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This is VAERS ID 307038

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 307038
VAERS Form:
Age:0.2
Sex:Female
Location:Texas
Vaccinated:2008-03-04
Onset:2008-03-09
Submitted:0000-00-00
Entered:2008-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC12B116BB / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UA0977AA / 0 LL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B087020Z / 0 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0409-U / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Barium enema abnormal, Faeces discoloured, Intussusception, Urinary system X-ray, 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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: X-ray: multiple air fluid levels, decreased colon gas; Barium enema with air contrast - ileocolic intussusception 3/28/08-KUB abnormally dilated loops small bowel with multiple air fluid. Air contract enema ileocolic intussusception succe
CDC 'Split Type':

Write-up: On 3/09 began vomiting after eating, including formula. On 3/11 was referred to CMC ER by Dr. XR suggestive of ileocolic intussusception, confirmed by air contrast enema. Reduced after air contrast enema. Tolerated feeds well and discharged after 24 hr"observation on 3/12. No h/o bloody stools.3/28/08-records received for DOS 3/11/08-DX: Intussusception. Vomiting with every oral intake since day before. 3/12/08-Seen in ED C/O vomiting. Observed in Ed and discharged to home.


Changed on 12/8/2009

VAERS ID: 307038 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Texas
Vaccinated:2008-03-04
Onset:2008-03-09
Submitted:0000-00-00
Entered:2008-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC12B116BB / 0 LL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC12B116BB / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UA0977AA / 0 LL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B087020Z / 0 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0409-U / 0 - / PO

Administered by: Private      Purchased by: Unknown Public
Symptoms: Barium enema abnormal, Faeces discoloured, Intussusception, Urinary system X-ray, 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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: X-ray: multiple air fluid levels, decreased colon gas; Barium enema with air contrast - ileocolic intussusception 3/28/08-KUB abnormally dilated loops small bowel with multiple air fluid. Air contract enema ileocolic intussusception succe
CDC 'Split Type':

Write-up: On 3/09 began vomiting after eating, including formula. On 3/11 was referred to CMC ER by Dr. XR suggestive of ileocolic intussusception, confirmed by air contrast enema. Reduced after air contrast enema. Tolerated feeds well and discharged after 24 hr"observation hr observation on 3/12. No h/o bloody stools.3/28/08-records received for DOS 3/11/08-DX: Intussusception. Vomiting with every oral intake since day before. 3/12/08-Seen in ED C/O vomiting. Observed in Ed and discharged to home.


Changed on 3/2/2010

VAERS ID: 307038 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Texas
Vaccinated:2008-03-04
Onset:2008-03-09
Submitted:0000-00-00
Entered:2008-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC12B116BB / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UA0977AA / 0 LL / UN
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B087020Z / 0 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0409-U / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema abnormal, Faeces discoloured, Intussusception, Urinary system X-ray, 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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: X-ray: multiple air fluid levels, decreased colon gas; Barium enema with air contrast - ileocolic intussusception 3/28/08-KUB abnormally dilated loops small bowel with multiple air fluid. Air contract enema ileocolic intussusception succe
CDC 'Split Type':

Write-up: On 3/09 began vomiting after eating, including formula. On 3/11 was referred to CMC ER by Dr. XR suggestive of ileocolic intussusception, confirmed by air contrast enema. Reduced after air contrast enema. Tolerated feeds well and discharged after 24 hr observation on 3/12. No h/o bloody stools.3/28/08-records received for DOS 3/11/08-DX: Intussusception. Vomiting with every oral intake since day before. 3/12/08-Seen in ED C/O vomiting. Observed in Ed and discharged to home.


