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This is VAERS ID 272462

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 272462
VAERS Form:
Age:0.5
Gender:Female
Location:Maryland
Vaccinated:2007-01-24
Onset:2007-02-17
Submitted:2007-02-17
Entered:2007-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC - / 1 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0940F / 1 - / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Enteroenterostomy, Haematochezia, Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: no
Allergies:
Diagnostic Lab Data: Air contrast enema x 2
CDC 'Split Type':

Write-up: intussussception

Changed on 12/8/2009

VAERS ID: 272462 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Maryland
Vaccinated:2007-01-24
Onset:2007-02-17
Submitted:2007-02-17
Entered:2007-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 - / -
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC - / 1 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0940F / 1 - / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Enteroenterostomy, Haematochezia, Intussusception, Surgery, Vomiting, Ultrasound abdomen 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: no
Allergies:
Diagnostic Lab Data: Air contrast enema x 2
CDC 'Split Type':

Write-up: intussussception 3/20/07 Received medical records from hospital which reveal patient experienced vomiting & bloody stools for 1 day. Seen at outlying ER on 2/16 & tx w/air contrast enema for +IS then transferred for higher level of care. Admitted to hospital 2/17-2/24/07. Air contrast enema from outlying ER successful but f/u US of abdomen revealed IS had recurred. Repeat air contrast enema reduced IS but again recurred & was so was taken to OR. Stayed in PICU for several days observation & treated w/antibiotics & TPN. Transitioned to oral feeds & antibiotics d/c 2 days prior to d/c home w/o further complication. FINAL DX: Intussusception, RLQ in cecum, adjacent to eleocecal valve. Surgically reduced after failure of air contrast enemas x 2. Exp lap; segmental resection of IS, ileal; & enteroenterostomy.

Changed on 3/2/2010

VAERS ID: 272462 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Maryland
Vaccinated:2007-01-24
Onset:2007-02-17
Submitted:2007-02-17
Entered:2007-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC - / 1 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0940F / 1 - / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Enteroenterostomy, Haematochezia, Intussusception, Surgery, Vomiting, Ultrasound abdomen 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: no
Allergies:
Diagnostic Lab Data: Air contrast enema x 2
CDC 'Split Type':

Write-up: intussussception 3/20/07 Received medical records from hospital which reveal patient experienced vomiting & bloody stools for 1 day. Seen at outlying ER on 2/16 & tx w/air contrast enema for +IS then transferred for higher level of care. Admitted to hospital 2/17-2/24/07. Air contrast enema from outlying ER successful but f/u US of abdomen revealed IS had recurred. Repeat air contrast enema reduced IS but again recurred & was so was taken to OR. Stayed in PICU for several days observation & treated w/antibiotics & TPN. Transitioned to oral feeds & antibiotics d/c 2 days prior to d/c home w/o further complication. FINAL DX: Intussusception, RLQ in cecum, adjacent to eleocecal valve. Surgically reduced after failure of air contrast enemas x 2. Exp lap; segmental resection of IS, ileal; & enteroenterostomy.

Changed on 4/7/2010

VAERS ID: 272462 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Maryland
Vaccinated:2007-01-24
Onset:2007-02-17
Submitted:2007-02-17
Entered:2007-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC - / 1 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0940F / 1 - / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Enteroenterostomy, Haematochezia, Intussusception, Surgery, Vomiting, Ultrasound abdomen 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: no
Allergies:
Diagnostic Lab Data: Air contrast enema x 2
CDC 'Split Type':

Write-up: intussussception 3/20/07 Received medical records from hospital which reveal patient experienced vomiting & bloody stools for 1 day. Seen at outlying ER on 2/16 & tx w/air contrast enema for +IS then transferred for higher level of care. Admitted to hospital 2/17-2/24/07. Air contrast enema from outlying ER successful but f/u US of abdomen revealed IS had recurred. Repeat air contrast enema reduced IS but again recurred & was so was taken to OR. Stayed in PICU for several days observation & treated w/antibiotics & TPN. Transitioned to oral feeds & antibiotics d/c 2 days prior to d/c home w/o further complication. FINAL DX: Intussusception, RLQ in cecum, adjacent to eleocecal valve. Surgically reduced after failure of air contrast enemas x 2. Exp lap; segmental resection of IS, ileal; & enteroenterostomy.

