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This is VAERS ID 308211

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 308211
VAERS Form:
Age:0.2
Sex:Female
Location:Texas
Vaccinated:2007-08-28
Onset:2008-03-19
Submitted:2008-03-25
Entered:2008-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 0 LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UF113AA / 0 LL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B58845E / 0 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0242U / 0 - / PO

Administered by: Other      Purchased by: Unknown
Symptoms: Abdominal distension, Abdominal pain, Barium double contrast, Intussusception, Enema administration

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:
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Barium enema X-ray 03/20/08. Labs and Diagnostics: Abd US (+) for ileocolic intussusception. KUB (+) for a paucityof gas in RUQ suspicious for IS. Air contrast barium enema
CDC 'Split Type':

Write-up: Information has been received from a physician concerning a 9-month-old female who on 28-AUG-2007 was vaccinated with an oral 2 ml dose of ROTATEQ. Concomitant vaccination included PEDVAXHIB (OMPC) (manufacturer unknown), PEDIARIX and PREVNAR. On 19-MAR"-2008 the patient experienced abdominal pain after receiving ROTATEQ. The patient was taken to the emergency room and was diagnosed with intussusception and was hospitalized. A barium enema was given and the patient was released on 20-Mar-2008. The out


Changed on 12/8/2009

VAERS ID: 308211 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Texas
Vaccinated:2007-08-28
Onset:2008-03-19
Submitted:2008-03-25
Entered:2008-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 0 LL / UN
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 0 LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UF113AA / 0 LL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B58845E / 0 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0242U / 0 - / PO

Administered by: Other      Purchased by: Unknown Other
Symptoms: Abdominal distension, Abdominal pain, Barium double contrast, Intussusception, Urinary system X-ray, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Middle ear effusion

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:
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Barium enema X-ray 03/20/08. Labs and Diagnostics: Abd US (+) for ileocolic intussusception. KUB (+) for a paucityof gas in RUQ suspicious for IS. Air contrast barium enema
CDC 'Split Type': (blank) WAES0803USA03574

Write-up: Information has been received from a physician concerning a 9-month-old female who on 28-AUG-2007 was vaccinated with an oral 2 ml dose of ROTATEQ. Concomitant vaccination included PEDVAXHIB (OMPC) (manufacturer unknown), PEDIARIX and PREVNAR. On 19-MAR"-2008 19-MAR-2008 the patient experienced abdominal pain after receiving ROTATEQ. The patient was taken to the emergency room and was diagnosed with intussusception and was hospitalized. A barium enema was given and the patient was released on 20-Mar-2008. The out outcome was reported as recovering. No product quality complaint was involved. Additional information has been requested. 4/30/2008 MR reeived for DOS 3/19-20/2008 with Final DX: Intussusception s/p reduction by air enema. Pt presented to ER with 4 day hx of abdominal pain and NBNB emesis. PE (+) for slight abd distention. Successfully reduced by Air Enema. No further vomiting or fever. Left purulent ear effusion noted prior to d/c. Sent home with azithromycin if pt develops ear pain.


Changed on 3/2/2010

VAERS ID: 308211 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Texas
Vaccinated:2007-08-28
Onset:2008-03-19
Submitted:2008-03-25
Entered:2008-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 0 LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UF113AA / 0 LL / UN
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B58845E / 0 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0242U / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal distension, Abdominal pain, Barium double contrast, Intussusception, Urinary system X-ray, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Middle ear effusion

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:
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Barium enema X-ray 03/20/08. Labs and Diagnostics: Abd US (+) for ileocolic intussusception. KUB (+) for a paucityof gas in RUQ suspicious for IS. Air contrast barium enema
CDC 'Split Type': WAES0803USA03574

Write-up: Information has been received from a physician concerning a 9-month-old female who on 28-AUG-2007 was vaccinated with an oral 2 ml dose of ROTATEQ. Concomitant vaccination included PEDVAXHIB (OMPC) (manufacturer unknown), PEDIARIX and PREVNAR. On 19-MAR-2008 the patient experienced abdominal pain after receiving ROTATEQ. The patient was taken to the emergency room and was diagnosed with intussusception and was hospitalized. A barium enema was given and the patient was released on 20-Mar-2008. The outcome was reported as recovering. No product quality complaint was involved. Additional information has been requested. 4/30/2008 MR reeived for DOS 3/19-20/2008 with Final DX: Intussusception s/p reduction by air enema. Pt presented to ER with 4 day hx of abdominal pain and NBNB emesis. PE (+) for slight abd distention. Successfully reduced by Air Enema. No further vomiting or fever. Left purulent ear effusion noted prior to d/c. Sent home with azithromycin if pt develops ear pain.


