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This is VAERS ID 289427

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 289427
VAERS Form:
Age:0.5
Gender:Female
Location:California
Vaccinated:2007-07-27
Onset:2007-08-18
Submitted:2007-08-30
Entered:2007-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B110AB / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE993AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08689K / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0778F / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium enema, Blood culture negative, Enema administration, Blood electrolytes normal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Intussusception~Rotavirus (Rotateq)~1~0~In Patient
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Barium enema 8-18-07.
CDC 'Split Type': none

Write-up: recurrent intussusception 8-18-07 (initial episode 6-07).


Changed on 12/8/2009

VAERS ID: 289427 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:California
Vaccinated:2007-07-27
Onset:2007-08-18
Submitted:2007-08-30
Entered:2007-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B110AB / 2 LL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B110AB / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE993AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08689K / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0778F / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium enema, Blood culture negative, Full blood count normal, Haematochezia, Intussusception, Mucous stools, Screaming, Vomiting, Enema administration, Blood electrolytes normal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Intussusception~Rotavirus (Rotateq)~1~0~In Patient
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Barium enema 8-18-07. LABS 2nd hospital: BE revealed IS at mid transverse colon, unsuccessful at reducing IS. CBC & electrolytes were WNL. Blood c/s neg. LABS 3rd hospital: air enema reduced IS.
CDC 'Split Type': none (blank)

Write-up: recurrent intussusception 8-18-07 (initial episode 6-07). 9/7/07 Received vax record from pcp which confirm vax all given on 7/27. Vaers database updated w/same. 9/7/07 Reviewed 2nd hospital medical records which reveal patient seen 8/18/07 for 2nd episode of IS. Initial episode 6/07. Presented on 8/18 w/abdominal pain, vomiting & had currant jelly stool in outlying ER. Transferred to higher level of care from 2nd hospital. 9/7/07 Reviewed 3rd hospital medical records which reveal patient admitted 8/18-8/19/07 for abdominal pain, screaming & drawing of legs to chest. Previous IS of 6/07 reduced w/air enema at same facility. Progressed well & was d/c to home. FINAL DX: Intussusception, enema reduced.


Changed on 3/2/2010

VAERS ID: 289427 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:California
Vaccinated:2007-07-27
Onset:2007-08-18
Submitted:2007-08-30
Entered:2007-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B110AB / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE993AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B08689K / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0778F / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium enema, Blood culture negative, Full blood count normal, Haematochezia, Intussusception, Mucous stools, Screaming, Vomiting, Enema administration, Blood electrolytes normal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Intussusception~Rotavirus (Rotateq)~1~0~In Patient
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Barium enema 8-18-07. LABS 2nd hospital: BE revealed IS at mid transverse colon, unsuccessful at reducing IS. CBC & electrolytes were WNL. Blood c/s neg. LABS 3rd hospital: air enema reduced IS.
CDC 'Split Type':

Write-up: recurrent intussusception 8-18-07 (initial episode 6-07). 9/7/07 Received vax record from pcp which confirm vax all given on 7/27. Vaers database updated w/same. 9/7/07 Reviewed 2nd hospital medical records which reveal patient seen 8/18/07 for 2nd episode of IS. Initial episode 6/07. Presented on 8/18 w/abdominal pain, vomiting & had currant jelly stool in outlying ER. Transferred to higher level of care from 2nd hospital. 9/7/07 Reviewed 3rd hospital medical records which reveal patient admitted 8/18-8/19/07 for abdominal pain, screaming & drawing of legs to chest. Previous IS of 6/07 reduced w/air enema at same facility. Progressed well & was d/c to home. FINAL DX: Intussusception, enema reduced.


