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This is VAERS ID 272130

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 272130
VAERS Form:
Age:0.3
Gender:Female
Location:Michigan
Vaccinated:2007-02-07
Onset:2007-02-10
Submitted:2007-02-12
Entered:2007-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B089AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08670F / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1112F / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Culture urine negative, Haematochezia, Enema administration, Diverticular hernia, Abdominal X-ray

Life Threatening? No
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: nasal congestion, gastroenteritis, multiple episodes of vomiting & bloody stools over the month prior to admission.
Allergies:
Diagnostic Lab Data: PCP LABS: UA revealed klebsiella pneumoniae at office. Hospital LABS: WBC 9.45, H/H 9.6/28.2. UA cloudy w/+ ketones, + protein, neg nitrite. Urine c/s neg. Abd xray revealed gas pattern c/w intussusception. Abd ultrasound + for intussus
CDC 'Split Type':

Write-up: Intusssception in 2 places. One of which required air enema, the other needed surgical reduction.


Changed on 12/8/2009

VAERS ID: 272130 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Michigan
Vaccinated:2007-02-07
Onset:2007-02-10
Submitted:2007-02-12
Entered:2007-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B089AA / 1 LL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B089AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08670F / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1112F / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Culture urine negative, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Mucous stools, Rash erythematous, Rhinorrhoea, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal, Diverticular hernia, Abdominal X-ray, Urine analysis abnormal

Life Threatening? No
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: nasal congestion, gastroenteritis, multiple episodes of vomiting & bloody stools over the month prior to admission.
Allergies:
Diagnostic Lab Data: PCP LABS: UA revealed klebsiella pneumoniae at office. Hospital LABS: WBC 9.45, H/H 9.6/28.2. UA cloudy w/+ ketones, + protein, neg nitrite. Urine c/s neg. Abd xray revealed gas pattern c/w intussusception. Abd ultrasound + for intussus
CDC 'Split Type':

Write-up: Intusssception in 2 places. One of which required air enema, the other needed surgical reduction. 2/15/07 Received medical records from PCP which included vax records. Patient seen on 12/28 w/nasal congestion & right nasolacrimal duct obstruction. Next visit on 1/2/07 for vomiting, listless, diarrhea. Other family members ill w/stomach flu. Exam revealed afebrile, good hydration. Dx w/gastroenteritis. Next seen 1/25/07 for vomiting, crankiness, decreased appetite, nasal congestion. Dx/vomiting secondary to unspecified acute illness, posible gastroenteritis. Seen for vax on 2/7. Then next seen on 2/10 for emesis, dry heaves, no diarrhea, normal stools. With other episodes, had some loose stools that were mucousy & little bit of blood at time. 2/11/07 phone call revealed patient continued to have vomiting. UA revealed UTI & was sent to hospital for admission for UTI, vomiting & dehydration. At hospital was found to have IS. 3/13/07 Medical records reviewed which reveal patient admitted 2/11/07 s/p vomiting for 1-2 days, 1 bloody mucous stool & having a UTI. Exam revealed VSS, abdomen soft & diffusely tender w/o masses palpable. ALso noted erythematous rash on back & arms. Lungs were clear w/mild subcostal retractions. Ped surgery consulted. Taken to OR after BE failed to reduce. Procedure was attempted laparoscopic reduction of IS; open resection of ileoileal IS, including Meckel''s diverticulectomy; & appendectomy. No D/C summary available. T/C to hospital to request d/c date which was 2/15/07. Final Dx: Ileoileal intussusception w/Meckels diverticulum as the lead point.


Changed on 3/2/2010

VAERS ID: 272130 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Michigan
Vaccinated:2007-02-07
Onset:2007-02-10
Submitted:2007-02-12
Entered:2007-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B089AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / LEDERLE LABORATORIES B08670F / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1112F / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Culture urine negative, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Mucous stools, Rash erythematous, Rhinorrhoea, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal, Diverticular hernia, Abdominal X-ray, Urine analysis abnormal

Life Threatening? No
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: nasal congestion, gastroenteritis, multiple episodes of vomiting & bloody stools over the month prior to admission.
Allergies:
Diagnostic Lab Data: PCP LABS: UA revealed klebsiella pneumoniae at office. Hospital LABS: WBC 9.45, H/H 9.6/28.2. UA cloudy w/+ ketones, + protein, neg nitrite. Urine c/s neg. Abd xray revealed gas pattern c/w intussusception. Abd ultrasound + for intussus
CDC 'Split Type':

