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This is VAERS ID 279032

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 279032
VAERS Form:
Age:0.3
Gender:Female
Location:Kentucky
Vaccinated:2006-11-07
Onset:2006-11-13
Submitted:2007-05-16
Entered:2007-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B065AA / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1180R / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08649B / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Barium double contrast, Haematochezia, Intussusception, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Barium Enema LABS: air contrast barium enema x 2 reduced IS x 2.
CDC 'Split Type':

Write-up: Patient started with vomiting developed bloody stools. Transferred from one medical center hospital to another one for intussusception - reduced by air contrast barium enema on 11-14-06 and again 11-15-06.6/1/07 Received hospital medical records which rev"eal patient experienced vomiting, bloody stools & decreased appetite w/low grade fever. Seen at outlying ER which abdominal x-ray reveled possible SBO & IS. Transferred to higher level of care & admitted from 11/14-11/17/2006. IS successfully reduced bu


Changed on 12/8/2009

VAERS ID: 279032 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Kentucky
Vaccinated:2006-11-07
Onset:2006-11-13
Submitted:2007-05-16
Entered:2007-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B065AA / 1 RL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B065AA / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1180R / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08649B / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 1 - / PO

Administered by: Private      Purchased by: Unknown Public
Symptoms: Barium double contrast, Haematochezia, Intussusception, Pyrexia, Small intestinal obstruction, Vomiting, Decreased appetite, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Barium Enema LABS: air contrast barium enema x 2 reduced IS x 2.
CDC 'Split Type':

Write-up: Patient started with vomiting developed bloody stools. Transferred from one medical center hospital to another one for intussusception - reduced by air contrast barium enema on 11-14-06 and again 11-15-06.6/1/07 Received hospital medical records which rev"eal reveal patient experienced vomiting, bloody stools & decreased appetite w/low grade fever. Seen at outlying ER which abdominal x-ray reveled possible SBO & IS. Transferred to higher level of care & admitted from 11/14-11/17/2006. IS successfully reduced bu but recurred next day. Repeat air contrast enema again reduced IS. Progressed well after 2nd enema, tolerated oral feeds & was d/c to home. FINAL DX: Intussusception. 6/1/07 Vax records received from CDC. VAERS database updated.


Changed on 1/5/2010

VAERS ID: 279032 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Kentucky
Vaccinated:2006-11-07
Onset:2006-11-13
Submitted:2007-05-16
Entered:2007-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B065AA / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1180R / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08649B / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium double contrast, Haematochezia, Intussusception, Pyrexia, Small intestinal obstruction, Vomiting, Decreased appetite, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Barium Enema LABS: air contrast barium enema x 2 reduced IS x 2.
CDC 'Split Type':

Write-up: Patient started with vomiting developed bloody stools. Transferred from one medical center hospital to another one for intussusception - reduced by air contrast barium enema on 11-14-06 and again 11-15-06.6/1/07 Received hospital medical records which reveal patient experienced vomiting, bloody stools & decreased appetite w/low grade fever. Seen at outlying ER which abdominal x-ray reveled possible SBO & IS. Transferred to higher level of care & admitted from 11/14-11/17/2006. IS successfully reduced but recurred next day. Repeat air contrast enema again reduced IS. Progressed well after 2nd enema, tolerated oral feeds & was d/c to home. FINAL DX: Intussusception. 6/1/07 Vax records received from CDC. VAERS database updated.


Changed on 3/2/2010

VAERS ID: 279032 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Kentucky
Vaccinated:2006-11-07
Onset:2006-11-13
Submitted:2007-05-16
Entered:2007-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B065AA / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1180R / 1 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B08649B / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium double contrast, Haematochezia, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Barium Enema LABS: air contrast barium enema x 2 reduced IS x 2.
CDC 'Split Type':

Write-up: Patient started with vomiting developed bloody stools. Transferred from one medical center hospital to another one for intussusception - reduced by air contrast barium enema on 11-14-06 and again 11-15-06.6/1/07 Received hospital medical records which reveal patient experienced vomiting, bloody stools & decreased appetite w/low grade fever. Seen at outlying ER which abdominal x-ray reveled possible SBO & IS. Transferred to higher level of care & admitted from 11/14-11/17/2006. IS successfully reduced but recurred next day. Repeat air contrast enema again reduced IS. Progressed well after 2nd enema, tolerated oral feeds & was d/c to home. FINAL DX: Intussusception. 6/1/07 Vax records received from CDC. VAERS database updated.


