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This is VAERS ID 299557

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 299557
VAERS Form:
Age:0.6
Gender:Female
Location:Washington
Vaccinated:2007-11-21
Onset:2007-12-07
Submitted:2007-12-10
Entered:2007-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B130AA / 1 LL / IM
FLU: INFLUENZA (FLUZONE) / SANOFI PASTEUR U2481EA / 0 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF192AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B53981H / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1108U / 2 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Barium double contrast, Diarrhoea haemorrhagic, Haematochezia, Enema administration, Food intolerance

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: air-contrast enema
CDC 'Split Type':

Write-up: Intussusception, reduced by diagnostic enema. Presented with vomiting and bloody stools on 12/7/07.


Changed on 12/8/2009

VAERS ID: 299557 Before After
VAERS Form:
Age:0.6
Gender:Female
Location:Washington
Vaccinated:2007-11-21
Onset:2007-12-07
Submitted:2007-12-10
Entered:2007-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B130AA / 1 LL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B130AA / 1 LL / IM
FLU: INFLUENZA (FLUZONE) INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2481EA / 0 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF192AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B53981H / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1108U / 2 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Barium double contrast, Diarrhoea haemorrhagic, Haematochezia, Intussusception, Vomiting, Enema administration, Ultrasound abdomen abnormal, Occult blood positive, Food intolerance

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: air-contrast enema 1/7/08-records received-Stool guaic positive. Ultrasound confirmed intussusception.
CDC 'Split Type':

Write-up: Intussusception, reduced by diagnostic enema. Presented with vomiting and bloody stools on 12/7/07. 1/7/08-records received for DOS 12/7-12/8/07-DC DX: Intussusception status post reduction. HX of emesis, not tolerating foods and bloody diarrhea. Vomiting. Air contrast enema with successful and uncomplicated reduction of ileocolic intussusception which had originally progressed nearly to the splenic flexture.


Changed on 3/2/2010

VAERS ID: 299557 Before After
VAERS Form:
Age:0.6
Gender:Female
Location:Washington
Vaccinated:2007-11-21
Onset:2007-12-07
Submitted:2007-12-10
Entered:2007-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B130AA / 1 LL / IM
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2481EA / 0 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF192AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B53981H / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1108U / 2 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Barium double contrast, Diarrhoea haemorrhagic, Haematochezia, Intussusception, Vomiting, Enema administration, Ultrasound abdomen abnormal, Occult blood positive, Food intolerance

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: air-contrast enema 1/7/08-records received-Stool guaic positive. Ultrasound confirmed intussusception.
CDC 'Split Type':

Write-up: Intussusception, reduced by diagnostic enema. Presented with vomiting and bloody stools on 12/7/07. 1/7/08-records received for DOS 12/7-12/8/07-DC DX: Intussusception status post reduction. HX of emesis, not tolerating foods and bloody diarrhea. Vomiting. Air contrast enema with successful and uncomplicated reduction of ileocolic intussusception which had originally progressed nearly to the splenic flexture.


Changed on 4/7/2010

VAERS ID: 299557 Before After
VAERS Form:
Age:0.6
Gender:Female
Location:Washington
Vaccinated:2007-11-21
Onset:2007-12-07
Submitted:2007-12-10
Entered:2007-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B130AA / 1 LL / IM
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2481EA / 0 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF192AA / 2 RL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B53981H / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1108U / 2 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Barium double contrast, Diarrhoea haemorrhagic, Haematochezia, Intussusception, Vomiting, Enema administration, Ultrasound abdomen abnormal, Occult blood positive, Food intolerance

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: air-contrast enema 1/7/08-records received-Stool guaic positive. Ultrasound confirmed intussusception.
CDC 'Split Type':

Write-up: Intussusception, reduced by diagnostic enema. Presented with vomiting and bloody stools on 12/7/07. 1/7/08-records received for DOS 12/7-12/8/07-DC DX: Intussusception status post reduction. HX of emesis, not tolerating foods and bloody diarrhea. Vomiting. Air contrast enema with successful and uncomplicated reduction of ileocolic intussusception which had originally progressed nearly to the splenic flexture.


Changed on 8/31/2010

VAERS ID: 299557 Before After
VAERS Form:
Age:0.6
Gender:Female
Location:Washington
Vaccinated:2007-11-21
Onset:2007-12-07
Submitted:2007-12-10
Entered:2007-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B130AA / 1 LL / IM
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2481EA / 0 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF192AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B53981H / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1108U / 2 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Barium double contrast, Diarrhoea haemorrhagic, Haematochezia, Intussusception, Vomiting, Enema administration, Ultrasound abdomen abnormal, Occult blood positive, Food intolerance

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: air-contrast enema 1/7/08-records received-Stool guaic positive. Ultrasound confirmed intussusception.
CDC 'Split Type':

Write-up: Intussusception, reduced by diagnostic enema. Presented with vomiting and bloody stools on 12/7/07. 1/7/08-records received for DOS 12/7-12/8/07-DC DX: Intussusception status post reduction. HX of emesis, not tolerating foods and bloody diarrhea. Vomiting. Air contrast enema with successful and uncomplicated reduction of ileocolic intussusception which had originally progressed nearly to the splenic flexture.


