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This is VAERS ID 308360

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 308360
VAERS Form:
Age:0.3
Sex:Male
Location:Connecticut
Vaccinated:2008-02-14
Onset:2008-03-20
Submitted:0000-00-00
Entered:2008-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B073AA / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1244F / 0 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0273 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C45153 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0903U / 1 - / PO

Administered by: Military      Purchased by: Unknown
Symptoms: Abdominal mass, Barium double contrast, Barium enema, Barium enema abnormal, Abdominal X-ray

Life Threatening? Yes
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: None
Current Illness: No
Preexisting Conditions: None. PMH: Partial L hemi-diaphragmatic paralysis.
Allergies:
Diagnostic Lab Data: Ultrasound; Blood work - values unknown. Labs and Diagnostics: Abd US (+) for IS to the sigmoid colon. Air contrast Barium enema (+) IS from ileum to sigmoid colon. CXR suspicious for congenital diaphragmatic hernia. Elevated hemidiaphra
CDC 'Split Type':

Write-up: Received 4 month immunization in AM. Vomiting blood and blood in stool in afternoon. Went to hospital ER - transported via ambulance to another hospital. Diagnosis with interruption. 04/09/2008 MR received for DOS 3/20-22/2008 with DX: Intussusception". Pt presented to local hospital with bloody stools and vomit and inconsolable crying. Intubated electively and transported to current facility. Palpable mass noted in LLQ on PE. Barium enema initially unsuccessful at reduction on first try. Reduction

Changed on 12/8/2009

VAERS ID: 308360 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Connecticut
Vaccinated:2008-02-14
Onset:2008-03-20
Submitted:0000-00-00
Entered:2008-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B073AA / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1244F / 0 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0273 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C45153 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0903U / 1 - / PO

Administered by: Military      Purchased by: Unknown Military
Symptoms: Abdominal mass, Barium double contrast, Barium enema, Barium enema abnormal, Chest X-ray abnormal, Crying, Dyspnoea, Extubation, Full blood count, Haematemesis, Haematochezia, Haematocrit decreased, Intussusception, Stridor, Ultrasound abdomen abnormal, Abdominal X-ray, Blood test, Breath sounds abnormal, Endotracheal intubation

Life Threatening? Yes
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: None
Current Illness: No
Preexisting Conditions: None. PMH: Partial L hemi-diaphragmatic paralysis.
Allergies:
Diagnostic Lab Data: Ultrasound; Blood work - values unknown. Labs and Diagnostics: Abd US (+) for IS to the sigmoid colon. Air contrast Barium enema (+) IS from ileum to sigmoid colon. CXR suspicious for congenital diaphragmatic hernia. Elevated hemidiaphra
CDC 'Split Type':

Write-up: Received 4 month immunization in AM. Vomiting blood and blood in stool in afternoon. Went to hospital ER - transported via ambulance to another hospital. Diagnosis with interruption. 04/09/2008 MR received for DOS 3/20-22/2008 with DX: Intussusception". Intussusception. Pt presented to local hospital with bloody stools and vomit and inconsolable crying. Intubated electively and transported to current facility. Palpable mass noted in LLQ on PE. Barium enema initially unsuccessful at reduction on first try. Reduction later sucessful. Pt extubated with mild WOB and decreased BS noted on L with mild stridor. Resolved with albuterol nebs. Pt to baseline 3/22/08 and D/c.

Changed on 1/5/2010

VAERS ID: 308360 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Connecticut
Vaccinated:2008-02-14
Onset:2008-03-20
Submitted:0000-00-00
Entered:2008-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B073AA / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1244F / 0 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0273 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C45153 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0903U / 1 - / PO

Administered by: Military      Purchased by: Military
Symptoms: Abdominal mass, Barium double contrast, Barium enema, Barium enema abnormal, Chest X-ray abnormal, Crying, Dyspnoea, Extubation, Full blood count, Haematemesis, Haematochezia, Haematocrit decreased, Intussusception, Stridor, Ultrasound abdomen abnormal, Abdominal X-ray, Blood test, Breath sounds abnormal, Endotracheal intubation

Life Threatening? Yes
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: None
Current Illness: No
Preexisting Conditions: None. PMH: Partial L hemi-diaphragmatic paralysis.
Allergies:
Diagnostic Lab Data: Ultrasound; Blood work - values unknown. Labs and Diagnostics: Abd US (+) for IS to the sigmoid colon. Air contrast Barium enema (+) IS from ileum to sigmoid colon. CXR suspicious for congenital diaphragmatic hernia. Elevated hemidiaphra
CDC 'Split Type':

Write-up: Received 4 month immunization in AM. Vomiting blood and blood in stool in afternoon. Went to hospital ER - transported via ambulance to another hospital. Diagnosis with interruption. 04/09/2008 MR received for DOS 3/20-22/2008 with DX: Intussusception. Pt presented to local hospital with bloody stools and vomit and inconsolable crying. Intubated electively and transported to current facility. Palpable mass noted in LLQ on PE. Barium enema initially unsuccessful at reduction on first try. Reduction later sucessful. Pt extubated with mild WOB and decreased BS noted on L with mild stridor. Resolved with albuterol nebs. Pt to baseline 3/22/08 and D/c.

