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This is VAERS ID 340169

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

VAERS ID: 340169
VAERS Form:
Age:0.5
Sex:Male
Location:New York
Vaccinated:2008-12-22
Onset:2009-02-06
Submitted:2009-02-10
Entered:2009-02-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079 / 2 LL / UN
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2787AA / 0 RL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC 808702K / 2 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0924X / 2 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Aspartate aminotransferase increased, Blood albumin increased, Blood creatinine decreased, Haematochezia, Intussusception, Irritability, Somnolence, Urinary system X-ray, Vomiting, X-ray abnormal, Enema administration, Platelet count increased, Neutrophil percentage increased, Globulins decreased, Abdominal X-ray

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None PMH: Currently w/OM & being tx w/oral antibiotics. Family Hx: celiac disease, intussusception & lactose intolerance.
Allergies:
Diagnostic Lab Data: LABS: Abdominal x-ray & KUB abnormal. Segs 47%(H), plts 457(H). Creatinine 8(L), albumin 5.0(H), globulin 2.1(L), AST 42(H).
CDC 'Split Type':

Write-up: Admitted to hospital 2/6/9 for intussusception. 3/9/09 Received hospital medical records of 2/6-2/7/2009. FINAL DX: Ileocecal intussusception Records reveal patient experienced irritability, abdominal pain, curling up in a ball then sleeping immediately after. Vomited at daycare & in evening had bloody stool. Taken to ER where dx w/IS & enema reduced. Admitted overnight for observation, did well & d/c to home.


Changed on 3/2/2010

VAERS ID: 340169 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:New York
Vaccinated:2008-12-22
Onset:2009-02-06
Submitted:2009-02-10
Entered:2009-02-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079 / 2 LL / UN
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2787AA / 0 RL / UN
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC 808702K / 2 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0924X / 2 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Aspartate aminotransferase increased, Blood albumin increased, Blood creatinine decreased, Haematochezia, Intussusception, Irritability, Somnolence, Urinary system X-ray, Vomiting, X-ray abnormal, Enema administration, Platelet count increased, Neutrophil percentage increased, Globulins decreased, Abdominal X-ray

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None PMH: Currently w/OM & being tx w/oral antibiotics. Family Hx: celiac disease, intussusception & lactose intolerance.
Allergies:
Diagnostic Lab Data: LABS: Abdominal x-ray & KUB abnormal. Segs 47%(H), plts 457(H). Creatinine 8(L), albumin 5.0(H), globulin 2.1(L), AST 42(H).
CDC 'Split Type':

Write-up: Admitted to hospital 2/6/9 for intussusception. 3/9/09 Received hospital medical records of 2/6-2/7/2009. FINAL DX: Ileocecal intussusception Records reveal patient experienced irritability, abdominal pain, curling up in a ball then sleeping immediately after. Vomited at daycare & in evening had bloody stool. Taken to ER where dx w/IS & enema reduced. Admitted overnight for observation, did well & d/c to home.


Changed on 4/7/2010

VAERS ID: 340169 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:New York
Vaccinated:2008-12-22
Onset:2009-02-06
Submitted:2009-02-10
Entered:2009-02-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079 / 2 LL / UN
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2787AA / 0 RL / UN
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC 808702K / 2 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0924X / 2 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Aspartate aminotransferase increased, Blood albumin increased, Blood creatinine decreased, Haematochezia, Intussusception, Irritability, Somnolence, Urinary system X-ray, Vomiting, X-ray abnormal, Enema administration, Platelet count increased, Neutrophil percentage increased, Globulins decreased, Abdominal X-ray

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None PMH: Currently w/OM & being tx w/oral antibiotics. Family Hx: celiac disease, intussusception & lactose intolerance.
Allergies:
Diagnostic Lab Data: LABS: Abdominal x-ray & KUB abnormal. Segs 47%(H), plts 457(H). Creatinine 8(L), albumin 5.0(H), globulin 2.1(L), AST 42(H).
CDC 'Split Type':

Write-up: Admitted to hospital 2/6/9 for intussusception. 3/9/09 Received hospital medical records of 2/6-2/7/2009. FINAL DX: Ileocecal intussusception Records reveal patient experienced irritability, abdominal pain, curling up in a ball then sleeping immediately after. Vomited at daycare & in evening had bloody stool. Taken to ER where dx w/IS & enema reduced. Admitted overnight for observation, did well & d/c to home.


