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This is VAERS ID 308364

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 308364
VAERS Form:
Age:0.3
Sex:Female
Location:Iowa
Vaccinated:2007-11-08
Onset:2007-12-27
Submitted:2008-02-21
Entered:2008-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B127AA / 1 UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0498U / 1 UN / UN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC B08702D / 1 UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1391U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Abdominal tenderness, Barium enema, Coagulopathy, Culture positive

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 18     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None 4/4/08-records received-alpha thalassemia on new born screen
Allergies:
Diagnostic Lab Data: Barium Enema 12/28/07 4/4/08-records received- WBC 42. Tip of central line grew alpha strep and coagulase negative staph. Stool culture negative.
CDC 'Split Type':

Write-up: Intussusception 4/4/08-records received for DOS 12/28/17-1/15/08-DC DX: Intussusception. Suspected post intussusception peritonitis. Presented day prior to admission with 16 hours non-bilious non-bloody vomiting. Decreased appetite and urine output. No di"arrhea. Day of admission developed current jelly/bloody stool. Barium enema showed irreducible intussusception and 2 unsuccessful attempts made. Laparotomy revealed no evidence of intussusception. Post operatively developed increasing abdominal distension


Changed on 12/8/2009

VAERS ID: 308364 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:Iowa
Vaccinated:2007-11-08
Onset:2007-12-27
Submitted:2008-02-21
Entered:2008-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B127AA / 1 UN / UN
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B127AA / 1 UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0498U / 1 UN / UN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC B08702D / 1 UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1391U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Abdominal tenderness, Barium enema, Coagulopathy, Culture stool negative, Diarrhoea, Haematochezia, Intussusception, Laparotomy, Pyrexia, Vomiting, White blood cell count increased, Enema administration, Staphylococcal infection, Urine output decreased, Decreased appetite, Culture positive, Transfusion, Streptococcus identification test positive

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 18     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None 4/4/08-records received-alpha thalassemia on new born screen
Allergies:
Diagnostic Lab Data: Barium Enema 12/28/07 4/4/08-records received- WBC 42. Tip of central line grew alpha strep and coagulase negative staph. Stool culture negative.
CDC 'Split Type':

Write-up: Intussusception 4/4/08-records received for DOS 12/28/17-1/15/08-DC DX: Intussusception. Suspected post intussusception peritonitis. Presented day prior to admission with 16 hours non-bilious non-bloody vomiting. Decreased appetite and urine output. No di"arrhea. diarrhea. Day of admission developed current jelly/bloody stool. Barium enema showed irreducible intussusception and 2 unsuccessful attempts made. Laparotomy revealed no evidence of intussusception. Post operatively developed increasing abdominal distension and tenderness. Coagulopathy improved with FFP and blood transfusion. Recurrent vomiting and loose stools. Fever.


Changed on 1/5/2010

VAERS ID: 308364 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:Iowa
Vaccinated:2007-11-08
Onset:2007-12-27
Submitted:2008-02-21
Entered:2008-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B127AA / 1 UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0498U / 1 UN / UN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC B08702D / 1 UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1391U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Abdominal tenderness, Barium enema, Coagulopathy, Culture stool negative, Diarrhoea, Haematochezia, Intussusception, Laparotomy, Pyrexia, Vomiting, White blood cell count increased, Enema administration, Staphylococcal infection, Urine output decreased, Decreased appetite, Culture positive, Transfusion, Streptococcus identification test positive

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 18     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None 4/4/08-records received-alpha thalassemia on new born screen
Allergies:
Diagnostic Lab Data: Barium Enema 12/28/07 4/4/08-records received- WBC 42. Tip of central line grew alpha strep and coagulase negative staph. Stool culture negative.
CDC 'Split Type':

Write-up: Intussusception 4/4/08-records received for DOS 12/28/17-1/15/08-DC DX: Intussusception. Suspected post intussusception peritonitis. Presented day prior to admission with 16 hours non-bilious non-bloody vomiting. Decreased appetite and urine output. No diarrhea. Day of admission developed current jelly/bloody stool. Barium enema showed irreducible intussusception and 2 unsuccessful attempts made. Laparotomy revealed no evidence of intussusception. Post operatively developed increasing abdominal distension and tenderness. Coagulopathy improved with FFP and blood transfusion. Recurrent vomiting and loose stools. Fever.


