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This is VAERS ID 286077

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 286077
VAERS Form:
Age:0.2
Gender:Female
Location:Texas
Vaccinated:2007-04-05
Onset:2007-05-21
Submitted:2007-07-26
Entered:2007-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR U1985BA / 0 UN / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0507F / 0 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0548 / 0 UN / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC 8362584 / 0 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1239F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Barium enema, Blood bicarbonate decreased, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Mylicon
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Barium enema/ Abdominal Series
CDC 'Split Type':

Write-up: Intussusseption on 5/21/7-reduced by air contrast enema


Changed on 12/8/2009

VAERS ID: 286077 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Texas
Vaccinated:2007-04-05
Onset:2007-05-21
Submitted:2007-07-26
Entered:2007-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR U1985BA / 0 UN / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0507F / 0 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0548 / 0 UN / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC 8362584 / 0 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1239F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Barium enema, Blood bicarbonate decreased, Full blood count normal, Haematochezia, Intussusception, Irritability, Enema administration, Laboratory test normal, Urine output decreased, Abdominal X-ray, Oral intake reduced

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Mylicon
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Barium enema/ Abdominal Series LABS: CBC WNL. Chemistry WNL, bicarb 18 (L). Abdominal x-ray abnormal. Air contrast enema confirmed & reduced IS.
CDC 'Split Type':

Write-up: Intussusseption on 5/21/7-reduced by air contrast enema. 8/31/07 Received vax record from pcp which confirmed RO dose & lot as reported. 9/28/07 Vax records faxed to CDC. 10/2/07 Reviewed hospital medical records which reveal patient experienced reduced oral intake, decreased urine output, irritability, bloody stool x 1. Admitted 5/21-5/22/2007 for overnight observation s/p IS reduction. Progressed well & d/c to home. FINAL DX: Intussusception, enema reduced.


Changed on 3/2/2010

VAERS ID: 286077 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Texas
Vaccinated:2007-04-05
Onset:2007-05-21
Submitted:2007-07-26
Entered:2007-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR U1985BA / 0 UN / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0507F / 0 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0548 / 0 UN / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC 8362584 / 0 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1239F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Barium enema, Blood bicarbonate decreased, Full blood count normal, Haematochezia, Intussusception, Irritability, Enema administration, Laboratory test normal, Urine output decreased, Abdominal X-ray, Oral intake reduced

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Mylicon
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Barium enema/ Abdominal Series LABS: CBC WNL. Chemistry WNL, bicarb 18 (L). Abdominal x-ray abnormal. Air contrast enema confirmed & reduced IS.
CDC 'Split Type':

Write-up: Intussusseption on 5/21/7-reduced by air contrast enema. 8/31/07 Received vax record from pcp which confirmed RO dose & lot as reported. 9/28/07 Vax records faxed to CDC. 10/2/07 Reviewed hospital medical records which reveal patient experienced reduced oral intake, decreased urine output, irritability, bloody stool x 1. Admitted 5/21-5/22/2007 for overnight observation s/p IS reduction. Progressed well & d/c to home. FINAL DX: Intussusception, enema reduced.


Changed on 4/7/2010

VAERS ID: 286077 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Texas
Vaccinated:2007-04-05
Onset:2007-05-21
Submitted:2007-07-26
Entered:2007-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR U1985BA / 0 UN / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0507F / 0 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0548 / 0 UN / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC 8362584 / 0 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1239F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Barium enema, Blood bicarbonate decreased, Full blood count normal, Haematochezia, Intussusception, Irritability, Enema administration, Laboratory test normal, Urine output decreased, Abdominal X-ray, Oral intake reduced

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Mylicon
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Barium enema/ Abdominal Series LABS: CBC WNL. Chemistry WNL, bicarb 18 (L). Abdominal x-ray abnormal. Air contrast enema confirmed & reduced IS.
CDC 'Split Type':

Write-up: Intussusseption on 5/21/7-reduced by air contrast enema. 8/31/07 Received vax record from pcp which confirmed RO dose & lot as reported. 9/28/07 Vax records faxed to CDC. 10/2/07 Reviewed hospital medical records which reveal patient experienced reduced oral intake, decreased urine output, irritability, bloody stool x 1. Admitted 5/21-5/22/2007 for overnight observation s/p IS reduction. Progressed well & d/c to home. FINAL DX: Intussusception, enema reduced.


Changed on 8/31/2010

VAERS ID: 286077 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Texas
Vaccinated:2007-04-05
Onset:2007-05-21
Submitted:2007-07-26
Entered:2007-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR U1985BA / 0 UN / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0507F / 0 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0548 / 0 UN / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 8362584 / 0 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1239F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Barium enema, Blood bicarbonate decreased, Full blood count normal, Haematochezia, Intussusception, Irritability, Enema administration, Laboratory test normal, Urine output decreased, Abdominal X-ray, Oral intake reduced

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Mylicon
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Barium enema/ Abdominal Series LABS: CBC WNL. Chemistry WNL, bicarb 18 (L). Abdominal x-ray abnormal. Air contrast enema confirmed & reduced IS.
CDC 'Split Type':

Write-up: Intussusseption on 5/21/7-reduced by air contrast enema. 8/31/07 Received vax record from pcp which confirmed RO dose & lot as reported. 9/28/07 Vax records faxed to CDC. 10/2/07 Reviewed hospital medical records which reveal patient experienced reduced oral intake, decreased urine output, irritability, bloody stool x 1. Admitted 5/21-5/22/2007 for overnight observation s/p IS reduction. Progressed well & d/c to home. FINAL DX: Intussusception, enema reduced.


