveal patient experienced colicky abdominal pain, sleep disturbance, decreased appetite, lethargy & bloody stools. Admitted for overnight observation & d/c to home in AM.


Changed on 4/14/2017

VAERS ID: 334086 Before After
VAERS Form:
Age:0.36
Sex:Male
Location:Illinois
Vaccinated:2008-11-28
Onset:2008-12-03
Submitted:2008-12-05
Entered:2008-12-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C2870AA / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D03125 / 1 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0407X / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Barium enema, Haematochezia, Intussusception, Lethargy, Sleep disorder, Enema administration, Ultrasound abdomen abnormal, Decreased appetite

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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound abdomen LABS: Abdominal US (+) IS. Contrast BE reduced.
CDC 'Split Type':

Write-up: Developed intussusception on 12-3-08. Barium enema reduced it. 1/6/09 Reviewed hospital medical records of 12/3-12/4/08 FINAL DX: Intussusception Records reveal patient experienced colicky abdominal pain, sleep disturbance, decreased appetite, lethargy & bloody stools. Admitted for overnight observation & d/c to home in AM.


Changed on 9/14/2017

VAERS ID: 334086 Before After
VAERS Form:(blank) 1
Age:0.36
Sex:Male
Location:Illinois
Vaccinated:2008-11-28
Onset:2008-12-03
Submitted:2008-12-05
Entered:2008-12-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C2870AA / 1 2 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D03125 / 1 2 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0407X / 1 2 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound abdomen LABS: Abdominal US (+) IS. Contrast BE reduced.
CDC 'Split Type':

Write-up: Developed intussusception on 12-3-08. Barium enema reduced it. 1/6/09 Reviewed hospital medical records of 12/3-12/4/08 FINAL DX: Intussusception Records reveal patient experienced colicky abdominal pain, sleep disturbance, decreased appetite, lethargy & bloody stools. Admitted for overnight observation & d/c to home in AM.


Changed on 2/14/2018

VAERS ID: 334086 Before After
VAERS Form:1
Age:0.36
Sex:Male
Location:Illinois
Vaccinated:2008-11-28
Onset:2008-12-03
Submitted:2008-12-05
Entered:2008-12-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C2870AA / 2 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D03125 / 2 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0407X / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound abdomen LABS: Abdominal US (+) IS. Contrast BE reduced.
CDC 'Split Type':

Write-up: Developed intussusception on 12-3-08. Barium enema reduced it. 1/6/09 Reviewed hospital medical records of 12/3-12/4/08 FINAL DX: Intussusception Records reveal patient experienced colicky abdominal pain, sleep disturbance, decreased appetite, lethargy & bloody stools. Admitted for overnight observation & d/c to home in AM.


Changed on 6/14/2018

VAERS ID: 334086 Before After
VAERS Form:1
Age:0.36
Sex:Male
Location:Illinois
Vaccinated:2008-11-28
Onset:2008-12-03
Submitted:2008-12-05
Entered:2008-12-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C2870AA / 2 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D03125 / 2 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0407X / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound abdomen LABS: Abdominal US (+) IS. Contrast BE reduced.
CDC 'Split Type':

Write-up: Developed intussusception on 12-3-08. Barium enema reduced it. 1/6/09 Reviewed hospital medical records of 12/3-12/4/08 FINAL DX: Intussusception Records reveal patient experienced colicky abdominal pain, sleep disturbance, decreased appetite, lethargy & bloody stools. Admitted for overnight observation & d/c to home in AM.


Changed on 8/14/2018

VAERS ID: 334086 Before After
VAERS Form:1
Age:0.36
Sex:Male
Location:Illinois
Vaccinated:2008-11-28
Onset:2008-12-03
Submitted:2008-12-05
Entered:2008-12-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C2870AA / 2 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D03125 / 2 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0407X / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound abdomen LABS: Abdominal US (+) IS. Contrast BE reduced.
CDC 'Split Type':

Write-up: Developed intussusception on 12-3-08. Barium enema reduced it. 1/6/09 Reviewed hospital medical records of 12/3-12/4/08 FINAL DX: Intussusception Records reveal patient experienced colicky abdominal pain, sleep disturbance, decreased appetite, lethargy & bloody stools. Admitted for overnight observation & d/c to home in AM.


Changed on 9/14/2018

VAERS ID: 334086 Before After
VAERS Form:1
Age:0.36
Sex:Male
Location:Illinois
Vaccinated:2008-11-28
Onset:2008-12-03
Submitted:2008-12-05
Entered:2008-12-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C2870AA / 2 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D03125 / 2 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0407X / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound abdomen LABS: Abdominal US (+) IS. Contrast BE reduced.
CDC 'Split Type':

Write-up: Developed intussusception on 12-3-08. Barium enema reduced it. 1/6/09 Reviewed hospital medical records of 12/3-12/4/08 FINAL DX: Intussusception Records reveal patient experienced colicky abdominal pain, sleep disturbance, decreased appetite, lethargy & bloody stools. Admitted for overnight observation & d/c to home in AM.


Changed on 10/14/2018

VAERS ID: 334086 Before After
VAERS Form:1
Age:0.36
Sex:Male
Location:Illinois
Vaccinated:2008-11-28
Onset:2008-12-03
Submitted:2008-12-05
Entered:2008-12-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C2870AA / 2 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D03125 / 2 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0407X / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound abdomen LABS: Abdominal US (+) IS. Contrast BE reduced.
CDC 'Split Type':

Write-up: Developed intussusception on 12-3-08. Barium enema reduced it. 1/6/09 Reviewed hospital medical records of 12/3-12/4/08 FINAL DX: Intussusception Records reveal patient experienced colicky abdominal pain, sleep disturbance, decreased appetite, lethargy & bloody stools. Admitted for overnight observation & d/c to home in AM.

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