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This is VAERS ID 339389

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

VAERS ID: 339389
VAERS Form:
Age:0.2
Sex:Male
Location:Pennsylvania
Vaccinated:2009-01-06
Onset:2009-02-08
Submitted:2009-02-10
Entered:2009-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3081BA / - LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF496AA / - RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A1229 / - LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D06803 / - RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1268X / - - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Appendicitis, Barium enema, Blood culture negative, Constipation, CSF culture negative, Culture urine negative, Gastrointestinal necrosis, Haematochezia, Intestinal perforation, Intussusception, Laparoscopy, Laparotomy, Lethargy, Malaise, Pyrexia, Somnolence, Vomiting, Enema administration, Ultrasound abdomen abnormal, Intestinal resection, Intestinal anastomosis, Serositis, Virus serology test positive, Urine output decreased, Adenovirus infection, 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: 9     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown - Done through ED LABS: US of abd c/w IS. Attempted BE x 2 failed. Surgical pathology: 2 perforations of ileocecum; adenovirus infection of small intestine, mucosal ischemic necrosis & acute serositis; appendix w/adenivirus inf
CDC 'Split Type':

Write-up: Fever, vomiting x 2 days, lethargic, poor PO. Seen in hospital ED 2/8/09. Admitted, had diagnostic laparoscopy with ileocecectomy. Dx with intussusception with perforated colon on 2-9-09. 2/25/09 Received hospital medical records of 2/8-2/16/2009. FINAL DX: bowel perforation s/p radiological attempt to reduce intussusception; diagnostic laparoscopy; laparotomy; ileocecal resection w/primary anastomosis Records reveal patient experienced abdominal pain, oral intake reduced, sleepy, emesis, decreased UOP, constipation x 2 days. Had been evaluated in outlying ER & had fever, looked unwell & had blood/urine/CSF c/s done. Tx w/antibiotcs & transferred to higer level of care for ped surgery consult. After admitted, had large bloody stool. Progressed well postoperatively & d/c to home w/surgery clinic f/u.


Changed on 3/2/2010

VAERS ID: 339389 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Pennsylvania
Vaccinated:2009-01-06
Onset:2009-02-08
Submitted:2009-02-10
Entered:2009-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3081BA / - LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF496AA / - RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A1229 / - LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC D06803 / - RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1268X / - - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Appendicitis, Barium enema, Blood culture negative, Constipation, CSF culture negative, Culture urine negative, Gastrointestinal necrosis, Haematochezia, Intestinal perforation, Intussusception, Laparoscopy, Laparotomy, Lethargy, Malaise, Pyrexia, Somnolence, Vomiting, Enema administration, Ultrasound abdomen abnormal, Intestinal resection, Intestinal anastomosis, Serositis, Virus serology test positive, Urine output decreased, Adenovirus infection, 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: 9     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown - Done through ED LABS: US of abd c/w IS. Attempted BE x 2 failed. Surgical pathology: 2 perforations of ileocecum; adenovirus infection of small intestine, mucosal ischemic necrosis & acute serositis; appendix w/adenivirus inf
CDC 'Split Type':

Write-up: Fever, vomiting x 2 days, lethargic, poor PO. Seen in hospital ED 2/8/09. Admitted, had diagnostic laparoscopy with ileocecectomy. Dx with intussusception with perforated colon on 2-9-09. 2/25/09 Received hospital medical records of 2/8-2/16/2009. FINAL DX: bowel perforation s/p radiological attempt to reduce intussusception; diagnostic laparoscopy; laparotomy; ileocecal resection w/primary anastomosis Records reveal patient experienced abdominal pain, oral intake reduced, sleepy, emesis, decreased UOP, constipation x 2 days. Had been evaluated in outlying ER & had fever, looked unwell & had blood/urine/CSF c/s done. Tx w/antibiotcs & transferred to higer level of care for ped surgery consult. After admitted, had large bloody stool. Progressed well postoperatively & d/c to home w/surgery clinic f/u.


