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This is VAERS ID 307761

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 307761
VAERS Form:
Age:0.2
Sex:Female
Location:North Carolina
Vaccinated:2008-01-30
Onset:2008-03-04
Submitted:2008-03-21
Entered:2008-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM AC21B125BB / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0077U / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B47442E / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0980F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Appendicectomy, Constipation, Crying, Dehydration

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: PMH: GERD
Allergies:
Diagnostic Lab Data: LABS: KUB revealed distal SBO. US abdomen (+) IS.
CDC 'Split Type':

Write-up: VOMTIING,CRYING,DRAWING LEGS UP,DIARRHEA,FEVER,TIRED, DEHYDRATED, THIS OCCURED FOR THREE DAYS WE TOOK CHILD TO DR TWO DAYS IN A ROW WITH KNOW ANSWER FINALLY WENT TO ER ON THIRD DAY AND THEY DID ULTRASOUND AND FOUND INTUSSUPTION WAS RUSHED TO Hospital AND"AIR ENAMA WAS TRIED BUT IT WAS TO LATE SO THEY PREFORMED SURGERY. 4/15/08 Reviewed hospital medical records for 3/8-3/9/2008. FINAL DX: Intussusception, exploratory laparotomy & appendectomy Records reveal patient transferred to higher level of care afte


Changed on 12/8/2009

VAERS ID: 307761 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:North Carolina
Vaccinated:2008-01-30
Onset:2008-03-04
Submitted:2008-03-21
Entered:2008-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM AC21B125BB / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0077U / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B47442E / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0980F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Appendicectomy, Constipation, Crying, Dehydration, Diarrhoea, Fatigue, Intussusception, Irritability, Pyrexia, Surgery, Urinary system X-ray, Vomiting, Enema administration, Ultrasound abdomen abnormal, Explorative laparotomy, Gastrointestinal oedema

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: PMH: GERD
Allergies:
Diagnostic Lab Data: LABS: KUB revealed distal SBO. US abdomen (+) IS.
CDC 'Split Type':

Write-up: VOMTIING,CRYING,DRAWING LEGS UP,DIARRHEA,FEVER,TIRED, DEHYDRATED, THIS OCCURED FOR THREE DAYS WE TOOK CHILD TO DR TWO DAYS IN A ROW WITH KNOW ANSWER FINALLY WENT TO ER ON THIRD DAY AND THEY DID ULTRASOUND AND FOUND INTUSSUPTION WAS RUSHED TO Hospital AND"AIR AND AIR ENAMA WAS TRIED BUT IT WAS TO LATE SO THEY PREFORMED SURGERY. 4/15/08 Reviewed hospital medical records for 3/8-3/9/2008. FINAL DX: Intussusception, exploratory laparotomy & appendectomy Records reveal patient transferred to higher level of care afte after having been dx w/IS at outlying ER by US. Had irritability, vomiting, fever, abdominal pain & distention, diarrhea/constipation x 2 days. Underwent air contrast enema w/partial reduction & taken to OR. Findings at time of surgery were resolved IS, edematous bowel. Progressed diet well & d/c to home.


Changed on 3/2/2010

VAERS ID: 307761 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:North Carolina
Vaccinated:2008-01-30
Onset:2008-03-04
Submitted:2008-03-21
Entered:2008-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM AC21B125BB / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0077U / 0 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B47442E / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0980F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Appendicectomy, Constipation, Crying, Dehydration, Diarrhoea, Fatigue, Intussusception, Irritability, Pyrexia, Surgery, Urinary system X-ray, Vomiting, Enema administration, Ultrasound abdomen abnormal, Explorative laparotomy, Gastrointestinal oedema

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: PMH: GERD
Allergies:
Diagnostic Lab Data: LABS: KUB revealed distal SBO. US abdomen (+) IS.
CDC 'Split Type':

Write-up: VOMTIING,CRYING,DRAWING LEGS UP,DIARRHEA,FEVER,TIRED, DEHYDRATED, THIS OCCURED FOR THREE DAYS WE TOOK CHILD TO DR TWO DAYS IN A ROW WITH KNOW ANSWER FINALLY WENT TO ER ON THIRD DAY AND THEY DID ULTRASOUND AND FOUND INTUSSUPTION WAS RUSHED TO Hospital AND AIR ENAMA WAS TRIED BUT IT WAS TO LATE SO THEY PREFORMED SURGERY. 4/15/08 Reviewed hospital medical records for 3/8-3/9/2008. FINAL DX: Intussusception, exploratory laparotomy & appendectomy Records reveal patient transferred to higher level of care after having been dx w/IS at outlying ER by US. Had irritability, vomiting, fever, abdominal pain & distention, diarrhea/constipation x 2 days. Underwent air contrast enema w/partial reduction & taken to OR. Findings at time of surgery were resolved IS, edematous bowel. Progressed diet well & d/c to home.


