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This is VAERS ID 296290

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

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     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Birth Hx: twin born at 37 wks.
Allergies:
Diagnostic Lab Data: LABS: abdominal x-ray revealed dilated loops. US of abdomen revealed IS.
CDC 'Split Type':

Write-up: INTUSSUSEPTION 8 DAYS AFTER 2ND DOSES OF PEDIARIX, PREVNAR, HIB, ROTATEQ

Changed on 12/8/2009

VAERS ID: 296290 Before After
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
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     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Birth Hx: twin born at 37 wks.
Allergies:
Diagnostic Lab Data: LABS: abdominal x-ray revealed dilated loops. US of abdomen revealed IS.
CDC 'Split Type':

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.

Changed on 3/2/2010

VAERS ID: 296290 Before After
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
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     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Birth Hx: twin born at 37 wks.
Allergies:
Diagnostic Lab Data: LABS: abdominal x-ray revealed dilated loops. US of abdomen revealed IS.
CDC 'Split Type':

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.

Changed on 4/7/2010

VAERS ID: 296290 Before After
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
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     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Birth Hx: twin born at 37 wks.
Allergies:
Diagnostic Lab Data: LABS: abdominal x-ray revealed dilated loops. US of abdomen revealed IS.
CDC 'Split Type':

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.

Changed on 8/31/2010

VAERS ID: 296290 Before After
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
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     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Birth Hx: twin born at 37 wks.
Allergies:
Diagnostic Lab Data: LABS: abdominal x-ray revealed dilated loops. US of abdomen revealed IS.
CDC 'Split Type':

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.

Changed on 5/13/2013

VAERS ID: 296290 Before After
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
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     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Birth Hx: twin born at 37 wks.
Allergies:
Diagnostic Lab Data: LABS: abdominal x-ray revealed dilated loops. US of abdomen revealed IS.
CDC 'Split Type':

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.

Changed on 4/14/2017

VAERS ID: 296290 Before After
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
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     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Birth Hx: twin born at 37 wks.
Allergies:
Diagnostic Lab Data: LABS: abdominal x-ray revealed dilated loops. US of abdomen revealed IS.
CDC 'Split Type':

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.

Changed on 9/14/2017

VAERS ID: 296290 Before After
VAERS Form:(blank) 1
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
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     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Birth Hx: twin born at 37 wks.
Allergies:
Diagnostic Lab Data: LABS: abdominal x-ray revealed dilated loops. US of abdomen revealed IS.
CDC 'Split Type':

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.

Changed on 2/14/2018

VAERS ID: 296290 Before After
VAERS Form:1
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
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     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Birth Hx: twin born at 37 wks.
Allergies:
Diagnostic Lab Data: LABS: abdominal x-ray revealed dilated loops. US of abdomen revealed IS.
CDC 'Split Type':

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.

Changed on 6/14/2018

VAERS ID: 296290 Before After
VAERS Form:1
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
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     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Birth Hx: twin born at 37 wks.
Allergies:
Diagnostic Lab Data: LABS: abdominal x-ray revealed dilated loops. US of abdomen revealed IS.
CDC 'Split Type':

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.

Changed on 8/14/2018

VAERS ID: 296290 Before After
VAERS Form:1
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
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     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Birth Hx: twin born at 37 wks.
Allergies:
Diagnostic Lab Data: LABS: abdominal x-ray revealed dilated loops. US of abdomen revealed IS.
CDC 'Split Type':

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.

Changed on 9/14/2018

VAERS ID: 296290 Before After
VAERS Form:1
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
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     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Birth Hx: twin born at 37 wks.
Allergies:
Diagnostic Lab Data: LABS: abdominal x-ray revealed dilated loops. US of abdomen revealed IS.
CDC 'Split Type':

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.

Changed on 10/14/2018

VAERS ID: 296290 Before After
VAERS Form:1
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
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     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Birth Hx: twin born at 37 wks.
Allergies:
Diagnostic Lab Data: LABS: abdominal x-ray revealed dilated loops. US of abdomen revealed IS.
CDC 'Split Type':

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.

Changed on 12/24/2020

VAERS ID: 296290 Before After
VAERS Form:1
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
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     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Birth Hx: twin born at 37 wks.
Allergies:
Diagnostic Lab Data: LABS: abdominal x-ray revealed dilated loops. US of abdomen revealed IS.
CDC 'Split Type':

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.

Changed on 12/30/2020

VAERS ID: 296290 Before After
VAERS Form:1
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
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     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Birth Hx: twin born at 37 wks.
Allergies:
Diagnostic Lab Data: LABS: abdominal x-ray revealed dilated loops. US of abdomen revealed IS.
CDC 'Split Type':

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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