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This is VAERS ID 339753

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

VAERS ID: 339753
VAERS Form:
Age:0.2
Sex:Male
Location:Tennessee
Vaccinated:2009-01-06
Onset:2009-01-09
Submitted:2009-01-14
Entered:2009-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 0 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR - / 0 LL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC - / 0 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Appendicectomy, Barium enema abnormal, Dehydration, Haematochezia, Hypersomnia, Intussusception, Laparoscopy, Laparotomy, Lethargy, Listless, Surgery, X-ray abnormal, Enema administration, Fluid intake reduced, Abdominal X-ray, Hypophagia

Life Threatening? No
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None. PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd X-ray (+) for obstruction. BE (+) for IS.
CDC 'Split Type':

Write-up: Intussusception - open reduction after failed enema reduction. Presenting sx: listlessness, decreased feedings (fluid intake) increased sleep. 3/3/09 MR received for DOS 1/10-xx/2008 with DX: Intussusception. Pt presented with acute onset of bloody stools and lethargy with decreased po intake. PE (+) for mild dehydration. IS dx by X-ray confirmed by BE which was only partially able to reduce. Admitted for surgical consult which dx IS. Admitted for Laparoscopy with attempted reduction of IS. Unable to reduce laparoscopically, so laparotomy performed with appendectomy. No post op data available.


Changed on 3/2/2010

VAERS ID: 339753 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Tennessee
Vaccinated:2009-01-06
Onset:2009-01-09
Submitted:2009-01-14
Entered:2009-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 0 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR - / 0 LL / UN
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC - / 0 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Appendicectomy, Barium enema abnormal, Dehydration, Haematochezia, Hypersomnia, Intussusception, Laparoscopy, Laparotomy, Lethargy, Listless, Surgery, X-ray abnormal, Enema administration, Fluid intake reduced, Abdominal X-ray, Hypophagia

Life Threatening? No
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None. PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd X-ray (+) for obstruction. BE (+) for IS.
CDC 'Split Type':

Write-up: Intussusception - open reduction after failed enema reduction. Presenting sx: listlessness, decreased feedings (fluid intake) increased sleep. 3/3/09 MR received for DOS 1/10-xx/2008 with DX: Intussusception. Pt presented with acute onset of bloody stools and lethargy with decreased po intake. PE (+) for mild dehydration. IS dx by X-ray confirmed by BE which was only partially able to reduce. Admitted for surgical consult which dx IS. Admitted for Laparoscopy with attempted reduction of IS. Unable to reduce laparoscopically, so laparotomy performed with appendectomy. No post op data available.


Changed on 4/7/2010

VAERS ID: 339753 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Tennessee
Vaccinated:2009-01-06
Onset:2009-01-09
Submitted:2009-01-14
Entered:2009-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 0 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR - / 0 LL / UN
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC - / 0 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Appendicectomy, Barium enema abnormal, Dehydration, Haematochezia, Hypersomnia, Intussusception, Laparoscopy, Laparotomy, Lethargy, Listless, Surgery, X-ray abnormal, Enema administration, Fluid intake reduced, Abdominal X-ray, Hypophagia

Life Threatening? No
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None. PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd X-ray (+) for obstruction. BE (+) for IS.
CDC 'Split Type':

Write-up: Intussusception - open reduction after failed enema reduction. Presenting sx: listlessness, decreased feedings (fluid intake) increased sleep. 3/3/09 MR received for DOS 1/10-xx/2008 with DX: Intussusception. Pt presented with acute onset of bloody stools and lethargy with decreased po intake. PE (+) for mild dehydration. IS dx by X-ray confirmed by BE which was only partially able to reduce. Admitted for surgical consult which dx IS. Admitted for Laparoscopy with attempted reduction of IS. Unable to reduce laparoscopically, so laparotomy performed with appendectomy. No post op data available.