Changed on 8/31/2010

VAERS ID: 272462 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Maryland
Vaccinated:2007-01-24
Onset:2007-02-17
Submitted:2007-02-17
Entered:2007-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH - / 1 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0940F / 1 - / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Enteroenterostomy, Haematochezia, Intussusception, Surgery, Vomiting, Ultrasound abdomen 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: no
Allergies:
Diagnostic Lab Data: Air contrast enema x 2
CDC 'Split Type':

Write-up: intussussception 3/20/07 Received medical records from hospital which reveal patient experienced vomiting & bloody stools for 1 day. Seen at outlying ER on 2/16 & tx w/air contrast enema for +IS then transferred for higher level of care. Admitted to hospital 2/17-2/24/07. Air contrast enema from outlying ER successful but f/u US of abdomen revealed IS had recurred. Repeat air contrast enema reduced IS but again recurred & was so was taken to OR. Stayed in PICU for several days observation & treated w/antibiotics & TPN. Transitioned to oral feeds & antibiotics d/c 2 days prior to d/c home w/o further complication. FINAL DX: Intussusception, RLQ in cecum, adjacent to eleocecal valve. Surgically reduced after failure of air contrast enemas x 2. Exp lap; segmental resection of IS, ileal; & enteroenterostomy.

Changed on 2/13/2013

VAERS ID: 272462 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Maryland
Vaccinated:2007-01-24
Onset:2007-02-17
Submitted:2007-02-17
Entered:2007-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / 1 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0940F / 1 - / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Enteroenterostomy, Haematochezia, Intussusception, Surgery, Vomiting, Ultrasound abdomen 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: no No
Allergies:
Diagnostic Lab Data: Air contrast enema x 2
CDC 'Split Type':

Write-up: intussussception Intussussception. 3/20/07 Received medical records from hospital which reveal patient experienced vomiting & bloody stools for 1 day. Seen at outlying ER on 2/16 & tx w/air contrast enema for +IS then transferred for higher level of care. Admitted to hospital 2/17-2/24/07. Air contrast enema from outlying ER successful but f/u US of abdomen revealed IS had recurred. Repeat air contrast enema reduced IS but again recurred & was so was taken to OR. Stayed in PICU for several days observation & treated w/antibiotics & TPN. Transitioned to oral feeds & antibiotics d/c 2 days prior to d/c home w/o further complication. FINAL DX: Intussusception, RLQ in cecum, adjacent to eleocecal valve. Surgically reduced after failure of air contrast enemas x 2. Exp lap; segmental resection of IS, ileal; & enteroenterostomy.

Changed on 5/13/2013

VAERS ID: 272462 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Maryland
Vaccinated:2007-01-24
Onset:2007-02-17
Submitted:2007-02-17
Entered:2007-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / 1 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0940F / 1 - / SC
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0940F / 1 - / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Enteroenterostomy, Haematochezia, Intussusception, Surgery, Vomiting, Ultrasound abdomen 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: Air contrast enema x 2
CDC 'Split Type':

Write-up: Intussussception. 3/20/07 Received medical records from hospital which reveal patient experienced vomiting & bloody stools for 1 day. Seen at outlying ER on 2/16 & tx w/air contrast enema for +IS then transferred for higher level of care. Admitted to hospital 2/17-2/24/07. Air contrast enema from outlying ER successful but f/u US of abdomen revealed IS had recurred. Repeat air contrast enema reduced IS but again recurred & was so was taken to OR. Stayed in PICU for several days observation & treated w/antibiotics & TPN. Transitioned to oral feeds & antibiotics d/c 2 days prior to d/c home w/o further complication. FINAL DX: Intussusception, RLQ in cecum, adjacent to eleocecal valve. Surgically reduced after failure of air contrast enemas x 2. Exp lap; segmental resection of IS, ileal; & enteroenterostomy.

Changed on 2/14/2017

VAERS ID: 272462 Before After
VAERS Form:
Age:0.5 0.47
Gender:Female
Location:Maryland
Vaccinated:2007-01-24
Onset:2007-02-17
Submitted:2007-02-17
Entered:2007-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / 1 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0940F / 1 - / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Enteroenterostomy, Haematochezia, Intussusception, Surgery, Vomiting, Ultrasound abdomen 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: Air contrast enema x 2
CDC 'Split Type':

Write-up: Intussussception. 3/20/07 Received medical records from hospital which reveal patient experienced vomiting & bloody stools for 1 day. Seen at outlying ER on 2/16 & tx w/air contrast enema for +IS then transferred for higher level of care. Admitted to hospital 2/17-2/24/07. Air contrast enema from outlying ER successful but f/u US of abdomen revealed IS had recurred. Repeat air contrast enema reduced IS but again recurred & was so was taken to OR. Stayed in PICU for several days observation & treated w/antibiotics & TPN. Transitioned to oral feeds & antibiotics d/c 2 days prior to d/c home w/o further complication. FINAL DX: Intussusception, RLQ in cecum, adjacent to eleocecal valve. Surgically reduced after failure of air contrast enemas x 2. Exp lap; segmental resection of IS, ileal; & enteroenterostomy.