Changed on 4/7/2010

VAERS ID: 289427 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:California
Vaccinated:2007-07-27
Onset:2007-08-18
Submitted:2007-08-30
Entered:2007-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B110AB / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE993AA / 2 RL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08689K / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0778F / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium enema, Blood culture negative, Full blood count normal, Haematochezia, Intussusception, Mucous stools, Screaming, Vomiting, Enema administration, Blood electrolytes normal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Intussusception~Rotavirus (Rotateq)~1~0~In Patient
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Barium enema 8-18-07. LABS 2nd hospital: BE revealed IS at mid transverse colon, unsuccessful at reducing IS. CBC & electrolytes were WNL. Blood c/s neg. LABS 3rd hospital: air enema reduced IS.
CDC 'Split Type':

Write-up: recurrent intussusception 8-18-07 (initial episode 6-07). 9/7/07 Received vax record from pcp which confirm vax all given on 7/27. Vaers database updated w/same. 9/7/07 Reviewed 2nd hospital medical records which reveal patient seen 8/18/07 for 2nd episode of IS. Initial episode 6/07. Presented on 8/18 w/abdominal pain, vomiting & had currant jelly stool in outlying ER. Transferred to higher level of care from 2nd hospital. 9/7/07 Reviewed 3rd hospital medical records which reveal patient admitted 8/18-8/19/07 for abdominal pain, screaming & drawing of legs to chest. Previous IS of 6/07 reduced w/air enema at same facility. Progressed well & was d/c to home. FINAL DX: Intussusception, enema reduced.


Changed on 8/31/2010

VAERS ID: 289427 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:California
Vaccinated:2007-07-27
Onset:2007-08-18
Submitted:2007-08-30
Entered:2007-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B110AB / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE993AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B08689K / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0778F / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium enema, Blood culture negative, Full blood count normal, Haematochezia, Intussusception, Mucous stools, Screaming, Vomiting, Enema administration, Blood electrolytes normal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Intussusception~Rotavirus (Rotateq)~1~0~In Patient
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Barium enema 8-18-07. LABS 2nd hospital: BE revealed IS at mid transverse colon, unsuccessful at reducing IS. CBC & electrolytes were WNL. Blood c/s neg. LABS 3rd hospital: air enema reduced IS.
CDC 'Split Type':

Write-up: recurrent intussusception 8-18-07 (initial episode 6-07). 9/7/07 Received vax record from pcp which confirm vax all given on 7/27. Vaers database updated w/same. 9/7/07 Reviewed 2nd hospital medical records which reveal patient seen 8/18/07 for 2nd episode of IS. Initial episode 6/07. Presented on 8/18 w/abdominal pain, vomiting & had currant jelly stool in outlying ER. Transferred to higher level of care from 2nd hospital. 9/7/07 Reviewed 3rd hospital medical records which reveal patient admitted 8/18-8/19/07 for abdominal pain, screaming & drawing of legs to chest. Previous IS of 6/07 reduced w/air enema at same facility. Progressed well & was d/c to home. FINAL DX: Intussusception, enema reduced.


Changed on 5/13/2013

VAERS ID: 289427 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:California
Vaccinated:2007-07-27
Onset:2007-08-18
Submitted:2007-08-30
Entered:2007-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B110AB / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE993AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08689K / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0778F / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0778F / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium enema, Blood culture negative, Full blood count normal, Haematochezia, Intussusception, Mucous stools, Screaming, Vomiting, Enema administration, Blood electrolytes normal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Intussusception~Rotavirus (Rotateq)~1~0~In Patient
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Barium enema 8-18-07. LABS 2nd hospital: BE revealed IS at mid transverse colon, unsuccessful at reducing IS. CBC & electrolytes were WNL. Blood c/s neg. LABS 3rd hospital: air enema reduced IS.
CDC 'Split Type':

Write-up: recurrent intussusception 8-18-07 (initial episode 6-07). 9/7/07 Received vax record from pcp which confirm vax all given on 7/27. Vaers database updated w/same. 9/7/07 Reviewed 2nd hospital medical records which reveal patient seen 8/18/07 for 2nd episode of IS. Initial episode 6/07. Presented on 8/18 w/abdominal pain, vomiting & had currant jelly stool in outlying ER. Transferred to higher level of care from 2nd hospital. 9/7/07 Reviewed 3rd hospital medical records which reveal patient admitted 8/18-8/19/07 for abdominal pain, screaming & drawing of legs to chest. Previous IS of 6/07 reduced w/air enema at same facility. Progressed well & was d/c to home. FINAL DX: Intussusception, enema reduced.