Changed on 3/2/2010

VAERS ID: 308360 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Connecticut
Vaccinated:2008-02-14
Onset:2008-03-20
Submitted:0000-00-00
Entered:2008-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B073AA / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1244F / 0 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0273 / 1 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC C45153 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0903U / 1 - / PO

Administered by: Military      Purchased by: Military
Symptoms: Haematemesis, Haematochezia, Intussusception, Blood test

Life Threatening? Yes
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: None
Current Illness: No
Preexisting Conditions: None. PMH: Partial L hemi-diaphragmatic paralysis.
Allergies:
Diagnostic Lab Data: Ultrasound; Blood work - values unknown. Labs and Diagnostics: Abd US (+) for IS to the sigmoid colon. Air contrast Barium enema (+) IS from ileum to sigmoid colon. CXR suspicious for congenital diaphragmatic hernia. Elevated hemidiaphra
CDC 'Split Type':

Write-up: Received 4 month immunization in AM. Vomiting blood and blood in stool in afternoon. Went to hospital ER - transported via ambulance to another hospital. Diagnosis with interruption. 04/09/2008 MR received for DOS 3/20-22/2008 with DX: Intussusception. Pt presented to local hospital with bloody stools and vomit and inconsolable crying. Intubated electively and transported to current facility. Palpable mass noted in LLQ on PE. Barium enema initially unsuccessful at reduction on first try. Reduction later sucessful. Pt extubated with mild WOB and decreased BS noted on L with mild stridor. Resolved with albuterol nebs. Pt to baseline 3/22/08 and D/c.

Changed on 4/7/2010

VAERS ID: 308360 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Connecticut
Vaccinated:2008-02-14
Onset:2008-03-20
Submitted:0000-00-00
Entered:2008-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B073AA / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1244F / 0 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0273 / 1 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C45153 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0903U / 1 - / PO

Administered by: Military      Purchased by: Military
Symptoms: Haematemesis, Haematochezia, Intussusception, Blood test

Life Threatening? Yes
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: None
Current Illness: No
Preexisting Conditions: None. PMH: Partial L hemi-diaphragmatic paralysis.
Allergies:
Diagnostic Lab Data: Ultrasound; Blood work - values unknown. Labs and Diagnostics: Abd US (+) for IS to the sigmoid colon. Air contrast Barium enema (+) IS from ileum to sigmoid colon. CXR suspicious for congenital diaphragmatic hernia. Elevated hemidiaphra
CDC 'Split Type':

Write-up: Received 4 month immunization in AM. Vomiting blood and blood in stool in afternoon. Went to hospital ER - transported via ambulance to another hospital. Diagnosis with interruption. 04/09/2008 MR received for DOS 3/20-22/2008 with DX: Intussusception. Pt presented to local hospital with bloody stools and vomit and inconsolable crying. Intubated electively and transported to current facility. Palpable mass noted in LLQ on PE. Barium enema initially unsuccessful at reduction on first try. Reduction later sucessful. Pt extubated with mild WOB and decreased BS noted on L with mild stridor. Resolved with albuterol nebs. Pt to baseline 3/22/08 and D/c.

Changed on 8/31/2010

VAERS ID: 308360 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Connecticut
Vaccinated:2008-02-14
Onset:2008-03-20
Submitted:0000-00-00
Entered:2008-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B073AA / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1244F / 0 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0273 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH C45153 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0903U / 1 - / PO

Administered by: Military      Purchased by: Military
Symptoms: Haematemesis, Haematochezia, Intussusception, Blood test

Life Threatening? Yes
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: None
Current Illness: No
Preexisting Conditions: None. PMH: Partial L hemi-diaphragmatic paralysis.
Allergies:
Diagnostic Lab Data: Ultrasound; Blood work - values unknown. Labs and Diagnostics: Abd US (+) for IS to the sigmoid colon. Air contrast Barium enema (+) IS from ileum to sigmoid colon. CXR suspicious for congenital diaphragmatic hernia. Elevated hemidiaphra
CDC 'Split Type':

Write-up: Received 4 month immunization in AM. Vomiting blood and blood in stool in afternoon. Went to hospital ER - transported via ambulance to another hospital. Diagnosis with interruption. 04/09/2008 MR received for DOS 3/20-22/2008 with DX: Intussusception. Pt presented to local hospital with bloody stools and vomit and inconsolable crying. Intubated electively and transported to current facility. Palpable mass noted in LLQ on PE. Barium enema initially unsuccessful at reduction on first try. Reduction later sucessful. Pt extubated with mild WOB and decreased BS noted on L with mild stridor. Resolved with albuterol nebs. Pt to baseline 3/22/08 and D/c.

