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This is VAERS ID 293334

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 293334
VAERS Form:
Age:0.5
Sex:Female
Location:Alabama
Vaccinated:2007-09-19
Onset:2007-09-28
Submitted:2007-10-09
Entered:2007-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08690K / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032F / 2 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: Abdominal pain, Constipation, Clostridium difficile toxin test, Abdominal hernia, Abdominal X-ray

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? No
Previous Vaccinations:
Other Medications: Omnicef
Current Illness: Ear infection
Preexisting Conditions: Ventral hernia
Allergies:
Diagnostic Lab Data: Abd sonar
CDC 'Split Type':

Write-up: Severe intestinal irritability with U/S documented small bowel intussusception.

Changed on 12/8/2009

VAERS ID: 293334 Before After
VAERS Form:
Age:0.5
Sex:Female
Location:Alabama
Vaccinated:2007-09-19
Onset:2007-09-28
Submitted:2007-10-09
Entered:2007-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 1 LL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08690K / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032F / 2 - / PO

Administered by: Public      Purchased by: Unknown Public
Symptoms: Abdominal pain, Constipation, Diarrhoea, Haematochezia, Intussusception, Irritability, Irritable bowel syndrome, Milk allergy, Clostridium difficile toxin test, Ultrasound abdomen, Ultrasound abdomen abnormal, Abdominal hernia, Intestinal functional disorder, Abdominal X-ray, Disbacteriosis

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? No
Previous Vaccinations:
Other Medications: Omnicef
Current Illness: Ear infection
Preexisting Conditions: Ventral hernia hernia. PMH: multiple ear infections.
Allergies:
Diagnostic Lab Data: Abd sonar sonar. Labs and diagnostics: US abd (10/3/07) shows a transient small bowel intussusception which resolved during the course of the study. US abd (10/5/07) again showed a transient small bowel intussusception in the RUQ. Abd X-ray 10
CDC 'Split Type':

Write-up: Severe intestinal irritability with U/S documented small bowel intussusception. 11/26/2007 MR received for several OV with ped surgeon and ped gastroenterology beginning 10/03/2007 to 11/08/07 operative report for ventral hernia repair. Child presented to ped surgeon on 10/03/2007 with c/o significant diarrhea as well as blood in stool. Seen again 10/5/07 for irritability and abdominal pain. DX: irritable bowel 2'' disrupted bowel flora. GI visit 10/18/07 with assessment: Constipation. Milk Allergy. Diarrhea. Abdominal pain. Ventral hernia. Ventral hernia repair on 11/08/07. 12/10/2007 Vaqx record received from PCP. Corresponds with VAERS report.

Changed on 3/2/2010

VAERS ID: 293334 Before After
VAERS Form:
Age:0.5
Sex:Female
Location:Alabama
Vaccinated:2007-09-19
Onset:2007-09-28
Submitted:2007-10-09
Entered:2007-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B08690K / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032F / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Abdominal pain, Constipation, Diarrhoea, Haematochezia, Intussusception, Irritability, Irritable bowel syndrome, Milk allergy, Clostridium difficile toxin test, Ultrasound abdomen, Ultrasound abdomen abnormal, Abdominal hernia, Intestinal functional disorder, Abdominal X-ray, Disbacteriosis

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? No
Previous Vaccinations:
Other Medications: Omnicef
Current Illness: Ear infection
Preexisting Conditions: Ventral hernia. PMH: multiple ear infections.
Allergies:
Diagnostic Lab Data: Abd sonar. Labs and diagnostics: US abd (10/3/07) shows a transient small bowel intussusception which resolved during the course of the study. US abd (10/5/07) again showed a transient small bowel intussusception in the RUQ. Abd X-ray 10
CDC 'Split Type':

Write-up: Severe intestinal irritability with U/S documented small bowel intussusception. 11/26/2007 MR received for several OV with ped surgeon and ped gastroenterology beginning 10/03/2007 to 11/08/07 operative report for ventral hernia repair. Child presented to ped surgeon on 10/03/2007 with c/o significant diarrhea as well as blood in stool. Seen again 10/5/07 for irritability and abdominal pain. DX: irritable bowel 2'' disrupted bowel flora. GI visit 10/18/07 with assessment: Constipation. Milk Allergy. Diarrhea. Abdominal pain. Ventral hernia. Ventral hernia repair on 11/08/07. 12/10/2007 Vaqx record received from PCP. Corresponds with VAERS report.