Changed on 2/5/2010

VAERS ID: 308364 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:Iowa
Vaccinated:2007-11-08
Onset:2007-12-27
Submitted:2008-02-21
Entered:2008-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B127AA / 1 UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0498U / 1 UN / UN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC B08702D / 1 UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1391U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Intussusception, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 18     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None 4/4/08-records received-alpha thalassemia on new born screen
Allergies:
Diagnostic Lab Data: Barium Enema 12/28/07 4/4/08-records received- WBC 42. Tip of central line grew alpha strep and coagulase negative staph. Stool culture negative.
CDC 'Split Type':

Write-up: Intussusception 4/4/08-records received for DOS 12/28/17-1/15/08-DC DX: Intussusception. Suspected post intussusception peritonitis. Presented day prior to admission with 16 hours non-bilious non-bloody vomiting. Decreased appetite and urine output. No diarrhea. Day of admission developed current jelly/bloody stool. Barium enema showed irreducible intussusception and 2 unsuccessful attempts made. Laparotomy revealed no evidence of intussusception. Post operatively developed increasing abdominal distension and tenderness. Coagulopathy improved with FFP and blood transfusion. Recurrent vomiting and loose stools. Fever. Follow-up: Rotavirus vaccine given after incident without adverse events.


Changed on 7/31/2010

VAERS ID: 308364 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:Iowa
Vaccinated:2007-11-08
Onset:2007-12-27
Submitted:2008-02-21
Entered:2008-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B127AA / 1 UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0498U / 1 UN / UN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC B08702D / 1 UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1391U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Intussusception, Peritonitis, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 18     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None 4/4/08-records received-alpha thalassemia on new born screen
Allergies:
Diagnostic Lab Data: Barium Enema 12/28/07 4/4/08-records received- WBC 42. Tip of central line grew alpha strep and coagulase negative staph. Stool culture negative.
CDC 'Split Type':

Write-up: Intussusception 4/4/08-records received for DOS 12/28/17-1/15/08-DC DX: Intussusception. Suspected post intussusception peritonitis. Presented day prior to admission with 16 hours non-bilious non-bloody vomiting. Decreased appetite and urine output. No diarrhea. Day of admission developed current jelly/bloody stool. Barium enema showed irreducible intussusception and 2 unsuccessful attempts made. Laparotomy revealed no evidence of intussusception. Post operatively developed increasing abdominal distension and tenderness. Coagulopathy improved with FFP and blood transfusion. Recurrent vomiting and loose stools. Fever. Follow-up: Rotavirus vaccine given after incident without adverse events.


Changed on 8/31/2010

VAERS ID: 308364 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:Iowa
Vaccinated:2007-11-08
Onset:2007-12-27
Submitted:2008-02-21
Entered:2008-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B127AA / 1 UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0498U / 1 UN / UN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B08702D / 1 UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1391U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Intussusception, Peritonitis, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 18     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None 4/4/08-records received-alpha thalassemia on new born screen
Allergies:
Diagnostic Lab Data: Barium Enema 12/28/07 4/4/08-records received- WBC 42. Tip of central line grew alpha strep and coagulase negative staph. Stool culture negative.
CDC 'Split Type':

Write-up: Intussusception 4/4/08-records received for DOS 12/28/17-1/15/08-DC DX: Intussusception. Suspected post intussusception peritonitis. Presented day prior to admission with 16 hours non-bilious non-bloody vomiting. Decreased appetite and urine output. No diarrhea. Day of admission developed current jelly/bloody stool. Barium enema showed irreducible intussusception and 2 unsuccessful attempts made. Laparotomy revealed no evidence of intussusception. Post operatively developed increasing abdominal distension and tenderness. Coagulopathy improved with FFP and blood transfusion. Recurrent vomiting and loose stools. Fever. Follow-up: Rotavirus vaccine given after incident without adverse events.


