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This is VAERS ID 303591

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 303591
VAERS Form:
Age:0.5
Gender:Female
Location:Iowa
Vaccinated:2007-10-24
Onset:2008-01-13
Submitted:2008-01-25
Entered:2008-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS A C21B124CA / 2 LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0676U / 2 RL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08700K / 2 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1391U / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Body temperature increased, Faeces discoloured, 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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound 2/14/08-records received- Hemoccult test of stool positive. US confirmed intussusception, water enema given without resolution. Therapuetic enema resolved intussusception after 4th attempt.
CDC 'Split Type':

Write-up: Developed intussusception at 8mo of age, 1-13-08. Unrelated to Rotateq? Transferred to hospital where this was corrected. 2/14/08-records received for DOS 1/8-1/12/08-DC DX: Intussusception. Intermittent fussiness began Wed, seen in ED treated with suppos"itory with positive stool and vomiting resolved. Thursday fussy, black stool and low grade temp.


Changed on 12/8/2009

VAERS ID: 303591 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Iowa
Vaccinated:2007-10-24
Onset:2008-01-13
Submitted:2008-01-25
Entered:2008-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS A C21B124CA / 2 LL / UN
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS A C21B124CA / 2 LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0676U / 2 RL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08700K / 2 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1391U / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Body temperature increased, Faeces discoloured, Intussusception, Irritability, Ultrasound scan, 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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound 2/14/08-records received- Hemoccult test of stool positive. US confirmed intussusception, water enema given without resolution. Therapuetic enema resolved intussusception after 4th attempt.
CDC 'Split Type':

Write-up: Developed intussusception at 8mo of age, 1-13-08. Unrelated to Rotateq? Transferred to hospital where this was corrected. 2/14/08-records received for DOS 1/8-1/12/08-DC DX: Intussusception. Intermittent fussiness began Wed, seen in ED treated with suppos"itory suppository with positive stool and vomiting resolved. Thursday fussy, black stool and low grade temp.


Changed on 3/2/2010

VAERS ID: 303591 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Iowa
Vaccinated:2007-10-24
Onset:2008-01-13
Submitted:2008-01-25
Entered:2008-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS A C21B124CA / 2 LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0676U / 2 RL / UN
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B08700K / 2 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1391U / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Body temperature increased, Faeces discoloured, Intussusception, Irritability, Ultrasound scan, 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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound 2/14/08-records received- Hemoccult test of stool positive. US confirmed intussusception, water enema given without resolution. Therapuetic enema resolved intussusception after 4th attempt.
CDC 'Split Type':

Write-up: Developed intussusception at 8mo of age, 1-13-08. Unrelated to Rotateq? Transferred to hospital where this was corrected. 2/14/08-records received for DOS 1/8-1/12/08-DC DX: Intussusception. Intermittent fussiness began Wed, seen in ED treated with suppository with positive stool and vomiting resolved. Thursday fussy, black stool and low grade temp.


Changed on 4/7/2010

VAERS ID: 303591 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Iowa
Vaccinated:2007-10-24
Onset:2008-01-13
Submitted:2008-01-25
Entered:2008-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS A C21B124CA / 2 LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0676U / 2 RL / UN
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08700K / 2 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1391U / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Body temperature increased, Faeces discoloured, Intussusception, Irritability, Ultrasound scan, 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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound 2/14/08-records received- Hemoccult test of stool positive. US confirmed intussusception, water enema given without resolution. Therapuetic enema resolved intussusception after 4th attempt.
CDC 'Split Type':

Write-up: Developed intussusception at 8mo of age, 1-13-08. Unrelated to Rotateq? Transferred to hospital where this was corrected. 2/14/08-records received for DOS 1/8-1/12/08-DC DX: Intussusception. Intermittent fussiness began Wed, seen in ED treated with suppository with positive stool and vomiting resolved. Thursday fussy, black stool and low grade temp.


Changed on 8/31/2010

VAERS ID: 303591 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Iowa
Vaccinated:2007-10-24
Onset:2008-01-13
Submitted:2008-01-25
Entered:2008-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS A C21B124CA / 2 LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0676U / 2 RL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B08700K / 2 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1391U / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Body temperature increased, Faeces discoloured, Intussusception, Irritability, Ultrasound scan, 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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound 2/14/08-records received- Hemoccult test of stool positive. US confirmed intussusception, water enema given without resolution. Therapuetic enema resolved intussusception after 4th attempt.
CDC 'Split Type':

Write-up: Developed intussusception at 8mo of age, 1-13-08. Unrelated to Rotateq? Transferred to hospital where this was corrected. 2/14/08-records received for DOS 1/8-1/12/08-DC DX: Intussusception. Intermittent fussiness began Wed, seen in ED treated with suppository with positive stool and vomiting resolved. Thursday fussy, black stool and low grade temp.


