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This is VAERS ID 308859

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 308859
VAERS Form:
Age:0.3
Sex:Female
Location:Kentucky
Vaccinated:2008-03-07
Onset:2008-03-14
Submitted:2008-04-03
Entered:2008-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 0 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C35172 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1195U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Chest X-ray normal, Culture stool negative, Blood alkaline phosphatase increased, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: reduction of intussusception by air contrast enema. Labs and Diagnostics: Abdominal X-ray with mild stool load and non-obstructive bowel pattern. CXR WNL. Air Contrast Barium enema (+) for ileocolic Intussusception. Head CT (+) for sinus
CDC 'Split Type':

Write-up: 03/14/2008 ileocolic intussusception reduced by air contrast enema at Hospital. Admitted for observation and discharged home the following day. 4/23/2008 MR received for DOS 3/14-15/2008 with D/C DX: Intussusception. Infant presented to ER with somnolen"ce/unresponsiveness following an episode of vomiting milk. Pt also had a spastic/shaking episode with bloody emesis and bloody/mucusy stool. PE (+) for lethargy and bloody stool in diaper. IS reduced by Air contrast Barium enema and d/c home next day.


Changed on 12/8/2009

VAERS ID: 308859 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:Kentucky
Vaccinated:2008-03-07
Onset:2008-03-14
Submitted:2008-04-03
Entered:2008-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 0 RL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 0 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C35172 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1195U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Chest X-ray normal, Culture stool negative, Culture urine negative, Full blood count normal, Haematemesis, Haematochezia, Intussusception, Laboratory test abnormal, Lethargy, Mucous stools, Muscle spasticity, Somnolence, Tremor, Unresponsive to stimuli, Vomiting, Drug screen negative, Blood alkaline phosphatase increased, Scan brain, Urine analysis normal, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: reduction of intussusception by air contrast enema. Labs and Diagnostics: Abdominal X-ray with mild stool load and non-obstructive bowel pattern. CXR WNL. Air Contrast Barium enema (+) for ileocolic Intussusception. Head CT (+) for sinus
CDC 'Split Type':

Write-up: 03/14/2008 ileocolic intussusception reduced by air contrast enema at Hospital. Admitted for observation and discharged home the following day. 4/23/2008 MR received for DOS 3/14-15/2008 with D/C DX: Intussusception. Infant presented to ER with somnolen"ce/unresponsiveness somnolence/unresponsiveness following an episode of vomiting milk. Pt also had a spastic/shaking episode with bloody emesis and bloody/mucusy stool. PE (+) for lethargy and bloody stool in diaper. IS reduced by Air contrast Barium enema and d/c home next day.


Changed on 3/2/2010

VAERS ID: 308859 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:Kentucky
Vaccinated:2008-03-07
Onset:2008-03-14
Submitted:2008-04-03
Entered:2008-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 0 RL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC C35172 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1195U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Chest X-ray normal, Culture stool negative, Culture urine negative, Full blood count normal, Haematemesis, Haematochezia, Intussusception, Laboratory test abnormal, Lethargy, Mucous stools, Muscle spasticity, Somnolence, Tremor, Unresponsive to stimuli, Vomiting, Drug screen negative, Blood alkaline phosphatase increased, Scan brain, Urine analysis normal, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: reduction of intussusception by air contrast enema. Labs and Diagnostics: Abdominal X-ray with mild stool load and non-obstructive bowel pattern. CXR WNL. Air Contrast Barium enema (+) for ileocolic Intussusception. Head CT (+) for sinus
CDC 'Split Type':

Write-up: 03/14/2008 ileocolic intussusception reduced by air contrast enema at Hospital. Admitted for observation and discharged home the following day. 4/23/2008 MR received for DOS 3/14-15/2008 with D/C DX: Intussusception. Infant presented to ER with somnolence/unresponsiveness following an episode of vomiting milk. Pt also had a spastic/shaking episode with bloody emesis and bloody/mucusy stool. PE (+) for lethargy and bloody stool in diaper. IS reduced by Air contrast Barium enema and d/c home next day.


Changed on 4/7/2010

VAERS ID: 308859 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:Kentucky
Vaccinated:2008-03-07
Onset:2008-03-14
Submitted:2008-04-03
Entered:2008-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 0 RL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C35172 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1195U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Chest X-ray normal, Culture stool negative, Culture urine negative, Full blood count normal, Haematemesis, Haematochezia, Intussusception, Laboratory test abnormal, Lethargy, Mucous stools, Muscle spasticity, Somnolence, Tremor, Unresponsive to stimuli, Vomiting, Drug screen negative, Blood alkaline phosphatase increased, Scan brain, Urine analysis normal, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: reduction of intussusception by air contrast enema. Labs and Diagnostics: Abdominal X-ray with mild stool load and non-obstructive bowel pattern. CXR WNL. Air Contrast Barium enema (+) for ileocolic Intussusception. Head CT (+) for sinus
CDC 'Split Type':

Write-up: 03/14/2008 ileocolic intussusception reduced by air contrast enema at Hospital. Admitted for observation and discharged home the following day. 4/23/2008 MR received for DOS 3/14-15/2008 with D/C DX: Intussusception. Infant presented to ER with somnolence/unresponsiveness following an episode of vomiting milk. Pt also had a spastic/shaking episode with bloody emesis and bloody/mucusy stool. PE (+) for lethargy and bloody stool in diaper. IS reduced by Air contrast Barium enema and d/c home next day.


