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This is VAERS ID 337851

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

VAERS ID: 337851
VAERS Form:
Age:0.4
Sex:Male
Location:Maine
Vaccinated:2008-12-30
Onset:2009-01-11
Submitted:2009-01-15
Entered:2009-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3183AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D01074 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0280X / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal mass, Blood culture, Dehydration, Depressed level of consciousness, Haematochezia, Hypothermia, Intussusception, Lethargy, Enema administration, Abdominal X-ray, Blood count

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: None
Current Illness: None
Preexisting Conditions: Congenital talipes equinovarus 1/29/09-records received-PMH:bilateral talipes equinovarus. Cavernous hemangioma.
Allergies:
Diagnostic Lab Data: Abdominal X-rays; blood count; blood cultures (Emergency Room). 1/29/09-records received-CT scan demonstrated extensive intussusception in upper rectum. Air contrast enema reduction.
CDC 'Split Type': ME00209

Write-up: Patient was admitted to medical center. Abdominal CT was performed. Patient diagnosed with intussusception. 1/29/09-records received for DOS 1/11-1/13/09-DC DX: Intussusception. History of hypothermia (34C), obtundation and hematochezia with clots. Lethargic, dehydrated and minimally arousable to tactile stimulation with bright red blood per rectum, left lower quadrant mass felt.


Changed on 3/2/2010

VAERS ID: 337851 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:Maine
Vaccinated:2008-12-30
Onset:2009-01-11
Submitted:2009-01-15
Entered:2009-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3183AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC D01074 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0280X / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal mass, Blood culture, Dehydration, Depressed level of consciousness, Haematochezia, Hypothermia, Intussusception, Lethargy, Enema administration, Abdominal X-ray, Blood count

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: None
Current Illness: None
Preexisting Conditions: Congenital talipes equinovarus 1/29/09-records received-PMH:bilateral talipes equinovarus. Cavernous hemangioma.
Allergies:
Diagnostic Lab Data: Abdominal X-rays; blood count; blood cultures (Emergency Room). 1/29/09-records received-CT scan demonstrated extensive intussusception in upper rectum. Air contrast enema reduction.
CDC 'Split Type': ME00209

Write-up: Patient was admitted to medical center. Abdominal CT was performed. Patient diagnosed with intussusception. 1/29/09-records received for DOS 1/11-1/13/09-DC DX: Intussusception. History of hypothermia (34C), obtundation and hematochezia with clots. Lethargic, dehydrated and minimally arousable to tactile stimulation with bright red blood per rectum, left lower quadrant mass felt.


Changed on 4/7/2010

VAERS ID: 337851 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:Maine
Vaccinated:2008-12-30
Onset:2009-01-11
Submitted:2009-01-15
Entered:2009-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3183AA / 0 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D01074 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0280X / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal mass, Blood culture, Dehydration, Depressed level of consciousness, Haematochezia, Hypothermia, Intussusception, Lethargy, Enema administration, Abdominal X-ray, Blood count

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: None
Current Illness: None
Preexisting Conditions: Congenital talipes equinovarus 1/29/09-records received-PMH:bilateral talipes equinovarus. Cavernous hemangioma.
Allergies:
Diagnostic Lab Data: Abdominal X-rays; blood count; blood cultures (Emergency Room). 1/29/09-records received-CT scan demonstrated extensive intussusception in upper rectum. Air contrast enema reduction.
CDC 'Split Type': ME00209

Write-up: Patient was admitted to medical center. Abdominal CT was performed. Patient diagnosed with intussusception. 1/29/09-records received for DOS 1/11-1/13/09-DC DX: Intussusception. History of hypothermia (34C), obtundation and hematochezia with clots. Lethargic, dehydrated and minimally arousable to tactile stimulation with bright red blood per rectum, left lower quadrant mass felt.


Changed on 8/31/2010

VAERS ID: 337851 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:Maine
Vaccinated:2008-12-30
Onset:2009-01-11
Submitted:2009-01-15
Entered:2009-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3183AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH D01074 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0280X / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal mass, Blood culture, Dehydration, Depressed level of consciousness, Haematochezia, Hypothermia, Intussusception, Lethargy, Enema administration, Abdominal X-ray, Blood count

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: None
Current Illness: None
Preexisting Conditions: Congenital talipes equinovarus 1/29/09-records received-PMH:bilateral talipes equinovarus. Cavernous hemangioma.
Allergies:
Diagnostic Lab Data: Abdominal X-rays; blood count; blood cultures (Emergency Room). 1/29/09-records received-CT scan demonstrated extensive intussusception in upper rectum. Air contrast enema reduction.
CDC 'Split Type': ME00209

Write-up: Patient was admitted to medical center. Abdominal CT was performed. Patient diagnosed with intussusception. 1/29/09-records received for DOS 1/11-1/13/09-DC DX: Intussusception. History of hypothermia (34C), obtundation and hematochezia with clots. Lethargic, dehydrated and minimally arousable to tactile stimulation with bright red blood per rectum, left lower quadrant mass felt.


