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This is VAERS ID 339776

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

VAERS ID: 339776
VAERS Form:
Age:0.3
Sex:Male
Location:Tennessee
Vaccinated:2009-01-05
Onset:2009-01-08
Submitted:2009-01-12
Entered:2009-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3227AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D16284 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1356X / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Atelectasis, Chest X-ray abnormal, Computerised tomogram normal, Intussusception, Irritability, Laparoscopy, Lethargy, Urinary system X-ray, Vomiting, Enema administration, Ultrasound abdomen, Colectomy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None 2/24/09-meconium aspiration.
Allergies:
Diagnostic Lab Data: KUB/Abdominal ultrasound 2/24/09-records received-pneumatic enema reduction unsuccessful. Head CT normal. Chest x-ray showed small area of atelectasis.
CDC 'Split Type':

Write-up: Intussusception. Required partial colectomy. 2/24/09-records received for DOS 1/8-1/13/09-DC DX: Intussusception. Presented with 2 day history of lethargy and vomiting, increased fussiness increased reflux. Attempted pneumatic reduction of intussusception unsuccessful. Partial reduction by laparoscopy and partial colectomy with removal of terminal ileum and ileocolostomy. Intussusception irreducile and resection of terminal ileum and right colon.


Changed on 3/2/2010

VAERS ID: 339776 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Tennessee
Vaccinated:2009-01-05
Onset:2009-01-08
Submitted:2009-01-12
Entered:2009-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3227AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC D16284 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1356X / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Atelectasis, Chest X-ray abnormal, Computerised tomogram normal, Intussusception, Irritability, Laparoscopy, Lethargy, Urinary system X-ray, Vomiting, Enema administration, Ultrasound abdomen, Colectomy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None 2/24/09-meconium aspiration.
Allergies:
Diagnostic Lab Data: KUB/Abdominal ultrasound 2/24/09-records received-pneumatic enema reduction unsuccessful. Head CT normal. Chest x-ray showed small area of atelectasis.
CDC 'Split Type':

Write-up: Intussusception. Required partial colectomy. 2/24/09-records received for DOS 1/8-1/13/09-DC DX: Intussusception. Presented with 2 day history of lethargy and vomiting, increased fussiness increased reflux. Attempted pneumatic reduction of intussusception unsuccessful. Partial reduction by laparoscopy and partial colectomy with removal of terminal ileum and ileocolostomy. Intussusception irreducile and resection of terminal ileum and right colon.


Changed on 4/7/2010

VAERS ID: 339776 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Tennessee
Vaccinated:2009-01-05
Onset:2009-01-08
Submitted:2009-01-12
Entered:2009-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3227AA / 1 RL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D16284 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1356X / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Atelectasis, Chest X-ray abnormal, Computerised tomogram normal, Intussusception, Irritability, Laparoscopy, Lethargy, Urinary system X-ray, Vomiting, Enema administration, Ultrasound abdomen, Colectomy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None 2/24/09-meconium aspiration.
Allergies:
Diagnostic Lab Data: KUB/Abdominal ultrasound 2/24/09-records received-pneumatic enema reduction unsuccessful. Head CT normal. Chest x-ray showed small area of atelectasis.
CDC 'Split Type':

Write-up: Intussusception. Required partial colectomy. 2/24/09-records received for DOS 1/8-1/13/09-DC DX: Intussusception. Presented with 2 day history of lethargy and vomiting, increased fussiness increased reflux. Attempted pneumatic reduction of intussusception unsuccessful. Partial reduction by laparoscopy and partial colectomy with removal of terminal ileum and ileocolostomy. Intussusception irreducile and resection of terminal ileum and right colon.


Changed on 8/31/2010

VAERS ID: 339776 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Tennessee
Vaccinated:2009-01-05
Onset:2009-01-08
Submitted:2009-01-12
Entered:2009-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3227AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH D16284 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1356X / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Atelectasis, Chest X-ray abnormal, Computerised tomogram normal, Intussusception, Irritability, Laparoscopy, Lethargy, Urinary system X-ray, Vomiting, Enema administration, Ultrasound abdomen, Colectomy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None 2/24/09-meconium aspiration.
Allergies:
Diagnostic Lab Data: KUB/Abdominal ultrasound 2/24/09-records received-pneumatic enema reduction unsuccessful. Head CT normal. Chest x-ray showed small area of atelectasis.
CDC 'Split Type':

Write-up: Intussusception. Required partial colectomy. 2/24/09-records received for DOS 1/8-1/13/09-DC DX: Intussusception. Presented with 2 day history of lethargy and vomiting, increased fussiness increased reflux. Attempted pneumatic reduction of intussusception unsuccessful. Partial reduction by laparoscopy and partial colectomy with removal of terminal ileum and ileocolostomy. Intussusception irreducile and resection of terminal ileum and right colon.


