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This is VAERS ID 284252

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 284252
VAERS Form:
Age:0.1
Gender:Female
Location:Texas
Vaccinated:2007-04-05
Onset:2007-06-16
Submitted:2007-07-10
Entered:2007-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR 41813CA / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0507F / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y0991 / 0 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08674C / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Diarrhoea, Haematochezia, Intussusception, Explorative laparotomy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: KUB (done at previous facility) showed dilated bowel loops and air throughout. WBCs 22,000. Platelets 579,000. Chem WNL. UA (-). Abd ultrasound with eveidence of a mass-effect in the RUQ c/w Intussusception. Bariu
CDC 'Split Type':

Write-up: Intussusception. Surgical correction in June 2007.


Changed on 12/8/2009

VAERS ID: 284252 Before After
VAERS Form:
Age:0.1
Gender:Female
Location:Texas
Vaccinated:2007-04-05
Onset:2007-06-16
Submitted:2007-07-10
Entered:2007-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR 41813CA / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0507F / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y0991 / 0 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08674C / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Diarrhoea, Haematochezia, Intussusception, Irritability, Mucous stools, Small intestinal resection, Surgery, Urinary system X-ray, Vomiting, White blood cell count increased, Platelet count increased, Ultrasound abdomen abnormal, Explorative laparotomy, Laboratory test normal, Urine analysis normal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none none. PMH: L cephalohematoma 2'' to vacuum assisted delivery. Hyperbilirubinemia after birth.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: KUB (done at previous facility) showed dilated bowel loops and air throughout. WBCs 22,000. Platelets 579,000. Chem WNL. UA (-). Abd ultrasound with eveidence of a mass-effect in the RUQ c/w Intussusception. Bariu
CDC 'Split Type':

Write-up: Intussusception. Surgical correction in June 2007. Hospital record for transfer facility rec''d for DOS 6/17-20/2007. Infant transfered to facility for surgical reduction of Intussusception which was non-reduceable by contrast enema. Child presented at first facility with 1 day hx of grossly bloody, watery stools with mucus and one episode of emesis. Child has been fussy. PE WNL. Barium contrast enema attempted to reduce IS but was unsuccessful. Infant had an Exploratory Lap, reduction of IS and small bowel resection with primary reanastomosis. DX: Intussusception. F/U visit 7/13/2007 with report of some fussiness since the surgery but otherwise healing well.


Changed on 3/2/2010

VAERS ID: 284252 Before After
VAERS Form:
Age:0.1
Gender:Female
Location:Texas
Vaccinated:2007-04-05
Onset:2007-06-16
Submitted:2007-07-10
Entered:2007-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR 41813CA / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0507F / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y0991 / 0 RL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B08674C / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Diarrhoea, Haematochezia, Intussusception, Irritability, Mucous stools, Small intestinal resection, Surgery, Urinary system X-ray, Vomiting, White blood cell count increased, Platelet count increased, Ultrasound abdomen abnormal, Explorative laparotomy, Laboratory test normal, Urine analysis normal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none. PMH: L cephalohematoma 2'' to vacuum assisted delivery. Hyperbilirubinemia after birth.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: KUB (done at previous facility) showed dilated bowel loops and air throughout. WBCs 22,000. Platelets 579,000. Chem WNL. UA (-). Abd ultrasound with eveidence of a mass-effect in the RUQ c/w Intussusception. Bariu
CDC 'Split Type':

Write-up: Intussusception. Surgical correction in June 2007. Hospital record for transfer facility rec''d for DOS 6/17-20/2007. Infant transfered to facility for surgical reduction of Intussusception which was non-reduceable by contrast enema. Child presented at first facility with 1 day hx of grossly bloody, watery stools with mucus and one episode of emesis. Child has been fussy. PE WNL. Barium contrast enema attempted to reduce IS but was unsuccessful. Infant had an Exploratory Lap, reduction of IS and small bowel resection with primary reanastomosis. DX: Intussusception. F/U visit 7/13/2007 with report of some fussiness since the surgery but otherwise healing well.


Changed on 4/7/2010

VAERS ID: 284252 Before After
VAERS Form:
Age:0.1
Gender:Female
Location:Texas
Vaccinated:2007-04-05
Onset:2007-06-16
Submitted:2007-07-10
Entered:2007-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR 41813CA / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0507F / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y0991 / 0 RL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08674C / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Diarrhoea, Haematochezia, Intussusception, Irritability, Mucous stools, Small intestinal resection, Surgery, Urinary system X-ray, Vomiting, White blood cell count increased, Platelet count increased, Ultrasound abdomen abnormal, Explorative laparotomy, Laboratory test normal, Urine analysis normal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none. PMH: L cephalohematoma 2'' to vacuum assisted delivery. Hyperbilirubinemia after birth.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: KUB (done at previous facility) showed dilated bowel loops and air throughout. WBCs 22,000. Platelets 579,000. Chem WNL. UA (-). Abd ultrasound with eveidence of a mass-effect in the RUQ c/w Intussusception. Bariu
CDC 'Split Type':

