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This is VAERS ID 288350

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 288350
VAERS Form:
Age:0.4
Gender:Female
Location:New Jersey
Vaccinated:2007-07-11
Onset:2007-07-22
Submitted:2007-08-13
Entered:2007-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2655AA / 1 - / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE980AA / 1 - / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Abnormal faeces, Appendicectomy, Barium enema, Full blood count, 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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None, other than GE reflux
Allergies:
Diagnostic Lab Data: Barium enema - defect; guaiac positive stool
CDC 'Split Type':

Write-up: Intussusception 7/22/07 requiring surgical reduction


Changed on 12/8/2009

VAERS ID: 288350 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:New Jersey
Vaccinated:2007-07-11
Onset:2007-07-22
Submitted:2007-08-13
Entered:2007-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2655AA / 1 - / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE980AA / 1 - / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 1 - / PO

Administered by: Private      Purchased by: Unknown Public
Symptoms: Abnormal faeces, Appendicectomy, Barium enema, Full blood count, Haematochezia, Intussusception, Small intestinal intussusception reduction, Surgery, Vomiting, White blood cell count increased, Abdominal X-ray, Occult blood positive, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None, other than GE reflux reflux. PMH: Acid reflux, coughing. NKDA.
Allergies:
Diagnostic Lab Data: Barium enema - defect; guaiac positive stool stool. Labs and Diagnostics: Abdominal X-ray (+) for some dilated bowel and opacification-consider IS. Barium enema showed a moderate sized filling defect. Contrast could not be refluxed into the te
CDC 'Split Type':

Write-up: Intussusception 7/22/07 requiring surgical reduction. 8/20/2007 MR received for DOS 7/22-27/2007. Infant presented to ER with parental c/o vomiting and poor PO intake. PE WNL. Passed a large, loose, guiac (+), foul-smelling stool in ER. Taken to OR for reduction of ileocolic intussusception and appendectomy. D/C DX: Intussusception. 10/18/2007 Vax record received and reviewed. Data same as VAERS report.


Changed on 5/13/2013

VAERS ID: 288350 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:New Jersey
Vaccinated:2007-07-11
Onset:2007-07-22
Submitted:2007-08-13
Entered:2007-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2655AA / 1 - / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE980AA / 1 - / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abnormal faeces, Appendicectomy, Barium enema, Full blood count, Haematochezia, Intussusception, Small intestinal intussusception reduction, Surgery, Vomiting, White blood cell count increased, Abdominal X-ray, Occult blood positive, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None, other than GE reflux. PMH: Acid reflux, coughing. NKDA.
Allergies:
Diagnostic Lab Data: Barium enema - defect; guaiac positive stool. Labs and Diagnostics: Abdominal X-ray (+) for some dilated bowel and opacification-consider IS. Barium enema showed a moderate sized filling defect. Contrast could not be refluxed into the te
CDC 'Split Type':

Write-up: Intussusception 7/22/07 requiring surgical reduction. 8/20/2007 MR received for DOS 7/22-27/2007. Infant presented to ER with parental c/o vomiting and poor PO intake. PE WNL. Passed a large, loose, guiac (+), foul-smelling stool in ER. Taken to OR for reduction of ileocolic intussusception and appendectomy. D/C DX: Intussusception. 10/18/2007 Vax record received and reviewed. Data same as VAERS report.


Changed on 5/14/2017

VAERS ID: 288350 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:New Jersey
Vaccinated:2007-07-11
Onset:2007-07-22
Submitted:2007-08-13
Entered:2007-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2655AA / 1 - / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE980AA / 1 - / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abnormal faeces, Appendicectomy, Barium enema, Full blood count, Haematochezia, Intussusception, Small intestinal intussusception reduction, Surgery, Vomiting, White blood cell count increased, Abdominal X-ray, Occult blood positive, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None, other than GE reflux. PMH: Acid reflux, coughing. NKDA.
Allergies:
Diagnostic Lab Data: Barium enema - defect; guaiac positive stool. Labs and Diagnostics: Abdominal X-ray (+) for some dilated bowel and opacification-consider IS. Barium enema showed a moderate sized filling defect. Contrast could not be refluxed into the te terminal ileum. CBC with WBCs of 21.3 on admission. 14.9 by 7/25/07.
CDC 'Split Type':

Write-up: Intussusception 7/22/07 requiring surgical reduction. 8/20/2007 MR received for DOS 7/22-27/2007. Infant presented to ER with parental c/o vomiting and poor PO intake. PE WNL. Passed a large, loose, guiac (+), foul-smelling stool in ER. Taken to OR for reduction of ileocolic intussusception and appendectomy. D/C DX: Intussusception. 10/18/2007 Vax record received and reviewed. Data same as VAERS report.


