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This is VAERS ID 354417

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

VAERS ID: 354417
VAERS Form:
Age:0.3
Gender:Male
Location:Illinois
Vaccinated:2009-07-30
Onset:2009-08-11
Submitted:2009-08-17
Entered:2009-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPPHIB: DTP + IPV + ACT-HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER C3237AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D48928 / 1 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA802A / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Barium enema, Blood chloride increased, Blood glucose increased, Blood potassium increased, Dehydration, Diarrhoea, Full blood count, Gastroenteritis, Haematochezia, Intussusception, Lethargy, Mean cell volume decreased, Mucous stools, Pallor, Vomiting, White blood cell count increased, X-ray abnormal, Ultrasound abdomen abnormal, Occult blood positive, Metabolic function test, Rotavirus test negative

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: CBC, BMP, STOOL FOR ROTAVIRUS, Ba ENEMA STUDY. 9/3/09 Hospital records received DOS 8/11/09 to 8/14/2009. LABS and DIAGNOSTICS: Ultrasound Abdomen - Abnormal. X-ray Abdomen - Abnormal. Stool Rotavirus (-). Guaiac (+). CBC - WBC 19.78 /mm3 (
CDC 'Split Type':

Write-up: THE PATIENT PRESENTED WITH DIARRHEA ON AUG 11, 2209. BECAUSE OF PERSITENT DIARRHEA, PATIENT WENT TO ER AT HOSPITAL AND WAS TRANSFERRED TO ANOTHER HOSPITAL. THE PATIENT WAS WORKED UP AND REHYDRATED. ON DAY 3 OF HOSPITALIZATION,THE PATIENT HAD EMESIS AND BLOODY STOOLS. HE WAS DIAGNOSED AS HAVING INTUSSUSCEPTION AND WAS REDUCED WITH Ba ENEMA. THE PATIENT WAS DISCHARGED NEXT DAY. 9/3/09 Hospital records received DOS 8/11/09 to 8/14/2009. Assessment: Dehydration, Gastroenteritis, Intussusception. Patient was seen at outside ED, given bolus of fluids and transfered. Patient presented on the day of admission with a 2 day history of diarrhea and a one day history of vomiting. Increased output of mucosy blood-tinged stools. Decreased PO intake and urine output, not producing tears, pale. Lethargic. Belly distended and tender. Reduction of intussusception with barium enema. ICD-9 Codes: 276.51 Dehydration, 558.9Y Gastroenteritis, 560.0 Intussusception.


Changed on 3/2/2010

VAERS ID: 354417 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Illinois
Vaccinated:2009-07-30
Onset:2009-08-11
Submitted:2009-08-17
Entered:2009-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPPHIB: DTP + IPV + ACT-HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER C3237AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC D48928 / 1 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA802A / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Barium enema, Blood chloride increased, Blood glucose increased, Blood potassium increased, Dehydration, Diarrhoea, Full blood count, Gastroenteritis, Haematochezia, Intussusception, Lethargy, Mean cell volume decreased, Mucous stools, Pallor, Vomiting, White blood cell count increased, X-ray abnormal, Ultrasound abdomen abnormal, Occult blood positive, Metabolic function test, Rotavirus test negative

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: CBC, BMP, STOOL FOR ROTAVIRUS, Ba ENEMA STUDY. 9/3/09 Hospital records received DOS 8/11/09 to 8/14/2009. LABS and DIAGNOSTICS: Ultrasound Abdomen - Abnormal. X-ray Abdomen - Abnormal. Stool Rotavirus (-). Guaiac (+). CBC - WBC 19.78 /mm3 (
CDC 'Split Type':

Write-up: THE PATIENT PRESENTED WITH DIARRHEA ON AUG 11, 2209. BECAUSE OF PERSITENT DIARRHEA, PATIENT WENT TO ER AT HOSPITAL AND WAS TRANSFERRED TO ANOTHER HOSPITAL. THE PATIENT WAS WORKED UP AND REHYDRATED. ON DAY 3 OF HOSPITALIZATION,THE PATIENT HAD EMESIS AND BLOODY STOOLS. HE WAS DIAGNOSED AS HAVING INTUSSUSCEPTION AND WAS REDUCED WITH Ba ENEMA. THE PATIENT WAS DISCHARGED NEXT DAY. 9/3/09 Hospital records received DOS 8/11/09 to 8/14/2009. Assessment: Dehydration, Gastroenteritis, Intussusception. Patient was seen at outside ED, given bolus of fluids and transfered. Patient presented on the day of admission with a 2 day history of diarrhea and a one day history of vomiting. Increased output of mucosy blood-tinged stools. Decreased PO intake and urine output, not producing tears, pale. Lethargic. Belly distended and tender. Reduction of intussusception with barium enema. ICD-9 Codes: 276.51 Dehydration, 558.9Y Gastroenteritis, 560.0 Intussusception.