Changed on 4/7/2010

VAERS ID: 307038 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Texas
Vaccinated:2008-03-04
Onset:2008-03-09
Submitted:0000-00-00
Entered:2008-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC12B116BB / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UA0977AA / 0 LL / UN
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B087020Z / 0 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0409-U / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema abnormal, Faeces discoloured, Intussusception, Urinary system X-ray, 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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: X-ray: multiple air fluid levels, decreased colon gas; Barium enema with air contrast - ileocolic intussusception 3/28/08-KUB abnormally dilated loops small bowel with multiple air fluid. Air contract enema ileocolic intussusception succe
CDC 'Split Type':

Write-up: On 3/09 began vomiting after eating, including formula. On 3/11 was referred to CMC ER by Dr. XR suggestive of ileocolic intussusception, confirmed by air contrast enema. Reduced after air contrast enema. Tolerated feeds well and discharged after 24 hr observation on 3/12. No h/o bloody stools.3/28/08-records received for DOS 3/11/08-DX: Intussusception. Vomiting with every oral intake since day before. 3/12/08-Seen in ED C/O vomiting. Observed in Ed and discharged to home.


Changed on 8/31/2010

VAERS ID: 307038 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Texas
Vaccinated:2008-03-04
Onset:2008-03-09
Submitted:0000-00-00
Entered:2008-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC12B116BB / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UA0977AA / 0 LL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B087020Z / 0 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0409-U / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema abnormal, Faeces discoloured, Intussusception, Urinary system X-ray, 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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: X-ray: multiple air fluid levels, decreased colon gas; Barium enema with air contrast - ileocolic intussusception 3/28/08-KUB abnormally dilated loops small bowel with multiple air fluid. Air contract enema ileocolic intussusception succe
CDC 'Split Type':

Write-up: On 3/09 began vomiting after eating, including formula. On 3/11 was referred to CMC ER by Dr. XR suggestive of ileocolic intussusception, confirmed by air contrast enema. Reduced after air contrast enema. Tolerated feeds well and discharged after 24 hr observation on 3/12. No h/o bloody stools.3/28/08-records received for DOS 3/11/08-DX: Intussusception. Vomiting with every oral intake since day before. 3/12/08-Seen in ED C/O vomiting. Observed in Ed and discharged to home.


Changed on 5/13/2013

VAERS ID: 307038 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Texas
Vaccinated:2008-03-04
Onset:2008-03-09
Submitted:0000-00-00
Entered:2008-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC12B116BB / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UA0977AA / 0 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B087020Z / 0 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0409-U / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0409-U / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema abnormal, Faeces discoloured, Intussusception, Urinary system X-ray, 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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: X-ray: multiple air fluid levels, decreased colon gas; Barium enema with air contrast - ileocolic intussusception 3/28/08-KUB abnormally dilated loops small bowel with multiple air fluid. Air contract enema ileocolic intussusception succe
CDC 'Split Type':

Write-up: On 3/09 began vomiting after eating, including formula. On 3/11 was referred to CMC ER by Dr. XR suggestive of ileocolic intussusception, confirmed by air contrast enema. Reduced after air contrast enema. Tolerated feeds well and discharged after 24 hr observation on 3/12. No h/o bloody stools.3/28/08-records received for DOS 3/11/08-DX: Intussusception. Vomiting with every oral intake since day before. 3/12/08-Seen in ED C/O vomiting. Observed in Ed and discharged to home.


Changed on 4/14/2017

VAERS ID: 307038 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Texas
Vaccinated:2008-03-04
Onset:2008-03-09
Submitted:0000-00-00
Entered:2008-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC12B116BB / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UA0977AA / 0 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B087020Z / 0 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0409-U / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema abnormal, Faeces discoloured, Intussusception, Urinary system X-ray, 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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: X-ray: multiple air fluid levels, decreased colon gas; Barium enema with air contrast - ileocolic intussusception 3/28/08-KUB abnormally dilated loops small bowel with multiple air fluid. Air contract enema ileocolic intussusception succe successfully reduced. 3/12/08-Abdominal sono no evidence of ileocolic intussusception.
CDC 'Split Type':

Write-up: On 3/09 began vomiting after eating, including formula. On 3/11 was referred to CMC ER by Dr. XR suggestive of ileocolic intussusception, confirmed by air contrast enema. Reduced after air contrast enema. Tolerated feeds well and discharged after 24 hr observation on 3/12. No h/o bloody stools.3/28/08-records received for DOS 3/11/08-DX: Intussusception. Vomiting with every oral intake since day before. 3/12/08-Seen in ED C/O vomiting. Observed in Ed and discharged to home.


