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VAERS ID: | 286241 |
VAERS Form: | |
Age: | 0.5 |
Gender: | Female |
Location: | Pennsylvania |
Vaccinated: | 2007-01-22 |
Onset: | 2007-07-11 |
Submitted: | 0000-00-00 |
Entered: | 2007-07-30 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC01B084CA / 2 | - / IM |
FLU: INFLUENZA (FLUZONE) / SANOFI PASTEUR | 42260AA / 0 | - / - |
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC | B08672K / 2 | - / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1110F / 2 | - / PO |
Administered by: Private Purchased by: Unknown
Symptoms: Abdominal distension, Abdominal mass, Abdominal pain, Decreased appetite, 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? Yes, days: 3
Write-up: Woke up morning of 7-11-07 obviously uncomfortable and throwing up small amounts of bile a few times every hour. Pediatrician referred us to the ER at 5:00; bloody diapers began around 6:30 PM. Ultrasound at 9:15 PM revealed intussusception. Drs attempted"to reduce via enema 3 times unsuccessfully. Surgery at approx 1:00 AM on 7-12-07. 8/3/07 Received vax record which confirmed RO dose & lot # as reported. 8/14/07 Received hospital medical records which reveal patient experienced abdominal pain, bilious v
Vaccinated: | 2007-01-22 |
Onset: | 2007-07-11 |
Submitted: | 0000-00-00 |
Entered: | 2007-07-30 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC01B084CA / 2 | - / IM |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC01B084CA / 2 | - / IM |
FLU: INFLUENZA (FLUZONE) INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR | 42260AA / 0 | - / - |
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC | B08672K / 2 | - / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1110F / 2 | - / PO |
Administered by: Private Purchased by: Unknown
Symptoms: Abdominal distension, Abdominal mass, Abdominal pain, Discomfort, Haematochezia, Intussusception, Laparotomy, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal, Intestinal resection, Decreased appetite, 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? Yes, days: 3
Write-up: Woke up morning of 7-11-07 obviously uncomfortable and throwing up small amounts of bile a few times every hour. Pediatrician referred us to the ER at 5:00; bloody diapers began around 6:30 PM. Ultrasound at 9:15 PM revealed intussusception. Drs attempted"to attempted to reduce via enema 3 times unsuccessfully. Surgery at approx 1:00 AM on 7-12-07. 8/3/07 Received vax record which confirmed RO dose & lot # as reported. 8/14/07 Received hospital medical records which reveal patient experienced abdominal pain, bilious v vomiting, decreased appetite & blood stools x 1 day. Admitted 7/12-7/14/2007. Exam revealed softly distended abdomen w/palpable mass at LLQ. BE unsuccessful & surg consult obtained. To OR for exp laparotomy & bowel resection FINAL DX: Intussusception, surgically reduced.
Vaccinated: | 2007-01-22 |
Onset: | 2007-07-11 |
Submitted: | 0000-00-00 |
Entered: | 2007-07-30 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC01B084CA / 2 | - / IM |
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR | 42260AA / 0 | - / - |
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC | B08672K / 2 | - / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1110F / 2 | - / PO |
Administered by: Private Purchased by: Unknown
Symptoms: Abdominal distension, Abdominal mass, Abdominal pain, Discomfort, Haematochezia, Intussusception, Laparotomy, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal, Intestinal resection, Decreased appetite, 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? Yes, days: 3
Write-up: Woke up morning of 7-11-07 obviously uncomfortable and throwing up small amounts of bile a few times every hour. Pediatrician referred us to the ER at 5:00; bloody diapers began around 6:30 PM. Ultrasound at 9:15 PM revealed intussusception. Drs attempted to reduce via enema 3 times unsuccessfully. Surgery at approx 1:00 AM on 7-12-07. 8/3/07 Received vax record which confirmed RO dose & lot # as reported. 8/14/07 Received hospital medical records which reveal patient experienced abdominal pain, bilious vomiting, decreased appetite & blood stools x 1 day. Admitted 7/12-7/14/2007. Exam revealed softly distended abdomen w/palpable mass at LLQ. BE unsuccessful & surg consult obtained. To OR for exp laparotomy & bowel resection FINAL DX: Intussusception, surgically reduced.