Changed on 5/13/2013

VAERS ID: 339776 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Tennessee
Vaccinated:2009-01-05
Onset:2009-01-08
Submitted:2009-01-12
Entered:2009-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3227AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D16284 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1356X / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1356X / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Atelectasis, Chest X-ray abnormal, Computerised tomogram normal, Intussusception, Irritability, Laparoscopy, Lethargy, Urinary system X-ray, Vomiting, Enema administration, Ultrasound abdomen, Colectomy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None 2/24/09-meconium aspiration.
Allergies:
Diagnostic Lab Data: KUB/Abdominal ultrasound 2/24/09-records received-pneumatic enema reduction unsuccessful. Head CT normal. Chest x-ray showed small area of atelectasis.
CDC 'Split Type':

Write-up: Intussusception. Required partial colectomy. 2/24/09-records received for DOS 1/8-1/13/09-DC DX: Intussusception. Presented with 2 day history of lethargy and vomiting, increased fussiness increased reflux. Attempted pneumatic reduction of intussusception unsuccessful. Partial reduction by laparoscopy and partial colectomy with removal of terminal ileum and ileocolostomy. Intussusception irreducile and resection of terminal ileum and right colon.


Changed on 6/14/2014

VAERS ID: 339776 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Tennessee
Vaccinated:2009-01-05
Onset:2009-01-08
Submitted:2009-01-12
Entered:2009-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3227AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D16284 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1356X / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Atelectasis, Chest X-ray abnormal, Computerised tomogram normal, Intussusception, Irritability, Laparoscopy, Lethargy, Urinary system X-ray, Vomiting, Enema administration, Ultrasound abdomen, Colectomy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None 2/24/09-meconium aspiration.
Allergies:
Diagnostic Lab Data: KUB/Abdominal ultrasound 2/24/09-records received-pneumatic enema reduction unsuccessful. Head CT normal. Chest x-ray showed small area of atelectasis.
CDC 'Split Type':

Write-up: Intussusception. Required partial colectomy. 2/24/09-records received for DOS 1/8-1/13/09-DC DX: Intussusception. Presented with 2 day history of lethargy and vomiting, increased fussiness increased reflux. Attempted pneumatic reduction of intussusception unsuccessful. Partial reduction by laparoscopy and partial colectomy with removal of terminal ileum and ileocolostomy. Intussusception irreducile and resection of terminal ileum and right colon.


Changed on 3/14/2015

VAERS ID: 339776 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Tennessee
Vaccinated:2009-01-05
Onset:2009-01-08
Submitted:2009-01-12
Entered:2009-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3227AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D16284 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1356X / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Atelectasis, Chest X-ray abnormal, Computerised tomogram normal, Intussusception, Irritability, Laparoscopy, Lethargy, Urinary system X-ray, Vomiting, Enema administration, Ultrasound abdomen, Colectomy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None 2/24/09-meconium aspiration.
Allergies:
Diagnostic Lab Data: KUB/Abdominal ultrasound 2/24/09-records received-pneumatic enema reduction unsuccessful. Head CT normal. Chest x-ray showed small area of atelectasis.
CDC 'Split Type':

Write-up: Intussusception. Required partial colectomy. 2/24/09-records received for DOS 1/8-1/13/09-DC DX: Intussusception. Presented with 2 day history of lethargy and vomiting, increased fussiness increased reflux. Attempted pneumatic reduction of intussusception unsuccessful. Partial reduction by laparoscopy and partial colectomy with removal of terminal ileum and ileocolostomy. Intussusception irreducile and resection of terminal ileum and right colon.


