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History of Changes from the VAERS Wayback Machine |
First Appeared on 12/31/2007 |
VAERS ID: | 277820 |
VAERS Form: | |
Age: | 0.6 |
Gender: | Female |
Location: | Texas |
Vaccinated: | 2007-04-21 |
Onset: | 2007-04-29 |
Submitted: | 2007-05-02 |
Entered: | 2007-05-03 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER | C2552AA / 2 | - / - |
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER | UE981AA / 2 | - / - |
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER | 20547 / 2 | - / - |
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC | B086820 / 2 | - / - |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0389F / 2 | - / PO |
Administered by: Private Purchased by: Unknown
Symptoms: Barium double contrast, Intussusception, Screaming, Sleep disorder, Somnolence
Life Threatening? Yes
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
Write-up: Intussusception, increased screaming, vomit, deep sleep
Vaccinated: | 2007-04-21 |
Onset: | 2007-04-29 |
Submitted: | 2007-05-02 |
Entered: | 2007-05-03 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER | C2552AA / 2 | - / - |
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER | UE981AA / 2 | - / - |
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER | 20547 / 2 | - / - |
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC | B086820 / 2 | - / - |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0389F / 2 | - / PO |
Administered by: Private Purchased by: Unknown Public
Symptoms: Barium double contrast, Intussusception, Screaming, Sleep disorder, Somnolence, Urinary system X-ray, Vomiting, Ultrasound abdomen abnormal
Life Threatening? Yes
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
Write-up: Intussusception, increased screaming, vomit, deep sleep sleep. 5/4/07 Received vax records from PCP which reveal the following also received on 4/21/07: DTaP C2552AA 3rd dose Hib UE981AA 3rd dose IPV 20547 3rd dose PCV B086820 3rd dose Rotavirus 0389F 3rd dose 6/19/07 Received ER records. No D/C Summary available. Patient seen only in ER on 4/30/07 for vomiting & increased sleepiness. FINAL DX: Intussusception, reduced by air contrast enema.
Vaccinated: | 2007-04-21 |
Onset: | 2007-04-29 |
Submitted: | 2007-05-02 |
Entered: | 2007-05-03 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER | C2552AA / 2 | - / - |
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER | UE981AA / 2 | - / - |
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER | 20547 / 2 | - / - |
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC | B086820 / 2 | - / - |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0389F / 2 | - / PO |
Administered by: Private Purchased by: Public
Symptoms: Barium double contrast, Intussusception, Screaming, Sleep disorder, Somnolence, Urinary system X-ray, Vomiting, Ultrasound abdomen abnormal
Life Threatening? Yes
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
Write-up: Intussusception, increased screaming, vomit, deep sleep. 5/4/07 Received vax records from PCP which reveal the following also received on 4/21/07: DTaP C2552AA 3rd dose Hib UE981AA 3rd dose IPV 20547 3rd dose PCV B086820 3rd dose Rotavirus 0389F 3rd dose 6/19/07 Received ER records. No D/C Summary available. Patient seen only in ER on 4/30/07 for vomiting & increased sleepiness. FINAL DX: Intussusception, reduced by air contrast enema.
Vaccinated: | 2007-04-21 |
Onset: | 2007-04-29 |
Submitted: | 2007-05-02 |
Entered: | 2007-05-03 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER | C2552AA / 2 | - / - |
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER | UE981AA / 2 | - / - |
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER | 20547 / 2 | - / - |
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC | B086820 / 2 | - / - |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0389F / 2 | - / PO |
Administered by: Private Purchased by: Public
Symptoms: Barium double contrast, Intussusception, Screaming, Sleep disorder, Somnolence, Urinary system X-ray, Vomiting, Ultrasound abdomen abnormal
Life Threatening? Yes
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
Write-up: Intussusception, increased screaming, vomit, deep sleep. 5/4/07 Received vax records from PCP which reveal the following also received on 4/21/07: DTaP C2552AA 3rd dose Hib UE981AA 3rd dose IPV 20547 3rd dose PCV B086820 3rd dose Rotavirus 0389F 3rd dose 6/19/07 Received ER records. No D/C Summary available. Patient seen only in ER on 4/30/07 for vomiting & increased sleepiness. FINAL DX: Intussusception, reduced by air contrast enema.
Vaccinated: | 2007-04-21 |
Onset: | 2007-04-29 |
Submitted: | 2007-05-02 |
Entered: | 2007-05-03 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER | C2552AA / 2 | - / - |
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER | UE981AA / 2 | - / - |
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER | 20547 / 2 | - / - |
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH | B086820 / 2 | - / - |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0389F / 2 | - / PO |
Administered by: Private Purchased by: Public
Symptoms: Barium double contrast, Intussusception, Screaming, Sleep disorder, Somnolence, Urinary system X-ray, Vomiting, Ultrasound abdomen abnormal
Life Threatening? Yes
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
Write-up: Intussusception, increased screaming, vomit, deep sleep. 5/4/07 Received vax records from PCP which reveal the following also received on 4/21/07: DTaP C2552AA 3rd dose Hib UE981AA 3rd dose IPV 20547 3rd dose PCV B086820 3rd dose Rotavirus 0389F 3rd dose 6/19/07 Received ER records. No D/C Summary available. Patient seen only in ER on 4/30/07 for vomiting & increased sleepiness. FINAL DX: Intussusception, reduced by air contrast enema.
