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VAERS ID: | 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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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 / 1 | LL / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 0405F / 1 | LL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B08689C / 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
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.
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 / 1 | LL / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 0405F / 1 | LL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B08689C / 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
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.
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 / 1 | LL / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 0405F / 1 | LL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B08689C / 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
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.
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 / 1 | LL / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 0405F / 1 | LL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B08689C / 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
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.
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 / 1 | LL / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 0405F / 1 | LL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B08689C / 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
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.
Link To This Search Result:
https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=278796&WAYBACKHISTORY=ON
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