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This is VAERS ID 288035

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 288035
VAERS Form:
Age:0.3
Gender:Female
Location:California
Vaccinated:2007-07-09
Onset:2007-07-13
Submitted:2007-07-23
Entered:2007-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B092AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF051AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B47300A / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0847F / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Abdominal pain, Abdominal tenderness, Barium enema, Intussusception, Gastrointestinal sounds abnormal

Life Threatening? Yes
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: X-ray, Barium enema, Surgery
CDC 'Split Type':

Write-up: Intussusception


Changed on 12/8/2009

VAERS ID: 288035 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:California
Vaccinated:2007-07-09
Onset:2007-07-13
Submitted:2007-07-23
Entered:2007-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B092AA / 1 LL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B092AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF051AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B47300A / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0847F / 1 - / PO

Administered by: Private      Purchased by: Unknown Private
Symptoms: Abdominal pain, Abdominal tenderness, Barium enema, Intussusception, Small intestinal intussusception reduction, Surgery, Urinary system X-ray, Vomiting, X-ray, Immunology test, Gastrointestinal sounds abnormal

Life Threatening? Yes
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None None. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: X-ray, Barium enema, Surgery Surgery. Labs and diagnostics: KUB with defect noted c/w possible intussusception. Barium enema with impression Ileocolic Intussusception. Path report recd from CDC. IHC (-) for Adenovirus and Rotavirus A.
CDC 'Split Type':

Write-up: Intussusception Intussusception. 8/21/2007 Vax record received and reviewed. Initial hospital record also rec''d. Infant presented for c/o 1 week hx of intermittent vomiting and abdominal pain. Initially seen 7/13 & 7/14 for same. DXd with viral illness/gastroenteritis. Admitted for further w/u. PE (+) for hypoactive BS, tenderness to palpation. BE (+) for IS. Unable to reduce x3. Transfered to another facility for surgical reduction of intussusception.


Changed on 3/2/2010

VAERS ID: 288035 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:California
Vaccinated:2007-07-09
Onset:2007-07-13
Submitted:2007-07-23
Entered:2007-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B092AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF051AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B47300A / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0847F / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Abdominal tenderness, Barium enema, Intussusception, Small intestinal intussusception reduction, Surgery, Urinary system X-ray, Vomiting, X-ray, Immunology test, Gastrointestinal sounds abnormal

Life Threatening? Yes
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: X-ray, Barium enema, Surgery. Labs and diagnostics: KUB with defect noted c/w possible intussusception. Barium enema with impression Ileocolic Intussusception. Path report recd from CDC. IHC (-) for Adenovirus and Rotavirus A.
CDC 'Split Type':

Write-up: Intussusception. 8/21/2007 Vax record received and reviewed. Initial hospital record also rec''d. Infant presented for c/o 1 week hx of intermittent vomiting and abdominal pain. Initially seen 7/13 & 7/14 for same. DXd with viral illness/gastroenteritis. Admitted for further w/u. PE (+) for hypoactive BS, tenderness to palpation. BE (+) for IS. Unable to reduce x3. Transfered to another facility for surgical reduction of intussusception.


Changed on 4/7/2010

VAERS ID: 288035 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:California
Vaccinated:2007-07-09
Onset:2007-07-13
Submitted:2007-07-23
Entered:2007-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B092AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF051AA / 1 RL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B47300A / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0847F / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Abdominal tenderness, Barium enema, Intussusception, Small intestinal intussusception reduction, Surgery, Urinary system X-ray, Vomiting, X-ray, Immunology test, Gastrointestinal sounds abnormal

Life Threatening? Yes
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: X-ray, Barium enema, Surgery. Labs and diagnostics: KUB with defect noted c/w possible intussusception. Barium enema with impression Ileocolic Intussusception. Path report recd from CDC. IHC (-) for Adenovirus and Rotavirus A.
CDC 'Split Type':

Write-up: Intussusception. 8/21/2007 Vax record received and reviewed. Initial hospital record also rec''d. Infant presented for c/o 1 week hx of intermittent vomiting and abdominal pain. Initially seen 7/13 & 7/14 for same. DXd with viral illness/gastroenteritis. Admitted for further w/u. PE (+) for hypoactive BS, tenderness to palpation. BE (+) for IS. Unable to reduce x3. Transfered to another facility for surgical reduction of intussusception.


Changed on 8/31/2010

VAERS ID: 288035 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:California
Vaccinated:2007-07-09
Onset:2007-07-13
Submitted:2007-07-23
Entered:2007-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B092AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF051AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B47300A / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0847F / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Abdominal tenderness, Barium enema, Intussusception, Small intestinal intussusception reduction, Surgery, Urinary system X-ray, Vomiting, X-ray, Immunology test, Gastrointestinal sounds abnormal

Life Threatening? Yes
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: X-ray, Barium enema, Surgery. Labs and diagnostics: KUB with defect noted c/w possible intussusception. Barium enema with impression Ileocolic Intussusception. Path report recd from CDC. IHC (-) for Adenovirus and Rotavirus A.
CDC 'Split Type':

Write-up: Intussusception. 8/21/2007 Vax record received and reviewed. Initial hospital record also rec''d. Infant presented for c/o 1 week hx of intermittent vomiting and abdominal pain. Initially seen 7/13 & 7/14 for same. DXd with viral illness/gastroenteritis. Admitted for further w/u. PE (+) for hypoactive BS, tenderness to palpation. BE (+) for IS. Unable to reduce x3. Transfered to another facility for surgical reduction of intussusception.