Changed on 5/12/2012

VAERS ID: 303591 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Iowa
Vaccinated:2007-10-24
Onset:2008-01-13
Submitted:2008-01-25
Entered:2008-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS A C21B124CA AC21B124CA / 2 LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0676U / 2 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08700K / 2 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1391U / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Body temperature increased, Faeces discoloured, Intussusception, Irritability, Ultrasound scan, 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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound 2/14/08-records received- Hemoccult test of stool positive. US confirmed intussusception, water enema given without resolution. Therapuetic enema resolved intussusception after 4th attempt.
CDC 'Split Type':

Write-up: Developed intussusception at 8mo of age, 1-13-08. Unrelated to Rotateq? Transferred to hospital where this was corrected. 2/14/08-records received for DOS 1/8-1/12/08-DC DX: Intussusception. Intermittent fussiness began Wed, seen in ED treated with suppository with positive stool and vomiting resolved. Thursday fussy, black stool and low grade temp.


Changed on 5/13/2013

VAERS ID: 303591 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Iowa
Vaccinated:2007-10-24
Onset:2008-01-13
Submitted:2008-01-25
Entered:2008-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124CA / 2 LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0676U / 2 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08700K / 2 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1391U / 2 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1391U / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Body temperature increased, Faeces discoloured, Intussusception, Irritability, Ultrasound scan, 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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound 2/14/08-records received- Hemoccult test of stool positive. US confirmed intussusception, water enema given without resolution. Therapuetic enema resolved intussusception after 4th attempt.
CDC 'Split Type':

Write-up: Developed intussusception at 8mo of age, 1-13-08. Unrelated to Rotateq? Transferred to hospital where this was corrected. 2/14/08-records received for DOS 1/8-1/12/08-DC DX: Intussusception. Intermittent fussiness began Wed, seen in ED treated with suppository with positive stool and vomiting resolved. Thursday fussy, black stool and low grade temp.


Changed on 4/14/2017

VAERS ID: 303591 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Iowa
Vaccinated:2007-10-24
Onset:2008-01-13
Submitted:2008-01-25
Entered:2008-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124CA / 2 LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0676U / 2 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08700K / 2 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1391U / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Body temperature increased, Faeces discoloured, Intussusception, Irritability, Ultrasound scan, 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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound 2/14/08-records received- Hemoccult test of stool positive. US confirmed intussusception, water enema given without resolution. Therapuetic enema resolved intussusception after 4th attempt.
CDC 'Split Type':

Write-up: Developed intussusception at 8mo of age, 1-13-08. Unrelated to Rotateq? Transferred to hospital where this was corrected. 2/14/08-records received for DOS 1/8-1/12/08-DC DX: Intussusception. Intermittent fussiness began Wed, seen in ED treated with suppository with positive stool and vomiting resolved. Thursday fussy, black stool and low grade temp.


Changed on 9/14/2017

VAERS ID: 303591 Before After
VAERS Form:(blank) 1
Age:0.5
Gender:Female
Location:Iowa
Vaccinated:2007-10-24
Onset:2008-01-13
Submitted:2008-01-25
Entered:2008-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124CA / 2 3 LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0676U / 2 3 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08700K / 2 3 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1391U / 2 3 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception, Ultrasound scan

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound 2/14/08-records received- Hemoccult test of stool positive. US confirmed intussusception, water enema given without resolution. Therapuetic enema resolved intussusception after 4th attempt.
CDC 'Split Type':

Write-up: Developed intussusception at 8mo of age, 1-13-08. Unrelated to Rotateq? Transferred to hospital where this was corrected. 2/14/08-records received for DOS 1/8-1/12/08-DC DX: Intussusception. Intermittent fussiness began Wed, seen in ED treated with suppository with positive stool and vomiting resolved. Thursday fussy, black stool and low grade temp.