Changed on 4/7/2010

VAERS ID: 308211 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Texas
Vaccinated:2007-08-28
Onset:2008-03-19
Submitted:2008-03-25
Entered:2008-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 0 LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UF113AA / 0 LL / UN
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B58845E / 0 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0242U / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal distension, Abdominal pain, Barium double contrast, Intussusception, Urinary system X-ray, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Middle ear effusion

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:
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Barium enema X-ray 03/20/08. Labs and Diagnostics: Abd US (+) for ileocolic intussusception. KUB (+) for a paucityof gas in RUQ suspicious for IS. Air contrast barium enema
CDC 'Split Type': WAES0803USA03574

Write-up: Information has been received from a physician concerning a 9-month-old female who on 28-AUG-2007 was vaccinated with an oral 2 ml dose of ROTATEQ. Concomitant vaccination included PEDVAXHIB (OMPC) (manufacturer unknown), PEDIARIX and PREVNAR. On 19-MAR-2008 the patient experienced abdominal pain after receiving ROTATEQ. The patient was taken to the emergency room and was diagnosed with intussusception and was hospitalized. A barium enema was given and the patient was released on 20-Mar-2008. The outcome was reported as recovering. No product quality complaint was involved. Additional information has been requested. 4/30/2008 MR reeived for DOS 3/19-20/2008 with Final DX: Intussusception s/p reduction by air enema. Pt presented to ER with 4 day hx of abdominal pain and NBNB emesis. PE (+) for slight abd distention. Successfully reduced by Air Enema. No further vomiting or fever. Left purulent ear effusion noted prior to d/c. Sent home with azithromycin if pt develops ear pain.


Changed on 8/31/2010

VAERS ID: 308211 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Texas
Vaccinated:2007-08-28
Onset:2008-03-19
Submitted:2008-03-25
Entered:2008-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 0 LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UF113AA / 0 LL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B58845E / 0 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0242U / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal distension, Abdominal pain, Barium double contrast, Intussusception, Urinary system X-ray, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Middle ear effusion

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:
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Barium enema X-ray 03/20/08. Labs and Diagnostics: Abd US (+) for ileocolic intussusception. KUB (+) for a paucityof gas in RUQ suspicious for IS. Air contrast barium enema
CDC 'Split Type': WAES0803USA03574

Write-up: Information has been received from a physician concerning a 9-month-old female who on 28-AUG-2007 was vaccinated with an oral 2 ml dose of ROTATEQ. Concomitant vaccination included PEDVAXHIB (OMPC) (manufacturer unknown), PEDIARIX and PREVNAR. On 19-MAR-2008 the patient experienced abdominal pain after receiving ROTATEQ. The patient was taken to the emergency room and was diagnosed with intussusception and was hospitalized. A barium enema was given and the patient was released on 20-Mar-2008. The outcome was reported as recovering. No product quality complaint was involved. Additional information has been requested. 4/30/2008 MR reeived for DOS 3/19-20/2008 with Final DX: Intussusception s/p reduction by air enema. Pt presented to ER with 4 day hx of abdominal pain and NBNB emesis. PE (+) for slight abd distention. Successfully reduced by Air Enema. No further vomiting or fever. Left purulent ear effusion noted prior to d/c. Sent home with azithromycin if pt develops ear pain.