Changed on 8/31/2010

VAERS ID: 339753 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Tennessee
Vaccinated:2009-01-06
Onset:2009-01-09
Submitted:2009-01-14
Entered:2009-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 0 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR - / 0 LL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH - / 0 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Appendicectomy, Barium enema abnormal, Dehydration, Haematochezia, Hypersomnia, Intussusception, Laparoscopy, Laparotomy, Lethargy, Listless, Surgery, X-ray abnormal, Enema administration, Fluid intake reduced, Abdominal X-ray, Hypophagia

Life Threatening? No
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None. PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd X-ray (+) for obstruction. BE (+) for IS.
CDC 'Split Type':

Write-up: Intussusception - open reduction after failed enema reduction. Presenting sx: listlessness, decreased feedings (fluid intake) increased sleep. 3/3/09 MR received for DOS 1/10-xx/2008 with DX: Intussusception. Pt presented with acute onset of bloody stools and lethargy with decreased po intake. PE (+) for mild dehydration. IS dx by X-ray confirmed by BE which was only partially able to reduce. Admitted for surgical consult which dx IS. Admitted for Laparoscopy with attempted reduction of IS. Unable to reduce laparoscopically, so laparotomy performed with appendectomy. No post op data available.


Changed on 5/13/2013

VAERS ID: 339753 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Tennessee
Vaccinated:2009-01-06
Onset:2009-01-09
Submitted:2009-01-14
Entered:2009-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 0 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR - / 0 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / 0 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Appendicectomy, Barium enema abnormal, Dehydration, Haematochezia, Hypersomnia, Intussusception, Laparoscopy, Laparotomy, Lethargy, Listless, Surgery, X-ray abnormal, Enema administration, Fluid intake reduced, Abdominal X-ray, Hypophagia

Life Threatening? No
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None. PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd X-ray (+) for obstruction. BE (+) for IS.
CDC 'Split Type':

Write-up: Intussusception - open reduction after failed enema reduction. Presenting sx: listlessness, decreased feedings (fluid intake) increased sleep. 3/3/09 MR received for DOS 1/10-xx/2008 with DX: Intussusception. Pt presented with acute onset of bloody stools and lethargy with decreased po intake. PE (+) for mild dehydration. IS dx by X-ray confirmed by BE which was only partially able to reduce. Admitted for surgical consult which dx IS. Admitted for Laparoscopy with attempted reduction of IS. Unable to reduce laparoscopically, so laparotomy performed with appendectomy. No post op data available.


Changed on 2/14/2017

VAERS ID: 339753 Before After
VAERS Form:
Age:0.2 0.17
Sex:Male
Location:Tennessee
Vaccinated:2009-01-06
Onset:2009-01-09
Submitted:2009-01-14
Entered:2009-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 0 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR - / 0 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / 0 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Appendicectomy, Barium enema abnormal, Dehydration, Haematochezia, Hypersomnia, Intussusception, Laparoscopy, Laparotomy, Lethargy, Listless, Surgery, X-ray abnormal, Enema administration, Fluid intake reduced, Abdominal X-ray, Hypophagia

Life Threatening? No
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None. PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd X-ray (+) for obstruction. BE (+) for IS.
CDC 'Split Type':

Write-up: Intussusception - open reduction after failed enema reduction. Presenting sx: listlessness, decreased feedings (fluid intake) increased sleep. 3/3/09 MR received for DOS 1/10-xx/2008 with DX: Intussusception. Pt presented with acute onset of bloody stools and lethargy with decreased po intake. PE (+) for mild dehydration. IS dx by X-ray confirmed by BE which was only partially able to reduce. Admitted for surgical consult which dx IS. Admitted for Laparoscopy with attempted reduction of IS. Unable to reduce laparoscopically, so laparotomy performed with appendectomy. No post op data available.