Changed on 1/4/2011

VAERS ID: 308360 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Connecticut
Vaccinated:2008-02-14
Onset:2008-03-20
Submitted:0000-00-00
Entered:2008-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B073AA / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1244F / 0 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0273 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45153 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0903U / 1 - / PO

Administered by: Military      Purchased by: Military
Symptoms: Haematemesis, Haematochezia, Intussusception, Blood test

Life Threatening? Yes
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: None
Current Illness: No
Preexisting Conditions: None. PMH: Partial L hemi-diaphragmatic paralysis.
Allergies:
Diagnostic Lab Data: Ultrasound; Blood work - values unknown. Labs and Diagnostics: Abd US (+) for IS to the sigmoid colon. Air contrast Barium enema (+) IS from ileum to sigmoid colon. CXR suspicious for congenital diaphragmatic hernia. Elevated hemidiaphra hemidiaphragm with new atelectasis. Distended stomach. CBC with Hct 26.9. Abd X-ray suspicious for IS/obstruction
CDC 'Split Type':

Write-up: Received 4 month immunization in AM. Vomiting blood and blood in stool in afternoon. Went to hospital ER - transported via ambulance to another hospital. Diagnosis with interruption. 04/09/2008 MR received for DOS 3/20-22/2008 with DX: Intussusception. Pt presented to local hospital with bloody stools and vomit and inconsolable crying. Intubated electively and transported to current facility. Palpable mass noted in LLQ on PE. Barium enema initially unsuccessful at reduction on first try. Reduction later sucessful. Pt extubated with mild WOB and decreased BS noted on L with mild stridor. Resolved with albuterol nebs. Pt to baseline 3/22/08 and D/c.

Changed on 4/13/2011

VAERS ID: 308360 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Connecticut
Vaccinated:2008-02-14
Onset:2008-03-20
Submitted:0000-00-00
Entered:2008-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B073AA / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1244F / 0 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0273 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45153 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0903U / 1 - / PO

Administered by: Military      Purchased by: Military
Symptoms: Abdominal mass, Barium double contrast, Barium enema, Barium enema abnormal, Chest X-ray abnormal, Crying, Dyspnoea, Extubation, Full blood count, Haematemesis, Haematochezia, Haematocrit decreased, Intussusception, Stridor, Ultrasound abdomen abnormal, Abdominal X-ray, Blood test, Breath sounds abnormal, Endotracheal intubation

Life Threatening? Yes
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: None
Current Illness: No
Preexisting Conditions: None. PMH: Partial L hemi-diaphragmatic paralysis.
Allergies:
Diagnostic Lab Data: Ultrasound; Blood work - values unknown. Labs and Diagnostics: Abd US (+) for IS to the sigmoid colon. Air contrast Barium enema (+) IS from ileum to sigmoid colon. CXR suspicious for congenital diaphragmatic hernia. Elevated hemidiaphragm with new atelectasis. Distended stomach. CBC with Hct 26.9. Abd X-ray suspicious for IS/obstruction
CDC 'Split Type':

Write-up: Received 4 month immunization in AM. Vomiting blood and blood in stool in afternoon. Went to hospital ER - transported via ambulance to another hospital. Diagnosis with interruption. 04/09/2008 MR received for DOS 3/20-22/2008 with DX: Intussusception. Pt presented to local hospital with bloody stools and vomit and inconsolable crying. Intubated electively and transported to current facility. Palpable mass noted in LLQ on PE. Barium enema initially unsuccessful at reduction on first try. Reduction later sucessful. Pt extubated with mild WOB and decreased BS noted on L with mild stridor. Resolved with albuterol nebs. Pt to baseline 3/22/08 and D/c.

