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This is VAERS ID 338111

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

VAERS ID: 338111
VAERS Form:
Age:0.2
Gender:Male
Location:California
Vaccinated:2008-10-20
Onset:2008-12-16
Submitted:2009-01-23
Entered:2009-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS HC21B150AA / 0 LL / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UF505AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D05881 / 0 UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0967X / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Appendicectomy, Barium enema, Computerised tomogram abnormal, Dehydration, Diet refusal, Faeces discoloured, Haematochezia, Intussusception, Irritability, Lethargy, Pallor, Surgery, Viral infection, Vomiting, Weight decreased, Enema administration, Explorative laparotomy, Intestinal resection, Intestinal anastomosis

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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: surgery for intussusception LABS: In outlying ER, CT of abd abnormal. BE unable to reduce IS.
CDC 'Split Type':

Write-up: It happen over night (Dec 16th 2008), my baby wake up, fussy, did not wanna eat, start vomiting yelow liquid, got pale, went to doc. and told us it could be stomach flu, came home, that night things did not get better, he was not holding anythig in his tummy, and in the morning (dec 17th 2008) was very dehydrated, had a black pasty, bloody stool, went back to doc office, then to ER and after that we went to another hospital where he had an intussusception surgery (Dec 18th 2008), he recoverd well and now he is doing fine, however before we were able to find out what the problem was......It was the most terrifying 24hrs of our lives. 1/27/09 Received hospital medical records of 12/18-12/22/2008. FINAL DX: Ileoileal intussusception, s/p exp lap, bowel resection & ileoileostomy anastamosis, appendectomy. Records reveal patient experienced vomiting x 2 days, dark stool, lethargy & weight loss. Seen at outlying ER & transfered to higher level of care after attempts to reduce w/BE were unsuccessful. Attempts to reduce in hospital also unsuccessful & taken to OR. Progressed well & d/c to home. 2/2/09 Received PCP medical records of 10/20/2008-01/23/2009 which reveal patient experienced good health on 10/20/08. RTC on 12/16 for irritability, diet refusal, vomiting, pale. Dx as probable viral infection. RTC 1/23/09 s/p IS surgery in good health w/surgical scar healing.


Changed on 3/2/2010

VAERS ID: 338111 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:California
Vaccinated:2008-10-20
Onset:2008-12-16
Submitted:2009-01-23
Entered:2009-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS HC21B150AA / 0 LL / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UF505AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC D05881 / 0 UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0967X / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Appendicectomy, Barium enema, Computerised tomogram abnormal, Dehydration, Diet refusal, Faeces discoloured, Haematochezia, Intussusception, Irritability, Lethargy, Pallor, Surgery, Viral infection, Vomiting, Weight decreased, Enema administration, Explorative laparotomy, Intestinal resection, Intestinal anastomosis

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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: surgery for intussusception LABS: In outlying ER, CT of abd abnormal. BE unable to reduce IS.
CDC 'Split Type':

Write-up: It happen over night (Dec 16th 2008), my baby wake up, fussy, did not wanna eat, start vomiting yelow liquid, got pale, went to doc. and told us it could be stomach flu, came home, that night things did not get better, he was not holding anythig in his tummy, and in the morning (dec 17th 2008) was very dehydrated, had a black pasty, bloody stool, went back to doc office, then to ER and after that we went to another hospital where he had an intussusception surgery (Dec 18th 2008), he recoverd well and now he is doing fine, however before we were able to find out what the problem was......It was the most terrifying 24hrs of our lives. 1/27/09 Received hospital medical records of 12/18-12/22/2008. FINAL DX: Ileoileal intussusception, s/p exp lap, bowel resection & ileoileostomy anastamosis, appendectomy. Records reveal patient experienced vomiting x 2 days, dark stool, lethargy & weight loss. Seen at outlying ER & transfered to higher level of care after attempts to reduce w/BE were unsuccessful. Attempts to reduce in hospital also unsuccessful & taken to OR. Progressed well & d/c to home. 2/2/09 Received PCP medical records of 10/20/2008-01/23/2009 which reveal patient experienced good health on 10/20/08. RTC on 12/16 for irritability, diet refusal, vomiting, pale. Dx as probable viral infection. RTC 1/23/09 s/p IS surgery in good health w/surgical scar healing.