Vaccinated: | 2007-01-22 |
Onset: | 2007-07-11 |
Submitted: | 0000-00-00 |
Entered: | 2007-07-30 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC01B084CA / 2 | - / IM |
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR | 42260AA / 0 | - / - |
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC | B08672K / 2 | - / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1110F / 2 | - / PO |
Administered by: Private Purchased by: Unknown
Symptoms: Abdominal distension, Abdominal mass, Abdominal pain, Discomfort, Haematochezia, Intussusception, Laparotomy, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal, Intestinal resection, Decreased appetite, 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? Yes, days: 3
Write-up: Woke up morning of 7-11-07 obviously uncomfortable and throwing up small amounts of bile a few times every hour. Pediatrician referred us to the ER at 5:00; bloody diapers began around 6:30 PM. Ultrasound at 9:15 PM revealed intussusception. Drs attempted to reduce via enema 3 times unsuccessfully. Surgery at approx 1:00 AM on 7-12-07. 8/3/07 Received vax record which confirmed RO dose & lot # as reported. 8/14/07 Received hospital medical records which reveal patient experienced abdominal pain, bilious vomiting, decreased appetite & blood stools x 1 day. Admitted 7/12-7/14/2007. Exam revealed softly distended abdomen w/palpable mass at LLQ. BE unsuccessful & surg consult obtained. To OR for exp laparotomy & bowel resection FINAL DX: Intussusception, surgically reduced.
Vaccinated: | 2007-01-22 |
Onset: | 2007-07-11 |
Submitted: | 0000-00-00 |
Entered: | 2007-07-30 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC01B084CA / 2 | - / IM |
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR | 42260AA / 0 | - / - |
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH | B08672K / 2 | - / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1110F / 2 | - / PO |
Administered by: Private Purchased by: Unknown
Symptoms: Abdominal distension, Abdominal mass, Abdominal pain, Discomfort, Haematochezia, Intussusception, Laparotomy, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal, Intestinal resection, Decreased appetite, 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? Yes, days: 3
Write-up: Woke up morning of 7-11-07 obviously uncomfortable and throwing up small amounts of bile a few times every hour. Pediatrician referred us to the ER at 5:00; bloody diapers began around 6:30 PM. Ultrasound at 9:15 PM revealed intussusception. Drs attempted to reduce via enema 3 times unsuccessfully. Surgery at approx 1:00 AM on 7-12-07. 8/3/07 Received vax record which confirmed RO dose & lot # as reported. 8/14/07 Received hospital medical records which reveal patient experienced abdominal pain, bilious vomiting, decreased appetite & blood stools x 1 day. Admitted 7/12-7/14/2007. Exam revealed softly distended abdomen w/palpable mass at LLQ. BE unsuccessful & surg consult obtained. To OR for exp laparotomy & bowel resection FINAL DX: Intussusception, surgically reduced.
Vaccinated: | 2007-01-22 |
Onset: | 2007-07-11 |
Submitted: | 0000-00-00 |
Entered: | 2007-07-30 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC01B084CA / 2 | - / IM |
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR | 42260AA / 0 | - / - |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B08672K / 2 | - / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1110F / 2 | - / PO |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1110F / 2 | - / PO |
Administered by: Private Purchased by: Unknown
Symptoms: Abdominal distension, Abdominal mass, Abdominal pain, Discomfort, Haematochezia, Intussusception, Laparotomy, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal, Intestinal resection, Decreased appetite, 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? Yes, days: 3
Write-up: Woke up morning of 7-11-07 obviously uncomfortable and throwing up small amounts of bile a few times every hour. Pediatrician referred us to the ER at 5:00; bloody diapers began around 6:30 PM. Ultrasound at 9:15 PM revealed intussusception. Drs attempted to reduce via enema 3 times unsuccessfully. Surgery at approx 1:00 AM on 7-12-07. 8/3/07 Received vax record which confirmed RO dose & lot # as reported. 8/14/07 Received hospital medical records which reveal patient experienced abdominal pain, bilious vomiting, decreased appetite & blood stools x 1 day. Admitted 7/12-7/14/2007. Exam revealed softly distended abdomen w/palpable mass at LLQ. BE unsuccessful & surg consult obtained. To OR for exp laparotomy & bowel resection FINAL DX: Intussusception, surgically reduced.
Vaccinated: | 2007-01-22 |
Onset: | 2007-07-11 |
Submitted: | 0000-00-00 |
Entered: | 2007-07-30 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC01B084CA / 2 | - / IM |
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR | 42260AA / 0 | - / - |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR | 42260AA / 0 | - / - |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B08672K / 2 | - / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1110F / 2 | - / PO |
Administered by: Private Purchased by: Unknown
Symptoms: Abdominal distension, Abdominal mass, Abdominal pain, Discomfort, Haematochezia, Intussusception, Laparotomy, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal, Intestinal resection, Decreased appetite, 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? Yes, days: 3
Write-up: Woke up morning of 7-11-07 obviously uncomfortable and throwing up small amounts of bile a few times every hour. Pediatrician referred us to the ER at 5:00; bloody diapers began around 6:30 PM. Ultrasound at 9:15 PM revealed intussusception. Drs attempted to reduce via enema 3 times unsuccessfully. Surgery at approx 1:00 AM on 7-12-07. 8/3/07 Received vax record which confirmed RO dose & lot # as reported. 8/14/07 Received hospital medical records which reveal patient experienced abdominal pain, bilious vomiting, decreased appetite & blood stools x 1 day. Admitted 7/12-7/14/2007. Exam revealed softly distended abdomen w/palpable mass at LLQ. BE unsuccessful & surg consult obtained. To OR for exp laparotomy & bowel resection FINAL DX: Intussusception, surgically reduced.
