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This is VAERS ID 278796

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

278796
VAERS Form:
Age:0.2
Gender:Female
Location:Louisiana
Vaccinated:2007-04-04
Onset:2007-05-15
Submitted:2007-05-17
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B101M / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0405F / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08689C / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / - - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Abdominal distension, Barium enema, Body temperature increased, Bowel sounds abnormal, Infrequent bowel movements

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Axid
Current Illness: None
Preexisting Conditions: GERD
Allergies:
Diagnostic Lab Data: UGI with small bowel follow through/Barium enema records received 5/23/07-CBC normal. Urine culture no growth. Chem normal. -KUB enlarged loops of small bowel and air fluid levels. UGI and barium enema showed no masses.
CDC 'Split Type':

Write-up:Pt received Rotateq vaccine 4/4/07 Pt had intussusception dx''''d 5/15/07 05/23/07-records received for DOS 5/15/07-DX: Intussusception. Surgical repair. HX nausea vomiting no bowel movement for past 48 hours Temp 100.4. PE abdomen soft mild distention with"decreased bowel sounds, non tender. no masses.


Changed on 12/8/2009

278796 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Louisiana
Vaccinated:2007-04-04
Onset:2007-05-15
Submitted:2007-05-17
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B101M / 0 LL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B101M / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0405F / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08689C / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / - - UN / - UN

Administered by: Private      Purchased by: Unknown Public
Symptoms: Abdominal distension, Barium enema, Body temperature increased, Bowel sounds abnormal, Intussusception, Laparotomy, Nausea, Urinary system X-ray, Vomiting, X-ray with contrast upper gastrointestinal tract, Infrequent bowel movements

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Axid
Current Illness: None
Preexisting Conditions: GERD
Allergies:
Diagnostic Lab Data: UGI with small bowel follow through/Barium enema records received 5/23/07-CBC normal. Urine culture no growth. Chem normal. -KUB enlarged loops of small bowel and air fluid levels. UGI and barium enema showed no masses.
CDC 'Split Type':

Write-up:Pt received Rotateq vaccine 4/4/07 Pt had intussusception dx''''d dx''d 5/15/07 05/23/07-records received for DOS 5/15/07-DX: Intussusception. Surgical repair. HX nausea vomiting no bowel movement for past 48 hours Temp 100.4. PE abdomen soft mild distention with"decreased with decreased bowel sounds, non tender. no masses.


Changed on 3/2/2010

278796 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Louisiana
Vaccinated:2007-04-04
Onset:2007-05-15
Submitted:2007-05-17
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B101M / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0405F / 0 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B08689C / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / - UN / UN

Administered by: Private      Purchased by: Public
Symptoms: Abdominal distension, Barium enema, Body temperature increased, Bowel sounds abnormal, Intussusception, Laparotomy, Nausea, Urinary system X-ray, Vomiting, X-ray with contrast upper gastrointestinal tract, Infrequent bowel movements

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Axid
Current Illness: None
Preexisting Conditions: GERD
Allergies:
Diagnostic Lab Data: UGI with small bowel follow through/Barium enema records received 5/23/07-CBC normal. Urine culture no growth. Chem normal. -KUB enlarged loops of small bowel and air fluid levels. UGI and barium enema showed no masses.
CDC 'Split Type':

Write-up:Pt received Rotateq vaccine 4/4/07 Pt had intussusception dx''d 5/15/07 05/23/07-records received for DOS 5/15/07-DX: Intussusception. Surgical repair. HX nausea vomiting no bowel movement for past 48 hours Temp 100.4. PE abdomen soft mild distention with decreased bowel sounds, non tender. no masses.


Changed on 4/7/2010

278796 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Louisiana
Vaccinated:2007-04-04
Onset:2007-05-15
Submitted:2007-05-17
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B101M / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0405F / 0 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08689C / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / - UN / UN

Administered by: Private      Purchased by: Public
Symptoms: Abdominal distension, Barium enema, Body temperature increased, Bowel sounds abnormal, Intussusception, Laparotomy, Nausea, Urinary system X-ray, Vomiting, X-ray with contrast upper gastrointestinal tract, Infrequent bowel movements

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Axid
Current Illness: None
Preexisting Conditions: GERD
Allergies:
Diagnostic Lab Data: UGI with small bowel follow through/Barium enema records received 5/23/07-CBC normal. Urine culture no growth. Chem normal. -KUB enlarged loops of small bowel and air fluid levels. UGI and barium enema showed no masses.
CDC 'Split Type':

Write-up:Pt received Rotateq vaccine 4/4/07 Pt had intussusception dx''d 5/15/07 05/23/07-records received for DOS 5/15/07-DX: Intussusception. Surgical repair. HX nausea vomiting no bowel movement for past 48 hours Temp 100.4. PE abdomen soft mild distention with decreased bowel sounds, non tender. no masses.


