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This is VAERS ID 289592

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 289592
VAERS Form:
Age:0.3
Gender:Female
Location:Virginia
Vaccinated:2007-07-13
Onset:2007-08-13
Submitted:2007-08-20
Entered:2007-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B090M / 0 LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1435F / 0 RL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08681K / 0 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1114F / 0 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: Abdominal distension, Barium double contrast, Gastrointestinal haemorrhage, Enema administration, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: Air contrast enema
CDC 'Split Type':

Write-up: 4 mo with intussusception


Changed on 12/8/2009

VAERS ID: 289592 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Virginia
Vaccinated:2007-07-13
Onset:2007-08-13
Submitted:2007-08-20
Entered:2007-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B090M / 0 LL / UN
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B090M / 0 LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1435F / 0 RL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08681K / 0 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1114F / 0 - / PO

Administered by: Public      Purchased by: Unknown Public
Symptoms: Abdominal distension, Barium double contrast, Gastrointestinal haemorrhage, Haematochezia, Intestinal obstruction, Intussusception, Lethargy, Vomiting, Enema administration, Abdominal X-ray, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No Birth HX: c-section due to breech presentation.
Allergies:
Diagnostic Lab Data: Air contrast enema LABS: abdominal series revealed IS. air contrast enema revealed sigmoid colon IS.
CDC 'Split Type':

Write-up: 4 mo with intussusception intussusception. 9/14/07 Reviewed ER medical records which reveal patient experienced vomiting, lethargy & bloody stools x 3 on 8/13/07. DX w/acute GI bleed & transferred to higher level of care. 10/5/07 Received vax record from community health center which confirms lot # but reveals 7/13 dose was 1st dose. VAERS database updated w/same. Vax record faxed to CDC. 10/5/07 Received hospital medical records which reveal patient experienced bloody stools, bilious vomiting, abdominal distention & reduced oral intake x 1 day. Seen in outlying ER & transferred to higher level of care. Admitted 8/13-8/15/2007 for peds surgery. Proximal bowel noted to be significntly dilated & NGT placed for decompression. Able to d/c NGT next day & tolerated oral feeds. Progressed well & d/c to home. FINAL DX: Intussusception w/obstructive symptoms, s/p difficult air enema reduction. Records faxed to CDC.


Changed on 3/2/2010

VAERS ID: 289592 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Virginia
Vaccinated:2007-07-13
Onset:2007-08-13
Submitted:2007-08-20
Entered:2007-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B090M / 0 LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1435F / 0 RL / UN
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B08681K / 0 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1114F / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Abdominal distension, Barium double contrast, Gastrointestinal haemorrhage, Haematochezia, Intestinal obstruction, Intussusception, Lethargy, Vomiting, Enema administration, Abdominal X-ray, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No Birth HX: c-section due to breech presentation.
Allergies:
Diagnostic Lab Data: Air contrast enema LABS: abdominal series revealed IS. air contrast enema revealed sigmoid colon IS.
CDC 'Split Type':

Write-up: 4 mo with intussusception. 9/14/07 Reviewed ER medical records which reveal patient experienced vomiting, lethargy & bloody stools x 3 on 8/13/07. DX w/acute GI bleed & transferred to higher level of care. 10/5/07 Received vax record from community health center which confirms lot # but reveals 7/13 dose was 1st dose. VAERS database updated w/same. Vax record faxed to CDC. 10/5/07 Received hospital medical records which reveal patient experienced bloody stools, bilious vomiting, abdominal distention & reduced oral intake x 1 day. Seen in outlying ER & transferred to higher level of care. Admitted 8/13-8/15/2007 for peds surgery. Proximal bowel noted to be significntly dilated & NGT placed for decompression. Able to d/c NGT next day & tolerated oral feeds. Progressed well & d/c to home. FINAL DX: Intussusception w/obstructive symptoms, s/p difficult air enema reduction. Records faxed to CDC.