Changed on 4/7/2010

VAERS ID: 279032 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Kentucky
Vaccinated:2006-11-07
Onset:2006-11-13
Submitted:2007-05-16
Entered:2007-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B065AA / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1180R / 1 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08649B / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium double contrast, Haematochezia, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Barium Enema LABS: air contrast barium enema x 2 reduced IS x 2.
CDC 'Split Type':

Write-up: Patient started with vomiting developed bloody stools. Transferred from one medical center hospital to another one for intussusception - reduced by air contrast barium enema on 11-14-06 and again 11-15-06.6/1/07 Received hospital medical records which reveal patient experienced vomiting, bloody stools & decreased appetite w/low grade fever. Seen at outlying ER which abdominal x-ray reveled possible SBO & IS. Transferred to higher level of care & admitted from 11/14-11/17/2006. IS successfully reduced but recurred next day. Repeat air contrast enema again reduced IS. Progressed well after 2nd enema, tolerated oral feeds & was d/c to home. FINAL DX: Intussusception. 6/1/07 Vax records received from CDC. VAERS database updated.


Changed on 8/31/2010

VAERS ID: 279032 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Kentucky
Vaccinated:2006-11-07
Onset:2006-11-13
Submitted:2007-05-16
Entered:2007-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B065AA / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1180R / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B08649B / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium double contrast, Haematochezia, Intussusception, Small intestinal obstruction, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Barium Enema LABS: air contrast barium enema x 2 reduced IS x 2.
CDC 'Split Type':

Write-up: Patient started with vomiting developed bloody stools. Transferred from one medical center hospital to another one for intussusception - reduced by air contrast barium enema on 11-14-06 and again 11-15-06.6/1/07 Received hospital medical records which reveal patient experienced vomiting, bloody stools & decreased appetite w/low grade fever. Seen at outlying ER which abdominal x-ray reveled possible SBO & IS. Transferred to higher level of care & admitted from 11/14-11/17/2006. IS successfully reduced but recurred next day. Repeat air contrast enema again reduced IS. Progressed well after 2nd enema, tolerated oral feeds & was d/c to home. FINAL DX: Intussusception. 6/1/07 Vax records received from CDC. VAERS database updated.


Changed on 1/4/2011

VAERS ID: 279032 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Kentucky
Vaccinated:2006-11-07
Onset:2006-11-13
Submitted:2007-05-16
Entered:2007-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B065AA / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1180R / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08649B / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium double contrast, Haematochezia, Intussusception, Small intestinal obstruction, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Barium Enema LABS: air contrast barium enema x 2 reduced IS x 2.
CDC 'Split Type':

Write-up: Patient started with vomiting developed bloody stools. Transferred from one medical center hospital to another one for intussusception - reduced by air contrast barium enema on 11-14-06 and again 11-15-06.6/1/07 Received hospital medical records which reveal patient experienced vomiting, bloody stools & decreased appetite w/low grade fever. Seen at outlying ER which abdominal x-ray reveled possible SBO & IS. Transferred to higher level of care & admitted from 11/14-11/17/2006. IS successfully reduced but recurred next day. Repeat air contrast enema again reduced IS. Progressed well after 2nd enema, tolerated oral feeds & was d/c to home. FINAL DX: Intussusception. 6/1/07 Vax records received from CDC. VAERS database updated.


Changed on 4/13/2011

VAERS ID: 279032 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Kentucky
Vaccinated:2006-11-07
Onset:2006-11-13
Submitted:2007-05-16
Entered:2007-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B065AA / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1180R / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08649B / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium double contrast, Haematochezia, Intussusception, Pyrexia, Small intestinal obstruction, Vomiting, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Barium Enema LABS: air contrast barium enema x 2 reduced IS x 2.
CDC 'Split Type':

Write-up: Patient started with vomiting developed bloody stools. Transferred from one medical center hospital to another one for intussusception - reduced by air contrast barium enema on 11-14-06 and again 11-15-06.6/1/07 Received hospital medical records which reveal patient experienced vomiting, bloody stools & decreased appetite w/low grade fever. Seen at outlying ER which abdominal x-ray reveled possible SBO & IS. Transferred to higher level of care & admitted from 11/14-11/17/2006. IS successfully reduced but recurred next day. Repeat air contrast enema again reduced IS. Progressed well after 2nd enema, tolerated oral feeds & was d/c to home. FINAL DX: Intussusception. 6/1/07 Vax records received from CDC. VAERS database updated.


