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This is VAERS ID 275291

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 275291
VAERS Form:
Age:0.2
Gender:Female
Location:Michigan
Vaccinated:2007-01-15
Onset:2007-03-12
Submitted:2007-03-30
Entered:2007-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B066AA / 0 LL / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UE972AA / - LA / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08657F / - RA / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0410F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Agitation, Barium enema, Crying, Faeces hard, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: RHINITIS
Preexisting Conditions: PMH: apnea monitor. Full term pregnancy, Mom had fever & was on antibiotics.
Allergies:
Diagnostic Lab Data: XRAY
CDC 'Split Type':

Write-up: CHILD BROUGHT TO OFFICE AM ON 3/12/07 HARD STOOLS,FUSSY & CRYING DIAPER WITH BLOOD IN STOOL BROUGHT BACK TO OFFICE IN PM 2 DIAPERS BLOOD STAINED DIAPER TESTED POSITIVE FOR BLOOD INTUSSUSUPTION-COULD NOT BE REDUCED BY ENEMA WAS SURGICALLY REDUCED BOWEL VIA"BLE


Changed on 12/8/2009

VAERS ID: 275291 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Michigan
Vaccinated:2007-01-15
Onset:2007-03-12
Submitted:2007-03-30
Entered:2007-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B066AA / 0 LL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B066AA / 0 LL / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UE972AA / - LA / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08657F / - RA / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0410F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Agitation, Barium enema, Crying, Faeces hard, Haematochezia, Intussusception, Lethargy, Pyrexia, Surgery, Vomiting, X-ray, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: RHINITIS
Preexisting Conditions: PMH: apnea monitor. Full term pregnancy, Mom had fever & was on antibiotics.
Allergies:
Diagnostic Lab Data: XRAY LABS: WBC 18.1, segs 62, lymphs 2, bands 2. Barium enema confirmed IS through descending colon, able to reduce to ileocecal valve only.
CDC 'Split Type':

Write-up: CHILD BROUGHT TO OFFICE AM ON 3/12/07 HARD STOOLS,FUSSY & CRYING DIAPER WITH BLOOD IN STOOL BROUGHT BACK TO OFFICE IN PM 2 DIAPERS BLOOD STAINED DIAPER TESTED POSITIVE FOR BLOOD INTUSSUSUPTION-COULD NOT BE REDUCED BY ENEMA WAS SURGICALLY REDUCED BOWEL VIA"BLE VIABLE 4/13/07 Received medical records from hospital which reveal patient experienced bloody stools, vomiting, lethargy & fever. Transferred from outlying hospital for higher level of care 3/12/07-3/17/07. Given IVF & antibiotics & taken to OR for exp lap & reduction of IS & appendectomy. Progressed well & d/c to home on 3/17/07. No D/C summary available. FINAL DX: Ileocecal intussusception, surgically reduced.


Changed on 3/2/2010

VAERS ID: 275291 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Michigan
Vaccinated:2007-01-15
Onset:2007-03-12
Submitted:2007-03-30
Entered:2007-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B066AA / 0 LL / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UE972AA / - LA / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / LEDERLE LABORATORIES B08657F / - RA / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0410F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Agitation, Barium enema, Crying, Faeces hard, Haematochezia, Intussusception, Lethargy, Pyrexia, Surgery, Vomiting, X-ray, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: RHINITIS
Preexisting Conditions: PMH: apnea monitor. Full term pregnancy, Mom had fever & was on antibiotics.
Allergies:
Diagnostic Lab Data: XRAY LABS: WBC 18.1, segs 62, lymphs 2, bands 2. Barium enema confirmed IS through descending colon, able to reduce to ileocecal valve only.
CDC 'Split Type':

Write-up: CHILD BROUGHT TO OFFICE AM ON 3/12/07 HARD STOOLS,FUSSY & CRYING DIAPER WITH BLOOD IN STOOL BROUGHT BACK TO OFFICE IN PM 2 DIAPERS BLOOD STAINED DIAPER TESTED POSITIVE FOR BLOOD INTUSSUSUPTION-COULD NOT BE REDUCED BY ENEMA WAS SURGICALLY REDUCED BOWEL VIABLE 4/13/07 Received medical records from hospital which reveal patient experienced bloody stools, vomiting, lethargy & fever. Transferred from outlying hospital for higher level of care 3/12/07-3/17/07. Given IVF & antibiotics & taken to OR for exp lap & reduction of IS & appendectomy. Progressed well & d/c to home on 3/17/07. No D/C summary available. FINAL DX: Ileocecal intussusception, surgically reduced.