Changed on 4/7/2010

VAERS ID: 289592 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Virginia
Vaccinated:2007-07-13
Onset:2007-08-13
Submitted:2007-08-20
Entered:2007-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B090M / 0 LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1435F / 0 RL / UN
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08681K / 0 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1114F / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Abdominal distension, Barium double contrast, Gastrointestinal haemorrhage, Haematochezia, Intestinal obstruction, Intussusception, Lethargy, Vomiting, Enema administration, Abdominal X-ray, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No Birth HX: c-section due to breech presentation.
Allergies:
Diagnostic Lab Data: Air contrast enema LABS: abdominal series revealed IS. air contrast enema revealed sigmoid colon IS.
CDC 'Split Type':

Write-up: 4 mo with intussusception. 9/14/07 Reviewed ER medical records which reveal patient experienced vomiting, lethargy & bloody stools x 3 on 8/13/07. DX w/acute GI bleed & transferred to higher level of care. 10/5/07 Received vax record from community health center which confirms lot # but reveals 7/13 dose was 1st dose. VAERS database updated w/same. Vax record faxed to CDC. 10/5/07 Received hospital medical records which reveal patient experienced bloody stools, bilious vomiting, abdominal distention & reduced oral intake x 1 day. Seen in outlying ER & transferred to higher level of care. Admitted 8/13-8/15/2007 for peds surgery. Proximal bowel noted to be significntly dilated & NGT placed for decompression. Able to d/c NGT next day & tolerated oral feeds. Progressed well & d/c to home. FINAL DX: Intussusception w/obstructive symptoms, s/p difficult air enema reduction. Records faxed to CDC.


Changed on 8/31/2010

VAERS ID: 289592 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Virginia
Vaccinated:2007-07-13
Onset:2007-08-13
Submitted:2007-08-20
Entered:2007-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B090M / 0 LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1435F / 0 RL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B08681K / 0 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1114F / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Abdominal distension, Barium double contrast, Gastrointestinal haemorrhage, Haematochezia, Intestinal obstruction, Intussusception, Lethargy, Vomiting, Enema administration, Abdominal X-ray, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No Birth HX: c-section due to breech presentation.
Allergies:
Diagnostic Lab Data: Air contrast enema LABS: abdominal series revealed IS. air contrast enema revealed sigmoid colon IS.
CDC 'Split Type':

Write-up: 4 mo with intussusception. 9/14/07 Reviewed ER medical records which reveal patient experienced vomiting, lethargy & bloody stools x 3 on 8/13/07. DX w/acute GI bleed & transferred to higher level of care. 10/5/07 Received vax record from community health center which confirms lot # but reveals 7/13 dose was 1st dose. VAERS database updated w/same. Vax record faxed to CDC. 10/5/07 Received hospital medical records which reveal patient experienced bloody stools, bilious vomiting, abdominal distention & reduced oral intake x 1 day. Seen in outlying ER & transferred to higher level of care. Admitted 8/13-8/15/2007 for peds surgery. Proximal bowel noted to be significntly dilated & NGT placed for decompression. Able to d/c NGT next day & tolerated oral feeds. Progressed well & d/c to home. FINAL DX: Intussusception w/obstructive symptoms, s/p difficult air enema reduction. Records faxed to CDC.


Changed on 5/13/2013

VAERS ID: 289592 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Virginia
Vaccinated:2007-07-13
Onset:2007-08-13
Submitted:2007-08-20
Entered:2007-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B090M / 0 LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1435F / 0 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08681K / 0 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1114F / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1114F / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Abdominal distension, Barium double contrast, Gastrointestinal haemorrhage, Haematochezia, Intestinal obstruction, Intussusception, Lethargy, Vomiting, Enema administration, Abdominal X-ray, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No Birth HX: c-section due to breech presentation.
Allergies:
Diagnostic Lab Data: Air contrast enema LABS: abdominal series revealed IS. air contrast enema revealed sigmoid colon IS.
CDC 'Split Type':

Write-up: 4 mo with intussusception. 9/14/07 Reviewed ER medical records which reveal patient experienced vomiting, lethargy & bloody stools x 3 on 8/13/07. DX w/acute GI bleed & transferred to higher level of care. 10/5/07 Received vax record from community health center which confirms lot # but reveals 7/13 dose was 1st dose. VAERS database updated w/same. Vax record faxed to CDC. 10/5/07 Received hospital medical records which reveal patient experienced bloody stools, bilious vomiting, abdominal distention & reduced oral intake x 1 day. Seen in outlying ER & transferred to higher level of care. Admitted 8/13-8/15/2007 for peds surgery. Proximal bowel noted to be significntly dilated & NGT placed for decompression. Able to d/c NGT next day & tolerated oral feeds. Progressed well & d/c to home. FINAL DX: Intussusception w/obstructive symptoms, s/p difficult air enema reduction. Records faxed to CDC.