Changed on 5/13/2013

VAERS ID: 308211 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Texas
Vaccinated:2007-08-28
Onset:2008-03-19
Submitted:2008-03-25
Entered:2008-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 0 LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UF113AA / 0 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B58845E / 0 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0242U / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0242U / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal distension, Abdominal pain, Barium double contrast, Intussusception, Urinary system X-ray, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Middle ear effusion

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:
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Barium enema X-ray 03/20/08. Labs and Diagnostics: Abd US (+) for ileocolic intussusception. KUB (+) for a paucityof gas in RUQ suspicious for IS. Air contrast barium enema
CDC 'Split Type': WAES0803USA03574

Write-up: Information has been received from a physician concerning a 9-month-old female who on 28-AUG-2007 was vaccinated with an oral 2 ml dose of ROTATEQ. Concomitant vaccination included PEDVAXHIB (OMPC) (manufacturer unknown), PEDIARIX and PREVNAR. On 19-MAR-2008 the patient experienced abdominal pain after receiving ROTATEQ. The patient was taken to the emergency room and was diagnosed with intussusception and was hospitalized. A barium enema was given and the patient was released on 20-Mar-2008. The outcome was reported as recovering. No product quality complaint was involved. Additional information has been requested. 4/30/2008 MR reeived for DOS 3/19-20/2008 with Final DX: Intussusception s/p reduction by air enema. Pt presented to ER with 4 day hx of abdominal pain and NBNB emesis. PE (+) for slight abd distention. Successfully reduced by Air Enema. No further vomiting or fever. Left purulent ear effusion noted prior to d/c. Sent home with azithromycin if pt develops ear pain.


Changed on 4/14/2017

VAERS ID: 308211 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Texas
Vaccinated:2007-08-28
Onset:2008-03-19
Submitted:2008-03-25
Entered:2008-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 0 LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UF113AA / 0 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B58845E / 0 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0242U / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal distension, Abdominal pain, Barium double contrast, Intussusception, Urinary system X-ray, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Middle ear effusion

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:
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Barium enema X-ray 03/20/08. Labs and Diagnostics: Abd US (+) for ileocolic intussusception. KUB (+) for a paucityof gas in RUQ suspicious for IS. Air contrast barium enema
CDC 'Split Type': WAES0803USA03574

Write-up: Information has been received from a physician concerning a 9-month-old female who on 28-AUG-2007 was vaccinated with an oral 2 ml dose of ROTATEQ. Concomitant vaccination included PEDVAXHIB (OMPC) (manufacturer unknown), PEDIARIX and PREVNAR. On 19-MAR-2008 the patient experienced abdominal pain after receiving ROTATEQ. The patient was taken to the emergency room and was diagnosed with intussusception and was hospitalized. A barium enema was given and the patient was released on 20-Mar-2008. The outcome was reported as recovering. No product quality complaint was involved. Additional information has been requested. 4/30/2008 MR reeived for DOS 3/19-20/2008 with Final DX: Intussusception s/p reduction by air enema. Pt presented to ER with 4 day hx of abdominal pain and NBNB emesis. PE (+) for slight abd distention. Successfully reduced by Air Enema. No further vomiting or fever. Left purulent ear effusion noted prior to d/c. Sent home with azithromycin if pt develops ear pain.


Changed on 9/14/2017

VAERS ID: 308211 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Female
Location:Texas
Vaccinated:2007-08-28
Onset:2008-03-19
Submitted:2008-03-25
Entered:2008-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 0 1 LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UF113AA / 0 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B58845E / 0 1 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0242U / 0 1 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Intussusception, X-ray 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:
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Barium enema X-ray 03/20/08. Labs and Diagnostics: Abd US (+) for ileocolic intussusception. KUB (+) for a paucityof gas in RUQ suspicious for IS. Air contrast barium enema
CDC 'Split Type': WAES0803USA03574

Write-up: Information has been received from a physician concerning a 9-month-old female who on 28-AUG-2007 was vaccinated with an oral 2 ml dose of ROTATEQ. Concomitant vaccination included PEDVAXHIB (OMPC) (manufacturer unknown), PEDIARIX and PREVNAR. On 19-MAR-2008 the patient experienced abdominal pain after receiving ROTATEQ. The patient was taken to the emergency room and was diagnosed with intussusception and was hospitalized. A barium enema was given and the patient was released on 20-Mar-2008. The outcome was reported as recovering. No product quality complaint was involved. Additional information has been requested. 4/30/2008 MR reeived for DOS 3/19-20/2008 with Final DX: Intussusception s/p reduction by air enema. Pt presented to ER with 4 day hx of abdominal pain and NBNB emesis. PE (+) for slight abd distention. Successfully reduced by Air Enema. No further vomiting or fever. Left purulent ear effusion noted prior to d/c. Sent home with azithromycin if pt develops ear pain.