Changed on 4/7/2010

VAERS ID: 338111 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:California
Vaccinated:2008-10-20
Onset:2008-12-16
Submitted:2009-01-23
Entered:2009-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS HC21B150AA / 0 LL / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UF505AA / 0 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D05881 / 0 UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0967X / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Appendicectomy, Barium enema, Computerised tomogram abnormal, Dehydration, Diet refusal, Faeces discoloured, Haematochezia, Intussusception, Irritability, Lethargy, Pallor, Surgery, Viral infection, Vomiting, Weight decreased, Enema administration, Explorative laparotomy, Intestinal resection, Intestinal anastomosis

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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: surgery for intussusception LABS: In outlying ER, CT of abd abnormal. BE unable to reduce IS.
CDC 'Split Type':

Write-up: It happen over night (Dec 16th 2008), my baby wake up, fussy, did not wanna eat, start vomiting yelow liquid, got pale, went to doc. and told us it could be stomach flu, came home, that night things did not get better, he was not holding anythig in his tummy, and in the morning (dec 17th 2008) was very dehydrated, had a black pasty, bloody stool, went back to doc office, then to ER and after that we went to another hospital where he had an intussusception surgery (Dec 18th 2008), he recoverd well and now he is doing fine, however before we were able to find out what the problem was......It was the most terrifying 24hrs of our lives. 1/27/09 Received hospital medical records of 12/18-12/22/2008. FINAL DX: Ileoileal intussusception, s/p exp lap, bowel resection & ileoileostomy anastamosis, appendectomy. Records reveal patient experienced vomiting x 2 days, dark stool, lethargy & weight loss. Seen at outlying ER & transfered to higher level of care after attempts to reduce w/BE were unsuccessful. Attempts to reduce in hospital also unsuccessful & taken to OR. Progressed well & d/c to home. 2/2/09 Received PCP medical records of 10/20/2008-01/23/2009 which reveal patient experienced good health on 10/20/08. RTC on 12/16 for irritability, diet refusal, vomiting, pale. Dx as probable viral infection. RTC 1/23/09 s/p IS surgery in good health w/surgical scar healing.


Changed on 8/31/2010

VAERS ID: 338111 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:California
Vaccinated:2008-10-20
Onset:2008-12-16
Submitted:2009-01-23
Entered:2009-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS HC21B150AA / 0 LL / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UF505AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH D05881 / 0 UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0967X / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Appendicectomy, Barium enema, Computerised tomogram abnormal, Dehydration, Diet refusal, Faeces discoloured, Haematochezia, Intussusception, Irritability, Lethargy, Pallor, Surgery, Viral infection, Vomiting, Weight decreased, Enema administration, Explorative laparotomy, Intestinal resection, Intestinal anastomosis

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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: surgery for intussusception LABS: In outlying ER, CT of abd abnormal. BE unable to reduce IS.
CDC 'Split Type':

Write-up: It happen over night (Dec 16th 2008), my baby wake up, fussy, did not wanna eat, start vomiting yelow liquid, got pale, went to doc. and told us it could be stomach flu, came home, that night things did not get better, he was not holding anythig in his tummy, and in the morning (dec 17th 2008) was very dehydrated, had a black pasty, bloody stool, went back to doc office, then to ER and after that we went to another hospital where he had an intussusception surgery (Dec 18th 2008), he recoverd well and now he is doing fine, however before we were able to find out what the problem was......It was the most terrifying 24hrs of our lives. 1/27/09 Received hospital medical records of 12/18-12/22/2008. FINAL DX: Ileoileal intussusception, s/p exp lap, bowel resection & ileoileostomy anastamosis, appendectomy. Records reveal patient experienced vomiting x 2 days, dark stool, lethargy & weight loss. Seen at outlying ER & transfered to higher level of care after attempts to reduce w/BE were unsuccessful. Attempts to reduce in hospital also unsuccessful & taken to OR. Progressed well & d/c to home. 2/2/09 Received PCP medical records of 10/20/2008-01/23/2009 which reveal patient experienced good health on 10/20/08. RTC on 12/16 for irritability, diet refusal, vomiting, pale. Dx as probable viral infection. RTC 1/23/09 s/p IS surgery in good health w/surgical scar healing.


