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This is VAERS ID 308065

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 308065
VAERS Form:
Age:0.2
Sex:Female
Location:Ohio
Vaccinated:2008-03-04
Onset:2008-03-10
Submitted:2008-03-20
Entered:2008-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 0 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF342AB / 0 LL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C45887 / 0 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1108U / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Abdominal distension, Abdominal pain, Ascites, Barium double contrast, Barium enema abnormal

Life Threatening? Yes
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abdominal US (+) for IS. Barium enema (+) for IS from the transverse colon.
CDC 'Split Type':

Write-up: Received ROTATEQ on 3/4/08. On evening of 3/10/08, she began to have blood in her stool. Also had some vomiting. Was seen in our office and then in ER. Diagnosed with intussusception, failed air reduction and had surgery to reduce it. 04/23/2008 MR recei"ved for DOS 3/12-16/2008 with D/C DX: Intussusception. Infant presented to ER with several day hx of emesis and abdominal pain, now with currant jelly stool. PE (+) abdominal distention. Unable to reduce IS with barium Enema. Pt taken to OR for Explor


Changed on 12/8/2009

VAERS ID: 308065 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Ohio
Vaccinated:2008-03-04
Onset:2008-03-10
Submitted:2008-03-20
Entered:2008-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 0 LL / UN
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 0 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF342AB / 0 LL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C45887 / 0 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1108U / 0 - / PO

Administered by: Private      Purchased by: Unknown Private
Symptoms: Abdominal distension, Abdominal pain, Ascites, Barium double contrast, Barium enema abnormal, Haematochezia, Intussusception, Large intestinal obstruction reduction, Vomiting, Ultrasound abdomen abnormal, Gastrointestinal tube insertion, Explorative laparotomy, Colectomy

Life Threatening? Yes
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abdominal US (+) for IS. Barium enema (+) for IS from the transverse colon.
CDC 'Split Type':

Write-up: Received ROTATEQ on 3/4/08. On evening of 3/10/08, she began to have blood in her stool. Also had some vomiting. Was seen in our office and then in ER. Diagnosed with intussusception, failed air reduction and had surgery to reduce it. 04/23/2008 MR recei"ved received for DOS 3/12-16/2008 with D/C DX: Intussusception. Infant presented to ER with several day hx of emesis and abdominal pain, now with currant jelly stool. PE (+) abdominal distention. Unable to reduce IS with barium Enema. Pt taken to OR for Explor Exploratory Lap, Reduction of IS, Right Hemicolectomy. Multiple serosal tears to the colon and ascites noted. Pt had NG tube post-op. By 3/16 pt tolerating po with normal BMs. D/C home.


Changed on 3/2/2010

VAERS ID: 308065 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Ohio
Vaccinated:2008-03-04
Onset:2008-03-10
Submitted:2008-03-20
Entered:2008-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 0 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF342AB / 0 LL / UN
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC C45887 / 0 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1108U / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal distension, Abdominal pain, Ascites, Barium double contrast, Barium enema abnormal, Haematochezia, Intussusception, Large intestinal obstruction reduction, Vomiting, Ultrasound abdomen abnormal, Gastrointestinal tube insertion, Explorative laparotomy, Colectomy

Life Threatening? Yes
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abdominal US (+) for IS. Barium enema (+) for IS from the transverse colon.
CDC 'Split Type':

Write-up: Received ROTATEQ on 3/4/08. On evening of 3/10/08, she began to have blood in her stool. Also had some vomiting. Was seen in our office and then in ER. Diagnosed with intussusception, failed air reduction and had surgery to reduce it. 04/23/2008 MR received for DOS 3/12-16/2008 with D/C DX: Intussusception. Infant presented to ER with several day hx of emesis and abdominal pain, now with currant jelly stool. PE (+) abdominal distention. Unable to reduce IS with barium Enema. Pt taken to OR for Exploratory Lap, Reduction of IS, Right Hemicolectomy. Multiple serosal tears to the colon and ascites noted. Pt had NG tube post-op. By 3/16 pt tolerating po with normal BMs. D/C home.


