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This is VAERS ID 271803

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 271803
VAERS Form:
Age:0.6
Gender:Female
Location:Connecticut
Vaccinated:2006-12-08
Onset:2007-01-26
Submitted:2007-01-31
Entered:2007-02-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B059AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08658H / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0411F / 2 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal tenderness, Anorexia, Body temperature, Abdominal X-ray

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Abdominal x-ray:positive for intussusception.
CDC 'Split Type':

Write-up: Intussusception (6 weeks after 3rd dose of Rotavirus vaccine) requiring surgery. 02/16/07-Records reviewed for DOS 01/26-01/28/07- DC DX:Intussusception Surgical procedure:Laparotomy for manual reduction of intussusception. Unreducible intussusception sta"tus post attempted radiographic reduction. Presented with history of vomiting hematechesia loss of appetite fever 100.4 plus. Reports currant jelly or blood stools present. Temp in ER 100.4 PE:WNL except for abdomen soft tenderness in periumbilical mild

Changed on 12/8/2009

VAERS ID: 271803 Before After
VAERS Form:
Age:0.6
Gender:Female
Location:Connecticut
Vaccinated:2006-12-08
Onset:2007-01-26
Submitted:2007-01-31
Entered:2007-02-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B059AA / 2 LL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B059AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08658H / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0411F / 2 - / PO

Administered by: Public      Purchased by: Unknown Public
Symptoms: Abdominal mass, Abdominal tenderness, Anorexia, Body temperature, Bowel sounds abnormal, Haematochezia, Intussusception, Laparotomy, Large intestinal obstruction reduction, Surgery, Vomiting, Abdominal X-ray

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Abdominal x-ray:positive for intussusception.
CDC 'Split Type':

Write-up: Intussusception (6 weeks after 3rd dose of Rotavirus vaccine) requiring surgery. 02/16/07-Records reviewed for DOS 01/26-01/28/07- DC DX:Intussusception Surgical procedure:Laparotomy for manual reduction of intussusception. Unreducible intussusception sta"tus status post attempted radiographic reduction. Presented with history of vomiting hematechesia loss of appetite fever 100.4 plus. Reports currant jelly or blood stools present. Temp in ER 100.4 PE:WNL except for abdomen soft tenderness in periumbilical mild in intensity. Mass soft mobile mass approximately 5cm in diameter to right below of umbilicus, hypoactive bowel sounds. Rectal exam shows empty vault.

Changed on 3/2/2010

VAERS ID: 271803 Before After
VAERS Form:
Age:0.6
Gender:Female
Location:Connecticut
Vaccinated:2006-12-08
Onset:2007-01-26
Submitted:2007-01-31
Entered:2007-02-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B059AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / LEDERLE LABORATORIES B08658H / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0411F / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Abdominal mass, Abdominal tenderness, Anorexia, Body temperature, Bowel sounds abnormal, Haematochezia, Intussusception, Laparotomy, Large intestinal obstruction reduction, Surgery, Vomiting, Abdominal X-ray

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Abdominal x-ray:positive for intussusception.
CDC 'Split Type':

Write-up: Intussusception (6 weeks after 3rd dose of Rotavirus vaccine) requiring surgery. 02/16/07-Records reviewed for DOS 01/26-01/28/07- DC DX:Intussusception Surgical procedure:Laparotomy for manual reduction of intussusception. Unreducible intussusception status post attempted radiographic reduction. Presented with history of vomiting hematechesia loss of appetite fever 100.4 plus. Reports currant jelly or blood stools present. Temp in ER 100.4 PE:WNL except for abdomen soft tenderness in periumbilical mild in intensity. Mass soft mobile mass approximately 5cm in diameter to right below of umbilicus, hypoactive bowel sounds. Rectal exam shows empty vault.

