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This is VAERS ID 282853

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 282853
VAERS Form:
Age:0.5
Gender:Female
Location:Wisconsin
Vaccinated:2007-04-10
Onset:2007-06-12
Submitted:2007-06-14
Entered:2007-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2554AA / 2 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z03262 / 2 UN / SC
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC E36258 / 2 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 2 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Barium double contrast, Blood culture negative, Blood glucose increased, Enema administration, Blood alkaline phosphatase increased

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: Tylenol
Current Illness: cold
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Gastrograffin Enema
CDC 'Split Type':

Write-up: 6/12/07: Vomiting and Fever 6/13/07: Hematemesis, Melena, Fever, Lethargy. (10 AM) 6/13/07: (6 PM) Ileocolic Intussusception diagnosed with gastrograffin enema; reduced by hydrostatics and laproscopy.


Changed on 12/8/2009

VAERS ID: 282853 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Wisconsin
Vaccinated:2007-04-10
Onset:2007-06-12
Submitted:2007-06-14
Entered:2007-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2554AA / 2 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z03262 / 2 UN / SC
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC E36258 / 2 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 2 - / PO

Administered by: Private      Purchased by: Unknown Private
Symptoms: Barium double contrast, Blood culture negative, Blood glucose increased, Haematemesis, Intussusception, Laparoscopy, Lethargy, Melaena, Pallor, Pyrexia, Vomiting, Enema administration, Infrequent bowel movements, Blood alkaline phosphatase increased

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: Tylenol
Current Illness: cold
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Gastrograffin Enema records received 7/5/07-Labs; monocyctes 1.2, neu band % 37, glucose 144, BUN 35, Alk 242 Albumin 5.5. Blood culture negative
CDC 'Split Type':

Write-up: 6/12/07: Vomiting and Fever 6/13/07: Hematemesis, Melena, Fever, Lethargy. (10 AM) 6/13/07: (6 PM) Ileocolic Intussusception diagnosed with gastrograffin enema; reduced by hydrostatics and laproscopy. 7/5/07-ER records from receiving hospital for DOS 6/14/07-HX of vomiting began yesterday. Number of episodes of vomiting became coffee ground in appearance this morning. Lethargic. No diarrhea. No stool at all since yesterday morning. PE: Pale, abdomen soft with diminished bowel sounds and does not appear grossly distended. 7/13/07-records from receiving hospital.DX: Ileo-ileo intussusception. Laparoscopic reduction of ileo-ileo-colic intusssusception. DOS 6/13-6/15/07. Barium enema parially reduction.


Changed on 3/2/2010

VAERS ID: 282853 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Wisconsin
Vaccinated:2007-04-10
Onset:2007-06-12
Submitted:2007-06-14
Entered:2007-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2554AA / 2 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z03262 / 2 UN / SC
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC E36258 / 2 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 2 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Blood culture negative, Blood glucose increased, Haematemesis, Intussusception, Laparoscopy, Lethargy, Melaena, Pallor, Pyrexia, Vomiting, Enema administration, Infrequent bowel movements, Blood alkaline phosphatase increased

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: Tylenol
Current Illness: cold
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Gastrograffin Enema records received 7/5/07-Labs; monocyctes 1.2, neu band % 37, glucose 144, BUN 35, Alk 242 Albumin 5.5. Blood culture negative
CDC 'Split Type':

Write-up: 6/12/07: Vomiting and Fever 6/13/07: Hematemesis, Melena, Fever, Lethargy. (10 AM) 6/13/07: (6 PM) Ileocolic Intussusception diagnosed with gastrograffin enema; reduced by hydrostatics and laproscopy. 7/5/07-ER records from receiving hospital for DOS 6/14/07-HX of vomiting began yesterday. Number of episodes of vomiting became coffee ground in appearance this morning. Lethargic. No diarrhea. No stool at all since yesterday morning. PE: Pale, abdomen soft with diminished bowel sounds and does not appear grossly distended. 7/13/07-records from receiving hospital.DX: Ileo-ileo intussusception. Laparoscopic reduction of ileo-ileo-colic intusssusception. DOS 6/13-6/15/07. Barium enema parially reduction.


