![]() |
National Vaccine Information Center Your Health. Your Family. Your Choice. |
MedAlerts Home |
History of Changes from the VAERS Wayback Machine |
VAERS ID: | 291515 |
VAERS Form: | |
Age: | 0.6 |
Sex: | Female |
Location: | Maryland |
Vaccinated: | 2007-03-06 |
Onset: | 2007-09-20 |
Submitted: | 2007-09-27 |
Entered: | 2007-09-27 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | ACZ1B0B4BA / 2 | LL / IM |
HIBV: HIB (HIBTITER) / WYETH PHARMACEUTICALS, INC | 04084F / 2 | RL / IM |
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC | B08684F / 2 | RL / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1115F / 2 | - / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Abdominal tenderness, Barium enema abnormal, Dehydration, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2
Write-up: Intussusception, admitted to hospital on 09/20/2007 with vomiting, dehydration. Reduced by air enema. Discharged in good health.
Vaccinated: | 2007-03-06 |
Onset: | 2007-09-20 |
Submitted: | 2007-09-27 |
Entered: | 2007-09-27 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | ACZ1B0B4BA / 2 | LL / IM |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | ACZ1B0B4BA / 2 | LL / IM |
HIBV: HIB (HIBTITER) / WYETH PHARMACEUTICALS, INC | 04084F / 2 | RL / IM |
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC | B08684F / 2 | RL / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1115F / 2 | - / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Abdominal tenderness, Barium enema abnormal, Dehydration, Intussusception, Vomiting, White blood cell count, Enema administration, Ultrasound abdomen abnormal, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2
Write-up: Intussusception, admitted to hospital on 09/20/2007 with vomiting, dehydration. Reduced by air enema. Discharged in good health. 9/28/07 Received pcp medical records & vax records which confirms RO dose & lot # as reported. 10/30/07 Reviewed hospital medical records which reveal patient experienced abdominal tenderness, vomiting & reduced oral intake x 5 days. Admitted 9/20-9/21/07 for observation s/p barium enema reduction of IS. Progressed well & d/c to home. FINAL DX: Intussusception, enema reduced. Records faxed to CDC.
Vaccinated: | 2007-03-06 |
Onset: | 2007-09-20 |
Submitted: | 2007-09-27 |
Entered: | 2007-09-27 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | ACZ1B0B4BA / 2 | LL / IM |
HIBV: HIB (HIBTITER) / WYETH PHARMACEUTICALS, INC | 04084F / 2 | RL / IM |
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC | B08684F / 2 | RL / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1115F / 2 | - / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Abdominal tenderness, Barium enema abnormal, Dehydration, Intussusception, Vomiting, White blood cell count, Enema administration, Ultrasound abdomen abnormal, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2
Write-up: Intussusception, admitted to hospital on 09/20/2007 with vomiting, dehydration. Reduced by air enema. Discharged in good health. 9/28/07 Received pcp medical records & vax records which confirms RO dose & lot # as reported. 10/30/07 Reviewed hospital medical records which reveal patient experienced abdominal tenderness, vomiting & reduced oral intake x 5 days. Admitted 9/20-9/21/07 for observation s/p barium enema reduction of IS. Progressed well & d/c to home. FINAL DX: Intussusception, enema reduced. Records faxed to CDC.
Vaccinated: | 2007-03-06 |
Onset: | 2007-09-20 |
Submitted: | 2007-09-27 |
Entered: | 2007-09-27 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | ACZ1B0B4BA / 2 | LL / IM |
HIBV: HIB (HIBTITER) / WYETH PHARMACEUTICALS, INC | 04084F / 2 | RL / IM |
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC | B08684F / 2 | RL / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1115F / 2 | - / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Abdominal tenderness, Barium enema abnormal, Dehydration, Intussusception, Vomiting, White blood cell count, Enema administration, Ultrasound abdomen abnormal, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2
Write-up: Intussusception, admitted to hospital on 09/20/2007 with vomiting, dehydration. Reduced by air enema. Discharged in good health. 9/28/07 Received pcp medical records & vax records which confirms RO dose & lot # as reported. 10/30/07 Reviewed hospital medical records which reveal patient experienced abdominal tenderness, vomiting & reduced oral intake x 5 days. Admitted 9/20-9/21/07 for observation s/p barium enema reduction of IS. Progressed well & d/c to home. FINAL DX: Intussusception, enema reduced. Records faxed to CDC.
