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This is VAERS ID 302692

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 302692
VAERS Form:
Age:0.2
Gender:Female
Location:Ohio
Vaccinated:2007-11-01
Onset:2007-11-08
Submitted:2008-01-15
Entered:2008-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124BA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR VF163AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B47300B / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0505U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Culture stool negative, Haematochezia, Enema administration, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Nystatin topical ointment
Current Illness: Cadidal diaper dermatitis
Preexisting Conditions: None. PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd X-ray suspicious for IS. Abd US shows ileocolic intussusception. Air enema (+) for filling defect. Stool (+) for occult blood. Stool cx (-).
CDC 'Split Type':

Write-up: Patient was treated for intussusception on 11/8/07. 02/26/2008 MR received for DOS 11/08-09/2007 with D/C DX: Intussusception. Infant presented to ER with projectile vomiting, fussiness, drawing up of the legs, and decreased UO. In ER had bloody stool"and RUQ pain. Reduced by Air Enema. Following reduction, pt tolerated po and d/c next day.

Changed on 12/8/2009

VAERS ID: 302692 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Ohio
Vaccinated:2007-11-01
Onset:2007-11-08
Submitted:2008-01-15
Entered:2008-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124BA / 0 RL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124BA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR VF163AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B47300B / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0505U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Culture stool negative, Haematochezia, Intussusception, Irritability, Vomiting projectile, Enema administration, Ultrasound abdomen abnormal, Urine output decreased, Abdominal X-ray, Occult blood positive

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Nystatin topical ointment
Current Illness: Cadidal diaper dermatitis
Preexisting Conditions: None. PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd X-ray suspicious for IS. Abd US shows ileocolic intussusception. Air enema (+) for filling defect. Stool (+) for occult blood. Stool cx (-).
CDC 'Split Type':

Write-up: Patient was treated for intussusception on 11/8/07. 02/26/2008 MR received for DOS 11/08-09/2007 with D/C DX: Intussusception. Infant presented to ER with projectile vomiting, fussiness, drawing up of the legs, and decreased UO. In ER had bloody stool"and stool and RUQ pain. Reduced by Air Enema. Following reduction, pt tolerated po and d/c next day.

Changed on 3/2/2010

VAERS ID: 302692 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Ohio
Vaccinated:2007-11-01
Onset:2007-11-08
Submitted:2008-01-15
Entered:2008-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124BA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR VF163AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B47300B / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0505U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Culture stool negative, Haematochezia, Intussusception, Irritability, Vomiting projectile, Enema administration, Ultrasound abdomen abnormal, Urine output decreased, Abdominal X-ray, Occult blood positive

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Nystatin topical ointment
Current Illness: Cadidal diaper dermatitis
Preexisting Conditions: None. PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd X-ray suspicious for IS. Abd US shows ileocolic intussusception. Air enema (+) for filling defect. Stool (+) for occult blood. Stool cx (-).
CDC 'Split Type':

Write-up: Patient was treated for intussusception on 11/8/07. 02/26/2008 MR received for DOS 11/08-09/2007 with D/C DX: Intussusception. Infant presented to ER with projectile vomiting, fussiness, drawing up of the legs, and decreased UO. In ER had bloody stool and RUQ pain. Reduced by Air Enema. Following reduction, pt tolerated po and d/c next day.

Changed on 4/7/2010

VAERS ID: 302692 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Ohio
Vaccinated:2007-11-01
Onset:2007-11-08
Submitted:2008-01-15
Entered:2008-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124BA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR VF163AA / 0 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B47300B / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0505U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Culture stool negative, Haematochezia, Intussusception, Irritability, Vomiting projectile, Enema administration, Ultrasound abdomen abnormal, Urine output decreased, Abdominal X-ray, Occult blood positive

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Nystatin topical ointment
Current Illness: Cadidal diaper dermatitis
Preexisting Conditions: None. PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd X-ray suspicious for IS. Abd US shows ileocolic intussusception. Air enema (+) for filling defect. Stool (+) for occult blood. Stool cx (-).
CDC 'Split Type':

Write-up: Patient was treated for intussusception on 11/8/07. 02/26/2008 MR received for DOS 11/08-09/2007 with D/C DX: Intussusception. Infant presented to ER with projectile vomiting, fussiness, drawing up of the legs, and decreased UO. In ER had bloody stool and RUQ pain. Reduced by Air Enema. Following reduction, pt tolerated po and d/c next day.