Changed on 4/7/2010

VAERS ID: 339389 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Pennsylvania
Vaccinated:2009-01-06
Onset:2009-02-08
Submitted:2009-02-10
Entered:2009-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3081BA / - LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF496AA / - RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A1229 / - LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D06803 / - RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1268X / - - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Appendicitis, Barium enema, Blood culture negative, Constipation, CSF culture negative, Culture urine negative, Gastrointestinal necrosis, Haematochezia, Intestinal perforation, Intussusception, Laparoscopy, Laparotomy, Lethargy, Malaise, Pyrexia, Somnolence, Vomiting, Enema administration, Ultrasound abdomen abnormal, Intestinal resection, Intestinal anastomosis, Serositis, Virus serology test positive, Urine output decreased, Adenovirus infection, 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: 9     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown - Done through ED LABS: US of abd c/w IS. Attempted BE x 2 failed. Surgical pathology: 2 perforations of ileocecum; adenovirus infection of small intestine, mucosal ischemic necrosis & acute serositis; appendix w/adenivirus inf
CDC 'Split Type':

Write-up: Fever, vomiting x 2 days, lethargic, poor PO. Seen in hospital ED 2/8/09. Admitted, had diagnostic laparoscopy with ileocecectomy. Dx with intussusception with perforated colon on 2-9-09. 2/25/09 Received hospital medical records of 2/8-2/16/2009. FINAL DX: bowel perforation s/p radiological attempt to reduce intussusception; diagnostic laparoscopy; laparotomy; ileocecal resection w/primary anastomosis Records reveal patient experienced abdominal pain, oral intake reduced, sleepy, emesis, decreased UOP, constipation x 2 days. Had been evaluated in outlying ER & had fever, looked unwell & had blood/urine/CSF c/s done. Tx w/antibiotcs & transferred to higer level of care for ped surgery consult. After admitted, had large bloody stool. Progressed well postoperatively & d/c to home w/surgery clinic f/u.


Changed on 8/31/2010

VAERS ID: 339389 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Pennsylvania
Vaccinated:2009-01-06
Onset:2009-02-08
Submitted:2009-02-10
Entered:2009-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3081BA / - LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF496AA / - RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A1229 / - LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH D06803 / - RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1268X / - - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Appendicitis, Barium enema, Blood culture negative, Constipation, CSF culture negative, Culture urine negative, Gastrointestinal necrosis, Haematochezia, Intestinal perforation, Intussusception, Laparoscopy, Laparotomy, Lethargy, Malaise, Pyrexia, Somnolence, Vomiting, Enema administration, Ultrasound abdomen abnormal, Intestinal resection, Intestinal anastomosis, Serositis, Virus serology test positive, Urine output decreased, Adenovirus infection, 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: 9     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown - Done through ED LABS: US of abd c/w IS. Attempted BE x 2 failed. Surgical pathology: 2 perforations of ileocecum; adenovirus infection of small intestine, mucosal ischemic necrosis & acute serositis; appendix w/adenivirus inf
CDC 'Split Type':

Write-up: Fever, vomiting x 2 days, lethargic, poor PO. Seen in hospital ED 2/8/09. Admitted, had diagnostic laparoscopy with ileocecectomy. Dx with intussusception with perforated colon on 2-9-09. 2/25/09 Received hospital medical records of 2/8-2/16/2009. FINAL DX: bowel perforation s/p radiological attempt to reduce intussusception; diagnostic laparoscopy; laparotomy; ileocecal resection w/primary anastomosis Records reveal patient experienced abdominal pain, oral intake reduced, sleepy, emesis, decreased UOP, constipation x 2 days. Had been evaluated in outlying ER & had fever, looked unwell & had blood/urine/CSF c/s done. Tx w/antibiotcs & transferred to higer level of care for ped surgery consult. After admitted, had large bloody stool. Progressed well postoperatively & d/c to home w/surgery clinic f/u.


Changed on 5/13/2013

VAERS ID: 339389 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Pennsylvania
Vaccinated:2009-01-06
Onset:2009-02-08
Submitted:2009-02-10
Entered:2009-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3081BA / - LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF496AA / - RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A1229 / - LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D06803 / - RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1268X / - - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1268X / - - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Appendicitis, Barium enema, Blood culture negative, Constipation, CSF culture negative, Culture urine negative, Gastrointestinal necrosis, Haematochezia, Intestinal perforation, Intussusception, Laparoscopy, Laparotomy, Lethargy, Malaise, Pyrexia, Somnolence, Vomiting, Enema administration, Ultrasound abdomen abnormal, Intestinal resection, Intestinal anastomosis, Serositis, Virus serology test positive, Urine output decreased, Adenovirus infection, 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: 9     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown - Done through ED LABS: US of abd c/w IS. Attempted BE x 2 failed. Surgical pathology: 2 perforations of ileocecum; adenovirus infection of small intestine, mucosal ischemic necrosis & acute serositis; appendix w/adenivirus inf
CDC 'Split Type':

