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This is VAERS ID 273374

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

273374
VAERS Form:
Age:0.3
Gender:Female
Location:Arizona
Vaccinated:2007-01-16
Onset:2007-02-19
Submitted:2007-03-05
Entered:2007-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084CA / 1 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1270F / 1 LL / -
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B47442A / 1 LL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1111F / - - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Barium double contrast, Chest X-ray normal, Computerised tomogram, Computerised tomogram normal, Haematemesis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CT, X-rays, Sonogram records received 3/36/07-Abdominal ultrasound revealed right lower quadrant intussusception with atypical swirl appearance of intussusception. Barium enema with resolution of intussusception. CXR and KUB normal. CT hea
CDC 'Split Type':

Write-up:Intussusception R lower quadrant. 03/26/07-records received from facility for DOS 02/19-02/21/07-DC DX: Intussusception. Vomiting, non-bilious however became bilious with small amounts of blood while in hospital. Several loose stools heme positive.


Changed on 12/8/2009

273374 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Arizona
Vaccinated:2007-01-16
Onset:2007-02-19
Submitted:2007-03-05
Entered:2007-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084CA / 1 RL / -
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084CA / 1 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1270F / 1 LL / -
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES WYETH PHARMACEUTICALS, INC B47442A / 1 LL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1111F / - - / -

Administered by: Private      Purchased by: Unknown Private
Symptoms: Barium double contrast, Chest X-ray normal, Computerised tomogram, Computerised tomogram normal, Haematemesis, Intussusception, Lymphocyte count, Lymphocyte count increased, Ultrasound scan, Urinary system X-ray, Vomiting, X-ray, Urine ketone body present, Occult blood positive

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CT, X-rays, Sonogram records received 3/36/07-Abdominal ultrasound revealed right lower quadrant intussusception with atypical swirl appearance of intussusception. Barium enema with resolution of intussusception. CXR and KUB normal. CT hea
CDC 'Split Type':

Write-up:Intussusception R lower quadrant. 03/26/07-records received from facility for DOS 02/19-02/21/07-DC DX: Intussusception. Vomiting, non-bilious however became bilious with small amounts of blood while in hospital. Several loose stools heme positive.


Changed on 1/5/2010

273374 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Arizona
Vaccinated:2007-01-16
Onset:2007-02-19
Submitted:2007-03-05
Entered:2007-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084CA / 1 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1270F / 1 LL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B47442A / 1 LL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1111F / - - / -

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Chest X-ray normal, Computerised tomogram, Computerised tomogram normal, Haematemesis, Intussusception, Lymphocyte count, Lymphocyte count increased, Ultrasound scan, Urinary system X-ray, Vomiting, X-ray, Urine ketone body present, Occult blood positive

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No 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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CT, X-rays, Sonogram records received 3/36/07-Abdominal ultrasound revealed right lower quadrant intussusception with atypical swirl appearance of intussusception. Barium enema with resolution of intussusception. CXR and KUB normal. CT hea
CDC 'Split Type':

Write-up:Intussusception R lower quadrant. 03/26/07-records received from facility for DOS 02/19-02/21/07-DC DX: Intussusception. Vomiting, non-bilious however became bilious with small amounts of blood while in hospital. Several loose stools heme positive.


Changed on 3/2/2010

273374 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Arizona
Vaccinated:2007-01-16
Onset:2007-02-19
Submitted:2007-03-05
Entered:2007-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084CA / 1 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1270F / 1 LL / -
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B47442A / 1 LL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1111F / - - / -

Administered by: Private      Purchased by: Private
Symptoms: Computerised tomogram, Intussusception, Ultrasound scan, 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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CT, X-rays, Sonogram records received 3/36/07-Abdominal ultrasound revealed right lower quadrant intussusception with atypical swirl appearance of intussusception. Barium enema with resolution of intussusception. CXR and KUB normal. CT hea
CDC 'Split Type':

Write-up:Intussusception R lower quadrant. 03/26/07-records received from facility for DOS 02/19-02/21/07-DC DX: Intussusception. Vomiting, non-bilious however became bilious with small amounts of blood while in hospital. Several loose stools heme positive.