Changed on 2/14/2018

VAERS ID: 308211 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Texas
Vaccinated:2007-08-28
Onset:2008-03-19
Submitted:2008-03-25
Entered:2008-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 1 LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UF113AA / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B58845E / 1 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0242U / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Intussusception, X-ray 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:
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Barium enema X-ray 03/20/08. Labs and Diagnostics: Abd US (+) for ileocolic intussusception. KUB (+) for a paucityof gas in RUQ suspicious for IS. Air contrast barium enema
CDC 'Split Type': WAES0803USA03574

Write-up: Information has been received from a physician concerning a 9-month-old female who on 28-AUG-2007 was vaccinated with an oral 2 ml dose of ROTATEQ. Concomitant vaccination included PEDVAXHIB (OMPC) (manufacturer unknown), PEDIARIX and PREVNAR. On 19-MAR-2008 the patient experienced abdominal pain after receiving ROTATEQ. The patient was taken to the emergency room and was diagnosed with intussusception and was hospitalized. A barium enema was given and the patient was released on 20-Mar-2008. The outcome was reported as recovering. No product quality complaint was involved. Additional information has been requested. 4/30/2008 MR reeived for DOS 3/19-20/2008 with Final DX: Intussusception s/p reduction by air enema. Pt presented to ER with 4 day hx of abdominal pain and NBNB emesis. PE (+) for slight abd distention. Successfully reduced by Air Enema. No further vomiting or fever. Left purulent ear effusion noted prior to d/c. Sent home with azithromycin if pt develops ear pain.


Changed on 6/14/2018

VAERS ID: 308211 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Texas
Vaccinated:2007-08-28
Onset:2008-03-19
Submitted:2008-03-25
Entered:2008-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 1 LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UF113AA / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B58845E / 1 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0242U / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Intussusception, X-ray 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:
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Barium enema X-ray 03/20/08. Labs and Diagnostics: Abd US (+) for ileocolic intussusception. KUB (+) for a paucityof gas in RUQ suspicious for IS. Air contrast barium enema
CDC 'Split Type': WAES0803USA03574

Write-up: Information has been received from a physician concerning a 9-month-old female who on 28-AUG-2007 was vaccinated with an oral 2 ml dose of ROTATEQ. Concomitant vaccination included PEDVAXHIB (OMPC) (manufacturer unknown), PEDIARIX and PREVNAR. On 19-MAR-2008 the patient experienced abdominal pain after receiving ROTATEQ. The patient was taken to the emergency room and was diagnosed with intussusception and was hospitalized. A barium enema was given and the patient was released on 20-Mar-2008. The outcome was reported as recovering. No product quality complaint was involved. Additional information has been requested. 4/30/2008 MR reeived for DOS 3/19-20/2008 with Final DX: Intussusception s/p reduction by air enema. Pt presented to ER with 4 day hx of abdominal pain and NBNB emesis. PE (+) for slight abd distention. Successfully reduced by Air Enema. No further vomiting or fever. Left purulent ear effusion noted prior to d/c. Sent home with azithromycin if pt develops ear pain.


