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History of Changes from the VAERS Wayback Machine |
VAERS ID: | 296290 |
VAERS Form: | |
Age: | 0.3 |
Sex: | Female |
Location: | New York |
Vaccinated: | 2007-10-31 |
Onset: | 2007-11-06 |
Submitted: | 2007-11-09 |
Entered: | 2007-11-09 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B194AA / 1 | RL / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 0676U / 1 | LL / IM |
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC | B50007A / 1 | LL / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0876U / 1 | - / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Haematochezia, Intensive care, Explorative laparotomy, Intestinal resection, Abdominal X-ray
Life Threatening? Yes
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: 7
Write-up: INTUSSUSEPTION 8 DAYS AFTER 2ND DOSES OF PEDIARIX, PREVNAR, HIB, ROTATEQ
Vaccinated: | 2007-10-31 |
Onset: | 2007-11-06 |
Submitted: | 2007-11-09 |
Entered: | 2007-11-09 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B194AA / 1 | RL / IM |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B194AA / 1 | RL / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 0676U / 1 | LL / IM |
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC | B50007A / 1 | LL / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0876U / 1 | - / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Haematochezia, Intensive care, Intussusception, Irritability, Pallor, Peripheral coldness, Pyrexia, Surgery, Vomiting, X-ray abnormal, Ultrasound abdomen abnormal, Explorative laparotomy, Intestinal resection, Abdominal X-ray
Life Threatening? Yes
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: 7
Write-up: INTUSSUSEPTION 8 DAYS AFTER 2ND DOSES OF PEDIARIX, PREVNAR, HIB, ROTATEQ ROTATEQ. 11/12/07 Received vax record from pcp which confirms RO dose & lot # as reported. 12/4/07 Reviewed hospital medical records which reveal patient experienced irritability, fever, vomiting, pallor, cold extremities & bloody stools x 1 day. Admitted 11/6-11/14/2007. Taken to OR for exp lap & ileocolic resection when unable to reduce in radiology. Placed on TPN postoperatively in PICU. Progressed well & d/c to home. FINAL DX: Intussusception, surgically reduced. Records faxed to CDC.
Vaccinated: | 2007-10-31 |
Onset: | 2007-11-06 |
Submitted: | 2007-11-09 |
Entered: | 2007-11-09 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B194AA / 1 | RL / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 0676U / 1 | LL / IM |
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC | B50007A / 1 | LL / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0876U / 1 | - / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Haematochezia, Intensive care, Intussusception, Irritability, Pallor, Peripheral coldness, Pyrexia, Surgery, Vomiting, X-ray abnormal, Ultrasound abdomen abnormal, Explorative laparotomy, Intestinal resection, Abdominal X-ray
Life Threatening? Yes
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: 7
Write-up: INTUSSUSEPTION 8 DAYS AFTER 2ND DOSES OF PEDIARIX, PREVNAR, HIB, ROTATEQ. 11/12/07 Received vax record from pcp which confirms RO dose & lot # as reported. 12/4/07 Reviewed hospital medical records which reveal patient experienced irritability, fever, vomiting, pallor, cold extremities & bloody stools x 1 day. Admitted 11/6-11/14/2007. Taken to OR for exp lap & ileocolic resection when unable to reduce in radiology. Placed on TPN postoperatively in PICU. Progressed well & d/c to home. FINAL DX: Intussusception, surgically reduced. Records faxed to CDC.
Vaccinated: | 2007-10-31 |
Onset: | 2007-11-06 |
Submitted: | 2007-11-09 |
Entered: | 2007-11-09 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B194AA / 1 | RL / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 0676U / 1 | LL / IM |
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC | B50007A / 1 | LL / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0876U / 1 | - / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Haematochezia, Intensive care, Intussusception, Irritability, Pallor, Peripheral coldness, Pyrexia, Surgery, Vomiting, X-ray abnormal, Ultrasound abdomen abnormal, Explorative laparotomy, Intestinal resection, Abdominal X-ray
Life Threatening? Yes
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: 7
Write-up: INTUSSUSEPTION 8 DAYS AFTER 2ND DOSES OF PEDIARIX, PREVNAR, HIB, ROTATEQ. 11/12/07 Received vax record from pcp which confirms RO dose & lot # as reported. 12/4/07 Reviewed hospital medical records which reveal patient experienced irritability, fever, vomiting, pallor, cold extremities & bloody stools x 1 day. Admitted 11/6-11/14/2007. Taken to OR for exp lap & ileocolic resection when unable to reduce in radiology. Placed on TPN postoperatively in PICU. Progressed well & d/c to home. FINAL DX: Intussusception, surgically reduced. Records faxed to CDC.