Changed on 5/13/2011

VAERS ID: 308360 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Connecticut
Vaccinated:2008-02-14
Onset:2008-03-20
Submitted:0000-00-00
Entered:2008-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B073AA / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1244F / 0 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0273 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45153 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0903U / 1 - / PO

Administered by: Military      Purchased by: Military
Symptoms: Abdominal mass, Barium double contrast, Barium enema, Barium enema abnormal, Chest X-ray abnormal, Crying, Dyspnoea, Extubation, Full blood count, Haematemesis, Haematochezia, Haematocrit decreased, Intussusception, Stridor, Ultrasound abdomen abnormal, Abdominal X-ray, Blood test, Breath sounds abnormal, Endotracheal intubation

Life Threatening? Yes
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: None
Current Illness: No
Preexisting Conditions: None. PMH: Partial L hemi-diaphragmatic paralysis.
Allergies:
Diagnostic Lab Data: Ultrasound; Blood work - values unknown. Labs and Diagnostics: Abd US (+) for IS to the sigmoid colon. Air contrast Barium enema (+) IS from ileum to sigmoid colon. CXR suspicious for congenital diaphragmatic hernia. Elevated hemidiaphragm with new atelectasis. Distended stomach. CBC with Hct 26.9. Abd X-ray suspicious for IS/obstruction
CDC 'Split Type':

Write-up: Received 4 month immunization in AM. Vomiting blood and blood in stool in afternoon. Went to hospital ER - transported via ambulance to another hospital. Diagnosis with interruption. 04/09/2008 MR received for DOS 3/20-22/2008 with DX: Intussusception. Pt presented to local hospital with bloody stools and vomit and inconsolable crying. Intubated electively and transported to current facility. Palpable mass noted in LLQ on PE. Barium enema initially unsuccessful at reduction on first try. Reduction later sucessful. Pt extubated with mild WOB and decreased BS noted on L with mild stridor. Resolved with albuterol nebs. Pt to baseline 3/22/08 and D/c.

Changed on 6/11/2011

VAERS ID: 308360 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Connecticut
Vaccinated:2008-02-14
Onset:2008-03-20
Submitted:0000-00-00
Entered:2008-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B073AA / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1244F / 0 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0273 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45153 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0903U / 1 - / PO

Administered by: Military      Purchased by: Military
Symptoms: Abdominal mass, Barium double contrast, Barium enema, Barium enema abnormal, Chest X-ray abnormal, Crying, Dyspnoea, Extubation, Full blood count, Haematemesis, Haematochezia, Haematocrit decreased, Intussusception, Stridor, Ultrasound abdomen abnormal, Abdominal X-ray, Blood test, Breath sounds abnormal, Endotracheal intubation

Life Threatening? Yes
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: None
Current Illness: No
Preexisting Conditions: None. PMH: Partial L hemi-diaphragmatic paralysis.
Allergies:
Diagnostic Lab Data: Ultrasound; Blood work - values unknown. Labs and Diagnostics: Abd US (+) for IS to the sigmoid colon. Air contrast Barium enema (+) IS from ileum to sigmoid colon. CXR suspicious for congenital diaphragmatic hernia. Elevated hemidiaphragm with new atelectasis. Distended stomach. CBC with Hct 26.9. Abd X-ray suspicious for IS/obstruction
CDC 'Split Type':

Write-up: Received 4 month immunization in AM. Vomiting blood and blood in stool in afternoon. Went to hospital ER - transported via ambulance to another hospital. Diagnosis with interruption. 04/09/2008 MR received for DOS 3/20-22/2008 with DX: Intussusception. Pt presented to local hospital with bloody stools and vomit and inconsolable crying. Intubated electively and transported to current facility. Palpable mass noted in LLQ on PE. Barium enema initially unsuccessful at reduction on first try. Reduction later sucessful. Pt extubated with mild WOB and decreased BS noted on L with mild stridor. Resolved with albuterol nebs. Pt to baseline 3/22/08 and D/c.

Changed on 5/13/2013

VAERS ID: 308360 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Connecticut
Vaccinated:2008-02-14
Onset:2008-03-20
Submitted:0000-00-00
Entered:2008-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B073AA / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1244F / 0 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0273 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45153 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0903U / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0903U / 1 - / PO

Administered by: Military      Purchased by: Military
Symptoms: Abdominal mass, Barium double contrast, Barium enema, Barium enema abnormal, Chest X-ray abnormal, Crying, Dyspnoea, Extubation, Full blood count, Haematemesis, Haematochezia, Haematocrit decreased, Intussusception, Stridor, Ultrasound abdomen abnormal, Abdominal X-ray, Blood test, Breath sounds abnormal, Endotracheal intubation