Changed on 5/13/2011

VAERS ID: 279032 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Kentucky
Vaccinated:2006-11-07
Onset:2006-11-13
Submitted:2007-05-16
Entered:2007-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B065AA / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1180R / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08649B / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium double contrast, Haematochezia, Intussusception, Pyrexia, Small intestinal obstruction, Vomiting, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Barium Enema LABS: air contrast barium enema x 2 reduced IS x 2.
CDC 'Split Type':

Write-up: Patient started with vomiting developed bloody stools. Transferred from one medical center hospital to another one for intussusception - reduced by air contrast barium enema on 11-14-06 and again 11-15-06.6/1/07 Received hospital medical records which reveal patient experienced vomiting, bloody stools & decreased appetite w/low grade fever. Seen at outlying ER which abdominal x-ray reveled possible SBO & IS. Transferred to higher level of care & admitted from 11/14-11/17/2006. IS successfully reduced but recurred next day. Repeat air contrast enema again reduced IS. Progressed well after 2nd enema, tolerated oral feeds & was d/c to home. FINAL DX: Intussusception. 6/1/07 Vax records received from CDC. VAERS database updated.


Changed on 6/11/2011

VAERS ID: 279032 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Kentucky
Vaccinated:2006-11-07
Onset:2006-11-13
Submitted:2007-05-16
Entered:2007-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B065AA / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1180R / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08649B / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium double contrast, Haematochezia, Intussusception, Pyrexia, Small intestinal obstruction, Vomiting, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Barium Enema LABS: air contrast barium enema x 2 reduced IS x 2.
CDC 'Split Type':

Write-up: Patient started with vomiting developed bloody stools. Transferred from one medical center hospital to another one for intussusception - reduced by air contrast barium enema on 11-14-06 and again 11-15-06.6/1/07 Received hospital medical records which reveal patient experienced vomiting, bloody stools & decreased appetite w/low grade fever. Seen at outlying ER which abdominal x-ray reveled possible SBO & IS. Transferred to higher level of care & admitted from 11/14-11/17/2006. IS successfully reduced but recurred next day. Repeat air contrast enema again reduced IS. Progressed well after 2nd enema, tolerated oral feeds & was d/c to home. FINAL DX: Intussusception. 6/1/07 Vax records received from CDC. VAERS database updated.


Changed on 5/13/2013

VAERS ID: 279032 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Kentucky
Vaccinated:2006-11-07
Onset:2006-11-13
Submitted:2007-05-16
Entered:2007-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B065AA / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1180R / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08649B / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium double contrast, Haematochezia, Intussusception, Pyrexia, Small intestinal obstruction, Vomiting, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Barium Enema LABS: air contrast barium enema x 2 reduced IS x 2.
CDC 'Split Type':

Write-up: Patient started with vomiting developed bloody stools. Transferred from one medical center hospital to another one for intussusception - reduced by air contrast barium enema on 11-14-06 and again 11-15-06.6/1/07 Received hospital medical records which reveal patient experienced vomiting, bloody stools & decreased appetite w/low grade fever. Seen at outlying ER which abdominal x-ray reveled possible SBO & IS. Transferred to higher level of care & admitted from 11/14-11/17/2006. IS successfully reduced but recurred next day. Repeat air contrast enema again reduced IS. Progressed well after 2nd enema, tolerated oral feeds & was d/c to home. FINAL DX: Intussusception. 6/1/07 Vax records received from CDC. VAERS database updated.


Changed on 6/14/2014

VAERS ID: 279032 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Kentucky
Vaccinated:2006-11-07
Onset:2006-11-13
Submitted:2007-05-16
Entered:2007-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B065AA / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1180R / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08649B / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium double contrast, Haematochezia, Intussusception, Pyrexia, Small intestinal obstruction, Vomiting, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Barium Enema LABS: air contrast barium enema x 2 reduced IS x 2.
CDC 'Split Type':

Write-up: Patient started with vomiting developed bloody stools. Transferred from one medical center hospital to another one for intussusception - reduced by air contrast barium enema on 11-14-06 and again 11-15-06.6/1/07 Received hospital medical records which reveal patient experienced vomiting, bloody stools & decreased appetite w/low grade fever. Seen at outlying ER which abdominal x-ray reveled possible SBO & IS. Transferred to higher level of care & admitted from 11/14-11/17/2006. IS successfully reduced but recurred next day. Repeat air contrast enema again reduced IS. Progressed well after 2nd enema, tolerated oral feeds & was d/c to home. FINAL DX: Intussusception. 6/1/07 Vax records received from CDC. VAERS database updated.


