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This is VAERS ID 278389

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 278389
VAERS Form:
Age:0.4
Gender:Female
Location:Arkansas
Vaccinated:2007-04-13
Onset:2007-05-01
Submitted:2007-05-11
Entered:2007-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2553AA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1014F / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR Z0306-2 / 1 LL / SC
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC BO8691 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1365F / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Appendicectomy, Dehydration, Enema administration, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: LABS: abdominal x-ray revealed SBO. Contrast study revealed mid transverse IS which reduced s/p several attempts.
CDC 'Split Type':

Write-up: Two weeks after receiving Rotateq - 05/03/07 dx with intussusception - requiring surgical intervention.


Changed on 12/8/2009

VAERS ID: 278389 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Arkansas
Vaccinated:2007-04-13
Onset:2007-05-01
Submitted:2007-05-11
Entered:2007-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2553AA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1014F / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR Z0306-2 / 1 LL / SC
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC BO8691 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1365F / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Appendicectomy, Dehydration, Haematochezia, Intussusception, Lethargy, Small intestinal obstruction, Surgery, Vomiting, Enema administration, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: LABS: abdominal x-ray revealed SBO. Contrast study revealed mid transverse IS which reduced s/p several attempts.
CDC 'Split Type':

Write-up: Two weeks after receiving Rotateq - 05/03/07 dx with intussusception - requiring surgical intervention. 5/22/07 Received vax records & operative note from PCP which reveals patient experienced intussusception which was initially reduced by contrast. However, symptoms persisted & contrast study was repeated which revealed recurence of IS right at ileocecal valve & patient taken to OR. Findings at surgery were ileoileal IS successfully reduced w/o difficulty, Peyer patch & incidental appendectomy was done. Vax record corrects lot numbers, VAERS database updated. 7/17/07 Received hospital medical records which reveal patient experienced vomiting, bloody stool, lethargy, dehydration & decreased appetite. FINAL DX: Intussusception.


Changed on 3/2/2010

VAERS ID: 278389 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Arkansas
Vaccinated:2007-04-13
Onset:2007-05-01
Submitted:2007-05-11
Entered:2007-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2553AA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1014F / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR Z0306-2 / 1 LL / SC
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC BO8691 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1365F / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Appendicectomy, Dehydration, Haematochezia, Intussusception, Lethargy, Small intestinal obstruction, Surgery, Vomiting, Enema administration, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: LABS: abdominal x-ray revealed SBO. Contrast study revealed mid transverse IS which reduced s/p several attempts.
CDC 'Split Type':

Write-up: Two weeks after receiving Rotateq - 05/03/07 dx with intussusception - requiring surgical intervention. 5/22/07 Received vax records & operative note from PCP which reveals patient experienced intussusception which was initially reduced by contrast. However, symptoms persisted & contrast study was repeated which revealed recurence of IS right at ileocecal valve & patient taken to OR. Findings at surgery were ileoileal IS successfully reduced w/o difficulty, Peyer patch & incidental appendectomy was done. Vax record corrects lot numbers, VAERS database updated. 7/17/07 Received hospital medical records which reveal patient experienced vomiting, bloody stool, lethargy, dehydration & decreased appetite. FINAL DX: Intussusception.


Changed on 4/7/2010

VAERS ID: 278389 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Arkansas
Vaccinated:2007-04-13
Onset:2007-05-01
Submitted:2007-05-11
Entered:2007-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2553AA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1014F / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR Z0306-2 / 1 LL / SC
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC BO8691 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1365F / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Appendicectomy, Dehydration, Haematochezia, Intussusception, Lethargy, Small intestinal obstruction, Surgery, Vomiting, Enema administration, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: LABS: abdominal x-ray revealed SBO. Contrast study revealed mid transverse IS which reduced s/p several attempts.
CDC 'Split Type':

Write-up: Two weeks after receiving Rotateq - 05/03/07 dx with intussusception - requiring surgical intervention. 5/22/07 Received vax records & operative note from PCP which reveals patient experienced intussusception which was initially reduced by contrast. However, symptoms persisted & contrast study was repeated which revealed recurence of IS right at ileocecal valve & patient taken to OR. Findings at surgery were ileoileal IS successfully reduced w/o difficulty, Peyer patch & incidental appendectomy was done. Vax record corrects lot numbers, VAERS database updated. 7/17/07 Received hospital medical records which reveal patient experienced vomiting, bloody stool, lethargy, dehydration & decreased appetite. FINAL DX: Intussusception.


Changed on 8/31/2010

VAERS ID: 278389 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Arkansas
Vaccinated:2007-04-13
Onset:2007-05-01
Submitted:2007-05-11
Entered:2007-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2553AA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1014F / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR Z0306-2 / 1 LL / SC
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH BO8691 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1365F / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Appendicectomy, Dehydration, Haematochezia, Intussusception, Lethargy, Small intestinal obstruction, Surgery, Vomiting, Enema administration, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: LABS: abdominal x-ray revealed SBO. Contrast study revealed mid transverse IS which reduced s/p several attempts.
CDC 'Split Type':

Write-up: Two weeks after receiving Rotateq - 05/03/07 dx with intussusception - requiring surgical intervention. 5/22/07 Received vax records & operative note from PCP which reveals patient experienced intussusception which was initially reduced by contrast. However, symptoms persisted & contrast study was repeated which revealed recurence of IS right at ileocecal valve & patient taken to OR. Findings at surgery were ileoileal IS successfully reduced w/o difficulty, Peyer patch & incidental appendectomy was done. Vax record corrects lot numbers, VAERS database updated. 7/17/07 Received hospital medical records which reveal patient experienced vomiting, bloody stool, lethargy, dehydration & decreased appetite. FINAL DX: Intussusception.


