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This is VAERS ID 273982

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

273982
VAERS Form:
Age:0.2
Gender:Female
Location:Colorado
Vaccinated:2007-02-16
Onset:2007-03-10
Submitted:2007-03-14
Entered:2007-03-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084BA / 0 UN / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1271F / 0 UN / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B36258C / 0 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Fatigue, Gastrointestinal necrosis, Haematochezia, Diverticulitis Meckel''s

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Air enema an intussusception was found but not completely reduced.
CDC 'Split Type':

Write-up:Patient came into office fussy. Alternating with tired, no source identified, patient was sent out with symptomatic care. Parents called the next day with bloody stools and sent to ED. Patient diagnosed with intussuception - Air Enema failed to reduce."Surgery showed 4cm of necrotic bowel. Primary anastomosed, Meckel''''s found at time of surgery. As given by MD


Changed on 12/8/2009

273982 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Colorado
Vaccinated:2007-02-16
Onset:2007-03-10
Submitted:2007-03-14
Entered:2007-03-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084BA / 0 UN / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084BA / 0 UN / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1271F / 0 UN / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B36258C / 0 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Diverticulitis Meckel's, Fatigue, Gastrointestinal necrosis, Haematochezia, Intussusception, Irritability, Laparotomy, Surgery, Vomiting, Diverticulitis Meckel''s

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Air enema an intussusception was found but not completely reduced.
CDC 'Split Type':

Write-up:Patient came into office fussy. Alternating with tired, no source identified, patient was sent out with symptomatic care. Parents called the next day with bloody stools and sent to ED. Patient diagnosed with intussuception - Air Enema failed to reduce."Surgery reduce. Surgery showed 4cm of necrotic bowel. Primary anastomosed, Meckel''''s Meckel''s found at time of surgery. As given by MD 04/11/07-DC Summary received for DOS 3/11-3/17/07-DX Intussusception. Presented with emesis and bright red blood per rectum. Laparotomy and ileal resection and subclavian placement. Recovered and discharged.


Changed on 1/5/2010

273982 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Colorado
Vaccinated:2007-02-16
Onset:2007-03-10
Submitted:2007-03-14
Entered:2007-03-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084BA / 0 UN / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1271F / 0 UN / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES WYETH PHARMACEUTICALS, INC B36258C / 0 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Diverticulitis Meckel's, Fatigue, Gastrointestinal necrosis, Haematochezia, Intussusception, Irritability, Laparotomy, Surgery, Vomiting

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Air enema an intussusception was found but not completely reduced.
CDC 'Split Type':

Write-up:Patient came into office fussy. Alternating with tired, no source identified, patient was sent out with symptomatic care. Parents called the next day with bloody stools and sent to ED. Patient diagnosed with intussuception - Air Enema failed to reduce. Surgery showed 4cm of necrotic bowel. Primary anastomosed, Meckel''s found at time of surgery. As given by MD 04/11/07-DC Summary received for DOS 3/11-3/17/07-DX Intussusception. Presented with emesis and bright red blood per rectum. Laparotomy and ileal resection and subclavian placement. Recovered and discharged.


Changed on 3/2/2010

273982 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Colorado
Vaccinated:2007-02-16
Onset:2007-03-10
Submitted:2007-03-14
Entered:2007-03-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084BA / 0 UN / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1271F / 0 UN / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B36258C / 0 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Diverticulitis Meckel's, Fatigue, Gastrointestinal necrosis, Haematochezia, Intussusception, Irritability, Surgery

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Air enema an intussusception was found but not completely reduced.
CDC 'Split Type':

Write-up:Patient came into office fussy. Alternating with tired, no source identified, patient was sent out with symptomatic care. Parents called the next day with bloody stools and sent to ED. Patient diagnosed with intussuception - Air Enema failed to reduce. Surgery showed 4cm of necrotic bowel. Primary anastomosed, Meckel''s found at time of surgery. As given by MD 04/11/07-DC Summary received for DOS 3/11-3/17/07-DX Intussusception. Presented with emesis and bright red blood per rectum. Laparotomy and ileal resection and subclavian placement. Recovered and discharged.