Changed on 8/14/2018

VAERS ID: 308211 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Texas
Vaccinated:2007-08-28
Onset:2008-03-19
Submitted:2008-03-25
Entered:2008-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 1 LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UF113AA / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B58845E / 1 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0242U / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Intussusception, X-ray 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:
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Barium enema X-ray 03/20/08. Labs and Diagnostics: Abd US (+) for ileocolic intussusception. KUB (+) for a paucityof gas in RUQ suspicious for IS. Air contrast barium enema
CDC 'Split Type': WAES0803USA03574

Write-up: Information has been received from a physician concerning a 9-month-old female who on 28-AUG-2007 was vaccinated with an oral 2 ml dose of ROTATEQ. Concomitant vaccination included PEDVAXHIB (OMPC) (manufacturer unknown), PEDIARIX and PREVNAR. On 19-MAR-2008 the patient experienced abdominal pain after receiving ROTATEQ. The patient was taken to the emergency room and was diagnosed with intussusception and was hospitalized. A barium enema was given and the patient was released on 20-Mar-2008. The outcome was reported as recovering. No product quality complaint was involved. Additional information has been requested. 4/30/2008 MR reeived for DOS 3/19-20/2008 with Final DX: Intussusception s/p reduction by air enema. Pt presented to ER with 4 day hx of abdominal pain and NBNB emesis. PE (+) for slight abd distention. Successfully reduced by Air Enema. No further vomiting or fever. Left purulent ear effusion noted prior to d/c. Sent home with azithromycin if pt develops ear pain.


Changed on 9/14/2018

VAERS ID: 308211 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Texas
Vaccinated:2007-08-28
Onset:2008-03-19
Submitted:2008-03-25
Entered:2008-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 1 LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UF113AA / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B58845E / 1 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0242U / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Intussusception, X-ray 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:
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Barium enema X-ray 03/20/08. Labs and Diagnostics: Abd US (+) for ileocolic intussusception. KUB (+) for a paucityof gas in RUQ suspicious for IS. Air contrast barium enema
CDC 'Split Type': WAES0803USA03574

Write-up: Information has been received from a physician concerning a 9-month-old female who on 28-AUG-2007 was vaccinated with an oral 2 ml dose of ROTATEQ. Concomitant vaccination included PEDVAXHIB (OMPC) (manufacturer unknown), PEDIARIX and PREVNAR. On 19-MAR-2008 the patient experienced abdominal pain after receiving ROTATEQ. The patient was taken to the emergency room and was diagnosed with intussusception and was hospitalized. A barium enema was given and the patient was released on 20-Mar-2008. The outcome was reported as recovering. No product quality complaint was involved. Additional information has been requested. 4/30/2008 MR reeived for DOS 3/19-20/2008 with Final DX: Intussusception s/p reduction by air enema. Pt presented to ER with 4 day hx of abdominal pain and NBNB emesis. PE (+) for slight abd distention. Successfully reduced by Air Enema. No further vomiting or fever. Left purulent ear effusion noted prior to d/c. Sent home with azithromycin if pt develops ear pain.


Changed on 10/14/2018

VAERS ID: 308211 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Texas
Vaccinated:2007-08-28
Onset:2008-03-19
Submitted:2008-03-25
Entered:2008-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 1 LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UF113AA / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B58845E / 1 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0242U / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Intussusception, X-ray 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:
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Barium enema X-ray 03/20/08. Labs and Diagnostics: Abd US (+) for ileocolic intussusception. KUB (+) for a paucityof gas in RUQ suspicious for IS. Air contrast barium enema
CDC 'Split Type': WAES0803USA03574

Write-up: Information has been received from a physician concerning a 9-month-old female who on 28-AUG-2007 was vaccinated with an oral 2 ml dose of ROTATEQ. Concomitant vaccination included PEDVAXHIB (OMPC) (manufacturer unknown), PEDIARIX and PREVNAR. On 19-MAR-2008 the patient experienced abdominal pain after receiving ROTATEQ. The patient was taken to the emergency room and was diagnosed with intussusception and was hospitalized. A barium enema was given and the patient was released on 20-Mar-2008. The outcome was reported as recovering. No product quality complaint was involved. Additional information has been requested. 4/30/2008 MR reeived for DOS 3/19-20/2008 with Final DX: Intussusception s/p reduction by air enema. Pt presented to ER with 4 day hx of abdominal pain and NBNB emesis. PE (+) for slight abd distention. Successfully reduced by Air Enema. No further vomiting or fever. Left purulent ear effusion noted prior to d/c. Sent home with azithromycin if pt develops ear pain.

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