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This is VAERS ID 298203

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 298203
VAERS Form:
Age:0.4
Gender:Female
Location:Florida
Vaccinated:2007-09-26
Onset:2007-11-24
Submitted:2007-11-28
Entered:2007-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B046AA / 1 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF163AA / 1 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0872 / - UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0509U / 1 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: Abdominal pain, Haematochezia, Intussusception, Irritability, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None PMH: congestion, rhinnorhea, cough & ear infection 3 wks prior tx w/antibiotics last dose 11/23.
Allergies:
Diagnostic Lab Data: Ultrasound showed telescoping of bowel segments. LABS: US revealed IS in right periumbilical region. Air contrast enema reduced IS.
CDC 'Split Type':

Write-up: Intussusception diagnosed by ultrasound after patient presented with vomiting and bloody stools. 12/04/07 Reviewed vax record which confirms RO dose/lot as reported. Faxed to CDC. 12/18/07 Reviewed hospital medical records which reveal patient experienc"ed irritability, reduced oral intake, vomiting, abdominal pain & bloody stools. Taken to ER 11/24/07. Admitted for observation overnight. Progressed well & d/c to home. FINAL DX: Intussusception, enema reduced. Records faxed to CDC.


Changed on 12/8/2009

VAERS ID: 298203 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Florida
Vaccinated:2007-09-26
Onset:2007-11-24
Submitted:2007-11-28
Entered:2007-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B046AA / 1 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF163AA / 1 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0872 / - UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0509U / 1 - / PO

Administered by: Public      Purchased by: Unknown Public
Symptoms: Abdominal pain, Haematochezia, Intussusception, Irritability, Vomiting, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None PMH: congestion, rhinnorhea, cough & ear infection 3 wks prior tx w/antibiotics last dose 11/23.
Allergies:
Diagnostic Lab Data: Ultrasound showed telescoping of bowel segments. LABS: US revealed IS in right periumbilical region. Air contrast enema reduced IS.
CDC 'Split Type':

Write-up: Intussusception diagnosed by ultrasound after patient presented with vomiting and bloody stools. 12/04/07 Reviewed vax record which confirms RO dose/lot as reported. Faxed to CDC. 12/18/07 Reviewed hospital medical records which reveal patient experienc"ed experienced irritability, reduced oral intake, vomiting, abdominal pain & bloody stools. Taken to ER 11/24/07. Admitted for observation overnight. Progressed well & d/c to home. FINAL DX: Intussusception, enema reduced. Records faxed to CDC.


Changed on 5/13/2013

VAERS ID: 298203 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Florida
Vaccinated:2007-09-26
Onset:2007-11-24
Submitted:2007-11-28
Entered:2007-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B046AA / 1 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF163AA / 1 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0872 / - UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0509U / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0509U / 1 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Abdominal pain, Haematochezia, Intussusception, Irritability, Vomiting, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None PMH: congestion, rhinnorhea, cough & ear infection 3 wks prior tx w/antibiotics last dose 11/23.
Allergies:
Diagnostic Lab Data: Ultrasound showed telescoping of bowel segments. LABS: US revealed IS in right periumbilical region. Air contrast enema reduced IS.
CDC 'Split Type':

Write-up: Intussusception diagnosed by ultrasound after patient presented with vomiting and bloody stools. 12/04/07 Reviewed vax record which confirms RO dose/lot as reported. Faxed to CDC. 12/18/07 Reviewed hospital medical records which reveal patient experienced irritability, reduced oral intake, vomiting, abdominal pain & bloody stools. Taken to ER 11/24/07. Admitted for observation overnight. Progressed well & d/c to home. FINAL DX: Intussusception, enema reduced. Records faxed to CDC.


Changed on 4/14/2017

VAERS ID: 298203 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Florida
Vaccinated:2007-09-26
Onset:2007-11-24
Submitted:2007-11-28
Entered:2007-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B046AA / 1 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF163AA / 1 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0872 / - UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0509U / 1 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Abdominal pain, Haematochezia, Intussusception, Irritability, Vomiting, 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None PMH: congestion, rhinnorhea, cough & ear infection 3 wks prior tx w/antibiotics last dose 11/23.
Allergies:
Diagnostic Lab Data: Ultrasound showed telescoping of bowel segments. LABS: US revealed IS in right periumbilical region. Air contrast enema reduced IS.
CDC 'Split Type':

Write-up: Intussusception diagnosed by ultrasound after patient presented with vomiting and bloody stools. 12/04/07 Reviewed vax record which confirms RO dose/lot as reported. Faxed to CDC. 12/18/07 Reviewed hospital medical records which reveal patient experienced irritability, reduced oral intake, vomiting, abdominal pain & bloody stools. Taken to ER 11/24/07. Admitted for observation overnight. Progressed well & d/c to home. FINAL DX: Intussusception, enema reduced. Records faxed to CDC.


Changed on 9/14/2017

VAERS ID: 298203 Before After
VAERS Form:(blank) 1
Age:0.4
Gender:Female
Location:Florida
Vaccinated:2007-09-26
Onset:2007-11-24
Submitted:2007-11-28
Entered:2007-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B046AA / 1 2 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF163AA / 1 2 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0872 / - UNK UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0509U / 1 2 - MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Haematochezia, Intussusception, Vomiting, Ultrasound abdomen abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: None
Current Illness: None
Preexisting Conditions: None PMH: congestion, rhinnorhea, cough & ear infection 3 wks prior tx w/antibiotics last dose 11/23.
Allergies:
Diagnostic Lab Data: Ultrasound showed telescoping of bowel segments. LABS: US revealed IS in right periumbilical region. Air contrast enema reduced IS.
CDC 'Split Type':

Write-up: Intussusception diagnosed by ultrasound after patient presented with vomiting and bloody stools. 12/04/07 Reviewed vax record which confirms RO dose/lot as reported. Faxed to CDC. 12/18/07 Reviewed hospital medical records which reveal patient experienced irritability, reduced oral intake, vomiting, abdominal pain & bloody stools. Taken to ER 11/24/07. Admitted for observation overnight. Progressed well & d/c to home. FINAL DX: Intussusception, enema reduced. Records faxed to CDC.


Changed on 2/14/2018

VAERS ID: 298203 Before After
VAERS Form:1
Age:0.4
Gender:Female
Location:Florida
Vaccinated:2007-09-26
Onset:2007-11-24
Submitted:2007-11-28
Entered:2007-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B046AA / 2 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF163AA / 2 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0872 / UNK UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0509U / 2 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Haematochezia, Intussusception, Vomiting, Ultrasound abdomen abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: None
Current Illness: None
Preexisting Conditions: None PMH: congestion, rhinnorhea, cough & ear infection 3 wks prior tx w/antibiotics last dose 11/23.
Allergies:
Diagnostic Lab Data: Ultrasound showed telescoping of bowel segments. LABS: US revealed IS in right periumbilical region. Air contrast enema reduced IS.
CDC 'Split Type':

Write-up: Intussusception diagnosed by ultrasound after patient presented with vomiting and bloody stools. 12/04/07 Reviewed vax record which confirms RO dose/lot as reported. Faxed to CDC. 12/18/07 Reviewed hospital medical records which reveal patient experienced irritability, reduced oral intake, vomiting, abdominal pain & bloody stools. Taken to ER 11/24/07. Admitted for observation overnight. Progressed well & d/c to home. FINAL DX: Intussusception, enema reduced. Records faxed to CDC.


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