Vaccinated: | 2007-10-31 |
Onset: | 2007-11-06 |
Submitted: | 2007-11-09 |
Entered: | 2007-11-09 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B194AA / 1 | RL / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 0676U / 1 | LL / IM |
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH | B50007A / 1 | LL / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0876U / 1 | - / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Haematochezia, Intensive care, Intussusception, Irritability, Pallor, Peripheral coldness, Pyrexia, Surgery, Vomiting, X-ray abnormal, Ultrasound abdomen abnormal, Explorative laparotomy, Intestinal resection, Abdominal X-ray
Life Threatening? Yes
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: 7
Write-up: INTUSSUSEPTION 8 DAYS AFTER 2ND DOSES OF PEDIARIX, PREVNAR, HIB, ROTATEQ. 11/12/07 Received vax record from pcp which confirms RO dose & lot # as reported. 12/4/07 Reviewed hospital medical records which reveal patient experienced irritability, fever, vomiting, pallor, cold extremities & bloody stools x 1 day. Admitted 11/6-11/14/2007. Taken to OR for exp lap & ileocolic resection when unable to reduce in radiology. Placed on TPN postoperatively in PICU. Progressed well & d/c to home. FINAL DX: Intussusception, surgically reduced. Records faxed to CDC.
Vaccinated: | 2007-10-31 |
Onset: | 2007-11-06 |
Submitted: | 2007-11-09 |
Entered: | 2007-11-09 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B194AA / 1 | RL / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 0676U / 1 | LL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B50007A / 1 | LL / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0876U / 1 | - / PO |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0876U / 1 | - / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Haematochezia, Intensive care, Intussusception, Irritability, Pallor, Peripheral coldness, Pyrexia, Surgery, Vomiting, X-ray abnormal, Ultrasound abdomen abnormal, Explorative laparotomy, Intestinal resection, Abdominal X-ray
Life Threatening? Yes
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: 7
Write-up: INTUSSUSEPTION 8 DAYS AFTER 2ND DOSES OF PEDIARIX, PREVNAR, HIB, ROTATEQ. 11/12/07 Received vax record from pcp which confirms RO dose & lot # as reported. 12/4/07 Reviewed hospital medical records which reveal patient experienced irritability, fever, vomiting, pallor, cold extremities & bloody stools x 1 day. Admitted 11/6-11/14/2007. Taken to OR for exp lap & ileocolic resection when unable to reduce in radiology. Placed on TPN postoperatively in PICU. Progressed well & d/c to home. FINAL DX: Intussusception, surgically reduced. Records faxed to CDC.
Vaccinated: | 2007-10-31 |
Onset: | 2007-11-06 |
Submitted: | 2007-11-09 |
Entered: | 2007-11-09 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B194AA / 1 | RL / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 0676U / 1 | LL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B50007A / 1 | LL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0876U / 1 | - / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Haematochezia, Intensive care, Intussusception, Irritability, Pallor, Peripheral coldness, Pyrexia, Surgery, Vomiting, X-ray abnormal, Ultrasound abdomen abnormal, Explorative laparotomy, Intestinal resection, Abdominal X-ray
Life Threatening? Yes
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: 7
Write-up: INTUSSUSEPTION 8 DAYS AFTER 2ND DOSES OF PEDIARIX, PREVNAR, HIB, ROTATEQ. 11/12/07 Received vax record from pcp which confirms RO dose & lot # as reported. 12/4/07 Reviewed hospital medical records which reveal patient experienced irritability, fever, vomiting, pallor, cold extremities & bloody stools x 1 day. Admitted 11/6-11/14/2007. Taken to OR for exp lap & ileocolic resection when unable to reduce in radiology. Placed on TPN postoperatively in PICU. Progressed well & d/c to home. FINAL DX: Intussusception, surgically reduced. Records faxed to CDC.
