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This is VAERS ID 464436

History of Changes from the VAERS Wayback Machine

First Appeared on 9/12/2012

VAERS ID: 464436
VAERS Form:
Age:0.2
Gender:Male
Location:New York
Vaccinated:2012-08-07
Onset:2012-09-08
Submitted:2012-09-10
Entered:2012-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B329A / 0 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH526AB / 0 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 918245 / 0 UN / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB208A / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Activated partial thromboplastin time, Diarrhoea, Diarrhoea haemorrhagic, Flatulence, Full blood count, Intussusception, Irritability, Prothrombin time, Pyrexia, Urinary system X-ray, Viral upper respiratory tract infection, Vomiting, Enema administration, Ultrasound abdomen abnormal, Urine output decreased, Laboratory test, Hypophagia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Mother states that this morning patient started acting fussier than usual and had decreased PO intake and few wet diapers (mom reports a total of three prior to presentation to the ED). At around 2 pm he vomited which mom described as milky appearing (non-bloody, non-bilious). At around 4 pm he had one episode of diarrhea (non-bloody) followed by another 3 episodes of vomiting. Mom decided to bring him into the ED at that time. Of note, patient had a recent episode of viral URI for which he presented to the ED on 8/28. Supportive measures were provided and mom was instructed to f/u with PMD and use anti-pyretics for fever reduction. In the ED, the patient had an episode of grossly bloody diarrhea. The patient was bolused x 2, and labs sent including PT/PTT, T+S, CBC and venous panel. A KUB was done which showed a paucity of bowel gas. An abdominal US was performed which was consistent with intussusception. Surgery was consulted. The patient underwent successful reduction of his intussusception via air enema prior to being transferred to the floor.


Changed on 5/13/2013

VAERS ID: 464436 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:New York
Vaccinated:2012-08-07
Onset:2012-09-08
Submitted:2012-09-10
Entered:2012-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B329A / 0 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH526AB / 0 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 918245 / 0 UN / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB208A / 0 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB208A / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Activated partial thromboplastin time, Diarrhoea, Diarrhoea haemorrhagic, Flatulence, Full blood count, Intussusception, Irritability, Prothrombin time, Pyrexia, Urinary system X-ray, Viral upper respiratory tract infection, Vomiting, Enema administration, Ultrasound abdomen abnormal, Urine output decreased, Laboratory test, Hypophagia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Mother states that this morning patient started acting fussier than usual and had decreased PO intake and few wet diapers (mom reports a total of three prior to presentation to the ED). At around 2 pm he vomited which mom described as milky appearing (non-bloody, non-bilious). At around 4 pm he had one episode of diarrhea (non-bloody) followed by another 3 episodes of vomiting. Mom decided to bring him into the ED at that time. Of note, patient had a recent episode of viral URI for which he presented to the ED on 8/28. Supportive measures were provided and mom was instructed to f/u with PMD and use anti-pyretics for fever reduction. In the ED, the patient had an episode of grossly bloody diarrhea. The patient was bolused x 2, and labs sent including PT/PTT, T+S, CBC and venous panel. A KUB was done which showed a paucity of bowel gas. An abdominal US was performed which was consistent with intussusception. Surgery was consulted. The patient underwent successful reduction of his intussusception via air enema prior to being transferred to the floor.


