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This is VAERS ID 368114

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

VAERS ID: 368114
VAERS Form:
Age:0.5
Gender:Male
Location:Iowa
Vaccinated:2009-10-13
Onset:2009-10-31
Submitted:2009-11-09
Entered:2009-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B213AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF729AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D90888 / 1 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA818A / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Full blood count, Intussusception, Urine analysis, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None. ED record and vaccination records received for date of service 10/31/09. PMH: None.
Allergies:
Diagnostic Lab Data: ED record and vaccination records received for date of service 10/31/09. Labs and diagnostics: UA. Labs: CBC, CMP Dx studies: air contrast barium enema
CDC 'Split Type':

Write-up: Intussusception resolved with Barium Enema after special Enema on 11/1/09. 11/18 & 11/19/09: ED record and vaccination records received for date of service 10/31/09. Dx: Intussusception Assessment: Presents with intussusception, admitted. 12/10/2009 ED record, Admission and consult notes for 10/31-11/1/2009, patient with c/o''s persistent vomiting x 2 days. Tx: IVF, NPO, barium enema + for intussusception


Changed on 3/2/2010

VAERS ID: 368114 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Iowa
Vaccinated:2009-10-13
Onset:2009-10-31
Submitted:2009-11-09
Entered:2009-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B213AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF729AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC D90888 / 1 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA818A / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Full blood count, Intussusception, Urine analysis, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None. ED record and vaccination records received for date of service 10/31/09. PMH: None.
Allergies:
Diagnostic Lab Data: ED record and vaccination records received for date of service 10/31/09. Labs and diagnostics: UA. Labs: CBC, CMP Dx studies: air contrast barium enema
CDC 'Split Type':

Write-up: Intussusception resolved with Barium Enema after special Enema on 11/1/09. 11/18 & 11/19/09: ED record and vaccination records received for date of service 10/31/09. Dx: Intussusception Assessment: Presents with intussusception, admitted. 12/10/2009 ED record, Admission and consult notes for 10/31-11/1/2009, patient with c/o''s persistent vomiting x 2 days. Tx: IVF, NPO, barium enema + for intussusception


Changed on 4/7/2010

VAERS ID: 368114 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Iowa
Vaccinated:2009-10-13
Onset:2009-10-31
Submitted:2009-11-09
Entered:2009-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B213AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF729AA / 1 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D90888 / 1 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA818A / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Full blood count, Intussusception, Urine analysis, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None. ED record and vaccination records received for date of service 10/31/09. PMH: None.
Allergies:
Diagnostic Lab Data: ED record and vaccination records received for date of service 10/31/09. Labs and diagnostics: UA. Labs: CBC, CMP Dx studies: air contrast barium enema
CDC 'Split Type':

Write-up: Intussusception resolved with Barium Enema after special Enema on 11/1/09. 11/18 & 11/19/09: ED record and vaccination records received for date of service 10/31/09. Dx: Intussusception Assessment: Presents with intussusception, admitted. 12/10/2009 ED record, Admission and consult notes for 10/31-11/1/2009, patient with c/o''s persistent vomiting x 2 days. Tx: IVF, NPO, barium enema + for intussusception


Changed on 5/11/2010

VAERS ID: 368114 Before After
VAERS Form:
Age:0.5 0.6
Gender:Male
Location:Iowa
Vaccinated:2009-10-13 2009-10-26
Onset:2009-10-31
Submitted:2009-11-09
Entered:2009-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B213AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF729AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D90888 / 1 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA818A A41CA943A / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Full blood count, Intussusception, Urine analysis, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None. ED record and vaccination records received for date of service 10/31/09. PMH: None.
Allergies:
Diagnostic Lab Data: ED record and vaccination records received for date of service 10/31/09. Labs and diagnostics: UA. Labs: CBC, CMP Dx studies: air contrast barium enema
CDC 'Split Type':

Write-up: Intussusception resolved with Barium Enema after special Enema on 11/1/09. 11/18 & 11/19/09: ED record and vaccination records received for date of service 10/31/09. Dx: Intussusception Assessment: Presents with intussusception, admitted. 12/10/2009 ED record, Admission and consult notes for 10/31-11/1/2009, patient with c/o''s persistent vomiting x 2 days. Tx: IVF, NPO, barium enema + for intussusception


Changed on 8/31/2010

VAERS ID: 368114 Before After
VAERS Form:
Age:0.6
Gender:Male
Location:Iowa
Vaccinated:2009-10-26
Onset:2009-10-31
Submitted:2009-11-09
Entered:2009-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B213AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF729AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH D90888 / 1 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA943A / 1 - / 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)? 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. ED record and vaccination records received for date of service 10/31/09. PMH: None.
Allergies:
Diagnostic Lab Data: ED record and vaccination records received for date of service 10/31/09. Labs and diagnostics: UA. Labs: CBC, CMP Dx studies: air contrast barium enema
CDC 'Split Type':