Vaccinated: | 2007-01-22 |
Onset: | 2007-07-11 |
Submitted: | 0000-00-00 |
Entered: | 2007-07-30 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC01B084CA / 2 | - / IM |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR | 42260AA / 0 | - / - |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B08672K / 2 | - / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1110F / 2 | - / PO |
Administered by: Private Purchased by: Unknown
Symptoms: Abdominal distension, Abdominal mass, Abdominal pain, Discomfort, Haematochezia, Intussusception, Laparotomy, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal, Intestinal resection, Decreased appetite, 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? Yes, days: 3
Write-up: Woke up morning of 7-11-07 obviously uncomfortable and throwing up small amounts of bile a few times every hour. Pediatrician referred us to the ER at 5:00; bloody diapers began around 6:30 PM. Ultrasound at 9:15 PM revealed intussusception. Drs attempted to reduce via enema 3 times unsuccessfully. Surgery at approx 1:00 AM on 7-12-07. 8/3/07 Received vax record which confirmed RO dose & lot # as reported. 8/14/07 Received hospital medical records which reveal patient experienced abdominal pain, bilious vomiting, decreased appetite & blood stools x 1 day. Admitted 7/12-7/14/2007. Exam revealed softly distended abdomen w/palpable mass at LLQ. BE unsuccessful & surg consult obtained. To OR for exp laparotomy & bowel resection FINAL DX: Intussusception, surgically reduced.
Vaccinated: | 2007-01-22 |
Onset: | 2007-07-11 |
Submitted: | 0000-00-00 |
Entered: | 2007-07-30 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC01B084CA / 2 3 | - / IM |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR | 42260AA / 0 1 | - / - |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B08672K / 2 3 | - / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1110F / 2 3 | - MO / PO |
Administered by: Private Purchased by: Unknown
Symptoms: Discomfort, Haematochezia, Intussusception, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal
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? Yes, days: 3
Write-up: Woke up morning of 7-11-07 obviously uncomfortable and throwing up small amounts of bile a few times every hour. Pediatrician referred us to the ER at 5:00; bloody diapers began around 6:30 PM. Ultrasound at 9:15 PM revealed intussusception. Drs attempted to reduce via enema 3 times unsuccessfully. Surgery at approx 1:00 AM on 7-12-07. 8/3/07 Received vax record which confirmed RO dose & lot # as reported. 8/14/07 Received hospital medical records which reveal patient experienced abdominal pain, bilious vomiting, decreased appetite & blood stools x 1 day. Admitted 7/12-7/14/2007. Exam revealed softly distended abdomen w/palpable mass at LLQ. BE unsuccessful & surg consult obtained. To OR for exp laparotomy & bowel resection FINAL DX: Intussusception, surgically reduced.
Vaccinated: | 2007-01-22 |
Onset: | 2007-07-11 |
Submitted: | 0000-00-00 |
Entered: | 2007-07-30 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC01B084CA / 3 | - / IM |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR | 42260AA / 1 | - / - |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B08672K / 3 | - / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1110F / 3 | MO / PO |
Administered by: Private Purchased by: Unknown
Symptoms: Discomfort, Haematochezia, Intussusception, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal
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? Yes, days: 3
Write-up: Woke up morning of 7-11-07 obviously uncomfortable and throwing up small amounts of bile a few times every hour. Pediatrician referred us to the ER at 5:00; bloody diapers began around 6:30 PM. Ultrasound at 9:15 PM revealed intussusception. Drs attempted to reduce via enema 3 times unsuccessfully. Surgery at approx 1:00 AM on 7-12-07. 8/3/07 Received vax record which confirmed RO dose & lot # as reported. 8/14/07 Received hospital medical records which reveal patient experienced abdominal pain, bilious vomiting, decreased appetite & blood stools x 1 day. Admitted 7/12-7/14/2007. Exam revealed softly distended abdomen w/palpable mass at LLQ. BE unsuccessful & surg consult obtained. To OR for exp laparotomy & bowel resection FINAL DX: Intussusception, surgically reduced.