Changed on 4/7/2010

VAERS ID: 275291 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Michigan
Vaccinated:2007-01-15
Onset:2007-03-12
Submitted:2007-03-30
Entered:2007-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B066AA / 0 LL / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UE972AA / - LA / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08657F / - RA / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0410F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Agitation, Barium enema, Crying, Faeces hard, Haematochezia, Intussusception, Lethargy, Pyrexia, Surgery, Vomiting, X-ray, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: RHINITIS
Preexisting Conditions: PMH: apnea monitor. Full term pregnancy, Mom had fever & was on antibiotics.
Allergies:
Diagnostic Lab Data: XRAY LABS: WBC 18.1, segs 62, lymphs 2, bands 2. Barium enema confirmed IS through descending colon, able to reduce to ileocecal valve only.
CDC 'Split Type':

Write-up: CHILD BROUGHT TO OFFICE AM ON 3/12/07 HARD STOOLS,FUSSY & CRYING DIAPER WITH BLOOD IN STOOL BROUGHT BACK TO OFFICE IN PM 2 DIAPERS BLOOD STAINED DIAPER TESTED POSITIVE FOR BLOOD INTUSSUSUPTION-COULD NOT BE REDUCED BY ENEMA WAS SURGICALLY REDUCED BOWEL VIABLE 4/13/07 Received medical records from hospital which reveal patient experienced bloody stools, vomiting, lethargy & fever. Transferred from outlying hospital for higher level of care 3/12/07-3/17/07. Given IVF & antibiotics & taken to OR for exp lap & reduction of IS & appendectomy. Progressed well & d/c to home on 3/17/07. No D/C summary available. FINAL DX: Ileocecal intussusception, surgically reduced.


Changed on 5/13/2013

VAERS ID: 275291 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Michigan
Vaccinated:2007-01-15
Onset:2007-03-12
Submitted:2007-03-30
Entered:2007-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B066AA / 0 LL / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UE972AA / - LA / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08657F / - RA / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0410F / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0410F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Agitation, Barium enema, Crying, Faeces hard, Haematochezia, Intussusception, Lethargy, Pyrexia, Surgery, Vomiting, X-ray, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: RHINITIS
Preexisting Conditions: PMH: apnea monitor. Full term pregnancy, Mom had fever & was on antibiotics.
Allergies:
Diagnostic Lab Data: XRAY LABS: WBC 18.1, segs 62, lymphs 2, bands 2. Barium enema confirmed IS through descending colon, able to reduce to ileocecal valve only.
CDC 'Split Type':

Write-up: CHILD BROUGHT TO OFFICE AM ON 3/12/07 HARD STOOLS,FUSSY & CRYING DIAPER WITH BLOOD IN STOOL BROUGHT BACK TO OFFICE IN PM 2 DIAPERS BLOOD STAINED DIAPER TESTED POSITIVE FOR BLOOD INTUSSUSUPTION-COULD NOT BE REDUCED BY ENEMA WAS SURGICALLY REDUCED BOWEL VIABLE 4/13/07 Received medical records from hospital which reveal patient experienced bloody stools, vomiting, lethargy & fever. Transferred from outlying hospital for higher level of care 3/12/07-3/17/07. Given IVF & antibiotics & taken to OR for exp lap & reduction of IS & appendectomy. Progressed well & d/c to home on 3/17/07. No D/C summary available. FINAL DX: Ileocecal intussusception, surgically reduced.


Changed on 2/14/2017

VAERS ID: 275291 Before After
VAERS Form:
Age:0.2 0.23
Gender:Female
Location:Michigan
Vaccinated:2007-01-15
Onset:2007-03-12
Submitted:2007-03-30
Entered:2007-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B066AA / 0 LL / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR SANOFI PASTEUR UE972AA / - LA / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES PFIZER/WYETH B08657F / - RA / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0410F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Agitation, Barium enema, Crying, Faeces hard, Haematochezia, Intussusception, Lethargy, Pyrexia, Surgery, Vomiting, X-ray, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: RHINITIS
Preexisting Conditions: PMH: apnea monitor. Full term pregnancy, Mom had fever & was on antibiotics.
Allergies:
Diagnostic Lab Data: XRAY LABS: WBC 18.1, segs 62, lymphs 2, bands 2. Barium enema confirmed IS through descending colon, able to reduce to ileocecal valve only.
CDC 'Split Type':

Write-up: CHILD BROUGHT TO OFFICE AM ON 3/12/07 HARD STOOLS,FUSSY & CRYING DIAPER WITH BLOOD IN STOOL BROUGHT BACK TO OFFICE IN PM 2 DIAPERS BLOOD STAINED DIAPER TESTED POSITIVE FOR BLOOD INTUSSUSUPTION-COULD NOT BE REDUCED BY ENEMA WAS SURGICALLY REDUCED BOWEL VIABLE 4/13/07 Received medical records from hospital which reveal patient experienced bloody stools, vomiting, lethargy & fever. Transferred from outlying hospital for higher level of care 3/12/07-3/17/07. Given IVF & antibiotics & taken to OR for exp lap & reduction of IS & appendectomy. Progressed well & d/c to home on 3/17/07. No D/C summary available. FINAL DX: Ileocecal intussusception, surgically reduced.


