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This is VAERS ID 267654

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 267654
VAERS Form:
Age:0.3
Gender:Female
Location:Colorado
Vaccinated:2006-09-14
Onset:2006-10-25
Submitted:2006-11-22
Entered:2006-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP HEPB IPV (PEDIARIX) / GLAXOSMITHKLINE AC21B071AA / 1 LL / IM
HIBV: HIB (HIBTITER) / LEDERLE LABORATORIES UE962AD / 1 RL / IM
PNC: PNEUMO, 7-VALENT (PREVNAR) / LEDERLE LABORATORIES B08651E / 1 RL / IM
ROTHB5: ROTAVIRUS VACCINE, LIVE, ORAL, PENTAVALENT (ROTATEQ) / MERCK & CO. INC. 0389F / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Colitis, Gastrooesophageal reflux disease, Gastroenteritis, Haematochezia, Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: HEALTHY
Preexisting Conditions: NKDA, MILK, FACIAL ASYMMETRY, CONGEN
Allergies:
Diagnostic Lab Data: 7/13/06: CBC W/DIFF - HEMATOCHEZIA STOOL CULTURE - NO SALMONELLA, SHIGELLA OR CAMPYLOBACTER ISOLATED STOOL WBC - MOD FECAL LEUKOCYTES
CDC 'Split Type':

Write-up: 7/13/06: WELL CHILD VISIT. PAST WEEK SPITTY & GAGGY. NO VOMITING, NON BILIOUS, NON BLOODY. STOOLS GREEN JELLY LIKE WITH BLOOD STREAKS, NO FEVER, FEEDING WELL. DX: APPEARS TO BE GERD POSSIBLY WITH VIRAL ENTERITIS OR BREAT MILK COLITIS. PLAN: CBC & STOOL O"AND P. HOLD VACCINES UNTIL LAB RESULTS 7/20/06: NO RECURRENCE OF BLOOD IN STOOL. OK FOR IMMS. 2M IMMS ADMIN. 9/14/06: 3M WELL CHILD VISIT. BORN W/ASSYMETRIC FACES SYNDROME. NO GROWTH CONCERNS. 4M IMMS ADMIN. 10/25/06: MOC CALLED STATING BABY GAGS AND S


Changed on 12/8/2009

VAERS ID: 267654 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Colorado
Vaccinated:2006-09-14
Onset:2006-10-25
Submitted:2006-11-22
Entered:2006-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP HEPB IPV (PEDIARIX) / GLAXOSMITHKLINE AC21B071AA / 1 LL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B071AA / 1 LL / IM
HIBV: HIB (HIBTITER) / LEDERLE LABORATORIES UE962AD / 1 RL / IM
PNC: PNEUMO, 7-VALENT (PREVNAR) PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08651E / 1 RL / IM
ROTHB5: ROTAVIRUS VACCINE, LIVE, ORAL, PENTAVALENT (ROTATEQ) ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0389F / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Colitis, Gastrooesophageal reflux disease, Gastroenteritis, Haematochezia, Intussusception, Irritability, Vomiting, White blood cell count increased

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? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: HEALTHY
Preexisting Conditions: NKDA, MILK, FACIAL ASYMMETRY, CONGEN
Allergies:
Diagnostic Lab Data: 7/13/06: CBC W/DIFF - HEMATOCHEZIA STOOL CULTURE - NO SALMONELLA, SHIGELLA OR CAMPYLOBACTER ISOLATED STOOL WBC - MOD FECAL LEUKOCYTES LABS: WBC 26.3 on admit.
CDC 'Split Type':