Life Threatening? Yes
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: None
Current Illness: No
Preexisting Conditions: None. PMH: Partial L hemi-diaphragmatic paralysis.
Allergies:
Diagnostic Lab Data: Ultrasound; Blood work - values unknown. Labs and Diagnostics: Abd US (+) for IS to the sigmoid colon. Air contrast Barium enema (+) IS from ileum to sigmoid colon. CXR suspicious for congenital diaphragmatic hernia. Elevated hemidiaphragm with new atelectasis. Distended stomach. CBC with Hct 26.9. Abd X-ray suspicious for IS/obstruction
CDC 'Split Type':

Write-up: Received 4 month immunization in AM. Vomiting blood and blood in stool in afternoon. Went to hospital ER - transported via ambulance to another hospital. Diagnosis with interruption. 04/09/2008 MR received for DOS 3/20-22/2008 with DX: Intussusception. Pt presented to local hospital with bloody stools and vomit and inconsolable crying. Intubated electively and transported to current facility. Palpable mass noted in LLQ on PE. Barium enema initially unsuccessful at reduction on first try. Reduction later sucessful. Pt extubated with mild WOB and decreased BS noted on L with mild stridor. Resolved with albuterol nebs. Pt to baseline 3/22/08 and D/c.

Changed on 6/14/2014

VAERS ID: 308360 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Connecticut
Vaccinated:2008-02-14
Onset:2008-03-20
Submitted:0000-00-00
Entered:2008-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B073AA / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1244F / 0 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0273 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45153 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0903U / 1 - / PO

Administered by: Military      Purchased by: Military
Symptoms: Abdominal mass, Barium double contrast, Barium enema, Barium enema abnormal, Chest X-ray abnormal, Crying, Dyspnoea, Extubation, Full blood count, Haematemesis, Haematochezia, Haematocrit decreased, Intussusception, Stridor, Ultrasound abdomen abnormal, Abdominal X-ray, Blood test, Breath sounds abnormal, Endotracheal intubation

Life Threatening? Yes
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: None
Current Illness: No
Preexisting Conditions: None. PMH: Partial L hemi-diaphragmatic paralysis.
Allergies:
Diagnostic Lab Data: Ultrasound; Blood work - values unknown. Labs and Diagnostics: Abd US (+) for IS to the sigmoid colon. Air contrast Barium enema (+) IS from ileum to sigmoid colon. CXR suspicious for congenital diaphragmatic hernia. Elevated hemidiaphragm with new atelectasis. Distended stomach. CBC with Hct 26.9. Abd X-ray suspicious for IS/obstruction
CDC 'Split Type':

Write-up: Received 4 month immunization in AM. Vomiting blood and blood in stool in afternoon. Went to hospital ER - transported via ambulance to another hospital. Diagnosis with interruption. 04/09/2008 MR received for DOS 3/20-22/2008 with DX: Intussusception. Pt presented to local hospital with bloody stools and vomit and inconsolable crying. Intubated electively and transported to current facility. Palpable mass noted in LLQ on PE. Barium enema initially unsuccessful at reduction on first try. Reduction later sucessful. Pt extubated with mild WOB and decreased BS noted on L with mild stridor. Resolved with albuterol nebs. Pt to baseline 3/22/08 and D/c.

Changed on 4/14/2017

VAERS ID: 308360 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Connecticut
Vaccinated:2008-02-14
Onset:2008-03-20
Submitted:0000-00-00
Entered:2008-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B073AA / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1244F / 0 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0273 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45153 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0903U / 1 - / PO

Administered by: Military      Purchased by: Military
Symptoms: Abdominal mass, Barium double contrast, Barium enema, Barium enema abnormal, Chest X-ray abnormal, Crying, Dyspnoea, Extubation, Full blood count, Haematemesis, Haematochezia, Haematocrit decreased, Intussusception, Stridor, Ultrasound abdomen abnormal, Abdominal X-ray, Blood test, Breath sounds abnormal, Endotracheal intubation

Life Threatening? Yes
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: None
Current Illness: No
Preexisting Conditions: None. PMH: Partial L hemi-diaphragmatic paralysis.
Allergies:
Diagnostic Lab Data: Ultrasound; Blood work - values unknown. Labs and Diagnostics: Abd US (+) for IS to the sigmoid colon. Air contrast Barium enema (+) IS from ileum to sigmoid colon. CXR suspicious for congenital diaphragmatic hernia. Elevated hemidiaphragm with new atelectasis. Distended stomach. CBC with Hct 26.9. Abd X-ray suspicious for IS/obstruction
CDC 'Split Type':

Write-up: Received 4 month immunization in AM. Vomiting blood and blood in stool in afternoon. Went to hospital ER - transported via ambulance to another hospital. Diagnosis with interruption. 04/09/2008 MR received for DOS 3/20-22/2008 with DX: Intussusception. Pt presented to local hospital with bloody stools and vomit and inconsolable crying. Intubated electively and transported to current facility. Palpable mass noted in LLQ on PE. Barium enema initially unsuccessful at reduction on first try. Reduction later sucessful. Pt extubated with mild WOB and decreased BS noted on L with mild stridor. Resolved with albuterol nebs. Pt to baseline 3/22/08 and D/c.