Write-up: Intusssception in 2 places. One of which required air enema, the other needed surgical reduction. 2/15/07 Received medical records from PCP which included vax records. Patient seen on 12/28 w/nasal congestion & right nasolacrimal duct obstruction. Next visit on 1/2/07 for vomiting, listless, diarrhea. Other family members ill w/stomach flu. Exam revealed afebrile, good hydration. Dx w/gastroenteritis. Next seen 1/25/07 for vomiting, crankiness, decreased appetite, nasal congestion. Dx/vomiting secondary to unspecified acute illness, posible gastroenteritis. Seen for vax on 2/7. Then next seen on 2/10 for emesis, dry heaves, no diarrhea, normal stools. With other episodes, had some loose stools that were mucousy & little bit of blood at time. 2/11/07 phone call revealed patient continued to have vomiting. UA revealed UTI & was sent to hospital for admission for UTI, vomiting & dehydration. At hospital was found to have IS. 3/13/07 Medical records reviewed which reveal patient admitted 2/11/07 s/p vomiting for 1-2 days, 1 bloody mucous stool & having a UTI. Exam revealed VSS, abdomen soft & diffusely tender w/o masses palpable. ALso noted erythematous rash on back & arms. Lungs were clear w/mild subcostal retractions. Ped surgery consulted. Taken to OR after BE failed to reduce. Procedure was attempted laparoscopic reduction of IS; open resection of ileoileal IS, including Meckel''s diverticulectomy; & appendectomy. No D/C summary available. T/C to hospital to request d/c date which was 2/15/07. Final Dx: Ileoileal intussusception w/Meckels diverticulum as the lead point.


Changed on 4/7/2010

VAERS ID: 272130 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Michigan
Vaccinated:2007-02-07
Onset:2007-02-10
Submitted:2007-02-12
Entered:2007-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B089AA / 1 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08670F / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1112F / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Culture urine negative, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Mucous stools, Rash erythematous, Rhinorrhoea, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal, Diverticular hernia, Abdominal X-ray, Urine analysis abnormal

Life Threatening? No
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: nasal congestion, gastroenteritis, multiple episodes of vomiting & bloody stools over the month prior to admission.
Allergies:
Diagnostic Lab Data: PCP LABS: UA revealed klebsiella pneumoniae at office. Hospital LABS: WBC 9.45, H/H 9.6/28.2. UA cloudy w/+ ketones, + protein, neg nitrite. Urine c/s neg. Abd xray revealed gas pattern c/w intussusception. Abd ultrasound + for intussus
CDC 'Split Type':

Write-up: Intusssception in 2 places. One of which required air enema, the other needed surgical reduction. 2/15/07 Received medical records from PCP which included vax records. Patient seen on 12/28 w/nasal congestion & right nasolacrimal duct obstruction. Next visit on 1/2/07 for vomiting, listless, diarrhea. Other family members ill w/stomach flu. Exam revealed afebrile, good hydration. Dx w/gastroenteritis. Next seen 1/25/07 for vomiting, crankiness, decreased appetite, nasal congestion. Dx/vomiting secondary to unspecified acute illness, posible gastroenteritis. Seen for vax on 2/7. Then next seen on 2/10 for emesis, dry heaves, no diarrhea, normal stools. With other episodes, had some loose stools that were mucousy & little bit of blood at time. 2/11/07 phone call revealed patient continued to have vomiting. UA revealed UTI & was sent to hospital for admission for UTI, vomiting & dehydration. At hospital was found to have IS. 3/13/07 Medical records reviewed which reveal patient admitted 2/11/07 s/p vomiting for 1-2 days, 1 bloody mucous stool & having a UTI. Exam revealed VSS, abdomen soft & diffusely tender w/o masses palpable. ALso noted erythematous rash on back & arms. Lungs were clear w/mild subcostal retractions. Ped surgery consulted. Taken to OR after BE failed to reduce. Procedure was attempted laparoscopic reduction of IS; open resection of ileoileal IS, including Meckel''s diverticulectomy; & appendectomy. No D/C summary available. T/C to hospital to request d/c date which was 2/15/07. Final Dx: Ileoileal intussusception w/Meckels diverticulum as the lead point.