Changed on 4/7/2010

VAERS ID: 354417 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Illinois
Vaccinated:2009-07-30
Onset:2009-08-11
Submitted:2009-08-17
Entered:2009-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPPHIB: DTP + IPV + ACT-HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER C3237AA / 1 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D48928 / 1 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA802A / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Barium enema, Blood chloride increased, Blood glucose increased, Blood potassium increased, Dehydration, Diarrhoea, Full blood count, Gastroenteritis, Haematochezia, Intussusception, Lethargy, Mean cell volume decreased, Mucous stools, Pallor, Vomiting, White blood cell count increased, X-ray abnormal, Ultrasound abdomen abnormal, Occult blood positive, Metabolic function test, Rotavirus test negative

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: CBC, BMP, STOOL FOR ROTAVIRUS, Ba ENEMA STUDY. 9/3/09 Hospital records received DOS 8/11/09 to 8/14/2009. LABS and DIAGNOSTICS: Ultrasound Abdomen - Abnormal. X-ray Abdomen - Abnormal. Stool Rotavirus (-). Guaiac (+). CBC - WBC 19.78 /mm3 (
CDC 'Split Type':

Write-up: THE PATIENT PRESENTED WITH DIARRHEA ON AUG 11, 2209. BECAUSE OF PERSITENT DIARRHEA, PATIENT WENT TO ER AT HOSPITAL AND WAS TRANSFERRED TO ANOTHER HOSPITAL. THE PATIENT WAS WORKED UP AND REHYDRATED. ON DAY 3 OF HOSPITALIZATION,THE PATIENT HAD EMESIS AND BLOODY STOOLS. HE WAS DIAGNOSED AS HAVING INTUSSUSCEPTION AND WAS REDUCED WITH Ba ENEMA. THE PATIENT WAS DISCHARGED NEXT DAY. 9/3/09 Hospital records received DOS 8/11/09 to 8/14/2009. Assessment: Dehydration, Gastroenteritis, Intussusception. Patient was seen at outside ED, given bolus of fluids and transfered. Patient presented on the day of admission with a 2 day history of diarrhea and a one day history of vomiting. Increased output of mucosy blood-tinged stools. Decreased PO intake and urine output, not producing tears, pale. Lethargic. Belly distended and tender. Reduction of intussusception with barium enema. ICD-9 Codes: 276.51 Dehydration, 558.9Y Gastroenteritis, 560.0 Intussusception.


Changed on 8/31/2010

VAERS ID: 354417 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Illinois
Vaccinated:2009-07-30
Onset:2009-08-11
Submitted:2009-08-17
Entered:2009-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPPHIB: DTP + IPV + ACT-HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER C3237AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH D48928 / 1 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA802A / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Barium enema, Blood chloride increased, Blood glucose increased, Blood potassium increased, Dehydration, Diarrhoea, Full blood count, Gastroenteritis, Haematochezia, Intussusception, Lethargy, Mean cell volume decreased, Mucous stools, Pallor, Vomiting, White blood cell count increased, X-ray abnormal, Ultrasound abdomen abnormal, Occult blood positive, Metabolic function test, Rotavirus test negative

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: CBC, BMP, STOOL FOR ROTAVIRUS, Ba ENEMA STUDY. 9/3/09 Hospital records received DOS 8/11/09 to 8/14/2009. LABS and DIAGNOSTICS: Ultrasound Abdomen - Abnormal. X-ray Abdomen - Abnormal. Stool Rotavirus (-). Guaiac (+). CBC - WBC 19.78 /mm3 (
CDC 'Split Type':

