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This is VAERS ID 279315

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 279315
VAERS Form:
Age:0.6
Gender:Female
Location:Connecticut
Vaccinated:2007-03-28
Onset:2007-05-10
Submitted:2007-05-18
Entered:2007-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 2 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08670H / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1165F / 1 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: Appendicectomy, Barium double contrast, Constipation, Dehydration, Blood electrolytes normal

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Abdominal ultrasound, air enema
CDC 'Split Type':

Write-up: Intussusception requiring surgical reduction


Changed on 12/8/2009

VAERS ID: 279315 Before After
VAERS Form:
Age:0.6
Gender:Female
Location:Connecticut
Vaccinated:2007-03-28
Onset:2007-05-10
Submitted:2007-05-18
Entered:2007-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 2 LL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 2 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08670H / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1165F / 1 - / PO

Administered by: Public      Purchased by: Unknown Public
Symptoms: Appendicectomy, Barium double contrast, Constipation, Dehydration, Haematocrit normal, Inappropriate schedule of drug administration, Intussusception, Surgery, Upper respiratory tract infection, Vomiting, White blood cell count, Ultrasound abdomen abnormal, Blood electrolytes normal, Occult blood positive

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none PMH: GERD
Allergies:
Diagnostic Lab Data: Abdominal ultrasound, air enema LABS: US of abdomen + for IS. WBC 10,000, Hct 29.5. Electrolytes WNL. Air enema reduction was unsuccessful.
CDC 'Split Type':

Write-up: Intussusception requiring surgical reduction 6/25/07 Received hospital outpatient clinic med recs which reveal patient seen at another hospital. Letter faxed to correct hospital to request med recs. Patient seen in ER on 5/11 for persistent vomiting, dehydration & heme + stool. US revealed +IS. Air enema reduction was not successful & taken to OR. D/C to home on 5/12/07. Developed candida diaper rash s/p surgery. 7/3/07 Received hospital medical records which reveal patient experienced vomiting & constipation & recent URI. Admitted 5/10-5/12/07. Surg consult done s/p unsuccessful enema reduction. Taken to OR for +IS which spontaneously reduced, appendectomy done. Did well post operatively & d/c to home FINAL DX: Intussusception.


Changed on 3/2/2010

VAERS ID: 279315 Before After
VAERS Form:
Age:0.6
Gender:Female
Location:Connecticut
Vaccinated:2007-03-28
Onset:2007-05-10
Submitted:2007-05-18
Entered:2007-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 2 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B08670H / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1165F / 1 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Appendicectomy, Barium double contrast, Constipation, Dehydration, Haematocrit normal, Inappropriate schedule of drug administration, Intussusception, Surgery, Upper respiratory tract infection, Vomiting, White blood cell count, Ultrasound abdomen abnormal, Blood electrolytes normal, Occult blood positive

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none PMH: GERD
Allergies:
Diagnostic Lab Data: Abdominal ultrasound, air enema LABS: US of abdomen + for IS. WBC 10,000, Hct 29.5. Electrolytes WNL. Air enema reduction was unsuccessful.
CDC 'Split Type':

Write-up: Intussusception requiring surgical reduction 6/25/07 Received hospital outpatient clinic med recs which reveal patient seen at another hospital. Letter faxed to correct hospital to request med recs. Patient seen in ER on 5/11 for persistent vomiting, dehydration & heme + stool. US revealed +IS. Air enema reduction was not successful & taken to OR. D/C to home on 5/12/07. Developed candida diaper rash s/p surgery. 7/3/07 Received hospital medical records which reveal patient experienced vomiting & constipation & recent URI. Admitted 5/10-5/12/07. Surg consult done s/p unsuccessful enema reduction. Taken to OR for +IS which spontaneously reduced, appendectomy done. Did well post operatively & d/c to home FINAL DX: Intussusception.


Changed on 4/7/2010

VAERS ID: 279315 Before After
VAERS Form:
Age:0.6
Gender:Female
Location:Connecticut
Vaccinated:2007-03-28
Onset:2007-05-10
Submitted:2007-05-18
Entered:2007-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 2 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08670H / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1165F / 1 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Appendicectomy, Barium double contrast, Constipation, Dehydration, Haematocrit normal, Inappropriate schedule of drug administration, Intussusception, Surgery, Upper respiratory tract infection, Vomiting, White blood cell count, Ultrasound abdomen abnormal, Blood electrolytes normal, Occult blood positive

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none PMH: GERD
Allergies:
Diagnostic Lab Data: Abdominal ultrasound, air enema LABS: US of abdomen + for IS. WBC 10,000, Hct 29.5. Electrolytes WNL. Air enema reduction was unsuccessful.
CDC 'Split Type':

Write-up: Intussusception requiring surgical reduction 6/25/07 Received hospital outpatient clinic med recs which reveal patient seen at another hospital. Letter faxed to correct hospital to request med recs. Patient seen in ER on 5/11 for persistent vomiting, dehydration & heme + stool. US revealed +IS. Air enema reduction was not successful & taken to OR. D/C to home on 5/12/07. Developed candida diaper rash s/p surgery. 7/3/07 Received hospital medical records which reveal patient experienced vomiting & constipation & recent URI. Admitted 5/10-5/12/07. Surg consult done s/p unsuccessful enema reduction. Taken to OR for +IS which spontaneously reduced, appendectomy done. Did well post operatively & d/c to home FINAL DX: Intussusception.