Changed on 2/14/2017

VAERS ID: 279032 Before After
VAERS Form:
Age:0.3 0.33
Gender:Female
Location:Kentucky
Vaccinated:2006-11-07
Onset:2006-11-13
Submitted:2007-05-16
Entered:2007-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B065AA / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1180R / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08649B / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium double contrast, Haematochezia, Intussusception, Pyrexia, Small intestinal obstruction, Vomiting, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Barium Enema LABS: air contrast barium enema x 2 reduced IS x 2.
CDC 'Split Type':

Write-up: Patient started with vomiting developed bloody stools. Transferred from one medical center hospital to another one for intussusception - reduced by air contrast barium enema on 11-14-06 and again 11-15-06.6/1/07 Received hospital medical records which reveal patient experienced vomiting, bloody stools & decreased appetite w/low grade fever. Seen at outlying ER which abdominal x-ray reveled possible SBO & IS. Transferred to higher level of care & admitted from 11/14-11/17/2006. IS successfully reduced but recurred next day. Repeat air contrast enema again reduced IS. Progressed well after 2nd enema, tolerated oral feeds & was d/c to home. FINAL DX: Intussusception. 6/1/07 Vax records received from CDC. VAERS database updated.


Changed on 9/14/2017

VAERS ID: 279032 Before After
VAERS Form:(blank) 1
Age:0.33
Gender:Female
Location:Kentucky
Vaccinated:2006-11-07
Onset:2006-11-13
Submitted:2007-05-16
Entered:2007-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B065AA / 1 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1180R / 1 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08649B / 1 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 1 2 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium double contrast, Haematochezia, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Barium Enema LABS: air contrast barium enema x 2 reduced IS x 2.
CDC 'Split Type':

Write-up: Patient started with vomiting developed bloody stools. Transferred from one medical center hospital to another one for intussusception - reduced by air contrast barium enema on 11-14-06 and again 11-15-06.6/1/07 Received hospital medical records which reveal patient experienced vomiting, bloody stools & decreased appetite w/low grade fever. Seen at outlying ER which abdominal x-ray reveled possible SBO & IS. Transferred to higher level of care & admitted from 11/14-11/17/2006. IS successfully reduced but recurred next day. Repeat air contrast enema again reduced IS. Progressed well after 2nd enema, tolerated oral feeds & was d/c to home. FINAL DX: Intussusception. 6/1/07 Vax records received from CDC. VAERS database updated.


Changed on 2/14/2018

VAERS ID: 279032 Before After
VAERS Form:1
Age:0.33
Gender:Female
Location:Kentucky
Vaccinated:2006-11-07
Onset:2006-11-13
Submitted:2007-05-16
Entered:2007-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B065AA / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1180R / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08649B / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium double contrast, Haematochezia, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Barium Enema LABS: air contrast barium enema x 2 reduced IS x 2.
CDC 'Split Type':

Write-up: Patient started with vomiting developed bloody stools. Transferred from one medical center hospital to another one for intussusception - reduced by air contrast barium enema on 11-14-06 and again 11-15-06.6/1/07 Received hospital medical records which reveal patient experienced vomiting, bloody stools & decreased appetite w/low grade fever. Seen at outlying ER which abdominal x-ray reveled possible SBO & IS. Transferred to higher level of care & admitted from 11/14-11/17/2006. IS successfully reduced but recurred next day. Repeat air contrast enema again reduced IS. Progressed well after 2nd enema, tolerated oral feeds & was d/c to home. FINAL DX: Intussusception. 6/1/07 Vax records received from CDC. VAERS database updated.


Changed on 6/14/2018

VAERS ID: 279032 Before After
VAERS Form:1
Age:0.33
Gender:Female
Location:Kentucky
Vaccinated:2006-11-07
Onset:2006-11-13
Submitted:2007-05-16
Entered:2007-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B065AA / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1180R / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08649B / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium double contrast, Haematochezia, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Barium Enema LABS: air contrast barium enema x 2 reduced IS x 2.
CDC 'Split Type':

Write-up: Patient started with vomiting developed bloody stools. Transferred from one medical center hospital to another one for intussusception - reduced by air contrast barium enema on 11-14-06 and again 11-15-06.6/1/07 Received hospital medical records which reveal patient experienced vomiting, bloody stools & decreased appetite w/low grade fever. Seen at outlying ER which abdominal x-ray reveled possible SBO & IS. Transferred to higher level of care & admitted from 11/14-11/17/2006. IS successfully reduced but recurred next day. Repeat air contrast enema again reduced IS. Progressed well after 2nd enema, tolerated oral feeds & was d/c to home. FINAL DX: Intussusception. 6/1/07 Vax records received from CDC. VAERS database updated.

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