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VAERS ID: | 302692 |
VAERS Form: | |
Age: | 0.2 |
Sex: | 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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=302692&WAYBACKHISTORY=ON
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