Changed on 4/7/2010

VAERS ID: 307761 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:North Carolina
Vaccinated:2008-01-30
Onset:2008-03-04
Submitted:2008-03-21
Entered:2008-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM AC21B125BB / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0077U / 0 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B47442E / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0980F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Appendicectomy, Constipation, Crying, Dehydration, Diarrhoea, Fatigue, Intussusception, Irritability, Pyrexia, Surgery, Urinary system X-ray, Vomiting, Enema administration, Ultrasound abdomen abnormal, Explorative laparotomy, Gastrointestinal oedema

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: PMH: GERD
Allergies:
Diagnostic Lab Data: LABS: KUB revealed distal SBO. US abdomen (+) IS.
CDC 'Split Type':

Write-up: VOMTIING,CRYING,DRAWING LEGS UP,DIARRHEA,FEVER,TIRED, DEHYDRATED, THIS OCCURED FOR THREE DAYS WE TOOK CHILD TO DR TWO DAYS IN A ROW WITH KNOW ANSWER FINALLY WENT TO ER ON THIRD DAY AND THEY DID ULTRASOUND AND FOUND INTUSSUPTION WAS RUSHED TO Hospital AND AIR ENAMA WAS TRIED BUT IT WAS TO LATE SO THEY PREFORMED SURGERY. 4/15/08 Reviewed hospital medical records for 3/8-3/9/2008. FINAL DX: Intussusception, exploratory laparotomy & appendectomy Records reveal patient transferred to higher level of care after having been dx w/IS at outlying ER by US. Had irritability, vomiting, fever, abdominal pain & distention, diarrhea/constipation x 2 days. Underwent air contrast enema w/partial reduction & taken to OR. Findings at time of surgery were resolved IS, edematous bowel. Progressed diet well & d/c to home.


Changed on 8/31/2010

VAERS ID: 307761 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:North Carolina
Vaccinated:2008-01-30
Onset:2008-03-04
Submitted:2008-03-21
Entered:2008-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM AC21B125BB / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0077U / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B47442E / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0980F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Appendicectomy, Constipation, Crying, Dehydration, Diarrhoea, Fatigue, Intussusception, Irritability, Pyrexia, Surgery, Urinary system X-ray, Vomiting, Enema administration, Ultrasound abdomen abnormal, Explorative laparotomy, Gastrointestinal oedema

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: PMH: GERD
Allergies:
Diagnostic Lab Data: LABS: KUB revealed distal SBO. US abdomen (+) IS.
CDC 'Split Type':

Write-up: VOMTIING,CRYING,DRAWING LEGS UP,DIARRHEA,FEVER,TIRED, DEHYDRATED, THIS OCCURED FOR THREE DAYS WE TOOK CHILD TO DR TWO DAYS IN A ROW WITH KNOW ANSWER FINALLY WENT TO ER ON THIRD DAY AND THEY DID ULTRASOUND AND FOUND INTUSSUPTION WAS RUSHED TO Hospital AND AIR ENAMA WAS TRIED BUT IT WAS TO LATE SO THEY PREFORMED SURGERY. 4/15/08 Reviewed hospital medical records for 3/8-3/9/2008. FINAL DX: Intussusception, exploratory laparotomy & appendectomy Records reveal patient transferred to higher level of care after having been dx w/IS at outlying ER by US. Had irritability, vomiting, fever, abdominal pain & distention, diarrhea/constipation x 2 days. Underwent air contrast enema w/partial reduction & taken to OR. Findings at time of surgery were resolved IS, edematous bowel. Progressed diet well & d/c to home.