Changed on 4/7/2010

VAERS ID: 271803 Before After
VAERS Form:
Age:0.6
Gender:Female
Location:Connecticut
Vaccinated:2006-12-08
Onset:2007-01-26
Submitted:2007-01-31
Entered:2007-02-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B059AA / 2 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08658H / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0411F / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Abdominal mass, Abdominal tenderness, Anorexia, Body temperature, Bowel sounds abnormal, Haematochezia, Intussusception, Laparotomy, Large intestinal obstruction reduction, Surgery, Vomiting, Abdominal X-ray

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Abdominal x-ray:positive for intussusception.
CDC 'Split Type':

Write-up: Intussusception (6 weeks after 3rd dose of Rotavirus vaccine) requiring surgery. 02/16/07-Records reviewed for DOS 01/26-01/28/07- DC DX:Intussusception Surgical procedure:Laparotomy for manual reduction of intussusception. Unreducible intussusception status post attempted radiographic reduction. Presented with history of vomiting hematechesia loss of appetite fever 100.4 plus. Reports currant jelly or blood stools present. Temp in ER 100.4 PE:WNL except for abdomen soft tenderness in periumbilical mild in intensity. Mass soft mobile mass approximately 5cm in diameter to right below of umbilicus, hypoactive bowel sounds. Rectal exam shows empty vault.

Changed on 8/31/2010

VAERS ID: 271803 Before After
VAERS Form:
Age:0.6
Gender:Female
Location:Connecticut
Vaccinated:2006-12-08
Onset:2007-01-26
Submitted:2007-01-31
Entered:2007-02-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B059AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08658H / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0411F / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Abdominal mass, Abdominal tenderness, Anorexia, Body temperature, Bowel sounds abnormal, Haematochezia, Intussusception, Laparotomy, Large intestinal obstruction reduction, Surgery, Vomiting, Abdominal X-ray

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Abdominal x-ray:positive for intussusception.
CDC 'Split Type':

Write-up: Intussusception (6 weeks after 3rd dose of Rotavirus vaccine) requiring surgery. 02/16/07-Records reviewed for DOS 01/26-01/28/07- DC DX:Intussusception Surgical procedure:Laparotomy for manual reduction of intussusception. Unreducible intussusception status post attempted radiographic reduction. Presented with history of vomiting hematechesia loss of appetite fever 100.4 plus. Reports currant jelly or blood stools present. Temp in ER 100.4 PE:WNL except for abdomen soft tenderness in periumbilical mild in intensity. Mass soft mobile mass approximately 5cm in diameter to right below of umbilicus, hypoactive bowel sounds. Rectal exam shows empty vault.

Changed on 4/13/2011

VAERS ID: 271803 Before After
VAERS Form:
Age:0.6
Gender:Female
Location:Connecticut
Vaccinated:2006-12-08
Onset:2007-01-26
Submitted:2007-01-31
Entered:2007-02-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B059AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08658H / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0411F / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Abdominal mass, Abdominal tenderness, Anorexia, Body temperature, Bowel sounds abnormal, Haematochezia, Intussusception, Laparotomy, Large intestinal obstruction reduction, Surgery, Vomiting, Abdominal X-ray

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Abdominal x-ray:positive for intussusception.
CDC 'Split Type':

Write-up: Intussusception (6 weeks after 3rd dose of Rotavirus vaccine) requiring surgery. 02/16/07-Records reviewed for DOS 01/26-01/28/07- DC DX:Intussusception Surgical procedure:Laparotomy for manual reduction of intussusception. Unreducible intussusception status post attempted radiographic reduction. Presented with history of vomiting hematechesia loss of appetite fever 100.4 plus. Reports currant jelly or blood stools present. Temp in ER 100.4 PE:WNL except for abdomen soft tenderness in periumbilical mild in intensity. Mass soft mobile mass approximately 5cm in diameter to right below of umbilicus, hypoactive bowel sounds. Rectal exam shows empty vault.