Changed on 2/14/2017

VAERS ID: 464436 Before After
VAERS Form:
Age:0.2 0.18
Gender:Male
Location:New York
Vaccinated:2012-08-07
Onset:2012-09-08
Submitted:2012-09-10
Entered:2012-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B329A / 0 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH526AB / 0 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 918245 / 0 UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB208A / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Activated partial thromboplastin time, Diarrhoea, Diarrhoea haemorrhagic, Flatulence, Full blood count, Intussusception, Irritability, Prothrombin time, Pyrexia, Urinary system X-ray, Viral upper respiratory tract infection, Vomiting, Enema administration, Ultrasound abdomen abnormal, Urine output decreased, Laboratory test, Hypophagia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Mother states that this morning patient started acting fussier than usual and had decreased PO intake and few wet diapers (mom reports a total of three prior to presentation to the ED). At around 2 pm he vomited which mom described as milky appearing (non-bloody, non-bilious). At around 4 pm he had one episode of diarrhea (non-bloody) followed by another 3 episodes of vomiting. Mom decided to bring him into the ED at that time. Of note, patient had a recent episode of viral URI for which he presented to the ED on 8/28. Supportive measures were provided and mom was instructed to f/u with PMD and use anti-pyretics for fever reduction. In the ED, the patient had an episode of grossly bloody diarrhea. The patient was bolused x 2, and labs sent including PT/PTT, T+S, CBC and venous panel. A KUB was done which showed a paucity of bowel gas. An abdominal US was performed which was consistent with intussusception. Surgery was consulted. The patient underwent successful reduction of his intussusception via air enema prior to being transferred to the floor.


Changed on 9/14/2017

VAERS ID: 464436 Before After
VAERS Form:(blank) 1
Age:0.18
Gender:Male
Location:New York
Vaccinated:2012-08-07
Onset:2012-09-08
Submitted:2012-09-10
Entered:2012-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B329A / 0 1 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH526AB / 0 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 918245 / 0 1 UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB208A / 0 1 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Activated partial thromboplastin time, Diarrhoea, Diarrhoea haemorrhagic, Flatulence, Full blood count, Intussusception, Irritability, Prothrombin time, Pyrexia, Urinary system X-ray, Viral upper respiratory tract infection, Vomiting, Enema administration, Ultrasound abdomen abnormal, Urine output decreased, Laboratory test, Hypophagia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Mother states that this morning patient started acting fussier than usual and had decreased PO intake and few wet diapers (mom reports a total of three prior to presentation to the ED). At around 2 pm he vomited which mom described as milky appearing (non-bloody, non-bilious). At around 4 pm he had one episode of diarrhea (non-bloody) followed by another 3 episodes of vomiting. Mom decided to bring him into the ED at that time. Of note, patient had a recent episode of viral URI for which he presented to the ED on 8/28. Supportive measures were provided and mom was instructed to f/u with PMD and use anti-pyretics for fever reduction. In the ED, the patient had an episode of grossly bloody diarrhea. The patient was bolused x 2, and labs sent including PT/PTT, T+S, CBC and venous panel. A KUB was done which showed a paucity of bowel gas. An abdominal US was performed which was consistent with intussusception. Surgery was consulted. The patient underwent successful reduction of his intussusception via air enema prior to being transferred to the floor.


Changed on 2/14/2018

VAERS ID: 464436 Before After
VAERS Form:1
Age:0.18
Gender:Male
Location:New York
Vaccinated:2012-08-07
Onset:2012-09-08
Submitted:2012-09-10
Entered:2012-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B329A / 1 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH526AB / 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 918245 / 1 UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB208A / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Activated partial thromboplastin time, Diarrhoea, Diarrhoea haemorrhagic, Flatulence, Full blood count, Intussusception, Irritability, Prothrombin time, Pyrexia, Urinary system X-ray, Viral upper respiratory tract infection, Vomiting, Enema administration, Ultrasound abdomen abnormal, Urine output decreased, Laboratory test, Hypophagia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Mother states that this morning patient started acting fussier than usual and had decreased PO intake and few wet diapers (mom reports a total of three prior to presentation to the ED). At around 2 pm he vomited which mom described as milky appearing (non-bloody, non-bilious). At around 4 pm he had one episode of diarrhea (non-bloody) followed by another 3 episodes of vomiting. Mom decided to bring him into the ED at that time. Of note, patient had a recent episode of viral URI for which he presented to the ED on 8/28. Supportive measures were provided and mom was instructed to f/u with PMD and use anti-pyretics for fever reduction. In the ED, the patient had an episode of grossly bloody diarrhea. The patient was bolused x 2, and labs sent including PT/PTT, T+S, CBC and venous panel. A KUB was done which showed a paucity of bowel gas. An abdominal US was performed which was consistent with intussusception. Surgery was consulted. The patient underwent successful reduction of his intussusception via air enema prior to being transferred to the floor.


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