Changed on 2/13/2013

VAERS ID: 338111 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:California
Vaccinated:2008-10-20
Onset:2008-12-16
Submitted:2009-01-23
Entered:2009-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS HC21B150AA / 0 LL / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UF505AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D05881 / 0 UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0967X / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Appendicectomy, Barium enema, Computerised tomogram abnormal, Dehydration, Diet refusal, Faeces discoloured, Haematochezia, Intussusception, Irritability, Lethargy, Pallor, Surgery, Viral infection, Vomiting, Weight decreased, Enema administration, Explorative laparotomy, Intestinal resection, Intestinal anastomosis

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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: surgery Surgery for intussusception LABS: In outlying ER, CT of abd abnormal. BE unable to reduce IS.
CDC 'Split Type':

Write-up: It happen over night (Dec 16th 2008), my baby wake up, fussy, did not wanna eat, start vomiting yelow liquid, got pale, went to doc. and told us it could be stomach flu, came home, that night things did not get better, he was not holding anythig in his tummy, and in the morning (dec (Dec 17th 2008) was very dehydrated, had a black pasty, bloody stool, went back to doc office, then to ER and after that we went to another hospital where he had an intussusception surgery (Dec 18th 2008), he recoverd well and now he is doing fine, however before we were able to find out what the problem was......It was the most terrifying 24hrs of our lives. 1/27/09 Received hospital medical records of 12/18-12/22/2008. FINAL DX: Ileoileal intussusception, s/p exp lap, bowel resection & ileoileostomy anastamosis, appendectomy. Records reveal patient experienced vomiting x 2 days, dark stool, lethargy & weight loss. Seen at outlying ER & transfered to higher level of care after attempts to reduce w/BE were unsuccessful. Attempts to reduce in hospital also unsuccessful & taken to OR. Progressed well & d/c to home. 2/2/09 Received PCP medical records of 10/20/2008-01/23/2009 which reveal patient experienced good health on 10/20/08. RTC on 12/16 for irritability, diet refusal, vomiting, pale. Dx as probable viral infection. RTC 1/23/09 s/p IS surgery in good health w/surgical scar healing.


Changed on 5/13/2013

VAERS ID: 338111 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:California
Vaccinated:2008-10-20
Onset:2008-12-16
Submitted:2009-01-23
Entered:2009-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS HC21B150AA / 0 LL / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UF505AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D05881 / 0 UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0967X / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0967X / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Appendicectomy, Barium enema, Computerised tomogram abnormal, Dehydration, Diet refusal, Faeces discoloured, Haematochezia, Intussusception, Irritability, Lethargy, Pallor, Surgery, Viral infection, Vomiting, Weight decreased, Enema administration, Explorative laparotomy, Intestinal resection, Intestinal anastomosis

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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Surgery for intussusception LABS: In outlying ER, CT of abd abnormal. BE unable to reduce IS.
CDC 'Split Type':

Write-up: It happen over night (Dec 16th 2008), my baby wake up, fussy, did not wanna eat, start vomiting yelow liquid, got pale, went to doc. and told us it could be stomach flu, came home, that night things did not get better, he was not holding anythig in his tummy, and in the morning (Dec 17th 2008) was very dehydrated, had a black pasty, bloody stool, went back to doc office, then to ER and after that we went to another hospital where he had an intussusception surgery (Dec 18th 2008), he recoverd well and now he is doing fine, however before we were able to find out what the problem was......It was the most terrifying 24hrs of our lives. 1/27/09 Received hospital medical records of 12/18-12/22/2008. FINAL DX: Ileoileal intussusception, s/p exp lap, bowel resection & ileoileostomy anastamosis, appendectomy. Records reveal patient experienced vomiting x 2 days, dark stool, lethargy & weight loss. Seen at outlying ER & transfered to higher level of care after attempts to reduce w/BE were unsuccessful. Attempts to reduce in hospital also unsuccessful & taken to OR. Progressed well & d/c to home. 2/2/09 Received PCP medical records of 10/20/2008-01/23/2009 which reveal patient experienced good health on 10/20/08. RTC on 12/16 for irritability, diet refusal, vomiting, pale. Dx as probable viral infection. RTC 1/23/09 s/p IS surgery in good health w/surgical scar healing.