Changed on 5/13/2011

VAERS ID: 271803 Before After
VAERS Form:
Age:0.6
Gender:Female
Location:Connecticut
Vaccinated:2006-12-08
Onset:2007-01-26
Submitted:2007-01-31
Entered:2007-02-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B059AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08658H / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0411F / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Abdominal mass, Abdominal tenderness, Anorexia, Body temperature, Bowel sounds abnormal, Haematochezia, Intussusception, Laparotomy, Large intestinal obstruction reduction, Surgery, Vomiting, Abdominal X-ray

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Abdominal x-ray:positive for intussusception.
CDC 'Split Type':

Write-up: Intussusception (6 weeks after 3rd dose of Rotavirus vaccine) requiring surgery. 02/16/07-Records reviewed for DOS 01/26-01/28/07- DC DX:Intussusception Surgical procedure:Laparotomy for manual reduction of intussusception. Unreducible intussusception status post attempted radiographic reduction. Presented with history of vomiting hematechesia loss of appetite fever 100.4 plus. Reports currant jelly or blood stools present. Temp in ER 100.4 PE:WNL except for abdomen soft tenderness in periumbilical mild in intensity. Mass soft mobile mass approximately 5cm in diameter to right below of umbilicus, hypoactive bowel sounds. Rectal exam shows empty vault.

Changed on 6/11/2011

VAERS ID: 271803 Before After
VAERS Form:
Age:0.6
Gender:Female
Location:Connecticut
Vaccinated:2006-12-08
Onset:2007-01-26
Submitted:2007-01-31
Entered:2007-02-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B059AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08658H / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0411F / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Abdominal mass, Abdominal tenderness, Anorexia, Body temperature, Bowel sounds abnormal, Haematochezia, Intussusception, Laparotomy, Large intestinal obstruction reduction, Surgery, Vomiting, Abdominal X-ray

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Abdominal x-ray:positive for intussusception.
CDC 'Split Type':

Write-up: Intussusception (6 weeks after 3rd dose of Rotavirus vaccine) requiring surgery. 02/16/07-Records reviewed for DOS 01/26-01/28/07- DC DX:Intussusception Surgical procedure:Laparotomy for manual reduction of intussusception. Unreducible intussusception status post attempted radiographic reduction. Presented with history of vomiting hematechesia loss of appetite fever 100.4 plus. Reports currant jelly or blood stools present. Temp in ER 100.4 PE:WNL except for abdomen soft tenderness in periumbilical mild in intensity. Mass soft mobile mass approximately 5cm in diameter to right below of umbilicus, hypoactive bowel sounds. Rectal exam shows empty vault.

Changed on 5/13/2013

VAERS ID: 271803 Before After
VAERS Form:
Age:0.6
Gender:Female
Location:Connecticut
Vaccinated:2006-12-08
Onset:2007-01-26
Submitted:2007-01-31
Entered:2007-02-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B059AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08658H / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0411F / 2 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0411F / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Abdominal mass, Abdominal tenderness, Anorexia, Body temperature, Bowel sounds abnormal, Haematochezia, Intussusception, Laparotomy, Large intestinal obstruction reduction, Surgery, Vomiting, Abdominal X-ray

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Abdominal x-ray:positive for intussusception.
CDC 'Split Type':

Write-up: Intussusception (6 weeks after 3rd dose of Rotavirus vaccine) requiring surgery. 02/16/07-Records reviewed for DOS 01/26-01/28/07- DC DX:Intussusception Surgical procedure:Laparotomy for manual reduction of intussusception. Unreducible intussusception status post attempted radiographic reduction. Presented with history of vomiting hematechesia loss of appetite fever 100.4 plus. Reports currant jelly or blood stools present. Temp in ER 100.4 PE:WNL except for abdomen soft tenderness in periumbilical mild in intensity. Mass soft mobile mass approximately 5cm in diameter to right below of umbilicus, hypoactive bowel sounds. Rectal exam shows empty vault.