Write-up: 7/13/06: WELL CHILD VISIT. PAST WEEK SPITTY & GAGGY. NO VOMITING, NON BILIOUS, NON BLOODY. STOOLS GREEN JELLY LIKE WITH BLOOD STREAKS, NO FEVER, FEEDING WELL. DX: APPEARS TO BE GERD POSSIBLY WITH VIRAL ENTERITIS OR BREAT MILK COLITIS. PLAN: CBC & STOOL O"AND O AND P. HOLD VACCINES UNTIL LAB RESULTS 7/20/06: NO RECURRENCE OF BLOOD IN STOOL. OK FOR IMMS. 2M IMMS ADMIN. 9/14/06: 3M WELL CHILD VISIT. BORN W/ASSYMETRIC FACES SYNDROME. NO GROWTH CONCERNS. 4M IMMS ADMIN. 10/25/06: MOC CALLED STATING BABY GAGS AND S SPITTING AFTER FEEDING. TRIED ZANTAC IN PAST WITHOUT RELIEF SO STOPPED. LAST VOID IN AM. 10/26/06, 10:15AM: FOC STATES CHILD VOMITING 4X DAY FOR PAST 2 DAYS MOSTLY AFTER BREASTFEEDING FORMULA. BROUGHT CHILD INTO ED. 2 DAYS AGO HAD X1 LARGE STOOL. INTERMITTENT FUSSINESS. AM X 1 BLOODY STOOL. NO FEVER OR URI SXS. DX: INTUSSUSCEPTION, INCOMPLETE REDUCTION BY AIR ENEMA. PLAN: ADMIT OR FOR INTUSSUSCEPTION REDUCTION PROCEDURE: RQL LIMITED LAPAROTOMY W/ILEOCOLIC INSTUSSUSCEPTION REDUCTION. APPENDECTOMY. NO COMPLICATIONS. DISCHARGED. 11/16/06: 6M WELL CHILD VISIT. HAD INTUSSUCEPTION, BUT DOING WELL. EATING SOLIDS, NO CHRONIC DIARRHEA OR CONSTIPATION. IMMS ADMIN, BUT ROTAVIRUS HELD. 12/12/06 Received medical records from hospital which reveal patient presented to ER s/p 36 hours of vomiting, fussiness & then 1 bloody diaper on 10/26/06. Air enema revealed incomplete reduction of ileocolic IS which was initially present at the sigmoid level & reduced to the hepatic flexure. Taken to OR & findings revealed distal ileum & appendix intussuscepted within right colon extending to mid transverse level which was reduced w/o difficulty & appendix removed. D/C to home on 10/28/06. Final DX: Intussusception, surgically reduced.


Changed on 3/2/2010

VAERS ID: 267654 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Colorado
Vaccinated:2006-09-14
Onset:2006-10-25
Submitted:2006-11-22
Entered:2006-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B071AA / 1 LL / IM
HIBV: HIB (HIBTITER) / LEDERLE LABORATORIES UE962AD / 1 RL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / LEDERLE LABORATORIES B08651E / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0389F / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Colitis, Gastrooesophageal reflux disease, Gastroenteritis, Haematochezia, Intussusception, Irritability, Vomiting, White blood cell count increased

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? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: HEALTHY
Preexisting Conditions: NKDA, MILK, FACIAL ASYMMETRY, CONGEN
Allergies:
Diagnostic Lab Data: 7/13/06: CBC W/DIFF - HEMATOCHEZIA STOOL CULTURE - NO SALMONELLA, SHIGELLA OR CAMPYLOBACTER ISOLATED STOOL WBC - MOD FECAL LEUKOCYTES LABS: WBC 26.3 on admit.
CDC 'Split Type':