Changed on 4/7/2010

VAERS ID: 308065 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Ohio
Vaccinated:2008-03-04
Onset:2008-03-10
Submitted:2008-03-20
Entered:2008-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 0 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF342AB / 0 LL / UN
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C45887 / 0 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1108U / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal distension, Abdominal pain, Ascites, Barium double contrast, Barium enema abnormal, Haematochezia, Intussusception, Large intestinal obstruction reduction, Vomiting, Ultrasound abdomen abnormal, Gastrointestinal tube insertion, Explorative laparotomy, Colectomy

Life Threatening? Yes
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abdominal US (+) for IS. Barium enema (+) for IS from the transverse colon.
CDC 'Split Type':

Write-up: Received ROTATEQ on 3/4/08. On evening of 3/10/08, she began to have blood in her stool. Also had some vomiting. Was seen in our office and then in ER. Diagnosed with intussusception, failed air reduction and had surgery to reduce it. 04/23/2008 MR received for DOS 3/12-16/2008 with D/C DX: Intussusception. Infant presented to ER with several day hx of emesis and abdominal pain, now with currant jelly stool. PE (+) abdominal distention. Unable to reduce IS with barium Enema. Pt taken to OR for Exploratory Lap, Reduction of IS, Right Hemicolectomy. Multiple serosal tears to the colon and ascites noted. Pt had NG tube post-op. By 3/16 pt tolerating po with normal BMs. D/C home.


Changed on 8/31/2010

VAERS ID: 308065 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Ohio
Vaccinated:2008-03-04
Onset:2008-03-10
Submitted:2008-03-20
Entered:2008-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 0 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF342AB / 0 LL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH C45887 / 0 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1108U / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal distension, Abdominal pain, Ascites, Barium double contrast, Barium enema abnormal, Haematochezia, Intussusception, Large intestinal obstruction reduction, Vomiting, Ultrasound abdomen abnormal, Gastrointestinal tube insertion, Explorative laparotomy, Colectomy

Life Threatening? Yes
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abdominal US (+) for IS. Barium enema (+) for IS from the transverse colon.
CDC 'Split Type':

Write-up: Received ROTATEQ on 3/4/08. On evening of 3/10/08, she began to have blood in her stool. Also had some vomiting. Was seen in our office and then in ER. Diagnosed with intussusception, failed air reduction and had surgery to reduce it. 04/23/2008 MR received for DOS 3/12-16/2008 with D/C DX: Intussusception. Infant presented to ER with several day hx of emesis and abdominal pain, now with currant jelly stool. PE (+) abdominal distention. Unable to reduce IS with barium Enema. Pt taken to OR for Exploratory Lap, Reduction of IS, Right Hemicolectomy. Multiple serosal tears to the colon and ascites noted. Pt had NG tube post-op. By 3/16 pt tolerating po with normal BMs. D/C home.


Changed on 5/13/2013

VAERS ID: 308065 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Ohio
Vaccinated:2008-03-04
Onset:2008-03-10
Submitted:2008-03-20
Entered:2008-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 0 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF342AB / 0 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45887 / 0 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1108U / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1108U / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal distension, Abdominal pain, Ascites, Barium double contrast, Barium enema abnormal, Haematochezia, Intussusception, Large intestinal obstruction reduction, Vomiting, Ultrasound abdomen abnormal, Gastrointestinal tube insertion, Explorative laparotomy, Colectomy

Life Threatening? Yes
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abdominal US (+) for IS. Barium enema (+) for IS from the transverse colon.
CDC 'Split Type':

Write-up: Received ROTATEQ on 3/4/08. On evening of 3/10/08, she began to have blood in her stool. Also had some vomiting. Was seen in our office and then in ER. Diagnosed with intussusception, failed air reduction and had surgery to reduce it. 04/23/2008 MR received for DOS 3/12-16/2008 with D/C DX: Intussusception. Infant presented to ER with several day hx of emesis and abdominal pain, now with currant jelly stool. PE (+) abdominal distention. Unable to reduce IS with barium Enema. Pt taken to OR for Exploratory Lap, Reduction of IS, Right Hemicolectomy. Multiple serosal tears to the colon and ascites noted. Pt had NG tube post-op. By 3/16 pt tolerating po with normal BMs. D/C home.