Changed on 2/14/2017

VAERS ID: 271803 Before After
VAERS Form:
Age:0.6 0.55
Gender:Female
Location:Connecticut
Vaccinated:2006-12-08
Onset:2007-01-26
Submitted:2007-01-31
Entered:2007-02-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B059AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08658H / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0411F / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Abdominal mass, Abdominal tenderness, Anorexia, Body temperature, Bowel sounds abnormal, Haematochezia, Intussusception, Laparotomy, Large intestinal obstruction reduction, Surgery, Vomiting, Abdominal X-ray

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Abdominal x-ray:positive for intussusception.
CDC 'Split Type':

Write-up: Intussusception (6 weeks after 3rd dose of Rotavirus vaccine) requiring surgery. 02/16/07-Records reviewed for DOS 01/26-01/28/07- DC DX:Intussusception Surgical procedure:Laparotomy for manual reduction of intussusception. Unreducible intussusception status post attempted radiographic reduction. Presented with history of vomiting hematechesia loss of appetite fever 100.4 plus. Reports currant jelly or blood stools present. Temp in ER 100.4 PE:WNL except for abdomen soft tenderness in periumbilical mild in intensity. Mass soft mobile mass approximately 5cm in diameter to right below of umbilicus, hypoactive bowel sounds. Rectal exam shows empty vault.

Changed on 5/14/2017

VAERS ID: 271803 Before After
VAERS Form:
Age:0.55
Gender:Female
Location:Connecticut
Vaccinated:2006-12-08
Onset:2007-01-26
Submitted:2007-01-31
Entered:2007-02-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B059AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES PFIZER/WYETH B08658H / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0411F / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Abdominal mass, Abdominal tenderness, Anorexia, Body temperature, Bowel sounds abnormal, Haematochezia, Intussusception, Laparotomy, Large intestinal obstruction reduction, Surgery, Vomiting, Abdominal X-ray

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Abdominal x-ray:positive for intussusception.
CDC 'Split Type':

Write-up: Intussusception (6 weeks after 3rd dose of Rotavirus vaccine) requiring surgery. 02/16/07-Records reviewed for DOS 01/26-01/28/07- DC DX:Intussusception Surgical procedure:Laparotomy for manual reduction of intussusception. Unreducible intussusception status post attempted radiographic reduction. Presented with history of vomiting hematechesia loss of appetite fever 100.4 plus. Reports currant jelly or blood stools present. Temp in ER 100.4 PE:WNL except for abdomen soft tenderness in periumbilical mild in intensity. Mass soft mobile mass approximately 5cm in diameter to right below of umbilicus, hypoactive bowel sounds. Rectal exam shows empty vault.

Changed on 9/14/2017

VAERS ID: 271803 Before After
VAERS Form:(blank) 1
Age:0.55
Gender:Female
Location:Connecticut
Vaccinated:2006-12-08
Onset:2007-01-26
Submitted:2007-01-31
Entered:2007-02-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B059AA / 2 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08658H / 2 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0411F / 2 3 - MO / PO

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

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Abdominal x-ray:positive for intussusception.
CDC 'Split Type':

Write-up: Intussusception (6 weeks after 3rd dose of Rotavirus vaccine) requiring surgery. 02/16/07-Records reviewed for DOS 01/26-01/28/07- DC DX:Intussusception Surgical procedure:Laparotomy for manual reduction of intussusception. Unreducible intussusception status post attempted radiographic reduction. Presented with history of vomiting hematechesia loss of appetite fever 100.4 plus. Reports currant jelly or blood stools present. Temp in ER 100.4 PE:WNL except for abdomen soft tenderness in periumbilical mild in intensity. Mass soft mobile mass approximately 5cm in diameter to right below of umbilicus, hypoactive bowel sounds. Rectal exam shows empty vault.