Write-up: 7/13/06: WELL CHILD VISIT. PAST WEEK SPITTY & GAGGY. NO VOMITING, NON BILIOUS, NON BLOODY. STOOLS GREEN JELLY LIKE WITH BLOOD STREAKS, NO FEVER, FEEDING WELL. DX: APPEARS TO BE GERD POSSIBLY WITH VIRAL ENTERITIS OR BREAT MILK COLITIS. PLAN: CBC & STOOL O AND P. HOLD VACCINES UNTIL LAB RESULTS 7/20/06: NO RECURRENCE OF BLOOD IN STOOL. OK FOR IMMS. 2M IMMS ADMIN. 9/14/06: 3M WELL CHILD VISIT. BORN W/ASSYMETRIC FACES SYNDROME. NO GROWTH CONCERNS. 4M IMMS ADMIN. 10/25/06: MOC CALLED STATING BABY GAGS AND SPITTING AFTER FEEDING. TRIED ZANTAC IN PAST WITHOUT RELIEF SO STOPPED. LAST VOID IN AM. 10/26/06, 10:15AM: FOC STATES CHILD VOMITING 4X DAY FOR PAST 2 DAYS MOSTLY AFTER BREASTFEEDING FORMULA. BROUGHT CHILD INTO ED. 2 DAYS AGO HAD X1 LARGE STOOL. INTERMITTENT FUSSINESS. AM X 1 BLOODY STOOL. NO FEVER OR URI SXS. DX: INTUSSUSCEPTION, INCOMPLETE REDUCTION BY AIR ENEMA. PLAN: ADMIT OR FOR INTUSSUSCEPTION REDUCTION PROCEDURE: RQL LIMITED LAPAROTOMY W/ILEOCOLIC INSTUSSUSCEPTION REDUCTION. APPENDECTOMY. NO COMPLICATIONS. DISCHARGED. 11/16/06: 6M WELL CHILD VISIT. HAD INTUSSUCEPTION, BUT DOING WELL. EATING SOLIDS, NO CHRONIC DIARRHEA OR CONSTIPATION. IMMS ADMIN, BUT ROTAVIRUS HELD. 12/12/06 Received medical records from hospital which reveal patient presented to ER s/p 36 hours of vomiting, fussiness & then 1 bloody diaper on 10/26/06. Air enema revealed incomplete reduction of ileocolic IS which was initially present at the sigmoid level & reduced to the hepatic flexure. Taken to OR & findings revealed distal ileum & appendix intussuscepted within right colon extending to mid transverse level which was reduced w/o difficulty & appendix removed. D/C to home on 10/28/06. Final DX: Intussusception, surgically reduced.


Changed on 4/7/2010

VAERS ID: 267654 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Colorado
Vaccinated:2006-09-14
Onset:2006-10-25
Submitted:2006-11-22
Entered:2006-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B071AA / 1 LL / IM
HIBV: HIB (HIBTITER) / LEDERLE LABORATORIES UE962AD / 1 RL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08651E / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0389F / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Colitis, Gastrooesophageal reflux disease, Gastroenteritis, Haematochezia, Intussusception, Irritability, Vomiting, White blood cell count increased

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? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: HEALTHY
Preexisting Conditions: NKDA, MILK, FACIAL ASYMMETRY, CONGEN
Allergies:
Diagnostic Lab Data: 7/13/06: CBC W/DIFF - HEMATOCHEZIA STOOL CULTURE - NO SALMONELLA, SHIGELLA OR CAMPYLOBACTER ISOLATED STOOL WBC - MOD FECAL LEUKOCYTES LABS: WBC 26.3 on admit.
CDC 'Split Type':

