National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 268404

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 268404
VAERS Form:
Age:0.2
Gender:Female
Location:Kansas
Vaccinated:2006-10-02
Onset:2006-12-04
Submitted:2006-12-05
Entered:2006-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP HEPB IPV (PEDIARIX) / GLAXOSMITHKLINE AC2B033BA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0084F / 0 LL / IM
PNC: PNEUMO, 7-VALENT (PREVNAR) / LEDERLE LABORATORIES B08639A / 0 RL / IM
ROTHB5: ROTAVIRUS VACCINE, LIVE, ORAL, PENTAVALENT (ROTATEQ) / MERCK & CO. INC. 0578 / 0 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: Barium double contrast, Haematochezia, Intussusception, Small intestinal intussusception reduction, Ultrasound abdomen abnormal

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: LABS: D/C summary states pelvic US showed IS (no report available).
CDC 'Split Type':

Write-up: Immunizations on 10/02/2006 symptoms of bloody stools 12/04 surgical reduction of intussusception 12/04.


Changed on 12/8/2009

VAERS ID: 268404 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Kansas
Vaccinated:2006-10-02
Onset:2006-12-04
Submitted:2006-12-05
Entered:2006-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP HEPB IPV (PEDIARIX) / GLAXOSMITHKLINE AC2B033BA / 0 LL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC2B033BA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0084F / 0 LL / IM
PNC: PNEUMO, 7-VALENT (PREVNAR) PNEUMO (PREVNAR) / LEDERLE LABORATORIES WYETH PHARMACEUTICALS, INC B08639A / 0 RL / IM
ROTHB5: ROTAVIRUS VACCINE, LIVE, ORAL, PENTAVALENT (ROTATEQ) ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0578 / 0 - / PO

Administered by: Public      Purchased by: Unknown Public
Symptoms: Barium double contrast, Haematochezia, Intussusception, Small intestinal intussusception reduction, Surgery, Enema administration, Ultrasound abdomen abnormal

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: LABS: D/C summary states pelvic US showed IS (no report available).
CDC 'Split Type':

Write-up: Immunizations on 10/02/2006 symptoms of bloody stools 12/04 surgical reduction of intussusception 12/04. 1/22/07 Received medical records from hospital which reveal patient admitted 12/4/-12/7/06 after having had bright red bloody diaper & was fussy prior to being seen in ER on 12/4/06. GYN & surgical consults done to r/o vaginal bleeding. US showed IS. Air enema attempt to reduce intussusception was unsuccessful & was taken to OR whre it was reduced w/o difficulty. Continued to improve & was d/c to home w/o complications. FINAL DX: Intussusception, surgically reduced.


Changed on 1/5/2010

VAERS ID: 268404 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Kansas
Vaccinated:2006-10-02
Onset:2006-12-04
Submitted:2006-12-05
Entered:2006-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC2B033BA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0084F / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08639A / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0578 / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Haematochezia, Intussusception, Small intestinal intussusception reduction, Surgery, Enema administration, Ultrasound abdomen abnormal

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: LABS: D/C summary states pelvic US showed IS (no report available).
CDC 'Split Type':

Write-up: Immunizations on 10/02/2006 symptoms of bloody stools 12/04 surgical reduction of intussusception 12/04. 1/22/07 Received medical records from hospital which reveal patient admitted 12/4/-12/7/06 after having had bright red bloody diaper & was fussy prior to being seen in ER on 12/4/06. GYN & surgical consults done to r/o vaginal bleeding. US showed IS. Air enema attempt to reduce intussusception was unsuccessful & was taken to OR whre it was reduced w/o difficulty. Continued to improve & was d/c to home w/o complications. FINAL DX: Intussusception, surgically reduced.