Vaccinated: | 2007-03-06 |
Onset: | 2007-09-20 |
Submitted: | 2007-09-27 |
Entered: | 2007-09-27 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | ACZ1B0B4BA / 2 | LL / IM |
HIBV: HIB (HIBTITER) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH | 04084F / 2 | RL / IM |
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH | B08684F / 2 | RL / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1115F / 2 | - / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Abdominal tenderness, Barium enema abnormal, Dehydration, Intussusception, Vomiting, White blood cell count, Enema administration, Ultrasound abdomen abnormal, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2
Write-up: Intussusception, admitted to hospital on 09/20/2007 with vomiting, dehydration. Reduced by air enema. Discharged in good health. 9/28/07 Received pcp medical records & vax records which confirms RO dose & lot # as reported. 10/30/07 Reviewed hospital medical records which reveal patient experienced abdominal tenderness, vomiting & reduced oral intake x 5 days. Admitted 9/20-9/21/07 for observation s/p barium enema reduction of IS. Progressed well & d/c to home. FINAL DX: Intussusception, enema reduced. Records faxed to CDC.
Vaccinated: | 2007-03-06 |
Onset: | 2007-09-20 |
Submitted: | 2007-09-27 |
Entered: | 2007-09-27 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | ACZ1B0B4BA / 2 | LL / IM |
HIBV: HIB (HIBTITER) / PFIZER/WYETH | 04084F / 2 | RL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B08684F / 2 | RL / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1115F / 2 | - / PO |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1115F / 2 | - / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Abdominal tenderness, Barium enema abnormal, Dehydration, Intussusception, Vomiting, White blood cell count, Enema administration, Ultrasound abdomen abnormal, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2
Write-up: Intussusception, admitted to hospital on 09/20/2007 with vomiting, dehydration. Reduced by air enema. Discharged in good health. 9/28/07 Received pcp medical records & vax records which confirms RO dose & lot # as reported. 10/30/07 Reviewed hospital medical records which reveal patient experienced abdominal tenderness, vomiting & reduced oral intake x 5 days. Admitted 9/20-9/21/07 for observation s/p barium enema reduction of IS. Progressed well & d/c to home. FINAL DX: Intussusception, enema reduced. Records faxed to CDC.
Vaccinated: | 2007-03-06 |
Onset: | 2007-09-20 |
Submitted: | 2007-09-27 |
Entered: | 2007-09-27 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | ACZ1B0B4BA / 2 | LL / IM |
HIBV: HIB (HIBTITER) / PFIZER/WYETH | 04084F / 2 | RL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B08684F / 2 | RL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1115F / 2 | - / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Abdominal tenderness, Barium enema abnormal, Dehydration, Intussusception, Vomiting, White blood cell count, Enema administration, Ultrasound abdomen abnormal, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2
Write-up: Intussusception, admitted to hospital on 09/20/2007 with vomiting, dehydration. Reduced by air enema. Discharged in good health. 9/28/07 Received pcp medical records & vax records which confirms RO dose & lot # as reported. 10/30/07 Reviewed hospital medical records which reveal patient experienced abdominal tenderness, vomiting & reduced oral intake x 5 days. Admitted 9/20-9/21/07 for observation s/p barium enema reduction of IS. Progressed well & d/c to home. FINAL DX: Intussusception, enema reduced. Records faxed to CDC.