Changed on 4/14/2017

VAERS ID: 308065 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Ohio
Vaccinated:2008-03-04
Onset:2008-03-10
Submitted:2008-03-20
Entered:2008-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 0 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF342AB / 0 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45887 / 0 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1108U / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal distension, Abdominal pain, Ascites, Barium double contrast, Barium enema abnormal, Haematochezia, Intussusception, Large intestinal obstruction reduction, Vomiting, Ultrasound abdomen abnormal, Gastrointestinal tube insertion, Explorative laparotomy, Colectomy

Life Threatening? Yes
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abdominal US (+) for IS. Barium enema (+) for IS from the transverse colon.
CDC 'Split Type':

Write-up: Received ROTATEQ on 3/4/08. On evening of 3/10/08, she began to have blood in her stool. Also had some vomiting. Was seen in our office and then in ER. Diagnosed with intussusception, failed air reduction and had surgery to reduce it. 04/23/2008 MR received for DOS 3/12-16/2008 with D/C DX: Intussusception. Infant presented to ER with several day hx of emesis and abdominal pain, now with currant jelly stool. PE (+) abdominal distention. Unable to reduce IS with barium Enema. Pt taken to OR for Exploratory Lap, Reduction of IS, Right Hemicolectomy. Multiple serosal tears to the colon and ascites noted. Pt had NG tube post-op. By 3/16 pt tolerating po with normal BMs. D/C home.


Changed on 9/14/2017

VAERS ID: 308065 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Female
Location:Ohio
Vaccinated:2008-03-04
Onset:2008-03-10
Submitted:2008-03-20
Entered:2008-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 0 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF342AB / 0 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45887 / 0 1 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1108U / 0 1 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Haematochezia, Intussusception, Vomiting

Life Threatening? Yes
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abdominal US (+) for IS. Barium enema (+) for IS from the transverse colon.
CDC 'Split Type':

Write-up: Received ROTATEQ on 3/4/08. On evening of 3/10/08, she began to have blood in her stool. Also had some vomiting. Was seen in our office and then in ER. Diagnosed with intussusception, failed air reduction and had surgery to reduce it. 04/23/2008 MR received for DOS 3/12-16/2008 with D/C DX: Intussusception. Infant presented to ER with several day hx of emesis and abdominal pain, now with currant jelly stool. PE (+) abdominal distention. Unable to reduce IS with barium Enema. Pt taken to OR for Exploratory Lap, Reduction of IS, Right Hemicolectomy. Multiple serosal tears to the colon and ascites noted. Pt had NG tube post-op. By 3/16 pt tolerating po with normal BMs. D/C home.


Changed on 2/14/2018

VAERS ID: 308065 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Ohio
Vaccinated:2008-03-04
Onset:2008-03-10
Submitted:2008-03-20
Entered:2008-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF342AB / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45887 / 1 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1108U / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Haematochezia, Intussusception, Vomiting

Life Threatening? Yes
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abdominal US (+) for IS. Barium enema (+) for IS from the transverse colon.
CDC 'Split Type':

Write-up: Received ROTATEQ on 3/4/08. On evening of 3/10/08, she began to have blood in her stool. Also had some vomiting. Was seen in our office and then in ER. Diagnosed with intussusception, failed air reduction and had surgery to reduce it. 04/23/2008 MR received for DOS 3/12-16/2008 with D/C DX: Intussusception. Infant presented to ER with several day hx of emesis and abdominal pain, now with currant jelly stool. PE (+) abdominal distention. Unable to reduce IS with barium Enema. Pt taken to OR for Exploratory Lap, Reduction of IS, Right Hemicolectomy. Multiple serosal tears to the colon and ascites noted. Pt had NG tube post-op. By 3/16 pt tolerating po with normal BMs. D/C home.