Changed on 5/13/2013

VAERS ID: 272130 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Michigan
Vaccinated:2007-02-07
Onset:2007-02-10
Submitted:2007-02-12
Entered:2007-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B089AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08670F / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1112F / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1112F / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Culture urine negative, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Mucous stools, Rash erythematous, Rhinorrhoea, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal, Diverticular hernia, Abdominal X-ray, Urine analysis abnormal

Life Threatening? No
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: nasal congestion, gastroenteritis, multiple episodes of vomiting & bloody stools over the month prior to admission.
Allergies:
Diagnostic Lab Data: PCP LABS: UA revealed klebsiella pneumoniae at office. Hospital LABS: WBC 9.45, H/H 9.6/28.2. UA cloudy w/+ ketones, + protein, neg nitrite. Urine c/s neg. Abd xray revealed gas pattern c/w intussusception. Abd ultrasound + for intussus
CDC 'Split Type':

Write-up: Intusssception in 2 places. One of which required air enema, the other needed surgical reduction. 2/15/07 Received medical records from PCP which included vax records. Patient seen on 12/28 w/nasal congestion & right nasolacrimal duct obstruction. Next visit on 1/2/07 for vomiting, listless, diarrhea. Other family members ill w/stomach flu. Exam revealed afebrile, good hydration. Dx w/gastroenteritis. Next seen 1/25/07 for vomiting, crankiness, decreased appetite, nasal congestion. Dx/vomiting secondary to unspecified acute illness, posible gastroenteritis. Seen for vax on 2/7. Then next seen on 2/10 for emesis, dry heaves, no diarrhea, normal stools. With other episodes, had some loose stools that were mucousy & little bit of blood at time. 2/11/07 phone call revealed patient continued to have vomiting. UA revealed UTI & was sent to hospital for admission for UTI, vomiting & dehydration. At hospital was found to have IS. 3/13/07 Medical records reviewed which reveal patient admitted 2/11/07 s/p vomiting for 1-2 days, 1 bloody mucous stool & having a UTI. Exam revealed VSS, abdomen soft & diffusely tender w/o masses palpable. ALso noted erythematous rash on back & arms. Lungs were clear w/mild subcostal retractions. Ped surgery consulted. Taken to OR after BE failed to reduce. Procedure was attempted laparoscopic reduction of IS; open resection of ileoileal IS, including Meckel''s diverticulectomy; & appendectomy. No D/C summary available. T/C to hospital to request d/c date which was 2/15/07. Final Dx: Ileoileal intussusception w/Meckels diverticulum as the lead point.


Changed on 2/14/2017

VAERS ID: 272130 Before After
VAERS Form:
Age:0.3 0.33
Gender:Female
Location:Michigan
Vaccinated:2007-02-07
Onset:2007-02-10
Submitted:2007-02-12
Entered:2007-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B089AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08670F / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1112F / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Culture urine negative, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Mucous stools, Rash erythematous, Rhinorrhoea, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal, Diverticular hernia, Abdominal X-ray, Urine analysis abnormal

Life Threatening? No
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: nasal congestion, gastroenteritis, multiple episodes of vomiting & bloody stools over the month prior to admission.
Allergies:
Diagnostic Lab Data: PCP LABS: UA revealed klebsiella pneumoniae at office. Hospital LABS: WBC 9.45, H/H 9.6/28.2. UA cloudy w/+ ketones, + protein, neg nitrite. Urine c/s neg. Abd xray revealed gas pattern c/w intussusception. Abd ultrasound + for intussus
CDC 'Split Type':