Changed on 7/13/2012

VAERS ID: 307761 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:North Carolina
Vaccinated:2008-01-30
Onset:2008-03-04
Submitted:2008-03-21
Entered:2008-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM AC21B125BB / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0077U / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47442E / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0980F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Appendicectomy, Constipation, Crying, Dehydration, Diarrhoea, Fatigue, Intussusception, Irritability, Pyrexia, Surgery, Urinary system X-ray, Vomiting, Enema administration, Ultrasound abdomen abnormal, Explorative laparotomy, Gastrointestinal oedema

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: PMH: GERD
Allergies:
Diagnostic Lab Data: LABS: KUB revealed distal SBO. US abdomen (+) IS.
CDC 'Split Type':

Write-up: VOMTIING,CRYING,DRAWING VOMTING, CRYING, DRAWING LEGS UP,DIARRHEA,FEVER,TIRED, UP, DIARRHEA, FEVER, TIRED, DEHYDRATED, THIS OCCURED OCCURRED FOR THREE DAYS WE TOOK CHILD TO DR TWO DAYS IN A ROW WITH KNOW ANSWER FINALLY WENT TO ER ON THIRD DAY AND THEY DID ULTRASOUND AND FOUND INTUSSUPTION INTUSSUSCEPTION WAS RUSHED TO Hospital AND AIR ENAMA ENEMA WAS TRIED BUT IT WAS TO LATE SO THEY PREFORMED PERFORMED SURGERY. 4/15/08 Reviewed hospital medical records for 3/8-3/9/2008. FINAL DX: Intussusception, exploratory laparotomy & appendectomy Records reveal patient transferred to higher level of care after having been dx w/IS at outlying ER by US. Had irritability, vomiting, fever, abdominal pain & distention, diarrhea/constipation x 2 days. Underwent air contrast enema w/partial reduction & taken to OR. Findings at time of surgery were resolved IS, edematous bowel. Progressed diet well & d/c to home.


Changed on 5/13/2013

VAERS ID: 307761 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:North Carolina
Vaccinated:2008-01-30
Onset:2008-03-04
Submitted:2008-03-21
Entered:2008-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM AC21B125BB / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0077U / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47442E / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0980F / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0980F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Appendicectomy, Constipation, Crying, Dehydration, Diarrhoea, Fatigue, Intussusception, Irritability, Pyrexia, Surgery, Urinary system X-ray, Vomiting, Enema administration, Ultrasound abdomen abnormal, Explorative laparotomy, Gastrointestinal oedema

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: PMH: GERD
Allergies:
Diagnostic Lab Data: LABS: KUB revealed distal SBO. US abdomen (+) IS.
CDC 'Split Type':

Write-up: VOMTING, CRYING, DRAWING LEGS UP, DIARRHEA, FEVER, TIRED, DEHYDRATED, THIS OCCURRED FOR THREE DAYS WE TOOK CHILD TO DR TWO DAYS IN A ROW WITH KNOW ANSWER FINALLY WENT TO ER ON THIRD DAY AND THEY DID ULTRASOUND AND FOUND INTUSSUSCEPTION WAS RUSHED TO Hospital AND AIR ENEMA WAS TRIED BUT IT WAS TO LATE SO THEY PERFORMED SURGERY. 4/15/08 Reviewed hospital medical records for 3/8-3/9/2008. FINAL DX: Intussusception, exploratory laparotomy & appendectomy Records reveal patient transferred to higher level of care after having been dx w/IS at outlying ER by US. Had irritability, vomiting, fever, abdominal pain & distention, diarrhea/constipation x 2 days. Underwent air contrast enema w/partial reduction & taken to OR. Findings at time of surgery were resolved IS, edematous bowel. Progressed diet well & d/c to home.


Changed on 2/14/2017

VAERS ID: 307761 Before After
VAERS Form:
Age:0.2 0.18
Sex:Female
Location:North Carolina
Vaccinated:2008-01-30
Onset:2008-03-04
Submitted:2008-03-21
Entered:2008-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM AC21B125BB / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0077U / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47442E / 0 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0980F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Appendicectomy, Constipation, Crying, Dehydration, Diarrhoea, Fatigue, Intussusception, Irritability, Pyrexia, Surgery, Urinary system X-ray, Vomiting, Enema administration, Ultrasound abdomen abnormal, Explorative laparotomy, Gastrointestinal oedema

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: PMH: GERD
Allergies:
Diagnostic Lab Data: LABS: KUB revealed distal SBO. US abdomen (+) IS.
CDC 'Split Type':