Changed on 8/31/2010

VAERS ID: 279315 Before After
VAERS Form:
Age:0.6
Gender:Female
Location:Connecticut
Vaccinated:2007-03-28
Onset:2007-05-10
Submitted:2007-05-18
Entered:2007-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 2 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B08670H / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1165F / 1 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Appendicectomy, Barium double contrast, Constipation, Dehydration, Haematocrit normal, Inappropriate schedule of drug administration, Intussusception, Surgery, Upper respiratory tract infection, Vomiting, White blood cell count, Ultrasound abdomen abnormal, Blood electrolytes normal, Occult blood positive

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none PMH: GERD
Allergies:
Diagnostic Lab Data: Abdominal ultrasound, air enema LABS: US of abdomen + for IS. WBC 10,000, Hct 29.5. Electrolytes WNL. Air enema reduction was unsuccessful.
CDC 'Split Type':

Write-up: Intussusception requiring surgical reduction 6/25/07 Received hospital outpatient clinic med recs which reveal patient seen at another hospital. Letter faxed to correct hospital to request med recs. Patient seen in ER on 5/11 for persistent vomiting, dehydration & heme + stool. US revealed +IS. Air enema reduction was not successful & taken to OR. D/C to home on 5/12/07. Developed candida diaper rash s/p surgery. 7/3/07 Received hospital medical records which reveal patient experienced vomiting & constipation & recent URI. Admitted 5/10-5/12/07. Surg consult done s/p unsuccessful enema reduction. Taken to OR for +IS which spontaneously reduced, appendectomy done. Did well post operatively & d/c to home FINAL DX: Intussusception.


Changed on 5/13/2013

VAERS ID: 279315 Before After
VAERS Form:
Age:0.6
Gender:Female
Location:Connecticut
Vaccinated:2007-03-28
Onset:2007-05-10
Submitted:2007-05-18
Entered:2007-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08670H / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1165F / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1165F / 1 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Appendicectomy, Barium double contrast, Constipation, Dehydration, Haematocrit normal, Inappropriate schedule of drug administration, Intussusception, Surgery, Upper respiratory tract infection, Vomiting, White blood cell count, Ultrasound abdomen abnormal, Blood electrolytes normal, Occult blood positive

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none PMH: GERD
Allergies:
Diagnostic Lab Data: Abdominal ultrasound, air enema LABS: US of abdomen + for IS. WBC 10,000, Hct 29.5. Electrolytes WNL. Air enema reduction was unsuccessful.
CDC 'Split Type':

Write-up: Intussusception requiring surgical reduction 6/25/07 Received hospital outpatient clinic med recs which reveal patient seen at another hospital. Letter faxed to correct hospital to request med recs. Patient seen in ER on 5/11 for persistent vomiting, dehydration & heme + stool. US revealed +IS. Air enema reduction was not successful & taken to OR. D/C to home on 5/12/07. Developed candida diaper rash s/p surgery. 7/3/07 Received hospital medical records which reveal patient experienced vomiting & constipation & recent URI. Admitted 5/10-5/12/07. Surg consult done s/p unsuccessful enema reduction. Taken to OR for +IS which spontaneously reduced, appendectomy done. Did well post operatively & d/c to home FINAL DX: Intussusception.


Changed on 5/14/2017

VAERS ID: 279315 Before After
VAERS Form:
Age:0.6
Gender:Female
Location:Connecticut
Vaccinated:2007-03-28
Onset:2007-05-10
Submitted:2007-05-18
Entered:2007-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08670H / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1165F / 1 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Appendicectomy, Barium double contrast, Constipation, Dehydration, Haematocrit normal, Inappropriate schedule of drug administration, Intussusception, Surgery, Upper respiratory tract infection, Vomiting, White blood cell count, Ultrasound abdomen abnormal, Blood electrolytes normal, Occult blood positive

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none PMH: GERD
Allergies:
Diagnostic Lab Data: Abdominal ultrasound, air enema LABS: US of abdomen + for IS. WBC 10,000, Hct 29.5. Electrolytes WNL. Air enema reduction was unsuccessful.
CDC 'Split Type':

Write-up: Intussusception requiring surgical reduction 6/25/07 Received hospital outpatient clinic med recs which reveal patient seen at another hospital. Letter faxed to correct hospital to request med recs. Patient seen in ER on 5/11 for persistent vomiting, dehydration & heme + stool. US revealed +IS. Air enema reduction was not successful & taken to OR. D/C to home on 5/12/07. Developed candida diaper rash s/p surgery. 7/3/07 Received hospital medical records which reveal patient experienced vomiting & constipation & recent URI. Admitted 5/10-5/12/07. Surg consult done s/p unsuccessful enema reduction. Taken to OR for +IS which spontaneously reduced, appendectomy done. Did well post operatively & d/c to home FINAL DX: Intussusception.