Changed on 9/14/2017

VAERS ID: 308360 Before After
VAERS Form:(blank) 1
Age:0.3
Sex:Male
Location:Connecticut
Vaccinated:2008-02-14
Onset:2008-03-20
Submitted:0000-00-00
Entered:2008-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B073AA / 1 2 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1244F / 0 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0273 / 1 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45153 / 1 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0903U / 1 2 - MO / PO

Administered by: Military      Purchased by: Military
Symptoms: Haematemesis, Haematochezia, Intussusception, Blood test

Life Threatening? Yes
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: None
Current Illness: No
Preexisting Conditions: None. PMH: Partial L hemi-diaphragmatic paralysis.
Allergies:
Diagnostic Lab Data: Ultrasound; Blood work - values unknown. Labs and Diagnostics: Abd US (+) for IS to the sigmoid colon. Air contrast Barium enema (+) IS from ileum to sigmoid colon. CXR suspicious for congenital diaphragmatic hernia. Elevated hemidiaphragm with new atelectasis. Distended stomach. CBC with Hct 26.9. Abd X-ray suspicious for IS/obstruction
CDC 'Split Type':

Write-up: Received 4 month immunization in AM. Vomiting blood and blood in stool in afternoon. Went to hospital ER - transported via ambulance to another hospital. Diagnosis with interruption. 04/09/2008 MR received for DOS 3/20-22/2008 with DX: Intussusception. Pt presented to local hospital with bloody stools and vomit and inconsolable crying. Intubated electively and transported to current facility. Palpable mass noted in LLQ on PE. Barium enema initially unsuccessful at reduction on first try. Reduction later sucessful. Pt extubated with mild WOB and decreased BS noted on L with mild stridor. Resolved with albuterol nebs. Pt to baseline 3/22/08 and D/c.

Changed on 2/14/2018

VAERS ID: 308360 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Connecticut
Vaccinated:2008-02-14
Onset:2008-03-20
Submitted:0000-00-00
Entered:2008-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B073AA / 2 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1244F / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0273 / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45153 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0903U / 2 MO / PO

Administered by: Military      Purchased by: Military
Symptoms: Haematemesis, Haematochezia, Intussusception, Blood test

Life Threatening? Yes
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: None
Current Illness: No
Preexisting Conditions: None. PMH: Partial L hemi-diaphragmatic paralysis.
Allergies:
Diagnostic Lab Data: Ultrasound; Blood work - values unknown. Labs and Diagnostics: Abd US (+) for IS to the sigmoid colon. Air contrast Barium enema (+) IS from ileum to sigmoid colon. CXR suspicious for congenital diaphragmatic hernia. Elevated hemidiaphragm with new atelectasis. Distended stomach. CBC with Hct 26.9. Abd X-ray suspicious for IS/obstruction
CDC 'Split Type':

Write-up: Received 4 month immunization in AM. Vomiting blood and blood in stool in afternoon. Went to hospital ER - transported via ambulance to another hospital. Diagnosis with interruption. 04/09/2008 MR received for DOS 3/20-22/2008 with DX: Intussusception. Pt presented to local hospital with bloody stools and vomit and inconsolable crying. Intubated electively and transported to current facility. Palpable mass noted in LLQ on PE. Barium enema initially unsuccessful at reduction on first try. Reduction later sucessful. Pt extubated with mild WOB and decreased BS noted on L with mild stridor. Resolved with albuterol nebs. Pt to baseline 3/22/08 and D/c.

Changed on 6/14/2018

VAERS ID: 308360 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Connecticut
Vaccinated:2008-02-14
Onset:2008-03-20
Submitted:0000-00-00
Entered:2008-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B073AA / 2 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1244F / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0273 / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45153 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0903U / 2 MO / PO

Administered by: Military      Purchased by: Military
Symptoms: Haematemesis, Haematochezia, Intussusception, Blood test

Life Threatening? Yes
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: None
Current Illness: No
Preexisting Conditions: None. PMH: Partial L hemi-diaphragmatic paralysis.
Allergies:
Diagnostic Lab Data: Ultrasound; Blood work - values unknown. Labs and Diagnostics: Abd US (+) for IS to the sigmoid colon. Air contrast Barium enema (+) IS from ileum to sigmoid colon. CXR suspicious for congenital diaphragmatic hernia. Elevated hemidiaphragm with new atelectasis. Distended stomach. CBC with Hct 26.9. Abd X-ray suspicious for IS/obstruction
CDC 'Split Type':