Write-up: VOMTING, CRYING, DRAWING LEGS UP, DIARRHEA, FEVER, TIRED, DEHYDRATED, THIS OCCURRED FOR THREE DAYS WE TOOK CHILD TO DR TWO DAYS IN A ROW WITH KNOW ANSWER FINALLY WENT TO ER ON THIRD DAY AND THEY DID ULTRASOUND AND FOUND INTUSSUSCEPTION WAS RUSHED TO Hospital AND AIR ENEMA WAS TRIED BUT IT WAS TO LATE SO THEY PERFORMED SURGERY. 4/15/08 Reviewed hospital medical records for 3/8-3/9/2008. FINAL DX: Intussusception, exploratory laparotomy & appendectomy Records reveal patient transferred to higher level of care after having been dx w/IS at outlying ER by US. Had irritability, vomiting, fever, abdominal pain & distention, diarrhea/constipation x 2 days. Underwent air contrast enema w/partial reduction & taken to OR. Findings at time of surgery were resolved IS, edematous bowel. Progressed diet well & d/c to home.


Changed on 4/14/2017

VAERS ID: 307761 Before After
VAERS Form:
Age:0.18
Sex:Female
Location:North Carolina
Vaccinated:2008-01-30
Onset:2008-03-04
Submitted:2008-03-21
Entered:2008-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM AC21B125BB / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0077U / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47442E / 0 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0980F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Appendicectomy, Constipation, Crying, Dehydration, Diarrhoea, Fatigue, Intussusception, Irritability, Pyrexia, Surgery, Urinary system X-ray, Vomiting, Enema administration, Ultrasound abdomen abnormal, Explorative laparotomy, Gastrointestinal oedema

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: PMH: GERD
Allergies:
Diagnostic Lab Data: LABS: KUB revealed distal SBO. US abdomen (+) IS.
CDC 'Split Type':

Write-up: VOMTING, CRYING, DRAWING LEGS UP, DIARRHEA, FEVER, TIRED, DEHYDRATED, THIS OCCURRED FOR THREE DAYS WE TOOK CHILD TO DR TWO DAYS IN A ROW WITH KNOW ANSWER FINALLY WENT TO ER ON THIRD DAY AND THEY DID ULTRASOUND AND FOUND INTUSSUSCEPTION WAS RUSHED TO Hospital AND AIR ENEMA WAS TRIED BUT IT WAS TO LATE SO THEY PERFORMED SURGERY. 4/15/08 Reviewed hospital medical records for 3/8-3/9/2008. FINAL DX: Intussusception, exploratory laparotomy & appendectomy Records reveal patient transferred to higher level of care after having been dx w/IS at outlying ER by US. Had irritability, vomiting, fever, abdominal pain & distention, diarrhea/constipation x 2 days. Underwent air contrast enema w/partial reduction & taken to OR. Findings at time of surgery were resolved IS, edematous bowel. Progressed diet well & d/c to home.


Changed on 9/14/2017

VAERS ID: 307761 Before After
VAERS Form:(blank) 1
Age:0.18
Sex:Female
Location:North Carolina
Vaccinated:2008-01-30
Onset:2008-03-04
Submitted:2008-03-21
Entered:2008-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM AC21B125BB / 0 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0077U / 0 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47442E / 0 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0980F / 0 1 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Crying, Dehydration, Diarrhoea, Fatigue, Intussusception, Pyrexia, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: PMH: GERD
Allergies:
Diagnostic Lab Data: LABS: KUB revealed distal SBO. US abdomen (+) IS.
CDC 'Split Type':

Write-up: VOMTING, CRYING, DRAWING LEGS UP, DIARRHEA, FEVER, TIRED, DEHYDRATED, THIS OCCURRED FOR THREE DAYS WE TOOK CHILD TO DR TWO DAYS IN A ROW WITH KNOW ANSWER FINALLY WENT TO ER ON THIRD DAY AND THEY DID ULTRASOUND AND FOUND INTUSSUSCEPTION WAS RUSHED TO Hospital AND AIR ENEMA WAS TRIED BUT IT WAS TO LATE SO THEY PERFORMED SURGERY. 4/15/08 Reviewed hospital medical records for 3/8-3/9/2008. FINAL DX: Intussusception, exploratory laparotomy & appendectomy Records reveal patient transferred to higher level of care after having been dx w/IS at outlying ER by US. Had irritability, vomiting, fever, abdominal pain & distention, diarrhea/constipation x 2 days. Underwent air contrast enema w/partial reduction & taken to OR. Findings at time of surgery were resolved IS, edematous bowel. Progressed diet well & d/c to home.


