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This is VAERS ID 258493

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 258493
VAERS Form:
Age:0.2
Gender:Female
Location:Virginia
Vaccinated:2006-06-07
Onset:2006-06-13
Submitted:2006-06-16
Entered:2006-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP HEPB IPV (PEDIARIX) / GLAXOSMITHKLINE AC21B037BA / - RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0540R / - LL / IM
PNC: PNEUMO, 7-VALENT (PREVNAR) / LEDERLE LABORATORIES A98338B / - LL / IM
ROTHB5: ROTAVIRUS VACCINE, LIVE, ORAL, PENTAVALENT (ROTATEQ) / MERCK & CO. INC. 0145F / - - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Gastrointestinal necrosis, Haematochezia, Intussusception, Irritability

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: 1     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: AAS showed obstructive picture; Gastrogaffin enema could not reduce intussuscepted bowel.
CDC 'Split Type':

Write-up: 2 weeks after administration presented with intermittent abdominal pain - noted to be pulling legs up and crying f/b infant lying still and not moving. After 24h of this pain brought in due to bloody stools and diagnosed with ileocecal intussusception."Had bowel necrotic bowel resected in OR immediately and is currently recovering in the PICU.


Changed on 12/8/2009

VAERS ID: 258493 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Virginia
Vaccinated:2006-06-07
Onset:2006-06-13
Submitted:2006-06-16
Entered:2006-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP HEPB IPV (PEDIARIX) / GLAXOSMITHKLINE AC21B037BA / - RL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B037BA / - RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0540R / - LL / IM
PNC: PNEUMO, 7-VALENT (PREVNAR) PNEUMO (PREVNAR) / LEDERLE LABORATORIES A98338B / - LL / IM
ROTHB5: ROTAVIRUS VACCINE, LIVE, ORAL, PENTAVALENT (ROTATEQ) ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0145F / - - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Gastrointestinal necrosis, Haematochezia, Intussusception, Irritability, Laboratory test abnormal, Lethargy

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: 1     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: AAS showed obstructive picture; Gastrogaffin enema could not reduce intussuscepted bowel. Discharge summary states lab test abnormal. msv
CDC 'Split Type':

Write-up: 2 weeks after administration presented with intermittent abdominal pain - noted to be pulling legs up and crying f/b infant lying still and not moving. After 24h of this pain brought in due to bloody stools and diagnosed with ileocecal intussusception."Had intussusception. Had bowel necrotic bowel resected in OR immediately and is currently recovering in the PICU. Discharge summary states lethergy. Medical record states irritable. msv


Changed on 1/5/2010

VAERS ID: 258493 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Virginia
Vaccinated:2006-06-07
Onset:2006-06-13
Submitted:2006-06-16
Entered:2006-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B037BA / - RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0540R / - LL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES WYETH PHARMACEUTICALS, INC A98338B / - LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0145F / - - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Gastrointestinal necrosis, Haematochezia, Intussusception, Irritability, Laboratory test abnormal, Lethargy

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes No
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? Yes
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: AAS showed obstructive picture; Gastrogaffin enema could not reduce intussuscepted bowel. Discharge summary states lab test abnormal. msv
CDC 'Split Type':

Write-up: 2 weeks after administration presented with intermittent abdominal pain - noted to be pulling legs up and crying f/b infant lying still and not moving. After 24h of this pain brought in due to bloody stools and diagnosed with ileocecal intussusception. Had bowel necrotic bowel resected in OR immediately and is currently recovering in the PICU. Discharge summary states lethergy. Medical record states irritable. msv


Changed on 3/2/2010

VAERS ID: 258493 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Virginia
Vaccinated:2006-06-07
Onset:2006-06-13
Submitted:2006-06-16
Entered:2006-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B037BA / - RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0540R / - LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC A98338B / - LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0145F / - - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Gastrointestinal necrosis, Haematochezia, Intussusception, Irritability, Laboratory test abnormal, Lethargy

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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? Yes
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: AAS showed obstructive picture; Gastrogaffin enema could not reduce intussuscepted bowel. Discharge summary states lab test abnormal. msv
CDC 'Split Type':