Changed on 4/7/2010

VAERS ID: 293334 Before After
VAERS Form:
Age:0.5
Sex:Female
Location:Alabama
Vaccinated:2007-09-19
Onset:2007-09-28
Submitted:2007-10-09
Entered:2007-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 2 RL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08690K / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032F / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Abdominal pain, Constipation, Diarrhoea, Haematochezia, Intussusception, Irritability, Irritable bowel syndrome, Milk allergy, Clostridium difficile toxin test, Ultrasound abdomen, Ultrasound abdomen abnormal, Abdominal hernia, Intestinal functional disorder, Abdominal X-ray, Disbacteriosis

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? No
Previous Vaccinations:
Other Medications: Omnicef
Current Illness: Ear infection
Preexisting Conditions: Ventral hernia. PMH: multiple ear infections.
Allergies:
Diagnostic Lab Data: Abd sonar. Labs and diagnostics: US abd (10/3/07) shows a transient small bowel intussusception which resolved during the course of the study. US abd (10/5/07) again showed a transient small bowel intussusception in the RUQ. Abd X-ray 10
CDC 'Split Type':

Write-up: Severe intestinal irritability with U/S documented small bowel intussusception. 11/26/2007 MR received for several OV with ped surgeon and ped gastroenterology beginning 10/03/2007 to 11/08/07 operative report for ventral hernia repair. Child presented to ped surgeon on 10/03/2007 with c/o significant diarrhea as well as blood in stool. Seen again 10/5/07 for irritability and abdominal pain. DX: irritable bowel 2'' disrupted bowel flora. GI visit 10/18/07 with assessment: Constipation. Milk Allergy. Diarrhea. Abdominal pain. Ventral hernia. Ventral hernia repair on 11/08/07. 12/10/2007 Vaqx record received from PCP. Corresponds with VAERS report.

Changed on 8/31/2010

VAERS ID: 293334 Before After
VAERS Form:
Age:0.5
Sex:Female
Location:Alabama
Vaccinated:2007-09-19
Onset:2007-09-28
Submitted:2007-10-09
Entered:2007-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B08690K / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032F / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Abdominal pain, Constipation, Diarrhoea, Haematochezia, Intussusception, Irritability, Irritable bowel syndrome, Milk allergy, Clostridium difficile toxin test, Ultrasound abdomen, Ultrasound abdomen abnormal, Abdominal hernia, Intestinal functional disorder, Abdominal X-ray, Disbacteriosis

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? No
Previous Vaccinations:
Other Medications: Omnicef
Current Illness: Ear infection
Preexisting Conditions: Ventral hernia. PMH: multiple ear infections.
Allergies:
Diagnostic Lab Data: Abd sonar. Labs and diagnostics: US abd (10/3/07) shows a transient small bowel intussusception which resolved during the course of the study. US abd (10/5/07) again showed a transient small bowel intussusception in the RUQ. Abd X-ray 10
CDC 'Split Type':

Write-up: Severe intestinal irritability with U/S documented small bowel intussusception. 11/26/2007 MR received for several OV with ped surgeon and ped gastroenterology beginning 10/03/2007 to 11/08/07 operative report for ventral hernia repair. Child presented to ped surgeon on 10/03/2007 with c/o significant diarrhea as well as blood in stool. Seen again 10/5/07 for irritability and abdominal pain. DX: irritable bowel 2'' disrupted bowel flora. GI visit 10/18/07 with assessment: Constipation. Milk Allergy. Diarrhea. Abdominal pain. Ventral hernia. Ventral hernia repair on 11/08/07. 12/10/2007 Vaqx record received from PCP. Corresponds with VAERS report.

