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This is VAERS ID 275635

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 275635
VAERS Form:
Age:0.3
Gender:Female
Location:Maryland
Vaccinated:2007-01-23
Onset:2007-02-11
Submitted:2007-04-05
Entered:2007-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR U1813AB / 1 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER Z0306 / 1 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0940F / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Barium enema, Blood culture negative, Culture urine negative, Decreased appetite, Abdominal 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: LABS: abdominal x-ray showed small bowel dilitation. Barium enema performed but unable to reduce IS. CBC, chemistry & UA were WNL. Blood & urine c/s were neg.
CDC 'Split Type':

Write-up: Intussusception - surgery.


Changed on 12/8/2009

VAERS ID: 275635 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Maryland
Vaccinated:2007-01-23
Onset:2007-02-11
Submitted:2007-04-05
Entered:2007-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR U1813AB / 1 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER Z0306 / 1 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0940F / 1 - / PO

Administered by: Private      Purchased by: Unknown Public
Symptoms: Barium enema, Blood culture negative, Culture urine negative, Full blood count normal, Haematochezia, Intussusception, Nausea, Surgery, Vomiting, Explorative laparotomy, Laboratory test normal, Decreased appetite, Urine analysis normal, Abdominal 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: LABS: abdominal x-ray showed small bowel dilitation. Barium enema performed but unable to reduce IS. CBC, chemistry & UA were WNL. Blood & urine c/s were neg.
CDC 'Split Type':

Write-up: Intussusception - surgery. 5/18/07 Received medical records from hospital which reveal patient experienced nausea, bilious vomiting & decreased oral intake for 2 days & 1 episode of blood stool Admitted 2/13/07-2/14/07. Taken to OR for exp laparotomy, mechanical reduction of IS. Progressed well postoperatively & d/c to home w/PCP & clinic f/u. FINAL DX: Intussusception, surgically reduced.


Changed on 5/13/2013

VAERS ID: 275635 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Maryland
Vaccinated:2007-01-23
Onset:2007-02-11
Submitted:2007-04-05
Entered:2007-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR U1813AB / 1 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER Z0306 / 1 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0940F / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0940F / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Blood culture negative, Culture urine negative, Full blood count normal, Haematochezia, Intussusception, Nausea, Surgery, Vomiting, Explorative laparotomy, Laboratory test normal, Decreased appetite, Urine analysis normal, Abdominal 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: LABS: abdominal x-ray showed small bowel dilitation. Barium enema performed but unable to reduce IS. CBC, chemistry & UA were WNL. Blood & urine c/s were neg.
CDC 'Split Type':

Write-up: Intussusception - surgery. 5/18/07 Received medical records from hospital which reveal patient experienced nausea, bilious vomiting & decreased oral intake for 2 days & 1 episode of blood stool Admitted 2/13/07-2/14/07. Taken to OR for exp laparotomy, mechanical reduction of IS. Progressed well postoperatively & d/c to home w/PCP & clinic f/u. FINAL DX: Intussusception, surgically reduced.


Changed on 5/14/2017

VAERS ID: 275635 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Maryland
Vaccinated:2007-01-23
Onset:2007-02-11
Submitted:2007-04-05
Entered:2007-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR U1813AB / 1 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER Z0306 / 1 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0940F / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Blood culture negative, Culture urine negative, Full blood count normal, Haematochezia, Intussusception, Nausea, Surgery, Vomiting, Explorative laparotomy, Laboratory test normal, Decreased appetite, Urine analysis normal, Abdominal 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: LABS: abdominal x-ray showed small bowel dilitation. Barium enema performed but unable to reduce IS. CBC, chemistry & UA were WNL. Blood & urine c/s were neg.
CDC 'Split Type':

Write-up: Intussusception - surgery. 5/18/07 Received medical records from hospital which reveal patient experienced nausea, bilious vomiting & decreased oral intake for 2 days & 1 episode of blood stool Admitted 2/13/07-2/14/07. Taken to OR for exp laparotomy, mechanical reduction of IS. Progressed well postoperatively & d/c to home w/PCP & clinic f/u. FINAL DX: Intussusception, surgically reduced.