Write-up: 2 weeks after administration presented with intermittent abdominal pain - noted to be pulling legs up and crying f/b infant lying still and not moving. After 24h of this pain brought in due to bloody stools and diagnosed with ileocecal intussusception. Had bowel necrotic bowel resected in OR immediately and is currently recovering in the PICU. Discharge summary states lethergy. Medical record states irritable. msv


Changed on 4/7/2010

VAERS ID: 258493 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Virginia
Vaccinated:2006-06-07
Onset:2006-06-13
Submitted:2006-06-16
Entered:2006-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B037BA / - RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0540R / - LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC A98338B / - LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0145F / - - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Gastrointestinal necrosis, Haematochezia, Intussusception, Irritability, Laboratory test abnormal, Lethargy

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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? Yes
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: AAS showed obstructive picture; Gastrogaffin enema could not reduce intussuscepted bowel. Discharge summary states lab test abnormal. msv
CDC 'Split Type':

Write-up: 2 weeks after administration presented with intermittent abdominal pain - noted to be pulling legs up and crying f/b infant lying still and not moving. After 24h of this pain brought in due to bloody stools and diagnosed with ileocecal intussusception. Had bowel necrotic bowel resected in OR immediately and is currently recovering in the PICU. Discharge summary states lethergy. Medical record states irritable. msv


Changed on 8/31/2010

VAERS ID: 258493 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Virginia
Vaccinated:2006-06-07
Onset:2006-06-13
Submitted:2006-06-16
Entered:2006-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B037BA / - RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0540R / - LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH A98338B / - LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0145F / - - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Gastrointestinal necrosis, Haematochezia, Intussusception, Irritability, Laboratory test abnormal, Lethargy

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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? Yes
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: AAS showed obstructive picture; Gastrogaffin enema could not reduce intussuscepted bowel. Discharge summary states lab test abnormal. msv
CDC 'Split Type':

Write-up: 2 weeks after administration presented with intermittent abdominal pain - noted to be pulling legs up and crying f/b infant lying still and not moving. After 24h of this pain brought in due to bloody stools and diagnosed with ileocecal intussusception. Had bowel necrotic bowel resected in OR immediately and is currently recovering in the PICU. Discharge summary states lethergy. Medical record states irritable. msv


Changed on 6/13/2012

VAERS ID: 258493 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Virginia
Vaccinated:2006-06-07
Onset:2006-06-13
Submitted:2006-06-16
Entered:2006-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B037BA / - RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0540R / - LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH A98338B / - LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0145F / - - / PO

Administered by: Unknown Military      Purchased by: Unknown Military
Symptoms: Abdominal pain, Gastrointestinal necrosis, Haematochezia, Intussusception, Irritability, Laboratory test abnormal, Lethargy

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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? Yes
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: AAS showed obstructive picture; Gastrogaffin enema could not reduce intussuscepted bowel. Discharge summary states lab test abnormal. msv
CDC 'Split Type':

Write-up: 2 weeks after administration presented with intermittent abdominal pain - noted to be pulling legs up and crying f/b infant lying still and not moving. After 24h of this pain brought in due to bloody stools and diagnosed with ileocecal intussusception. Had bowel necrotic bowel resected in OR immediately and is currently recovering in the PICU. Discharge summary states lethergy. Medical record states irritable. msv


Changed on 5/13/2013

VAERS ID: 258493 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Virginia
Vaccinated:2006-06-07
Onset:2006-06-13
Submitted:2006-06-16
Entered:2006-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B037BA / - RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0540R / - LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH A98338B / - LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0145F / - - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0145F / - - / PO

Administered by: Military      Purchased by: Military
Symptoms: Abdominal pain, Gastrointestinal necrosis, Haematochezia, Intussusception, Irritability, Laboratory test abnormal, Lethargy

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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? Yes
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: AAS showed obstructive picture; Gastrogaffin enema could not reduce intussuscepted bowel. Discharge summary states lab test abnormal.
CDC 'Split Type':

Write-up: 2 weeks after administration presented with intermittent abdominal pain - noted to be pulling legs up and crying f/b infant lying still and not moving. After 24h of this pain brought in due to bloody stools and diagnosed with ileocecal intussusception. Had bowel necrotic bowel resected in OR immediately and is currently recovering in the PICU. Discharge summary states lethergy. Medical record states irritable.


