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This is VAERS ID 273884

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

273884
VAERS Form:
Age:0.2
Gender:Female
Location:Missouri
Vaccinated:2007-01-25
Onset:2007-03-10
Submitted:2007-03-13
Entered:2007-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / AVENTIS PASTEUR C2521AA / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1158F / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR Z0324 / 0 RL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08670F / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1166F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Appendicectomy, Barium double contrast, 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? No
Previous Vaccinations:
Other Medications: Polytrim ophthalmic
Current Illness: None known
Preexisting Conditions: Dacryostenosis
Allergies:
Diagnostic Lab Data: Air contrast enema - (+) for intususception
CDC 'Split Type':

Write-up:Intususception diagnosed by hospital.


Changed on 12/8/2009

273884 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Missouri
Vaccinated:2007-01-25
Onset:2007-03-10
Submitted:2007-03-13
Entered:2007-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / AVENTIS PASTEUR C2521AA / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1158F / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR Z0324 / 0 RL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08670F / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1166F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Appendicectomy, Barium double contrast, Haematochezia, Intussusception, Laparotomy, Mucous stools, Vomiting, Ultrasound abdomen abnormal, Rotavirus test negative

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? No
Previous Vaccinations:
Other Medications: Polytrim ophthalmic
Current Illness: None known
Preexisting Conditions: Dacryostenosis
Allergies:
Diagnostic Lab Data: Air contrast enema - (+) for intususception records received 4/24/07-Colon air contrast enema revealed ileocolic intussusception. US positive for ileocolic intussusception. Labs WNL rotavirus antigen negative
CDC 'Split Type':

Write-up:Intususception diagnosed by hospital. 04/24/07-records received from facility for DOS 03/13-03/16/07. DC DX: Intussusception. C/O fussy for 2 days large emesis, bloody stools. Multiple mucousy bloody stools. Abdomen fullness palpated in right lower quadrant. Unsuccessful attempt at reduction via enema. Laparotomy including appendectomy.


Changed on 3/2/2010

273884 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Missouri
Vaccinated:2007-01-25
Onset:2007-03-10
Submitted:2007-03-13
Entered:2007-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / AVENTIS PASTEUR C2521AA / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1158F / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR Z0324 / 0 RL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / LEDERLE LABORATORIES B08670F / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1166F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Appendicectomy, Barium double contrast, Haematochezia, Intussusception, Laparotomy, Mucous stools, Vomiting, Ultrasound abdomen abnormal, Rotavirus test negative

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? No
Previous Vaccinations:
Other Medications: Polytrim ophthalmic
Current Illness: None known
Preexisting Conditions: Dacryostenosis
Allergies:
Diagnostic Lab Data: Air contrast enema - (+) for intususception records received 4/24/07-Colon air contrast enema revealed ileocolic intussusception. US positive for ileocolic intussusception. Labs WNL rotavirus antigen negative
CDC 'Split Type':

Write-up:Intususception diagnosed by hospital. 04/24/07-records received from facility for DOS 03/13-03/16/07. DC DX: Intussusception. C/O fussy for 2 days large emesis, bloody stools. Multiple mucousy bloody stools. Abdomen fullness palpated in right lower quadrant. Unsuccessful attempt at reduction via enema. Laparotomy including appendectomy.


Changed on 4/7/2010

273884 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Missouri
Vaccinated:2007-01-25
Onset:2007-03-10
Submitted:2007-03-13
Entered:2007-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / AVENTIS PASTEUR C2521AA / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1158F / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR Z0324 / 0 RL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08670F / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1166F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Appendicectomy, Barium double contrast, Haematochezia, Intussusception, Laparotomy, Mucous stools, Vomiting, Ultrasound abdomen abnormal, Rotavirus test negative

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? No
Previous Vaccinations:
Other Medications: Polytrim ophthalmic
Current Illness: None known
Preexisting Conditions: Dacryostenosis
Allergies:
Diagnostic Lab Data: Air contrast enema - (+) for intususception records received 4/24/07-Colon air contrast enema revealed ileocolic intussusception. US positive for ileocolic intussusception. Labs WNL rotavirus antigen negative
CDC 'Split Type':

Write-up:Intususception diagnosed by hospital. 04/24/07-records received from facility for DOS 03/13-03/16/07. DC DX: Intussusception. C/O fussy for 2 days large emesis, bloody stools. Multiple mucousy bloody stools. Abdomen fullness palpated in right lower quadrant. Unsuccessful attempt at reduction via enema. Laparotomy including appendectomy.