Changed on 5/14/2017

VAERS ID: 272462 Before After
VAERS Form:
Age:0.47
Gender:Female
Location:Maryland
Vaccinated:2007-01-24
Onset:2007-02-17
Submitted:2007-02-17
Entered:2007-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / 1 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0940F / 1 - / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Enteroenterostomy, Haematochezia, Intussusception, Surgery, Vomiting, Ultrasound abdomen 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: Air contrast enema x 2
CDC 'Split Type':

Write-up: Intussussception. 3/20/07 Received medical records from hospital which reveal patient experienced vomiting & bloody stools for 1 day. Seen at outlying ER on 2/16 & tx w/air contrast enema for +IS then transferred for higher level of care. Admitted to hospital 2/17-2/24/07. Air contrast enema from outlying ER successful but f/u US of abdomen revealed IS had recurred. Repeat air contrast enema reduced IS but again recurred & was so was taken to OR. Stayed in PICU for several days observation & treated w/antibiotics & TPN. Transitioned to oral feeds & antibiotics d/c 2 days prior to d/c home w/o further complication. FINAL DX: Intussusception, RLQ in cecum, adjacent to eleocecal valve. Surgically reduced after failure of air contrast enemas x 2. Exp lap; segmental resection of IS, ileal; & enteroenterostomy.

Changed on 9/14/2017

VAERS ID: 272462 Before After
VAERS Form:(blank) 1
Age:0.47
Gender:Female
Location:Maryland
Vaccinated:2007-01-24
Onset:2007-02-17
Submitted:2007-02-17
Entered:2007-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 2 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 2 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / 1 2 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0940F / 1 2 - / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: Air contrast enema x 2
CDC 'Split Type':

Write-up: Intussussception. 3/20/07 Received medical records from hospital which reveal patient experienced vomiting & bloody stools for 1 day. Seen at outlying ER on 2/16 & tx w/air contrast enema for +IS then transferred for higher level of care. Admitted to hospital 2/17-2/24/07. Air contrast enema from outlying ER successful but f/u US of abdomen revealed IS had recurred. Repeat air contrast enema reduced IS but again recurred & was so was taken to OR. Stayed in PICU for several days observation & treated w/antibiotics & TPN. Transitioned to oral feeds & antibiotics d/c 2 days prior to d/c home w/o further complication. FINAL DX: Intussusception, RLQ in cecum, adjacent to eleocecal valve. Surgically reduced after failure of air contrast enemas x 2. Exp lap; segmental resection of IS, ileal; & enteroenterostomy.

Changed on 2/14/2018

VAERS ID: 272462 Before After
VAERS Form:1
Age:0.47
Gender:Female
Location:Maryland
Vaccinated:2007-01-24
Onset:2007-02-17
Submitted:2007-02-17
Entered:2007-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 2 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / 2 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0940F / 2 - / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: Air contrast enema x 2
CDC 'Split Type':

Write-up: Intussussception. 3/20/07 Received medical records from hospital which reveal patient experienced vomiting & bloody stools for 1 day. Seen at outlying ER on 2/16 & tx w/air contrast enema for +IS then transferred for higher level of care. Admitted to hospital 2/17-2/24/07. Air contrast enema from outlying ER successful but f/u US of abdomen revealed IS had recurred. Repeat air contrast enema reduced IS but again recurred & was so was taken to OR. Stayed in PICU for several days observation & treated w/antibiotics & TPN. Transitioned to oral feeds & antibiotics d/c 2 days prior to d/c home w/o further complication. FINAL DX: Intussusception, RLQ in cecum, adjacent to eleocecal valve. Surgically reduced after failure of air contrast enemas x 2. Exp lap; segmental resection of IS, ileal; & enteroenterostomy.