Changed on 4/7/2010

VAERS ID: 282853 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Wisconsin
Vaccinated:2007-04-10
Onset:2007-06-12
Submitted:2007-06-14
Entered:2007-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2554AA / 2 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z03262 / 2 UN / SC
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC E36258 / 2 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 2 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Blood culture negative, Blood glucose increased, Haematemesis, Intussusception, Laparoscopy, Lethargy, Melaena, Pallor, Pyrexia, Vomiting, Enema administration, Infrequent bowel movements, Blood alkaline phosphatase increased

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: Tylenol
Current Illness: cold
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Gastrograffin Enema records received 7/5/07-Labs; monocyctes 1.2, neu band % 37, glucose 144, BUN 35, Alk 242 Albumin 5.5. Blood culture negative
CDC 'Split Type':

Write-up: 6/12/07: Vomiting and Fever 6/13/07: Hematemesis, Melena, Fever, Lethargy. (10 AM) 6/13/07: (6 PM) Ileocolic Intussusception diagnosed with gastrograffin enema; reduced by hydrostatics and laproscopy. 7/5/07-ER records from receiving hospital for DOS 6/14/07-HX of vomiting began yesterday. Number of episodes of vomiting became coffee ground in appearance this morning. Lethargic. No diarrhea. No stool at all since yesterday morning. PE: Pale, abdomen soft with diminished bowel sounds and does not appear grossly distended. 7/13/07-records from receiving hospital.DX: Ileo-ileo intussusception. Laparoscopic reduction of ileo-ileo-colic intusssusception. DOS 6/13-6/15/07. Barium enema parially reduction.


Changed on 8/31/2010

VAERS ID: 282853 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Wisconsin
Vaccinated:2007-04-10
Onset:2007-06-12
Submitted:2007-06-14
Entered:2007-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2554AA / 2 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z03262 / 2 UN / SC
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH E36258 / 2 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 2 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Blood culture negative, Blood glucose increased, Haematemesis, Intussusception, Laparoscopy, Lethargy, Melaena, Pallor, Pyrexia, Vomiting, Enema administration, Infrequent bowel movements, Blood alkaline phosphatase increased

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: Tylenol
Current Illness: cold
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Gastrograffin Enema records received 7/5/07-Labs; monocyctes 1.2, neu band % 37, glucose 144, BUN 35, Alk 242 Albumin 5.5. Blood culture negative
CDC 'Split Type':

Write-up: 6/12/07: Vomiting and Fever 6/13/07: Hematemesis, Melena, Fever, Lethargy. (10 AM) 6/13/07: (6 PM) Ileocolic Intussusception diagnosed with gastrograffin enema; reduced by hydrostatics and laproscopy. 7/5/07-ER records from receiving hospital for DOS 6/14/07-HX of vomiting began yesterday. Number of episodes of vomiting became coffee ground in appearance this morning. Lethargic. No diarrhea. No stool at all since yesterday morning. PE: Pale, abdomen soft with diminished bowel sounds and does not appear grossly distended. 7/13/07-records from receiving hospital.DX: Ileo-ileo intussusception. Laparoscopic reduction of ileo-ileo-colic intusssusception. DOS 6/13-6/15/07. Barium enema parially reduction.


Changed on 5/13/2013

VAERS ID: 282853 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Wisconsin
Vaccinated:2007-04-10
Onset:2007-06-12
Submitted:2007-06-14
Entered:2007-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2554AA / 2 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z03262 / 2 UN / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E36258 / 2 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 2 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 2 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Blood culture negative, Blood glucose increased, Haematemesis, Intussusception, Laparoscopy, Lethargy, Melaena, Pallor, Pyrexia, Vomiting, Enema administration, Infrequent bowel movements, Blood alkaline phosphatase increased

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: Tylenol
Current Illness: cold
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Gastrograffin Enema records received 7/5/07-Labs; monocyctes 1.2, neu band % 37, glucose 144, BUN 35, Alk 242 Albumin 5.5. Blood culture negative
CDC 'Split Type':

Write-up: 6/12/07: Vomiting and Fever 6/13/07: Hematemesis, Melena, Fever, Lethargy. (10 AM) 6/13/07: (6 PM) Ileocolic Intussusception diagnosed with gastrograffin enema; reduced by hydrostatics and laproscopy. 7/5/07-ER records from receiving hospital for DOS 6/14/07-HX of vomiting began yesterday. Number of episodes of vomiting became coffee ground in appearance this morning. Lethargic. No diarrhea. No stool at all since yesterday morning. PE: Pale, abdomen soft with diminished bowel sounds and does not appear grossly distended. 7/13/07-records from receiving hospital.DX: Ileo-ileo intussusception. Laparoscopic reduction of ileo-ileo-colic intusssusception. DOS 6/13-6/15/07. Barium enema parially reduction.