Write-up: Intussusception. Surgical correction in June 2007. Hospital record for transfer facility rec''d for DOS 6/17-20/2007. Infant transfered to facility for surgical reduction of Intussusception which was non-reduceable by contrast enema. Child presented at first facility with 1 day hx of grossly bloody, watery stools with mucus and one episode of emesis. Child has been fussy. PE WNL. Barium contrast enema attempted to reduce IS but was unsuccessful. Infant had an Exploratory Lap, reduction of IS and small bowel resection with primary reanastomosis. DX: Intussusception. F/U visit 7/13/2007 with report of some fussiness since the surgery but otherwise healing well.


Changed on 8/31/2010

VAERS ID: 284252 Before After
VAERS Form:
Age:0.1
Gender:Female
Location:Texas
Vaccinated:2007-04-05
Onset:2007-06-16
Submitted:2007-07-10
Entered:2007-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR 41813CA / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0507F / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y0991 / 0 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B08674C / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Diarrhoea, Haematochezia, Intussusception, Irritability, Mucous stools, Small intestinal resection, Surgery, Urinary system X-ray, Vomiting, White blood cell count increased, Platelet count increased, Ultrasound abdomen abnormal, Explorative laparotomy, Laboratory test normal, Urine analysis normal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none. PMH: L cephalohematoma 2'' to vacuum assisted delivery. Hyperbilirubinemia after birth.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: KUB (done at previous facility) showed dilated bowel loops and air throughout. WBCs 22,000. Platelets 579,000. Chem WNL. UA (-). Abd ultrasound with eveidence of a mass-effect in the RUQ c/w Intussusception. Bariu
CDC 'Split Type':

Write-up: Intussusception. Surgical correction in June 2007. Hospital record for transfer facility rec''d for DOS 6/17-20/2007. Infant transfered to facility for surgical reduction of Intussusception which was non-reduceable by contrast enema. Child presented at first facility with 1 day hx of grossly bloody, watery stools with mucus and one episode of emesis. Child has been fussy. PE WNL. Barium contrast enema attempted to reduce IS but was unsuccessful. Infant had an Exploratory Lap, reduction of IS and small bowel resection with primary reanastomosis. DX: Intussusception. F/U visit 7/13/2007 with report of some fussiness since the surgery but otherwise healing well.


Changed on 5/13/2013

VAERS ID: 284252 Before After
VAERS Form:
Age:0.1
Gender:Female
Location:Texas
Vaccinated:2007-04-05
Onset:2007-06-16
Submitted:2007-07-10
Entered:2007-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR 41813CA / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0507F / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y0991 / 0 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08674C / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Diarrhoea, Haematochezia, Intussusception, Irritability, Mucous stools, Small intestinal resection, Surgery, Urinary system X-ray, Vomiting, White blood cell count increased, Platelet count increased, Ultrasound abdomen abnormal, Explorative laparotomy, Laboratory test normal, Urine analysis normal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none. PMH: L cephalohematoma 2'' to vacuum assisted delivery. Hyperbilirubinemia after birth.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: KUB (done at previous facility) showed dilated bowel loops and air throughout. WBCs 22,000. Platelets 579,000. Chem WNL. UA (-). Abd ultrasound with eveidence of a mass-effect in the RUQ c/w Intussusception. Bariu
CDC 'Split Type':

Write-up: Intussusception. Surgical correction in June 2007. Hospital record for transfer facility rec''d for DOS 6/17-20/2007. Infant transfered to facility for surgical reduction of Intussusception which was non-reduceable by contrast enema. Child presented at first facility with 1 day hx of grossly bloody, watery stools with mucus and one episode of emesis. Child has been fussy. PE WNL. Barium contrast enema attempted to reduce IS but was unsuccessful. Infant had an Exploratory Lap, reduction of IS and small bowel resection with primary reanastomosis. DX: Intussusception. F/U visit 7/13/2007 with report of some fussiness since the surgery but otherwise healing well.