Changed on 9/14/2017

VAERS ID: 307038 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Female
Location:Texas
Vaccinated:2008-03-04
Onset:2008-03-09
Submitted:0000-00-00
Entered:2008-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC12B116BB / 0 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UA0977AA / 0 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B087020Z / 0 1 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0409-U / 0 1 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema abnormal, Faeces discoloured, Intussusception, Urinary system X-ray, 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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: X-ray: multiple air fluid levels, decreased colon gas; Barium enema with air contrast - ileocolic intussusception 3/28/08-KUB abnormally dilated loops small bowel with multiple air fluid. Air contract enema ileocolic intussusception successfully reduced. 3/12/08-Abdominal sono no evidence of ileocolic intussusception.
CDC 'Split Type':

Write-up: On 3/09 began vomiting after eating, including formula. On 3/11 was referred to CMC ER by Dr. XR suggestive of ileocolic intussusception, confirmed by air contrast enema. Reduced after air contrast enema. Tolerated feeds well and discharged after 24 hr observation on 3/12. No h/o bloody stools.3/28/08-records received for DOS 3/11/08-DX: Intussusception. Vomiting with every oral intake since day before. 3/12/08-Seen in ED C/O vomiting. Observed in Ed and discharged to home.


Changed on 2/14/2018

VAERS ID: 307038 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Texas
Vaccinated:2008-03-04
Onset:2008-03-09
Submitted:0000-00-00
Entered:2008-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC12B116BB / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UA0977AA / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B087020Z / 1 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0409-U / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema abnormal, Faeces discoloured, Intussusception, Urinary system X-ray, 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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: X-ray: multiple air fluid levels, decreased colon gas; Barium enema with air contrast - ileocolic intussusception 3/28/08-KUB abnormally dilated loops small bowel with multiple air fluid. Air contract enema ileocolic intussusception successfully reduced. 3/12/08-Abdominal sono no evidence of ileocolic intussusception.
CDC 'Split Type':

Write-up: On 3/09 began vomiting after eating, including formula. On 3/11 was referred to CMC ER by Dr. XR suggestive of ileocolic intussusception, confirmed by air contrast enema. Reduced after air contrast enema. Tolerated feeds well and discharged after 24 hr observation on 3/12. No h/o bloody stools.3/28/08-records received for DOS 3/11/08-DX: Intussusception. Vomiting with every oral intake since day before. 3/12/08-Seen in ED C/O vomiting. Observed in Ed and discharged to home.


Changed on 6/14/2018

VAERS ID: 307038 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Texas
Vaccinated:2008-03-04
Onset:2008-03-09
Submitted:0000-00-00
Entered:2008-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC12B116BB / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UA0977AA / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B087020Z / 1 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0409-U / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema abnormal, Faeces discoloured, Intussusception, Urinary system X-ray, 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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: X-ray: multiple air fluid levels, decreased colon gas; Barium enema with air contrast - ileocolic intussusception 3/28/08-KUB abnormally dilated loops small bowel with multiple air fluid. Air contract enema ileocolic intussusception successfully reduced. 3/12/08-Abdominal sono no evidence of ileocolic intussusception.
CDC 'Split Type':

Write-up: On 3/09 began vomiting after eating, including formula. On 3/11 was referred to CMC ER by Dr. XR suggestive of ileocolic intussusception, confirmed by air contrast enema. Reduced after air contrast enema. Tolerated feeds well and discharged after 24 hr observation on 3/12. No h/o bloody stools.3/28/08-records received for DOS 3/11/08-DX: Intussusception. Vomiting with every oral intake since day before. 3/12/08-Seen in ED C/O vomiting. Observed in Ed and discharged to home.