Vaccinated: | 2007-10-31 |
Onset: | 2007-11-06 |
Submitted: | 2007-11-09 |
Entered: | 2007-11-09 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B194AA / 1 2 | RL / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 0676U / 1 2 | LL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B50007A / 1 2 | LL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0876U / 1 2 | - MO / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Intussusception
Life Threatening? Yes
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: 7
Write-up: INTUSSUSEPTION 8 DAYS AFTER 2ND DOSES OF PEDIARIX, PREVNAR, HIB, ROTATEQ. 11/12/07 Received vax record from pcp which confirms RO dose & lot # as reported. 12/4/07 Reviewed hospital medical records which reveal patient experienced irritability, fever, vomiting, pallor, cold extremities & bloody stools x 1 day. Admitted 11/6-11/14/2007. Taken to OR for exp lap & ileocolic resection when unable to reduce in radiology. Placed on TPN postoperatively in PICU. Progressed well & d/c to home. FINAL DX: Intussusception, surgically reduced. Records faxed to CDC.
Vaccinated: | 2007-10-31 |
Onset: | 2007-11-06 |
Submitted: | 2007-11-09 |
Entered: | 2007-11-09 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B194AA / 2 | RL / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 0676U / 2 | LL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B50007A / 2 | LL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0876U / 2 | MO / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Intussusception
Life Threatening? Yes
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: 7
Write-up: INTUSSUSEPTION 8 DAYS AFTER 2ND DOSES OF PEDIARIX, PREVNAR, HIB, ROTATEQ. 11/12/07 Received vax record from pcp which confirms RO dose & lot # as reported. 12/4/07 Reviewed hospital medical records which reveal patient experienced irritability, fever, vomiting, pallor, cold extremities & bloody stools x 1 day. Admitted 11/6-11/14/2007. Taken to OR for exp lap & ileocolic resection when unable to reduce in radiology. Placed on TPN postoperatively in PICU. Progressed well & d/c to home. FINAL DX: Intussusception, surgically reduced. Records faxed to CDC.
Vaccinated: | 2007-10-31 |
Onset: | 2007-11-06 |
Submitted: | 2007-11-09 |
Entered: | 2007-11-09 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B194AA / 2 | RL / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 0676U / 2 | LL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B50007A / 2 | LL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0876U / 2 | MO / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Intussusception
Life Threatening? Yes
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: 7
Write-up: INTUSSUSEPTION 8 DAYS AFTER 2ND DOSES OF PEDIARIX, PREVNAR, HIB, ROTATEQ. 11/12/07 Received vax record from pcp which confirms RO dose & lot # as reported. 12/4/07 Reviewed hospital medical records which reveal patient experienced irritability, fever, vomiting, pallor, cold extremities & bloody stools x 1 day. Admitted 11/6-11/14/2007. Taken to OR for exp lap & ileocolic resection when unable to reduce in radiology. Placed on TPN postoperatively in PICU. Progressed well & d/c to home. FINAL DX: Intussusception, surgically reduced. Records faxed to CDC.
Vaccinated: | 2007-10-31 |
Onset: | 2007-11-06 |
Submitted: | 2007-11-09 |
Entered: | 2007-11-09 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B194AA / 2 | RL / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 0676U / 2 | LL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B50007A / 2 | LL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0876U / 2 | MO / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Intussusception
Life Threatening? Yes
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: 7
Write-up: INTUSSUSEPTION 8 DAYS AFTER 2ND DOSES OF PEDIARIX, PREVNAR, HIB, ROTATEQ. 11/12/07 Received vax record from pcp which confirms RO dose & lot # as reported. 12/4/07 Reviewed hospital medical records which reveal patient experienced irritability, fever, vomiting, pallor, cold extremities & bloody stools x 1 day. Admitted 11/6-11/14/2007. Taken to OR for exp lap & ileocolic resection when unable to reduce in radiology. Placed on TPN postoperatively in PICU. Progressed well & d/c to home. FINAL DX: Intussusception, surgically reduced. Records faxed to CDC.