Changed on 5/13/2013

VAERS ID: 293334 Before After
VAERS Form:
Age:0.5
Sex:Female
Location:Alabama
Vaccinated:2007-09-19
Onset:2007-09-28
Submitted:2007-10-09
Entered:2007-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08690K / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032F / 2 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032F / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Abdominal pain, Constipation, Diarrhoea, Haematochezia, Intussusception, Irritability, Irritable bowel syndrome, Milk allergy, Clostridium difficile toxin test, Ultrasound abdomen, Ultrasound abdomen abnormal, Abdominal hernia, Intestinal functional disorder, Abdominal X-ray, Disbacteriosis

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? No
Previous Vaccinations:
Other Medications: Omnicef
Current Illness: Ear infection
Preexisting Conditions: Ventral hernia. PMH: multiple ear infections.
Allergies:
Diagnostic Lab Data: Abd sonar. Labs and diagnostics: US abd (10/3/07) shows a transient small bowel intussusception which resolved during the course of the study. US abd (10/5/07) again showed a transient small bowel intussusception in the RUQ. Abd X-ray 10
CDC 'Split Type':

Write-up: Severe intestinal irritability with U/S documented small bowel intussusception. 11/26/2007 MR received for several OV with ped surgeon and ped gastroenterology beginning 10/03/2007 to 11/08/07 operative report for ventral hernia repair. Child presented to ped surgeon on 10/03/2007 with c/o significant diarrhea as well as blood in stool. Seen again 10/5/07 for irritability and abdominal pain. DX: irritable bowel 2'' disrupted bowel flora. GI visit 10/18/07 with assessment: Constipation. Milk Allergy. Diarrhea. Abdominal pain. Ventral hernia. Ventral hernia repair on 11/08/07. 12/10/2007 Vaqx record received from PCP. Corresponds with VAERS report.

Changed on 2/14/2017

VAERS ID: 293334 Before After
VAERS Form:
Age:0.5
Sex:Female
Location:Alabama
Vaccinated:2007-09-19
Onset:2007-09-28
Submitted:2007-10-09
Entered:2007-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08690K / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032F / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Abdominal pain, Constipation, Diarrhoea, Haematochezia, Intussusception, Irritability, Irritable bowel syndrome, Milk allergy, Clostridium difficile toxin test, Ultrasound abdomen, Ultrasound abdomen abnormal, Abdominal hernia, Intestinal functional disorder, Abdominal X-ray, Disbacteriosis

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? No
Previous Vaccinations:
Other Medications: Omnicef
Current Illness: Ear infection
Preexisting Conditions: Ventral hernia. PMH: multiple ear infections.
Allergies:
Diagnostic Lab Data: Abd sonar. Labs and diagnostics: US abd (10/3/07) shows a transient small bowel intussusception which resolved during the course of the study. US abd (10/5/07) again showed a transient small bowel intussusception in the RUQ. Abd X-ray 10 10/11/07 with a non-obstructive gas pattern. US abd (10/11/07) no IS. C-diff toxin (-).
CDC 'Split Type':

Write-up: Severe intestinal irritability with U/S documented small bowel intussusception. 11/26/2007 MR received for several OV with ped surgeon and ped gastroenterology beginning 10/03/2007 to 11/08/07 operative report for ventral hernia repair. Child presented to ped surgeon on 10/03/2007 with c/o significant diarrhea as well as blood in stool. Seen again 10/5/07 for irritability and abdominal pain. DX: irritable bowel 2'' disrupted bowel flora. GI visit 10/18/07 with assessment: Constipation. Milk Allergy. Diarrhea. Abdominal pain. Ventral hernia. Ventral hernia repair on 11/08/07. 12/10/2007 Vaqx record received from PCP. Corresponds with VAERS report.

Changed on 9/14/2017

VAERS ID: 293334 Before After
VAERS Form:(blank) 1
Age:0.5
Sex:Female
Location:Alabama
Vaccinated:2007-09-19
Onset:2007-09-28
Submitted:2007-10-09
Entered:2007-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 1 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 2 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08690K / 2 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032F / 2 3 - MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Intussusception, Ultrasound abdomen, Intestinal functional disorder

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? No
Previous Vaccinations:
Other Medications: Omnicef
Current Illness: Ear infection
Preexisting Conditions: Ventral hernia. PMH: multiple ear infections.
Allergies:
Diagnostic Lab Data: Abd sonar. Labs and diagnostics: US abd (10/3/07) shows a transient small bowel intussusception which resolved during the course of the study. US abd (10/5/07) again showed a transient small bowel intussusception in the RUQ. Abd X-ray 10/11/07 with a non-obstructive gas pattern. US abd (10/11/07) no IS. C-diff toxin (-).
CDC 'Split Type':