Write-up: Received 4 month immunization in AM. Vomiting blood and blood in stool in afternoon. Went to hospital ER - transported via ambulance to another hospital. Diagnosis with interruption. 04/09/2008 MR received for DOS 3/20-22/2008 with DX: Intussusception. Pt presented to local hospital with bloody stools and vomit and inconsolable crying. Intubated electively and transported to current facility. Palpable mass noted in LLQ on PE. Barium enema initially unsuccessful at reduction on first try. Reduction later sucessful. Pt extubated with mild WOB and decreased BS noted on L with mild stridor. Resolved with albuterol nebs. Pt to baseline 3/22/08 and D/c.

Changed on 8/14/2018

VAERS ID: 308360 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Connecticut
Vaccinated:2008-02-14
Onset:2008-03-20
Submitted:0000-00-00
Entered:2008-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B073AA / 2 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1244F / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0273 / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45153 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0903U / 2 MO / PO

Administered by: Military      Purchased by: Military
Symptoms: Haematemesis, Haematochezia, Intussusception, Blood test

Life Threatening? Yes
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: None
Current Illness: No
Preexisting Conditions: None. PMH: Partial L hemi-diaphragmatic paralysis.
Allergies:
Diagnostic Lab Data: Ultrasound; Blood work - values unknown. Labs and Diagnostics: Abd US (+) for IS to the sigmoid colon. Air contrast Barium enema (+) IS from ileum to sigmoid colon. CXR suspicious for congenital diaphragmatic hernia. Elevated hemidiaphragm with new atelectasis. Distended stomach. CBC with Hct 26.9. Abd X-ray suspicious for IS/obstruction
CDC 'Split Type':

Write-up: Received 4 month immunization in AM. Vomiting blood and blood in stool in afternoon. Went to hospital ER - transported via ambulance to another hospital. Diagnosis with interruption. 04/09/2008 MR received for DOS 3/20-22/2008 with DX: Intussusception. Pt presented to local hospital with bloody stools and vomit and inconsolable crying. Intubated electively and transported to current facility. Palpable mass noted in LLQ on PE. Barium enema initially unsuccessful at reduction on first try. Reduction later sucessful. Pt extubated with mild WOB and decreased BS noted on L with mild stridor. Resolved with albuterol nebs. Pt to baseline 3/22/08 and D/c.

Changed on 9/14/2018

VAERS ID: 308360 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Connecticut
Vaccinated:2008-02-14
Onset:2008-03-20
Submitted:0000-00-00
Entered:2008-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B073AA / 2 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1244F / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0273 / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45153 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0903U / 2 MO / PO

Administered by: Military      Purchased by: Military
Symptoms: Haematemesis, Haematochezia, Intussusception, Blood test

Life Threatening? Yes
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: None
Current Illness: No
Preexisting Conditions: None. PMH: Partial L hemi-diaphragmatic paralysis.
Allergies:
Diagnostic Lab Data: Ultrasound; Blood work - values unknown. Labs and Diagnostics: Abd US (+) for IS to the sigmoid colon. Air contrast Barium enema (+) IS from ileum to sigmoid colon. CXR suspicious for congenital diaphragmatic hernia. Elevated hemidiaphragm with new atelectasis. Distended stomach. CBC with Hct 26.9. Abd X-ray suspicious for IS/obstruction
CDC 'Split Type':

Write-up: Received 4 month immunization in AM. Vomiting blood and blood in stool in afternoon. Went to hospital ER - transported via ambulance to another hospital. Diagnosis with interruption. 04/09/2008 MR received for DOS 3/20-22/2008 with DX: Intussusception. Pt presented to local hospital with bloody stools and vomit and inconsolable crying. Intubated electively and transported to current facility. Palpable mass noted in LLQ on PE. Barium enema initially unsuccessful at reduction on first try. Reduction later sucessful. Pt extubated with mild WOB and decreased BS noted on L with mild stridor. Resolved with albuterol nebs. Pt to baseline 3/22/08 and D/c.