Changed on 9/14/2017

VAERS ID: 288350 Before After
VAERS Form:(blank) 1
Age:0.4
Gender:Female
Location:New Jersey
Vaccinated:2007-07-11
Onset:2007-07-22
Submitted:2007-08-13
Entered:2007-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2655AA / 1 2 - / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE980AA / 1 2 - / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 1 2 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Intussusception, Surgery, Occult blood positive

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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None, other than GE reflux. PMH: Acid reflux, coughing. NKDA.
Allergies:
Diagnostic Lab Data: Barium enema - defect; guaiac positive stool. Labs and Diagnostics: Abdominal X-ray (+) for some dilated bowel and opacification-consider IS. Barium enema showed a moderate sized filling defect. Contrast could not be refluxed into the terminal ileum. CBC with WBCs of 21.3 on admission. 14.9 by 7/25/07.
CDC 'Split Type':

Write-up: Intussusception 7/22/07 requiring surgical reduction. 8/20/2007 MR received for DOS 7/22-27/2007. Infant presented to ER with parental c/o vomiting and poor PO intake. PE WNL. Passed a large, loose, guiac (+), foul-smelling stool in ER. Taken to OR for reduction of ileocolic intussusception and appendectomy. D/C DX: Intussusception. 10/18/2007 Vax record received and reviewed. Data same as VAERS report.


Changed on 2/14/2018

VAERS ID: 288350 Before After
VAERS Form:1
Age:0.4
Gender:Female
Location:New Jersey
Vaccinated:2007-07-11
Onset:2007-07-22
Submitted:2007-08-13
Entered:2007-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2655AA / 2 - / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE980AA / 2 - / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Intussusception, Surgery, Occult blood positive

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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None, other than GE reflux. PMH: Acid reflux, coughing. NKDA.
Allergies:
Diagnostic Lab Data: Barium enema - defect; guaiac positive stool. Labs and Diagnostics: Abdominal X-ray (+) for some dilated bowel and opacification-consider IS. Barium enema showed a moderate sized filling defect. Contrast could not be refluxed into the terminal ileum. CBC with WBCs of 21.3 on admission. 14.9 by 7/25/07.
CDC 'Split Type':

Write-up: Intussusception 7/22/07 requiring surgical reduction. 8/20/2007 MR received for DOS 7/22-27/2007. Infant presented to ER with parental c/o vomiting and poor PO intake. PE WNL. Passed a large, loose, guiac (+), foul-smelling stool in ER. Taken to OR for reduction of ileocolic intussusception and appendectomy. D/C DX: Intussusception. 10/18/2007 Vax record received and reviewed. Data same as VAERS report.


Changed on 6/14/2018

VAERS ID: 288350 Before After
VAERS Form:1
Age:0.4
Gender:Female
Location:New Jersey
Vaccinated:2007-07-11
Onset:2007-07-22
Submitted:2007-08-13
Entered:2007-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2655AA / 2 - / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE980AA / 2 - / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Intussusception, Surgery, Occult blood positive

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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None, other than GE reflux. PMH: Acid reflux, coughing. NKDA.
Allergies:
Diagnostic Lab Data: Barium enema - defect; guaiac positive stool. Labs and Diagnostics: Abdominal X-ray (+) for some dilated bowel and opacification-consider IS. Barium enema showed a moderate sized filling defect. Contrast could not be refluxed into the terminal ileum. CBC with WBCs of 21.3 on admission. 14.9 by 7/25/07.
CDC 'Split Type':

Write-up: Intussusception 7/22/07 requiring surgical reduction. 8/20/2007 MR received for DOS 7/22-27/2007. Infant presented to ER with parental c/o vomiting and poor PO intake. PE WNL. Passed a large, loose, guiac (+), foul-smelling stool in ER. Taken to OR for reduction of ileocolic intussusception and appendectomy. D/C DX: Intussusception. 10/18/2007 Vax record received and reviewed. Data same as VAERS report.