Changed on 5/13/2013

VAERS ID: 288035 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:California
Vaccinated:2007-07-09
Onset:2007-07-13
Submitted:2007-07-23
Entered:2007-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B092AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF051AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47300A / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0847F / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0847F / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Abdominal tenderness, Barium enema, Intussusception, Small intestinal intussusception reduction, Surgery, Urinary system X-ray, Vomiting, X-ray, Immunology test, Gastrointestinal sounds abnormal

Life Threatening? Yes
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: X-ray, Barium enema, Surgery. Labs and diagnostics: KUB with defect noted c/w possible intussusception. Barium enema with impression Ileocolic Intussusception. Path report recd from CDC. IHC (-) for Adenovirus and Rotavirus A.
CDC 'Split Type':

Write-up: Intussusception. 8/21/2007 Vax record received and reviewed. Initial hospital record also rec''d. Infant presented for c/o 1 week hx of intermittent vomiting and abdominal pain. Initially seen 7/13 & 7/14 for same. DXd with viral illness/gastroenteritis. Admitted for further w/u. PE (+) for hypoactive BS, tenderness to palpation. BE (+) for IS. Unable to reduce x3. Transfered to another facility for surgical reduction of intussusception.


Changed on 2/14/2017

VAERS ID: 288035 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:California
Vaccinated:2007-07-09
Onset:2007-07-13
Submitted:2007-07-23
Entered:2007-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B092AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF051AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47300A / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0847F / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Abdominal tenderness, Barium enema, Intussusception, Small intestinal intussusception reduction, Surgery, Urinary system X-ray, Vomiting, X-ray, Immunology test, Gastrointestinal sounds abnormal

Life Threatening? Yes
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: X-ray, Barium enema, Surgery. Labs and diagnostics: KUB with defect noted c/w possible intussusception. Barium enema with impression Ileocolic Intussusception. Path report recd from CDC. IHC (-) for Adenovirus and Rotavirus A.
CDC 'Split Type':

Write-up: Intussusception. 8/21/2007 Vax record received and reviewed. Initial hospital record also rec''d. Infant presented for c/o 1 week hx of intermittent vomiting and abdominal pain. Initially seen 7/13 & 7/14 for same. DXd with viral illness/gastroenteritis. Admitted for further w/u. PE (+) for hypoactive BS, tenderness to palpation. BE (+) for IS. Unable to reduce x3. Transfered to another facility for surgical reduction of intussusception.


Changed on 9/14/2017

VAERS ID: 288035 Before After
VAERS Form:(blank) 1
Age:0.3
Gender:Female
Location:California
Vaccinated:2007-07-09
Onset:2007-07-13
Submitted:2007-07-23
Entered:2007-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B092AA / 1 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF051AA / 1 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47300A / 1 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0847F / 1 2 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Intussusception, Surgery, X-ray

Life Threatening? Yes
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: X-ray, Barium enema, Surgery. Labs and diagnostics: KUB with defect noted c/w possible intussusception. Barium enema with impression Ileocolic Intussusception. Path report recd from CDC. IHC (-) for Adenovirus and Rotavirus A.
CDC 'Split Type':

Write-up: Intussusception. 8/21/2007 Vax record received and reviewed. Initial hospital record also rec''d. Infant presented for c/o 1 week hx of intermittent vomiting and abdominal pain. Initially seen 7/13 & 7/14 for same. DXd with viral illness/gastroenteritis. Admitted for further w/u. PE (+) for hypoactive BS, tenderness to palpation. BE (+) for IS. Unable to reduce x3. Transfered to another facility for surgical reduction of intussusception.


Changed on 2/14/2018

VAERS ID: 288035 Before After
VAERS Form:1
Age:0.3
Gender:Female
Location:California
Vaccinated:2007-07-09
Onset:2007-07-13
Submitted:2007-07-23
Entered:2007-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B092AA / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF051AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47300A / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0847F / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Intussusception, Surgery, X-ray

Life Threatening? Yes
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: X-ray, Barium enema, Surgery. Labs and diagnostics: KUB with defect noted c/w possible intussusception. Barium enema with impression Ileocolic Intussusception. Path report recd from CDC. IHC (-) for Adenovirus and Rotavirus A.
CDC 'Split Type':

Write-up: Intussusception. 8/21/2007 Vax record received and reviewed. Initial hospital record also rec''d. Infant presented for c/o 1 week hx of intermittent vomiting and abdominal pain. Initially seen 7/13 & 7/14 for same. DXd with viral illness/gastroenteritis. Admitted for further w/u. PE (+) for hypoactive BS, tenderness to palpation. BE (+) for IS. Unable to reduce x3. Transfered to another facility for surgical reduction of intussusception.


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