Changed on 2/14/2017

VAERS ID: 338111 Before After
VAERS Form:
Age:0.2 0.17
Gender:Male
Location:California
Vaccinated:2008-10-20
Onset:2008-12-16
Submitted:2009-01-23
Entered:2009-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS HC21B150AA / 0 LL / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UF505AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D05881 / 0 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0967X / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Appendicectomy, Barium enema, Computerised tomogram abnormal, Dehydration, Diet refusal, Faeces discoloured, Haematochezia, Intussusception, Irritability, Lethargy, Pallor, Surgery, Viral infection, Vomiting, Weight decreased, Enema administration, Explorative laparotomy, Intestinal resection, Intestinal anastomosis

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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Surgery for intussusception LABS: In outlying ER, CT of abd abnormal. BE unable to reduce IS.
CDC 'Split Type':

Write-up: It happen over night (Dec 16th 2008), my baby wake up, fussy, did not wanna eat, start vomiting yelow liquid, got pale, went to doc. and told us it could be stomach flu, came home, that night things did not get better, he was not holding anythig in his tummy, and in the morning (Dec 17th 2008) was very dehydrated, had a black pasty, bloody stool, went back to doc office, then to ER and after that we went to another hospital where he had an intussusception surgery (Dec 18th 2008), he recoverd well and now he is doing fine, however before we were able to find out what the problem was......It was the most terrifying 24hrs of our lives. 1/27/09 Received hospital medical records of 12/18-12/22/2008. FINAL DX: Ileoileal intussusception, s/p exp lap, bowel resection & ileoileostomy anastamosis, appendectomy. Records reveal patient experienced vomiting x 2 days, dark stool, lethargy & weight loss. Seen at outlying ER & transfered to higher level of care after attempts to reduce w/BE were unsuccessful. Attempts to reduce in hospital also unsuccessful & taken to OR. Progressed well & d/c to home. 2/2/09 Received PCP medical records of 10/20/2008-01/23/2009 which reveal patient experienced good health on 10/20/08. RTC on 12/16 for irritability, diet refusal, vomiting, pale. Dx as probable viral infection. RTC 1/23/09 s/p IS surgery in good health w/surgical scar healing.


Changed on 4/14/2017

VAERS ID: 338111 Before After
VAERS Form:
Age:0.17
Gender:Male
Location:California
Vaccinated:2008-10-20
Onset:2008-12-16
Submitted:2009-01-23
Entered:2009-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS HC21B150AA / 0 LL / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UF505AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D05881 / 0 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0967X / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Appendicectomy, Barium enema, Computerised tomogram abnormal, Dehydration, Diet refusal, Faeces discoloured, Haematochezia, Intussusception, Irritability, Lethargy, Pallor, Surgery, Viral infection, Vomiting, Weight decreased, Enema administration, Explorative laparotomy, Intestinal resection, Intestinal anastomosis

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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Surgery for intussusception LABS: In outlying ER, CT of abd abnormal. BE unable to reduce IS.
CDC 'Split Type':

Write-up: It happen over night (Dec 16th 2008), my baby wake up, fussy, did not wanna eat, start vomiting yelow liquid, got pale, went to doc. and told us it could be stomach flu, came home, that night things did not get better, he was not holding anythig in his tummy, and in the morning (Dec 17th 2008) was very dehydrated, had a black pasty, bloody stool, went back to doc office, then to ER and after that we went to another hospital where he had an intussusception surgery (Dec 18th 2008), he recoverd well and now he is doing fine, however before we were able to find out what the problem was......It was the most terrifying 24hrs of our lives. 1/27/09 Received hospital medical records of 12/18-12/22/2008. FINAL DX: Ileoileal intussusception, s/p exp lap, bowel resection & ileoileostomy anastamosis, appendectomy. Records reveal patient experienced vomiting x 2 days, dark stool, lethargy & weight loss. Seen at outlying ER & transfered to higher level of care after attempts to reduce w/BE were unsuccessful. Attempts to reduce in hospital also unsuccessful & taken to OR. Progressed well & d/c to home. 2/2/09 Received PCP medical records of 10/20/2008-01/23/2009 which reveal patient experienced good health on 10/20/08. RTC on 12/16 for irritability, diet refusal, vomiting, pale. Dx as probable viral infection. RTC 1/23/09 s/p IS surgery in good health w/surgical scar healing.