Write-up: Fever, vomiting x 2 days, lethargic, poor PO. Seen in hospital ED 2/8/09. Admitted, had diagnostic laparoscopy with ileocecectomy. Dx with intussusception with perforated colon on 2-9-09. 2/25/09 Received hospital medical records of 2/8-2/16/2009. FINAL DX: bowel perforation s/p radiological attempt to reduce intussusception; diagnostic laparoscopy; laparotomy; ileocecal resection w/primary anastomosis Records reveal patient experienced abdominal pain, oral intake reduced, sleepy, emesis, decreased UOP, constipation x 2 days. Had been evaluated in outlying ER & had fever, looked unwell & had blood/urine/CSF c/s done. Tx w/antibiotcs & transferred to higer level of care for ped surgery consult. After admitted, had large bloody stool. Progressed well postoperatively & d/c to home w/surgery clinic f/u.


Changed on 4/14/2017

VAERS ID: 339389 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Pennsylvania
Vaccinated:2009-01-06
Onset:2009-02-08
Submitted:2009-02-10
Entered:2009-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3081BA / - LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF496AA / - RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A1229 / - LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D06803 / - RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1268X / - - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Appendicitis, Barium enema, Blood culture negative, Constipation, CSF culture negative, Culture urine negative, Gastrointestinal necrosis, Haematochezia, Intestinal perforation, Intussusception, Laparoscopy, Laparotomy, Lethargy, Malaise, Pyrexia, Somnolence, Vomiting, Enema administration, Ultrasound abdomen abnormal, Intestinal resection, Intestinal anastomosis, Serositis, Virus serology test positive, Urine output decreased, Adenovirus infection, 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: 9     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown - Done through ED LABS: US of abd c/w IS. Attempted BE x 2 failed. Surgical pathology: 2 perforations of ileocecum; adenovirus infection of small intestine, mucosal ischemic necrosis & acute serositis; appendix w/adenivirus inf infection, acute serositis & periappendicitis. Blood, urine, stool & CSF c/s neg. CSF tests WNL.
CDC 'Split Type':

Write-up: Fever, vomiting x 2 days, lethargic, poor PO. Seen in hospital ED 2/8/09. Admitted, had diagnostic laparoscopy with ileocecectomy. Dx with intussusception with perforated colon on 2-9-09. 2/25/09 Received hospital medical records of 2/8-2/16/2009. FINAL DX: bowel perforation s/p radiological attempt to reduce intussusception; diagnostic laparoscopy; laparotomy; ileocecal resection w/primary anastomosis Records reveal patient experienced abdominal pain, oral intake reduced, sleepy, emesis, decreased UOP, constipation x 2 days. Had been evaluated in outlying ER & had fever, looked unwell & had blood/urine/CSF c/s done. Tx w/antibiotcs & transferred to higer level of care for ped surgery consult. After admitted, had large bloody stool. Progressed well postoperatively & d/c to home w/surgery clinic f/u.


Changed on 9/14/2017

VAERS ID: 339389 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:Pennsylvania
Vaccinated:2009-01-06
Onset:2009-02-08
Submitted:2009-02-10
Entered:2009-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3081BA / - UNK LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF496AA / - UNK RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A1229 / - UNK LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D06803 / - UNK RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1268X / - UNK - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception, Laparoscopy, Lethargy, Pyrexia, Vomiting, 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: 9     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown - Done through ED LABS: US of abd c/w IS. Attempted BE x 2 failed. Surgical pathology: 2 perforations of ileocecum; adenovirus infection of small intestine, mucosal ischemic necrosis & acute serositis; appendix w/adenivirus infection, acute serositis & periappendicitis. Blood, urine, stool & CSF c/s neg. CSF tests WNL.
CDC 'Split Type':

Write-up: Fever, vomiting x 2 days, lethargic, poor PO. Seen in hospital ED 2/8/09. Admitted, had diagnostic laparoscopy with ileocecectomy. Dx with intussusception with perforated colon on 2-9-09. 2/25/09 Received hospital medical records of 2/8-2/16/2009. FINAL DX: bowel perforation s/p radiological attempt to reduce intussusception; diagnostic laparoscopy; laparotomy; ileocecal resection w/primary anastomosis Records reveal patient experienced abdominal pain, oral intake reduced, sleepy, emesis, decreased UOP, constipation x 2 days. Had been evaluated in outlying ER & had fever, looked unwell & had blood/urine/CSF c/s done. Tx w/antibiotcs & transferred to higer level of care for ped surgery consult. After admitted, had large bloody stool. Progressed well postoperatively & d/c to home w/surgery clinic f/u.