Changed on 4/13/2011

VAERS ID: 308364 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:Iowa
Vaccinated:2007-11-08
Onset:2007-12-27
Submitted:2008-02-21
Entered:2008-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B127AA / 1 UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0498U / 1 UN / UN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PFIZER/WYETH B08702D / 1 UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1391U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Abdominal tenderness, Barium enema, Coagulopathy, Culture stool negative, Diarrhoea, Haematochezia, Intussusception, Laparotomy, Peritonitis, Pyrexia, Vomiting, White blood cell count increased, Enema administration, Staphylococcal infection, Urine output decreased, Decreased appetite, Culture positive, Transfusion, Streptococcus identification test positive

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 18     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None 4/4/08-records received-alpha thalassemia on new born screen
Allergies:
Diagnostic Lab Data: Barium Enema 12/28/07 4/4/08-records received- WBC 42. Tip of central line grew alpha strep and coagulase negative staph. Stool culture negative.
CDC 'Split Type':

Write-up: Intussusception 4/4/08-records received for DOS 12/28/17-1/15/08-DC DX: Intussusception. Suspected post intussusception peritonitis. Presented day prior to admission with 16 hours non-bilious non-bloody vomiting. Decreased appetite and urine output. No diarrhea. Day of admission developed current jelly/bloody stool. Barium enema showed irreducible intussusception and 2 unsuccessful attempts made. Laparotomy revealed no evidence of intussusception. Post operatively developed increasing abdominal distension and tenderness. Coagulopathy improved with FFP and blood transfusion. Recurrent vomiting and loose stools. Fever. Follow-up: Rotavirus vaccine given after incident without adverse events.


Changed on 5/13/2011

VAERS ID: 308364 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:Iowa
Vaccinated:2007-11-08
Onset:2007-12-27
Submitted:2008-02-21
Entered:2008-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B127AA / 1 UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0498U / 1 UN / UN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PFIZER/WYETH B08702D / 1 UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1391U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Abdominal tenderness, Barium enema, Coagulopathy, Culture stool negative, Diarrhoea, Haematochezia, Intussusception, Laparotomy, Peritonitis, Pyrexia, Vomiting, White blood cell count increased, Enema administration, Staphylococcal infection, Urine output decreased, Decreased appetite, Culture positive, Transfusion, Streptococcus identification test positive

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 18     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None 4/4/08-records received-alpha thalassemia on new born screen
Allergies:
Diagnostic Lab Data: Barium Enema 12/28/07 4/4/08-records received- WBC 42. Tip of central line grew alpha strep and coagulase negative staph. Stool culture negative.
CDC 'Split Type':

Write-up: Intussusception 4/4/08-records received for DOS 12/28/17-1/15/08-DC DX: Intussusception. Suspected post intussusception peritonitis. Presented day prior to admission with 16 hours non-bilious non-bloody vomiting. Decreased appetite and urine output. No diarrhea. Day of admission developed current jelly/bloody stool. Barium enema showed irreducible intussusception and 2 unsuccessful attempts made. Laparotomy revealed no evidence of intussusception. Post operatively developed increasing abdominal distension and tenderness. Coagulopathy improved with FFP and blood transfusion. Recurrent vomiting and loose stools. Fever. Follow-up: Rotavirus vaccine given after incident without adverse events.