Changed on 10/14/2018

VAERS ID: 308360 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Connecticut
Vaccinated:2008-02-14
Onset:2008-03-20
Submitted:0000-00-00
Entered:2008-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B073AA / 2 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1244F / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0273 / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45153 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0903U / 2 MO / PO

Administered by: Military      Purchased by: Military
Symptoms: Haematemesis, Haematochezia, Intussusception, Blood test

Life Threatening? Yes
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: None
Current Illness: No
Preexisting Conditions: None. PMH: Partial L hemi-diaphragmatic paralysis.
Allergies:
Diagnostic Lab Data: Ultrasound; Blood work - values unknown. Labs and Diagnostics: Abd US (+) for IS to the sigmoid colon. Air contrast Barium enema (+) IS from ileum to sigmoid colon. CXR suspicious for congenital diaphragmatic hernia. Elevated hemidiaphragm with new atelectasis. Distended stomach. CBC with Hct 26.9. Abd X-ray suspicious for IS/obstruction
CDC 'Split Type':

Write-up: Received 4 month immunization in AM. Vomiting blood and blood in stool in afternoon. Went to hospital ER - transported via ambulance to another hospital. Diagnosis with interruption. 04/09/2008 MR received for DOS 3/20-22/2008 with DX: Intussusception. Pt presented to local hospital with bloody stools and vomit and inconsolable crying. Intubated electively and transported to current facility. Palpable mass noted in LLQ on PE. Barium enema initially unsuccessful at reduction on first try. Reduction later sucessful. Pt extubated with mild WOB and decreased BS noted on L with mild stridor. Resolved with albuterol nebs. Pt to baseline 3/22/08 and D/c.

Changed on 12/24/2020

VAERS ID: 308360 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Connecticut
Vaccinated:2008-02-14
Onset:2008-03-20
Submitted:0000-00-00
Entered:2008-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B073AA / 2 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1244F / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0273 / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45153 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0903U / 2 MO / PO

Administered by: Military      Purchased by: Military
Symptoms: Haematemesis, Haematochezia, Intussusception, Blood test

Life Threatening? Yes
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: None
Current Illness: No
Preexisting Conditions: None. PMH: Partial L hemi-diaphragmatic paralysis.
Allergies:
Diagnostic Lab Data: Ultrasound; Blood work - values unknown. Labs and Diagnostics: Abd US (+) for IS to the sigmoid colon. Air contrast Barium enema (+) IS from ileum to sigmoid colon. CXR suspicious for congenital diaphragmatic hernia. Elevated hemidiaphragm with new atelectasis. Distended stomach. CBC with Hct 26.9. Abd X-ray suspicious for IS/obstruction
CDC 'Split Type':

Write-up: Received 4 month immunization in AM. Vomiting blood and blood in stool in afternoon. Went to hospital ER - transported via ambulance to another hospital. Diagnosis with interruption. 04/09/2008 MR received for DOS 3/20-22/2008 with DX: Intussusception. Pt presented to local hospital with bloody stools and vomit and inconsolable crying. Intubated electively and transported to current facility. Palpable mass noted in LLQ on PE. Barium enema initially unsuccessful at reduction on first try. Reduction later sucessful. Pt extubated with mild WOB and decreased BS noted on L with mild stridor. Resolved with albuterol nebs. Pt to baseline 3/22/08 and D/c.

Changed on 12/30/2020

VAERS ID: 308360 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Connecticut
Vaccinated:2008-02-14
Onset:2008-03-20
Submitted:0000-00-00
Entered:2008-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B073AA / 2 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1244F / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0273 / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45153 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0903U / 2 MO / PO

Administered by: Military      Purchased by: Military
Symptoms: Haematemesis, Haematochezia, Intussusception, Blood test

Life Threatening? Yes
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: None
Current Illness: No
Preexisting Conditions: None. PMH: Partial L hemi-diaphragmatic paralysis.
Allergies:
Diagnostic Lab Data: Ultrasound; Blood work - values unknown. Labs and Diagnostics: Abd US (+) for IS to the sigmoid colon. Air contrast Barium enema (+) IS from ileum to sigmoid colon. CXR suspicious for congenital diaphragmatic hernia. Elevated hemidiaphragm with new atelectasis. Distended stomach. CBC with Hct 26.9. Abd X-ray suspicious for IS/obstruction
CDC 'Split Type':

Write-up: Received 4 month immunization in AM. Vomiting blood and blood in stool in afternoon. Went to hospital ER - transported via ambulance to another hospital. Diagnosis with interruption. 04/09/2008 MR received for DOS 3/20-22/2008 with DX: Intussusception. Pt presented to local hospital with bloody stools and vomit and inconsolable crying. Intubated electively and transported to current facility. Palpable mass noted in LLQ on PE. Barium enema initially unsuccessful at reduction on first try. Reduction later sucessful. Pt extubated with mild WOB and decreased BS noted on L with mild stridor. Resolved with albuterol nebs. Pt to baseline 3/22/08 and D/c.

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