Vaccinated: | 2007-04-21 |
Onset: | 2007-04-29 |
Submitted: | 2007-05-02 |
Entered: | 2007-05-03 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER | C2552AA / 2 | - / - |
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER | UE981AA / 2 | - / - |
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER | 20547 / 2 | - / - |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B086820 / 2 | - / - |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0389F / 2 | - / PO |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0389F / 2 | - / PO |
Administered by: Private Purchased by: Public
Symptoms: Barium double contrast, Intussusception, Screaming, Sleep disorder, Somnolence, Urinary system X-ray, Vomiting, Ultrasound abdomen abnormal
Life Threatening? Yes
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
Write-up: Intussusception, increased screaming, vomit, deep sleep. 5/4/07 Received vax records from PCP which reveal the following also received on 4/21/07: DTaP C2552AA 3rd dose Hib UE981AA 3rd dose IPV 20547 3rd dose PCV B086820 3rd dose Rotavirus 0389F 3rd dose 6/19/07 Received ER records. No D/C Summary available. Patient seen only in ER on 4/30/07 for vomiting & increased sleepiness. FINAL DX: Intussusception, reduced by air contrast enema.
Vaccinated: | 2007-04-21 |
Onset: | 2007-04-29 |
Submitted: | 2007-05-02 |
Entered: | 2007-05-03 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER | C2552AA / 2 | - / - |
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER | UE981AA / 2 | - / - |
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER | 20547 / 2 | - / - |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B086820 / 2 | - / - |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0389F / 2 | - / PO |
Administered by: Private Purchased by: Public
Symptoms: Barium double contrast, Intussusception, Screaming, Sleep disorder, Somnolence, Urinary system X-ray, Vomiting, Ultrasound abdomen abnormal
Life Threatening? Yes
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
Write-up: Intussusception, increased screaming, vomit, deep sleep. 5/4/07 Received vax records from PCP which reveal the following also received on 4/21/07: DTaP C2552AA 3rd dose Hib UE981AA 3rd dose IPV 20547 3rd dose PCV B086820 3rd dose Rotavirus 0389F 3rd dose 6/19/07 Received ER records. No D/C Summary available. Patient seen only in ER on 4/30/07 for vomiting & increased sleepiness. FINAL DX: Intussusception, reduced by air contrast enema.
Vaccinated: | 2007-04-21 |
Onset: | 2007-04-29 |
Submitted: | 2007-05-02 |
Entered: | 2007-05-03 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER | C2552AA / 2 3 | - / - |
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER | UE981AA / 2 3 | - / - |
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER | 20547 / 2 3 | - / - |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B086820 / 2 3 | - / - |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0389F / 2 3 | - MO / PO |
Administered by: Private Purchased by: Public
Symptoms: Intussusception, Screaming, Sleep disorder, Vomiting
Life Threatening? Yes
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
Write-up: Intussusception, increased screaming, vomit, deep sleep. 5/4/07 Received vax records from PCP which reveal the following also received on 4/21/07: DTaP C2552AA 3rd dose Hib UE981AA 3rd dose IPV 20547 3rd dose PCV B086820 3rd dose Rotavirus 0389F 3rd dose 6/19/07 Received ER records. No D/C Summary available. Patient seen only in ER on 4/30/07 for vomiting & increased sleepiness. FINAL DX: Intussusception, reduced by air contrast enema.
Vaccinated: | 2007-04-21 |
Onset: | 2007-04-29 |
Submitted: | 2007-05-02 |
Entered: | 2007-05-03 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER | C2552AA / 3 | - / - |
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER | UE981AA / 3 | - / - |
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER | 20547 / 3 | - / - |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B086820 / 3 | - / - |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0389F / 3 | MO / PO |
Administered by: Private Purchased by: Public
Symptoms: Intussusception, Screaming, Sleep disorder, Vomiting
Life Threatening? Yes
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
Write-up: Intussusception, increased screaming, vomit, deep sleep. 5/4/07 Received vax records from PCP which reveal the following also received on 4/21/07: DTaP C2552AA 3rd dose Hib UE981AA 3rd dose IPV 20547 3rd dose PCV B086820 3rd dose Rotavirus 0389F 3rd dose 6/19/07 Received ER records. No D/C Summary available. Patient seen only in ER on 4/30/07 for vomiting & increased sleepiness. FINAL DX: Intussusception, reduced by air contrast enema.
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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=277820&WAYBACKHISTORY=ON
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