Changed on 6/11/2011

VAERS ID: 308364 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:Iowa
Vaccinated:2007-11-08
Onset:2007-12-27
Submitted:2008-02-21
Entered:2008-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B127AA / 1 UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0498U / 1 UN / UN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PFIZER/WYETH B08702D / 1 UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1391U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Abdominal tenderness, Barium enema, Coagulopathy, Culture stool negative, Diarrhoea, Haematochezia, Intussusception, Laparotomy, Peritonitis, Pyrexia, Vomiting, White blood cell count increased, Enema administration, Staphylococcal infection, Urine output decreased, Decreased appetite, Culture positive, Transfusion, Streptococcus identification test positive

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 18     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None 4/4/08-records received-alpha thalassemia on new born screen
Allergies:
Diagnostic Lab Data: Barium Enema 12/28/07 4/4/08-records received- WBC 42. Tip of central line grew alpha strep and coagulase negative staph. Stool culture negative.
CDC 'Split Type':

Write-up: Intussusception 4/4/08-records received for DOS 12/28/17-1/15/08-DC DX: Intussusception. Suspected post intussusception peritonitis. Presented day prior to admission with 16 hours non-bilious non-bloody vomiting. Decreased appetite and urine output. No diarrhea. Day of admission developed current jelly/bloody stool. Barium enema showed irreducible intussusception and 2 unsuccessful attempts made. Laparotomy revealed no evidence of intussusception. Post operatively developed increasing abdominal distension and tenderness. Coagulopathy improved with FFP and blood transfusion. Recurrent vomiting and loose stools. Fever. Follow-up: Rotavirus vaccine given after incident without adverse events.


Changed on 7/13/2012

VAERS ID: 308364 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:Iowa
Vaccinated:2007-11-08
Onset:2007-12-27
Submitted:2008-02-21
Entered:2008-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B127AA / 1 UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0498U / 1 UN / UN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PFIZER/WYETH B08702D / 1 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08702D / 1 UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1391U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Abdominal tenderness, Barium enema, Coagulopathy, Culture stool negative, Diarrhoea, Haematochezia, Intussusception, Laparotomy, Peritonitis, Pyrexia, Vomiting, White blood cell count increased, Enema administration, Staphylococcal infection, Urine output decreased, Decreased appetite, Culture positive, Transfusion, Streptococcus identification test positive

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 18     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None 4/4/08-records received-alpha thalassemia on new born screen
Allergies:
Diagnostic Lab Data: Barium Enema 12/28/07 4/4/08-records received- WBC 42. Tip of central line grew alpha strep and coagulase negative staph. Stool culture negative.
CDC 'Split Type':

Write-up: Intussusception 4/4/08-records received for DOS 12/28/17-1/15/08-DC DX: Intussusception. Suspected post intussusception peritonitis. Presented day prior to admission with 16 hours non-bilious non-bloody vomiting. Decreased appetite and urine output. No diarrhea. Day of admission developed current jelly/bloody stool. Barium enema showed irreducible intussusception and 2 unsuccessful attempts made. Laparotomy revealed no evidence of intussusception. Post operatively developed increasing abdominal distension and tenderness. Coagulopathy improved with FFP and blood transfusion. Recurrent vomiting and loose stools. Fever. Follow-up: Rotavirus vaccine given after incident without adverse events.


Changed on 5/13/2013

VAERS ID: 308364 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:Iowa
Vaccinated:2007-11-08
Onset:2007-12-27
Submitted:2008-02-21
Entered:2008-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B127AA / 1 UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0498U / 1 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08702D / 1 UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1391U / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1391U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Abdominal tenderness, Barium enema, Coagulopathy, Culture stool negative, Diarrhoea, Haematochezia, Intussusception, Laparotomy, Peritonitis, Pyrexia, Vomiting, White blood cell count increased, Enema administration, Staphylococcal infection, Urine output decreased, Decreased appetite, Culture positive, Transfusion, Streptococcus identification test positive

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 18     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None 4/4/08-records received-alpha thalassemia on new born screen
Allergies:
Diagnostic Lab Data: Barium Enema 12/28/07 4/4/08-records received- WBC 42. Tip of central line grew alpha strep and coagulase negative staph. Stool culture negative.
CDC 'Split Type':

Write-up: Intussusception 4/4/08-records received for DOS 12/28/17-1/15/08-DC DX: Intussusception. Suspected post intussusception peritonitis. Presented day prior to admission with 16 hours non-bilious non-bloody vomiting. Decreased appetite and urine output. No diarrhea. Day of admission developed current jelly/bloody stool. Barium enema showed irreducible intussusception and 2 unsuccessful attempts made. Laparotomy revealed no evidence of intussusception. Post operatively developed increasing abdominal distension and tenderness. Coagulopathy improved with FFP and blood transfusion. Recurrent vomiting and loose stools. Fever. Follow-up: Rotavirus vaccine given after incident without adverse events.


