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This is VAERS ID 268134

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 268134
VAERS Form:
Age:0.2
Gender:Female
Location:California
Vaccinated:2006-11-14
Onset:2006-11-29
Submitted:2006-12-01
Entered:2006-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / AVENTIS PASTEUR, INC. C2650AA / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0679F / 0 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR, INC. 41031 / 0 LL / IM
PNC: PNEUMO, 7-VALENT (PREVNAR) / LEDERLE LABORATORIES B08689D / 0 RL / IM
ROTHB5: ROTAVIRUS VACCINE, LIVE, ORAL, PENTAVALENT (ROTATEQ) / MERCK & CO. INC. 0848F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Anaemia, Haematochezia, Intussusception, Listless, Oral intake reduced

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Records available. Anemia reported by parents.
CDC 'Split Type':

Write-up: On 11/29/06 pt was listless, fed poorly and had 3 bloody mucousy stools. In my office the patient was pale and listless. The patient was refered to ER. An air contrast BE was diagnostic and therapeutic for the pt intussisption. The pt spent one night in h"ospital and is doing well.


Changed on 12/8/2009

VAERS ID: 268134 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:California
Vaccinated:2006-11-14
Onset:2006-11-29
Submitted:2006-12-01
Entered:2006-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / AVENTIS PASTEUR, INC. AVENTIS PASTEUR C2650AA / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0679F / 0 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR, INC. AVENTIS PASTEUR 41031 / 0 LL / IM
PNC: PNEUMO, 7-VALENT (PREVNAR) PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08689D / 0 RL / IM
ROTHB5: ROTAVIRUS VACCINE, LIVE, ORAL, PENTAVALENT (ROTATEQ) ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0848F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Anaemia, Haematochezia, Intussusception, Listless, Pallor, Oral intake reduced

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Records available. Anemia reported by parents.
CDC 'Split Type':

Write-up: On 11/29/06 pt was listless, fed poorly and had 3 bloody mucousy stools. In my office the patient was pale and listless. The patient was refered to ER. An air contrast BE was diagnostic and therapeutic for the pt intussisption. The pt spent one night in h"ospital hospital and is doing well.


Changed on 3/2/2010

VAERS ID: 268134 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:California
Vaccinated:2006-11-14
Onset:2006-11-29
Submitted:2006-12-01
Entered:2006-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / AVENTIS PASTEUR C2650AA / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0679F / 0 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR 41031 / 0 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / LEDERLE LABORATORIES B08689D / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0848F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Anaemia, Haematochezia, Intussusception, Listless, Pallor, Oral intake reduced

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Records available. Anemia reported by parents.
CDC 'Split Type':

Write-up: On 11/29/06 pt was listless, fed poorly and had 3 bloody mucousy stools. In my office the patient was pale and listless. The patient was refered to ER. An air contrast BE was diagnostic and therapeutic for the pt intussisption. The pt spent one night in hospital and is doing well.


Changed on 4/7/2010

VAERS ID: 268134 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:California
Vaccinated:2006-11-14
Onset:2006-11-29
Submitted:2006-12-01
Entered:2006-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / AVENTIS PASTEUR C2650AA / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0679F / 0 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR 41031 / 0 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08689D / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0848F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Anaemia, Haematochezia, Intussusception, Listless, Pallor, Oral intake reduced

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Records available. Anemia reported by parents.
CDC 'Split Type':

Write-up: On 11/29/06 pt was listless, fed poorly and had 3 bloody mucousy stools. In my office the patient was pale and listless. The patient was refered to ER. An air contrast BE was diagnostic and therapeutic for the pt intussisption. The pt spent one night in hospital and is doing well.


Changed on 5/13/2013

VAERS ID: 268134 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:California
Vaccinated:2006-11-14
Onset:2006-11-29
Submitted:2006-12-01
Entered:2006-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / AVENTIS PASTEUR C2650AA / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0679F / 0 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR 41031 / 0 LL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08689D / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0848F / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0848F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Anaemia, Haematochezia, Intussusception, Listless, Pallor, Oral intake reduced

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Records available. Anemia reported by parents.
CDC 'Split Type':

Write-up: On 11/29/06 pt was listless, fed poorly and had 3 bloody mucousy stools. In my office the patient was pale and listless. The patient was refered to ER. An air contrast BE was diagnostic and therapeutic for the pt intussisption. The pt spent one night in hospital and is doing well.


Changed on 2/14/2017

VAERS ID: 268134 Before After
VAERS Form:
Age:0.2 0.17
Gender:Female
Location:California
Vaccinated:2006-11-14
Onset:2006-11-29
Submitted:2006-12-01
Entered:2006-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / AVENTIS PASTEUR SANOFI PASTEUR C2650AA / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0679F / 0 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR SANOFI PASTEUR 41031 / 0 LL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES PFIZER/WYETH B08689D / 0 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0848F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Anaemia, Haematochezia, Intussusception, Listless, Pallor, Oral intake reduced

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Records available. Anemia reported by parents.
CDC 'Split Type':

Write-up: On 11/29/06 pt was listless, fed poorly and had 3 bloody mucousy stools. In my office the patient was pale and listless. The patient was refered to ER. An air contrast BE was diagnostic and therapeutic for the pt intussisption. The pt spent one night in hospital and is doing well.


Changed on 9/14/2017

VAERS ID: 268134 Before After
VAERS Form:(blank) 1
Age:0.17
Gender:Female
Location:California
Vaccinated:2006-11-14
Onset:2006-11-29
Submitted:2006-12-01
Entered:2006-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2650AA / 0 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0679F / 0 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 41031 / 0 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08689D / 0 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0848F / 0 1 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Anaemia, Haematochezia, Intussusception, Listless, Pallor, Oral intake reduced

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Records available. Anemia reported by parents.
CDC 'Split Type':

Write-up: On 11/29/06 pt was listless, fed poorly and had 3 bloody mucousy stools. In my office the patient was pale and listless. The patient was refered to ER. An air contrast BE was diagnostic and therapeutic for the pt intussisption. The pt spent one night in hospital and is doing well.


Changed on 2/14/2018

VAERS ID: 268134 Before After
VAERS Form:1
Age:0.17
Gender:Female
Location:California
Vaccinated:2006-11-14
Onset:2006-11-29
Submitted:2006-12-01
Entered:2006-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2650AA / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0679F / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 41031 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08689D / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0848F / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Anaemia, Haematochezia, Intussusception, Listless, Pallor, Oral intake reduced

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Records available. Anemia reported by parents.
CDC 'Split Type':

Write-up: On 11/29/06 pt was listless, fed poorly and had 3 bloody mucousy stools. In my office the patient was pale and listless. The patient was refered to ER. An air contrast BE was diagnostic and therapeutic for the pt intussisption. The pt spent one night in hospital and is doing well.


Changed on 6/14/2018

VAERS ID: 268134 Before After
VAERS Form:1
Age:0.17
Gender:Female
Location:California
Vaccinated:2006-11-14
Onset:2006-11-29
Submitted:2006-12-01
Entered:2006-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2650AA / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0679F / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 41031 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08689D / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0848F / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Anaemia, Haematochezia, Intussusception, Listless, Pallor, Oral intake reduced

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Records available. Anemia reported by parents.
CDC 'Split Type':

Write-up: On 11/29/06 pt was listless, fed poorly and had 3 bloody mucousy stools. In my office the patient was pale and listless. The patient was refered to ER. An air contrast BE was diagnostic and therapeutic for the pt intussisption. The pt spent one night in hospital and is doing well.

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