Changed on 4/14/2017

VAERS ID: 339753 Before After
VAERS Form:
Age:0.17
Sex:Male
Location:Tennessee
Vaccinated:2009-01-06
Onset:2009-01-09
Submitted:2009-01-14
Entered:2009-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 0 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR - / 0 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / 0 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Appendicectomy, Barium enema abnormal, Dehydration, Haematochezia, Hypersomnia, Intussusception, Laparoscopy, Laparotomy, Lethargy, Listless, Surgery, X-ray abnormal, Enema administration, Fluid intake reduced, Abdominal X-ray, Hypophagia

Life Threatening? No
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None. PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd X-ray (+) for obstruction. BE (+) for IS.
CDC 'Split Type':

Write-up: Intussusception - open reduction after failed enema reduction. Presenting sx: listlessness, decreased feedings (fluid intake) increased sleep. 3/3/09 MR received for DOS 1/10-xx/2008 with DX: Intussusception. Pt presented with acute onset of bloody stools and lethargy with decreased po intake. PE (+) for mild dehydration. IS dx by X-ray confirmed by BE which was only partially able to reduce. Admitted for surgical consult which dx IS. Admitted for Laparoscopy with attempted reduction of IS. Unable to reduce laparoscopically, so laparotomy performed with appendectomy. No post op data available.


Changed on 9/14/2017

VAERS ID: 339753 Before After
VAERS Form:(blank) 1
Age:0.17
Sex:Male
Location:Tennessee
Vaccinated:2009-01-06
Onset:2009-01-09
Submitted:2009-01-14
Entered:2009-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 0 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR - / 0 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / 0 1 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 0 1 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Hypersomnia, Intussusception, Listless, Surgery, Enema administration, Fluid intake reduced, Hypophagia

Life Threatening? No
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None. PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd X-ray (+) for obstruction. BE (+) for IS.
CDC 'Split Type':

Write-up: Intussusception - open reduction after failed enema reduction. Presenting sx: listlessness, decreased feedings (fluid intake) increased sleep. 3/3/09 MR received for DOS 1/10-xx/2008 with DX: Intussusception. Pt presented with acute onset of bloody stools and lethargy with decreased po intake. PE (+) for mild dehydration. IS dx by X-ray confirmed by BE which was only partially able to reduce. Admitted for surgical consult which dx IS. Admitted for Laparoscopy with attempted reduction of IS. Unable to reduce laparoscopically, so laparotomy performed with appendectomy. No post op data available.


Changed on 2/14/2018

VAERS ID: 339753 Before After
VAERS Form:1
Age:0.17
Sex:Male
Location:Tennessee
Vaccinated:2009-01-06
Onset:2009-01-09
Submitted:2009-01-14
Entered:2009-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR - / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / 1 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Hypersomnia, Intussusception, Listless, Surgery, Enema administration, Fluid intake reduced, Hypophagia

Life Threatening? No
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None. PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd X-ray (+) for obstruction. BE (+) for IS.
CDC 'Split Type':

Write-up: Intussusception - open reduction after failed enema reduction. Presenting sx: listlessness, decreased feedings (fluid intake) increased sleep. 3/3/09 MR received for DOS 1/10-xx/2008 with DX: Intussusception. Pt presented with acute onset of bloody stools and lethargy with decreased po intake. PE (+) for mild dehydration. IS dx by X-ray confirmed by BE which was only partially able to reduce. Admitted for surgical consult which dx IS. Admitted for Laparoscopy with attempted reduction of IS. Unable to reduce laparoscopically, so laparotomy performed with appendectomy. No post op data available.


Changed on 6/14/2018

VAERS ID: 339753 Before After
VAERS Form:1
Age:0.17
Sex:Male
Location:Tennessee
Vaccinated:2009-01-06
Onset:2009-01-09
Submitted:2009-01-14
Entered:2009-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR - / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / 1 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Hypersomnia, Intussusception, Listless, Surgery, Enema administration, Fluid intake reduced, Hypophagia

Life Threatening? No
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None. PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd X-ray (+) for obstruction. BE (+) for IS.
CDC 'Split Type':

Write-up: Intussusception - open reduction after failed enema reduction. Presenting sx: listlessness, decreased feedings (fluid intake) increased sleep. 3/3/09 MR received for DOS 1/10-xx/2008 with DX: Intussusception. Pt presented with acute onset of bloody stools and lethargy with decreased po intake. PE (+) for mild dehydration. IS dx by X-ray confirmed by BE which was only partially able to reduce. Admitted for surgical consult which dx IS. Admitted for Laparoscopy with attempted reduction of IS. Unable to reduce laparoscopically, so laparotomy performed with appendectomy. No post op data available.