Changed on 5/13/2013

273884 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Missouri
Vaccinated:2007-01-25
Onset:2007-03-10
Submitted:2007-03-13
Entered:2007-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / AVENTIS PASTEUR C2521AA / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1158F / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR Z0324 / 0 RL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08670F / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1166F / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1166F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Appendicectomy, Barium double contrast, Haematochezia, Intussusception, Laparotomy, Mucous stools, Vomiting, Ultrasound abdomen abnormal, Rotavirus test negative

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? No
Previous Vaccinations:
Other Medications: Polytrim ophthalmic
Current Illness: None known
Preexisting Conditions: Dacryostenosis
Allergies:
Diagnostic Lab Data: Air contrast enema - (+) for intususception records received 4/24/07-Colon air contrast enema revealed ileocolic intussusception. US positive for ileocolic intussusception. Labs WNL rotavirus antigen negative
CDC 'Split Type':

Write-up:Intususception diagnosed by hospital. 04/24/07-records received from facility for DOS 03/13-03/16/07. DC DX: Intussusception. C/O fussy for 2 days large emesis, bloody stools. Multiple mucousy bloody stools. Abdomen fullness palpated in right lower quadrant. Unsuccessful attempt at reduction via enema. Laparotomy including appendectomy.


Changed on 2/14/2017

273884 Before After
VAERS Form:
Age:0.2 0.19
Gender:Female
Location:Missouri
Vaccinated:2007-01-25
Onset:2007-03-10
Submitted:2007-03-13
Entered:2007-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / AVENTIS PASTEUR SANOFI PASTEUR C2521AA / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1158F / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR SANOFI PASTEUR Z0324 / 0 RL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES PFIZER/WYETH B08670F / 0 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1166F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Appendicectomy, Barium double contrast, Haematochezia, Intussusception, Laparotomy, Mucous stools, Vomiting, Ultrasound abdomen abnormal, Rotavirus test negative

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? No
Previous Vaccinations:
Other Medications: Polytrim ophthalmic
Current Illness: None known
Preexisting Conditions: Dacryostenosis
Allergies:
Diagnostic Lab Data: Air contrast enema - (+) for intususception records received 4/24/07-Colon air contrast enema revealed ileocolic intussusception. US positive for ileocolic intussusception. Labs WNL rotavirus antigen negative
CDC 'Split Type':

Write-up:Intususception diagnosed by hospital. 04/24/07-records received from facility for DOS 03/13-03/16/07. DC DX: Intussusception. C/O fussy for 2 days large emesis, bloody stools. Multiple mucousy bloody stools. Abdomen fullness palpated in right lower quadrant. Unsuccessful attempt at reduction via enema. Laparotomy including appendectomy.


Changed on 9/14/2017

273884 Before After
VAERS Form:(blank) 1
Age:0.19
Gender:Female
Location:Missouri
Vaccinated:2007-01-25
Onset:2007-03-10
Submitted:2007-03-13
Entered:2007-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2521AA / 0 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1158F / 0 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0324 / 0 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08670F / 0 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1166F / 0 1 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, 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? No
Previous Vaccinations:
Other Medications: Polytrim ophthalmic
Current Illness: None known
Preexisting Conditions: Dacryostenosis
Allergies:
Diagnostic Lab Data: Air contrast enema - (+) for intususception records received 4/24/07-Colon air contrast enema revealed ileocolic intussusception. US positive for ileocolic intussusception. Labs WNL rotavirus antigen negative
CDC 'Split Type':

Write-up:Intususception diagnosed by hospital. 04/24/07-records received from facility for DOS 03/13-03/16/07. DC DX: Intussusception. C/O fussy for 2 days large emesis, bloody stools. Multiple mucousy bloody stools. Abdomen fullness palpated in right lower quadrant. Unsuccessful attempt at reduction via enema. Laparotomy including appendectomy.


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