Changed on 5/13/2013

VAERS ID: 278389 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Arkansas
Vaccinated:2007-04-13
Onset:2007-05-01
Submitted:2007-05-11
Entered:2007-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2553AA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1014F / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR Z0306-2 / 1 LL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH BO8691 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1365F / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1365F / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Appendicectomy, Dehydration, Haematochezia, Intussusception, Lethargy, Small intestinal obstruction, Surgery, Vomiting, Enema administration, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: LABS: abdominal x-ray revealed SBO. Contrast study revealed mid transverse IS which reduced s/p several attempts.
CDC 'Split Type':

Write-up: Two weeks after receiving Rotateq - 05/03/07 dx with intussusception - requiring surgical intervention. 5/22/07 Received vax records & operative note from PCP which reveals patient experienced intussusception which was initially reduced by contrast. However, symptoms persisted & contrast study was repeated which revealed recurence of IS right at ileocecal valve & patient taken to OR. Findings at surgery were ileoileal IS successfully reduced w/o difficulty, Peyer patch & incidental appendectomy was done. Vax record corrects lot numbers, VAERS database updated. 7/17/07 Received hospital medical records which reveal patient experienced vomiting, bloody stool, lethargy, dehydration & decreased appetite. FINAL DX: Intussusception.


Changed on 5/14/2017

VAERS ID: 278389 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Arkansas
Vaccinated:2007-04-13
Onset:2007-05-01
Submitted:2007-05-11
Entered:2007-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2553AA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1014F / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR Z0306-2 / 1 LL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH BO8691 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1365F / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Appendicectomy, Dehydration, Haematochezia, Intussusception, Lethargy, Small intestinal obstruction, Surgery, Vomiting, Enema administration, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: LABS: abdominal x-ray revealed SBO. Contrast study revealed mid transverse IS which reduced s/p several attempts.
CDC 'Split Type':

Write-up: Two weeks after receiving Rotateq - 05/03/07 dx with intussusception - requiring surgical intervention. 5/22/07 Received vax records & operative note from PCP which reveals patient experienced intussusception which was initially reduced by contrast. However, symptoms persisted & contrast study was repeated which revealed recurence of IS right at ileocecal valve & patient taken to OR. Findings at surgery were ileoileal IS successfully reduced w/o difficulty, Peyer patch & incidental appendectomy was done. Vax record corrects lot numbers, VAERS database updated. 7/17/07 Received hospital medical records which reveal patient experienced vomiting, bloody stool, lethargy, dehydration & decreased appetite. FINAL DX: Intussusception.


Changed on 9/14/2017

VAERS ID: 278389 Before After
VAERS Form:(blank) 1
Age:0.4
Gender:Female
Location:Arkansas
Vaccinated:2007-04-13
Onset:2007-05-01
Submitted:2007-05-11
Entered:2007-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2553AA / 1 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1014F / 1 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR Z0306-2 / 1 2 LL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH BO8691 / 1 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1365F / 1 2 - MO / PO

Administered by: Private      Purchased by: Unknown
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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: LABS: abdominal x-ray revealed SBO. Contrast study revealed mid transverse IS which reduced s/p several attempts.
CDC 'Split Type':

Write-up: Two weeks after receiving Rotateq - 05/03/07 dx with intussusception - requiring surgical intervention. 5/22/07 Received vax records & operative note from PCP which reveals patient experienced intussusception which was initially reduced by contrast. However, symptoms persisted & contrast study was repeated which revealed recurence of IS right at ileocecal valve & patient taken to OR. Findings at surgery were ileoileal IS successfully reduced w/o difficulty, Peyer patch & incidental appendectomy was done. Vax record corrects lot numbers, VAERS database updated. 7/17/07 Received hospital medical records which reveal patient experienced vomiting, bloody stool, lethargy, dehydration & decreased appetite. FINAL DX: Intussusception.


Changed on 2/14/2018

VAERS ID: 278389 Before After
VAERS Form:1
Age:0.4
Gender:Female
Location:Arkansas
Vaccinated:2007-04-13
Onset:2007-05-01
Submitted:2007-05-11
Entered:2007-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2553AA / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1014F / 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR Z0306-2 / 2 LL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH BO8691 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1365F / 2 MO / PO

Administered by: Private      Purchased by: Unknown
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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: LABS: abdominal x-ray revealed SBO. Contrast study revealed mid transverse IS which reduced s/p several attempts.
CDC 'Split Type':

Write-up: Two weeks after receiving Rotateq - 05/03/07 dx with intussusception - requiring surgical intervention. 5/22/07 Received vax records & operative note from PCP which reveals patient experienced intussusception which was initially reduced by contrast. However, symptoms persisted & contrast study was repeated which revealed recurence of IS right at ileocecal valve & patient taken to OR. Findings at surgery were ileoileal IS successfully reduced w/o difficulty, Peyer patch & incidental appendectomy was done. Vax record corrects lot numbers, VAERS database updated. 7/17/07 Received hospital medical records which reveal patient experienced vomiting, bloody stool, lethargy, dehydration & decreased appetite. FINAL DX: Intussusception.


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