Write-up: 7/13/06: WELL CHILD VISIT. PAST WEEK SPITTY & GAGGY. NO VOMITING, NON BILIOUS, NON BLOODY. STOOLS GREEN JELLY LIKE WITH BLOOD STREAKS, NO FEVER, FEEDING WELL. DX: APPEARS TO BE GERD POSSIBLY WITH VIRAL ENTERITIS OR BREAT MILK COLITIS. PLAN: CBC & STOOL O AND P. HOLD VACCINES UNTIL LAB RESULTS 7/20/06: NO RECURRENCE OF BLOOD IN STOOL. OK FOR IMMS. 2M IMMS ADMIN. 9/14/06: 3M WELL CHILD VISIT. BORN W/ASSYMETRIC FACES SYNDROME. NO GROWTH CONCERNS. 4M IMMS ADMIN. 10/25/06: MOC CALLED STATING BABY GAGS AND SPITTING AFTER FEEDING. TRIED ZANTAC IN PAST WITHOUT RELIEF SO STOPPED. LAST VOID IN AM. 10/26/06, 10:15AM: FOC STATES CHILD VOMITING 4X DAY FOR PAST 2 DAYS MOSTLY AFTER BREASTFEEDING FORMULA. BROUGHT CHILD INTO ED. 2 DAYS AGO HAD X1 LARGE STOOL. INTERMITTENT FUSSINESS. AM X 1 BLOODY STOOL. NO FEVER OR URI SXS. DX: INTUSSUSCEPTION, INCOMPLETE REDUCTION BY AIR ENEMA. PLAN: ADMIT OR FOR INTUSSUSCEPTION REDUCTION PROCEDURE: RQL LIMITED LAPAROTOMY W/ILEOCOLIC INSTUSSUSCEPTION REDUCTION. APPENDECTOMY. NO COMPLICATIONS. DISCHARGED. 11/16/06: 6M WELL CHILD VISIT. HAD INTUSSUCEPTION, BUT DOING WELL. EATING SOLIDS, NO CHRONIC DIARRHEA OR CONSTIPATION. IMMS ADMIN, BUT ROTAVIRUS HELD. 12/12/06 Received medical records from hospital which reveal patient presented to ER s/p 36 hours of vomiting, fussiness & then 1 bloody diaper on 10/26/06. Air enema revealed incomplete reduction of ileocolic IS which was initially present at the sigmoid level & reduced to the hepatic flexure. Taken to OR & findings revealed distal ileum & appendix intussuscepted within right colon extending to mid transverse level which was reduced w/o difficulty & appendix removed. D/C to home on 10/28/06. Final DX: Intussusception, surgically reduced.


Changed on 5/13/2013

VAERS ID: 267654 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Colorado
Vaccinated:2006-09-14
Onset:2006-10-25
Submitted:2006-11-22
Entered:2006-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B071AA / 1 LL / IM
HIBV: HIB (HIBTITER) / LEDERLE LABORATORIES UE962AD / 1 RL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08651E / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0389F / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0389F / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Colitis, Gastrooesophageal reflux disease, Gastroenteritis, Haematochezia, Intussusception, Irritability, Vomiting, White blood cell count increased

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? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: HEALTHY
Preexisting Conditions: NKDA, MILK, FACIAL ASYMMETRY, CONGEN
Allergies:
Diagnostic Lab Data: 7/13/06: CBC W/DIFF - HEMATOCHEZIA STOOL CULTURE - NO SALMONELLA, SHIGELLA OR CAMPYLOBACTER ISOLATED STOOL WBC - MOD FECAL LEUKOCYTES LABS: WBC 26.3 on admit.
CDC 'Split Type':

Write-up: 7/13/06: WELL CHILD VISIT. PAST WEEK SPITTY & GAGGY. NO VOMITING, NON BILIOUS, NON BLOODY. STOOLS GREEN JELLY LIKE WITH BLOOD STREAKS, NO FEVER, FEEDING WELL. DX: APPEARS TO BE GERD POSSIBLY WITH VIRAL ENTERITIS OR BREAT MILK COLITIS. PLAN: CBC & STOOL O AND P. HOLD VACCINES UNTIL LAB RESULTS 7/20/06: NO RECURRENCE OF BLOOD IN STOOL. OK FOR IMMS. 2M IMMS ADMIN. 9/14/06: 3M WELL CHILD VISIT. BORN W/ASSYMETRIC FACES SYNDROME. NO GROWTH CONCERNS. 4M IMMS ADMIN. 10/25/06: MOC CALLED STATING BABY GAGS AND SPITTING AFTER FEEDING. TRIED ZANTAC IN PAST WITHOUT RELIEF SO STOPPED. LAST VOID IN AM. 10/26/06, 10:15AM: FOC STATES CHILD VOMITING 4X DAY FOR PAST 2 DAYS MOSTLY AFTER BREASTFEEDING FORMULA. BROUGHT CHILD INTO ED. 2 DAYS AGO HAD X1 LARGE STOOL. INTERMITTENT FUSSINESS. AM X 1 BLOODY STOOL. NO FEVER OR URI SXS. DX: INTUSSUSCEPTION, INCOMPLETE REDUCTION BY AIR ENEMA. PLAN: ADMIT OR FOR INTUSSUSCEPTION REDUCTION PROCEDURE: RQL LIMITED LAPAROTOMY W/ILEOCOLIC INSTUSSUSCEPTION REDUCTION. APPENDECTOMY. NO COMPLICATIONS. DISCHARGED. 11/16/06: 6M WELL CHILD VISIT. HAD INTUSSUCEPTION, BUT DOING WELL. EATING SOLIDS, NO CHRONIC DIARRHEA OR CONSTIPATION. IMMS ADMIN, BUT ROTAVIRUS HELD. 12/12/06 Received medical records from hospital which reveal patient presented to ER s/p 36 hours of vomiting, fussiness & then 1 bloody diaper on 10/26/06. Air enema revealed incomplete reduction of ileocolic IS which was initially present at the sigmoid level & reduced to the hepatic flexure. Taken to OR & findings revealed distal ileum & appendix intussuscepted within right colon extending to mid transverse level which was reduced w/o difficulty & appendix removed. D/C to home on 10/28/06. Final DX: Intussusception, surgically reduced.