Changed on 2/14/2018

VAERS ID: 271803 Before After
VAERS Form:1
Age:0.55
Gender:Female
Location:Connecticut
Vaccinated:2006-12-08
Onset:2007-01-26
Submitted:2007-01-31
Entered:2007-02-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B059AA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08658H / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0411F / 3 MO / PO

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

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Abdominal x-ray:positive for intussusception.
CDC 'Split Type':

Write-up: Intussusception (6 weeks after 3rd dose of Rotavirus vaccine) requiring surgery. 02/16/07-Records reviewed for DOS 01/26-01/28/07- DC DX:Intussusception Surgical procedure:Laparotomy for manual reduction of intussusception. Unreducible intussusception status post attempted radiographic reduction. Presented with history of vomiting hematechesia loss of appetite fever 100.4 plus. Reports currant jelly or blood stools present. Temp in ER 100.4 PE:WNL except for abdomen soft tenderness in periumbilical mild in intensity. Mass soft mobile mass approximately 5cm in diameter to right below of umbilicus, hypoactive bowel sounds. Rectal exam shows empty vault.

Changed on 6/14/2018

VAERS ID: 271803 Before After
VAERS Form:1
Age:0.55
Gender:Female
Location:Connecticut
Vaccinated:2006-12-08
Onset:2007-01-26
Submitted:2007-01-31
Entered:2007-02-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B059AA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08658H / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0411F / 3 MO / PO

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

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Abdominal x-ray:positive for intussusception.
CDC 'Split Type':

Write-up: Intussusception (6 weeks after 3rd dose of Rotavirus vaccine) requiring surgery. 02/16/07-Records reviewed for DOS 01/26-01/28/07- DC DX:Intussusception Surgical procedure:Laparotomy for manual reduction of intussusception. Unreducible intussusception status post attempted radiographic reduction. Presented with history of vomiting hematechesia loss of appetite fever 100.4 plus. Reports currant jelly or blood stools present. Temp in ER 100.4 PE:WNL except for abdomen soft tenderness in periumbilical mild in intensity. Mass soft mobile mass approximately 5cm in diameter to right below of umbilicus, hypoactive bowel sounds. Rectal exam shows empty vault.

Changed on 8/14/2018

VAERS ID: 271803 Before After
VAERS Form:1
Age:0.55
Gender:Female
Location:Connecticut
Vaccinated:2006-12-08
Onset:2007-01-26
Submitted:2007-01-31
Entered:2007-02-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B059AA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08658H / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0411F / 3 MO / PO

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

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Abdominal x-ray:positive for intussusception.
CDC 'Split Type':

Write-up: Intussusception (6 weeks after 3rd dose of Rotavirus vaccine) requiring surgery. 02/16/07-Records reviewed for DOS 01/26-01/28/07- DC DX:Intussusception Surgical procedure:Laparotomy for manual reduction of intussusception. Unreducible intussusception status post attempted radiographic reduction. Presented with history of vomiting hematechesia loss of appetite fever 100.4 plus. Reports currant jelly or blood stools present. Temp in ER 100.4 PE:WNL except for abdomen soft tenderness in periumbilical mild in intensity. Mass soft mobile mass approximately 5cm in diameter to right below of umbilicus, hypoactive bowel sounds. Rectal exam shows empty vault.

Changed on 9/14/2018

VAERS ID: 271803 Before After
VAERS Form:1
Age:0.55
Gender:Female
Location:Connecticut
Vaccinated:2006-12-08
Onset:2007-01-26
Submitted:2007-01-31
Entered:2007-02-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B059AA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08658H / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0411F / 3 MO / PO

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

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Abdominal x-ray:positive for intussusception.
CDC 'Split Type':

Write-up: Intussusception (6 weeks after 3rd dose of Rotavirus vaccine) requiring surgery. 02/16/07-Records reviewed for DOS 01/26-01/28/07- DC DX:Intussusception Surgical procedure:Laparotomy for manual reduction of intussusception. Unreducible intussusception status post attempted radiographic reduction. Presented with history of vomiting hematechesia loss of appetite fever 100.4 plus. Reports currant jelly or blood stools present. Temp in ER 100.4 PE:WNL except for abdomen soft tenderness in periumbilical mild in intensity. Mass soft mobile mass approximately 5cm in diameter to right below of umbilicus, hypoactive bowel sounds. Rectal exam shows empty vault.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=271803&WAYBACKHISTORY=ON


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