Changed on 8/31/2010

VAERS ID: 340169 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:New York
Vaccinated:2008-12-22
Onset:2009-02-06
Submitted:2009-02-10
Entered:2009-02-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079 / 2 LL / UN
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2787AA / 0 RL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 808702K / 2 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0924X / 2 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Aspartate aminotransferase increased, Blood albumin increased, Blood creatinine decreased, Haematochezia, Intussusception, Irritability, Somnolence, Urinary system X-ray, Vomiting, X-ray abnormal, Enema administration, Platelet count increased, Neutrophil percentage increased, Globulins decreased, Abdominal X-ray

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None PMH: Currently w/OM & being tx w/oral antibiotics. Family Hx: celiac disease, intussusception & lactose intolerance.
Allergies:
Diagnostic Lab Data: LABS: Abdominal x-ray & KUB abnormal. Segs 47%(H), plts 457(H). Creatinine 8(L), albumin 5.0(H), globulin 2.1(L), AST 42(H).
CDC 'Split Type':

Write-up: Admitted to hospital 2/6/9 for intussusception. 3/9/09 Received hospital medical records of 2/6-2/7/2009. FINAL DX: Ileocecal intussusception Records reveal patient experienced irritability, abdominal pain, curling up in a ball then sleeping immediately after. Vomited at daycare & in evening had bloody stool. Taken to ER where dx w/IS & enema reduced. Admitted overnight for observation, did well & d/c to home.


Changed on 5/13/2013

VAERS ID: 340169 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:New York
Vaccinated:2008-12-22
Onset:2009-02-06
Submitted:2009-02-10
Entered:2009-02-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079 / 2 LL / UN
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2787AA / 0 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 808702K / 2 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0924X / 2 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0924X / 2 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Aspartate aminotransferase increased, Blood albumin increased, Blood creatinine decreased, Haematochezia, Intussusception, Irritability, Somnolence, Urinary system X-ray, Vomiting, X-ray abnormal, Enema administration, Platelet count increased, Neutrophil percentage increased, Globulins decreased, Abdominal X-ray

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None PMH: Currently w/OM & being tx w/oral antibiotics. Family Hx: celiac disease, intussusception & lactose intolerance.
Allergies:
Diagnostic Lab Data: LABS: Abdominal x-ray & KUB abnormal. Segs 47%(H), plts 457(H). Creatinine 8(L), albumin 5.0(H), globulin 2.1(L), AST 42(H).
CDC 'Split Type':

Write-up: Admitted to hospital 2/6/9 for intussusception. 3/9/09 Received hospital medical records of 2/6-2/7/2009. FINAL DX: Ileocecal intussusception Records reveal patient experienced irritability, abdominal pain, curling up in a ball then sleeping immediately after. Vomited at daycare & in evening had bloody stool. Taken to ER where dx w/IS & enema reduced. Admitted overnight for observation, did well & d/c to home.


Changed on 7/7/2013

VAERS ID: 340169 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:New York
Vaccinated:2008-12-22
Onset:2009-02-06
Submitted:2009-02-10
Entered:2009-02-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079 / 2 LL / UN
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2787AA / 0 RL / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2787AA / 0 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 808702K / 2 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0924X / 2 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Aspartate aminotransferase increased, Blood albumin increased, Blood creatinine decreased, Haematochezia, Intussusception, Irritability, Somnolence, Urinary system X-ray, Vomiting, X-ray abnormal, Enema administration, Platelet count increased, Neutrophil percentage increased, Globulins decreased, Abdominal X-ray

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None PMH: Currently w/OM & being tx w/oral antibiotics. Family Hx: celiac disease, intussusception & lactose intolerance.
Allergies:
Diagnostic Lab Data: LABS: Abdominal x-ray & KUB abnormal. Segs 47%(H), plts 457(H). Creatinine 8(L), albumin 5.0(H), globulin 2.1(L), AST 42(H).
CDC 'Split Type':

Write-up: Admitted to hospital 2/6/9 for intussusception. 3/9/09 Received hospital medical records of 2/6-2/7/2009. FINAL DX: Ileocecal intussusception Records reveal patient experienced irritability, abdominal pain, curling up in a ball then sleeping immediately after. Vomited at daycare & in evening had bloody stool. Taken to ER where dx w/IS & enema reduced. Admitted overnight for observation, did well & d/c to home.