Write-up: Intussusception resolved with Barium Enema after special Enema on 11/1/09. 11/18 & 11/19/09: ED record and vaccination records received for date of service 10/31/09. Dx: Intussusception Assessment: Presents with intussusception, admitted. 12/10/2009 ED record, Admission and consult notes for 10/31-11/1/2009, patient with c/o''s persistent vomiting x 2 days. Tx: IVF, NPO, barium enema + for intussusception


Changed on 4/13/2011

VAERS ID: 368114 Before After
VAERS Form:
Age:0.6
Gender:Male
Location:Iowa
Vaccinated:2009-10-26
Onset:2009-10-31
Submitted:2009-11-09
Entered:2009-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B213AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF729AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D90888 / 1 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA943A / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Full blood count, Intussusception, Urine analysis, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None. ED record and vaccination records received for date of service 10/31/09. PMH: None.
Allergies:
Diagnostic Lab Data: ED record and vaccination records received for date of service 10/31/09. Labs and diagnostics: UA. Labs: CBC, CMP Dx studies: air contrast barium enema
CDC 'Split Type':

Write-up: Intussusception resolved with Barium Enema after special Enema on 11/1/09. 11/18 & 11/19/09: ED record and vaccination records received for date of service 10/31/09. Dx: Intussusception Assessment: Presents with intussusception, admitted. 12/10/2009 ED record, Admission and consult notes for 10/31-11/1/2009, patient with c/o''s persistent vomiting x 2 days. Tx: IVF, NPO, barium enema + for intussusception


Changed on 5/13/2011

VAERS ID: 368114 Before After
VAERS Form:
Age:0.6
Gender:Male
Location:Iowa
Vaccinated:2009-10-26
Onset:2009-10-31
Submitted:2009-11-09
Entered:2009-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B213AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF729AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D90888 / 1 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA943A / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Full blood count, Intussusception, Urine analysis, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None. ED record and vaccination records received for date of service 10/31/09. PMH: None.
Allergies:
Diagnostic Lab Data: ED record and vaccination records received for date of service 10/31/09. Labs and diagnostics: UA. Labs: CBC, CMP Dx studies: air contrast barium enema
CDC 'Split Type':

Write-up: Intussusception resolved with Barium Enema after special Enema on 11/1/09. 11/18 & 11/19/09: ED record and vaccination records received for date of service 10/31/09. Dx: Intussusception Assessment: Presents with intussusception, admitted. 12/10/2009 ED record, Admission and consult notes for 10/31-11/1/2009, patient with c/o''s persistent vomiting x 2 days. Tx: IVF, NPO, barium enema + for intussusception


Changed on 6/11/2011

VAERS ID: 368114 Before After
VAERS Form:
Age:0.6
Gender:Male
Location:Iowa
Vaccinated:2009-10-26
Onset:2009-10-31
Submitted:2009-11-09
Entered:2009-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B213AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF729AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D90888 / 1 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA943A / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Full blood count, Intussusception, Urine analysis, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None. ED record and vaccination records received for date of service 10/31/09. PMH: None.
Allergies:
Diagnostic Lab Data: ED record and vaccination records received for date of service 10/31/09. Labs and diagnostics: UA. Labs: CBC, CMP Dx studies: air contrast barium enema
CDC 'Split Type':

Write-up: Intussusception resolved with Barium Enema after special Enema on 11/1/09. 11/18 & 11/19/09: ED record and vaccination records received for date of service 10/31/09. Dx: Intussusception Assessment: Presents with intussusception, admitted. 12/10/2009 ED record, Admission and consult notes for 10/31-11/1/2009, patient with c/o''s persistent vomiting x 2 days. Tx: IVF, NPO, barium enema + for intussusception


Changed on 5/13/2013

VAERS ID: 368114 Before After
VAERS Form:
Age:0.6
Gender:Male
Location:Iowa
Vaccinated:2009-10-26
Onset:2009-10-31
Submitted:2009-11-09
Entered:2009-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B213AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF729AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D90888 / 1 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA943A / 1 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA943A / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Full blood count, Intussusception, Urine analysis, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None. ED record and vaccination records received for date of service 10/31/09. PMH: None.
Allergies:
Diagnostic Lab Data: ED record and vaccination records received for date of service 10/31/09. Labs and diagnostics: UA. Labs: CBC, CMP Dx studies: air contrast barium enema
CDC 'Split Type':

