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This is VAERS ID 284028

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 284028
VAERS Form:
Age:0.5
Gender:Female
Location:Georgia
Vaccinated:2007-04-13
Onset:2007-06-23
Submitted:2007-07-06
Entered:2007-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2570BA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF093AA / 2 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0548 / 2 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08670B / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0024U / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Bowel sounds abnormal, Diarrhoea, Intussusception, Enema administration, 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? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: GERD- Prematurity 36 weeks. PMH: premie-36 weeks, GERD. NKDA.
Allergies:
Diagnostic Lab Data: Xray-Air Enemia. Labs and Diagnostics: Abd X-ray: with gaseous distention of bowel loops suggesting adynamic ileus. Abd ultrasound suspicious for Intussusception in the RLQ with thickened walls in tortuous configuration. Air enema used t
CDC 'Split Type':

Write-up: Patient dx with Intussusception. 07/18/2007 MR received for 2 ER visits 6/24 and 6/26 2007 for c/o persistant vomiting. Initially had diarrhea but none since vomiting started. No blood in stools. PE significant for hypoactive bowel sounds and lip pallo"r. Otherwise WNL. Air enema sucessful in reducing the IS. Discharge DX: Intussusception.


Changed on 12/8/2009

VAERS ID: 284028 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Georgia
Vaccinated:2007-04-13
Onset:2007-06-23
Submitted:2007-07-06
Entered:2007-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2570BA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF093AA / 2 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0548 / 2 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08670B / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0024U / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Bowel sounds abnormal, Diarrhoea, Intussusception, Pallor, Vomiting, Enema administration, Ultrasound abdomen abnormal, 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? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: GERD- Prematurity 36 weeks. PMH: premie-36 weeks, GERD. NKDA.
Allergies:
Diagnostic Lab Data: Xray-Air Enemia. Labs and Diagnostics: Abd X-ray: with gaseous distention of bowel loops suggesting adynamic ileus. Abd ultrasound suspicious for Intussusception in the RLQ with thickened walls in tortuous configuration. Air enema used t
CDC 'Split Type':

Write-up: Patient dx with Intussusception. 07/18/2007 MR received for 2 ER visits 6/24 and 6/26 2007 for c/o persistant vomiting. Initially had diarrhea but none since vomiting started. No blood in stools. PE significant for hypoactive bowel sounds and lip pallo"r. pallor. Otherwise WNL. Air enema sucessful in reducing the IS. Discharge DX: Intussusception.


Changed on 3/2/2010

VAERS ID: 284028 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Georgia
Vaccinated:2007-04-13
Onset:2007-06-23
Submitted:2007-07-06
Entered:2007-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2570BA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF093AA / 2 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0548 / 2 RL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B08670B / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0024U / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Bowel sounds abnormal, Diarrhoea, Intussusception, Pallor, Vomiting, Enema administration, Ultrasound abdomen abnormal, 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? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: GERD- Prematurity 36 weeks. PMH: premie-36 weeks, GERD. NKDA.
Allergies:
Diagnostic Lab Data: Xray-Air Enemia. Labs and Diagnostics: Abd X-ray: with gaseous distention of bowel loops suggesting adynamic ileus. Abd ultrasound suspicious for Intussusception in the RLQ with thickened walls in tortuous configuration. Air enema used t
CDC 'Split Type':

Write-up: Patient dx with Intussusception. 07/18/2007 MR received for 2 ER visits 6/24 and 6/26 2007 for c/o persistant vomiting. Initially had diarrhea but none since vomiting started. No blood in stools. PE significant for hypoactive bowel sounds and lip pallor. Otherwise WNL. Air enema sucessful in reducing the IS. Discharge DX: Intussusception.


Changed on 4/7/2010

VAERS ID: 284028 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Georgia
Vaccinated:2007-04-13
Onset:2007-06-23
Submitted:2007-07-06
Entered:2007-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2570BA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF093AA / 2 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0548 / 2 RL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08670B / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0024U / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Bowel sounds abnormal, Diarrhoea, Intussusception, Pallor, Vomiting, Enema administration, Ultrasound abdomen abnormal, 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? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: GERD- Prematurity 36 weeks. PMH: premie-36 weeks, GERD. NKDA.
Allergies:
Diagnostic Lab Data: Xray-Air Enemia. Labs and Diagnostics: Abd X-ray: with gaseous distention of bowel loops suggesting adynamic ileus. Abd ultrasound suspicious for Intussusception in the RLQ with thickened walls in tortuous configuration. Air enema used t
CDC 'Split Type':

Write-up: Patient dx with Intussusception. 07/18/2007 MR received for 2 ER visits 6/24 and 6/26 2007 for c/o persistant vomiting. Initially had diarrhea but none since vomiting started. No blood in stools. PE significant for hypoactive bowel sounds and lip pallor. Otherwise WNL. Air enema sucessful in reducing the IS. Discharge DX: Intussusception.