Changed on 2/14/2017

VAERS ID: 267654 Before After
VAERS Form:
Age:0.3 0.33
Gender:Female
Location:Colorado
Vaccinated:2006-09-14
Onset:2006-10-25
Submitted:2006-11-22
Entered:2006-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B071AA / 1 LL / IM
HIBV: HIB (HIBTITER) / LEDERLE LABORATORIES PFIZER/WYETH UE962AD / 1 RL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES PFIZER/WYETH B08651E / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0389F / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Colitis, Gastrooesophageal reflux disease, Gastroenteritis, Haematochezia, Intussusception, Irritability, Vomiting, White blood cell count increased

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? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: HEALTHY
Preexisting Conditions: NKDA, MILK, FACIAL ASYMMETRY, CONGEN
Allergies:
Diagnostic Lab Data: 7/13/06: CBC W/DIFF - HEMATOCHEZIA STOOL CULTURE - NO SALMONELLA, SHIGELLA OR CAMPYLOBACTER ISOLATED STOOL WBC - MOD FECAL LEUKOCYTES LABS: WBC 26.3 on admit.
CDC 'Split Type':

Write-up: 7/13/06: WELL CHILD VISIT. PAST WEEK SPITTY & GAGGY. NO VOMITING, NON BILIOUS, NON BLOODY. STOOLS GREEN JELLY LIKE WITH BLOOD STREAKS, NO FEVER, FEEDING WELL. DX: APPEARS TO BE GERD POSSIBLY WITH VIRAL ENTERITIS OR BREAT MILK COLITIS. PLAN: CBC & STOOL O AND P. HOLD VACCINES UNTIL LAB RESULTS 7/20/06: NO RECURRENCE OF BLOOD IN STOOL. OK FOR IMMS. 2M IMMS ADMIN. 9/14/06: 3M WELL CHILD VISIT. BORN W/ASSYMETRIC FACES SYNDROME. NO GROWTH CONCERNS. 4M IMMS ADMIN. 10/25/06: MOC CALLED STATING BABY GAGS AND SPITTING AFTER FEEDING. TRIED ZANTAC IN PAST WITHOUT RELIEF SO STOPPED. LAST VOID IN AM. 10/26/06, 10:15AM: FOC STATES CHILD VOMITING 4X DAY FOR PAST 2 DAYS MOSTLY AFTER BREASTFEEDING FORMULA. BROUGHT CHILD INTO ED. 2 DAYS AGO HAD X1 LARGE STOOL. INTERMITTENT FUSSINESS. AM X 1 BLOODY STOOL. NO FEVER OR URI SXS. DX: INTUSSUSCEPTION, INCOMPLETE REDUCTION BY AIR ENEMA. PLAN: ADMIT OR FOR INTUSSUSCEPTION REDUCTION PROCEDURE: RQL LIMITED LAPAROTOMY W/ILEOCOLIC INSTUSSUSCEPTION REDUCTION. APPENDECTOMY. NO COMPLICATIONS. DISCHARGED. 11/16/06: 6M WELL CHILD VISIT. HAD INTUSSUCEPTION, BUT DOING WELL. EATING SOLIDS, NO CHRONIC DIARRHEA OR CONSTIPATION. IMMS ADMIN, BUT ROTAVIRUS HELD. 12/12/06 Received medical records from hospital which reveal patient presented to ER s/p 36 hours of vomiting, fussiness & then 1 bloody diaper on 10/26/06. Air enema revealed incomplete reduction of ileocolic IS which was initially present at the sigmoid level & reduced to the hepatic flexure. Taken to OR & findings revealed distal ileum & appendix intussuscepted within right colon extending to mid transverse level which was reduced w/o difficulty & appendix removed. D/C to home on 10/28/06. Final DX: Intussusception, surgically reduced.