Changed on 4/7/2010

273374 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Arizona
Vaccinated:2007-01-16
Onset:2007-02-19
Submitted:2007-03-05
Entered:2007-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084CA / 1 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1270F / 1 LL / -
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B47442A / 1 LL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1111F / - - / -

Administered by: Private      Purchased by: Private
Symptoms: Computerised tomogram, Intussusception, Ultrasound scan, 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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CT, X-rays, Sonogram records received 3/36/07-Abdominal ultrasound revealed right lower quadrant intussusception with atypical swirl appearance of intussusception. Barium enema with resolution of intussusception. CXR and KUB normal. CT hea
CDC 'Split Type':

Write-up:Intussusception R lower quadrant. 03/26/07-records received from facility for DOS 02/19-02/21/07-DC DX: Intussusception. Vomiting, non-bilious however became bilious with small amounts of blood while in hospital. Several loose stools heme positive.


Changed on 8/31/2010

273374 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Arizona
Vaccinated:2007-01-16
Onset:2007-02-19
Submitted:2007-03-05
Entered:2007-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084CA / 1 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1270F / 1 LL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B47442A / 1 LL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1111F / - - / -

Administered by: Private      Purchased by: Private
Symptoms: Computerised tomogram, Intussusception, Ultrasound scan, 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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CT, X-rays, Sonogram records received 3/36/07-Abdominal ultrasound revealed right lower quadrant intussusception with atypical swirl appearance of intussusception. Barium enema with resolution of intussusception. CXR and KUB normal. CT hea
CDC 'Split Type':

Write-up:Intussusception R lower quadrant. 03/26/07-records received from facility for DOS 02/19-02/21/07-DC DX: Intussusception. Vomiting, non-bilious however became bilious with small amounts of blood while in hospital. Several loose stools heme positive.


Changed on 1/4/2011

273374 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Arizona
Vaccinated:2007-01-16
Onset:2007-02-19
Submitted:2007-03-05
Entered:2007-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084CA / 1 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1270F / 1 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47442A / 1 LL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1111F / - - / -

Administered by: Private      Purchased by: Private
Symptoms: Computerised tomogram, Intussusception, Ultrasound scan, 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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CT, X-rays, Sonogram records received 3/36/07-Abdominal ultrasound revealed right lower quadrant intussusception with atypical swirl appearance of intussusception. Barium enema with resolution of intussusception. CXR and KUB normal. CT hea head normal. WBC 13.3, neutrophils 68%, lymphycotes 25%. Urine 2+ ketones.
CDC 'Split Type':

Write-up:Intussusception R lower quadrant. 03/26/07-records received from facility for DOS 02/19-02/21/07-DC DX: Intussusception. Vomiting, non-bilious however became bilious with small amounts of blood while in hospital. Several loose stools heme positive.


Changed on 4/13/2011

273374 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Arizona
Vaccinated:2007-01-16
Onset:2007-02-19
Submitted:2007-03-05
Entered:2007-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084CA / 1 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1270F / 1 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47442A / 1 LL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1111F / - - / -

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Chest X-ray normal, Computerised tomogram, Computerised tomogram normal, Haematemesis, Intussusception, Lymphocyte count, Lymphocyte count increased, Ultrasound scan, Urinary system X-ray, Vomiting, X-ray, Urine ketone body present, Occult blood positive

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CT, X-rays, Sonogram records received 3/36/07-Abdominal ultrasound revealed right lower quadrant intussusception with atypical swirl appearance of intussusception. Barium enema with resolution of intussusception. CXR and KUB normal. CT head normal. WBC 13.3, neutrophils 68%, lymphycotes 25%. Urine 2+ ketones.
CDC 'Split Type':

Write-up:Intussusception R lower quadrant. 03/26/07-records received from facility for DOS 02/19-02/21/07-DC DX: Intussusception. Vomiting, non-bilious however became bilious with small amounts of blood while in hospital. Several loose stools heme positive.