Changed on 2/14/2018

VAERS ID: 307761 Before After
VAERS Form:1
Age:0.18
Sex:Female
Location:North Carolina
Vaccinated:2008-01-30
Onset:2008-03-04
Submitted:2008-03-21
Entered:2008-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM AC21B125BB / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0077U / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47442E / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0980F / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Crying, Dehydration, Diarrhoea, Fatigue, Intussusception, Pyrexia, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: PMH: GERD
Allergies:
Diagnostic Lab Data: LABS: KUB revealed distal SBO. US abdomen (+) IS.
CDC 'Split Type':

Write-up: VOMTING, CRYING, DRAWING LEGS UP, DIARRHEA, FEVER, TIRED, DEHYDRATED, THIS OCCURRED FOR THREE DAYS WE TOOK CHILD TO DR TWO DAYS IN A ROW WITH KNOW ANSWER FINALLY WENT TO ER ON THIRD DAY AND THEY DID ULTRASOUND AND FOUND INTUSSUSCEPTION WAS RUSHED TO Hospital AND AIR ENEMA WAS TRIED BUT IT WAS TO LATE SO THEY PERFORMED SURGERY. 4/15/08 Reviewed hospital medical records for 3/8-3/9/2008. FINAL DX: Intussusception, exploratory laparotomy & appendectomy Records reveal patient transferred to higher level of care after having been dx w/IS at outlying ER by US. Had irritability, vomiting, fever, abdominal pain & distention, diarrhea/constipation x 2 days. Underwent air contrast enema w/partial reduction & taken to OR. Findings at time of surgery were resolved IS, edematous bowel. Progressed diet well & d/c to home.


Changed on 6/14/2018

VAERS ID: 307761 Before After
VAERS Form:1
Age:0.18
Sex:Female
Location:North Carolina
Vaccinated:2008-01-30
Onset:2008-03-04
Submitted:2008-03-21
Entered:2008-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM AC21B125BB / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0077U / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47442E / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0980F / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Crying, Dehydration, Diarrhoea, Fatigue, Intussusception, Pyrexia, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: PMH: GERD
Allergies:
Diagnostic Lab Data: LABS: KUB revealed distal SBO. US abdomen (+) IS.
CDC 'Split Type':

Write-up: VOMTING, CRYING, DRAWING LEGS UP, DIARRHEA, FEVER, TIRED, DEHYDRATED, THIS OCCURRED FOR THREE DAYS WE TOOK CHILD TO DR TWO DAYS IN A ROW WITH KNOW ANSWER FINALLY WENT TO ER ON THIRD DAY AND THEY DID ULTRASOUND AND FOUND INTUSSUSCEPTION WAS RUSHED TO Hospital AND AIR ENEMA WAS TRIED BUT IT WAS TO LATE SO THEY PERFORMED SURGERY. 4/15/08 Reviewed hospital medical records for 3/8-3/9/2008. FINAL DX: Intussusception, exploratory laparotomy & appendectomy Records reveal patient transferred to higher level of care after having been dx w/IS at outlying ER by US. Had irritability, vomiting, fever, abdominal pain & distention, diarrhea/constipation x 2 days. Underwent air contrast enema w/partial reduction & taken to OR. Findings at time of surgery were resolved IS, edematous bowel. Progressed diet well & d/c to home.


Changed on 8/14/2018

VAERS ID: 307761 Before After
VAERS Form:1
Age:0.18
Sex:Female
Location:North Carolina
Vaccinated:2008-01-30
Onset:2008-03-04
Submitted:2008-03-21
Entered:2008-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM AC21B125BB / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0077U / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47442E / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0980F / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Crying, Dehydration, Diarrhoea, Fatigue, Intussusception, Pyrexia, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: PMH: GERD
Allergies:
Diagnostic Lab Data: LABS: KUB revealed distal SBO. US abdomen (+) IS.
CDC 'Split Type':