Changed on 9/14/2017

VAERS ID: 267654 Before After
VAERS Form:(blank) 1
Age:0.33
Gender:Female
Location:Colorado
Vaccinated:2006-09-14
Onset:2006-10-25
Submitted:2006-11-22
Entered:2006-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B071AA / 1 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH UE962AD / 1 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08651E / 1 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0389F / 1 2 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Colitis, Gastrooesophageal reflux disease, Gastroenteritis, Haematochezia, Intussusception, Irritability, Vomiting, White blood cell count increased

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? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: HEALTHY
Preexisting Conditions: NKDA, MILK, FACIAL ASYMMETRY, CONGEN
Allergies:
Diagnostic Lab Data: 7/13/06: CBC W/DIFF - HEMATOCHEZIA STOOL CULTURE - NO SALMONELLA, SHIGELLA OR CAMPYLOBACTER ISOLATED STOOL WBC - MOD FECAL LEUKOCYTES LABS: WBC 26.3 on admit.
CDC 'Split Type':

Write-up: 7/13/06: WELL CHILD VISIT. PAST WEEK SPITTY & GAGGY. NO VOMITING, NON BILIOUS, NON BLOODY. STOOLS GREEN JELLY LIKE WITH BLOOD STREAKS, NO FEVER, FEEDING WELL. DX: APPEARS TO BE GERD POSSIBLY WITH VIRAL ENTERITIS OR BREAT MILK COLITIS. PLAN: CBC & STOOL O AND P. HOLD VACCINES UNTIL LAB RESULTS 7/20/06: NO RECURRENCE OF BLOOD IN STOOL. OK FOR IMMS. 2M IMMS ADMIN. 9/14/06: 3M WELL CHILD VISIT. BORN W/ASSYMETRIC FACES SYNDROME. NO GROWTH CONCERNS. 4M IMMS ADMIN. 10/25/06: MOC CALLED STATING BABY GAGS AND SPITTING AFTER FEEDING. TRIED ZANTAC IN PAST WITHOUT RELIEF SO STOPPED. LAST VOID IN AM. 10/26/06, 10:15AM: FOC STATES CHILD VOMITING 4X DAY FOR PAST 2 DAYS MOSTLY AFTER BREASTFEEDING FORMULA. BROUGHT CHILD INTO ED. 2 DAYS AGO HAD X1 LARGE STOOL. INTERMITTENT FUSSINESS. AM X 1 BLOODY STOOL. NO FEVER OR URI SXS. DX: INTUSSUSCEPTION, INCOMPLETE REDUCTION BY AIR ENEMA. PLAN: ADMIT OR FOR INTUSSUSCEPTION REDUCTION PROCEDURE: RQL LIMITED LAPAROTOMY W/ILEOCOLIC INSTUSSUSCEPTION REDUCTION. APPENDECTOMY. NO COMPLICATIONS. DISCHARGED. 11/16/06: 6M WELL CHILD VISIT. HAD INTUSSUCEPTION, BUT DOING WELL. EATING SOLIDS, NO CHRONIC DIARRHEA OR CONSTIPATION. IMMS ADMIN, BUT ROTAVIRUS HELD. 12/12/06 Received medical records from hospital which reveal patient presented to ER s/p 36 hours of vomiting, fussiness & then 1 bloody diaper on 10/26/06. Air enema revealed incomplete reduction of ileocolic IS which was initially present at the sigmoid level & reduced to the hepatic flexure. Taken to OR & findings revealed distal ileum & appendix intussuscepted within right colon extending to mid transverse level which was reduced w/o difficulty & appendix removed. D/C to home on 10/28/06. Final DX: Intussusception, surgically reduced.