Write-up: THE PATIENT PRESENTED WITH DIARRHEA ON AUG 11, 2209. BECAUSE OF PERSITENT DIARRHEA, PATIENT WENT TO ER AT HOSPITAL AND WAS TRANSFERRED TO ANOTHER HOSPITAL. THE PATIENT WAS WORKED UP AND REHYDRATED. ON DAY 3 OF HOSPITALIZATION,THE PATIENT HAD EMESIS AND BLOODY STOOLS. HE WAS DIAGNOSED AS HAVING INTUSSUSCEPTION AND WAS REDUCED WITH Ba ENEMA. THE PATIENT WAS DISCHARGED NEXT DAY. 9/3/09 Hospital records received DOS 8/11/09 to 8/14/2009. Assessment: Dehydration, Gastroenteritis, Intussusception. Patient was seen at outside ED, given bolus of fluids and transfered. Patient presented on the day of admission with a 2 day history of diarrhea and a one day history of vomiting. Increased output of mucosy blood-tinged stools. Decreased PO intake and urine output, not producing tears, pale. Lethargic. Belly distended and tender. Reduction of intussusception with barium enema. ICD-9 Codes: 276.51 Dehydration, 558.9Y Gastroenteritis, 560.0 Intussusception.


Changed on 5/13/2013

VAERS ID: 354417 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Illinois
Vaccinated:2009-07-30
Onset:2009-08-11
Submitted:2009-08-17
Entered:2009-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPPHIB: DTP + IPV + ACT-HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER C3237AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D48928 / 1 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA802A / 1 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA802A / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Barium enema, Blood chloride increased, Blood glucose increased, Blood potassium increased, Dehydration, Diarrhoea, Full blood count, Gastroenteritis, Haematochezia, Intussusception, Lethargy, Mean cell volume decreased, Mucous stools, Pallor, Vomiting, White blood cell count increased, X-ray abnormal, Ultrasound abdomen abnormal, Occult blood positive, Metabolic function test, Rotavirus test negative

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: CBC, BMP, STOOL FOR ROTAVIRUS, Ba ENEMA STUDY. 9/3/09 Hospital records received DOS 8/11/09 to 8/14/2009. LABS and DIAGNOSTICS: Ultrasound Abdomen - Abnormal. X-ray Abdomen - Abnormal. Stool Rotavirus (-). Guaiac (+). CBC - WBC 19.78 /mm3 (
CDC 'Split Type':

Write-up: THE PATIENT PRESENTED WITH DIARRHEA ON AUG 11, 2209. BECAUSE OF PERSITENT DIARRHEA, PATIENT WENT TO ER AT HOSPITAL AND WAS TRANSFERRED TO ANOTHER HOSPITAL. THE PATIENT WAS WORKED UP AND REHYDRATED. ON DAY 3 OF HOSPITALIZATION,THE PATIENT HAD EMESIS AND BLOODY STOOLS. HE WAS DIAGNOSED AS HAVING INTUSSUSCEPTION AND WAS REDUCED WITH Ba ENEMA. THE PATIENT WAS DISCHARGED NEXT DAY. 9/3/09 Hospital records received DOS 8/11/09 to 8/14/2009. Assessment: Dehydration, Gastroenteritis, Intussusception. Patient was seen at outside ED, given bolus of fluids and transfered. Patient presented on the day of admission with a 2 day history of diarrhea and a one day history of vomiting. Increased output of mucosy blood-tinged stools. Decreased PO intake and urine output, not producing tears, pale. Lethargic. Belly distended and tender. Reduction of intussusception with barium enema. ICD-9 Codes: 276.51 Dehydration, 558.9Y Gastroenteritis, 560.0 Intussusception.


Changed on 2/14/2017

VAERS ID: 354417 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Illinois
Vaccinated:2009-07-30
Onset:2009-08-11
Submitted:2009-08-17
Entered:2009-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPPHIB: DTP + IPV + ACT-HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER C3237AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D48928 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA802A / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Barium enema, Blood chloride increased, Blood glucose increased, Blood potassium increased, Dehydration, Diarrhoea, Full blood count, Gastroenteritis, Haematochezia, Intussusception, Lethargy, Mean cell volume decreased, Mucous stools, Pallor, Vomiting, White blood cell count increased, X-ray abnormal, Ultrasound abdomen abnormal, Occult blood positive, Metabolic function test, Rotavirus test negative