Changed on 2/14/2018

VAERS ID: 303591 Before After
VAERS Form:1
Age:0.5
Gender:Female
Location:Iowa
Vaccinated:2007-10-24
Onset:2008-01-13
Submitted:2008-01-25
Entered:2008-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124CA / 3 LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0676U / 3 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08700K / 3 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1391U / 3 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception, Ultrasound scan

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound 2/14/08-records received- Hemoccult test of stool positive. US confirmed intussusception, water enema given without resolution. Therapuetic enema resolved intussusception after 4th attempt.
CDC 'Split Type':

Write-up: Developed intussusception at 8mo of age, 1-13-08. Unrelated to Rotateq? Transferred to hospital where this was corrected. 2/14/08-records received for DOS 1/8-1/12/08-DC DX: Intussusception. Intermittent fussiness began Wed, seen in ED treated with suppository with positive stool and vomiting resolved. Thursday fussy, black stool and low grade temp.


Changed on 6/14/2018

VAERS ID: 303591 Before After
VAERS Form:1
Age:0.5
Gender:Female
Location:Iowa
Vaccinated:2007-10-24
Onset:2008-01-13
Submitted:2008-01-25
Entered:2008-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124CA / 3 LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0676U / 3 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08700K / 3 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1391U / 3 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception, Ultrasound scan

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound 2/14/08-records received- Hemoccult test of stool positive. US confirmed intussusception, water enema given without resolution. Therapuetic enema resolved intussusception after 4th attempt.
CDC 'Split Type':

Write-up: Developed intussusception at 8mo of age, 1-13-08. Unrelated to Rotateq? Transferred to hospital where this was corrected. 2/14/08-records received for DOS 1/8-1/12/08-DC DX: Intussusception. Intermittent fussiness began Wed, seen in ED treated with suppository with positive stool and vomiting resolved. Thursday fussy, black stool and low grade temp.


Changed on 8/14/2018

VAERS ID: 303591 Before After
VAERS Form:1
Age:0.5
Gender:Female
Location:Iowa
Vaccinated:2007-10-24
Onset:2008-01-13
Submitted:2008-01-25
Entered:2008-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124CA / 3 LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0676U / 3 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08700K / 3 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1391U / 3 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception, Ultrasound scan

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound 2/14/08-records received- Hemoccult test of stool positive. US confirmed intussusception, water enema given without resolution. Therapuetic enema resolved intussusception after 4th attempt.
CDC 'Split Type':

Write-up: Developed intussusception at 8mo of age, 1-13-08. Unrelated to Rotateq? Transferred to hospital where this was corrected. 2/14/08-records received for DOS 1/8-1/12/08-DC DX: Intussusception. Intermittent fussiness began Wed, seen in ED treated with suppository with positive stool and vomiting resolved. Thursday fussy, black stool and low grade temp.


Changed on 9/14/2018

VAERS ID: 303591 Before After
VAERS Form:1
Age:0.5
Gender:Female
Location:Iowa
Vaccinated:2007-10-24
Onset:2008-01-13
Submitted:2008-01-25
Entered:2008-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124CA / 3 LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0676U / 3 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08700K / 3 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1391U / 3 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception, Ultrasound scan

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound 2/14/08-records received- Hemoccult test of stool positive. US confirmed intussusception, water enema given without resolution. Therapuetic enema resolved intussusception after 4th attempt.
CDC 'Split Type':

Write-up: Developed intussusception at 8mo of age, 1-13-08. Unrelated to Rotateq? Transferred to hospital where this was corrected. 2/14/08-records received for DOS 1/8-1/12/08-DC DX: Intussusception. Intermittent fussiness began Wed, seen in ED treated with suppository with positive stool and vomiting resolved. Thursday fussy, black stool and low grade temp.


Changed on 10/14/2018

VAERS ID: 303591 Before After
VAERS Form:1
Age:0.5
Gender:Female
Location:Iowa
Vaccinated:2007-10-24
Onset:2008-01-13
Submitted:2008-01-25
Entered:2008-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B124CA / 3 LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0676U / 3 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08700K / 3 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1391U / 3 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception, Ultrasound scan

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound 2/14/08-records received- Hemoccult test of stool positive. US confirmed intussusception, water enema given without resolution. Therapuetic enema resolved intussusception after 4th attempt.
CDC 'Split Type':

Write-up: Developed intussusception at 8mo of age, 1-13-08. Unrelated to Rotateq? Transferred to hospital where this was corrected. 2/14/08-records received for DOS 1/8-1/12/08-DC DX: Intussusception. Intermittent fussiness began Wed, seen in ED treated with suppository with positive stool and vomiting resolved. Thursday fussy, black stool and low grade temp.

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