Changed on 5/13/2013

VAERS ID: 337851 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:Maine
Vaccinated:2008-12-30
Onset:2009-01-11
Submitted:2009-01-15
Entered:2009-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3183AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D01074 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0280X / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0280X / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal mass, Blood culture, Dehydration, Depressed level of consciousness, Haematochezia, Hypothermia, Intussusception, Lethargy, Enema administration, Abdominal X-ray, Blood count

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: None
Current Illness: None
Preexisting Conditions: Congenital talipes equinovarus 1/29/09-records received-PMH:bilateral talipes equinovarus. Cavernous hemangioma.
Allergies:
Diagnostic Lab Data: Abdominal X-rays; blood count; blood cultures (Emergency Room). 1/29/09-records received-CT scan demonstrated extensive intussusception in upper rectum. Air contrast enema reduction.
CDC 'Split Type': ME00209

Write-up: Patient was admitted to medical center. Abdominal CT was performed. Patient diagnosed with intussusception. 1/29/09-records received for DOS 1/11-1/13/09-DC DX: Intussusception. History of hypothermia (34C), obtundation and hematochezia with clots. Lethargic, dehydrated and minimally arousable to tactile stimulation with bright red blood per rectum, left lower quadrant mass felt.


Changed on 4/14/2017

VAERS ID: 337851 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:Maine
Vaccinated:2008-12-30
Onset:2009-01-11
Submitted:2009-01-15
Entered:2009-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3183AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D01074 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0280X / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal mass, Blood culture, Dehydration, Depressed level of consciousness, Haematochezia, Hypothermia, Intussusception, Lethargy, Enema administration, Abdominal X-ray, Blood count

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: None
Current Illness: None
Preexisting Conditions: Congenital talipes equinovarus 1/29/09-records received-PMH:bilateral talipes equinovarus. Cavernous hemangioma.
Allergies:
Diagnostic Lab Data: Abdominal X-rays; blood count; blood cultures (Emergency Room). 1/29/09-records received-CT scan demonstrated extensive intussusception in upper rectum. Air contrast enema reduction.
CDC 'Split Type': ME00209

Write-up: Patient was admitted to medical center. Abdominal CT was performed. Patient diagnosed with intussusception. 1/29/09-records received for DOS 1/11-1/13/09-DC DX: Intussusception. History of hypothermia (34C), obtundation and hematochezia with clots. Lethargic, dehydrated and minimally arousable to tactile stimulation with bright red blood per rectum, left lower quadrant mass felt.


Changed on 9/14/2017

VAERS ID: 337851 Before After
VAERS Form:(blank) 1
Age:0.4
Sex:Male
Location:Maine
Vaccinated:2008-12-30
Onset:2009-01-11
Submitted:2009-01-15
Entered:2009-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3183AA / 0 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D01074 / 1 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0280X / 1 2 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Blood culture, Intussusception, Abdominal X-ray, Blood count

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: None
Current Illness: None
Preexisting Conditions: Congenital talipes equinovarus 1/29/09-records received-PMH:bilateral talipes equinovarus. Cavernous hemangioma.
Allergies:
Diagnostic Lab Data: Abdominal X-rays; blood count; blood cultures (Emergency Room). 1/29/09-records received-CT scan demonstrated extensive intussusception in upper rectum. Air contrast enema reduction.
CDC 'Split Type': ME00209

Write-up: Patient was admitted to medical center. Abdominal CT was performed. Patient diagnosed with intussusception. 1/29/09-records received for DOS 1/11-1/13/09-DC DX: Intussusception. History of hypothermia (34C), obtundation and hematochezia with clots. Lethargic, dehydrated and minimally arousable to tactile stimulation with bright red blood per rectum, left lower quadrant mass felt.


Changed on 2/14/2018

VAERS ID: 337851 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Maine
Vaccinated:2008-12-30
Onset:2009-01-11
Submitted:2009-01-15
Entered:2009-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3183AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D01074 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0280X / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Blood culture, Intussusception, Abdominal X-ray, Blood count

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: None
Current Illness: None
Preexisting Conditions: Congenital talipes equinovarus 1/29/09-records received-PMH:bilateral talipes equinovarus. Cavernous hemangioma.
Allergies:
Diagnostic Lab Data: Abdominal X-rays; blood count; blood cultures (Emergency Room). 1/29/09-records received-CT scan demonstrated extensive intussusception in upper rectum. Air contrast enema reduction.
CDC 'Split Type': ME00209

Write-up: Patient was admitted to medical center. Abdominal CT was performed. Patient diagnosed with intussusception. 1/29/09-records received for DOS 1/11-1/13/09-DC DX: Intussusception. History of hypothermia (34C), obtundation and hematochezia with clots. Lethargic, dehydrated and minimally arousable to tactile stimulation with bright red blood per rectum, left lower quadrant mass felt.


