National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 277882

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

277882
VAERS Form:
Age:0.4
Gender:Female
Location:Pennsylvania
Vaccinated:2007-04-03
Onset:2007-04-26
Submitted:2007-05-03
Entered:2007-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2569AA / 1 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF073AA / 1 RL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08672K / 1 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1238F / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Barium double contrast, Haematochezia, Intussusception, Blood test 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)? No
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Pilonydal dimple
Allergies:
Diagnostic Lab Data: Patient admitted to hospital overnight 4/27-4/28. Diagnosed w/intussusception reduced w/air.
CDC 'Split Type':

Write-up:Patient developed vomiting on 4/26/2007 on 4/27 parent report bilious vomiting episode 1 referred to hospital ED for evaluation.


Changed on 12/8/2009

277882 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Pennsylvania
Vaccinated:2007-04-03
Onset:2007-04-26
Submitted:2007-05-03
Entered:2007-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2569AA / 1 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF073AA / 1 RL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08672K / 1 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1238F / 1 - / PO

Administered by: Private      Purchased by: Unknown Private
Symptoms: Barium double contrast, Haematochezia, Intussusception, Vomiting, Blood test normal, Ultrasound abdomen abnormal, Abdominal X-ray, Occult blood negative

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Pilonydal dimple
Allergies:
Diagnostic Lab Data: Patient admitted to hospital overnight 4/27-4/28. Diagnosed w/intussusception reduced w/air. LABS: heme (+) stool. US (+) for IS in transverse colon. Blood work WNL. Abd x-ray suspicious for IS. Air enema successfully reduced IS.
CDC 'Split Type':

Write-up:Patient developed vomiting on 4/26/2007 on 4/27 parent report bilious vomiting episode 1 referred to hospital ED for evaluation. 5/4/07 Received vax records from PCP which confirm RO lot & dose as reported on VAERS form. 7/6/07 Received hospital medical records which reveal patient experienced bilious emesis & had blood in stool in ER. Surgery consult done. Admitted 4/27-4/28/07. FINAL DX: Ileocolic intussusception, successfully reduced by air enema.


Changed on 3/2/2010

277882 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Pennsylvania
Vaccinated:2007-04-03
Onset:2007-04-26
Submitted:2007-05-03
Entered:2007-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2569AA / 1 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF073AA / 1 RL / -
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B08672K / 1 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1238F / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Haematochezia, Intussusception, Vomiting, Blood test normal, Ultrasound abdomen abnormal, Abdominal X-ray, Occult blood negative

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Pilonydal dimple
Allergies:
Diagnostic Lab Data: Patient admitted to hospital overnight 4/27-4/28. Diagnosed w/intussusception reduced w/air. LABS: heme (+) stool. US (+) for IS in transverse colon. Blood work WNL. Abd x-ray suspicious for IS. Air enema successfully reduced IS.
CDC 'Split Type':

Write-up:Patient developed vomiting on 4/26/2007 on 4/27 parent report bilious vomiting episode 1 referred to hospital ED for evaluation. 5/4/07 Received vax records from PCP which confirm RO lot & dose as reported on VAERS form. 7/6/07 Received hospital medical records which reveal patient experienced bilious emesis & had blood in stool in ER. Surgery consult done. Admitted 4/27-4/28/07. FINAL DX: Ileocolic intussusception, successfully reduced by air enema.


Changed on 4/7/2010

277882 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Pennsylvania
Vaccinated:2007-04-03
Onset:2007-04-26
Submitted:2007-05-03
Entered:2007-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2569AA / 1 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF073AA / 1 RL / -
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08672K / 1 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1238F / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Haematochezia, Intussusception, Vomiting, Blood test normal, Ultrasound abdomen abnormal, Abdominal X-ray, Occult blood negative

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Pilonydal dimple
Allergies:
Diagnostic Lab Data: Patient admitted to hospital overnight 4/27-4/28. Diagnosed w/intussusception reduced w/air. LABS: heme (+) stool. US (+) for IS in transverse colon. Blood work WNL. Abd x-ray suspicious for IS. Air enema successfully reduced IS.
CDC 'Split Type':

Write-up:Patient developed vomiting on 4/26/2007 on 4/27 parent report bilious vomiting episode 1 referred to hospital ED for evaluation. 5/4/07 Received vax records from PCP which confirm RO lot & dose as reported on VAERS form. 7/6/07 Received hospital medical records which reveal patient experienced bilious emesis & had blood in stool in ER. Surgery consult done. Admitted 4/27-4/28/07. FINAL DX: Ileocolic intussusception, successfully reduced by air enema.


