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This is VAERS ID 291515

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 291515
VAERS Form:
Age:0.6
Gender: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     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: LABS: WBC 10.6, US of abdomen c/w IS.
CDC 'Split Type':

Write-up: Intussusception, admitted to hospital on 09/20/2007 with vomiting, dehydration. Reduced by air enema. Discharged in good health.

Changed on 12/8/2009

VAERS ID: 291515 Before After
VAERS Form:
Age:0.6
Gender: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
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     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None PMH: hospitalized w/enterovirus 9/2006, dry skin, vomiting, good growth & development.
Allergies:
Diagnostic Lab Data: LABS: WBC 10.6, US of abdomen c/w IS.
CDC 'Split Type':

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.

Changed on 3/2/2010

VAERS ID: 291515 Before After
VAERS Form:
Age:0.6
Gender: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
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     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None PMH: hospitalized w/enterovirus 9/2006, dry skin, vomiting, good growth & development.
Allergies:
Diagnostic Lab Data: LABS: WBC 10.6, US of abdomen c/w IS.
CDC 'Split Type':

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.

Changed on 4/7/2010

VAERS ID: 291515 Before After
VAERS Form:
Age:0.6
Gender: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
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     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None PMH: hospitalized w/enterovirus 9/2006, dry skin, vomiting, good growth & development.
Allergies:
Diagnostic Lab Data: LABS: WBC 10.6, US of abdomen c/w IS.
CDC 'Split Type':

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.

Changed on 8/31/2010

VAERS ID: 291515 Before After
VAERS Form:
Age:0.6
Gender: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
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     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None PMH: hospitalized w/enterovirus 9/2006, dry skin, vomiting, good growth & development.
Allergies:
Diagnostic Lab Data: LABS: WBC 10.6, US of abdomen c/w IS.
CDC 'Split Type':

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.

Changed on 5/13/2013

VAERS ID: 291515 Before After
VAERS Form:
Age:0.6
Gender: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
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     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None PMH: hospitalized w/enterovirus 9/2006, dry skin, vomiting, good growth & development.
Allergies:
Diagnostic Lab Data: LABS: WBC 10.6, US of abdomen c/w IS.
CDC 'Split Type':

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.

Changed on 4/14/2017

VAERS ID: 291515 Before After
VAERS Form:
Age:0.6
Gender: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
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     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None PMH: hospitalized w/enterovirus 9/2006, dry skin, vomiting, good growth & development.
Allergies:
Diagnostic Lab Data: LABS: WBC 10.6, US of abdomen c/w IS.
CDC 'Split Type':

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.

Changed on 9/14/2017

VAERS ID: 291515 Before After
VAERS Form:(blank) 1
Age:0.6
Gender: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
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     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None PMH: hospitalized w/enterovirus 9/2006, dry skin, vomiting, good growth & development.
Allergies:
Diagnostic Lab Data: LABS: WBC 10.6, US of abdomen c/w IS.
CDC 'Split Type':

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.

Changed on 2/14/2018

VAERS ID: 291515 Before After
VAERS Form:1
Age:0.6
Gender: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
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     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None PMH: hospitalized w/enterovirus 9/2006, dry skin, vomiting, good growth & development.
Allergies:
Diagnostic Lab Data: LABS: WBC 10.6, US of abdomen c/w IS.
CDC 'Split Type':

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.

Changed on 6/14/2018

VAERS ID: 291515 Before After
VAERS Form:1
Age:0.6
Gender: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
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     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None PMH: hospitalized w/enterovirus 9/2006, dry skin, vomiting, good growth & development.
Allergies:
Diagnostic Lab Data: LABS: WBC 10.6, US of abdomen c/w IS.
CDC 'Split Type':

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.

Changed on 8/14/2018

VAERS ID: 291515 Before After
VAERS Form:1
Age:0.6
Gender: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
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     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None PMH: hospitalized w/enterovirus 9/2006, dry skin, vomiting, good growth & development.
Allergies:
Diagnostic Lab Data: LABS: WBC 10.6, US of abdomen c/w IS.
CDC 'Split Type':

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.

Changed on 9/14/2018

VAERS ID: 291515 Before After
VAERS Form:1
Age:0.6
Gender: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
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     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None PMH: hospitalized w/enterovirus 9/2006, dry skin, vomiting, good growth & development.
Allergies:
Diagnostic Lab Data: LABS: WBC 10.6, US of abdomen c/w IS.
CDC 'Split Type':

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.

Changed on 10/14/2018

VAERS ID: 291515 Before After
VAERS Form:1
Age:0.6
Gender: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
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     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None PMH: hospitalized w/enterovirus 9/2006, dry skin, vomiting, good growth & development.
Allergies:
Diagnostic Lab Data: LABS: WBC 10.6, US of abdomen c/w IS.
CDC 'Split Type':

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.

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