Changed on 6/14/2014

VAERS ID: 258493 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Virginia
Vaccinated:2006-06-07
Onset:2006-06-13
Submitted:2006-06-16
Entered:2006-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B037BA / - RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0540R / - LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH A98338B / - LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0145F / - - / PO

Administered by: Military      Purchased by: Military
Symptoms: Abdominal pain, Gastrointestinal necrosis, Haematochezia, Intussusception, Irritability, Laboratory test abnormal, Lethargy

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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? Yes
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: AAS showed obstructive picture; Gastrogaffin enema could not reduce intussuscepted bowel. Discharge summary states lab test abnormal.
CDC 'Split Type':

Write-up: 2 weeks after administration presented with intermittent abdominal pain - noted to be pulling legs up and crying f/b infant lying still and not moving. After 24h of this pain brought in due to bloody stools and diagnosed with ileocecal intussusception. Had bowel necrotic bowel resected in OR immediately and is currently recovering in the PICU. Discharge summary states lethergy. Medical record states irritable.


Changed on 2/14/2017

VAERS ID: 258493 Before After
VAERS Form:
Age:0.2 0.22
Gender:Female
Location:Virginia
Vaccinated:2006-06-07
Onset:2006-06-13
Submitted:2006-06-16
Entered:2006-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B037BA / - RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0540R / - LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH A98338B / - LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0145F / - - / PO

Administered by: Military      Purchased by: Military
Symptoms: Abdominal pain, Gastrointestinal necrosis, Haematochezia, Intussusception, Irritability, Laboratory test abnormal, Lethargy

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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? Yes
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: AAS showed obstructive picture; Gastrogaffin enema could not reduce intussuscepted bowel. Discharge summary states lab test abnormal.
CDC 'Split Type':

Write-up: 2 weeks after administration presented with intermittent abdominal pain - noted to be pulling legs up and crying f/b infant lying still and not moving. After 24h of this pain brought in due to bloody stools and diagnosed with ileocecal intussusception. Had bowel necrotic bowel resected in OR immediately and is currently recovering in the PICU. Discharge summary states lethergy. Medical record states irritable.


Changed on 9/14/2017

VAERS ID: 258493 Before After
VAERS Form:(blank) 1
Age:0.22
Gender:Female
Location:Virginia
Vaccinated:2006-06-07
Onset:2006-06-13
Submitted:2006-06-16
Entered:2006-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B037BA / - UNK RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0540R / - UNK LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH A98338B / - UNK LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0145F / - UNK - MO / PO

Administered by: Military      Purchased by: Military
Symptoms: Abdominal pain, Gastrointestinal necrosis, Haematochezia, Intussusception, Irritability, Laboratory test abnormal, Lethargy

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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? Yes
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: AAS showed obstructive picture; Gastrogaffin enema could not reduce intussuscepted bowel. Discharge summary states lab test abnormal.
CDC 'Split Type':

Write-up: 2 weeks after administration presented with intermittent abdominal pain - noted to be pulling legs up and crying f/b infant lying still and not moving. After 24h of this pain brought in due to bloody stools and diagnosed with ileocecal intussusception. Had bowel necrotic bowel resected in OR immediately and is currently recovering in the PICU. Discharge summary states lethergy. Medical record states irritable.


Changed on 2/14/2018

VAERS ID: 258493 Before After
VAERS Form:1
Age:0.22
Gender:Female
Location:Virginia
Vaccinated:2006-06-07
Onset:2006-06-13
Submitted:2006-06-16
Entered:2006-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B037BA / UNK RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0540R / UNK LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH A98338B / UNK LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0145F / UNK MO / PO

Administered by: Military      Purchased by: Military
Symptoms: Abdominal pain, Gastrointestinal necrosis, Haematochezia, Intussusception, Irritability, Laboratory test abnormal, Lethargy

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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? Yes
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: AAS showed obstructive picture; Gastrogaffin enema could not reduce intussuscepted bowel. Discharge summary states lab test abnormal.
CDC 'Split Type':

Write-up: 2 weeks after administration presented with intermittent abdominal pain - noted to be pulling legs up and crying f/b infant lying still and not moving. After 24h of this pain brought in due to bloody stools and diagnosed with ileocecal intussusception. Had bowel necrotic bowel resected in OR immediately and is currently recovering in the PICU. Discharge summary states lethergy. Medical record states irritable.


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