Changed on 2/14/2017

VAERS ID: 284252 Before After
VAERS Form:
Age:0.1
Gender:Female
Location:Texas
Vaccinated:2007-04-05
Onset:2007-06-16
Submitted:2007-07-10
Entered:2007-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR 41813CA / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0507F / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y0991 / 0 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08674C / 0 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Diarrhoea, Haematochezia, Intussusception, Irritability, Mucous stools, Small intestinal resection, Surgery, Urinary system X-ray, Vomiting, White blood cell count increased, Platelet count increased, Ultrasound abdomen abnormal, Explorative laparotomy, Laboratory test normal, Urine analysis normal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none. PMH: L cephalohematoma 2'' to vacuum assisted delivery. Hyperbilirubinemia after birth.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: KUB (done at previous facility) showed dilated bowel loops and air throughout. WBCs 22,000. Platelets 579,000. Chem WNL. UA (-). Abd ultrasound with eveidence of a mass-effect in the RUQ c/w Intussusception. Bariu Barium contrast enema attempted to reduce IS but was unsuccessful.
CDC 'Split Type':

Write-up: Intussusception. Surgical correction in June 2007. Hospital record for transfer facility rec''d for DOS 6/17-20/2007. Infant transfered to facility for surgical reduction of Intussusception which was non-reduceable by contrast enema. Child presented at first facility with 1 day hx of grossly bloody, watery stools with mucus and one episode of emesis. Child has been fussy. PE WNL. Barium contrast enema attempted to reduce IS but was unsuccessful. Infant had an Exploratory Lap, reduction of IS and small bowel resection with primary reanastomosis. DX: Intussusception. F/U visit 7/13/2007 with report of some fussiness since the surgery but otherwise healing well.


Changed on 9/14/2017

VAERS ID: 284252 Before After
VAERS Form:(blank) 1
Age:0.1
Gender:Female
Location:Texas
Vaccinated:2007-04-05
Onset:2007-06-16
Submitted:2007-07-10
Entered:2007-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR 41813CA / 0 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0507F / 0 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y0991 / 0 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08674C / 0 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 0 1 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception, Surgery

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none. PMH: L cephalohematoma 2'' to vacuum assisted delivery. Hyperbilirubinemia after birth.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: KUB (done at previous facility) showed dilated bowel loops and air throughout. WBCs 22,000. Platelets 579,000. Chem WNL. UA (-). Abd ultrasound with eveidence of a mass-effect in the RUQ c/w Intussusception. Barium contrast enema attempted to reduce IS but was unsuccessful.
CDC 'Split Type':

Write-up: Intussusception. Surgical correction in June 2007. Hospital record for transfer facility rec''d for DOS 6/17-20/2007. Infant transfered to facility for surgical reduction of Intussusception which was non-reduceable by contrast enema. Child presented at first facility with 1 day hx of grossly bloody, watery stools with mucus and one episode of emesis. Child has been fussy. PE WNL. Barium contrast enema attempted to reduce IS but was unsuccessful. Infant had an Exploratory Lap, reduction of IS and small bowel resection with primary reanastomosis. DX: Intussusception. F/U visit 7/13/2007 with report of some fussiness since the surgery but otherwise healing well.


Changed on 2/14/2018

VAERS ID: 284252 Before After
VAERS Form:1
Age:0.1
Gender:Female
Location:Texas
Vaccinated:2007-04-05
Onset:2007-06-16
Submitted:2007-07-10
Entered:2007-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR 41813CA / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0507F / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y0991 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08674C / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception, Surgery

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none. PMH: L cephalohematoma 2'' to vacuum assisted delivery. Hyperbilirubinemia after birth.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: KUB (done at previous facility) showed dilated bowel loops and air throughout. WBCs 22,000. Platelets 579,000. Chem WNL. UA (-). Abd ultrasound with eveidence of a mass-effect in the RUQ c/w Intussusception. Barium contrast enema attempted to reduce IS but was unsuccessful.
CDC 'Split Type':

Write-up: Intussusception. Surgical correction in June 2007. Hospital record for transfer facility rec''d for DOS 6/17-20/2007. Infant transfered to facility for surgical reduction of Intussusception which was non-reduceable by contrast enema. Child presented at first facility with 1 day hx of grossly bloody, watery stools with mucus and one episode of emesis. Child has been fussy. PE WNL. Barium contrast enema attempted to reduce IS but was unsuccessful. Infant had an Exploratory Lap, reduction of IS and small bowel resection with primary reanastomosis. DX: Intussusception. F/U visit 7/13/2007 with report of some fussiness since the surgery but otherwise healing well.


Changed on 6/14/2018

VAERS ID: 284252 Before After
VAERS Form:1
Age:0.1
Gender:Female
Location:Texas
Vaccinated:2007-04-05
Onset:2007-06-16
Submitted:2007-07-10
Entered:2007-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR 41813CA / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0507F / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y0991 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08674C / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception, Surgery

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none. PMH: L cephalohematoma 2'' to vacuum assisted delivery. Hyperbilirubinemia after birth.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: KUB (done at previous facility) showed dilated bowel loops and air throughout. WBCs 22,000. Platelets 579,000. Chem WNL. UA (-). Abd ultrasound with eveidence of a mass-effect in the RUQ c/w Intussusception. Barium contrast enema attempted to reduce IS but was unsuccessful.
CDC 'Split Type':

Write-up: Intussusception. Surgical correction in June 2007. Hospital record for transfer facility rec''d for DOS 6/17-20/2007. Infant transfered to facility for surgical reduction of Intussusception which was non-reduceable by contrast enema. Child presented at first facility with 1 day hx of grossly bloody, watery stools with mucus and one episode of emesis. Child has been fussy. PE WNL. Barium contrast enema attempted to reduce IS but was unsuccessful. Infant had an Exploratory Lap, reduction of IS and small bowel resection with primary reanastomosis. DX: Intussusception. F/U visit 7/13/2007 with report of some fussiness since the surgery but otherwise healing well.