Changed on 2/14/2018

VAERS ID: 267654 Before After
VAERS Form:1
Age:0.33
Gender:Female
Location:Colorado
Vaccinated:2006-09-14
Onset:2006-10-25
Submitted:2006-11-22
Entered:2006-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B071AA / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH UE962AD / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08651E / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0389F / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Colitis, Gastrooesophageal reflux disease, Gastroenteritis, Haematochezia, Intussusception, Irritability, Vomiting, White blood cell count increased

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? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: HEALTHY
Preexisting Conditions: NKDA, MILK, FACIAL ASYMMETRY, CONGEN
Allergies:
Diagnostic Lab Data: 7/13/06: CBC W/DIFF - HEMATOCHEZIA STOOL CULTURE - NO SALMONELLA, SHIGELLA OR CAMPYLOBACTER ISOLATED STOOL WBC - MOD FECAL LEUKOCYTES LABS: WBC 26.3 on admit.
CDC 'Split Type':

Write-up: 7/13/06: WELL CHILD VISIT. PAST WEEK SPITTY & GAGGY. NO VOMITING, NON BILIOUS, NON BLOODY. STOOLS GREEN JELLY LIKE WITH BLOOD STREAKS, NO FEVER, FEEDING WELL. DX: APPEARS TO BE GERD POSSIBLY WITH VIRAL ENTERITIS OR BREAT MILK COLITIS. PLAN: CBC & STOOL O AND P. HOLD VACCINES UNTIL LAB RESULTS 7/20/06: NO RECURRENCE OF BLOOD IN STOOL. OK FOR IMMS. 2M IMMS ADMIN. 9/14/06: 3M WELL CHILD VISIT. BORN W/ASSYMETRIC FACES SYNDROME. NO GROWTH CONCERNS. 4M IMMS ADMIN. 10/25/06: MOC CALLED STATING BABY GAGS AND SPITTING AFTER FEEDING. TRIED ZANTAC IN PAST WITHOUT RELIEF SO STOPPED. LAST VOID IN AM. 10/26/06, 10:15AM: FOC STATES CHILD VOMITING 4X DAY FOR PAST 2 DAYS MOSTLY AFTER BREASTFEEDING FORMULA. BROUGHT CHILD INTO ED. 2 DAYS AGO HAD X1 LARGE STOOL. INTERMITTENT FUSSINESS. AM X 1 BLOODY STOOL. NO FEVER OR URI SXS. DX: INTUSSUSCEPTION, INCOMPLETE REDUCTION BY AIR ENEMA. PLAN: ADMIT OR FOR INTUSSUSCEPTION REDUCTION PROCEDURE: RQL LIMITED LAPAROTOMY W/ILEOCOLIC INSTUSSUSCEPTION REDUCTION. APPENDECTOMY. NO COMPLICATIONS. DISCHARGED. 11/16/06: 6M WELL CHILD VISIT. HAD INTUSSUCEPTION, BUT DOING WELL. EATING SOLIDS, NO CHRONIC DIARRHEA OR CONSTIPATION. IMMS ADMIN, BUT ROTAVIRUS HELD. 12/12/06 Received medical records from hospital which reveal patient presented to ER s/p 36 hours of vomiting, fussiness & then 1 bloody diaper on 10/26/06. Air enema revealed incomplete reduction of ileocolic IS which was initially present at the sigmoid level & reduced to the hepatic flexure. Taken to OR & findings revealed distal ileum & appendix intussuscepted within right colon extending to mid transverse level which was reduced w/o difficulty & appendix removed. D/C to home on 10/28/06. Final DX: Intussusception, surgically reduced.


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