Changed on 4/7/2010

273982 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Colorado
Vaccinated:2007-02-16
Onset:2007-03-10
Submitted:2007-03-14
Entered:2007-03-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084BA / 0 UN / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1271F / 0 UN / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B36258C / 0 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Diverticulitis Meckel's, Fatigue, Gastrointestinal necrosis, Haematochezia, Intussusception, Irritability, Surgery

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Air enema an intussusception was found but not completely reduced.
CDC 'Split Type':

Write-up:Patient came into office fussy. Alternating with tired, no source identified, patient was sent out with symptomatic care. Parents called the next day with bloody stools and sent to ED. Patient diagnosed with intussuception - Air Enema failed to reduce. Surgery showed 4cm of necrotic bowel. Primary anastomosed, Meckel''s found at time of surgery. As given by MD 04/11/07-DC Summary received for DOS 3/11-3/17/07-DX Intussusception. Presented with emesis and bright red blood per rectum. Laparotomy and ileal resection and subclavian placement. Recovered and discharged.


Changed on 8/31/2010

273982 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Colorado
Vaccinated:2007-02-16
Onset:2007-03-10
Submitted:2007-03-14
Entered:2007-03-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084BA / 0 UN / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1271F / 0 UN / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B36258C / 0 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Diverticulitis Meckel's, Fatigue, Gastrointestinal necrosis, Haematochezia, Intussusception, Irritability, Surgery

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Air enema an intussusception was found but not completely reduced.
CDC 'Split Type':

Write-up:Patient came into office fussy. Alternating with tired, no source identified, patient was sent out with symptomatic care. Parents called the next day with bloody stools and sent to ED. Patient diagnosed with intussuception - Air Enema failed to reduce. Surgery showed 4cm of necrotic bowel. Primary anastomosed, Meckel''s found at time of surgery. As given by MD 04/11/07-DC Summary received for DOS 3/11-3/17/07-DX Intussusception. Presented with emesis and bright red blood per rectum. Laparotomy and ileal resection and subclavian placement. Recovered and discharged.


Changed on 4/13/2011

273982 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Colorado
Vaccinated:2007-02-16
Onset:2007-03-10
Submitted:2007-03-14
Entered:2007-03-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084BA / 0 UN / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1271F / 0 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B36258C / 0 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Diverticulitis Meckel's, Fatigue, Gastrointestinal necrosis, Haematochezia, Intussusception, Irritability, Laparotomy, Surgery, Vomiting

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Air enema an intussusception was found but not completely reduced.
CDC 'Split Type':

Write-up:Patient came into office fussy. Alternating with tired, no source identified, patient was sent out with symptomatic care. Parents called the next day with bloody stools and sent to ED. Patient diagnosed with intussuception - Air Enema failed to reduce. Surgery showed 4cm of necrotic bowel. Primary anastomosed, Meckel''s found at time of surgery. As given by MD 04/11/07-DC Summary received for DOS 3/11-3/17/07-DX Intussusception. Presented with emesis and bright red blood per rectum. Laparotomy and ileal resection and subclavian placement. Recovered and discharged.


Changed on 5/13/2011

273982 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Colorado
Vaccinated:2007-02-16
Onset:2007-03-10
Submitted:2007-03-14
Entered:2007-03-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084BA / 0 UN / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1271F / 0 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B36258C / 0 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Diverticulitis Meckel's, Fatigue, Gastrointestinal necrosis, Haematochezia, Intussusception, Irritability, Laparotomy, Surgery, Vomiting

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Air enema an intussusception was found but not completely reduced.
CDC 'Split Type':

Write-up:Patient came into office fussy. Alternating with tired, no source identified, patient was sent out with symptomatic care. Parents called the next day with bloody stools and sent to ED. Patient diagnosed with intussuception - Air Enema failed to reduce. Surgery showed 4cm of necrotic bowel. Primary anastomosed, Meckel''s found at time of surgery. As given by MD 04/11/07-DC Summary received for DOS 3/11-3/17/07-DX Intussusception. Presented with emesis and bright red blood per rectum. Laparotomy and ileal resection and subclavian placement. Recovered and discharged.


Changed on 6/11/2011

273982 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Colorado
Vaccinated:2007-02-16
Onset:2007-03-10
Submitted:2007-03-14
Entered:2007-03-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084BA / 0 UN / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1271F / 0 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B36258C / 0 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Diverticulitis Meckel's, Fatigue, Gastrointestinal necrosis, Haematochezia, Intussusception, Irritability, Laparotomy, Surgery, Vomiting

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Air enema an intussusception was found but not completely reduced.
CDC 'Split Type':

Write-up:Patient came into office fussy. Alternating with tired, no source identified, patient was sent out with symptomatic care. Parents called the next day with bloody stools and sent to ED. Patient diagnosed with intussuception - Air Enema failed to reduce. Surgery showed 4cm of necrotic bowel. Primary anastomosed, Meckel''s found at time of surgery. As given by MD 04/11/07-DC Summary received for DOS 3/11-3/17/07-DX Intussusception. Presented with emesis and bright red blood per rectum. Laparotomy and ileal resection and subclavian placement. Recovered and discharged.


