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This is VAERS ID 288995

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 288995
VAERS Form:
Age:0.3
Gender:Female
Location:Texas
Vaccinated:2007-05-01
Onset:2007-05-14
Submitted:2007-08-25
Entered:2007-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2554AA / 1 LL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UF099AA / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER 20326 / 1 - / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B36258D / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 02370 / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium double contrast, Haematochezia, Intussusception, Enema administration

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prilosec
Current Illness: None
Preexisting Conditions: Acid reflux, eczema
Allergies:
Diagnostic Lab Data: Xrays, air enema
CDC 'Split Type':

Write-up: Given Rotateq vaccine on May 1, 2007, developed symptoms of intussusception on May 14, 2007 and then officially diagnosed, treated, and hospitalized for intussusception on May 17, 2007


Changed on 12/8/2009

VAERS ID: 288995 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Texas
Vaccinated:2007-05-01
Onset:2007-05-14
Submitted:2007-08-25
Entered:2007-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2554AA / 1 LL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UF099AA / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER 20326 / 1 - / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B36258D / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 02370 / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium double contrast, Haematochezia, Intussusception, Large intestinal obstruction reduction, Urinary system X-ray, Vomiting, X-ray, Enema administration

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prilosec
Current Illness: None
Preexisting Conditions: Acid reflux, eczema eczema. PMH: GERD
Allergies:
Diagnostic Lab Data: Xrays, air enema. Labs and Diagnostics: KUB suspicious for intussusception. Air contrast enema confirmed ileocolic intussusception which was sucessfully reduced.
CDC 'Split Type':

Write-up: Given Rotateq vaccine on May 1, 2007, developed symptoms of intussusception on May 14, 2007 and then officially diagnosed, treated, and hospitalized for intussusception on May 17, 2007. 0924/2007 Hospital record received for DOS 5/17-18/2007 for DX of Ileocolic Intussusception. Child presented to ER on 5/17/07 with 3 day hx of abdominal pain, vomiting and bloody stool. IS reduced by air contrast enema. PE (+) systolic ejection murmur prior to D/C.


Changed on 3/2/2010

VAERS ID: 288995 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Texas
Vaccinated:2007-05-01
Onset:2007-05-14
Submitted:2007-08-25
Entered:2007-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2554AA / 1 LL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UF099AA / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER 20326 / 1 - / -
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B36258D / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 02370 / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium double contrast, Haematochezia, Intussusception, Large intestinal obstruction reduction, Urinary system X-ray, Vomiting, X-ray, Enema administration

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prilosec
Current Illness: None
Preexisting Conditions: Acid reflux, eczema. PMH: GERD
Allergies:
Diagnostic Lab Data: Xrays, air enema. Labs and Diagnostics: KUB suspicious for intussusception. Air contrast enema confirmed ileocolic intussusception which was sucessfully reduced.
CDC 'Split Type':

Write-up: Given Rotateq vaccine on May 1, 2007, developed symptoms of intussusception on May 14, 2007 and then officially diagnosed, treated, and hospitalized for intussusception on May 17, 2007. 0924/2007 Hospital record received for DOS 5/17-18/2007 for DX of Ileocolic Intussusception. Child presented to ER on 5/17/07 with 3 day hx of abdominal pain, vomiting and bloody stool. IS reduced by air contrast enema. PE (+) systolic ejection murmur prior to D/C.


Changed on 4/7/2010

VAERS ID: 288995 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Texas
Vaccinated:2007-05-01
Onset:2007-05-14
Submitted:2007-08-25
Entered:2007-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2554AA / 1 LL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UF099AA / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER 20326 / 1 - / -
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B36258D / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 02370 / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium double contrast, Haematochezia, Intussusception, Large intestinal obstruction reduction, Urinary system X-ray, Vomiting, X-ray, Enema administration

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prilosec
Current Illness: None
Preexisting Conditions: Acid reflux, eczema. PMH: GERD
Allergies:
Diagnostic Lab Data: Xrays, air enema. Labs and Diagnostics: KUB suspicious for intussusception. Air contrast enema confirmed ileocolic intussusception which was sucessfully reduced.
CDC 'Split Type':

Write-up: Given Rotateq vaccine on May 1, 2007, developed symptoms of intussusception on May 14, 2007 and then officially diagnosed, treated, and hospitalized for intussusception on May 17, 2007. 0924/2007 Hospital record received for DOS 5/17-18/2007 for DX of Ileocolic Intussusception. Child presented to ER on 5/17/07 with 3 day hx of abdominal pain, vomiting and bloody stool. IS reduced by air contrast enema. PE (+) systolic ejection murmur prior to D/C.