Vaccinated: | 2007-03-06 |
Onset: | 2007-09-20 |
Submitted: | 2007-09-27 |
Entered: | 2007-09-27 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | ACZ1B0B4BA / 2 3 | LL / IM |
HIBV: HIB (HIBTITER) / PFIZER/WYETH | 04084F / 2 3 | RL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B08684F / 2 3 | RL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1115F / 2 3 | - MO / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Dehydration, Intussusception, Vomiting, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2
Write-up: Intussusception, admitted to hospital on 09/20/2007 with vomiting, dehydration. Reduced by air enema. Discharged in good health. 9/28/07 Received pcp medical records & vax records which confirms RO dose & lot # as reported. 10/30/07 Reviewed hospital medical records which reveal patient experienced abdominal tenderness, vomiting & reduced oral intake x 5 days. Admitted 9/20-9/21/07 for observation s/p barium enema reduction of IS. Progressed well & d/c to home. FINAL DX: Intussusception, enema reduced. Records faxed to CDC.
Vaccinated: | 2007-03-06 |
Onset: | 2007-09-20 |
Submitted: | 2007-09-27 |
Entered: | 2007-09-27 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | ACZ1B0B4BA / 3 | LL / IM |
HIBV: HIB (HIBTITER) / PFIZER/WYETH | 04084F / 3 | RL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B08684F / 3 | RL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1115F / 3 | MO / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Dehydration, Intussusception, Vomiting, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2
Write-up: Intussusception, admitted to hospital on 09/20/2007 with vomiting, dehydration. Reduced by air enema. Discharged in good health. 9/28/07 Received pcp medical records & vax records which confirms RO dose & lot # as reported. 10/30/07 Reviewed hospital medical records which reveal patient experienced abdominal tenderness, vomiting & reduced oral intake x 5 days. Admitted 9/20-9/21/07 for observation s/p barium enema reduction of IS. Progressed well & d/c to home. FINAL DX: Intussusception, enema reduced. Records faxed to CDC.
Vaccinated: | 2007-03-06 |
Onset: | 2007-09-20 |
Submitted: | 2007-09-27 |
Entered: | 2007-09-27 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | ACZ1B0B4BA / 3 | LL / IM |
HIBV: HIB (HIBTITER) / PFIZER/WYETH | 04084F / 3 | RL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B08684F / 3 | RL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1115F / 3 | MO / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Dehydration, Intussusception, Vomiting, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2
Write-up: Intussusception, admitted to hospital on 09/20/2007 with vomiting, dehydration. Reduced by air enema. Discharged in good health. 9/28/07 Received pcp medical records & vax records which confirms RO dose & lot # as reported. 10/30/07 Reviewed hospital medical records which reveal patient experienced abdominal tenderness, vomiting & reduced oral intake x 5 days. Admitted 9/20-9/21/07 for observation s/p barium enema reduction of IS. Progressed well & d/c to home. FINAL DX: Intussusception, enema reduced. Records faxed to CDC.
Vaccinated: | 2007-03-06 |
Onset: | 2007-09-20 |
Submitted: | 2007-09-27 |
Entered: | 2007-09-27 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | ACZ1B0B4BA / 3 | LL / IM |
HIBV: HIB (HIBTITER) / PFIZER/WYETH | 04084F / 3 | RL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B08684F / 3 | RL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1115F / 3 | MO / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Dehydration, Intussusception, Vomiting, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2
Write-up: Intussusception, admitted to hospital on 09/20/2007 with vomiting, dehydration. Reduced by air enema. Discharged in good health. 9/28/07 Received pcp medical records & vax records which confirms RO dose & lot # as reported. 10/30/07 Reviewed hospital medical records which reveal patient experienced abdominal tenderness, vomiting & reduced oral intake x 5 days. Admitted 9/20-9/21/07 for observation s/p barium enema reduction of IS. Progressed well & d/c to home. FINAL DX: Intussusception, enema reduced. Records faxed to CDC.