Changed on 5/13/2013

VAERS ID: 286077 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Texas
Vaccinated:2007-04-05
Onset:2007-05-21
Submitted:2007-07-26
Entered:2007-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR U1985BA / 0 UN / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0507F / 0 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0548 / 0 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 8362584 / 0 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1239F / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1239F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Barium enema, Blood bicarbonate decreased, Full blood count normal, Haematochezia, Intussusception, Irritability, Enema administration, Laboratory test normal, Urine output decreased, Abdominal X-ray, Oral intake reduced

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Mylicon
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Barium enema/ Abdominal Series LABS: CBC WNL. Chemistry WNL, bicarb 18 (L). Abdominal x-ray abnormal. Air contrast enema confirmed & reduced IS.
CDC 'Split Type':

Write-up: Intussusseption on 5/21/7-reduced by air contrast enema. 8/31/07 Received vax record from pcp which confirmed RO dose & lot as reported. 9/28/07 Vax records faxed to CDC. 10/2/07 Reviewed hospital medical records which reveal patient experienced reduced oral intake, decreased urine output, irritability, bloody stool x 1. Admitted 5/21-5/22/2007 for overnight observation s/p IS reduction. Progressed well & d/c to home. FINAL DX: Intussusception, enema reduced.


Changed on 5/14/2017

VAERS ID: 286077 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Texas
Vaccinated:2007-04-05
Onset:2007-05-21
Submitted:2007-07-26
Entered:2007-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR U1985BA / 0 UN / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0507F / 0 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0548 / 0 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 8362584 / 0 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1239F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Barium enema, Blood bicarbonate decreased, Full blood count normal, Haematochezia, Intussusception, Irritability, Enema administration, Laboratory test normal, Urine output decreased, Abdominal X-ray, Oral intake reduced

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Mylicon
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Barium enema/ Abdominal Series LABS: CBC WNL. Chemistry WNL, bicarb 18 (L). Abdominal x-ray abnormal. Air contrast enema confirmed & reduced IS.
CDC 'Split Type':

Write-up: Intussusseption on 5/21/7-reduced by air contrast enema. 8/31/07 Received vax record from pcp which confirmed RO dose & lot as reported. 9/28/07 Vax records faxed to CDC. 10/2/07 Reviewed hospital medical records which reveal patient experienced reduced oral intake, decreased urine output, irritability, bloody stool x 1. Admitted 5/21-5/22/2007 for overnight observation s/p IS reduction. Progressed well & d/c to home. FINAL DX: Intussusception, enema reduced.


Changed on 9/14/2017

VAERS ID: 286077 Before After
VAERS Form:(blank) 1
Age:0.2
Gender:Female
Location:Texas
Vaccinated:2007-04-05
Onset:2007-05-21
Submitted:2007-07-26
Entered:2007-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR U1985BA / 0 1 UN / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0507F / 0 1 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0548 / 0 1 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 8362584 / 0 1 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1239F / 0 1 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Barium enema, Intussusception, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Mylicon
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Barium enema/ Abdominal Series LABS: CBC WNL. Chemistry WNL, bicarb 18 (L). Abdominal x-ray abnormal. Air contrast enema confirmed & reduced IS.
CDC 'Split Type':

Write-up: Intussusseption on 5/21/7-reduced by air contrast enema. 8/31/07 Received vax record from pcp which confirmed RO dose & lot as reported. 9/28/07 Vax records faxed to CDC. 10/2/07 Reviewed hospital medical records which reveal patient experienced reduced oral intake, decreased urine output, irritability, bloody stool x 1. Admitted 5/21-5/22/2007 for overnight observation s/p IS reduction. Progressed well & d/c to home. FINAL DX: Intussusception, enema reduced.


Changed on 2/14/2018

VAERS ID: 286077 Before After
VAERS Form:1
Age:0.2
Gender:Female
Location:Texas
Vaccinated:2007-04-05
Onset:2007-05-21
Submitted:2007-07-26
Entered:2007-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR U1985BA / 1 UN / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0507F / 1 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0548 / 1 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 8362584 / 1 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1239F / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Barium enema, Intussusception, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Mylicon
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Barium enema/ Abdominal Series LABS: CBC WNL. Chemistry WNL, bicarb 18 (L). Abdominal x-ray abnormal. Air contrast enema confirmed & reduced IS.
CDC 'Split Type':

Write-up: Intussusseption on 5/21/7-reduced by air contrast enema. 8/31/07 Received vax record from pcp which confirmed RO dose & lot as reported. 9/28/07 Vax records faxed to CDC. 10/2/07 Reviewed hospital medical records which reveal patient experienced reduced oral intake, decreased urine output, irritability, bloody stool x 1. Admitted 5/21-5/22/2007 for overnight observation s/p IS reduction. Progressed well & d/c to home. FINAL DX: Intussusception, enema reduced.


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