Changed on 5/13/2011

273374 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Arizona
Vaccinated:2007-01-16
Onset:2007-02-19
Submitted:2007-03-05
Entered:2007-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084CA / 1 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1270F / 1 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47442A / 1 LL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1111F / - - / -

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Chest X-ray normal, Computerised tomogram, Computerised tomogram normal, Haematemesis, Intussusception, Lymphocyte count, Lymphocyte count increased, Ultrasound scan, Urinary system X-ray, Vomiting, X-ray, Urine ketone body present, Occult blood positive

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CT, X-rays, Sonogram records received 3/36/07-Abdominal ultrasound revealed right lower quadrant intussusception with atypical swirl appearance of intussusception. Barium enema with resolution of intussusception. CXR and KUB normal. CT head normal. WBC 13.3, neutrophils 68%, lymphycotes 25%. Urine 2+ ketones.
CDC 'Split Type':

Write-up:Intussusception R lower quadrant. 03/26/07-records received from facility for DOS 02/19-02/21/07-DC DX: Intussusception. Vomiting, non-bilious however became bilious with small amounts of blood while in hospital. Several loose stools heme positive.


Changed on 6/11/2011

273374 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Arizona
Vaccinated:2007-01-16
Onset:2007-02-19
Submitted:2007-03-05
Entered:2007-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084CA / 1 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1270F / 1 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47442A / 1 LL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1111F / - - / -

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Chest X-ray normal, Computerised tomogram, Computerised tomogram normal, Haematemesis, Intussusception, Lymphocyte count, Lymphocyte count increased, Ultrasound scan, Urinary system X-ray, Vomiting, X-ray, Urine ketone body present, Occult blood positive

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CT, X-rays, Sonogram records received 3/36/07-Abdominal ultrasound revealed right lower quadrant intussusception with atypical swirl appearance of intussusception. Barium enema with resolution of intussusception. CXR and KUB normal. CT head normal. WBC 13.3, neutrophils 68%, lymphycotes 25%. Urine 2+ ketones.
CDC 'Split Type':

Write-up:Intussusception R lower quadrant. 03/26/07-records received from facility for DOS 02/19-02/21/07-DC DX: Intussusception. Vomiting, non-bilious however became bilious with small amounts of blood while in hospital. Several loose stools heme positive.


Changed on 5/13/2013

273374 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Arizona
Vaccinated:2007-01-16
Onset:2007-02-19
Submitted:2007-03-05
Entered:2007-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084CA / 1 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1270F / 1 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47442A / 1 LL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1111F / - - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1111F / - - / -

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Chest X-ray normal, Computerised tomogram, Computerised tomogram normal, Haematemesis, Intussusception, Lymphocyte count, Lymphocyte count increased, Ultrasound scan, Urinary system X-ray, Vomiting, X-ray, Urine ketone body present, Occult blood positive

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CT, X-rays, Sonogram records received 3/36/07-Abdominal ultrasound revealed right lower quadrant intussusception with atypical swirl appearance of intussusception. Barium enema with resolution of intussusception. CXR and KUB normal. CT head normal. WBC 13.3, neutrophils 68%, lymphycotes 25%. Urine 2+ ketones.
CDC 'Split Type':

Write-up:Intussusception R lower quadrant. 03/26/07-records received from facility for DOS 02/19-02/21/07-DC DX: Intussusception. Vomiting, non-bilious however became bilious with small amounts of blood while in hospital. Several loose stools heme positive.


Changed on 6/14/2014

273374 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Arizona
Vaccinated:2007-01-16
Onset:2007-02-19
Submitted:2007-03-05
Entered:2007-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084CA / 1 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1270F / 1 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47442A / 1 LL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1111F / - - / -

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Chest X-ray normal, Computerised tomogram, Computerised tomogram normal, Haematemesis, Intussusception, Lymphocyte count, Lymphocyte count increased, Ultrasound scan, Urinary system X-ray, Vomiting, X-ray, Urine ketone body present, Occult blood positive

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CT, X-rays, Sonogram records received 3/36/07-Abdominal ultrasound revealed right lower quadrant intussusception with atypical swirl appearance of intussusception. Barium enema with resolution of intussusception. CXR and KUB normal. CT head normal. WBC 13.3, neutrophils 68%, lymphycotes 25%. Urine 2+ ketones.
CDC 'Split Type':

Write-up:Intussusception R lower quadrant. 03/26/07-records received from facility for DOS 02/19-02/21/07-DC DX: Intussusception. Vomiting, non-bilious however became bilious with small amounts of blood while in hospital. Several loose stools heme positive.


