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This is VAERS ID 266161

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 266161
VAERS Form:
Age:0.2
Gender:Female
Location:New Jersey
Vaccinated:2006-10-02
Onset:2006-10-08
Submitted:2006-11-07
Entered:2006-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP HEPB IPV (PEDIARIX) / GLAXOSMITHKLINE AC21B056AA / 0 LL / -
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR, INC. UE965AA / 0 RL / -
PNC: PNEUMO, 7-VALENT (PREVNAR) / LEDERLE LABORATORIES B08642E / 0 RL / -
ROTHB5: ROTAVIRUS VACCINE, LIVE, ORAL, PENTAVALENT (ROTATEQ) / MERCK & CO. INC. 0726F / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Haematochezia, Ileus, Intussusception, Vomiting

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: LABS: abdominal films revealed dilated loops & + fluid levels. US of abd revealed right mid abdomen telescoping./ss
CDC 'Split Type':

Write-up: Pt given Rotateq vaccine PO 10/02/06. Pt diagnosed with intussusception 10/08/06 and had surgical reduction 10/09/2006.


Changed on 12/8/2009

VAERS ID: 266161 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:New Jersey
Vaccinated:2006-10-02
Onset:2006-10-08
Submitted:2006-11-07
Entered:2006-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP HEPB IPV (PEDIARIX) / GLAXOSMITHKLINE AC21B056AA / 0 LL / -
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B056AA / 0 LL / -
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR, INC. AVENTIS PASTEUR UE965AA / 0 RL / -
PNC: PNEUMO, 7-VALENT (PREVNAR) PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08642E / 0 RL / -
ROTHB5: ROTAVIRUS VACCINE, LIVE, ORAL, PENTAVALENT (ROTATEQ) ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 0 - / PO

Administered by: Private      Purchased by: Unknown Public
Symptoms: Haematochezia, Ileus, Intussusception, Vomiting

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: LABS: abdominal films revealed dilated loops & + fluid levels. US of abd revealed right mid abdomen telescoping./ss
CDC 'Split Type':

Write-up: Pt given Rotateq vaccine PO 10/02/06. Pt diagnosed with intussusception 10/08/06 and had surgical reduction 10/09/2006. 11/16/06 Received medical records from hospital which reveal patient had history of 3 days of vomiting & 1 day of blood tinged stool prior to admission on 10/9/06. Afebrile. Air enema success only at ileocecal valve & was taken to OR for reduction of intussusception. Developed post op ileus which resolved & progressed to stable status. D/C to home on 10/12. D/C Dx: S/P intussusception, surgically resolved./ss


Changed on 3/2/2010

VAERS ID: 266161 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:New Jersey
Vaccinated:2006-10-02
Onset:2006-10-08
Submitted:2006-11-07
Entered:2006-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B056AA / 0 LL / -
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UE965AA / 0 RL / -
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / LEDERLE LABORATORIES B08642E / 0 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Haematochezia, Ileus, Intussusception, Vomiting

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: LABS: abdominal films revealed dilated loops & + fluid levels. US of abd revealed right mid abdomen telescoping./ss
CDC 'Split Type':

Write-up: Pt given Rotateq vaccine PO 10/02/06. Pt diagnosed with intussusception 10/08/06 and had surgical reduction 10/09/2006. 11/16/06 Received medical records from hospital which reveal patient had history of 3 days of vomiting & 1 day of blood tinged stool prior to admission on 10/9/06. Afebrile. Air enema success only at ileocecal valve & was taken to OR for reduction of intussusception. Developed post op ileus which resolved & progressed to stable status. D/C to home on 10/12. D/C Dx: S/P intussusception, surgically resolved./ss


Changed on 4/7/2010

VAERS ID: 266161 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:New Jersey
Vaccinated:2006-10-02
Onset:2006-10-08
Submitted:2006-11-07
Entered:2006-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B056AA / 0 LL / -
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UE965AA / 0 RL / -
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08642E / 0 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Haematochezia, Ileus, Intussusception, Vomiting

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: LABS: abdominal films revealed dilated loops & + fluid levels. US of abd revealed right mid abdomen telescoping./ss
CDC 'Split Type':

Write-up: Pt given Rotateq vaccine PO 10/02/06. Pt diagnosed with intussusception 10/08/06 and had surgical reduction 10/09/2006. 11/16/06 Received medical records from hospital which reveal patient had history of 3 days of vomiting & 1 day of blood tinged stool prior to admission on 10/9/06. Afebrile. Air enema success only at ileocecal valve & was taken to OR for reduction of intussusception. Developed post op ileus which resolved & progressed to stable status. D/C to home on 10/12. D/C Dx: S/P intussusception, surgically resolved./ss


Changed on 5/13/2013

VAERS ID: 266161 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:New Jersey
Vaccinated:2006-10-02
Onset:2006-10-08
Submitted:2006-11-07
Entered:2006-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B056AA / 0 LL / -
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UE965AA / 0 RL / -
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08642E / 0 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Haematochezia, Ileus, Intussusception, Vomiting

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: LABS: abdominal films revealed dilated loops & + fluid levels. US of abd revealed right mid abdomen telescoping./ss
CDC 'Split Type':