Changed on 3/2/2010

VAERS ID: 268404 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Kansas
Vaccinated:2006-10-02
Onset:2006-12-04
Submitted:2006-12-05
Entered:2006-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC2B033BA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0084F / 0 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B08639A / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0578 / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Haematochezia, Intussusception

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: LABS: D/C summary states pelvic US showed IS (no report available).
CDC 'Split Type':

Write-up: Immunizations on 10/02/2006 symptoms of bloody stools 12/04 surgical reduction of intussusception 12/04. 1/22/07 Received medical records from hospital which reveal patient admitted 12/4/-12/7/06 after having had bright red bloody diaper & was fussy prior to being seen in ER on 12/4/06. GYN & surgical consults done to r/o vaginal bleeding. US showed IS. Air enema attempt to reduce intussusception was unsuccessful & was taken to OR whre it was reduced w/o difficulty. Continued to improve & was d/c to home w/o complications. FINAL DX: Intussusception, surgically reduced.


Changed on 4/7/2010

VAERS ID: 268404 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Kansas
Vaccinated:2006-10-02
Onset:2006-12-04
Submitted:2006-12-05
Entered:2006-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC2B033BA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0084F / 0 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08639A / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0578 / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Haematochezia, Intussusception

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: LABS: D/C summary states pelvic US showed IS (no report available).
CDC 'Split Type':

Write-up: Immunizations on 10/02/2006 symptoms of bloody stools 12/04 surgical reduction of intussusception 12/04. 1/22/07 Received medical records from hospital which reveal patient admitted 12/4/-12/7/06 after having had bright red bloody diaper & was fussy prior to being seen in ER on 12/4/06. GYN & surgical consults done to r/o vaginal bleeding. US showed IS. Air enema attempt to reduce intussusception was unsuccessful & was taken to OR whre it was reduced w/o difficulty. Continued to improve & was d/c to home w/o complications. FINAL DX: Intussusception, surgically reduced.


Changed on 8/31/2010

VAERS ID: 268404 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Kansas
Vaccinated:2006-10-02
Onset:2006-12-04
Submitted:2006-12-05
Entered:2006-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC2B033BA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0084F / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B08639A / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0578 / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Haematochezia, Intussusception, Ultrasound abdomen abnormal

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: LABS: D/C summary states pelvic US showed IS (no report available).
CDC 'Split Type':

Write-up: Immunizations on 10/02/2006 symptoms of bloody stools 12/04 surgical reduction of intussusception 12/04. 1/22/07 Received medical records from hospital which reveal patient admitted 12/4/-12/7/06 after having had bright red bloody diaper & was fussy prior to being seen in ER on 12/4/06. GYN & surgical consults done to r/o vaginal bleeding. US showed IS. Air enema attempt to reduce intussusception was unsuccessful & was taken to OR whre it was reduced w/o difficulty. Continued to improve & was d/c to home w/o complications. FINAL DX: Intussusception, surgically reduced.


Changed on 1/4/2011

VAERS ID: 268404 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Kansas
Vaccinated:2006-10-02
Onset:2006-12-04
Submitted:2006-12-05
Entered:2006-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC2B033BA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0084F / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08639A / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0578 / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Haematochezia, Intussusception, Ultrasound abdomen abnormal

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: LABS: D/C summary states pelvic US showed IS (no report available).
CDC 'Split Type':

Write-up: Immunizations on 10/02/2006 symptoms of bloody stools 12/04 surgical reduction of intussusception 12/04. 1/22/07 Received medical records from hospital which reveal patient admitted 12/4/-12/7/06 after having had bright red bloody diaper & was fussy prior to being seen in ER on 12/4/06. GYN & surgical consults done to r/o vaginal bleeding. US showed IS. Air enema attempt to reduce intussusception was unsuccessful & was taken to OR whre it was reduced w/o difficulty. Continued to improve & was d/c to home w/o complications. FINAL DX: Intussusception, surgically reduced.


Changed on 4/13/2011

VAERS ID: 268404 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Kansas
Vaccinated:2006-10-02
Onset:2006-12-04
Submitted:2006-12-05
Entered:2006-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC2B033BA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0084F / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08639A / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0578 / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Haematochezia, Intussusception, Small intestinal intussusception reduction, Surgery, Enema administration, Ultrasound abdomen abnormal

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: LABS: D/C summary states pelvic US showed IS (no report available).
CDC 'Split Type':

Write-up: Immunizations on 10/02/2006 symptoms of bloody stools 12/04 surgical reduction of intussusception 12/04. 1/22/07 Received medical records from hospital which reveal patient admitted 12/4/-12/7/06 after having had bright red bloody diaper & was fussy prior to being seen in ER on 12/4/06. GYN & surgical consults done to r/o vaginal bleeding. US showed IS. Air enema attempt to reduce intussusception was unsuccessful & was taken to OR whre it was reduced w/o difficulty. Continued to improve & was d/c to home w/o complications. FINAL DX: Intussusception, surgically reduced.