Changed on 2/14/2017

VAERS ID: 308364 Before After
VAERS Form:
Age:0.3 0.34
Sex:Female
Location:Iowa
Vaccinated:2007-11-08
Onset:2007-12-27
Submitted:2008-02-21
Entered:2008-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B127AA / 1 UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0498U / 1 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08702D / 1 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1391U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Abdominal tenderness, Barium enema, Coagulopathy, Culture stool negative, Diarrhoea, Haematochezia, Intussusception, Laparotomy, Peritonitis, Pyrexia, Vomiting, White blood cell count increased, Enema administration, Staphylococcal infection, Urine output decreased, Decreased appetite, Culture positive, Transfusion, Streptococcus identification test positive

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 18     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None 4/4/08-records received-alpha thalassemia on new born screen
Allergies:
Diagnostic Lab Data: Barium Enema 12/28/07 4/4/08-records received- WBC 42. Tip of central line grew alpha strep and coagulase negative staph. Stool culture negative.
CDC 'Split Type':

Write-up: Intussusception 4/4/08-records received for DOS 12/28/17-1/15/08-DC DX: Intussusception. Suspected post intussusception peritonitis. Presented day prior to admission with 16 hours non-bilious non-bloody vomiting. Decreased appetite and urine output. No diarrhea. Day of admission developed current jelly/bloody stool. Barium enema showed irreducible intussusception and 2 unsuccessful attempts made. Laparotomy revealed no evidence of intussusception. Post operatively developed increasing abdominal distension and tenderness. Coagulopathy improved with FFP and blood transfusion. Recurrent vomiting and loose stools. Fever. Follow-up: Rotavirus vaccine given after incident without adverse events.


Changed on 4/14/2017

VAERS ID: 308364 Before After
VAERS Form:
Age:0.34
Sex:Female
Location:Iowa
Vaccinated:2007-11-08
Onset:2007-12-27
Submitted:2008-02-21
Entered:2008-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B127AA / 1 UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0498U / 1 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08702D / 1 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1391U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Abdominal tenderness, Barium enema, Coagulopathy, Culture stool negative, Diarrhoea, Haematochezia, Intussusception, Laparotomy, Peritonitis, Pyrexia, Vomiting, White blood cell count increased, Enema administration, Staphylococcal infection, Urine output decreased, Decreased appetite, Culture positive, Transfusion, Streptococcus identification test positive

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 18     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None 4/4/08-records received-alpha thalassemia on new born screen
Allergies:
Diagnostic Lab Data: Barium Enema 12/28/07 4/4/08-records received- WBC 42. Tip of central line grew alpha strep and coagulase negative staph. Stool culture negative.
CDC 'Split Type':

Write-up: Intussusception 4/4/08-records received for DOS 12/28/17-1/15/08-DC DX: Intussusception. Suspected post intussusception peritonitis. Presented day prior to admission with 16 hours non-bilious non-bloody vomiting. Decreased appetite and urine output. No diarrhea. Day of admission developed current jelly/bloody stool. Barium enema showed irreducible intussusception and 2 unsuccessful attempts made. Laparotomy revealed no evidence of intussusception. Post operatively developed increasing abdominal distension and tenderness. Coagulopathy improved with FFP and blood transfusion. Recurrent vomiting and loose stools. Fever. Follow-up: Rotavirus vaccine given after incident without adverse events.