Write-up: Severe intestinal irritability with U/S documented small bowel intussusception. 11/26/2007 MR received for several OV with ped surgeon and ped gastroenterology beginning 10/03/2007 to 11/08/07 operative report for ventral hernia repair. Child presented to ped surgeon on 10/03/2007 with c/o significant diarrhea as well as blood in stool. Seen again 10/5/07 for irritability and abdominal pain. DX: irritable bowel 2'' disrupted bowel flora. GI visit 10/18/07 with assessment: Constipation. Milk Allergy. Diarrhea. Abdominal pain. Ventral hernia. Ventral hernia repair on 11/08/07. 12/10/2007 Vaqx record received from PCP. Corresponds with VAERS report.

Changed on 2/14/2018

VAERS ID: 293334 Before After
VAERS Form:1
Age:0.5
Sex:Female
Location:Alabama
Vaccinated:2007-09-19
Onset:2007-09-28
Submitted:2007-10-09
Entered:2007-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08690K / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032F / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Intussusception, Ultrasound abdomen, Intestinal functional disorder

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? No
Previous Vaccinations:
Other Medications: Omnicef
Current Illness: Ear infection
Preexisting Conditions: Ventral hernia. PMH: multiple ear infections.
Allergies:
Diagnostic Lab Data: Abd sonar. Labs and diagnostics: US abd (10/3/07) shows a transient small bowel intussusception which resolved during the course of the study. US abd (10/5/07) again showed a transient small bowel intussusception in the RUQ. Abd X-ray 10/11/07 with a non-obstructive gas pattern. US abd (10/11/07) no IS. C-diff toxin (-).
CDC 'Split Type':

Write-up: Severe intestinal irritability with U/S documented small bowel intussusception. 11/26/2007 MR received for several OV with ped surgeon and ped gastroenterology beginning 10/03/2007 to 11/08/07 operative report for ventral hernia repair. Child presented to ped surgeon on 10/03/2007 with c/o significant diarrhea as well as blood in stool. Seen again 10/5/07 for irritability and abdominal pain. DX: irritable bowel 2'' disrupted bowel flora. GI visit 10/18/07 with assessment: Constipation. Milk Allergy. Diarrhea. Abdominal pain. Ventral hernia. Ventral hernia repair on 11/08/07. 12/10/2007 Vaqx record received from PCP. Corresponds with VAERS report.

Changed on 6/14/2018

VAERS ID: 293334 Before After
VAERS Form:1
Age:0.5
Sex:Female
Location:Alabama
Vaccinated:2007-09-19
Onset:2007-09-28
Submitted:2007-10-09
Entered:2007-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08690K / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032F / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Intussusception, Ultrasound abdomen, Intestinal functional disorder

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? No
Previous Vaccinations:
Other Medications: Omnicef
Current Illness: Ear infection
Preexisting Conditions: Ventral hernia. PMH: multiple ear infections.
Allergies:
Diagnostic Lab Data: Abd sonar. Labs and diagnostics: US abd (10/3/07) shows a transient small bowel intussusception which resolved during the course of the study. US abd (10/5/07) again showed a transient small bowel intussusception in the RUQ. Abd X-ray 10/11/07 with a non-obstructive gas pattern. US abd (10/11/07) no IS. C-diff toxin (-).
CDC 'Split Type':

Write-up: Severe intestinal irritability with U/S documented small bowel intussusception. 11/26/2007 MR received for several OV with ped surgeon and ped gastroenterology beginning 10/03/2007 to 11/08/07 operative report for ventral hernia repair. Child presented to ped surgeon on 10/03/2007 with c/o significant diarrhea as well as blood in stool. Seen again 10/5/07 for irritability and abdominal pain. DX: irritable bowel 2'' disrupted bowel flora. GI visit 10/18/07 with assessment: Constipation. Milk Allergy. Diarrhea. Abdominal pain. Ventral hernia. Ventral hernia repair on 11/08/07. 12/10/2007 Vaqx record received from PCP. Corresponds with VAERS report.