Changed on 8/31/2010

VAERS ID: 288995 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Texas
Vaccinated:2007-05-01
Onset:2007-05-14
Submitted:2007-08-25
Entered:2007-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2554AA / 1 LL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UF099AA / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER 20326 / 1 - / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B36258D / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 02370 / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium double contrast, Haematochezia, Intussusception, Large intestinal obstruction reduction, Urinary system X-ray, Vomiting, X-ray, Enema administration

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prilosec
Current Illness: None
Preexisting Conditions: Acid reflux, eczema. PMH: GERD
Allergies:
Diagnostic Lab Data: Xrays, air enema. Labs and Diagnostics: KUB suspicious for intussusception. Air contrast enema confirmed ileocolic intussusception which was sucessfully reduced.
CDC 'Split Type':

Write-up: Given Rotateq vaccine on May 1, 2007, developed symptoms of intussusception on May 14, 2007 and then officially diagnosed, treated, and hospitalized for intussusception on May 17, 2007. 0924/2007 Hospital record received for DOS 5/17-18/2007 for DX of Ileocolic Intussusception. Child presented to ER on 5/17/07 with 3 day hx of abdominal pain, vomiting and bloody stool. IS reduced by air contrast enema. PE (+) systolic ejection murmur prior to D/C.


Changed on 5/13/2013

VAERS ID: 288995 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Texas
Vaccinated:2007-05-01
Onset:2007-05-14
Submitted:2007-08-25
Entered:2007-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2554AA / 1 LL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UF099AA / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER 20326 / 1 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B36258D / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 02370 / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 02370 / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium double contrast, Haematochezia, Intussusception, Large intestinal obstruction reduction, Urinary system X-ray, Vomiting, X-ray, Enema administration

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prilosec
Current Illness: None
Preexisting Conditions: Acid reflux, eczema. PMH: GERD
Allergies:
Diagnostic Lab Data: Xrays, air enema. Labs and Diagnostics: KUB suspicious for intussusception. Air contrast enema confirmed ileocolic intussusception which was sucessfully reduced.
CDC 'Split Type':

Write-up: Given Rotateq vaccine on May 1, 2007, developed symptoms of intussusception on May 14, 2007 and then officially diagnosed, treated, and hospitalized for intussusception on May 17, 2007. 0924/2007 Hospital record received for DOS 5/17-18/2007 for DX of Ileocolic Intussusception. Child presented to ER on 5/17/07 with 3 day hx of abdominal pain, vomiting and bloody stool. IS reduced by air contrast enema. PE (+) systolic ejection murmur prior to D/C.


Changed on 2/14/2017

VAERS ID: 288995 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Texas
Vaccinated:2007-05-01
Onset:2007-05-14
Submitted:2007-08-25
Entered:2007-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2554AA / 1 LL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UF099AA / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER 20326 / 1 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B36258D / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 02370 / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium double contrast, Haematochezia, Intussusception, Large intestinal obstruction reduction, Urinary system X-ray, Vomiting, X-ray, Enema administration

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prilosec
Current Illness: None
Preexisting Conditions: Acid reflux, eczema. PMH: GERD
Allergies:
Diagnostic Lab Data: Xrays, air enema. Labs and Diagnostics: KUB suspicious for intussusception. Air contrast enema confirmed ileocolic intussusception which was sucessfully reduced.
CDC 'Split Type':

Write-up: Given Rotateq vaccine on May 1, 2007, developed symptoms of intussusception on May 14, 2007 and then officially diagnosed, treated, and hospitalized for intussusception on May 17, 2007. 0924/2007 Hospital record received for DOS 5/17-18/2007 for DX of Ileocolic Intussusception. Child presented to ER on 5/17/07 with 3 day hx of abdominal pain, vomiting and bloody stool. IS reduced by air contrast enema. PE (+) systolic ejection murmur prior to D/C.