Vaccinated: | 2007-03-06 |
Onset: | 2007-09-20 |
Submitted: | 2007-09-27 |
Entered: | 2007-09-27 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | ACZ1B0B4BA / 3 | LL / IM |
HIBV: HIB (HIBTITER) / PFIZER/WYETH | 04084F / 3 | RL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B08684F / 3 | RL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1115F / 3 | MO / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Dehydration, Intussusception, Vomiting, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2
Write-up: Intussusception, admitted to hospital on 09/20/2007 with vomiting, dehydration. Reduced by air enema. Discharged in good health. 9/28/07 Received pcp medical records & vax records which confirms RO dose & lot # as reported. 10/30/07 Reviewed hospital medical records which reveal patient experienced abdominal tenderness, vomiting & reduced oral intake x 5 days. Admitted 9/20-9/21/07 for observation s/p barium enema reduction of IS. Progressed well & d/c to home. FINAL DX: Intussusception, enema reduced. Records faxed to CDC.
Vaccinated: | 2007-03-06 |
Onset: | 2007-09-20 |
Submitted: | 2007-09-27 |
Entered: | 2007-09-27 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | ACZ1B0B4BA / 3 | LL / IM |
HIBV: HIB (HIBTITER) / PFIZER/WYETH | 04084F / 3 | RL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B08684F / 3 | RL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1115F / 3 | MO / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Dehydration, Intussusception, Vomiting, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2
Write-up: Intussusception, admitted to hospital on 09/20/2007 with vomiting, dehydration. Reduced by air enema. Discharged in good health. 9/28/07 Received pcp medical records & vax records which confirms RO dose & lot # as reported. 10/30/07 Reviewed hospital medical records which reveal patient experienced abdominal tenderness, vomiting & reduced oral intake x 5 days. Admitted 9/20-9/21/07 for observation s/p barium enema reduction of IS. Progressed well & d/c to home. FINAL DX: Intussusception, enema reduced. Records faxed to CDC.
Vaccinated: | 2007-03-06 |
Onset: | 2007-09-20 |
Submitted: | 2007-09-27 |
Entered: | 2007-09-27 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | ACZ1B0B4BA / 3 | LL / IM |
HIBV: HIB (HIBTITER) / PFIZER/WYETH | 04084F / 3 | RL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B08684F / 3 | RL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1115F / 3 | MO / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Dehydration, Intussusception, Vomiting, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2
Write-up: Intussusception, admitted to hospital on 09/20/2007 with vomiting, dehydration. Reduced by air enema. Discharged in good health. 9/28/07 Received pcp medical records & vax records which confirms RO dose & lot # as reported. 10/30/07 Reviewed hospital medical records which reveal patient experienced abdominal tenderness, vomiting & reduced oral intake x 5 days. Admitted 9/20-9/21/07 for observation s/p barium enema reduction of IS. Progressed well & d/c to home. FINAL DX: Intussusception, enema reduced. Records faxed to CDC.
Vaccinated: | 2007-03-06 |
Onset: | 2007-09-20 |
Submitted: | 2007-09-27 |
Entered: | 2007-09-27 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | ACZ1B0B4BA / 3 | LL / IM |
HIBV: HIB (HIBTITER) / PFIZER/WYETH | 04084F / 3 | RL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B08684F / 3 | RL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1115F / 3 | MO / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Dehydration, Intussusception, Vomiting, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2
Write-up: Intussusception, admitted to hospital on 09/20/2007 with vomiting, dehydration. Reduced by air enema. Discharged in good health. 9/28/07 Received pcp medical records & vax records which confirms RO dose & lot # as reported. 10/30/07 Reviewed hospital medical records which reveal patient experienced abdominal tenderness, vomiting & reduced oral intake x 5 days. Admitted 9/20-9/21/07 for observation s/p barium enema reduction of IS. Progressed well & d/c to home. FINAL DX: Intussusception, enema reduced. Records faxed to CDC.
Link To This Search Result:
https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=291515&WAYBACKHISTORY=ON
Copyright ©
2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166