Changed on 8/31/2010

VAERS ID: 284028 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Georgia
Vaccinated:2007-04-13
Onset:2007-06-23
Submitted:2007-07-06
Entered:2007-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2570BA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF093AA / 2 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0548 / 2 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B08670B / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0024U / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Bowel sounds abnormal, Diarrhoea, Intussusception, Pallor, Vomiting, Enema administration, Ultrasound abdomen abnormal, 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? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: GERD- Prematurity 36 weeks. PMH: premie-36 weeks, GERD. NKDA.
Allergies:
Diagnostic Lab Data: Xray-Air Enemia. Labs and Diagnostics: Abd X-ray: with gaseous distention of bowel loops suggesting adynamic ileus. Abd ultrasound suspicious for Intussusception in the RLQ with thickened walls in tortuous configuration. Air enema used t
CDC 'Split Type':

Write-up: Patient dx with Intussusception. 07/18/2007 MR received for 2 ER visits 6/24 and 6/26 2007 for c/o persistant vomiting. Initially had diarrhea but none since vomiting started. No blood in stools. PE significant for hypoactive bowel sounds and lip pallor. Otherwise WNL. Air enema sucessful in reducing the IS. Discharge DX: Intussusception.


Changed on 5/13/2013

VAERS ID: 284028 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Georgia
Vaccinated:2007-04-13
Onset:2007-06-23
Submitted:2007-07-06
Entered:2007-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2570BA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF093AA / 2 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0548 / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08670B / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0024U / 2 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0024U / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Bowel sounds abnormal, Diarrhoea, Intussusception, Pallor, Vomiting, Enema administration, Ultrasound abdomen abnormal, 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? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: GERD- Prematurity 36 weeks. PMH: premie-36 weeks, GERD. NKDA.
Allergies:
Diagnostic Lab Data: Xray-Air Enemia. Labs and Diagnostics: Abd X-ray: with gaseous distention of bowel loops suggesting adynamic ileus. Abd ultrasound suspicious for Intussusception in the RLQ with thickened walls in tortuous configuration. Air enema used t
CDC 'Split Type':

Write-up: Patient dx with Intussusception. 07/18/2007 MR received for 2 ER visits 6/24 and 6/26 2007 for c/o persistant vomiting. Initially had diarrhea but none since vomiting started. No blood in stools. PE significant for hypoactive bowel sounds and lip pallor. Otherwise WNL. Air enema sucessful in reducing the IS. Discharge DX: Intussusception.


Changed on 5/14/2017

VAERS ID: 284028 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Georgia
Vaccinated:2007-04-13
Onset:2007-06-23
Submitted:2007-07-06
Entered:2007-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2570BA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF093AA / 2 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0548 / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08670B / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0024U / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Bowel sounds abnormal, Diarrhoea, Intussusception, Pallor, Vomiting, Enema administration, Ultrasound abdomen abnormal, 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? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: GERD- Prematurity 36 weeks. PMH: premie-36 weeks, GERD. NKDA.
Allergies:
Diagnostic Lab Data: Xray-Air Enemia. Labs and Diagnostics: Abd X-ray: with gaseous distention of bowel loops suggesting adynamic ileus. Abd ultrasound suspicious for Intussusception in the RLQ with thickened walls in tortuous configuration. Air enema used t to reduce.
CDC 'Split Type':

Write-up: Patient dx with Intussusception. 07/18/2007 MR received for 2 ER visits 6/24 and 6/26 2007 for c/o persistant vomiting. Initially had diarrhea but none since vomiting started. No blood in stools. PE significant for hypoactive bowel sounds and lip pallor. Otherwise WNL. Air enema sucessful in reducing the IS. Discharge DX: Intussusception.