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: CBC, BMP, STOOL FOR ROTAVIRUS, Ba ENEMA STUDY. 9/3/09 Hospital records received DOS 8/11/09 to 8/14/2009. LABS and DIAGNOSTICS: Ultrasound Abdomen - Abnormal. X-ray Abdomen - Abnormal. Stool Rotavirus (-). Guaiac (+). CBC - WBC 19.78 /mm3 ( (H) MCV um3 (L). CHEM - Potassium 6.8 mEq/L (H) Chloride 113 mEq/L (H) Glucose 111 mg/dL (H).
CDC 'Split Type':

Write-up: THE PATIENT PRESENTED WITH DIARRHEA ON AUG 11, 2209. BECAUSE OF PERSITENT DIARRHEA, PATIENT WENT TO ER AT HOSPITAL AND WAS TRANSFERRED TO ANOTHER HOSPITAL. THE PATIENT WAS WORKED UP AND REHYDRATED. ON DAY 3 OF HOSPITALIZATION,THE PATIENT HAD EMESIS AND BLOODY STOOLS. HE WAS DIAGNOSED AS HAVING INTUSSUSCEPTION AND WAS REDUCED WITH Ba ENEMA. THE PATIENT WAS DISCHARGED NEXT DAY. 9/3/09 Hospital records received DOS 8/11/09 to 8/14/2009. Assessment: Dehydration, Gastroenteritis, Intussusception. Patient was seen at outside ED, given bolus of fluids and transfered. Patient presented on the day of admission with a 2 day history of diarrhea and a one day history of vomiting. Increased output of mucosy blood-tinged stools. Decreased PO intake and urine output, not producing tears, pale. Lethargic. Belly distended and tender. Reduction of intussusception with barium enema. ICD-9 Codes: 276.51 Dehydration, 558.9Y Gastroenteritis, 560.0 Intussusception.


Changed on 9/14/2017

VAERS ID: 354417 Before After
VAERS Form:(blank) 1
Age:0.3
Gender:Male
Location:Illinois
Vaccinated:2009-07-30
Onset:2009-08-11
Submitted:2009-08-17
Entered:2009-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPPHIB: DTP + IPV + ACT-HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER C3237AA / 1 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D48928 / 1 2 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA802A / 1 2 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Diarrhoea, Full blood count, Haematochezia, Intussusception, Vomiting, Metabolic function test

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: CBC, BMP, STOOL FOR ROTAVIRUS, Ba ENEMA STUDY. 9/3/09 Hospital records received DOS 8/11/09 to 8/14/2009. LABS and DIAGNOSTICS: Ultrasound Abdomen - Abnormal. X-ray Abdomen - Abnormal. Stool Rotavirus (-). Guaiac (+). CBC - WBC 19.78 /mm3 (H) MCV um3 (L). CHEM - Potassium 6.8 mEq/L (H) Chloride 113 mEq/L (H) Glucose 111 mg/dL (H).
CDC 'Split Type':

Write-up: THE PATIENT PRESENTED WITH DIARRHEA ON AUG 11, 2209. BECAUSE OF PERSITENT DIARRHEA, PATIENT WENT TO ER AT HOSPITAL AND WAS TRANSFERRED TO ANOTHER HOSPITAL. THE PATIENT WAS WORKED UP AND REHYDRATED. ON DAY 3 OF HOSPITALIZATION,THE PATIENT HAD EMESIS AND BLOODY STOOLS. HE WAS DIAGNOSED AS HAVING INTUSSUSCEPTION AND WAS REDUCED WITH Ba ENEMA. THE PATIENT WAS DISCHARGED NEXT DAY. 9/3/09 Hospital records received DOS 8/11/09 to 8/14/2009. Assessment: Dehydration, Gastroenteritis, Intussusception. Patient was seen at outside ED, given bolus of fluids and transfered. Patient presented on the day of admission with a 2 day history of diarrhea and a one day history of vomiting. Increased output of mucosy blood-tinged stools. Decreased PO intake and urine output, not producing tears, pale. Lethargic. Belly distended and tender. Reduction of intussusception with barium enema. ICD-9 Codes: 276.51 Dehydration, 558.9Y Gastroenteritis, 560.0 Intussusception.