Write-up: Intusssception in 2 places. One of which required air enema, the other needed surgical reduction. 2/15/07 Received medical records from PCP which included vax records. Patient seen on 12/28 w/nasal congestion & right nasolacrimal duct obstruction. Next visit on 1/2/07 for vomiting, listless, diarrhea. Other family members ill w/stomach flu. Exam revealed afebrile, good hydration. Dx w/gastroenteritis. Next seen 1/25/07 for vomiting, crankiness, decreased appetite, nasal congestion. Dx/vomiting secondary to unspecified acute illness, posible gastroenteritis. Seen for vax on 2/7. Then next seen on 2/10 for emesis, dry heaves, no diarrhea, normal stools. With other episodes, had some loose stools that were mucousy & little bit of blood at time. 2/11/07 phone call revealed patient continued to have vomiting. UA revealed UTI & was sent to hospital for admission for UTI, vomiting & dehydration. At hospital was found to have IS. 3/13/07 Medical records reviewed which reveal patient admitted 2/11/07 s/p vomiting for 1-2 days, 1 bloody mucous stool & having a UTI. Exam revealed VSS, abdomen soft & diffusely tender w/o masses palpable. ALso noted erythematous rash on back & arms. Lungs were clear w/mild subcostal retractions. Ped surgery consulted. Taken to OR after BE failed to reduce. Procedure was attempted laparoscopic reduction of IS; open resection of ileoileal IS, including Meckel''s diverticulectomy; & appendectomy. No D/C summary available. T/C to hospital to request d/c date which was 2/15/07. Final Dx: Ileoileal intussusception w/Meckels diverticulum as the lead point.


Changed on 5/14/2017

VAERS ID: 272130 Before After
VAERS Form:
Age:0.33
Gender:Female
Location:Michigan
Vaccinated:2007-02-07
Onset:2007-02-10
Submitted:2007-02-12
Entered:2007-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B089AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES PFIZER/WYETH B08670F / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1112F / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Culture urine negative, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Mucous stools, Rash erythematous, Rhinorrhoea, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal, Diverticular hernia, Abdominal X-ray, Urine analysis abnormal

Life Threatening? No
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: nasal congestion, gastroenteritis, multiple episodes of vomiting & bloody stools over the month prior to admission.
Allergies:
Diagnostic Lab Data: PCP LABS: UA revealed klebsiella pneumoniae at office. Hospital LABS: WBC 9.45, H/H 9.6/28.2. UA cloudy w/+ ketones, + protein, neg nitrite. Urine c/s neg. Abd xray revealed gas pattern c/w intussusception. Abd ultrasound + for intussus intussusception & ascites. Barium enema not successful at reducing ileoileal intussusception.
CDC 'Split Type':

Write-up: Intusssception in 2 places. One of which required air enema, the other needed surgical reduction. 2/15/07 Received medical records from PCP which included vax records. Patient seen on 12/28 w/nasal congestion & right nasolacrimal duct obstruction. Next visit on 1/2/07 for vomiting, listless, diarrhea. Other family members ill w/stomach flu. Exam revealed afebrile, good hydration. Dx w/gastroenteritis. Next seen 1/25/07 for vomiting, crankiness, decreased appetite, nasal congestion. Dx/vomiting secondary to unspecified acute illness, posible gastroenteritis. Seen for vax on 2/7. Then next seen on 2/10 for emesis, dry heaves, no diarrhea, normal stools. With other episodes, had some loose stools that were mucousy & little bit of blood at time. 2/11/07 phone call revealed patient continued to have vomiting. UA revealed UTI & was sent to hospital for admission for UTI, vomiting & dehydration. At hospital was found to have IS. 3/13/07 Medical records reviewed which reveal patient admitted 2/11/07 s/p vomiting for 1-2 days, 1 bloody mucous stool & having a UTI. Exam revealed VSS, abdomen soft & diffusely tender w/o masses palpable. ALso noted erythematous rash on back & arms. Lungs were clear w/mild subcostal retractions. Ped surgery consulted. Taken to OR after BE failed to reduce. Procedure was attempted laparoscopic reduction of IS; open resection of ileoileal IS, including Meckel''s diverticulectomy; & appendectomy. No D/C summary available. T/C to hospital to request d/c date which was 2/15/07. Final Dx: Ileoileal intussusception w/Meckels diverticulum as the lead point.


Changed on 9/14/2017

VAERS ID: 272130 Before After
VAERS Form:(blank) 1
Age:0.33
Gender:Female
Location:Michigan
Vaccinated:2007-02-07
Onset:2007-02-10
Submitted:2007-02-12
Entered:2007-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B089AA / 1 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08670F / 1 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1112F / 1 2 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception, Surgery, Enema administration

Life Threatening? No
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: nasal congestion, gastroenteritis, multiple episodes of vomiting & bloody stools over the month prior to admission.
Allergies:
Diagnostic Lab Data: PCP LABS: UA revealed klebsiella pneumoniae at office. Hospital LABS: WBC 9.45, H/H 9.6/28.2. UA cloudy w/+ ketones, + protein, neg nitrite. Urine c/s neg. Abd xray revealed gas pattern c/w intussusception. Abd ultrasound + for intussusception & ascites. Barium enema not successful at reducing ileoileal intussusception.
CDC 'Split Type':