Changed on 8/31/2010

277882 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Pennsylvania
Vaccinated:2007-04-03
Onset:2007-04-26
Submitted:2007-05-03
Entered:2007-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2569AA / 1 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF073AA / 1 RL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B08672K / 1 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1238F / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Haematochezia, Intussusception, Vomiting, Blood test normal, Ultrasound abdomen abnormal, Abdominal X-ray, Occult blood negative

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Pilonydal dimple
Allergies:
Diagnostic Lab Data: Patient admitted to hospital overnight 4/27-4/28. Diagnosed w/intussusception reduced w/air. LABS: heme (+) stool. US (+) for IS in transverse colon. Blood work WNL. Abd x-ray suspicious for IS. Air enema successfully reduced IS.
CDC 'Split Type':

Write-up:Patient developed vomiting on 4/26/2007 on 4/27 parent report bilious vomiting episode 1 referred to hospital ED for evaluation. 5/4/07 Received vax records from PCP which confirm RO lot & dose as reported on VAERS form. 7/6/07 Received hospital medical records which reveal patient experienced bilious emesis & had blood in stool in ER. Surgery consult done. Admitted 4/27-4/28/07. FINAL DX: Ileocolic intussusception, successfully reduced by air enema.


Changed on 5/13/2013

277882 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Pennsylvania
Vaccinated:2007-04-03
Onset:2007-04-26
Submitted:2007-05-03
Entered:2007-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2569AA / 1 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF073AA / 1 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08672K / 1 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1238F / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1238F / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Haematochezia, Intussusception, Vomiting, Blood test normal, Ultrasound abdomen abnormal, Abdominal X-ray, Occult blood negative

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Pilonydal dimple
Allergies:
Diagnostic Lab Data: Patient admitted to hospital overnight 4/27-4/28. Diagnosed w/intussusception reduced w/air. LABS: heme (+) stool. US (+) for IS in transverse colon. Blood work WNL. Abd x-ray suspicious for IS. Air enema successfully reduced IS.
CDC 'Split Type':

Write-up:Patient developed vomiting on 4/26/2007 on 4/27 parent report bilious vomiting episode 1 referred to hospital ED for evaluation. 5/4/07 Received vax records from PCP which confirm RO lot & dose as reported on VAERS form. 7/6/07 Received hospital medical records which reveal patient experienced bilious emesis & had blood in stool in ER. Surgery consult done. Admitted 4/27-4/28/07. FINAL DX: Ileocolic intussusception, successfully reduced by air enema.


Changed on 2/14/2017

277882 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Pennsylvania
Vaccinated:2007-04-03
Onset:2007-04-26
Submitted:2007-05-03
Entered:2007-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2569AA / 1 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF073AA / 1 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08672K / 1 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1238F / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Haematochezia, Intussusception, Vomiting, Blood test normal, Ultrasound abdomen abnormal, Abdominal X-ray, Occult blood negative

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Pilonydal dimple
Allergies:
Diagnostic Lab Data: Patient admitted to hospital overnight 4/27-4/28. Diagnosed w/intussusception reduced w/air. LABS: heme (+) stool. US (+) for IS in transverse colon. Blood work WNL. Abd x-ray suspicious for IS. Air enema successfully reduced IS.
CDC 'Split Type':

Write-up:Patient developed vomiting on 4/26/2007 on 4/27 parent report bilious vomiting episode 1 referred to hospital ED for evaluation. 5/4/07 Received vax records from PCP which confirm RO lot & dose as reported on VAERS form. 7/6/07 Received hospital medical records which reveal patient experienced bilious emesis & had blood in stool in ER. Surgery consult done. Admitted 4/27-4/28/07. FINAL DX: Ileocolic intussusception, successfully reduced by air enema.


Changed on 9/14/2017

277882 Before After
VAERS Form:(blank) 1
Age:0.4
Gender:Female
Location:Pennsylvania
Vaccinated:2007-04-03
Onset:2007-04-26
Submitted:2007-05-03
Entered:2007-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2569AA / 1 2 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF073AA / 1 2 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08672K / 1 2 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1238F / 1 2 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Intussusception, 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)? No
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Pilonydal dimple
Allergies:
Diagnostic Lab Data: Patient admitted to hospital overnight 4/27-4/28. Diagnosed w/intussusception reduced w/air. LABS: heme (+) stool. US (+) for IS in transverse colon. Blood work WNL. Abd x-ray suspicious for IS. Air enema successfully reduced IS.
CDC 'Split Type':

Write-up:Patient developed vomiting on 4/26/2007 on 4/27 parent report bilious vomiting episode 1 referred to hospital ED for evaluation. 5/4/07 Received vax records from PCP which confirm RO lot & dose as reported on VAERS form. 7/6/07 Received hospital medical records which reveal patient experienced bilious emesis & had blood in stool in ER. Surgery consult done. Admitted 4/27-4/28/07. FINAL DX: Ileocolic intussusception, successfully reduced by air enema.


New Search

Link To This Search Result:

http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=277882&WAYBACKHISTORY=ON


Copyright © 2018 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166