Changed on 9/14/2017

VAERS ID: 279315 Before After
VAERS Form:(blank) 1
Age:0.6
Gender:Female
Location:Connecticut
Vaccinated:2007-03-28
Onset:2007-05-10
Submitted:2007-05-18
Entered:2007-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 2 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08670H / 2 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1165F / 1 2 - MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Barium double contrast, Inappropriate schedule of drug administration, Intussusception, Surgery

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none PMH: GERD
Allergies:
Diagnostic Lab Data: Abdominal ultrasound, air enema LABS: US of abdomen + for IS. WBC 10,000, Hct 29.5. Electrolytes WNL. Air enema reduction was unsuccessful.
CDC 'Split Type':

Write-up: Intussusception requiring surgical reduction 6/25/07 Received hospital outpatient clinic med recs which reveal patient seen at another hospital. Letter faxed to correct hospital to request med recs. Patient seen in ER on 5/11 for persistent vomiting, dehydration & heme + stool. US revealed +IS. Air enema reduction was not successful & taken to OR. D/C to home on 5/12/07. Developed candida diaper rash s/p surgery. 7/3/07 Received hospital medical records which reveal patient experienced vomiting & constipation & recent URI. Admitted 5/10-5/12/07. Surg consult done s/p unsuccessful enema reduction. Taken to OR for +IS which spontaneously reduced, appendectomy done. Did well post operatively & d/c to home FINAL DX: Intussusception.


Changed on 2/14/2018

VAERS ID: 279315 Before After
VAERS Form:1
Age:0.6
Gender:Female
Location:Connecticut
Vaccinated:2007-03-28
Onset:2007-05-10
Submitted:2007-05-18
Entered:2007-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08670H / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1165F / 2 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Barium double contrast, Inappropriate schedule of drug administration, Intussusception, Surgery

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none PMH: GERD
Allergies:
Diagnostic Lab Data: Abdominal ultrasound, air enema LABS: US of abdomen + for IS. WBC 10,000, Hct 29.5. Electrolytes WNL. Air enema reduction was unsuccessful.
CDC 'Split Type':

Write-up: Intussusception requiring surgical reduction 6/25/07 Received hospital outpatient clinic med recs which reveal patient seen at another hospital. Letter faxed to correct hospital to request med recs. Patient seen in ER on 5/11 for persistent vomiting, dehydration & heme + stool. US revealed +IS. Air enema reduction was not successful & taken to OR. D/C to home on 5/12/07. Developed candida diaper rash s/p surgery. 7/3/07 Received hospital medical records which reveal patient experienced vomiting & constipation & recent URI. Admitted 5/10-5/12/07. Surg consult done s/p unsuccessful enema reduction. Taken to OR for +IS which spontaneously reduced, appendectomy done. Did well post operatively & d/c to home FINAL DX: Intussusception.


Changed on 6/14/2018

VAERS ID: 279315 Before After
VAERS Form:1
Age:0.6
Gender:Female
Location:Connecticut
Vaccinated:2007-03-28
Onset:2007-05-10
Submitted:2007-05-18
Entered:2007-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08670H / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1165F / 2 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Barium double contrast, Inappropriate schedule of drug administration, Intussusception, Surgery

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none PMH: GERD
Allergies:
Diagnostic Lab Data: Abdominal ultrasound, air enema LABS: US of abdomen + for IS. WBC 10,000, Hct 29.5. Electrolytes WNL. Air enema reduction was unsuccessful.
CDC 'Split Type':

Write-up: Intussusception requiring surgical reduction 6/25/07 Received hospital outpatient clinic med recs which reveal patient seen at another hospital. Letter faxed to correct hospital to request med recs. Patient seen in ER on 5/11 for persistent vomiting, dehydration & heme + stool. US revealed +IS. Air enema reduction was not successful & taken to OR. D/C to home on 5/12/07. Developed candida diaper rash s/p surgery. 7/3/07 Received hospital medical records which reveal patient experienced vomiting & constipation & recent URI. Admitted 5/10-5/12/07. Surg consult done s/p unsuccessful enema reduction. Taken to OR for +IS which spontaneously reduced, appendectomy done. Did well post operatively & d/c to home FINAL DX: Intussusception.

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