Changed on 5/13/2011

VAERS ID: 268404 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Kansas
Vaccinated:2006-10-02
Onset:2006-12-04
Submitted:2006-12-05
Entered:2006-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC2B033BA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0084F / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08639A / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0578 / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Haematochezia, Intussusception, Small intestinal intussusception reduction, Surgery, Enema administration, Ultrasound abdomen abnormal

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: LABS: D/C summary states pelvic US showed IS (no report available).
CDC 'Split Type':

Write-up: Immunizations on 10/02/2006 symptoms of bloody stools 12/04 surgical reduction of intussusception 12/04. 1/22/07 Received medical records from hospital which reveal patient admitted 12/4/-12/7/06 after having had bright red bloody diaper & was fussy prior to being seen in ER on 12/4/06. GYN & surgical consults done to r/o vaginal bleeding. US showed IS. Air enema attempt to reduce intussusception was unsuccessful & was taken to OR whre it was reduced w/o difficulty. Continued to improve & was d/c to home w/o complications. FINAL DX: Intussusception, surgically reduced.


Changed on 6/11/2011

VAERS ID: 268404 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Kansas
Vaccinated:2006-10-02
Onset:2006-12-04
Submitted:2006-12-05
Entered:2006-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC2B033BA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0084F / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08639A / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0578 / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Haematochezia, Intussusception, Small intestinal intussusception reduction, Surgery, Enema administration, Ultrasound abdomen abnormal

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: LABS: D/C summary states pelvic US showed IS (no report available).
CDC 'Split Type':

Write-up: Immunizations on 10/02/2006 symptoms of bloody stools 12/04 surgical reduction of intussusception 12/04. 1/22/07 Received medical records from hospital which reveal patient admitted 12/4/-12/7/06 after having had bright red bloody diaper & was fussy prior to being seen in ER on 12/4/06. GYN & surgical consults done to r/o vaginal bleeding. US showed IS. Air enema attempt to reduce intussusception was unsuccessful & was taken to OR whre it was reduced w/o difficulty. Continued to improve & was d/c to home w/o complications. FINAL DX: Intussusception, surgically reduced.


Changed on 5/13/2013

VAERS ID: 268404 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Kansas
Vaccinated:2006-10-02
Onset:2006-12-04
Submitted:2006-12-05
Entered:2006-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC2B033BA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0084F / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08639A / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0578 / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0578 / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Haematochezia, Intussusception, Small intestinal intussusception reduction, Surgery, Enema administration, Ultrasound abdomen abnormal

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: LABS: D/C summary states pelvic US showed IS (no report available).
CDC 'Split Type':

Write-up: Immunizations on 10/02/2006 symptoms of bloody stools 12/04 surgical reduction of intussusception 12/04. 1/22/07 Received medical records from hospital which reveal patient admitted 12/4/-12/7/06 after having had bright red bloody diaper & was fussy prior to being seen in ER on 12/4/06. GYN & surgical consults done to r/o vaginal bleeding. US showed IS. Air enema attempt to reduce intussusception was unsuccessful & was taken to OR whre it was reduced w/o difficulty. Continued to improve & was d/c to home w/o complications. FINAL DX: Intussusception, surgically reduced.


