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This is VAERS ID 299129

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 299129
VAERS Form:
Age:0.2
Gender:Female
Location:Minnesota
Vaccinated:2007-11-07
Onset:2007-12-04
Submitted:2007-12-10
Entered:2007-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B125CB / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0257U / 0 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08700K / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0969U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Anaemia, Barium double contrast, Blood culture negative, Bacteria stool identified, Decreased appetite

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Air Contrast Enema with confirmed intussuseption
CDC 'Split Type':

Write-up: Documented case of Intussusecption 4 weeks after dose of Rotateq.


Changed on 12/8/2009

VAERS ID: 299129 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Minnesota
Vaccinated:2007-11-07
Onset:2007-12-04
Submitted:2007-12-10
Entered:2007-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B125CB / 0 LL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B125CB / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0257U / 0 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08700K / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0969U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Anaemia, Barium double contrast, Blood culture negative, Haematochezia, Haemoglobin decreased, Intussusception, Rectal haemorrhage, Somnolence, Urinary system X-ray, Vomiting, Vomiting projectile, X-ray with contrast upper gastrointestinal tract, Bacteria stool identified, Decreased appetite

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None 1/10/08-records received- PMH: unrepaired umbilical hernia.
Allergies:
Diagnostic Lab Data: Air Contrast Enema with confirmed intussuseption 1/10/08-records received-Hemoglobin 8.8. Air contrast enema: outlining intussusception in region of hepatic flexure of colon. Successful pneumatic reduction of ileocolic intussusception. UGI
CDC 'Split Type':

Write-up: Documented case of Intussusecption 4 weeks after dose of Rotateq. 1/10/08-records received for DOS 12/4-12/7/07-DC DX: Intussusception. Hematochezia, resolved.Vomiting resolved. Physiologic anemia in infancy. C/O bright red blood from rectum, emesis, vomiting projectile in nature. Decreased appetite and increased sleep.


Changed on 3/2/2010

VAERS ID: 299129 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Minnesota
Vaccinated:2007-11-07
Onset:2007-12-04
Submitted:2007-12-10
Entered:2007-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B125CB / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0257U / 0 RL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B08700K / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0969U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Anaemia, Barium double contrast, Blood culture negative, Haematochezia, Haemoglobin decreased, Intussusception, Rectal haemorrhage, Somnolence, Urinary system X-ray, Vomiting, Vomiting projectile, X-ray with contrast upper gastrointestinal tract, Bacteria stool identified, Decreased appetite

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None 1/10/08-records received- PMH: unrepaired umbilical hernia.
Allergies:
Diagnostic Lab Data: Air Contrast Enema with confirmed intussuseption 1/10/08-records received-Hemoglobin 8.8. Air contrast enema: outlining intussusception in region of hepatic flexure of colon. Successful pneumatic reduction of ileocolic intussusception. UGI
CDC 'Split Type':

Write-up: Documented case of Intussusecption 4 weeks after dose of Rotateq. 1/10/08-records received for DOS 12/4-12/7/07-DC DX: Intussusception. Hematochezia, resolved.Vomiting resolved. Physiologic anemia in infancy. C/O bright red blood from rectum, emesis, vomiting projectile in nature. Decreased appetite and increased sleep.


Changed on 4/7/2010

VAERS ID: 299129 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Minnesota
Vaccinated:2007-11-07
Onset:2007-12-04
Submitted:2007-12-10
Entered:2007-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B125CB / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0257U / 0 RL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08700K / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0969U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Anaemia, Barium double contrast, Blood culture negative, Haematochezia, Haemoglobin decreased, Intussusception, Rectal haemorrhage, Somnolence, Urinary system X-ray, Vomiting, Vomiting projectile, X-ray with contrast upper gastrointestinal tract, Bacteria stool identified, Decreased appetite

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None 1/10/08-records received- PMH: unrepaired umbilical hernia.
Allergies:
Diagnostic Lab Data: Air Contrast Enema with confirmed intussuseption 1/10/08-records received-Hemoglobin 8.8. Air contrast enema: outlining intussusception in region of hepatic flexure of colon. Successful pneumatic reduction of ileocolic intussusception. UGI
CDC 'Split Type':

Write-up: Documented case of Intussusecption 4 weeks after dose of Rotateq. 1/10/08-records received for DOS 12/4-12/7/07-DC DX: Intussusception. Hematochezia, resolved.Vomiting resolved. Physiologic anemia in infancy. C/O bright red blood from rectum, emesis, vomiting projectile in nature. Decreased appetite and increased sleep.


Changed on 8/31/2010

VAERS ID: 299129 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Minnesota
Vaccinated:2007-11-07
Onset:2007-12-04
Submitted:2007-12-10
Entered:2007-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B125CB / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0257U / 0 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B08700K / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0969U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Anaemia, Barium double contrast, Blood culture negative, Haematochezia, Haemoglobin decreased, Intussusception, Rectal haemorrhage, Somnolence, Urinary system X-ray, Vomiting, Vomiting projectile, X-ray with contrast upper gastrointestinal tract, Bacteria stool identified, Decreased appetite

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None 1/10/08-records received- PMH: unrepaired umbilical hernia.
Allergies:
Diagnostic Lab Data: Air Contrast Enema with confirmed intussuseption 1/10/08-records received-Hemoglobin 8.8. Air contrast enema: outlining intussusception in region of hepatic flexure of colon. Successful pneumatic reduction of ileocolic intussusception. UGI
CDC 'Split Type':

Write-up: Documented case of Intussusecption 4 weeks after dose of Rotateq. 1/10/08-records received for DOS 12/4-12/7/07-DC DX: Intussusception. Hematochezia, resolved.Vomiting resolved. Physiologic anemia in infancy. C/O bright red blood from rectum, emesis, vomiting projectile in nature. Decreased appetite and increased sleep.