Changed on 2/14/2017

VAERS ID: 339776 Before After
VAERS Form:
Age:0.3 0.34
Sex:Male
Location:Tennessee
Vaccinated:2009-01-05
Onset:2009-01-08
Submitted:2009-01-12
Entered:2009-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3227AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D16284 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1356X / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Atelectasis, Chest X-ray abnormal, Computerised tomogram normal, Intussusception, Irritability, Laparoscopy, Lethargy, Urinary system X-ray, Vomiting, Enema administration, Ultrasound abdomen, Colectomy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None 2/24/09-meconium aspiration.
Allergies:
Diagnostic Lab Data: KUB/Abdominal ultrasound 2/24/09-records received-pneumatic enema reduction unsuccessful. Head CT normal. Chest x-ray showed small area of atelectasis.
CDC 'Split Type':

Write-up: Intussusception. Required partial colectomy. 2/24/09-records received for DOS 1/8-1/13/09-DC DX: Intussusception. Presented with 2 day history of lethargy and vomiting, increased fussiness increased reflux. Attempted pneumatic reduction of intussusception unsuccessful. Partial reduction by laparoscopy and partial colectomy with removal of terminal ileum and ileocolostomy. Intussusception irreducile and resection of terminal ileum and right colon.


Changed on 4/14/2017

VAERS ID: 339776 Before After
VAERS Form:
Age:0.34
Sex:Male
Location:Tennessee
Vaccinated:2009-01-05
Onset:2009-01-08
Submitted:2009-01-12
Entered:2009-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3227AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D16284 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1356X / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Atelectasis, Chest X-ray abnormal, Computerised tomogram normal, Intussusception, Irritability, Laparoscopy, Lethargy, Urinary system X-ray, Vomiting, Enema administration, Ultrasound abdomen, Colectomy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None 2/24/09-meconium aspiration.
Allergies:
Diagnostic Lab Data: KUB/Abdominal ultrasound 2/24/09-records received-pneumatic enema reduction unsuccessful. Head CT normal. Chest x-ray showed small area of atelectasis.
CDC 'Split Type':

Write-up: Intussusception. Required partial colectomy. 2/24/09-records received for DOS 1/8-1/13/09-DC DX: Intussusception. Presented with 2 day history of lethargy and vomiting, increased fussiness increased reflux. Attempted pneumatic reduction of intussusception unsuccessful. Partial reduction by laparoscopy and partial colectomy with removal of terminal ileum and ileocolostomy. Intussusception irreducile and resection of terminal ileum and right colon.


Changed on 9/14/2017

VAERS ID: 339776 Before After
VAERS Form:(blank) 1
Age:0.34
Sex:Male
Location:Tennessee
Vaccinated:2009-01-05
Onset:2009-01-08
Submitted:2009-01-12
Entered:2009-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3227AA / 1 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D16284 / 1 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1356X / 1 2 - MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Intussusception, Urinary system X-ray, Ultrasound abdomen, Colectomy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None 2/24/09-meconium aspiration.
Allergies:
Diagnostic Lab Data: KUB/Abdominal ultrasound 2/24/09-records received-pneumatic enema reduction unsuccessful. Head CT normal. Chest x-ray showed small area of atelectasis.
CDC 'Split Type':

Write-up: Intussusception. Required partial colectomy. 2/24/09-records received for DOS 1/8-1/13/09-DC DX: Intussusception. Presented with 2 day history of lethargy and vomiting, increased fussiness increased reflux. Attempted pneumatic reduction of intussusception unsuccessful. Partial reduction by laparoscopy and partial colectomy with removal of terminal ileum and ileocolostomy. Intussusception irreducile and resection of terminal ileum and right colon.


Changed on 2/14/2018

VAERS ID: 339776 Before After
VAERS Form:1
Age:0.34
Sex:Male
Location:Tennessee
Vaccinated:2009-01-05
Onset:2009-01-08
Submitted:2009-01-12
Entered:2009-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3227AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D16284 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1356X / 2 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Intussusception, Urinary system X-ray, Ultrasound abdomen, Colectomy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None 2/24/09-meconium aspiration.
Allergies:
Diagnostic Lab Data: KUB/Abdominal ultrasound 2/24/09-records received-pneumatic enema reduction unsuccessful. Head CT normal. Chest x-ray showed small area of atelectasis.
CDC 'Split Type':

Write-up: Intussusception. Required partial colectomy. 2/24/09-records received for DOS 1/8-1/13/09-DC DX: Intussusception. Presented with 2 day history of lethargy and vomiting, increased fussiness increased reflux. Attempted pneumatic reduction of intussusception unsuccessful. Partial reduction by laparoscopy and partial colectomy with removal of terminal ileum and ileocolostomy. Intussusception irreducile and resection of terminal ileum and right colon.