Changed on 8/14/2018

VAERS ID: 293334 Before After
VAERS Form:1
Age:0.5
Sex:Female
Location:Alabama
Vaccinated:2007-09-19
Onset:2007-09-28
Submitted:2007-10-09
Entered:2007-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08690K / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032F / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Intussusception, Ultrasound abdomen, Intestinal functional disorder

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? No
Previous Vaccinations:
Other Medications: Omnicef
Current Illness: Ear infection
Preexisting Conditions: Ventral hernia. PMH: multiple ear infections.
Allergies:
Diagnostic Lab Data: Abd sonar. Labs and diagnostics: US abd (10/3/07) shows a transient small bowel intussusception which resolved during the course of the study. US abd (10/5/07) again showed a transient small bowel intussusception in the RUQ. Abd X-ray 10/11/07 with a non-obstructive gas pattern. US abd (10/11/07) no IS. C-diff toxin (-).
CDC 'Split Type':

Write-up: Severe intestinal irritability with U/S documented small bowel intussusception. 11/26/2007 MR received for several OV with ped surgeon and ped gastroenterology beginning 10/03/2007 to 11/08/07 operative report for ventral hernia repair. Child presented to ped surgeon on 10/03/2007 with c/o significant diarrhea as well as blood in stool. Seen again 10/5/07 for irritability and abdominal pain. DX: irritable bowel 2'' disrupted bowel flora. GI visit 10/18/07 with assessment: Constipation. Milk Allergy. Diarrhea. Abdominal pain. Ventral hernia. Ventral hernia repair on 11/08/07. 12/10/2007 Vaqx record received from PCP. Corresponds with VAERS report.

Changed on 9/14/2018

VAERS ID: 293334 Before After
VAERS Form:1
Age:0.5
Sex:Female
Location:Alabama
Vaccinated:2007-09-19
Onset:2007-09-28
Submitted:2007-10-09
Entered:2007-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08690K / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032F / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Intussusception, Ultrasound abdomen, Intestinal functional disorder

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? No
Previous Vaccinations:
Other Medications: Omnicef
Current Illness: Ear infection
Preexisting Conditions: Ventral hernia. PMH: multiple ear infections.
Allergies:
Diagnostic Lab Data: Abd sonar. Labs and diagnostics: US abd (10/3/07) shows a transient small bowel intussusception which resolved during the course of the study. US abd (10/5/07) again showed a transient small bowel intussusception in the RUQ. Abd X-ray 10/11/07 with a non-obstructive gas pattern. US abd (10/11/07) no IS. C-diff toxin (-).
CDC 'Split Type':

Write-up: Severe intestinal irritability with U/S documented small bowel intussusception. 11/26/2007 MR received for several OV with ped surgeon and ped gastroenterology beginning 10/03/2007 to 11/08/07 operative report for ventral hernia repair. Child presented to ped surgeon on 10/03/2007 with c/o significant diarrhea as well as blood in stool. Seen again 10/5/07 for irritability and abdominal pain. DX: irritable bowel 2'' disrupted bowel flora. GI visit 10/18/07 with assessment: Constipation. Milk Allergy. Diarrhea. Abdominal pain. Ventral hernia. Ventral hernia repair on 11/08/07. 12/10/2007 Vaqx record received from PCP. Corresponds with VAERS report.

Changed on 10/14/2018

VAERS ID: 293334 Before After
VAERS Form:1
Age:0.5
Sex:Female
Location:Alabama
Vaccinated:2007-09-19
Onset:2007-09-28
Submitted:2007-10-09
Entered:2007-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08690K / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032F / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Intussusception, Ultrasound abdomen, Intestinal functional disorder

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? No
Previous Vaccinations:
Other Medications: Omnicef
Current Illness: Ear infection
Preexisting Conditions: Ventral hernia. PMH: multiple ear infections.
Allergies:
Diagnostic Lab Data: Abd sonar. Labs and diagnostics: US abd (10/3/07) shows a transient small bowel intussusception which resolved during the course of the study. US abd (10/5/07) again showed a transient small bowel intussusception in the RUQ. Abd X-ray 10/11/07 with a non-obstructive gas pattern. US abd (10/11/07) no IS. C-diff toxin (-).
CDC 'Split Type':