Changed on 9/14/2017

VAERS ID: 308364 Before After
VAERS Form:(blank) 1
Age:0.34
Sex:Female
Location:Iowa
Vaccinated:2007-11-08
Onset:2007-12-27
Submitted:2008-02-21
Entered:2008-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B127AA / 1 2 UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0498U / 1 2 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08702D / 1 2 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1391U / 1 2 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Intussusception, Peritonitis, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 18     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None 4/4/08-records received-alpha thalassemia on new born screen
Allergies:
Diagnostic Lab Data: Barium Enema 12/28/07 4/4/08-records received- WBC 42. Tip of central line grew alpha strep and coagulase negative staph. Stool culture negative.
CDC 'Split Type':

Write-up: Intussusception 4/4/08-records received for DOS 12/28/17-1/15/08-DC DX: Intussusception. Suspected post intussusception peritonitis. Presented day prior to admission with 16 hours non-bilious non-bloody vomiting. Decreased appetite and urine output. No diarrhea. Day of admission developed current jelly/bloody stool. Barium enema showed irreducible intussusception and 2 unsuccessful attempts made. Laparotomy revealed no evidence of intussusception. Post operatively developed increasing abdominal distension and tenderness. Coagulopathy improved with FFP and blood transfusion. Recurrent vomiting and loose stools. Fever. Follow-up: Rotavirus vaccine given after incident without adverse events.


Changed on 2/14/2018

VAERS ID: 308364 Before After
VAERS Form:1
Age:0.34
Sex:Female
Location:Iowa
Vaccinated:2007-11-08
Onset:2007-12-27
Submitted:2008-02-21
Entered:2008-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B127AA / 2 UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0498U / 2 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08702D / 2 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1391U / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Intussusception, Peritonitis, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 18     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None 4/4/08-records received-alpha thalassemia on new born screen
Allergies:
Diagnostic Lab Data: Barium Enema 12/28/07 4/4/08-records received- WBC 42. Tip of central line grew alpha strep and coagulase negative staph. Stool culture negative.
CDC 'Split Type':

Write-up: Intussusception 4/4/08-records received for DOS 12/28/17-1/15/08-DC DX: Intussusception. Suspected post intussusception peritonitis. Presented day prior to admission with 16 hours non-bilious non-bloody vomiting. Decreased appetite and urine output. No diarrhea. Day of admission developed current jelly/bloody stool. Barium enema showed irreducible intussusception and 2 unsuccessful attempts made. Laparotomy revealed no evidence of intussusception. Post operatively developed increasing abdominal distension and tenderness. Coagulopathy improved with FFP and blood transfusion. Recurrent vomiting and loose stools. Fever. Follow-up: Rotavirus vaccine given after incident without adverse events.


Changed on 6/14/2018

VAERS ID: 308364 Before After
VAERS Form:1
Age:0.34
Sex:Female
Location:Iowa
Vaccinated:2007-11-08
Onset:2007-12-27
Submitted:2008-02-21
Entered:2008-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B127AA / 2 UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0498U / 2 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08702D / 2 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1391U / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Intussusception, Peritonitis, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 18     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None 4/4/08-records received-alpha thalassemia on new born screen
Allergies:
Diagnostic Lab Data: Barium Enema 12/28/07 4/4/08-records received- WBC 42. Tip of central line grew alpha strep and coagulase negative staph. Stool culture negative.
CDC 'Split Type':

Write-up: Intussusception 4/4/08-records received for DOS 12/28/17-1/15/08-DC DX: Intussusception. Suspected post intussusception peritonitis. Presented day prior to admission with 16 hours non-bilious non-bloody vomiting. Decreased appetite and urine output. No diarrhea. Day of admission developed current jelly/bloody stool. Barium enema showed irreducible intussusception and 2 unsuccessful attempts made. Laparotomy revealed no evidence of intussusception. Post operatively developed increasing abdominal distension and tenderness. Coagulopathy improved with FFP and blood transfusion. Recurrent vomiting and loose stools. Fever. Follow-up: Rotavirus vaccine given after incident without adverse events.