Changed on 5/13/2013

VAERS ID: 299557 Before After
VAERS Form:
Age:0.6
Gender:Female
Location:Washington
Vaccinated:2007-11-21
Onset:2007-12-07
Submitted:2007-12-10
Entered:2007-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B130AA / 1 LL / IM
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2481EA / 0 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF192AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B53981H / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1108U / 2 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1108U / 2 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Barium double contrast, Diarrhoea haemorrhagic, Haematochezia, Intussusception, Vomiting, Enema administration, Ultrasound abdomen abnormal, Occult blood positive, Food intolerance

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: air-contrast enema 1/7/08-records received-Stool guaic positive. Ultrasound confirmed intussusception.
CDC 'Split Type':

Write-up: Intussusception, reduced by diagnostic enema. Presented with vomiting and bloody stools on 12/7/07. 1/7/08-records received for DOS 12/7-12/8/07-DC DX: Intussusception status post reduction. HX of emesis, not tolerating foods and bloody diarrhea. Vomiting. Air contrast enema with successful and uncomplicated reduction of ileocolic intussusception which had originally progressed nearly to the splenic flexture.


Changed on 7/7/2013

VAERS ID: 299557 Before After
VAERS Form:
Age:0.6
Gender:Female
Location:Washington
Vaccinated:2007-11-21
Onset:2007-12-07
Submitted:2007-12-10
Entered:2007-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B130AA / 1 LL / IM
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2481EA / 0 RL / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2481EA / 0 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF192AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B53981H / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1108U / 2 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Barium double contrast, Diarrhoea haemorrhagic, Haematochezia, Intussusception, Vomiting, Enema administration, Ultrasound abdomen abnormal, Occult blood positive, Food intolerance

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: air-contrast enema 1/7/08-records received-Stool guaic positive. Ultrasound confirmed intussusception.
CDC 'Split Type':

Write-up: Intussusception, reduced by diagnostic enema. Presented with vomiting and bloody stools on 12/7/07. 1/7/08-records received for DOS 12/7-12/8/07-DC DX: Intussusception status post reduction. HX of emesis, not tolerating foods and bloody diarrhea. Vomiting. Air contrast enema with successful and uncomplicated reduction of ileocolic intussusception which had originally progressed nearly to the splenic flexture.


Changed on 4/14/2017

VAERS ID: 299557 Before After
VAERS Form:
Age:0.6
Gender:Female
Location:Washington
Vaccinated:2007-11-21
Onset:2007-12-07
Submitted:2007-12-10
Entered:2007-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B130AA / 1 LL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2481EA / 0 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF192AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B53981H / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1108U / 2 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Barium double contrast, Diarrhoea haemorrhagic, Haematochezia, Intussusception, Vomiting, Enema administration, Ultrasound abdomen abnormal, Occult blood positive, Food intolerance

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: air-contrast enema 1/7/08-records received-Stool guaic positive. Ultrasound confirmed intussusception.
CDC 'Split Type':

Write-up: Intussusception, reduced by diagnostic enema. Presented with vomiting and bloody stools on 12/7/07. 1/7/08-records received for DOS 12/7-12/8/07-DC DX: Intussusception status post reduction. HX of emesis, not tolerating foods and bloody diarrhea. Vomiting. Air contrast enema with successful and uncomplicated reduction of ileocolic intussusception which had originally progressed nearly to the splenic flexture.


Changed on 9/14/2017

VAERS ID: 299557 Before After
VAERS Form:(blank) 1
Age:0.6
Gender:Female
Location:Washington
Vaccinated:2007-11-21
Onset:2007-12-07
Submitted:2007-12-10
Entered:2007-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B130AA / 1 2 LL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2481EA / 0 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF192AA / 2 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B53981H / 2 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1108U / 2 3 - MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Barium double contrast, Haematochezia, Intussusception, Vomiting, 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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: air-contrast enema 1/7/08-records received-Stool guaic positive. Ultrasound confirmed intussusception.
CDC 'Split Type':

Write-up: Intussusception, reduced by diagnostic enema. Presented with vomiting and bloody stools on 12/7/07. 1/7/08-records received for DOS 12/7-12/8/07-DC DX: Intussusception status post reduction. HX of emesis, not tolerating foods and bloody diarrhea. Vomiting. Air contrast enema with successful and uncomplicated reduction of ileocolic intussusception which had originally progressed nearly to the splenic flexture.


Changed on 2/14/2018

VAERS ID: 299557 Before After
VAERS Form:1
Age:0.6
Gender:Female
Location:Washington
Vaccinated:2007-11-21
Onset:2007-12-07
Submitted:2007-12-10
Entered:2007-12-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B130AA / 2 LL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2481EA / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF192AA / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B53981H / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1108U / 3 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Barium double contrast, Haematochezia, Intussusception, Vomiting, 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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: air-contrast enema 1/7/08-records received-Stool guaic positive. Ultrasound confirmed intussusception.
CDC 'Split Type':

Write-up: Intussusception, reduced by diagnostic enema. Presented with vomiting and bloody stools on 12/7/07. 1/7/08-records received for DOS 12/7-12/8/07-DC DX: Intussusception status post reduction. HX of emesis, not tolerating foods and bloody diarrhea. Vomiting. Air contrast enema with successful and uncomplicated reduction of ileocolic intussusception which had originally progressed nearly to the splenic flexture.


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