Changed on 9/14/2017

VAERS ID: 288995 Before After
VAERS Form:(blank) 1
Age:0.3
Gender:Female
Location:Texas
Vaccinated:2007-05-01
Onset:2007-05-14
Submitted:2007-08-25
Entered:2007-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2554AA / 1 2 LL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UF099AA / 1 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER 20326 / 1 2 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B36258D / 1 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 02370 / 1 2 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Intussusception, X-ray, Enema administration

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prilosec
Current Illness: None
Preexisting Conditions: Acid reflux, eczema. PMH: GERD
Allergies:
Diagnostic Lab Data: Xrays, air enema. Labs and Diagnostics: KUB suspicious for intussusception. Air contrast enema confirmed ileocolic intussusception which was sucessfully reduced.
CDC 'Split Type':

Write-up: Given Rotateq vaccine on May 1, 2007, developed symptoms of intussusception on May 14, 2007 and then officially diagnosed, treated, and hospitalized for intussusception on May 17, 2007. 0924/2007 Hospital record received for DOS 5/17-18/2007 for DX of Ileocolic Intussusception. Child presented to ER on 5/17/07 with 3 day hx of abdominal pain, vomiting and bloody stool. IS reduced by air contrast enema. PE (+) systolic ejection murmur prior to D/C.


Changed on 2/14/2018

VAERS ID: 288995 Before After
VAERS Form:1
Age:0.3
Gender:Female
Location:Texas
Vaccinated:2007-05-01
Onset:2007-05-14
Submitted:2007-08-25
Entered:2007-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2554AA / 2 LL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UF099AA / 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER 20326 / 2 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B36258D / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 02370 / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Intussusception, X-ray, Enema administration

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prilosec
Current Illness: None
Preexisting Conditions: Acid reflux, eczema. PMH: GERD
Allergies:
Diagnostic Lab Data: Xrays, air enema. Labs and Diagnostics: KUB suspicious for intussusception. Air contrast enema confirmed ileocolic intussusception which was sucessfully reduced.
CDC 'Split Type':

Write-up: Given Rotateq vaccine on May 1, 2007, developed symptoms of intussusception on May 14, 2007 and then officially diagnosed, treated, and hospitalized for intussusception on May 17, 2007. 0924/2007 Hospital record received for DOS 5/17-18/2007 for DX of Ileocolic Intussusception. Child presented to ER on 5/17/07 with 3 day hx of abdominal pain, vomiting and bloody stool. IS reduced by air contrast enema. PE (+) systolic ejection murmur prior to D/C.


Changed on 6/14/2018

VAERS ID: 288995 Before After
VAERS Form:1
Age:0.3
Gender:Female
Location:Texas
Vaccinated:2007-05-01
Onset:2007-05-14
Submitted:2007-08-25
Entered:2007-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2554AA / 2 LL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UF099AA / 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER 20326 / 2 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B36258D / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 02370 / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Intussusception, X-ray, Enema administration

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prilosec
Current Illness: None
Preexisting Conditions: Acid reflux, eczema. PMH: GERD
Allergies:
Diagnostic Lab Data: Xrays, air enema. Labs and Diagnostics: KUB suspicious for intussusception. Air contrast enema confirmed ileocolic intussusception which was sucessfully reduced.
CDC 'Split Type':

Write-up: Given Rotateq vaccine on May 1, 2007, developed symptoms of intussusception on May 14, 2007 and then officially diagnosed, treated, and hospitalized for intussusception on May 17, 2007. 0924/2007 Hospital record received for DOS 5/17-18/2007 for DX of Ileocolic Intussusception. Child presented to ER on 5/17/07 with 3 day hx of abdominal pain, vomiting and bloody stool. IS reduced by air contrast enema. PE (+) systolic ejection murmur prior to D/C.


Changed on 8/14/2018

VAERS ID: 288995 Before After
VAERS Form:1
Age:0.3
Gender:Female
Location:Texas
Vaccinated:2007-05-01
Onset:2007-05-14
Submitted:2007-08-25
Entered:2007-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2554AA / 2 LL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UF099AA / 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER 20326 / 2 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B36258D / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 02370 / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Intussusception, X-ray, Enema administration

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prilosec
Current Illness: None
Preexisting Conditions: Acid reflux, eczema. PMH: GERD
Allergies:
Diagnostic Lab Data: Xrays, air enema. Labs and Diagnostics: KUB suspicious for intussusception. Air contrast enema confirmed ileocolic intussusception which was sucessfully reduced.
CDC 'Split Type':

Write-up: Given Rotateq vaccine on May 1, 2007, developed symptoms of intussusception on May 14, 2007 and then officially diagnosed, treated, and hospitalized for intussusception on May 17, 2007. 0924/2007 Hospital record received for DOS 5/17-18/2007 for DX of Ileocolic Intussusception. Child presented to ER on 5/17/07 with 3 day hx of abdominal pain, vomiting and bloody stool. IS reduced by air contrast enema. PE (+) systolic ejection murmur prior to D/C.

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