Write-up: VOMTING, CRYING, DRAWING LEGS UP, DIARRHEA, FEVER, TIRED, DEHYDRATED, THIS OCCURRED FOR THREE DAYS WE TOOK CHILD TO DR TWO DAYS IN A ROW WITH KNOW ANSWER FINALLY WENT TO ER ON THIRD DAY AND THEY DID ULTRASOUND AND FOUND INTUSSUSCEPTION WAS RUSHED TO Hospital AND AIR ENEMA WAS TRIED BUT IT WAS TO LATE SO THEY PERFORMED SURGERY. 4/15/08 Reviewed hospital medical records for 3/8-3/9/2008. FINAL DX: Intussusception, exploratory laparotomy & appendectomy Records reveal patient transferred to higher level of care after having been dx w/IS at outlying ER by US. Had irritability, vomiting, fever, abdominal pain & distention, diarrhea/constipation x 2 days. Underwent air contrast enema w/partial reduction & taken to OR. Findings at time of surgery were resolved IS, edematous bowel. Progressed diet well & d/c to home.


Changed on 9/14/2018

VAERS ID: 307761 Before After
VAERS Form:1
Age:0.18
Sex:Female
Location:North Carolina
Vaccinated:2008-01-30
Onset:2008-03-04
Submitted:2008-03-21
Entered:2008-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM AC21B125BB / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0077U / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47442E / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0980F / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Crying, Dehydration, Diarrhoea, Fatigue, Intussusception, Pyrexia, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: PMH: GERD
Allergies:
Diagnostic Lab Data: LABS: KUB revealed distal SBO. US abdomen (+) IS.
CDC 'Split Type':

Write-up: VOMTING, CRYING, DRAWING LEGS UP, DIARRHEA, FEVER, TIRED, DEHYDRATED, THIS OCCURRED FOR THREE DAYS WE TOOK CHILD TO DR TWO DAYS IN A ROW WITH KNOW ANSWER FINALLY WENT TO ER ON THIRD DAY AND THEY DID ULTRASOUND AND FOUND INTUSSUSCEPTION WAS RUSHED TO Hospital AND AIR ENEMA WAS TRIED BUT IT WAS TO LATE SO THEY PERFORMED SURGERY. 4/15/08 Reviewed hospital medical records for 3/8-3/9/2008. FINAL DX: Intussusception, exploratory laparotomy & appendectomy Records reveal patient transferred to higher level of care after having been dx w/IS at outlying ER by US. Had irritability, vomiting, fever, abdominal pain & distention, diarrhea/constipation x 2 days. Underwent air contrast enema w/partial reduction & taken to OR. Findings at time of surgery were resolved IS, edematous bowel. Progressed diet well & d/c to home.


Changed on 10/14/2018

VAERS ID: 307761 Before After
VAERS Form:1
Age:0.18
Sex:Female
Location:North Carolina
Vaccinated:2008-01-30
Onset:2008-03-04
Submitted:2008-03-21
Entered:2008-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM AC21B125BB / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0077U / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47442E / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0980F / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Crying, Dehydration, Diarrhoea, Fatigue, Intussusception, Pyrexia, Surgery, Vomiting, Enema administration, Ultrasound abdomen abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: PMH: GERD
Allergies:
Diagnostic Lab Data: LABS: KUB revealed distal SBO. US abdomen (+) IS.
CDC 'Split Type':

Write-up: VOMTING, CRYING, DRAWING LEGS UP, DIARRHEA, FEVER, TIRED, DEHYDRATED, THIS OCCURRED FOR THREE DAYS WE TOOK CHILD TO DR TWO DAYS IN A ROW WITH KNOW ANSWER FINALLY WENT TO ER ON THIRD DAY AND THEY DID ULTRASOUND AND FOUND INTUSSUSCEPTION WAS RUSHED TO Hospital AND AIR ENEMA WAS TRIED BUT IT WAS TO LATE SO THEY PERFORMED SURGERY. 4/15/08 Reviewed hospital medical records for 3/8-3/9/2008. FINAL DX: Intussusception, exploratory laparotomy & appendectomy Records reveal patient transferred to higher level of care after having been dx w/IS at outlying ER by US. Had irritability, vomiting, fever, abdominal pain & distention, diarrhea/constipation x 2 days. Underwent air contrast enema w/partial reduction & taken to OR. Findings at time of surgery were resolved IS, edematous bowel. Progressed diet well & d/c to home.

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