Changed on 6/14/2018

VAERS ID: 308065 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Ohio
Vaccinated:2008-03-04
Onset:2008-03-10
Submitted:2008-03-20
Entered:2008-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF342AB / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45887 / 1 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1108U / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Haematochezia, Intussusception, Vomiting

Life Threatening? Yes
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abdominal US (+) for IS. Barium enema (+) for IS from the transverse colon.
CDC 'Split Type':

Write-up: Received ROTATEQ on 3/4/08. On evening of 3/10/08, she began to have blood in her stool. Also had some vomiting. Was seen in our office and then in ER. Diagnosed with intussusception, failed air reduction and had surgery to reduce it. 04/23/2008 MR received for DOS 3/12-16/2008 with D/C DX: Intussusception. Infant presented to ER with several day hx of emesis and abdominal pain, now with currant jelly stool. PE (+) abdominal distention. Unable to reduce IS with barium Enema. Pt taken to OR for Exploratory Lap, Reduction of IS, Right Hemicolectomy. Multiple serosal tears to the colon and ascites noted. Pt had NG tube post-op. By 3/16 pt tolerating po with normal BMs. D/C home.


Changed on 8/14/2018

VAERS ID: 308065 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Ohio
Vaccinated:2008-03-04
Onset:2008-03-10
Submitted:2008-03-20
Entered:2008-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF342AB / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45887 / 1 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1108U / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Haematochezia, Intussusception, Vomiting

Life Threatening? Yes
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abdominal US (+) for IS. Barium enema (+) for IS from the transverse colon.
CDC 'Split Type':

Write-up: Received ROTATEQ on 3/4/08. On evening of 3/10/08, she began to have blood in her stool. Also had some vomiting. Was seen in our office and then in ER. Diagnosed with intussusception, failed air reduction and had surgery to reduce it. 04/23/2008 MR received for DOS 3/12-16/2008 with D/C DX: Intussusception. Infant presented to ER with several day hx of emesis and abdominal pain, now with currant jelly stool. PE (+) abdominal distention. Unable to reduce IS with barium Enema. Pt taken to OR for Exploratory Lap, Reduction of IS, Right Hemicolectomy. Multiple serosal tears to the colon and ascites noted. Pt had NG tube post-op. By 3/16 pt tolerating po with normal BMs. D/C home.


Changed on 9/14/2018

VAERS ID: 308065 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Ohio
Vaccinated:2008-03-04
Onset:2008-03-10
Submitted:2008-03-20
Entered:2008-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF342AB / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45887 / 1 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1108U / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Haematochezia, Intussusception, Vomiting

Life Threatening? Yes
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abdominal US (+) for IS. Barium enema (+) for IS from the transverse colon.
CDC 'Split Type':

Write-up: Received ROTATEQ on 3/4/08. On evening of 3/10/08, she began to have blood in her stool. Also had some vomiting. Was seen in our office and then in ER. Diagnosed with intussusception, failed air reduction and had surgery to reduce it. 04/23/2008 MR received for DOS 3/12-16/2008 with D/C DX: Intussusception. Infant presented to ER with several day hx of emesis and abdominal pain, now with currant jelly stool. PE (+) abdominal distention. Unable to reduce IS with barium Enema. Pt taken to OR for Exploratory Lap, Reduction of IS, Right Hemicolectomy. Multiple serosal tears to the colon and ascites noted. Pt had NG tube post-op. By 3/16 pt tolerating po with normal BMs. D/C home.


Changed on 10/14/2018

VAERS ID: 308065 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Ohio
Vaccinated:2008-03-04
Onset:2008-03-10
Submitted:2008-03-20
Entered:2008-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF342AB / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45887 / 1 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1108U / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Haematochezia, Intussusception, Vomiting

Life Threatening? Yes
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abdominal US (+) for IS. Barium enema (+) for IS from the transverse colon.
CDC 'Split Type':

Write-up: Received ROTATEQ on 3/4/08. On evening of 3/10/08, she began to have blood in her stool. Also had some vomiting. Was seen in our office and then in ER. Diagnosed with intussusception, failed air reduction and had surgery to reduce it. 04/23/2008 MR received for DOS 3/12-16/2008 with D/C DX: Intussusception. Infant presented to ER with several day hx of emesis and abdominal pain, now with currant jelly stool. PE (+) abdominal distention. Unable to reduce IS with barium Enema. Pt taken to OR for Exploratory Lap, Reduction of IS, Right Hemicolectomy. Multiple serosal tears to the colon and ascites noted. Pt had NG tube post-op. By 3/16 pt tolerating po with normal BMs. D/C home.

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