Changed on 5/14/2017

VAERS ID: 282853 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Wisconsin
Vaccinated:2007-04-10
Onset:2007-06-12
Submitted:2007-06-14
Entered:2007-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2554AA / 2 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z03262 / 2 UN / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E36258 / 2 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 2 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Blood culture negative, Blood glucose increased, Haematemesis, Intussusception, Laparoscopy, Lethargy, Melaena, Pallor, Pyrexia, Vomiting, Enema administration, Infrequent bowel movements, Blood alkaline phosphatase increased

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: Tylenol
Current Illness: cold
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Gastrograffin Enema records received 7/5/07-Labs; monocyctes 1.2, neu band % 37, glucose 144, BUN 35, Alk 242 Albumin 5.5. Blood culture negative
CDC 'Split Type':

Write-up: 6/12/07: Vomiting and Fever 6/13/07: Hematemesis, Melena, Fever, Lethargy. (10 AM) 6/13/07: (6 PM) Ileocolic Intussusception diagnosed with gastrograffin enema; reduced by hydrostatics and laproscopy. 7/5/07-ER records from receiving hospital for DOS 6/14/07-HX of vomiting began yesterday. Number of episodes of vomiting became coffee ground in appearance this morning. Lethargic. No diarrhea. No stool at all since yesterday morning. PE: Pale, abdomen soft with diminished bowel sounds and does not appear grossly distended. 7/13/07-records from receiving hospital.DX: Ileo-ileo intussusception. Laparoscopic reduction of ileo-ileo-colic intusssusception. DOS 6/13-6/15/07. Barium enema parially reduction.


Changed on 9/14/2017

VAERS ID: 282853 Before After
VAERS Form:(blank) 1
Age:0.5
Gender:Female
Location:Wisconsin
Vaccinated:2007-04-10
Onset:2007-06-12
Submitted:2007-06-14
Entered:2007-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2554AA / 2 3 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z03262 / 2 3 UN / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E36258 / 2 3 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 2 3 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Haematemesis, Intussusception, Laparoscopy, Lethargy, Melaena, Pyrexia, Vomiting, Enema administration

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: Tylenol
Current Illness: cold
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Gastrograffin Enema records received 7/5/07-Labs; monocyctes 1.2, neu band % 37, glucose 144, BUN 35, Alk 242 Albumin 5.5. Blood culture negative
CDC 'Split Type':

Write-up: 6/12/07: Vomiting and Fever 6/13/07: Hematemesis, Melena, Fever, Lethargy. (10 AM) 6/13/07: (6 PM) Ileocolic Intussusception diagnosed with gastrograffin enema; reduced by hydrostatics and laproscopy. 7/5/07-ER records from receiving hospital for DOS 6/14/07-HX of vomiting began yesterday. Number of episodes of vomiting became coffee ground in appearance this morning. Lethargic. No diarrhea. No stool at all since yesterday morning. PE: Pale, abdomen soft with diminished bowel sounds and does not appear grossly distended. 7/13/07-records from receiving hospital.DX: Ileo-ileo intussusception. Laparoscopic reduction of ileo-ileo-colic intusssusception. DOS 6/13-6/15/07. Barium enema parially reduction.


Changed on 2/14/2018

VAERS ID: 282853 Before After
VAERS Form:1
Age:0.5
Gender:Female
Location:Wisconsin
Vaccinated:2007-04-10
Onset:2007-06-12
Submitted:2007-06-14
Entered:2007-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2554AA / 3 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z03262 / 3 UN / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E36258 / 3 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 3 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Haematemesis, Intussusception, Laparoscopy, Lethargy, Melaena, Pyrexia, Vomiting, Enema administration

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: Tylenol
Current Illness: cold
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Gastrograffin Enema records received 7/5/07-Labs; monocyctes 1.2, neu band % 37, glucose 144, BUN 35, Alk 242 Albumin 5.5. Blood culture negative
CDC 'Split Type':

Write-up: 6/12/07: Vomiting and Fever 6/13/07: Hematemesis, Melena, Fever, Lethargy. (10 AM) 6/13/07: (6 PM) Ileocolic Intussusception diagnosed with gastrograffin enema; reduced by hydrostatics and laproscopy. 7/5/07-ER records from receiving hospital for DOS 6/14/07-HX of vomiting began yesterday. Number of episodes of vomiting became coffee ground in appearance this morning. Lethargic. No diarrhea. No stool at all since yesterday morning. PE: Pale, abdomen soft with diminished bowel sounds and does not appear grossly distended. 7/13/07-records from receiving hospital.DX: Ileo-ileo intussusception. Laparoscopic reduction of ileo-ileo-colic intusssusception. DOS 6/13-6/15/07. Barium enema parially reduction.


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