Changed on 2/14/2018

VAERS ID: 339389 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Pennsylvania
Vaccinated:2009-01-06
Onset:2009-02-08
Submitted:2009-02-10
Entered:2009-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3081BA / UNK LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF496AA / UNK RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A1229 / UNK LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D06803 / UNK RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1268X / UNK MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception, Laparoscopy, Lethargy, Pyrexia, Vomiting, 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: 9     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown - Done through ED LABS: US of abd c/w IS. Attempted BE x 2 failed. Surgical pathology: 2 perforations of ileocecum; adenovirus infection of small intestine, mucosal ischemic necrosis & acute serositis; appendix w/adenivirus infection, acute serositis & periappendicitis. Blood, urine, stool & CSF c/s neg. CSF tests WNL.
CDC 'Split Type':

Write-up: Fever, vomiting x 2 days, lethargic, poor PO. Seen in hospital ED 2/8/09. Admitted, had diagnostic laparoscopy with ileocecectomy. Dx with intussusception with perforated colon on 2-9-09. 2/25/09 Received hospital medical records of 2/8-2/16/2009. FINAL DX: bowel perforation s/p radiological attempt to reduce intussusception; diagnostic laparoscopy; laparotomy; ileocecal resection w/primary anastomosis Records reveal patient experienced abdominal pain, oral intake reduced, sleepy, emesis, decreased UOP, constipation x 2 days. Had been evaluated in outlying ER & had fever, looked unwell & had blood/urine/CSF c/s done. Tx w/antibiotcs & transferred to higer level of care for ped surgery consult. After admitted, had large bloody stool. Progressed well postoperatively & d/c to home w/surgery clinic f/u.


Changed on 6/14/2018

VAERS ID: 339389 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Pennsylvania
Vaccinated:2009-01-06
Onset:2009-02-08
Submitted:2009-02-10
Entered:2009-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3081BA / UNK LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF496AA / UNK RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A1229 / UNK LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D06803 / UNK RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1268X / UNK MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception, Laparoscopy, Lethargy, Pyrexia, Vomiting, 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: 9     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown - Done through ED LABS: US of abd c/w IS. Attempted BE x 2 failed. Surgical pathology: 2 perforations of ileocecum; adenovirus infection of small intestine, mucosal ischemic necrosis & acute serositis; appendix w/adenivirus infection, acute serositis & periappendicitis. Blood, urine, stool & CSF c/s neg. CSF tests WNL.
CDC 'Split Type':

Write-up: Fever, vomiting x 2 days, lethargic, poor PO. Seen in hospital ED 2/8/09. Admitted, had diagnostic laparoscopy with ileocecectomy. Dx with intussusception with perforated colon on 2-9-09. 2/25/09 Received hospital medical records of 2/8-2/16/2009. FINAL DX: bowel perforation s/p radiological attempt to reduce intussusception; diagnostic laparoscopy; laparotomy; ileocecal resection w/primary anastomosis Records reveal patient experienced abdominal pain, oral intake reduced, sleepy, emesis, decreased UOP, constipation x 2 days. Had been evaluated in outlying ER & had fever, looked unwell & had blood/urine/CSF c/s done. Tx w/antibiotcs & transferred to higer level of care for ped surgery consult. After admitted, had large bloody stool. Progressed well postoperatively & d/c to home w/surgery clinic f/u.