Changed on 6/14/2018

VAERS ID: 272462 Before After
VAERS Form:1
Age:0.47
Gender:Female
Location:Maryland
Vaccinated:2007-01-24
Onset:2007-02-17
Submitted:2007-02-17
Entered:2007-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 2 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / 2 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0940F / 2 - / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: Air contrast enema x 2
CDC 'Split Type':

Write-up: Intussussception. 3/20/07 Received medical records from hospital which reveal patient experienced vomiting & bloody stools for 1 day. Seen at outlying ER on 2/16 & tx w/air contrast enema for +IS then transferred for higher level of care. Admitted to hospital 2/17-2/24/07. Air contrast enema from outlying ER successful but f/u US of abdomen revealed IS had recurred. Repeat air contrast enema reduced IS but again recurred & was so was taken to OR. Stayed in PICU for several days observation & treated w/antibiotics & TPN. Transitioned to oral feeds & antibiotics d/c 2 days prior to d/c home w/o further complication. FINAL DX: Intussusception, RLQ in cecum, adjacent to eleocecal valve. Surgically reduced after failure of air contrast enemas x 2. Exp lap; segmental resection of IS, ileal; & enteroenterostomy.

Changed on 8/14/2018

VAERS ID: 272462 Before After
VAERS Form:1
Age:0.47
Gender:Female
Location:Maryland
Vaccinated:2007-01-24
Onset:2007-02-17
Submitted:2007-02-17
Entered:2007-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 2 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / 2 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0940F / 2 - / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: Air contrast enema x 2
CDC 'Split Type':

Write-up: Intussussception. 3/20/07 Received medical records from hospital which reveal patient experienced vomiting & bloody stools for 1 day. Seen at outlying ER on 2/16 & tx w/air contrast enema for +IS then transferred for higher level of care. Admitted to hospital 2/17-2/24/07. Air contrast enema from outlying ER successful but f/u US of abdomen revealed IS had recurred. Repeat air contrast enema reduced IS but again recurred & was so was taken to OR. Stayed in PICU for several days observation & treated w/antibiotics & TPN. Transitioned to oral feeds & antibiotics d/c 2 days prior to d/c home w/o further complication. FINAL DX: Intussusception, RLQ in cecum, adjacent to eleocecal valve. Surgically reduced after failure of air contrast enemas x 2. Exp lap; segmental resection of IS, ileal; & enteroenterostomy.

Changed on 9/14/2018

VAERS ID: 272462 Before After
VAERS Form:1
Age:0.47
Gender:Female
Location:Maryland
Vaccinated:2007-01-24
Onset:2007-02-17
Submitted:2007-02-17
Entered:2007-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 2 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / 2 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0940F / 2 - / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: Air contrast enema x 2
CDC 'Split Type':

Write-up: Intussussception. 3/20/07 Received medical records from hospital which reveal patient experienced vomiting & bloody stools for 1 day. Seen at outlying ER on 2/16 & tx w/air contrast enema for +IS then transferred for higher level of care. Admitted to hospital 2/17-2/24/07. Air contrast enema from outlying ER successful but f/u US of abdomen revealed IS had recurred. Repeat air contrast enema reduced IS but again recurred & was so was taken to OR. Stayed in PICU for several days observation & treated w/antibiotics & TPN. Transitioned to oral feeds & antibiotics d/c 2 days prior to d/c home w/o further complication. FINAL DX: Intussusception, RLQ in cecum, adjacent to eleocecal valve. Surgically reduced after failure of air contrast enemas x 2. Exp lap; segmental resection of IS, ileal; & enteroenterostomy.

Changed on 10/14/2018

VAERS ID: 272462 Before After
VAERS Form:1
Age:0.47
Gender:Female
Location:Maryland
Vaccinated:2007-01-24
Onset:2007-02-17
Submitted:2007-02-17
Entered:2007-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 2 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / 2 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0940F / 2 - / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: Air contrast enema x 2
CDC 'Split Type':

Write-up: Intussussception. 3/20/07 Received medical records from hospital which reveal patient experienced vomiting & bloody stools for 1 day. Seen at outlying ER on 2/16 & tx w/air contrast enema for +IS then transferred for higher level of care. Admitted to hospital 2/17-2/24/07. Air contrast enema from outlying ER successful but f/u US of abdomen revealed IS had recurred. Repeat air contrast enema reduced IS but again recurred & was so was taken to OR. Stayed in PICU for several days observation & treated w/antibiotics & TPN. Transitioned to oral feeds & antibiotics d/c 2 days prior to d/c home w/o further complication. FINAL DX: Intussusception, RLQ in cecum, adjacent to eleocecal valve. Surgically reduced after failure of air contrast enemas x 2. Exp lap; segmental resection of IS, ileal; & enteroenterostomy.

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