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This is VAERS ID 277820

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     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Reports to follow
CDC 'Split Type':

Write-up: Intussusception, increased screaming, vomit, deep sleep

Changed on 12/8/2009

VAERS ID: 277820 Before After
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 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     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Reports to follow LABS: KUB, US of abdomen revealed IS at hepatic flexure & air contrast enema successfully reduced..
CDC 'Split Type':

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.

Changed on 3/2/2010

VAERS ID: 277820 Before After
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) 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     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Reports to follow LABS: KUB, US of abdomen revealed IS at hepatic flexure & air contrast enema successfully reduced..
CDC 'Split Type':

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.

Changed on 4/7/2010

VAERS ID: 277820 Before After
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 (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     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Reports to follow LABS: KUB, US of abdomen revealed IS at hepatic flexure & air contrast enema successfully reduced..
CDC 'Split Type':

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.

Changed on 8/31/2010

VAERS ID: 277820 Before After
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 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     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Reports to follow LABS: KUB, US of abdomen revealed IS at hepatic flexure & air contrast enema successfully reduced..
CDC 'Split Type':

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.

Changed on 5/13/2013

VAERS ID: 277820 Before After
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) / 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     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Reports to follow LABS: KUB, US of abdomen revealed IS at hepatic flexure & air contrast enema successfully reduced..
CDC 'Split Type':

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.

Changed on 2/14/2017

VAERS ID: 277820 Before After
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) / 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     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Reports to follow LABS: KUB, US of abdomen revealed IS at hepatic flexure & air contrast enema successfully reduced..
CDC 'Split Type':

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.

Changed on 9/14/2017

VAERS ID: 277820 Before After
VAERS Form:(blank) 1
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 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     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Reports to follow LABS: KUB, US of abdomen revealed IS at hepatic flexure & air contrast enema successfully reduced..
CDC 'Split Type':

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.

Changed on 2/14/2018

VAERS ID: 277820 Before After
VAERS Form:1
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 / 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     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Reports to follow LABS: KUB, US of abdomen revealed IS at hepatic flexure & air contrast enema successfully reduced..
CDC 'Split Type':

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.

Changed on 6/14/2018

VAERS ID: 277820 Before After
VAERS Form:1
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 / 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     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Reports to follow LABS: KUB, US of abdomen revealed IS at hepatic flexure & air contrast enema successfully reduced..
CDC 'Split Type':

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.

Changed on 8/14/2018

VAERS ID: 277820 Before After
VAERS Form:1
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 / 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     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Reports to follow LABS: KUB, US of abdomen revealed IS at hepatic flexure & air contrast enema successfully reduced..
CDC 'Split Type':

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.

Changed on 9/14/2018

VAERS ID: 277820 Before After
VAERS Form:1
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 / 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     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Reports to follow LABS: KUB, US of abdomen revealed IS at hepatic flexure & air contrast enema successfully reduced..
CDC 'Split Type':

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.

Changed on 10/14/2018

VAERS ID: 277820 Before After
VAERS Form:1
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 / 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     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Reports to follow LABS: KUB, US of abdomen revealed IS at hepatic flexure & air contrast enema successfully reduced..
CDC 'Split Type':

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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