Changed on 8/14/2018

VAERS ID: 288350 Before After
VAERS Form:1
Age:0.4
Gender:Female
Location:New Jersey
Vaccinated:2007-07-11
Onset:2007-07-22
Submitted:2007-08-13
Entered:2007-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2655AA / 2 - / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE980AA / 2 - / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Intussusception, Surgery, Occult blood positive

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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None, other than GE reflux. PMH: Acid reflux, coughing. NKDA.
Allergies:
Diagnostic Lab Data: Barium enema - defect; guaiac positive stool. Labs and Diagnostics: Abdominal X-ray (+) for some dilated bowel and opacification-consider IS. Barium enema showed a moderate sized filling defect. Contrast could not be refluxed into the terminal ileum. CBC with WBCs of 21.3 on admission. 14.9 by 7/25/07.
CDC 'Split Type':

Write-up: Intussusception 7/22/07 requiring surgical reduction. 8/20/2007 MR received for DOS 7/22-27/2007. Infant presented to ER with parental c/o vomiting and poor PO intake. PE WNL. Passed a large, loose, guiac (+), foul-smelling stool in ER. Taken to OR for reduction of ileocolic intussusception and appendectomy. D/C DX: Intussusception. 10/18/2007 Vax record received and reviewed. Data same as VAERS report.


Changed on 9/14/2018

VAERS ID: 288350 Before After
VAERS Form:1
Age:0.4
Gender:Female
Location:New Jersey
Vaccinated:2007-07-11
Onset:2007-07-22
Submitted:2007-08-13
Entered:2007-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2655AA / 2 - / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE980AA / 2 - / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Intussusception, Surgery, Occult blood positive

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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None, other than GE reflux. PMH: Acid reflux, coughing. NKDA.
Allergies:
Diagnostic Lab Data: Barium enema - defect; guaiac positive stool. Labs and Diagnostics: Abdominal X-ray (+) for some dilated bowel and opacification-consider IS. Barium enema showed a moderate sized filling defect. Contrast could not be refluxed into the terminal ileum. CBC with WBCs of 21.3 on admission. 14.9 by 7/25/07.
CDC 'Split Type':

Write-up: Intussusception 7/22/07 requiring surgical reduction. 8/20/2007 MR received for DOS 7/22-27/2007. Infant presented to ER with parental c/o vomiting and poor PO intake. PE WNL. Passed a large, loose, guiac (+), foul-smelling stool in ER. Taken to OR for reduction of ileocolic intussusception and appendectomy. D/C DX: Intussusception. 10/18/2007 Vax record received and reviewed. Data same as VAERS report.


Changed on 10/14/2018

VAERS ID: 288350 Before After
VAERS Form:1
Age:0.4
Gender:Female
Location:New Jersey
Vaccinated:2007-07-11
Onset:2007-07-22
Submitted:2007-08-13
Entered:2007-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2655AA / 2 - / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE980AA / 2 - / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Intussusception, Surgery, Occult blood positive

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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None, other than GE reflux. PMH: Acid reflux, coughing. NKDA.
Allergies:
Diagnostic Lab Data: Barium enema - defect; guaiac positive stool. Labs and Diagnostics: Abdominal X-ray (+) for some dilated bowel and opacification-consider IS. Barium enema showed a moderate sized filling defect. Contrast could not be refluxed into the terminal ileum. CBC with WBCs of 21.3 on admission. 14.9 by 7/25/07.
CDC 'Split Type':

Write-up: Intussusception 7/22/07 requiring surgical reduction. 8/20/2007 MR received for DOS 7/22-27/2007. Infant presented to ER with parental c/o vomiting and poor PO intake. PE WNL. Passed a large, loose, guiac (+), foul-smelling stool in ER. Taken to OR for reduction of ileocolic intussusception and appendectomy. D/C DX: Intussusception. 10/18/2007 Vax record received and reviewed. Data same as VAERS report.

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