Changed on 6/14/2018

VAERS ID: 337851 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Maine
Vaccinated:2008-12-30
Onset:2009-01-11
Submitted:2009-01-15
Entered:2009-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3183AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D01074 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0280X / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Blood culture, Intussusception, Abdominal X-ray, Blood count

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: None
Current Illness: None
Preexisting Conditions: Congenital talipes equinovarus 1/29/09-records received-PMH:bilateral talipes equinovarus. Cavernous hemangioma.
Allergies:
Diagnostic Lab Data: Abdominal X-rays; blood count; blood cultures (Emergency Room). 1/29/09-records received-CT scan demonstrated extensive intussusception in upper rectum. Air contrast enema reduction.
CDC 'Split Type': ME00209

Write-up: Patient was admitted to medical center. Abdominal CT was performed. Patient diagnosed with intussusception. 1/29/09-records received for DOS 1/11-1/13/09-DC DX: Intussusception. History of hypothermia (34C), obtundation and hematochezia with clots. Lethargic, dehydrated and minimally arousable to tactile stimulation with bright red blood per rectum, left lower quadrant mass felt.


Changed on 8/14/2018

VAERS ID: 337851 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Maine
Vaccinated:2008-12-30
Onset:2009-01-11
Submitted:2009-01-15
Entered:2009-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3183AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D01074 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0280X / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Blood culture, Intussusception, Abdominal X-ray, Blood count

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: None
Current Illness: None
Preexisting Conditions: Congenital talipes equinovarus 1/29/09-records received-PMH:bilateral talipes equinovarus. Cavernous hemangioma.
Allergies:
Diagnostic Lab Data: Abdominal X-rays; blood count; blood cultures (Emergency Room). 1/29/09-records received-CT scan demonstrated extensive intussusception in upper rectum. Air contrast enema reduction.
CDC 'Split Type': ME00209

Write-up: Patient was admitted to medical center. Abdominal CT was performed. Patient diagnosed with intussusception. 1/29/09-records received for DOS 1/11-1/13/09-DC DX: Intussusception. History of hypothermia (34C), obtundation and hematochezia with clots. Lethargic, dehydrated and minimally arousable to tactile stimulation with bright red blood per rectum, left lower quadrant mass felt.


Changed on 9/14/2018

VAERS ID: 337851 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Maine
Vaccinated:2008-12-30
Onset:2009-01-11
Submitted:2009-01-15
Entered:2009-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3183AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D01074 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0280X / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Blood culture, Intussusception, Abdominal X-ray, Blood count

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: None
Current Illness: None
Preexisting Conditions: Congenital talipes equinovarus 1/29/09-records received-PMH:bilateral talipes equinovarus. Cavernous hemangioma.
Allergies:
Diagnostic Lab Data: Abdominal X-rays; blood count; blood cultures (Emergency Room). 1/29/09-records received-CT scan demonstrated extensive intussusception in upper rectum. Air contrast enema reduction.
CDC 'Split Type': ME00209

Write-up: Patient was admitted to medical center. Abdominal CT was performed. Patient diagnosed with intussusception. 1/29/09-records received for DOS 1/11-1/13/09-DC DX: Intussusception. History of hypothermia (34C), obtundation and hematochezia with clots. Lethargic, dehydrated and minimally arousable to tactile stimulation with bright red blood per rectum, left lower quadrant mass felt.


Changed on 10/14/2018

VAERS ID: 337851 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Maine
Vaccinated:2008-12-30
Onset:2009-01-11
Submitted:2009-01-15
Entered:2009-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3183AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D01074 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0280X / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Blood culture, Intussusception, Abdominal X-ray, Blood count

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: None
Current Illness: None
Preexisting Conditions: Congenital talipes equinovarus 1/29/09-records received-PMH:bilateral talipes equinovarus. Cavernous hemangioma.
Allergies:
Diagnostic Lab Data: Abdominal X-rays; blood count; blood cultures (Emergency Room). 1/29/09-records received-CT scan demonstrated extensive intussusception in upper rectum. Air contrast enema reduction.
CDC 'Split Type': ME00209

Write-up: Patient was admitted to medical center. Abdominal CT was performed. Patient diagnosed with intussusception. 1/29/09-records received for DOS 1/11-1/13/09-DC DX: Intussusception. History of hypothermia (34C), obtundation and hematochezia with clots. Lethargic, dehydrated and minimally arousable to tactile stimulation with bright red blood per rectum, left lower quadrant mass felt.

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