Changed on 4/14/2017

VAERS ID: 340169 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:New York
Vaccinated:2008-12-22
Onset:2009-02-06
Submitted:2009-02-10
Entered:2009-02-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079 / 2 LL / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2787AA / 0 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 808702K / 2 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0924X / 2 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Aspartate aminotransferase increased, Blood albumin increased, Blood creatinine decreased, Haematochezia, Intussusception, Irritability, Somnolence, Urinary system X-ray, Vomiting, X-ray abnormal, Enema administration, Platelet count increased, Neutrophil percentage increased, Globulins decreased, Abdominal X-ray

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None PMH: Currently w/OM & being tx w/oral antibiotics. Family Hx: celiac disease, intussusception & lactose intolerance.
Allergies:
Diagnostic Lab Data: LABS: Abdominal x-ray & KUB abnormal. Segs 47%(H), plts 457(H). Creatinine 8(L), albumin 5.0(H), globulin 2.1(L), AST 42(H).
CDC 'Split Type':

Write-up: Admitted to hospital 2/6/9 for intussusception. 3/9/09 Received hospital medical records of 2/6-2/7/2009. FINAL DX: Ileocecal intussusception Records reveal patient experienced irritability, abdominal pain, curling up in a ball then sleeping immediately after. Vomited at daycare & in evening had bloody stool. Taken to ER where dx w/IS & enema reduced. Admitted overnight for observation, did well & d/c to home.


Changed on 9/14/2017

VAERS ID: 340169 Before After
VAERS Form:(blank) 1
Age:0.5
Sex:Male
Location:New York
Vaccinated:2008-12-22
Onset:2009-02-06
Submitted:2009-02-10
Entered:2009-02-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079 / 2 3 LL / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2787AA / 0 1 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 808702K / 2 3 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0924X / 2 3 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None PMH: Currently w/OM & being tx w/oral antibiotics. Family Hx: celiac disease, intussusception & lactose intolerance.
Allergies:
Diagnostic Lab Data: LABS: Abdominal x-ray & KUB abnormal. Segs 47%(H), plts 457(H). Creatinine 8(L), albumin 5.0(H), globulin 2.1(L), AST 42(H).
CDC 'Split Type':

Write-up: Admitted to hospital 2/6/9 for intussusception. 3/9/09 Received hospital medical records of 2/6-2/7/2009. FINAL DX: Ileocecal intussusception Records reveal patient experienced irritability, abdominal pain, curling up in a ball then sleeping immediately after. Vomited at daycare & in evening had bloody stool. Taken to ER where dx w/IS & enema reduced. Admitted overnight for observation, did well & d/c to home.


Changed on 2/14/2018

VAERS ID: 340169 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:New York
Vaccinated:2008-12-22
Onset:2009-02-06
Submitted:2009-02-10
Entered:2009-02-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079 / 3 LL / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2787AA / 1 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 808702K / 3 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0924X / 3 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None PMH: Currently w/OM & being tx w/oral antibiotics. Family Hx: celiac disease, intussusception & lactose intolerance.
Allergies:
Diagnostic Lab Data: LABS: Abdominal x-ray & KUB abnormal. Segs 47%(H), plts 457(H). Creatinine 8(L), albumin 5.0(H), globulin 2.1(L), AST 42(H).
CDC 'Split Type':

Write-up: Admitted to hospital 2/6/9 for intussusception. 3/9/09 Received hospital medical records of 2/6-2/7/2009. FINAL DX: Ileocecal intussusception Records reveal patient experienced irritability, abdominal pain, curling up in a ball then sleeping immediately after. Vomited at daycare & in evening had bloody stool. Taken to ER where dx w/IS & enema reduced. Admitted overnight for observation, did well & d/c to home.