Changed on 8/31/2010

278796 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Louisiana
Vaccinated:2007-04-04
Onset:2007-05-15
Submitted:2007-05-17
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B101M / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0405F / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B08689C / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / - UN / UN

Administered by: Private      Purchased by: Public
Symptoms: Abdominal distension, Barium enema, Body temperature increased, Bowel sounds abnormal, Intussusception, Laparotomy, Nausea, Urinary system X-ray, Vomiting, X-ray with contrast upper gastrointestinal tract, Infrequent bowel movements

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Axid
Current Illness: None
Preexisting Conditions: GERD
Allergies:
Diagnostic Lab Data: UGI with small bowel follow through/Barium enema records received 5/23/07-CBC normal. Urine culture no growth. Chem normal. -KUB enlarged loops of small bowel and air fluid levels. UGI and barium enema showed no masses.
CDC 'Split Type':

Write-up:Pt received Rotateq vaccine 4/4/07 Pt had intussusception dx''d 5/15/07 05/23/07-records received for DOS 5/15/07-DX: Intussusception. Surgical repair. HX nausea vomiting no bowel movement for past 48 hours Temp 100.4. PE abdomen soft mild distention with decreased bowel sounds, non tender. no masses.


Changed on 5/13/2013

278796 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Louisiana
Vaccinated:2007-04-04
Onset:2007-05-15
Submitted:2007-05-17
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B101M / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0405F / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08689C / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / - UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / - UN / UN

Administered by: Private      Purchased by: Public
Symptoms: Abdominal distension, Barium enema, Body temperature increased, Bowel sounds abnormal, Intussusception, Laparotomy, Nausea, Urinary system X-ray, Vomiting, X-ray with contrast upper gastrointestinal tract, Infrequent bowel movements

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Axid
Current Illness: None
Preexisting Conditions: GERD
Allergies:
Diagnostic Lab Data: UGI with small bowel follow through/Barium enema records received 5/23/07-CBC normal. Urine culture no growth. Chem normal. -KUB enlarged loops of small bowel and air fluid levels. UGI and barium enema showed no masses.
CDC 'Split Type':

Write-up:Pt received Rotateq vaccine 4/4/07 Pt had intussusception dx''d 5/15/07 05/23/07-records received for DOS 5/15/07-DX: Intussusception. Surgical repair. HX nausea vomiting no bowel movement for past 48 hours Temp 100.4. PE abdomen soft mild distention with decreased bowel sounds, non tender. no masses.


Changed on 5/14/2017

278796 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Louisiana
Vaccinated:2007-04-04
Onset:2007-05-15
Submitted:2007-05-17
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B101M / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0405F / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08689C / 0 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / - UN / UN

Administered by: Private      Purchased by: Public
Symptoms: Abdominal distension, Barium enema, Body temperature increased, Bowel sounds abnormal, Intussusception, Laparotomy, Nausea, Urinary system X-ray, Vomiting, X-ray with contrast upper gastrointestinal tract, Infrequent bowel movements

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Axid
Current Illness: None
Preexisting Conditions: GERD
Allergies:
Diagnostic Lab Data: UGI with small bowel follow through/Barium enema records received 5/23/07-CBC normal. Urine culture no growth. Chem normal. -KUB enlarged loops of small bowel and air fluid levels. UGI and barium enema showed no masses.
CDC 'Split Type':

Write-up:Pt received Rotateq vaccine 4/4/07 Pt had intussusception dx''d 5/15/07 05/23/07-records received for DOS 5/15/07-DX: Intussusception. Surgical repair. HX nausea vomiting no bowel movement for past 48 hours Temp 100.4. PE abdomen soft mild distention with decreased bowel sounds, non tender. no masses.


Changed on 9/14/2017

278796 Before After
VAERS Form:(blank) 1
Age:0.2
Gender:Female
Location:Louisiana
Vaccinated:2007-04-04
Onset:2007-05-15
Submitted:2007-05-17
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B101M / 0 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0405F / 0 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08689C / 0 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / - UNK UN / UN

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Intussusception, X-ray with contrast upper gastrointestinal tract

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Axid
Current Illness: None
Preexisting Conditions: GERD
Allergies:
Diagnostic Lab Data: UGI with small bowel follow through/Barium enema records received 5/23/07-CBC normal. Urine culture no growth. Chem normal. -KUB enlarged loops of small bowel and air fluid levels. UGI and barium enema showed no masses.
CDC 'Split Type':

Write-up:Pt received Rotateq vaccine 4/4/07 Pt had intussusception dx''d 5/15/07 05/23/07-records received for DOS 5/15/07-DX: Intussusception. Surgical repair. HX nausea vomiting no bowel movement for past 48 hours Temp 100.4. PE abdomen soft mild distention with decreased bowel sounds, non tender. no masses.


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