Changed on 6/14/2014

VAERS ID: 268404 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Kansas
Vaccinated:2006-10-02
Onset:2006-12-04
Submitted:2006-12-05
Entered:2006-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC2B033BA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0084F / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08639A / 0 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0578 / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Haematochezia, Intussusception, Small intestinal intussusception reduction, Surgery, Enema administration, Ultrasound abdomen abnormal

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: LABS: D/C summary states pelvic US showed IS (no report available).
CDC 'Split Type':

Write-up: Immunizations on 10/02/2006 symptoms of bloody stools 12/04 surgical reduction of intussusception 12/04. 1/22/07 Received medical records from hospital which reveal patient admitted 12/4/-12/7/06 after having had bright red bloody diaper & was fussy prior to being seen in ER on 12/4/06. GYN & surgical consults done to r/o vaginal bleeding. US showed IS. Air enema attempt to reduce intussusception was unsuccessful & was taken to OR whre it was reduced w/o difficulty. Continued to improve & was d/c to home w/o complications. FINAL DX: Intussusception, surgically reduced.


Changed on 2/14/2017

VAERS ID: 268404 Before After
VAERS Form:
Age:0.2 0.17
Gender:Female
Location:Kansas
Vaccinated:2006-10-02
Onset:2006-12-04
Submitted:2006-12-05
Entered:2006-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC2B033BA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0084F / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08639A / 0 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0578 / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Haematochezia, Intussusception, Small intestinal intussusception reduction, Surgery, Enema administration, Ultrasound abdomen abnormal

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: LABS: D/C summary states pelvic US showed IS (no report available).
CDC 'Split Type':

Write-up: Immunizations on 10/02/2006 symptoms of bloody stools 12/04 surgical reduction of intussusception 12/04. 1/22/07 Received medical records from hospital which reveal patient admitted 12/4/-12/7/06 after having had bright red bloody diaper & was fussy prior to being seen in ER on 12/4/06. GYN & surgical consults done to r/o vaginal bleeding. US showed IS. Air enema attempt to reduce intussusception was unsuccessful & was taken to OR whre it was reduced w/o difficulty. Continued to improve & was d/c to home w/o complications. FINAL DX: Intussusception, surgically reduced.


Changed on 5/14/2017

VAERS ID: 268404 Before After
VAERS Form:
Age:0.17
Gender:Female
Location:Kansas
Vaccinated:2006-10-02
Onset:2006-12-04
Submitted:2006-12-05
Entered:2006-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC2B033BA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0084F / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08639A / 0 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0578 / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Haematochezia, Intussusception, Small intestinal intussusception reduction, Surgery, Enema administration, Ultrasound abdomen abnormal

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: LABS: D/C summary states pelvic US showed IS (no report available).
CDC 'Split Type':

Write-up: Immunizations on 10/02/2006 symptoms of bloody stools 12/04 surgical reduction of intussusception 12/04. 1/22/07 Received medical records from hospital which reveal patient admitted 12/4/-12/7/06 after having had bright red bloody diaper & was fussy prior to being seen in ER on 12/4/06. GYN & surgical consults done to r/o vaginal bleeding. US showed IS. Air enema attempt to reduce intussusception was unsuccessful & was taken to OR whre it was reduced w/o difficulty. Continued to improve & was d/c to home w/o complications. FINAL DX: Intussusception, surgically reduced.


Changed on 9/14/2017

VAERS ID: 268404 Before After
VAERS Form:(blank) 1
Age:0.17
Gender:Female
Location:Kansas
Vaccinated:2006-10-02
Onset:2006-12-04
Submitted:2006-12-05
Entered:2006-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC2B033BA / 0 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0084F / 0 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08639A / 0 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0578 / 0 1 - MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Haematochezia, Intussusception

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: LABS: D/C summary states pelvic US showed IS (no report available).
CDC 'Split Type':

Write-up: Immunizations on 10/02/2006 symptoms of bloody stools 12/04 surgical reduction of intussusception 12/04. 1/22/07 Received medical records from hospital which reveal patient admitted 12/4/-12/7/06 after having had bright red bloody diaper & was fussy prior to being seen in ER on 12/4/06. GYN & surgical consults done to r/o vaginal bleeding. US showed IS. Air enema attempt to reduce intussusception was unsuccessful & was taken to OR whre it was reduced w/o difficulty. Continued to improve & was d/c to home w/o complications. FINAL DX: Intussusception, surgically reduced.