Vaccinated: | 2007-10-31 |
Onset: | 2007-11-06 |
Submitted: | 2007-11-09 |
Entered: | 2007-11-09 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B194AA / 2 | RL / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 0676U / 2 | LL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B50007A / 2 | LL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0876U / 2 | MO / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Intussusception
Life Threatening? Yes
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: 7
Write-up: INTUSSUSEPTION 8 DAYS AFTER 2ND DOSES OF PEDIARIX, PREVNAR, HIB, ROTATEQ. 11/12/07 Received vax record from pcp which confirms RO dose & lot # as reported. 12/4/07 Reviewed hospital medical records which reveal patient experienced irritability, fever, vomiting, pallor, cold extremities & bloody stools x 1 day. Admitted 11/6-11/14/2007. Taken to OR for exp lap & ileocolic resection when unable to reduce in radiology. Placed on TPN postoperatively in PICU. Progressed well & d/c to home. FINAL DX: Intussusception, surgically reduced. Records faxed to CDC.
Vaccinated: | 2007-10-31 |
Onset: | 2007-11-06 |
Submitted: | 2007-11-09 |
Entered: | 2007-11-09 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B194AA / 2 | RL / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 0676U / 2 | LL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B50007A / 2 | LL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0876U / 2 | MO / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Intussusception
Life Threatening? Yes
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: 7
Write-up: INTUSSUSEPTION 8 DAYS AFTER 2ND DOSES OF PEDIARIX, PREVNAR, HIB, ROTATEQ. 11/12/07 Received vax record from pcp which confirms RO dose & lot # as reported. 12/4/07 Reviewed hospital medical records which reveal patient experienced irritability, fever, vomiting, pallor, cold extremities & bloody stools x 1 day. Admitted 11/6-11/14/2007. Taken to OR for exp lap & ileocolic resection when unable to reduce in radiology. Placed on TPN postoperatively in PICU. Progressed well & d/c to home. FINAL DX: Intussusception, surgically reduced. Records faxed to CDC.
Vaccinated: | 2007-10-31 |
Onset: | 2007-11-06 |
Submitted: | 2007-11-09 |
Entered: | 2007-11-09 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B194AA / 2 | RL / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 0676U / 2 | LL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B50007A / 2 | LL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0876U / 2 | MO / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Intussusception
Life Threatening? Yes
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: 7
Write-up: INTUSSUSEPTION 8 DAYS AFTER 2ND DOSES OF PEDIARIX, PREVNAR, HIB, ROTATEQ. 11/12/07 Received vax record from pcp which confirms RO dose & lot # as reported. 12/4/07 Reviewed hospital medical records which reveal patient experienced irritability, fever, vomiting, pallor, cold extremities & bloody stools x 1 day. Admitted 11/6-11/14/2007. Taken to OR for exp lap & ileocolic resection when unable to reduce in radiology. Placed on TPN postoperatively in PICU. Progressed well & d/c to home. FINAL DX: Intussusception, surgically reduced. Records faxed to CDC.
Vaccinated: | 2007-10-31 |
Onset: | 2007-11-06 |
Submitted: | 2007-11-09 |
Entered: | 2007-11-09 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B194AA / 2 | RL / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 0676U / 2 | LL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B50007A / 2 | LL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0876U / 2 | MO / PO |
Administered by: Unknown Purchased by: Unknown
Symptoms: Intussusception
Life Threatening? Yes
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: 7
Write-up: INTUSSUSEPTION 8 DAYS AFTER 2ND DOSES OF PEDIARIX, PREVNAR, HIB, ROTATEQ. 11/12/07 Received vax record from pcp which confirms RO dose & lot # as reported. 12/4/07 Reviewed hospital medical records which reveal patient experienced irritability, fever, vomiting, pallor, cold extremities & bloody stools x 1 day. Admitted 11/6-11/14/2007. Taken to OR for exp lap & ileocolic resection when unable to reduce in radiology. Placed on TPN postoperatively in PICU. Progressed well & d/c to home. FINAL DX: Intussusception, surgically reduced. Records faxed to CDC.
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