Changed on 8/14/2018

VAERS ID: 339389 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Pennsylvania
Vaccinated:2009-01-06
Onset:2009-02-08
Submitted:2009-02-10
Entered:2009-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3081BA / UNK LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF496AA / UNK RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A1229 / UNK LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D06803 / UNK RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1268X / UNK MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception, Laparoscopy, Lethargy, Pyrexia, Vomiting, 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: 9     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown - Done through ED LABS: US of abd c/w IS. Attempted BE x 2 failed. Surgical pathology: 2 perforations of ileocecum; adenovirus infection of small intestine, mucosal ischemic necrosis & acute serositis; appendix w/adenivirus infection, acute serositis & periappendicitis. Blood, urine, stool & CSF c/s neg. CSF tests WNL.
CDC 'Split Type':

Write-up: Fever, vomiting x 2 days, lethargic, poor PO. Seen in hospital ED 2/8/09. Admitted, had diagnostic laparoscopy with ileocecectomy. Dx with intussusception with perforated colon on 2-9-09. 2/25/09 Received hospital medical records of 2/8-2/16/2009. FINAL DX: bowel perforation s/p radiological attempt to reduce intussusception; diagnostic laparoscopy; laparotomy; ileocecal resection w/primary anastomosis Records reveal patient experienced abdominal pain, oral intake reduced, sleepy, emesis, decreased UOP, constipation x 2 days. Had been evaluated in outlying ER & had fever, looked unwell & had blood/urine/CSF c/s done. Tx w/antibiotcs & transferred to higer level of care for ped surgery consult. After admitted, had large bloody stool. Progressed well postoperatively & d/c to home w/surgery clinic f/u.


Changed on 9/14/2018

VAERS ID: 339389 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Pennsylvania
Vaccinated:2009-01-06
Onset:2009-02-08
Submitted:2009-02-10
Entered:2009-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3081BA / UNK LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF496AA / UNK RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A1229 / UNK LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D06803 / UNK RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1268X / UNK MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception, Laparoscopy, Lethargy, Pyrexia, Vomiting, 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: 9     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown - Done through ED LABS: US of abd c/w IS. Attempted BE x 2 failed. Surgical pathology: 2 perforations of ileocecum; adenovirus infection of small intestine, mucosal ischemic necrosis & acute serositis; appendix w/adenivirus infection, acute serositis & periappendicitis. Blood, urine, stool & CSF c/s neg. CSF tests WNL.
CDC 'Split Type':

Write-up: Fever, vomiting x 2 days, lethargic, poor PO. Seen in hospital ED 2/8/09. Admitted, had diagnostic laparoscopy with ileocecectomy. Dx with intussusception with perforated colon on 2-9-09. 2/25/09 Received hospital medical records of 2/8-2/16/2009. FINAL DX: bowel perforation s/p radiological attempt to reduce intussusception; diagnostic laparoscopy; laparotomy; ileocecal resection w/primary anastomosis Records reveal patient experienced abdominal pain, oral intake reduced, sleepy, emesis, decreased UOP, constipation x 2 days. Had been evaluated in outlying ER & had fever, looked unwell & had blood/urine/CSF c/s done. Tx w/antibiotcs & transferred to higer level of care for ped surgery consult. After admitted, had large bloody stool. Progressed well postoperatively & d/c to home w/surgery clinic f/u.


Changed on 10/14/2018

VAERS ID: 339389 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Pennsylvania
Vaccinated:2009-01-06
Onset:2009-02-08
Submitted:2009-02-10
Entered:2009-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3081BA / UNK LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF496AA / UNK RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A1229 / UNK LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D06803 / UNK RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1268X / UNK MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception, Laparoscopy, Lethargy, Pyrexia, Vomiting, 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: 9     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown - Done through ED LABS: US of abd c/w IS. Attempted BE x 2 failed. Surgical pathology: 2 perforations of ileocecum; adenovirus infection of small intestine, mucosal ischemic necrosis & acute serositis; appendix w/adenivirus infection, acute serositis & periappendicitis. Blood, urine, stool & CSF c/s neg. CSF tests WNL.
CDC 'Split Type':

Write-up: Fever, vomiting x 2 days, lethargic, poor PO. Seen in hospital ED 2/8/09. Admitted, had diagnostic laparoscopy with ileocecectomy. Dx with intussusception with perforated colon on 2-9-09. 2/25/09 Received hospital medical records of 2/8-2/16/2009. FINAL DX: bowel perforation s/p radiological attempt to reduce intussusception; diagnostic laparoscopy; laparotomy; ileocecal resection w/primary anastomosis Records reveal patient experienced abdominal pain, oral intake reduced, sleepy, emesis, decreased UOP, constipation x 2 days. Had been evaluated in outlying ER & had fever, looked unwell & had blood/urine/CSF c/s done. Tx w/antibiotcs & transferred to higer level of care for ped surgery consult. After admitted, had large bloody stool. Progressed well postoperatively & d/c to home w/surgery clinic f/u.

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