Write-up: Intussusception resolved with Barium Enema after special Enema on 11/1/09. 11/18 & 11/19/09: ED record and vaccination records received for date of service 10/31/09. Dx: Intussusception Assessment: Presents with intussusception, admitted. 12/10/2009 ED record, Admission and consult notes for 10/31-11/1/2009, patient with c/o''s persistent vomiting x 2 days. Tx: IVF, NPO, barium enema + for intussusception


Changed on 2/14/2017

VAERS ID: 368114 Before After
VAERS Form:
Age:0.6 0.55
Gender:Male
Location:Iowa
Vaccinated:2009-10-26
Onset:2009-10-31
Submitted:2009-11-09
Entered:2009-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B213AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF729AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D90888 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA943A / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Full blood count, Intussusception, Urine analysis, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None. ED record and vaccination records received for date of service 10/31/09. PMH: None.
Allergies:
Diagnostic Lab Data: ED record and vaccination records received for date of service 10/31/09. Labs and diagnostics: UA. Labs: CBC, CMP Dx studies: air contrast barium enema
CDC 'Split Type':

Write-up: Intussusception resolved with Barium Enema after special Enema on 11/1/09. 11/18 & 11/19/09: ED record and vaccination records received for date of service 10/31/09. Dx: Intussusception Assessment: Presents with intussusception, admitted. 12/10/2009 ED record, Admission and consult notes for 10/31-11/1/2009, patient with c/o''s persistent vomiting x 2 days. Tx: IVF, NPO, barium enema + for intussusception


Changed on 4/14/2017

VAERS ID: 368114 Before After
VAERS Form:
Age:0.55
Gender:Male
Location:Iowa
Vaccinated:2009-10-26
Onset:2009-10-31
Submitted:2009-11-09
Entered:2009-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B213AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF729AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D90888 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA943A / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Full blood count, Intussusception, Urine analysis, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None. ED record and vaccination records received for date of service 10/31/09. PMH: None.
Allergies:
Diagnostic Lab Data: ED record and vaccination records received for date of service 10/31/09. Labs and diagnostics: UA. Labs: CBC, CMP Dx studies: air contrast barium enema
CDC 'Split Type':

Write-up: Intussusception resolved with Barium Enema after special Enema on 11/1/09. 11/18 & 11/19/09: ED record and vaccination records received for date of service 10/31/09. Dx: Intussusception Assessment: Presents with intussusception, admitted. 12/10/2009 ED record, Admission and consult notes for 10/31-11/1/2009, patient with c/o''s persistent vomiting x 2 days. Tx: IVF, NPO, barium enema + for intussusception


Changed on 9/14/2017

VAERS ID: 368114 Before After
VAERS Form:(blank) 1
Age:0.55
Gender:Male
Location:Iowa
Vaccinated:2009-10-26
Onset:2009-10-31
Submitted:2009-11-09
Entered:2009-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B213AA / 1 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF729AA / 1 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D90888 / 1 2 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA943A / 1 2 - 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)? 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. ED record and vaccination records received for date of service 10/31/09. PMH: None.
Allergies:
Diagnostic Lab Data: ED record and vaccination records received for date of service 10/31/09. Labs and diagnostics: UA. Labs: CBC, CMP Dx studies: air contrast barium enema
CDC 'Split Type':

Write-up: Intussusception resolved with Barium Enema after special Enema on 11/1/09. 11/18 & 11/19/09: ED record and vaccination records received for date of service 10/31/09. Dx: Intussusception Assessment: Presents with intussusception, admitted. 12/10/2009 ED record, Admission and consult notes for 10/31-11/1/2009, patient with c/o''s persistent vomiting x 2 days. Tx: IVF, NPO, barium enema + for intussusception


Changed on 2/14/2018

VAERS ID: 368114 Before After
VAERS Form:1
Age:0.55
Gender:Male
Location:Iowa
Vaccinated:2009-10-26
Onset:2009-10-31
Submitted:2009-11-09
Entered:2009-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B213AA / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF729AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D90888 / 2 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA943A / 2 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)? 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. ED record and vaccination records received for date of service 10/31/09. PMH: None.
Allergies:
Diagnostic Lab Data: ED record and vaccination records received for date of service 10/31/09. Labs and diagnostics: UA. Labs: CBC, CMP Dx studies: air contrast barium enema
CDC 'Split Type':

Write-up: Intussusception resolved with Barium Enema after special Enema on 11/1/09. 11/18 & 11/19/09: ED record and vaccination records received for date of service 10/31/09. Dx: Intussusception Assessment: Presents with intussusception, admitted. 12/10/2009 ED record, Admission and consult notes for 10/31-11/1/2009, patient with c/o''s persistent vomiting x 2 days. Tx: IVF, NPO, barium enema + for intussusception


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