Changed on 9/14/2017

VAERS ID: 338111 Before After
VAERS Form:(blank) 1
Age:0.17
Gender:Male
Location:California
Vaccinated:2008-10-20
Onset:2008-12-16
Submitted:2009-01-23
Entered:2009-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS HC21B150AA / 0 1 LL / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UF505AA / 0 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D05881 / 0 1 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0967X / 0 1 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Dehydration, Diet refusal, Faeces discoloured, Haematochezia, Intussusception, Irritability, Pallor, Surgery, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Surgery for intussusception LABS: In outlying ER, CT of abd abnormal. BE unable to reduce IS.
CDC 'Split Type':

Write-up: It happen over night (Dec 16th 2008), my baby wake up, fussy, did not wanna eat, start vomiting yelow liquid, got pale, went to doc. and told us it could be stomach flu, came home, that night things did not get better, he was not holding anythig in his tummy, and in the morning (Dec 17th 2008) was very dehydrated, had a black pasty, bloody stool, went back to doc office, then to ER and after that we went to another hospital where he had an intussusception surgery (Dec 18th 2008), he recoverd well and now he is doing fine, however before we were able to find out what the problem was......It was the most terrifying 24hrs of our lives. 1/27/09 Received hospital medical records of 12/18-12/22/2008. FINAL DX: Ileoileal intussusception, s/p exp lap, bowel resection & ileoileostomy anastamosis, appendectomy. Records reveal patient experienced vomiting x 2 days, dark stool, lethargy & weight loss. Seen at outlying ER & transfered to higher level of care after attempts to reduce w/BE were unsuccessful. Attempts to reduce in hospital also unsuccessful & taken to OR. Progressed well & d/c to home. 2/2/09 Received PCP medical records of 10/20/2008-01/23/2009 which reveal patient experienced good health on 10/20/08. RTC on 12/16 for irritability, diet refusal, vomiting, pale. Dx as probable viral infection. RTC 1/23/09 s/p IS surgery in good health w/surgical scar healing.


Changed on 2/14/2018

VAERS ID: 338111 Before After
VAERS Form:1
Age:0.17
Gender:Male
Location:California
Vaccinated:2008-10-20
Onset:2008-12-16
Submitted:2009-01-23
Entered:2009-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS HC21B150AA / 1 LL / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UF505AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D05881 / 1 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0967X / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Dehydration, Diet refusal, Faeces discoloured, Haematochezia, Intussusception, Irritability, Pallor, Surgery, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Surgery for intussusception LABS: In outlying ER, CT of abd abnormal. BE unable to reduce IS.
CDC 'Split Type':

Write-up: It happen over night (Dec 16th 2008), my baby wake up, fussy, did not wanna eat, start vomiting yelow liquid, got pale, went to doc. and told us it could be stomach flu, came home, that night things did not get better, he was not holding anythig in his tummy, and in the morning (Dec 17th 2008) was very dehydrated, had a black pasty, bloody stool, went back to doc office, then to ER and after that we went to another hospital where he had an intussusception surgery (Dec 18th 2008), he recoverd well and now he is doing fine, however before we were able to find out what the problem was......It was the most terrifying 24hrs of our lives. 1/27/09 Received hospital medical records of 12/18-12/22/2008. FINAL DX: Ileoileal intussusception, s/p exp lap, bowel resection & ileoileostomy anastamosis, appendectomy. Records reveal patient experienced vomiting x 2 days, dark stool, lethargy & weight loss. Seen at outlying ER & transfered to higher level of care after attempts to reduce w/BE were unsuccessful. Attempts to reduce in hospital also unsuccessful & taken to OR. Progressed well & d/c to home. 2/2/09 Received PCP medical records of 10/20/2008-01/23/2009 which reveal patient experienced good health on 10/20/08. RTC on 12/16 for irritability, diet refusal, vomiting, pale. Dx as probable viral infection. RTC 1/23/09 s/p IS surgery in good health w/surgical scar healing.