Vaccinated: | 2007-01-22 |
Onset: | 2007-07-11 |
Submitted: | 0000-00-00 |
Entered: | 2007-07-30 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC01B084CA / 3 | - / IM |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR | 42260AA / 1 | - / - |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B08672K / 3 | - / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1110F / 3 | MO / PO |
Administered by: Private Purchased by: Unknown
Symptoms: Discomfort, Haematochezia, Intussusception, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal
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? Yes, days: 3
Write-up: Woke up morning of 7-11-07 obviously uncomfortable and throwing up small amounts of bile a few times every hour. Pediatrician referred us to the ER at 5:00; bloody diapers began around 6:30 PM. Ultrasound at 9:15 PM revealed intussusception. Drs attempted to reduce via enema 3 times unsuccessfully. Surgery at approx 1:00 AM on 7-12-07. 8/3/07 Received vax record which confirmed RO dose & lot # as reported. 8/14/07 Received hospital medical records which reveal patient experienced abdominal pain, bilious vomiting, decreased appetite & blood stools x 1 day. Admitted 7/12-7/14/2007. Exam revealed softly distended abdomen w/palpable mass at LLQ. BE unsuccessful & surg consult obtained. To OR for exp laparotomy & bowel resection FINAL DX: Intussusception, surgically reduced.
Vaccinated: | 2007-01-22 |
Onset: | 2007-07-11 |
Submitted: | 0000-00-00 |
Entered: | 2007-07-30 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC01B084CA / 3 | - / IM |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR | 42260AA / 1 | - / - |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B08672K / 3 | - / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1110F / 3 | MO / PO |
Administered by: Private Purchased by: Unknown
Symptoms: Discomfort, Haematochezia, Intussusception, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal
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? Yes, days: 3
Write-up: Woke up morning of 7-11-07 obviously uncomfortable and throwing up small amounts of bile a few times every hour. Pediatrician referred us to the ER at 5:00; bloody diapers began around 6:30 PM. Ultrasound at 9:15 PM revealed intussusception. Drs attempted to reduce via enema 3 times unsuccessfully. Surgery at approx 1:00 AM on 7-12-07. 8/3/07 Received vax record which confirmed RO dose & lot # as reported. 8/14/07 Received hospital medical records which reveal patient experienced abdominal pain, bilious vomiting, decreased appetite & blood stools x 1 day. Admitted 7/12-7/14/2007. Exam revealed softly distended abdomen w/palpable mass at LLQ. BE unsuccessful & surg consult obtained. To OR for exp laparotomy & bowel resection FINAL DX: Intussusception, surgically reduced.
Vaccinated: | 2007-01-22 |
Onset: | 2007-07-11 |
Submitted: | 0000-00-00 |
Entered: | 2007-07-30 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC01B084CA / 3 | - / IM |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR | 42260AA / 1 | - / - |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B08672K / 3 | - / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1110F / 3 | MO / PO |
Administered by: Private Purchased by: Unknown
Symptoms: Discomfort, Haematochezia, Intussusception, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal
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? Yes, days: 3
Write-up: Woke up morning of 7-11-07 obviously uncomfortable and throwing up small amounts of bile a few times every hour. Pediatrician referred us to the ER at 5:00; bloody diapers began around 6:30 PM. Ultrasound at 9:15 PM revealed intussusception. Drs attempted to reduce via enema 3 times unsuccessfully. Surgery at approx 1:00 AM on 7-12-07. 8/3/07 Received vax record which confirmed RO dose & lot # as reported. 8/14/07 Received hospital medical records which reveal patient experienced abdominal pain, bilious vomiting, decreased appetite & blood stools x 1 day. Admitted 7/12-7/14/2007. Exam revealed softly distended abdomen w/palpable mass at LLQ. BE unsuccessful & surg consult obtained. To OR for exp laparotomy & bowel resection FINAL DX: Intussusception, surgically reduced.
Vaccinated: | 2007-01-22 |
Onset: | 2007-07-11 |
Submitted: | 0000-00-00 |
Entered: | 2007-07-30 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC01B084CA / 3 | - / IM |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR | 42260AA / 1 | - / - |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B08672K / 3 | - / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1110F / 3 | MO / PO |
Administered by: Private Purchased by: Unknown
Symptoms: Discomfort, Haematochezia, Intussusception, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal
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? Yes, days: 3
Write-up: Woke up morning of 7-11-07 obviously uncomfortable and throwing up small amounts of bile a few times every hour. Pediatrician referred us to the ER at 5:00; bloody diapers began around 6:30 PM. Ultrasound at 9:15 PM revealed intussusception. Drs attempted to reduce via enema 3 times unsuccessfully. Surgery at approx 1:00 AM on 7-12-07. 8/3/07 Received vax record which confirmed RO dose & lot # as reported. 8/14/07 Received hospital medical records which reveal patient experienced abdominal pain, bilious vomiting, decreased appetite & blood stools x 1 day. Admitted 7/12-7/14/2007. Exam revealed softly distended abdomen w/palpable mass at LLQ. BE unsuccessful & surg consult obtained. To OR for exp laparotomy & bowel resection FINAL DX: Intussusception, surgically reduced.
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