Changed on 2/14/2018

VAERS ID: 268404 Before After
VAERS Form:1
Age:0.17
Gender:Female
Location:Kansas
Vaccinated:2006-10-02
Onset:2006-12-04
Submitted:2006-12-05
Entered:2006-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC2B033BA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0084F / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08639A / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0578 / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Haematochezia, Intussusception

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: LABS: D/C summary states pelvic US showed IS (no report available).
CDC 'Split Type':

Write-up: Immunizations on 10/02/2006 symptoms of bloody stools 12/04 surgical reduction of intussusception 12/04. 1/22/07 Received medical records from hospital which reveal patient admitted 12/4/-12/7/06 after having had bright red bloody diaper & was fussy prior to being seen in ER on 12/4/06. GYN & surgical consults done to r/o vaginal bleeding. US showed IS. Air enema attempt to reduce intussusception was unsuccessful & was taken to OR whre it was reduced w/o difficulty. Continued to improve & was d/c to home w/o complications. FINAL DX: Intussusception, surgically reduced.


Changed on 6/14/2018

VAERS ID: 268404 Before After
VAERS Form:1
Age:0.17
Gender:Female
Location:Kansas
Vaccinated:2006-10-02
Onset:2006-12-04
Submitted:2006-12-05
Entered:2006-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC2B033BA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0084F / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08639A / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0578 / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Haematochezia, Intussusception

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: LABS: D/C summary states pelvic US showed IS (no report available).
CDC 'Split Type':

Write-up: Immunizations on 10/02/2006 symptoms of bloody stools 12/04 surgical reduction of intussusception 12/04. 1/22/07 Received medical records from hospital which reveal patient admitted 12/4/-12/7/06 after having had bright red bloody diaper & was fussy prior to being seen in ER on 12/4/06. GYN & surgical consults done to r/o vaginal bleeding. US showed IS. Air enema attempt to reduce intussusception was unsuccessful & was taken to OR whre it was reduced w/o difficulty. Continued to improve & was d/c to home w/o complications. FINAL DX: Intussusception, surgically reduced.


Changed on 8/14/2018

VAERS ID: 268404 Before After
VAERS Form:1
Age:0.17
Gender:Female
Location:Kansas
Vaccinated:2006-10-02
Onset:2006-12-04
Submitted:2006-12-05
Entered:2006-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC2B033BA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0084F / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08639A / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0578 / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Haematochezia, Intussusception

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: LABS: D/C summary states pelvic US showed IS (no report available).
CDC 'Split Type':

Write-up: Immunizations on 10/02/2006 symptoms of bloody stools 12/04 surgical reduction of intussusception 12/04. 1/22/07 Received medical records from hospital which reveal patient admitted 12/4/-12/7/06 after having had bright red bloody diaper & was fussy prior to being seen in ER on 12/4/06. GYN & surgical consults done to r/o vaginal bleeding. US showed IS. Air enema attempt to reduce intussusception was unsuccessful & was taken to OR whre it was reduced w/o difficulty. Continued to improve & was d/c to home w/o complications. FINAL DX: Intussusception, surgically reduced.


Changed on 9/14/2018

VAERS ID: 268404 Before After
VAERS Form:1
Age:0.17
Gender:Female
Location:Kansas
Vaccinated:2006-10-02
Onset:2006-12-04
Submitted:2006-12-05
Entered:2006-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC2B033BA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0084F / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08639A / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0578 / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Haematochezia, Intussusception

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: LABS: D/C summary states pelvic US showed IS (no report available).
CDC 'Split Type':

Write-up: Immunizations on 10/02/2006 symptoms of bloody stools 12/04 surgical reduction of intussusception 12/04. 1/22/07 Received medical records from hospital which reveal patient admitted 12/4/-12/7/06 after having had bright red bloody diaper & was fussy prior to being seen in ER on 12/4/06. GYN & surgical consults done to r/o vaginal bleeding. US showed IS. Air enema attempt to reduce intussusception was unsuccessful & was taken to OR whre it was reduced w/o difficulty. Continued to improve & was d/c to home w/o complications. FINAL DX: Intussusception, surgically reduced.

New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=268404&WAYBACKHISTORY=ON


Copyright © 2018 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166