Changed on 6/14/2018

VAERS ID: 338111 Before After
VAERS Form:1
Age:0.17
Gender:Male
Location:California
Vaccinated:2008-10-20
Onset:2008-12-16
Submitted:2009-01-23
Entered:2009-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS HC21B150AA / 1 LL / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UF505AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D05881 / 1 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0967X / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Dehydration, Diet refusal, Faeces discoloured, Haematochezia, Intussusception, Irritability, Pallor, Surgery, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Surgery for intussusception LABS: In outlying ER, CT of abd abnormal. BE unable to reduce IS.
CDC 'Split Type':

Write-up: It happen over night (Dec 16th 2008), my baby wake up, fussy, did not wanna eat, start vomiting yelow liquid, got pale, went to doc. and told us it could be stomach flu, came home, that night things did not get better, he was not holding anythig in his tummy, and in the morning (Dec 17th 2008) was very dehydrated, had a black pasty, bloody stool, went back to doc office, then to ER and after that we went to another hospital where he had an intussusception surgery (Dec 18th 2008), he recoverd well and now he is doing fine, however before we were able to find out what the problem was......It was the most terrifying 24hrs of our lives. 1/27/09 Received hospital medical records of 12/18-12/22/2008. FINAL DX: Ileoileal intussusception, s/p exp lap, bowel resection & ileoileostomy anastamosis, appendectomy. Records reveal patient experienced vomiting x 2 days, dark stool, lethargy & weight loss. Seen at outlying ER & transfered to higher level of care after attempts to reduce w/BE were unsuccessful. Attempts to reduce in hospital also unsuccessful & taken to OR. Progressed well & d/c to home. 2/2/09 Received PCP medical records of 10/20/2008-01/23/2009 which reveal patient experienced good health on 10/20/08. RTC on 12/16 for irritability, diet refusal, vomiting, pale. Dx as probable viral infection. RTC 1/23/09 s/p IS surgery in good health w/surgical scar healing.


Changed on 8/14/2018

VAERS ID: 338111 Before After
VAERS Form:1
Age:0.17
Gender:Male
Location:California
Vaccinated:2008-10-20
Onset:2008-12-16
Submitted:2009-01-23
Entered:2009-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS HC21B150AA / 1 LL / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UF505AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D05881 / 1 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0967X / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Dehydration, Diet refusal, Faeces discoloured, Haematochezia, Intussusception, Irritability, Pallor, Surgery, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Surgery for intussusception LABS: In outlying ER, CT of abd abnormal. BE unable to reduce IS.
CDC 'Split Type':

Write-up: It happen over night (Dec 16th 2008), my baby wake up, fussy, did not wanna eat, start vomiting yelow liquid, got pale, went to doc. and told us it could be stomach flu, came home, that night things did not get better, he was not holding anythig in his tummy, and in the morning (Dec 17th 2008) was very dehydrated, had a black pasty, bloody stool, went back to doc office, then to ER and after that we went to another hospital where he had an intussusception surgery (Dec 18th 2008), he recoverd well and now he is doing fine, however before we were able to find out what the problem was......It was the most terrifying 24hrs of our lives. 1/27/09 Received hospital medical records of 12/18-12/22/2008. FINAL DX: Ileoileal intussusception, s/p exp lap, bowel resection & ileoileostomy anastamosis, appendectomy. Records reveal patient experienced vomiting x 2 days, dark stool, lethargy & weight loss. Seen at outlying ER & transfered to higher level of care after attempts to reduce w/BE were unsuccessful. Attempts to reduce in hospital also unsuccessful & taken to OR. Progressed well & d/c to home. 2/2/09 Received PCP medical records of 10/20/2008-01/23/2009 which reveal patient experienced good health on 10/20/08. RTC on 12/16 for irritability, diet refusal, vomiting, pale. Dx as probable viral infection. RTC 1/23/09 s/p IS surgery in good health w/surgical scar healing.