Changed on 2/14/2017

VAERS ID: 289427 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:California
Vaccinated:2007-07-27
Onset:2007-08-18
Submitted:2007-08-30
Entered:2007-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B110AB / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE993AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08689K / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0778F / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium enema, Blood culture negative, Full blood count normal, Haematochezia, Intussusception, Mucous stools, Screaming, Vomiting, Enema administration, Blood electrolytes normal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Intussusception~Rotavirus (Rotateq)~1~0~In (Rotateq)~1~0.40~In Patient
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Barium enema 8-18-07. LABS 2nd hospital: BE revealed IS at mid transverse colon, unsuccessful at reducing IS. CBC & electrolytes were WNL. Blood c/s neg. LABS 3rd hospital: air enema reduced IS.
CDC 'Split Type':

Write-up: recurrent intussusception 8-18-07 (initial episode 6-07). 9/7/07 Received vax record from pcp which confirm vax all given on 7/27. Vaers database updated w/same. 9/7/07 Reviewed 2nd hospital medical records which reveal patient seen 8/18/07 for 2nd episode of IS. Initial episode 6/07. Presented on 8/18 w/abdominal pain, vomiting & had currant jelly stool in outlying ER. Transferred to higher level of care from 2nd hospital. 9/7/07 Reviewed 3rd hospital medical records which reveal patient admitted 8/18-8/19/07 for abdominal pain, screaming & drawing of legs to chest. Previous IS of 6/07 reduced w/air enema at same facility. Progressed well & was d/c to home. FINAL DX: Intussusception, enema reduced.


Changed on 9/14/2017

VAERS ID: 289427 Before After
VAERS Form:(blank) 1
Age:0.5
Gender:Female
Location:California
Vaccinated:2007-07-27
Onset:2007-08-18
Submitted:2007-08-30
Entered:2007-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B110AB / 2 3 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE993AA / 2 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08689K / 2 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0778F / 1 2 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Intussusception~Rotavirus (Rotateq)~1~0.40~In Patient
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Barium enema 8-18-07. LABS 2nd hospital: BE revealed IS at mid transverse colon, unsuccessful at reducing IS. CBC & electrolytes were WNL. Blood c/s neg. LABS 3rd hospital: air enema reduced IS.
CDC 'Split Type':

Write-up: recurrent intussusception 8-18-07 (initial episode 6-07). 9/7/07 Received vax record from pcp which confirm vax all given on 7/27. Vaers database updated w/same. 9/7/07 Reviewed 2nd hospital medical records which reveal patient seen 8/18/07 for 2nd episode of IS. Initial episode 6/07. Presented on 8/18 w/abdominal pain, vomiting & had currant jelly stool in outlying ER. Transferred to higher level of care from 2nd hospital. 9/7/07 Reviewed 3rd hospital medical records which reveal patient admitted 8/18-8/19/07 for abdominal pain, screaming & drawing of legs to chest. Previous IS of 6/07 reduced w/air enema at same facility. Progressed well & was d/c to home. FINAL DX: Intussusception, enema reduced.


Changed on 2/14/2018

VAERS ID: 289427 Before After
VAERS Form:1
Age:0.5
Gender:Female
Location:California
Vaccinated:2007-07-27
Onset:2007-08-18
Submitted:2007-08-30
Entered:2007-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B110AB / 3 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE993AA / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08689K / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0778F / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Intussusception~Rotavirus (Rotateq)~1~0.40~In Patient
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Barium enema 8-18-07. LABS 2nd hospital: BE revealed IS at mid transverse colon, unsuccessful at reducing IS. CBC & electrolytes were WNL. Blood c/s neg. LABS 3rd hospital: air enema reduced IS.
CDC 'Split Type':

Write-up: recurrent intussusception 8-18-07 (initial episode 6-07). 9/7/07 Received vax record from pcp which confirm vax all given on 7/27. Vaers database updated w/same. 9/7/07 Reviewed 2nd hospital medical records which reveal patient seen 8/18/07 for 2nd episode of IS. Initial episode 6/07. Presented on 8/18 w/abdominal pain, vomiting & had currant jelly stool in outlying ER. Transferred to higher level of care from 2nd hospital. 9/7/07 Reviewed 3rd hospital medical records which reveal patient admitted 8/18-8/19/07 for abdominal pain, screaming & drawing of legs to chest. Previous IS of 6/07 reduced w/air enema at same facility. Progressed well & was d/c to home. FINAL DX: Intussusception, enema reduced.


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