Changed on 8/31/2010

VAERS ID: 308859 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:Kentucky
Vaccinated:2008-03-07
Onset:2008-03-14
Submitted:2008-04-03
Entered:2008-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 0 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH C35172 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1195U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Chest X-ray normal, Culture stool negative, Culture urine negative, Full blood count normal, Haematemesis, Haematochezia, Intussusception, Laboratory test abnormal, Lethargy, Mucous stools, Muscle spasticity, Somnolence, Tremor, Unresponsive to stimuli, Vomiting, Drug screen negative, Blood alkaline phosphatase increased, Scan brain, Urine analysis normal, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: reduction of intussusception by air contrast enema. Labs and Diagnostics: Abdominal X-ray with mild stool load and non-obstructive bowel pattern. CXR WNL. Air Contrast Barium enema (+) for ileocolic Intussusception. Head CT (+) for sinus
CDC 'Split Type':

Write-up: 03/14/2008 ileocolic intussusception reduced by air contrast enema at Hospital. Admitted for observation and discharged home the following day. 4/23/2008 MR received for DOS 3/14-15/2008 with D/C DX: Intussusception. Infant presented to ER with somnolence/unresponsiveness following an episode of vomiting milk. Pt also had a spastic/shaking episode with bloody emesis and bloody/mucusy stool. PE (+) for lethargy and bloody stool in diaper. IS reduced by Air contrast Barium enema and d/c home next day.


Changed on 7/13/2012

VAERS ID: 308859 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:Kentucky
Vaccinated:2008-03-07
Onset:2008-03-14
Submitted:2008-04-03
Entered:2008-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 0 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C35172 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1195U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Chest X-ray normal, Culture stool negative, Culture urine negative, Full blood count normal, Haematemesis, Haematochezia, Intussusception, Laboratory test abnormal, Lethargy, Mucous stools, Muscle spasticity, Somnolence, Tremor, Unresponsive to stimuli, Vomiting, Drug screen negative, Blood alkaline phosphatase increased, Scan brain, Urine analysis normal, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: reduction Reduction of intussusception by air contrast enema. Labs and Diagnostics: Abdominal X-ray with mild stool load and non-obstructive bowel pattern. CXR WNL. Air Contrast Barium enema (+) for ileocolic Intussusception. Head CT (+) for sinus disease. CBC, UA, Chemistry unremarkable except Alk Phos 308. urine drug screen (-). Urine, stool and nasal cx (-).
CDC 'Split Type':

Write-up: 03/14/2008 ileocolic intussusception reduced by air contrast enema at Hospital. Admitted for observation and discharged home the following day. 4/23/2008 MR received for DOS 3/14-15/2008 with D/C DX: Intussusception. Infant presented to ER with somnolence/unresponsiveness following an episode of vomiting milk. Pt also had a spastic/shaking episode with bloody emesis and bloody/mucusy stool. PE (+) for lethargy and bloody stool in diaper. IS reduced by Air contrast Barium enema and d/c home next day.


Changed on 5/13/2013

VAERS ID: 308859 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:Kentucky
Vaccinated:2008-03-07
Onset:2008-03-14
Submitted:2008-04-03
Entered:2008-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 0 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C35172 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1195U / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1195U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Chest X-ray normal, Culture stool negative, Culture urine negative, Full blood count normal, Haematemesis, Haematochezia, Intussusception, Laboratory test abnormal, Lethargy, Mucous stools, Muscle spasticity, Somnolence, Tremor, Unresponsive to stimuli, Vomiting, Drug screen negative, Blood alkaline phosphatase increased, Scan brain, Urine analysis normal, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Reduction of intussusception by air contrast enema. Labs and Diagnostics: Abdominal X-ray with mild stool load and non-obstructive bowel pattern. CXR WNL. Air Contrast Barium enema (+) for ileocolic Intussusception. Head CT (+) for sinus disease. CBC, UA, Chemistry unremarkable except Alk Phos 308. urine drug screen (-). Urine, stool and nasal cx (-).
CDC 'Split Type':

Write-up: 03/14/2008 ileocolic intussusception reduced by air contrast enema at Hospital. Admitted for observation and discharged home the following day. 4/23/2008 MR received for DOS 3/14-15/2008 with D/C DX: Intussusception. Infant presented to ER with somnolence/unresponsiveness following an episode of vomiting milk. Pt also had a spastic/shaking episode with bloody emesis and bloody/mucusy stool. PE (+) for lethargy and bloody stool in diaper. IS reduced by Air contrast Barium enema and d/c home next day.