Write-up: Intusssception in 2 places. One of which required air enema, the other needed surgical reduction. 2/15/07 Received medical records from PCP which included vax records. Patient seen on 12/28 w/nasal congestion & right nasolacrimal duct obstruction. Next visit on 1/2/07 for vomiting, listless, diarrhea. Other family members ill w/stomach flu. Exam revealed afebrile, good hydration. Dx w/gastroenteritis. Next seen 1/25/07 for vomiting, crankiness, decreased appetite, nasal congestion. Dx/vomiting secondary to unspecified acute illness, posible gastroenteritis. Seen for vax on 2/7. Then next seen on 2/10 for emesis, dry heaves, no diarrhea, normal stools. With other episodes, had some loose stools that were mucousy & little bit of blood at time. 2/11/07 phone call revealed patient continued to have vomiting. UA revealed UTI & was sent to hospital for admission for UTI, vomiting & dehydration. At hospital was found to have IS. 3/13/07 Medical records reviewed which reveal patient admitted 2/11/07 s/p vomiting for 1-2 days, 1 bloody mucous stool & having a UTI. Exam revealed VSS, abdomen soft & diffusely tender w/o masses palpable. ALso noted erythematous rash on back & arms. Lungs were clear w/mild subcostal retractions. Ped surgery consulted. Taken to OR after BE failed to reduce. Procedure was attempted laparoscopic reduction of IS; open resection of ileoileal IS, including Meckel''s diverticulectomy; & appendectomy. No D/C summary available. T/C to hospital to request d/c date which was 2/15/07. Final Dx: Ileoileal intussusception w/Meckels diverticulum as the lead point.


Changed on 2/14/2018

VAERS ID: 272130 Before After
VAERS Form:1
Age:0.33
Gender:Female
Location:Michigan
Vaccinated:2007-02-07
Onset:2007-02-10
Submitted:2007-02-12
Entered:2007-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B089AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08670F / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1112F / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception, Surgery, Enema administration

Life Threatening? No
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: nasal congestion, gastroenteritis, multiple episodes of vomiting & bloody stools over the month prior to admission.
Allergies:
Diagnostic Lab Data: PCP LABS: UA revealed klebsiella pneumoniae at office. Hospital LABS: WBC 9.45, H/H 9.6/28.2. UA cloudy w/+ ketones, + protein, neg nitrite. Urine c/s neg. Abd xray revealed gas pattern c/w intussusception. Abd ultrasound + for intussusception & ascites. Barium enema not successful at reducing ileoileal intussusception.
CDC 'Split Type':

Write-up: Intusssception in 2 places. One of which required air enema, the other needed surgical reduction. 2/15/07 Received medical records from PCP which included vax records. Patient seen on 12/28 w/nasal congestion & right nasolacrimal duct obstruction. Next visit on 1/2/07 for vomiting, listless, diarrhea. Other family members ill w/stomach flu. Exam revealed afebrile, good hydration. Dx w/gastroenteritis. Next seen 1/25/07 for vomiting, crankiness, decreased appetite, nasal congestion. Dx/vomiting secondary to unspecified acute illness, posible gastroenteritis. Seen for vax on 2/7. Then next seen on 2/10 for emesis, dry heaves, no diarrhea, normal stools. With other episodes, had some loose stools that were mucousy & little bit of blood at time. 2/11/07 phone call revealed patient continued to have vomiting. UA revealed UTI & was sent to hospital for admission for UTI, vomiting & dehydration. At hospital was found to have IS. 3/13/07 Medical records reviewed which reveal patient admitted 2/11/07 s/p vomiting for 1-2 days, 1 bloody mucous stool & having a UTI. Exam revealed VSS, abdomen soft & diffusely tender w/o masses palpable. ALso noted erythematous rash on back & arms. Lungs were clear w/mild subcostal retractions. Ped surgery consulted. Taken to OR after BE failed to reduce. Procedure was attempted laparoscopic reduction of IS; open resection of ileoileal IS, including Meckel''s diverticulectomy; & appendectomy. No D/C summary available. T/C to hospital to request d/c date which was 2/15/07. Final Dx: Ileoileal intussusception w/Meckels diverticulum as the lead point.


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