Changed on 2/14/2018

VAERS ID: 354417 Before After
VAERS Form:1
Age:0.3
Gender:Male
Location:Illinois
Vaccinated:2009-07-30
Onset:2009-08-11
Submitted:2009-08-17
Entered:2009-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPPHIB: DTP + IPV + ACT-HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER C3237AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D48928 / 2 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA802A / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Diarrhoea, Full blood count, Haematochezia, Intussusception, Vomiting, Metabolic function test

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: CBC, BMP, STOOL FOR ROTAVIRUS, Ba ENEMA STUDY. 9/3/09 Hospital records received DOS 8/11/09 to 8/14/2009. LABS and DIAGNOSTICS: Ultrasound Abdomen - Abnormal. X-ray Abdomen - Abnormal. Stool Rotavirus (-). Guaiac (+). CBC - WBC 19.78 /mm3 (H) MCV um3 (L). CHEM - Potassium 6.8 mEq/L (H) Chloride 113 mEq/L (H) Glucose 111 mg/dL (H).
CDC 'Split Type':

Write-up: THE PATIENT PRESENTED WITH DIARRHEA ON AUG 11, 2209. BECAUSE OF PERSITENT DIARRHEA, PATIENT WENT TO ER AT HOSPITAL AND WAS TRANSFERRED TO ANOTHER HOSPITAL. THE PATIENT WAS WORKED UP AND REHYDRATED. ON DAY 3 OF HOSPITALIZATION,THE PATIENT HAD EMESIS AND BLOODY STOOLS. HE WAS DIAGNOSED AS HAVING INTUSSUSCEPTION AND WAS REDUCED WITH Ba ENEMA. THE PATIENT WAS DISCHARGED NEXT DAY. 9/3/09 Hospital records received DOS 8/11/09 to 8/14/2009. Assessment: Dehydration, Gastroenteritis, Intussusception. Patient was seen at outside ED, given bolus of fluids and transfered. Patient presented on the day of admission with a 2 day history of diarrhea and a one day history of vomiting. Increased output of mucosy blood-tinged stools. Decreased PO intake and urine output, not producing tears, pale. Lethargic. Belly distended and tender. Reduction of intussusception with barium enema. ICD-9 Codes: 276.51 Dehydration, 558.9Y Gastroenteritis, 560.0 Intussusception.


Changed on 6/14/2018

VAERS ID: 354417 Before After
VAERS Form:1
Age:0.3
Gender:Male
Location:Illinois
Vaccinated:2009-07-30
Onset:2009-08-11
Submitted:2009-08-17
Entered:2009-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPPHIB: DTP + IPV + ACT-HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER C3237AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D48928 / 2 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA802A / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Diarrhoea, Full blood count, Haematochezia, Intussusception, Vomiting, Metabolic function test

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: CBC, BMP, STOOL FOR ROTAVIRUS, Ba ENEMA STUDY. 9/3/09 Hospital records received DOS 8/11/09 to 8/14/2009. LABS and DIAGNOSTICS: Ultrasound Abdomen - Abnormal. X-ray Abdomen - Abnormal. Stool Rotavirus (-). Guaiac (+). CBC - WBC 19.78 /mm3 (H) MCV um3 (L). CHEM - Potassium 6.8 mEq/L (H) Chloride 113 mEq/L (H) Glucose 111 mg/dL (H).
CDC 'Split Type':

Write-up: THE PATIENT PRESENTED WITH DIARRHEA ON AUG 11, 2209. BECAUSE OF PERSITENT DIARRHEA, PATIENT WENT TO ER AT HOSPITAL AND WAS TRANSFERRED TO ANOTHER HOSPITAL. THE PATIENT WAS WORKED UP AND REHYDRATED. ON DAY 3 OF HOSPITALIZATION,THE PATIENT HAD EMESIS AND BLOODY STOOLS. HE WAS DIAGNOSED AS HAVING INTUSSUSCEPTION AND WAS REDUCED WITH Ba ENEMA. THE PATIENT WAS DISCHARGED NEXT DAY. 9/3/09 Hospital records received DOS 8/11/09 to 8/14/2009. Assessment: Dehydration, Gastroenteritis, Intussusception. Patient was seen at outside ED, given bolus of fluids and transfered. Patient presented on the day of admission with a 2 day history of diarrhea and a one day history of vomiting. Increased output of mucosy blood-tinged stools. Decreased PO intake and urine output, not producing tears, pale. Lethargic. Belly distended and tender. Reduction of intussusception with barium enema. ICD-9 Codes: 276.51 Dehydration, 558.9Y Gastroenteritis, 560.0 Intussusception.

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