Changed on 8/14/2018

VAERS ID: 339753 Before After
VAERS Form:1
Age:0.17
Sex:Male
Location:Tennessee
Vaccinated:2009-01-06
Onset:2009-01-09
Submitted:2009-01-14
Entered:2009-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR - / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / 1 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Hypersomnia, Intussusception, Listless, Surgery, Enema administration, Fluid intake reduced, Hypophagia

Life Threatening? No
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None. PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd X-ray (+) for obstruction. BE (+) for IS.
CDC 'Split Type':

Write-up: Intussusception - open reduction after failed enema reduction. Presenting sx: listlessness, decreased feedings (fluid intake) increased sleep. 3/3/09 MR received for DOS 1/10-xx/2008 with DX: Intussusception. Pt presented with acute onset of bloody stools and lethargy with decreased po intake. PE (+) for mild dehydration. IS dx by X-ray confirmed by BE which was only partially able to reduce. Admitted for surgical consult which dx IS. Admitted for Laparoscopy with attempted reduction of IS. Unable to reduce laparoscopically, so laparotomy performed with appendectomy. No post op data available.


Changed on 9/14/2018

VAERS ID: 339753 Before After
VAERS Form:1
Age:0.17
Sex:Male
Location:Tennessee
Vaccinated:2009-01-06
Onset:2009-01-09
Submitted:2009-01-14
Entered:2009-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR - / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / 1 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Hypersomnia, Intussusception, Listless, Surgery, Enema administration, Fluid intake reduced, Hypophagia

Life Threatening? No
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None. PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd X-ray (+) for obstruction. BE (+) for IS.
CDC 'Split Type':

Write-up: Intussusception - open reduction after failed enema reduction. Presenting sx: listlessness, decreased feedings (fluid intake) increased sleep. 3/3/09 MR received for DOS 1/10-xx/2008 with DX: Intussusception. Pt presented with acute onset of bloody stools and lethargy with decreased po intake. PE (+) for mild dehydration. IS dx by X-ray confirmed by BE which was only partially able to reduce. Admitted for surgical consult which dx IS. Admitted for Laparoscopy with attempted reduction of IS. Unable to reduce laparoscopically, so laparotomy performed with appendectomy. No post op data available.


Changed on 10/14/2018

VAERS ID: 339753 Before After
VAERS Form:1
Age:0.17
Sex:Male
Location:Tennessee
Vaccinated:2009-01-06
Onset:2009-01-09
Submitted:2009-01-14
Entered:2009-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR - / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / 1 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Hypersomnia, Intussusception, Listless, Surgery, Enema administration, Fluid intake reduced, Hypophagia

Life Threatening? No
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None. PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd X-ray (+) for obstruction. BE (+) for IS.
CDC 'Split Type':

Write-up: Intussusception - open reduction after failed enema reduction. Presenting sx: listlessness, decreased feedings (fluid intake) increased sleep. 3/3/09 MR received for DOS 1/10-xx/2008 with DX: Intussusception. Pt presented with acute onset of bloody stools and lethargy with decreased po intake. PE (+) for mild dehydration. IS dx by X-ray confirmed by BE which was only partially able to reduce. Admitted for surgical consult which dx IS. Admitted for Laparoscopy with attempted reduction of IS. Unable to reduce laparoscopically, so laparotomy performed with appendectomy. No post op data available.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=339753&WAYBACKHISTORY=ON


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