Changed on 9/14/2017

VAERS ID: 275291 Before After
VAERS Form:(blank) 1
Age:0.23
Gender:Female
Location:Michigan
Vaccinated:2007-01-15
Onset:2007-03-12
Submitted:2007-03-30
Entered:2007-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B066AA / 0 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE972AA / - UNK LA / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08657F / - UNK RA / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0410F / 0 1 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Agitation, Crying, Faeces hard, Haematochezia, Intussusception, Surgery, X-ray, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: RHINITIS
Preexisting Conditions: PMH: apnea monitor. Full term pregnancy, Mom had fever & was on antibiotics.
Allergies:
Diagnostic Lab Data: XRAY LABS: WBC 18.1, segs 62, lymphs 2, bands 2. Barium enema confirmed IS through descending colon, able to reduce to ileocecal valve only.
CDC 'Split Type':

Write-up: CHILD BROUGHT TO OFFICE AM ON 3/12/07 HARD STOOLS,FUSSY & CRYING DIAPER WITH BLOOD IN STOOL BROUGHT BACK TO OFFICE IN PM 2 DIAPERS BLOOD STAINED DIAPER TESTED POSITIVE FOR BLOOD INTUSSUSUPTION-COULD NOT BE REDUCED BY ENEMA WAS SURGICALLY REDUCED BOWEL VIABLE 4/13/07 Received medical records from hospital which reveal patient experienced bloody stools, vomiting, lethargy & fever. Transferred from outlying hospital for higher level of care 3/12/07-3/17/07. Given IVF & antibiotics & taken to OR for exp lap & reduction of IS & appendectomy. Progressed well & d/c to home on 3/17/07. No D/C summary available. FINAL DX: Ileocecal intussusception, surgically reduced.


Changed on 2/14/2018

VAERS ID: 275291 Before After
VAERS Form:1
Age:0.23
Gender:Female
Location:Michigan
Vaccinated:2007-01-15
Onset:2007-03-12
Submitted:2007-03-30
Entered:2007-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B066AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE972AA / UNK LA / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08657F / UNK RA / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0410F / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Agitation, Crying, Faeces hard, Haematochezia, Intussusception, Surgery, X-ray, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: RHINITIS
Preexisting Conditions: PMH: apnea monitor. Full term pregnancy, Mom had fever & was on antibiotics.
Allergies:
Diagnostic Lab Data: XRAY LABS: WBC 18.1, segs 62, lymphs 2, bands 2. Barium enema confirmed IS through descending colon, able to reduce to ileocecal valve only.
CDC 'Split Type':

Write-up: CHILD BROUGHT TO OFFICE AM ON 3/12/07 HARD STOOLS,FUSSY & CRYING DIAPER WITH BLOOD IN STOOL BROUGHT BACK TO OFFICE IN PM 2 DIAPERS BLOOD STAINED DIAPER TESTED POSITIVE FOR BLOOD INTUSSUSUPTION-COULD NOT BE REDUCED BY ENEMA WAS SURGICALLY REDUCED BOWEL VIABLE 4/13/07 Received medical records from hospital which reveal patient experienced bloody stools, vomiting, lethargy & fever. Transferred from outlying hospital for higher level of care 3/12/07-3/17/07. Given IVF & antibiotics & taken to OR for exp lap & reduction of IS & appendectomy. Progressed well & d/c to home on 3/17/07. No D/C summary available. FINAL DX: Ileocecal intussusception, surgically reduced.


Changed on 6/14/2018

VAERS ID: 275291 Before After
VAERS Form:1
Age:0.23
Gender:Female
Location:Michigan
Vaccinated:2007-01-15
Onset:2007-03-12
Submitted:2007-03-30
Entered:2007-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B066AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE972AA / UNK LA / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08657F / UNK RA / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0410F / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Agitation, Crying, Faeces hard, Haematochezia, Intussusception, Surgery, X-ray, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: RHINITIS
Preexisting Conditions: PMH: apnea monitor. Full term pregnancy, Mom had fever & was on antibiotics.
Allergies:
Diagnostic Lab Data: XRAY LABS: WBC 18.1, segs 62, lymphs 2, bands 2. Barium enema confirmed IS through descending colon, able to reduce to ileocecal valve only.
CDC 'Split Type':

Write-up: CHILD BROUGHT TO OFFICE AM ON 3/12/07 HARD STOOLS,FUSSY & CRYING DIAPER WITH BLOOD IN STOOL BROUGHT BACK TO OFFICE IN PM 2 DIAPERS BLOOD STAINED DIAPER TESTED POSITIVE FOR BLOOD INTUSSUSUPTION-COULD NOT BE REDUCED BY ENEMA WAS SURGICALLY REDUCED BOWEL VIABLE 4/13/07 Received medical records from hospital which reveal patient experienced bloody stools, vomiting, lethargy & fever. Transferred from outlying hospital for higher level of care 3/12/07-3/17/07. Given IVF & antibiotics & taken to OR for exp lap & reduction of IS & appendectomy. Progressed well & d/c to home on 3/17/07. No D/C summary available. FINAL DX: Ileocecal intussusception, surgically reduced.

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