Write-up: Pt given Rotateq vaccine PO 10/02/06. Pt diagnosed with intussusception 10/08/06 and had surgical reduction 10/09/2006. 11/16/06 Received medical records from hospital which reveal patient had history of 3 days of vomiting & 1 day of blood tinged stool prior to admission on 10/9/06. Afebrile. Air enema success only at ileocecal valve & was taken to OR for reduction of intussusception. Developed post op ileus which resolved & progressed to stable status. D/C to home on 10/12. D/C Dx: S/P intussusception, surgically resolved./ss


Changed on 2/14/2017

VAERS ID: 266161 Before After
VAERS Form:
Age:0.2 0.22
Gender:Female
Location:New Jersey
Vaccinated:2006-10-02
Onset:2006-10-08
Submitted:2006-11-07
Entered:2006-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B056AA / 0 LL / -
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UE965AA / 0 RL / -
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08642E / 0 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Haematochezia, Ileus, Intussusception, Vomiting

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: LABS: abdominal films revealed dilated loops & + fluid levels. US of abd revealed right mid abdomen telescoping./ss
CDC 'Split Type':

Write-up: Pt given Rotateq vaccine PO 10/02/06. Pt diagnosed with intussusception 10/08/06 and had surgical reduction 10/09/2006. 11/16/06 Received medical records from hospital which reveal patient had history of 3 days of vomiting & 1 day of blood tinged stool prior to admission on 10/9/06. Afebrile. Air enema success only at ileocecal valve & was taken to OR for reduction of intussusception. Developed post op ileus which resolved & progressed to stable status. D/C to home on 10/12. D/C Dx: S/P intussusception, surgically resolved./ss


Changed on 5/14/2017

VAERS ID: 266161 Before After
VAERS Form:
Age:0.22
Gender:Female
Location:New Jersey
Vaccinated:2006-10-02
Onset:2006-10-08
Submitted:2006-11-07
Entered:2006-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B056AA / 0 LL / -
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR SANOFI PASTEUR UE965AA / 0 RL / -
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES PFIZER/WYETH B08642E / 0 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Haematochezia, Ileus, Intussusception, Vomiting

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: LABS: abdominal films revealed dilated loops & + fluid levels. US of abd revealed right mid abdomen telescoping./ss
CDC 'Split Type':

Write-up: Pt given Rotateq vaccine PO 10/02/06. Pt diagnosed with intussusception 10/08/06 and had surgical reduction 10/09/2006. 11/16/06 Received medical records from hospital which reveal patient had history of 3 days of vomiting & 1 day of blood tinged stool prior to admission on 10/9/06. Afebrile. Air enema success only at ileocecal valve & was taken to OR for reduction of intussusception. Developed post op ileus which resolved & progressed to stable status. D/C to home on 10/12. D/C Dx: S/P intussusception, surgically resolved./ss


Changed on 9/14/2017

VAERS ID: 266161 Before After
VAERS Form:(blank) 1
Age:0.22
Gender:Female
Location:New Jersey
Vaccinated:2006-10-02
Onset:2006-10-08
Submitted:2006-11-07
Entered:2006-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B056AA / 0 1 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE965AA / 0 1 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08642E / 0 1 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 0 1 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Haematochezia, Ileus, Intussusception, Vomiting

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: LABS: abdominal films revealed dilated loops & + fluid levels. US of abd revealed right mid abdomen telescoping./ss
CDC 'Split Type':

Write-up: Pt given Rotateq vaccine PO 10/02/06. Pt diagnosed with intussusception 10/08/06 and had surgical reduction 10/09/2006. 11/16/06 Received medical records from hospital which reveal patient had history of 3 days of vomiting & 1 day of blood tinged stool prior to admission on 10/9/06. Afebrile. Air enema success only at ileocecal valve & was taken to OR for reduction of intussusception. Developed post op ileus which resolved & progressed to stable status. D/C to home on 10/12. D/C Dx: S/P intussusception, surgically resolved./ss


Changed on 2/14/2018

VAERS ID: 266161 Before After
VAERS Form:1
Age:0.22
Gender:Female
Location:New Jersey
Vaccinated:2006-10-02
Onset:2006-10-08
Submitted:2006-11-07
Entered:2006-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B056AA / 1 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE965AA / 1 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08642E / 1 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Haematochezia, Ileus, Intussusception, Vomiting

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: LABS: abdominal films revealed dilated loops & + fluid levels. US of abd revealed right mid abdomen telescoping./ss
CDC 'Split Type':

Write-up: Pt given Rotateq vaccine PO 10/02/06. Pt diagnosed with intussusception 10/08/06 and had surgical reduction 10/09/2006. 11/16/06 Received medical records from hospital which reveal patient had history of 3 days of vomiting & 1 day of blood tinged stool prior to admission on 10/9/06. Afebrile. Air enema success only at ileocecal valve & was taken to OR for reduction of intussusception. Developed post op ileus which resolved & progressed to stable status. D/C to home on 10/12. D/C Dx: S/P intussusception, surgically resolved./ss


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