Changed on 9/14/2018

VAERS ID: 338111 Before After
VAERS Form:1
Age:0.17
Gender:Male
Location:California
Vaccinated:2008-10-20
Onset:2008-12-16
Submitted:2009-01-23
Entered:2009-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS HC21B150AA / 1 LL / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UF505AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D05881 / 1 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0967X / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Dehydration, Diet refusal, Faeces discoloured, Haematochezia, Intussusception, Irritability, Pallor, Surgery, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Surgery for intussusception LABS: In outlying ER, CT of abd abnormal. BE unable to reduce IS.
CDC 'Split Type':

Write-up: It happen over night (Dec 16th 2008), my baby wake up, fussy, did not wanna eat, start vomiting yelow liquid, got pale, went to doc. and told us it could be stomach flu, came home, that night things did not get better, he was not holding anythig in his tummy, and in the morning (Dec 17th 2008) was very dehydrated, had a black pasty, bloody stool, went back to doc office, then to ER and after that we went to another hospital where he had an intussusception surgery (Dec 18th 2008), he recoverd well and now he is doing fine, however before we were able to find out what the problem was......It was the most terrifying 24hrs of our lives. 1/27/09 Received hospital medical records of 12/18-12/22/2008. FINAL DX: Ileoileal intussusception, s/p exp lap, bowel resection & ileoileostomy anastamosis, appendectomy. Records reveal patient experienced vomiting x 2 days, dark stool, lethargy & weight loss. Seen at outlying ER & transfered to higher level of care after attempts to reduce w/BE were unsuccessful. Attempts to reduce in hospital also unsuccessful & taken to OR. Progressed well & d/c to home. 2/2/09 Received PCP medical records of 10/20/2008-01/23/2009 which reveal patient experienced good health on 10/20/08. RTC on 12/16 for irritability, diet refusal, vomiting, pale. Dx as probable viral infection. RTC 1/23/09 s/p IS surgery in good health w/surgical scar healing.


Changed on 10/14/2018

VAERS ID: 338111 Before After
VAERS Form:1
Age:0.17
Gender:Male
Location:California
Vaccinated:2008-10-20
Onset:2008-12-16
Submitted:2009-01-23
Entered:2009-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS HC21B150AA / 1 LL / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UF505AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D05881 / 1 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0967X / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Dehydration, Diet refusal, Faeces discoloured, Haematochezia, Intussusception, Irritability, Pallor, Surgery, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Surgery for intussusception LABS: In outlying ER, CT of abd abnormal. BE unable to reduce IS.
CDC 'Split Type':

Write-up: It happen over night (Dec 16th 2008), my baby wake up, fussy, did not wanna eat, start vomiting yelow liquid, got pale, went to doc. and told us it could be stomach flu, came home, that night things did not get better, he was not holding anythig in his tummy, and in the morning (Dec 17th 2008) was very dehydrated, had a black pasty, bloody stool, went back to doc office, then to ER and after that we went to another hospital where he had an intussusception surgery (Dec 18th 2008), he recoverd well and now he is doing fine, however before we were able to find out what the problem was......It was the most terrifying 24hrs of our lives. 1/27/09 Received hospital medical records of 12/18-12/22/2008. FINAL DX: Ileoileal intussusception, s/p exp lap, bowel resection & ileoileostomy anastamosis, appendectomy. Records reveal patient experienced vomiting x 2 days, dark stool, lethargy & weight loss. Seen at outlying ER & transfered to higher level of care after attempts to reduce w/BE were unsuccessful. Attempts to reduce in hospital also unsuccessful & taken to OR. Progressed well & d/c to home. 2/2/09 Received PCP medical records of 10/20/2008-01/23/2009 which reveal patient experienced good health on 10/20/08. RTC on 12/16 for irritability, diet refusal, vomiting, pale. Dx as probable viral infection. RTC 1/23/09 s/p IS surgery in good health w/surgical scar healing.

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