Changed on 2/14/2017

273374 Before After
VAERS Form:
Age:0.3 0.33
Gender:Female
Location:Arizona
Vaccinated:2007-01-16
Onset:2007-02-19
Submitted:2007-03-05
Entered:2007-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084CA / 1 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1270F / 1 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47442A / 1 LL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1111F / - - / -

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Chest X-ray normal, Computerised tomogram, Computerised tomogram normal, Haematemesis, Intussusception, Lymphocyte count, Lymphocyte count increased, Ultrasound scan, Urinary system X-ray, Vomiting, X-ray, Urine ketone body present, Occult blood positive

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CT, X-rays, Sonogram records received 3/36/07-Abdominal ultrasound revealed right lower quadrant intussusception with atypical swirl appearance of intussusception. Barium enema with resolution of intussusception. CXR and KUB normal. CT head normal. WBC 13.3, neutrophils 68%, lymphycotes 25%. Urine 2+ ketones.
CDC 'Split Type':

Write-up:Intussusception R lower quadrant. 03/26/07-records received from facility for DOS 02/19-02/21/07-DC DX: Intussusception. Vomiting, non-bilious however became bilious with small amounts of blood while in hospital. Several loose stools heme positive.


Changed on 5/14/2017

273374 Before After
VAERS Form:
Age:0.33
Gender:Female
Location:Arizona
Vaccinated:2007-01-16
Onset:2007-02-19
Submitted:2007-03-05
Entered:2007-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084CA / 1 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1270F / 1 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47442A / 1 LL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1111F / - - / -

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Chest X-ray normal, Computerised tomogram, Computerised tomogram normal, Haematemesis, Intussusception, Lymphocyte count, Lymphocyte count increased, Ultrasound scan, Urinary system X-ray, Vomiting, X-ray, Urine ketone body present, Occult blood positive

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CT, X-rays, Sonogram records received 3/36/07-Abdominal ultrasound revealed right lower quadrant intussusception with atypical swirl appearance of intussusception. Barium enema with resolution of intussusception. CXR and KUB normal. CT head normal. WBC 13.3, neutrophils 68%, lymphycotes 25%. Urine 2+ ketones.
CDC 'Split Type':

Write-up:Intussusception R lower quadrant. 03/26/07-records received from facility for DOS 02/19-02/21/07-DC DX: Intussusception. Vomiting, non-bilious however became bilious with small amounts of blood while in hospital. Several loose stools heme positive.


Changed on 9/14/2017

273374 Before After
VAERS Form:(blank) 1
Age:0.33
Gender:Female
Location:Arizona
Vaccinated:2007-01-16
Onset:2007-02-19
Submitted:2007-03-05
Entered:2007-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084CA / 1 2 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1270F / 1 2 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47442A / 1 2 LL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1111F / - UNK - / -

Administered by: Private      Purchased by: Private
Symptoms: Computerised tomogram, Intussusception, Ultrasound scan, 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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CT, X-rays, Sonogram records received 3/36/07-Abdominal ultrasound revealed right lower quadrant intussusception with atypical swirl appearance of intussusception. Barium enema with resolution of intussusception. CXR and KUB normal. CT head normal. WBC 13.3, neutrophils 68%, lymphycotes 25%. Urine 2+ ketones.
CDC 'Split Type':

Write-up:Intussusception R lower quadrant. 03/26/07-records received from facility for DOS 02/19-02/21/07-DC DX: Intussusception. Vomiting, non-bilious however became bilious with small amounts of blood while in hospital. Several loose stools heme positive.


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