Changed on 8/14/2018

VAERS ID: 308364 Before After
VAERS Form:1
Age:0.34
Sex:Female
Location:Iowa
Vaccinated:2007-11-08
Onset:2007-12-27
Submitted:2008-02-21
Entered:2008-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B127AA / 2 UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0498U / 2 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08702D / 2 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1391U / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Intussusception, Peritonitis, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 18     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None 4/4/08-records received-alpha thalassemia on new born screen
Allergies:
Diagnostic Lab Data: Barium Enema 12/28/07 4/4/08-records received- WBC 42. Tip of central line grew alpha strep and coagulase negative staph. Stool culture negative.
CDC 'Split Type':

Write-up: Intussusception 4/4/08-records received for DOS 12/28/17-1/15/08-DC DX: Intussusception. Suspected post intussusception peritonitis. Presented day prior to admission with 16 hours non-bilious non-bloody vomiting. Decreased appetite and urine output. No diarrhea. Day of admission developed current jelly/bloody stool. Barium enema showed irreducible intussusception and 2 unsuccessful attempts made. Laparotomy revealed no evidence of intussusception. Post operatively developed increasing abdominal distension and tenderness. Coagulopathy improved with FFP and blood transfusion. Recurrent vomiting and loose stools. Fever. Follow-up: Rotavirus vaccine given after incident without adverse events.


Changed on 9/14/2018

VAERS ID: 308364 Before After
VAERS Form:1
Age:0.34
Sex:Female
Location:Iowa
Vaccinated:2007-11-08
Onset:2007-12-27
Submitted:2008-02-21
Entered:2008-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B127AA / 2 UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0498U / 2 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08702D / 2 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1391U / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Intussusception, Peritonitis, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 18     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None 4/4/08-records received-alpha thalassemia on new born screen
Allergies:
Diagnostic Lab Data: Barium Enema 12/28/07 4/4/08-records received- WBC 42. Tip of central line grew alpha strep and coagulase negative staph. Stool culture negative.
CDC 'Split Type':

Write-up: Intussusception 4/4/08-records received for DOS 12/28/17-1/15/08-DC DX: Intussusception. Suspected post intussusception peritonitis. Presented day prior to admission with 16 hours non-bilious non-bloody vomiting. Decreased appetite and urine output. No diarrhea. Day of admission developed current jelly/bloody stool. Barium enema showed irreducible intussusception and 2 unsuccessful attempts made. Laparotomy revealed no evidence of intussusception. Post operatively developed increasing abdominal distension and tenderness. Coagulopathy improved with FFP and blood transfusion. Recurrent vomiting and loose stools. Fever. Follow-up: Rotavirus vaccine given after incident without adverse events.


Changed on 10/14/2018

VAERS ID: 308364 Before After
VAERS Form:1
Age:0.34
Sex:Female
Location:Iowa
Vaccinated:2007-11-08
Onset:2007-12-27
Submitted:2008-02-21
Entered:2008-03-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B127AA / 2 UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0498U / 2 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08702D / 2 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1391U / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Intussusception, Peritonitis, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 18     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None 4/4/08-records received-alpha thalassemia on new born screen
Allergies:
Diagnostic Lab Data: Barium Enema 12/28/07 4/4/08-records received- WBC 42. Tip of central line grew alpha strep and coagulase negative staph. Stool culture negative.
CDC 'Split Type':

Write-up: Intussusception 4/4/08-records received for DOS 12/28/17-1/15/08-DC DX: Intussusception. Suspected post intussusception peritonitis. Presented day prior to admission with 16 hours non-bilious non-bloody vomiting. Decreased appetite and urine output. No diarrhea. Day of admission developed current jelly/bloody stool. Barium enema showed irreducible intussusception and 2 unsuccessful attempts made. Laparotomy revealed no evidence of intussusception. Post operatively developed increasing abdominal distension and tenderness. Coagulopathy improved with FFP and blood transfusion. Recurrent vomiting and loose stools. Fever. Follow-up: Rotavirus vaccine given after incident without adverse events.

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