Changed on 5/13/2013

273982 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Colorado
Vaccinated:2007-02-16
Onset:2007-03-10
Submitted:2007-03-14
Entered:2007-03-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084BA / 0 UN / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1271F / 0 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B36258C / 0 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032F / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Diverticulitis Meckel's, Fatigue, Gastrointestinal necrosis, Haematochezia, Intussusception, Irritability, Laparotomy, Surgery, Vomiting

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Air enema an intussusception was found but not completely reduced.
CDC 'Split Type':

Write-up:Patient came into office fussy. Alternating with tired, no source identified, patient was sent out with symptomatic care. Parents called the next day with bloody stools and sent to ED. Patient diagnosed with intussuception - Air Enema failed to reduce. Surgery showed 4cm of necrotic bowel. Primary anastomosed, Meckel''s found at time of surgery. As given by MD 04/11/07-DC Summary received for DOS 3/11-3/17/07-DX Intussusception. Presented with emesis and bright red blood per rectum. Laparotomy and ileal resection and subclavian placement. Recovered and discharged.


Changed on 2/14/2017

273982 Before After
VAERS Form:
Age:0.2 0.17
Gender:Female
Location:Colorado
Vaccinated:2007-02-16
Onset:2007-03-10
Submitted:2007-03-14
Entered:2007-03-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084BA / 0 UN / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1271F / 0 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B36258C / 0 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Diverticulitis Meckel's, Fatigue, Gastrointestinal necrosis, Haematochezia, Intussusception, Irritability, Laparotomy, Surgery, Vomiting

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Air enema an intussusception was found but not completely reduced.
CDC 'Split Type':

Write-up:Patient came into office fussy. Alternating with tired, no source identified, patient was sent out with symptomatic care. Parents called the next day with bloody stools and sent to ED. Patient diagnosed with intussuception - Air Enema failed to reduce. Surgery showed 4cm of necrotic bowel. Primary anastomosed, Meckel''s found at time of surgery. As given by MD 04/11/07-DC Summary received for DOS 3/11-3/17/07-DX Intussusception. Presented with emesis and bright red blood per rectum. Laparotomy and ileal resection and subclavian placement. Recovered and discharged.


Changed on 5/14/2017

273982 Before After
VAERS Form:
Age:0.17
Gender:Female
Location:Colorado
Vaccinated:2007-02-16
Onset:2007-03-10
Submitted:2007-03-14
Entered:2007-03-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084BA / 0 UN / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1271F / 0 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B36258C / 0 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Diverticulitis Meckel's, Fatigue, Gastrointestinal necrosis, Haematochezia, Intussusception, Irritability, Laparotomy, Surgery, Vomiting

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Air enema an intussusception was found but not completely reduced.
CDC 'Split Type':

Write-up:Patient came into office fussy. Alternating with tired, no source identified, patient was sent out with symptomatic care. Parents called the next day with bloody stools and sent to ED. Patient diagnosed with intussuception - Air Enema failed to reduce. Surgery showed 4cm of necrotic bowel. Primary anastomosed, Meckel''s found at time of surgery. As given by MD 04/11/07-DC Summary received for DOS 3/11-3/17/07-DX Intussusception. Presented with emesis and bright red blood per rectum. Laparotomy and ileal resection and subclavian placement. Recovered and discharged.


Changed on 9/14/2017

273982 Before After
VAERS Form:(blank) 1
Age:0.17
Gender:Female
Location:Colorado
Vaccinated:2007-02-16
Onset:2007-03-10
Submitted:2007-03-14
Entered:2007-03-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B084BA / 0 1 UN / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1271F / 0 1 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B36258C / 0 1 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032F / 0 1 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Diverticulitis Meckel's, Fatigue, Gastrointestinal necrosis, Haematochezia, Intussusception, Irritability, Surgery

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Air enema an intussusception was found but not completely reduced.
CDC 'Split Type':

Write-up:Patient came into office fussy. Alternating with tired, no source identified, patient was sent out with symptomatic care. Parents called the next day with bloody stools and sent to ED. Patient diagnosed with intussuception - Air Enema failed to reduce. Surgery showed 4cm of necrotic bowel. Primary anastomosed, Meckel''s found at time of surgery. As given by MD 04/11/07-DC Summary received for DOS 3/11-3/17/07-DX Intussusception. Presented with emesis and bright red blood per rectum. Laparotomy and ileal resection and subclavian placement. Recovered and discharged.


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