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This is VAERS ID 286241

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

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     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Operative confirmation LABS: abdominal x-ray c/w IS. abdominal US c/w large ileocolic IS in LLQ. BE attempted x 2 unsuccessful.
CDC 'Split Type':

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

Changed on 12/8/2009

VAERS ID: 286241 Before After
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
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     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Operative confirmation LABS: abdominal x-ray c/w IS. abdominal US c/w large ileocolic IS in LLQ. BE attempted x 2 unsuccessful.
CDC 'Split Type':

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.

Changed on 3/2/2010

VAERS ID: 286241 Before After
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
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     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Operative confirmation LABS: abdominal x-ray c/w IS. abdominal US c/w large ileocolic IS in LLQ. BE attempted x 2 unsuccessful.
CDC 'Split Type':

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.

Changed on 4/7/2010

VAERS ID: 286241 Before After
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
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     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Operative confirmation LABS: abdominal x-ray c/w IS. abdominal US c/w large ileocolic IS in LLQ. BE attempted x 2 unsuccessful.
CDC 'Split Type':

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.

Changed on 8/31/2010

VAERS ID: 286241 Before After
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
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     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Operative confirmation LABS: abdominal x-ray c/w IS. abdominal US c/w large ileocolic IS in LLQ. BE attempted x 2 unsuccessful.
CDC 'Split Type':

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.

Changed on 5/13/2013

VAERS ID: 286241 Before After
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
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     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Operative confirmation LABS: abdominal x-ray c/w IS. abdominal US c/w large ileocolic IS in LLQ. BE attempted x 2 unsuccessful.
CDC 'Split Type':

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.

Changed on 7/7/2013

VAERS ID: 286241 Before After
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
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     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Operative confirmation LABS: abdominal x-ray c/w IS. abdominal US c/w large ileocolic IS in LLQ. BE attempted x 2 unsuccessful.
CDC 'Split Type':

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.

Changed on 2/14/2017

VAERS ID: 286241 Before After
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
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     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Operative confirmation LABS: abdominal x-ray c/w IS. abdominal US c/w large ileocolic IS in LLQ. BE attempted x 2 unsuccessful.
CDC 'Split Type':

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.

Changed on 9/14/2017

VAERS ID: 286241 Before After
VAERS Form:(blank) 1
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
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     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Operative confirmation LABS: abdominal x-ray c/w IS. abdominal US c/w large ileocolic IS in LLQ. BE attempted x 2 unsuccessful.
CDC 'Split Type':

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.

Changed on 2/14/2018

VAERS ID: 286241 Before After
VAERS Form:1
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
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     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Operative confirmation LABS: abdominal x-ray c/w IS. abdominal US c/w large ileocolic IS in LLQ. BE attempted x 2 unsuccessful.
CDC 'Split Type':

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.

Changed on 6/14/2018

VAERS ID: 286241 Before After
VAERS Form:1
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
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     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Operative confirmation LABS: abdominal x-ray c/w IS. abdominal US c/w large ileocolic IS in LLQ. BE attempted x 2 unsuccessful.
CDC 'Split Type':

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.

Changed on 8/14/2018

VAERS ID: 286241 Before After
VAERS Form:1
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
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     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Operative confirmation LABS: abdominal x-ray c/w IS. abdominal US c/w large ileocolic IS in LLQ. BE attempted x 2 unsuccessful.
CDC 'Split Type':

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.

Changed on 9/14/2018

VAERS ID: 286241 Before After
VAERS Form:1
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
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     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Operative confirmation LABS: abdominal x-ray c/w IS. abdominal US c/w large ileocolic IS in LLQ. BE attempted x 2 unsuccessful.
CDC 'Split Type':

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.

Changed on 10/14/2018

VAERS ID: 286241 Before After
VAERS Form:1
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
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     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Operative confirmation LABS: abdominal x-ray c/w IS. abdominal US c/w large ileocolic IS in LLQ. BE attempted x 2 unsuccessful.
CDC 'Split Type':

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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