Changed on 9/14/2017

VAERS ID: 275635 Before After
VAERS Form:(blank) 1
Age:0.3
Gender:Female
Location:Maryland
Vaccinated:2007-01-23
Onset:2007-02-11
Submitted:2007-04-05
Entered:2007-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR U1813AB / 1 2 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER Z0306 / 1 2 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0940F / 1 2 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, 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: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: LABS: abdominal x-ray showed small bowel dilitation. Barium enema performed but unable to reduce IS. CBC, chemistry & UA were WNL. Blood & urine c/s were neg.
CDC 'Split Type':

Write-up: Intussusception - surgery. 5/18/07 Received medical records from hospital which reveal patient experienced nausea, bilious vomiting & decreased oral intake for 2 days & 1 episode of blood stool Admitted 2/13/07-2/14/07. Taken to OR for exp laparotomy, mechanical reduction of IS. Progressed well postoperatively & d/c to home w/PCP & clinic f/u. FINAL DX: Intussusception, surgically reduced.


Changed on 2/14/2018

VAERS ID: 275635 Before After
VAERS Form:1
Age:0.3
Gender:Female
Location:Maryland
Vaccinated:2007-01-23
Onset:2007-02-11
Submitted:2007-04-05
Entered:2007-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR U1813AB / 2 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER Z0306 / 2 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0940F / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, 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: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: LABS: abdominal x-ray showed small bowel dilitation. Barium enema performed but unable to reduce IS. CBC, chemistry & UA were WNL. Blood & urine c/s were neg.
CDC 'Split Type':

Write-up: Intussusception - surgery. 5/18/07 Received medical records from hospital which reveal patient experienced nausea, bilious vomiting & decreased oral intake for 2 days & 1 episode of blood stool Admitted 2/13/07-2/14/07. Taken to OR for exp laparotomy, mechanical reduction of IS. Progressed well postoperatively & d/c to home w/PCP & clinic f/u. FINAL DX: Intussusception, surgically reduced.


Changed on 6/14/2018

VAERS ID: 275635 Before After
VAERS Form:1
Age:0.3
Gender:Female
Location:Maryland
Vaccinated:2007-01-23
Onset:2007-02-11
Submitted:2007-04-05
Entered:2007-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR U1813AB / 2 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER Z0306 / 2 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0940F / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, 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: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: LABS: abdominal x-ray showed small bowel dilitation. Barium enema performed but unable to reduce IS. CBC, chemistry & UA were WNL. Blood & urine c/s were neg.
CDC 'Split Type':

Write-up: Intussusception - surgery. 5/18/07 Received medical records from hospital which reveal patient experienced nausea, bilious vomiting & decreased oral intake for 2 days & 1 episode of blood stool Admitted 2/13/07-2/14/07. Taken to OR for exp laparotomy, mechanical reduction of IS. Progressed well postoperatively & d/c to home w/PCP & clinic f/u. FINAL DX: Intussusception, surgically reduced.


Changed on 8/14/2018

VAERS ID: 275635 Before After
VAERS Form:1
Age:0.3
Gender:Female
Location:Maryland
Vaccinated:2007-01-23
Onset:2007-02-11
Submitted:2007-04-05
Entered:2007-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR U1813AB / 2 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER Z0306 / 2 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0940F / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, 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: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: LABS: abdominal x-ray showed small bowel dilitation. Barium enema performed but unable to reduce IS. CBC, chemistry & UA were WNL. Blood & urine c/s were neg.
CDC 'Split Type':

Write-up: Intussusception - surgery. 5/18/07 Received medical records from hospital which reveal patient experienced nausea, bilious vomiting & decreased oral intake for 2 days & 1 episode of blood stool Admitted 2/13/07-2/14/07. Taken to OR for exp laparotomy, mechanical reduction of IS. Progressed well postoperatively & d/c to home w/PCP & clinic f/u. FINAL DX: Intussusception, surgically reduced.


Changed on 9/14/2018

VAERS ID: 275635 Before After
VAERS Form:1
Age:0.3
Gender:Female
Location:Maryland
Vaccinated:2007-01-23
Onset:2007-02-11
Submitted:2007-04-05
Entered:2007-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR U1813AB / 2 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER Z0306 / 2 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0940F / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, 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: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: LABS: abdominal x-ray showed small bowel dilitation. Barium enema performed but unable to reduce IS. CBC, chemistry & UA were WNL. Blood & urine c/s were neg.
CDC 'Split Type':

Write-up: Intussusception - surgery. 5/18/07 Received medical records from hospital which reveal patient experienced nausea, bilious vomiting & decreased oral intake for 2 days & 1 episode of blood stool Admitted 2/13/07-2/14/07. Taken to OR for exp laparotomy, mechanical reduction of IS. Progressed well postoperatively & d/c to home w/PCP & clinic f/u. FINAL DX: Intussusception, surgically reduced.

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