Changed on 8/14/2018

VAERS ID: 284252 Before After
VAERS Form:1
Age:0.1
Gender:Female
Location:Texas
Vaccinated:2007-04-05
Onset:2007-06-16
Submitted:2007-07-10
Entered:2007-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR 41813CA / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0507F / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y0991 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08674C / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception, Surgery

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none. PMH: L cephalohematoma 2'' to vacuum assisted delivery. Hyperbilirubinemia after birth.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: KUB (done at previous facility) showed dilated bowel loops and air throughout. WBCs 22,000. Platelets 579,000. Chem WNL. UA (-). Abd ultrasound with eveidence of a mass-effect in the RUQ c/w Intussusception. Barium contrast enema attempted to reduce IS but was unsuccessful.
CDC 'Split Type':

Write-up: Intussusception. Surgical correction in June 2007. Hospital record for transfer facility rec''d for DOS 6/17-20/2007. Infant transfered to facility for surgical reduction of Intussusception which was non-reduceable by contrast enema. Child presented at first facility with 1 day hx of grossly bloody, watery stools with mucus and one episode of emesis. Child has been fussy. PE WNL. Barium contrast enema attempted to reduce IS but was unsuccessful. Infant had an Exploratory Lap, reduction of IS and small bowel resection with primary reanastomosis. DX: Intussusception. F/U visit 7/13/2007 with report of some fussiness since the surgery but otherwise healing well.


Changed on 9/14/2018

VAERS ID: 284252 Before After
VAERS Form:1
Age:0.1
Gender:Female
Location:Texas
Vaccinated:2007-04-05
Onset:2007-06-16
Submitted:2007-07-10
Entered:2007-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR 41813CA / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0507F / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y0991 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08674C / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception, Surgery

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none. PMH: L cephalohematoma 2'' to vacuum assisted delivery. Hyperbilirubinemia after birth.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: KUB (done at previous facility) showed dilated bowel loops and air throughout. WBCs 22,000. Platelets 579,000. Chem WNL. UA (-). Abd ultrasound with eveidence of a mass-effect in the RUQ c/w Intussusception. Barium contrast enema attempted to reduce IS but was unsuccessful.
CDC 'Split Type':

Write-up: Intussusception. Surgical correction in June 2007. Hospital record for transfer facility rec''d for DOS 6/17-20/2007. Infant transfered to facility for surgical reduction of Intussusception which was non-reduceable by contrast enema. Child presented at first facility with 1 day hx of grossly bloody, watery stools with mucus and one episode of emesis. Child has been fussy. PE WNL. Barium contrast enema attempted to reduce IS but was unsuccessful. Infant had an Exploratory Lap, reduction of IS and small bowel resection with primary reanastomosis. DX: Intussusception. F/U visit 7/13/2007 with report of some fussiness since the surgery but otherwise healing well.


Changed on 10/14/2018

VAERS ID: 284252 Before After
VAERS Form:1
Age:0.1
Gender:Female
Location:Texas
Vaccinated:2007-04-05
Onset:2007-06-16
Submitted:2007-07-10
Entered:2007-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR 41813CA / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0507F / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y0991 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08674C / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception, Surgery

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none. PMH: L cephalohematoma 2'' to vacuum assisted delivery. Hyperbilirubinemia after birth.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: KUB (done at previous facility) showed dilated bowel loops and air throughout. WBCs 22,000. Platelets 579,000. Chem WNL. UA (-). Abd ultrasound with eveidence of a mass-effect in the RUQ c/w Intussusception. Barium contrast enema attempted to reduce IS but was unsuccessful.
CDC 'Split Type':

Write-up: Intussusception. Surgical correction in June 2007. Hospital record for transfer facility rec''d for DOS 6/17-20/2007. Infant transfered to facility for surgical reduction of Intussusception which was non-reduceable by contrast enema. Child presented at first facility with 1 day hx of grossly bloody, watery stools with mucus and one episode of emesis. Child has been fussy. PE WNL. Barium contrast enema attempted to reduce IS but was unsuccessful. Infant had an Exploratory Lap, reduction of IS and small bowel resection with primary reanastomosis. DX: Intussusception. F/U visit 7/13/2007 with report of some fussiness since the surgery but otherwise healing well.

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