Changed on 8/31/2010

VAERS ID: 302692 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Ohio
Vaccinated:2007-11-01
Onset:2007-11-08
Submitted:2008-01-15
Entered:2008-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124BA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR VF163AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B47300B / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0505U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Culture stool negative, Haematochezia, Intussusception, Irritability, Vomiting projectile, Enema administration, Ultrasound abdomen abnormal, Urine output decreased, Abdominal X-ray, Occult blood positive

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Nystatin topical ointment
Current Illness: Cadidal diaper dermatitis
Preexisting Conditions: None. PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd X-ray suspicious for IS. Abd US shows ileocolic intussusception. Air enema (+) for filling defect. Stool (+) for occult blood. Stool cx (-).
CDC 'Split Type':

Write-up: Patient was treated for intussusception on 11/8/07. 02/26/2008 MR received for DOS 11/08-09/2007 with D/C DX: Intussusception. Infant presented to ER with projectile vomiting, fussiness, drawing up of the legs, and decreased UO. In ER had bloody stool and RUQ pain. Reduced by Air Enema. Following reduction, pt tolerated po and d/c next day.

Changed on 5/13/2013

VAERS ID: 302692 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Ohio
Vaccinated:2007-11-01
Onset:2007-11-08
Submitted:2008-01-15
Entered:2008-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124BA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR VF163AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47300B / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0505U / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0505U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Culture stool negative, Haematochezia, Intussusception, Irritability, Vomiting projectile, Enema administration, Ultrasound abdomen abnormal, Urine output decreased, Abdominal X-ray, Occult blood positive

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Nystatin topical ointment
Current Illness: Cadidal diaper dermatitis
Preexisting Conditions: None. PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd X-ray suspicious for IS. Abd US shows ileocolic intussusception. Air enema (+) for filling defect. Stool (+) for occult blood. Stool cx (-).
CDC 'Split Type':

Write-up: Patient was treated for intussusception on 11/8/07. 02/26/2008 MR received for DOS 11/08-09/2007 with D/C DX: Intussusception. Infant presented to ER with projectile vomiting, fussiness, drawing up of the legs, and decreased UO. In ER had bloody stool and RUQ pain. Reduced by Air Enema. Following reduction, pt tolerated po and d/c next day.

Changed on 2/14/2017

VAERS ID: 302692 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Ohio
Vaccinated:2007-11-01
Onset:2007-11-08
Submitted:2008-01-15
Entered:2008-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124BA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR VF163AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47300B / 0 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0505U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Culture stool negative, Haematochezia, Intussusception, Irritability, Vomiting projectile, Enema administration, Ultrasound abdomen abnormal, Urine output decreased, Abdominal X-ray, Occult blood positive

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Nystatin topical ointment
Current Illness: Cadidal diaper dermatitis
Preexisting Conditions: None. PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd X-ray suspicious for IS. Abd US shows ileocolic intussusception. Air enema (+) for filling defect. Stool (+) for occult blood. Stool cx (-).
CDC 'Split Type':

Write-up: Patient was treated for intussusception on 11/8/07. 02/26/2008 MR received for DOS 11/08-09/2007 with D/C DX: Intussusception. Infant presented to ER with projectile vomiting, fussiness, drawing up of the legs, and decreased UO. In ER had bloody stool and RUQ pain. Reduced by Air Enema. Following reduction, pt tolerated po and d/c next day.