Changed on 9/14/2017

VAERS ID: 284028 Before After
VAERS Form:(blank) 1
Age:0.5
Gender:Female
Location:Georgia
Vaccinated:2007-04-13
Onset:2007-06-23
Submitted:2007-07-06
Entered:2007-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2570BA / 2 3 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF093AA / 2 3 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0548 / 2 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08670B / 2 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0024U / 2 3 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception

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? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: GERD- Prematurity 36 weeks. PMH: premie-36 weeks, GERD. NKDA.
Allergies:
Diagnostic Lab Data: Xray-Air Enemia. Labs and Diagnostics: Abd X-ray: with gaseous distention of bowel loops suggesting adynamic ileus. Abd ultrasound suspicious for Intussusception in the RLQ with thickened walls in tortuous configuration. Air enema used to reduce.
CDC 'Split Type':

Write-up: Patient dx with Intussusception. 07/18/2007 MR received for 2 ER visits 6/24 and 6/26 2007 for c/o persistant vomiting. Initially had diarrhea but none since vomiting started. No blood in stools. PE significant for hypoactive bowel sounds and lip pallor. Otherwise WNL. Air enema sucessful in reducing the IS. Discharge DX: Intussusception.


Changed on 2/14/2018

VAERS ID: 284028 Before After
VAERS Form:1
Age:0.5
Gender:Female
Location:Georgia
Vaccinated:2007-04-13
Onset:2007-06-23
Submitted:2007-07-06
Entered:2007-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2570BA / 3 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF093AA / 3 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0548 / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08670B / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0024U / 3 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception

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? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: GERD- Prematurity 36 weeks. PMH: premie-36 weeks, GERD. NKDA.
Allergies:
Diagnostic Lab Data: Xray-Air Enemia. Labs and Diagnostics: Abd X-ray: with gaseous distention of bowel loops suggesting adynamic ileus. Abd ultrasound suspicious for Intussusception in the RLQ with thickened walls in tortuous configuration. Air enema used to reduce.
CDC 'Split Type':

Write-up: Patient dx with Intussusception. 07/18/2007 MR received for 2 ER visits 6/24 and 6/26 2007 for c/o persistant vomiting. Initially had diarrhea but none since vomiting started. No blood in stools. PE significant for hypoactive bowel sounds and lip pallor. Otherwise WNL. Air enema sucessful in reducing the IS. Discharge DX: Intussusception.


Changed on 6/14/2018

VAERS ID: 284028 Before After
VAERS Form:1
Age:0.5
Gender:Female
Location:Georgia
Vaccinated:2007-04-13
Onset:2007-06-23
Submitted:2007-07-06
Entered:2007-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2570BA / 3 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF093AA / 3 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0548 / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08670B / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0024U / 3 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception

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? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: GERD- Prematurity 36 weeks. PMH: premie-36 weeks, GERD. NKDA.
Allergies:
Diagnostic Lab Data: Xray-Air Enemia. Labs and Diagnostics: Abd X-ray: with gaseous distention of bowel loops suggesting adynamic ileus. Abd ultrasound suspicious for Intussusception in the RLQ with thickened walls in tortuous configuration. Air enema used to reduce.
CDC 'Split Type':

Write-up: Patient dx with Intussusception. 07/18/2007 MR received for 2 ER visits 6/24 and 6/26 2007 for c/o persistant vomiting. Initially had diarrhea but none since vomiting started. No blood in stools. PE significant for hypoactive bowel sounds and lip pallor. Otherwise WNL. Air enema sucessful in reducing the IS. Discharge DX: Intussusception.


Changed on 8/14/2018

VAERS ID: 284028 Before After
VAERS Form:1
Age:0.5
Gender:Female
Location:Georgia
Vaccinated:2007-04-13
Onset:2007-06-23
Submitted:2007-07-06
Entered:2007-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2570BA / 3 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF093AA / 3 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0548 / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08670B / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0024U / 3 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception

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? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: GERD- Prematurity 36 weeks. PMH: premie-36 weeks, GERD. NKDA.
Allergies:
Diagnostic Lab Data: Xray-Air Enemia. Labs and Diagnostics: Abd X-ray: with gaseous distention of bowel loops suggesting adynamic ileus. Abd ultrasound suspicious for Intussusception in the RLQ with thickened walls in tortuous configuration. Air enema used to reduce.
CDC 'Split Type':

Write-up: Patient dx with Intussusception. 07/18/2007 MR received for 2 ER visits 6/24 and 6/26 2007 for c/o persistant vomiting. Initially had diarrhea but none since vomiting started. No blood in stools. PE significant for hypoactive bowel sounds and lip pallor. Otherwise WNL. Air enema sucessful in reducing the IS. Discharge DX: Intussusception.

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