Changed on 6/14/2018

VAERS ID: 340169 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:New York
Vaccinated:2008-12-22
Onset:2009-02-06
Submitted:2009-02-10
Entered:2009-02-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079 / 3 LL / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2787AA / 1 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 808702K / 3 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0924X / 3 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None PMH: Currently w/OM & being tx w/oral antibiotics. Family Hx: celiac disease, intussusception & lactose intolerance.
Allergies:
Diagnostic Lab Data: LABS: Abdominal x-ray & KUB abnormal. Segs 47%(H), plts 457(H). Creatinine 8(L), albumin 5.0(H), globulin 2.1(L), AST 42(H).
CDC 'Split Type':

Write-up: Admitted to hospital 2/6/9 for intussusception. 3/9/09 Received hospital medical records of 2/6-2/7/2009. FINAL DX: Ileocecal intussusception Records reveal patient experienced irritability, abdominal pain, curling up in a ball then sleeping immediately after. Vomited at daycare & in evening had bloody stool. Taken to ER where dx w/IS & enema reduced. Admitted overnight for observation, did well & d/c to home.


Changed on 8/14/2018

VAERS ID: 340169 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:New York
Vaccinated:2008-12-22
Onset:2009-02-06
Submitted:2009-02-10
Entered:2009-02-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079 / 3 LL / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2787AA / 1 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 808702K / 3 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0924X / 3 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None PMH: Currently w/OM & being tx w/oral antibiotics. Family Hx: celiac disease, intussusception & lactose intolerance.
Allergies:
Diagnostic Lab Data: LABS: Abdominal x-ray & KUB abnormal. Segs 47%(H), plts 457(H). Creatinine 8(L), albumin 5.0(H), globulin 2.1(L), AST 42(H).
CDC 'Split Type':

Write-up: Admitted to hospital 2/6/9 for intussusception. 3/9/09 Received hospital medical records of 2/6-2/7/2009. FINAL DX: Ileocecal intussusception Records reveal patient experienced irritability, abdominal pain, curling up in a ball then sleeping immediately after. Vomited at daycare & in evening had bloody stool. Taken to ER where dx w/IS & enema reduced. Admitted overnight for observation, did well & d/c to home.


Changed on 9/14/2018

VAERS ID: 340169 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:New York
Vaccinated:2008-12-22
Onset:2009-02-06
Submitted:2009-02-10
Entered:2009-02-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079 / 3 LL / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2787AA / 1 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 808702K / 3 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0924X / 3 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None PMH: Currently w/OM & being tx w/oral antibiotics. Family Hx: celiac disease, intussusception & lactose intolerance.
Allergies:
Diagnostic Lab Data: LABS: Abdominal x-ray & KUB abnormal. Segs 47%(H), plts 457(H). Creatinine 8(L), albumin 5.0(H), globulin 2.1(L), AST 42(H).
CDC 'Split Type':

Write-up: Admitted to hospital 2/6/9 for intussusception. 3/9/09 Received hospital medical records of 2/6-2/7/2009. FINAL DX: Ileocecal intussusception Records reveal patient experienced irritability, abdominal pain, curling up in a ball then sleeping immediately after. Vomited at daycare & in evening had bloody stool. Taken to ER where dx w/IS & enema reduced. Admitted overnight for observation, did well & d/c to home.


Changed on 10/14/2018

VAERS ID: 340169 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:New York
Vaccinated:2008-12-22
Onset:2009-02-06
Submitted:2009-02-10
Entered:2009-02-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079 / 3 LL / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2787AA / 1 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 808702K / 3 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0924X / 3 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None PMH: Currently w/OM & being tx w/oral antibiotics. Family Hx: celiac disease, intussusception & lactose intolerance.
Allergies:
Diagnostic Lab Data: LABS: Abdominal x-ray & KUB abnormal. Segs 47%(H), plts 457(H). Creatinine 8(L), albumin 5.0(H), globulin 2.1(L), AST 42(H).
CDC 'Split Type':

Write-up: Admitted to hospital 2/6/9 for intussusception. 3/9/09 Received hospital medical records of 2/6-2/7/2009. FINAL DX: Ileocecal intussusception Records reveal patient experienced irritability, abdominal pain, curling up in a ball then sleeping immediately after. Vomited at daycare & in evening had bloody stool. Taken to ER where dx w/IS & enema reduced. Admitted overnight for observation, did well & d/c to home.

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