Changed on 8/14/2018

VAERS ID: 307038 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Texas
Vaccinated:2008-03-04
Onset:2008-03-09
Submitted:0000-00-00
Entered:2008-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC12B116BB / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UA0977AA / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B087020Z / 1 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0409-U / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema abnormal, Faeces discoloured, Intussusception, Urinary system X-ray, 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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: X-ray: multiple air fluid levels, decreased colon gas; Barium enema with air contrast - ileocolic intussusception 3/28/08-KUB abnormally dilated loops small bowel with multiple air fluid. Air contract enema ileocolic intussusception successfully reduced. 3/12/08-Abdominal sono no evidence of ileocolic intussusception.
CDC 'Split Type':

Write-up: On 3/09 began vomiting after eating, including formula. On 3/11 was referred to CMC ER by Dr. XR suggestive of ileocolic intussusception, confirmed by air contrast enema. Reduced after air contrast enema. Tolerated feeds well and discharged after 24 hr observation on 3/12. No h/o bloody stools.3/28/08-records received for DOS 3/11/08-DX: Intussusception. Vomiting with every oral intake since day before. 3/12/08-Seen in ED C/O vomiting. Observed in Ed and discharged to home.


Changed on 9/14/2018

VAERS ID: 307038 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Texas
Vaccinated:2008-03-04
Onset:2008-03-09
Submitted:0000-00-00
Entered:2008-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC12B116BB / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UA0977AA / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B087020Z / 1 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0409-U / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema abnormal, Faeces discoloured, Intussusception, Urinary system X-ray, 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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: X-ray: multiple air fluid levels, decreased colon gas; Barium enema with air contrast - ileocolic intussusception 3/28/08-KUB abnormally dilated loops small bowel with multiple air fluid. Air contract enema ileocolic intussusception successfully reduced. 3/12/08-Abdominal sono no evidence of ileocolic intussusception.
CDC 'Split Type':

Write-up: On 3/09 began vomiting after eating, including formula. On 3/11 was referred to CMC ER by Dr. XR suggestive of ileocolic intussusception, confirmed by air contrast enema. Reduced after air contrast enema. Tolerated feeds well and discharged after 24 hr observation on 3/12. No h/o bloody stools.3/28/08-records received for DOS 3/11/08-DX: Intussusception. Vomiting with every oral intake since day before. 3/12/08-Seen in ED C/O vomiting. Observed in Ed and discharged to home.


Changed on 10/14/2018

VAERS ID: 307038 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Texas
Vaccinated:2008-03-04
Onset:2008-03-09
Submitted:0000-00-00
Entered:2008-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC12B116BB / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UA0977AA / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B087020Z / 1 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0409-U / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema abnormal, Faeces discoloured, Intussusception, Urinary system X-ray, 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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: X-ray: multiple air fluid levels, decreased colon gas; Barium enema with air contrast - ileocolic intussusception 3/28/08-KUB abnormally dilated loops small bowel with multiple air fluid. Air contract enema ileocolic intussusception successfully reduced. 3/12/08-Abdominal sono no evidence of ileocolic intussusception.
CDC 'Split Type':

Write-up: On 3/09 began vomiting after eating, including formula. On 3/11 was referred to CMC ER by Dr. XR suggestive of ileocolic intussusception, confirmed by air contrast enema. Reduced after air contrast enema. Tolerated feeds well and discharged after 24 hr observation on 3/12. No h/o bloody stools.3/28/08-records received for DOS 3/11/08-DX: Intussusception. Vomiting with every oral intake since day before. 3/12/08-Seen in ED C/O vomiting. Observed in Ed and discharged to home.

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