Changed on 9/14/2017

VAERS ID: 302692 Before After
VAERS Form:(blank) 1
Age:0.2
Gender:Female
Location:Ohio
Vaccinated:2007-11-01
Onset:2007-11-08
Submitted:2008-01-15
Entered:2008-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124BA / 0 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR VF163AA / 0 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47300B / 0 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0505U / 0 1 - 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Nystatin topical ointment
Current Illness: Cadidal diaper dermatitis
Preexisting Conditions: None. PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd X-ray suspicious for IS. Abd US shows ileocolic intussusception. Air enema (+) for filling defect. Stool (+) for occult blood. Stool cx (-).
CDC 'Split Type':

Write-up: Patient was treated for intussusception on 11/8/07. 02/26/2008 MR received for DOS 11/08-09/2007 with D/C DX: Intussusception. Infant presented to ER with projectile vomiting, fussiness, drawing up of the legs, and decreased UO. In ER had bloody stool and RUQ pain. Reduced by Air Enema. Following reduction, pt tolerated po and d/c next day.

Changed on 2/14/2018

VAERS ID: 302692 Before After
VAERS Form:1
Age:0.2
Gender:Female
Location:Ohio
Vaccinated:2007-11-01
Onset:2007-11-08
Submitted:2008-01-15
Entered:2008-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124BA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR VF163AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47300B / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0505U / 1 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Nystatin topical ointment
Current Illness: Cadidal diaper dermatitis
Preexisting Conditions: None. PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd X-ray suspicious for IS. Abd US shows ileocolic intussusception. Air enema (+) for filling defect. Stool (+) for occult blood. Stool cx (-).
CDC 'Split Type':

Write-up: Patient was treated for intussusception on 11/8/07. 02/26/2008 MR received for DOS 11/08-09/2007 with D/C DX: Intussusception. Infant presented to ER with projectile vomiting, fussiness, drawing up of the legs, and decreased UO. In ER had bloody stool and RUQ pain. Reduced by Air Enema. Following reduction, pt tolerated po and d/c next day.

Changed on 6/14/2018

VAERS ID: 302692 Before After
VAERS Form:1
Age:0.2
Gender:Female
Location:Ohio
Vaccinated:2007-11-01
Onset:2007-11-08
Submitted:2008-01-15
Entered:2008-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124BA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR VF163AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47300B / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0505U / 1 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Nystatin topical ointment
Current Illness: Cadidal diaper dermatitis
Preexisting Conditions: None. PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd X-ray suspicious for IS. Abd US shows ileocolic intussusception. Air enema (+) for filling defect. Stool (+) for occult blood. Stool cx (-).
CDC 'Split Type':

Write-up: Patient was treated for intussusception on 11/8/07. 02/26/2008 MR received for DOS 11/08-09/2007 with D/C DX: Intussusception. Infant presented to ER with projectile vomiting, fussiness, drawing up of the legs, and decreased UO. In ER had bloody stool and RUQ pain. Reduced by Air Enema. Following reduction, pt tolerated po and d/c next day.

Changed on 8/14/2018

VAERS ID: 302692 Before After
VAERS Form:1
Age:0.2
Gender:Female
Location:Ohio
Vaccinated:2007-11-01
Onset:2007-11-08
Submitted:2008-01-15
Entered:2008-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124BA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR VF163AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47300B / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0505U / 1 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Nystatin topical ointment
Current Illness: Cadidal diaper dermatitis
Preexisting Conditions: None. PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd X-ray suspicious for IS. Abd US shows ileocolic intussusception. Air enema (+) for filling defect. Stool (+) for occult blood. Stool cx (-).
CDC 'Split Type':

Write-up: Patient was treated for intussusception on 11/8/07. 02/26/2008 MR received for DOS 11/08-09/2007 with D/C DX: Intussusception. Infant presented to ER with projectile vomiting, fussiness, drawing up of the legs, and decreased UO. In ER had bloody stool and RUQ pain. Reduced by Air Enema. Following reduction, pt tolerated po and d/c next day.

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