Changed on 5/13/2013

VAERS ID: 299129 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Minnesota
Vaccinated:2007-11-07
Onset:2007-12-04
Submitted:2007-12-10
Entered:2007-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B125CB / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0257U / 0 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08700K / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0969U / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0969U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Anaemia, Barium double contrast, Blood culture negative, Haematochezia, Haemoglobin decreased, Intussusception, Rectal haemorrhage, Somnolence, Urinary system X-ray, Vomiting, Vomiting projectile, X-ray with contrast upper gastrointestinal tract, Bacteria stool identified, Decreased appetite

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None 1/10/08-records received- PMH: unrepaired umbilical hernia.
Allergies:
Diagnostic Lab Data: Air Contrast Enema with confirmed intussuseption 1/10/08-records received-Hemoglobin 8.8. Air contrast enema: outlining intussusception in region of hepatic flexure of colon. Successful pneumatic reduction of ileocolic intussusception. UGI
CDC 'Split Type':

Write-up: Documented case of Intussusecption 4 weeks after dose of Rotateq. 1/10/08-records received for DOS 12/4-12/7/07-DC DX: Intussusception. Hematochezia, resolved.Vomiting resolved. Physiologic anemia in infancy. C/O bright red blood from rectum, emesis, vomiting projectile in nature. Decreased appetite and increased sleep.


Changed on 2/14/2017

VAERS ID: 299129 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Minnesota
Vaccinated:2007-11-07
Onset:2007-12-04
Submitted:2007-12-10
Entered:2007-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B125CB / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0257U / 0 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08700K / 0 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0969U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Anaemia, Barium double contrast, Blood culture negative, Haematochezia, Haemoglobin decreased, Intussusception, Rectal haemorrhage, Somnolence, Urinary system X-ray, Vomiting, Vomiting projectile, X-ray with contrast upper gastrointestinal tract, Bacteria stool identified, Decreased appetite

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None 1/10/08-records received- PMH: unrepaired umbilical hernia.
Allergies:
Diagnostic Lab Data: Air Contrast Enema with confirmed intussuseption 1/10/08-records received-Hemoglobin 8.8. Air contrast enema: outlining intussusception in region of hepatic flexure of colon. Successful pneumatic reduction of ileocolic intussusception. UGI with KUB:suspicious for small bowel obstruction. No evidence of malrotation. Blood culture no growth. Stool positive for Clostridium difficile toxin A and or B.
CDC 'Split Type':

Write-up: Documented case of Intussusecption 4 weeks after dose of Rotateq. 1/10/08-records received for DOS 12/4-12/7/07-DC DX: Intussusception. Hematochezia, resolved.Vomiting resolved. Physiologic anemia in infancy. C/O bright red blood from rectum, emesis, vomiting projectile in nature. Decreased appetite and increased sleep.


Changed on 9/14/2017

VAERS ID: 299129 Before After
VAERS Form:(blank) 1
Age:0.2
Gender:Female
Location:Minnesota
Vaccinated:2007-11-07
Onset:2007-12-04
Submitted:2007-12-10
Entered:2007-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B125CB / 0 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0257U / 0 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08700K / 0 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0969U / 0 1 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, 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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None 1/10/08-records received- PMH: unrepaired umbilical hernia.
Allergies:
Diagnostic Lab Data: Air Contrast Enema with confirmed intussuseption 1/10/08-records received-Hemoglobin 8.8. Air contrast enema: outlining intussusception in region of hepatic flexure of colon. Successful pneumatic reduction of ileocolic intussusception. UGI with KUB:suspicious for small bowel obstruction. No evidence of malrotation. Blood culture no growth. Stool positive for Clostridium difficile toxin A and or B.
CDC 'Split Type':

Write-up: Documented case of Intussusecption 4 weeks after dose of Rotateq. 1/10/08-records received for DOS 12/4-12/7/07-DC DX: Intussusception. Hematochezia, resolved.Vomiting resolved. Physiologic anemia in infancy. C/O bright red blood from rectum, emesis, vomiting projectile in nature. Decreased appetite and increased sleep.


Changed on 2/14/2018

VAERS ID: 299129 Before After
VAERS Form:1
Age:0.2
Gender:Female
Location:Minnesota
Vaccinated:2007-11-07
Onset:2007-12-04
Submitted:2007-12-10
Entered:2007-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B125CB / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0257U / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08700K / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0969U / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, 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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None 1/10/08-records received- PMH: unrepaired umbilical hernia.
Allergies:
Diagnostic Lab Data: Air Contrast Enema with confirmed intussuseption 1/10/08-records received-Hemoglobin 8.8. Air contrast enema: outlining intussusception in region of hepatic flexure of colon. Successful pneumatic reduction of ileocolic intussusception. UGI with KUB:suspicious for small bowel obstruction. No evidence of malrotation. Blood culture no growth. Stool positive for Clostridium difficile toxin A and or B.
CDC 'Split Type':

Write-up: Documented case of Intussusecption 4 weeks after dose of Rotateq. 1/10/08-records received for DOS 12/4-12/7/07-DC DX: Intussusception. Hematochezia, resolved.Vomiting resolved. Physiologic anemia in infancy. C/O bright red blood from rectum, emesis, vomiting projectile in nature. Decreased appetite and increased sleep.


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