Changed on 6/14/2018

VAERS ID: 339776 Before After
VAERS Form:1
Age:0.34
Sex:Male
Location:Tennessee
Vaccinated:2009-01-05
Onset:2009-01-08
Submitted:2009-01-12
Entered:2009-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3227AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D16284 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1356X / 2 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Intussusception, Urinary system X-ray, Ultrasound abdomen, Colectomy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None 2/24/09-meconium aspiration.
Allergies:
Diagnostic Lab Data: KUB/Abdominal ultrasound 2/24/09-records received-pneumatic enema reduction unsuccessful. Head CT normal. Chest x-ray showed small area of atelectasis.
CDC 'Split Type':

Write-up: Intussusception. Required partial colectomy. 2/24/09-records received for DOS 1/8-1/13/09-DC DX: Intussusception. Presented with 2 day history of lethargy and vomiting, increased fussiness increased reflux. Attempted pneumatic reduction of intussusception unsuccessful. Partial reduction by laparoscopy and partial colectomy with removal of terminal ileum and ileocolostomy. Intussusception irreducile and resection of terminal ileum and right colon.


Changed on 8/14/2018

VAERS ID: 339776 Before After
VAERS Form:1
Age:0.34
Sex:Male
Location:Tennessee
Vaccinated:2009-01-05
Onset:2009-01-08
Submitted:2009-01-12
Entered:2009-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3227AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D16284 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1356X / 2 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Intussusception, Urinary system X-ray, Ultrasound abdomen, Colectomy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None 2/24/09-meconium aspiration.
Allergies:
Diagnostic Lab Data: KUB/Abdominal ultrasound 2/24/09-records received-pneumatic enema reduction unsuccessful. Head CT normal. Chest x-ray showed small area of atelectasis.
CDC 'Split Type':

Write-up: Intussusception. Required partial colectomy. 2/24/09-records received for DOS 1/8-1/13/09-DC DX: Intussusception. Presented with 2 day history of lethargy and vomiting, increased fussiness increased reflux. Attempted pneumatic reduction of intussusception unsuccessful. Partial reduction by laparoscopy and partial colectomy with removal of terminal ileum and ileocolostomy. Intussusception irreducile and resection of terminal ileum and right colon.


Changed on 9/14/2018

VAERS ID: 339776 Before After
VAERS Form:1
Age:0.34
Sex:Male
Location:Tennessee
Vaccinated:2009-01-05
Onset:2009-01-08
Submitted:2009-01-12
Entered:2009-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3227AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D16284 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1356X / 2 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Intussusception, Urinary system X-ray, Ultrasound abdomen, Colectomy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None 2/24/09-meconium aspiration.
Allergies:
Diagnostic Lab Data: KUB/Abdominal ultrasound 2/24/09-records received-pneumatic enema reduction unsuccessful. Head CT normal. Chest x-ray showed small area of atelectasis.
CDC 'Split Type':

Write-up: Intussusception. Required partial colectomy. 2/24/09-records received for DOS 1/8-1/13/09-DC DX: Intussusception. Presented with 2 day history of lethargy and vomiting, increased fussiness increased reflux. Attempted pneumatic reduction of intussusception unsuccessful. Partial reduction by laparoscopy and partial colectomy with removal of terminal ileum and ileocolostomy. Intussusception irreducile and resection of terminal ileum and right colon.


Changed on 10/14/2018

VAERS ID: 339776 Before After
VAERS Form:1
Age:0.34
Sex:Male
Location:Tennessee
Vaccinated:2009-01-05
Onset:2009-01-08
Submitted:2009-01-12
Entered:2009-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3227AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D16284 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1356X / 2 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Intussusception, Urinary system X-ray, Ultrasound abdomen, Colectomy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None 2/24/09-meconium aspiration.
Allergies:
Diagnostic Lab Data: KUB/Abdominal ultrasound 2/24/09-records received-pneumatic enema reduction unsuccessful. Head CT normal. Chest x-ray showed small area of atelectasis.
CDC 'Split Type':

Write-up: Intussusception. Required partial colectomy. 2/24/09-records received for DOS 1/8-1/13/09-DC DX: Intussusception. Presented with 2 day history of lethargy and vomiting, increased fussiness increased reflux. Attempted pneumatic reduction of intussusception unsuccessful. Partial reduction by laparoscopy and partial colectomy with removal of terminal ileum and ileocolostomy. Intussusception irreducile and resection of terminal ileum and right colon.

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