Changed on 5/14/2017

VAERS ID: 289592 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Virginia
Vaccinated:2007-07-13
Onset:2007-08-13
Submitted:2007-08-20
Entered:2007-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B090M / 0 LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1435F / 0 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08681K / 0 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1114F / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Abdominal distension, Barium double contrast, Gastrointestinal haemorrhage, Haematochezia, Intestinal obstruction, Intussusception, Lethargy, Vomiting, Enema administration, Abdominal X-ray, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No Birth HX: c-section due to breech presentation.
Allergies:
Diagnostic Lab Data: Air contrast enema LABS: abdominal series revealed IS. air contrast enema revealed sigmoid colon IS.
CDC 'Split Type':

Write-up: 4 mo with intussusception. 9/14/07 Reviewed ER medical records which reveal patient experienced vomiting, lethargy & bloody stools x 3 on 8/13/07. DX w/acute GI bleed & transferred to higher level of care. 10/5/07 Received vax record from community health center which confirms lot # but reveals 7/13 dose was 1st dose. VAERS database updated w/same. Vax record faxed to CDC. 10/5/07 Received hospital medical records which reveal patient experienced bloody stools, bilious vomiting, abdominal distention & reduced oral intake x 1 day. Seen in outlying ER & transferred to higher level of care. Admitted 8/13-8/15/2007 for peds surgery. Proximal bowel noted to be significntly dilated & NGT placed for decompression. Able to d/c NGT next day & tolerated oral feeds. Progressed well & d/c to home. FINAL DX: Intussusception w/obstructive symptoms, s/p difficult air enema reduction. Records faxed to CDC.


Changed on 9/14/2017

VAERS ID: 289592 Before After
VAERS Form:(blank) 1
Age:0.3
Gender:Female
Location:Virginia
Vaccinated:2007-07-13
Onset:2007-08-13
Submitted:2007-08-20
Entered:2007-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B090M / 0 1 LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1435F / 0 1 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08681K / 0 1 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1114F / 0 1 - MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Barium double contrast, Intussusception

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No Birth HX: c-section due to breech presentation.
Allergies:
Diagnostic Lab Data: Air contrast enema LABS: abdominal series revealed IS. air contrast enema revealed sigmoid colon IS.
CDC 'Split Type':

Write-up: 4 mo with intussusception. 9/14/07 Reviewed ER medical records which reveal patient experienced vomiting, lethargy & bloody stools x 3 on 8/13/07. DX w/acute GI bleed & transferred to higher level of care. 10/5/07 Received vax record from community health center which confirms lot # but reveals 7/13 dose was 1st dose. VAERS database updated w/same. Vax record faxed to CDC. 10/5/07 Received hospital medical records which reveal patient experienced bloody stools, bilious vomiting, abdominal distention & reduced oral intake x 1 day. Seen in outlying ER & transferred to higher level of care. Admitted 8/13-8/15/2007 for peds surgery. Proximal bowel noted to be significntly dilated & NGT placed for decompression. Able to d/c NGT next day & tolerated oral feeds. Progressed well & d/c to home. FINAL DX: Intussusception w/obstructive symptoms, s/p difficult air enema reduction. Records faxed to CDC.


Changed on 2/14/2018

VAERS ID: 289592 Before After
VAERS Form:1
Age:0.3
Gender:Female
Location:Virginia
Vaccinated:2007-07-13
Onset:2007-08-13
Submitted:2007-08-20
Entered:2007-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B090M / 1 LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1435F / 1 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08681K / 1 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1114F / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Barium double contrast, Intussusception

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No Birth HX: c-section due to breech presentation.
Allergies:
Diagnostic Lab Data: Air contrast enema LABS: abdominal series revealed IS. air contrast enema revealed sigmoid colon IS.
CDC 'Split Type':

Write-up: 4 mo with intussusception. 9/14/07 Reviewed ER medical records which reveal patient experienced vomiting, lethargy & bloody stools x 3 on 8/13/07. DX w/acute GI bleed & transferred to higher level of care. 10/5/07 Received vax record from community health center which confirms lot # but reveals 7/13 dose was 1st dose. VAERS database updated w/same. Vax record faxed to CDC. 10/5/07 Received hospital medical records which reveal patient experienced bloody stools, bilious vomiting, abdominal distention & reduced oral intake x 1 day. Seen in outlying ER & transferred to higher level of care. Admitted 8/13-8/15/2007 for peds surgery. Proximal bowel noted to be significntly dilated & NGT placed for decompression. Able to d/c NGT next day & tolerated oral feeds. Progressed well & d/c to home. FINAL DX: Intussusception w/obstructive symptoms, s/p difficult air enema reduction. Records faxed to CDC.


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