Write-up: Severe intestinal irritability with U/S documented small bowel intussusception. 11/26/2007 MR received for several OV with ped surgeon and ped gastroenterology beginning 10/03/2007 to 11/08/07 operative report for ventral hernia repair. Child presented to ped surgeon on 10/03/2007 with c/o significant diarrhea as well as blood in stool. Seen again 10/5/07 for irritability and abdominal pain. DX: irritable bowel 2'' disrupted bowel flora. GI visit 10/18/07 with assessment: Constipation. Milk Allergy. Diarrhea. Abdominal pain. Ventral hernia. Ventral hernia repair on 11/08/07. 12/10/2007 Vaqx record received from PCP. Corresponds with VAERS report.

Changed on 12/24/2020

VAERS ID: 293334 Before After
VAERS Form:1
Age:0.5
Sex:Female
Location:Alabama
Vaccinated:2007-09-19
Onset:2007-09-28
Submitted:2007-10-09
Entered:2007-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08690K / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032F / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Intussusception, Ultrasound abdomen, Intestinal functional disorder

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? No
Previous Vaccinations:
Other Medications: Omnicef
Current Illness: Ear infection
Preexisting Conditions: Ventral hernia. PMH: multiple ear infections.
Allergies:
Diagnostic Lab Data: Abd sonar. Labs and diagnostics: US abd (10/3/07) shows a transient small bowel intussusception which resolved during the course of the study. US abd (10/5/07) again showed a transient small bowel intussusception in the RUQ. Abd X-ray 10/11/07 with a non-obstructive gas pattern. US abd (10/11/07) no IS. C-diff toxin (-).
CDC 'Split Type':

Write-up: Severe intestinal irritability with U/S documented small bowel intussusception. 11/26/2007 MR received for several OV with ped surgeon and ped gastroenterology beginning 10/03/2007 to 11/08/07 operative report for ventral hernia repair. Child presented to ped surgeon on 10/03/2007 with c/o significant diarrhea as well as blood in stool. Seen again 10/5/07 for irritability and abdominal pain. DX: irritable bowel 2'' disrupted bowel flora. GI visit 10/18/07 with assessment: Constipation. Milk Allergy. Diarrhea. Abdominal pain. Ventral hernia. Ventral hernia repair on 11/08/07. 12/10/2007 Vaqx record received from PCP. Corresponds with VAERS report.

Changed on 12/30/2020

VAERS ID: 293334 Before After
VAERS Form:1
Age:0.5
Sex:Female
Location:Alabama
Vaccinated:2007-09-19
Onset:2007-09-28
Submitted:2007-10-09
Entered:2007-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08690K / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032F / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Intussusception, Ultrasound abdomen, Intestinal functional disorder

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? No
Previous Vaccinations:
Other Medications: Omnicef
Current Illness: Ear infection
Preexisting Conditions: Ventral hernia. PMH: multiple ear infections.
Allergies:
Diagnostic Lab Data: Abd sonar. Labs and diagnostics: US abd (10/3/07) shows a transient small bowel intussusception which resolved during the course of the study. US abd (10/5/07) again showed a transient small bowel intussusception in the RUQ. Abd X-ray 10/11/07 with a non-obstructive gas pattern. US abd (10/11/07) no IS. C-diff toxin (-).
CDC 'Split Type':

Write-up: Severe intestinal irritability with U/S documented small bowel intussusception. 11/26/2007 MR received for several OV with ped surgeon and ped gastroenterology beginning 10/03/2007 to 11/08/07 operative report for ventral hernia repair. Child presented to ped surgeon on 10/03/2007 with c/o significant diarrhea as well as blood in stool. Seen again 10/5/07 for irritability and abdominal pain. DX: irritable bowel 2'' disrupted bowel flora. GI visit 10/18/07 with assessment: Constipation. Milk Allergy. Diarrhea. Abdominal pain. Ventral hernia. Ventral hernia repair on 11/08/07. 12/10/2007 Vaqx record received from PCP. Corresponds with VAERS report.

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