Changed on 2/14/2017

VAERS ID: 308859 Before After
VAERS Form:
Age:0.3 0.33
Sex:Female
Location:Kentucky
Vaccinated:2008-03-07
Onset:2008-03-14
Submitted:2008-04-03
Entered:2008-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 0 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C35172 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1195U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Chest X-ray normal, Culture stool negative, Culture urine negative, Full blood count normal, Haematemesis, Haematochezia, Intussusception, Laboratory test abnormal, Lethargy, Mucous stools, Muscle spasticity, Somnolence, Tremor, Unresponsive to stimuli, Vomiting, Drug screen negative, Blood alkaline phosphatase increased, Scan brain, Urine analysis normal, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Reduction of intussusception by air contrast enema. Labs and Diagnostics: Abdominal X-ray with mild stool load and non-obstructive bowel pattern. CXR WNL. Air Contrast Barium enema (+) for ileocolic Intussusception. Head CT (+) for sinus disease. CBC, UA, Chemistry unremarkable except Alk Phos 308. urine drug screen (-). Urine, stool and nasal cx (-).
CDC 'Split Type':

Write-up: 03/14/2008 ileocolic intussusception reduced by air contrast enema at Hospital. Admitted for observation and discharged home the following day. 4/23/2008 MR received for DOS 3/14-15/2008 with D/C DX: Intussusception. Infant presented to ER with somnolence/unresponsiveness following an episode of vomiting milk. Pt also had a spastic/shaking episode with bloody emesis and bloody/mucusy stool. PE (+) for lethargy and bloody stool in diaper. IS reduced by Air contrast Barium enema and d/c home next day.


Changed on 9/14/2017

VAERS ID: 308859 Before After
VAERS Form:(blank) 1
Age:0.33
Sex:Female
Location:Kentucky
Vaccinated:2008-03-07
Onset:2008-03-14
Submitted:2008-04-03
Entered:2008-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 0 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C35172 / 1 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1195U / 1 2 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Reduction of intussusception by air contrast enema. Labs and Diagnostics: Abdominal X-ray with mild stool load and non-obstructive bowel pattern. CXR WNL. Air Contrast Barium enema (+) for ileocolic Intussusception. Head CT (+) for sinus disease. CBC, UA, Chemistry unremarkable except Alk Phos 308. urine drug screen (-). Urine, stool and nasal cx (-).
CDC 'Split Type':

Write-up: 03/14/2008 ileocolic intussusception reduced by air contrast enema at Hospital. Admitted for observation and discharged home the following day. 4/23/2008 MR received for DOS 3/14-15/2008 with D/C DX: Intussusception. Infant presented to ER with somnolence/unresponsiveness following an episode of vomiting milk. Pt also had a spastic/shaking episode with bloody emesis and bloody/mucusy stool. PE (+) for lethargy and bloody stool in diaper. IS reduced by Air contrast Barium enema and d/c home next day.


Changed on 2/14/2018

VAERS ID: 308859 Before After
VAERS Form:1
Age:0.33
Sex:Female
Location:Kentucky
Vaccinated:2008-03-07
Onset:2008-03-14
Submitted:2008-04-03
Entered:2008-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C35172 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1195U / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Reduction of intussusception by air contrast enema. Labs and Diagnostics: Abdominal X-ray with mild stool load and non-obstructive bowel pattern. CXR WNL. Air Contrast Barium enema (+) for ileocolic Intussusception. Head CT (+) for sinus disease. CBC, UA, Chemistry unremarkable except Alk Phos 308. urine drug screen (-). Urine, stool and nasal cx (-).
CDC 'Split Type':

Write-up: 03/14/2008 ileocolic intussusception reduced by air contrast enema at Hospital. Admitted for observation and discharged home the following day. 4/23/2008 MR received for DOS 3/14-15/2008 with D/C DX: Intussusception. Infant presented to ER with somnolence/unresponsiveness following an episode of vomiting milk. Pt also had a spastic/shaking episode with bloody emesis and bloody/mucusy stool. PE (+) for lethargy and bloody stool in diaper. IS reduced by Air contrast Barium enema and d/c home next day.


Changed on 6/14/2018

VAERS ID: 308859 Before After
VAERS Form:1
Age:0.33
Sex:Female
Location:Kentucky
Vaccinated:2008-03-07
Onset:2008-03-14
Submitted:2008-04-03
Entered:2008-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C35172 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1195U / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Reduction of intussusception by air contrast enema. Labs and Diagnostics: Abdominal X-ray with mild stool load and non-obstructive bowel pattern. CXR WNL. Air Contrast Barium enema (+) for ileocolic Intussusception. Head CT (+) for sinus disease. CBC, UA, Chemistry unremarkable except Alk Phos 308. urine drug screen (-). Urine, stool and nasal cx (-).
CDC 'Split Type':

Write-up: 03/14/2008 ileocolic intussusception reduced by air contrast enema at Hospital. Admitted for observation and discharged home the following day. 4/23/2008 MR received for DOS 3/14-15/2008 with D/C DX: Intussusception. Infant presented to ER with somnolence/unresponsiveness following an episode of vomiting milk. Pt also had a spastic/shaking episode with bloody emesis and bloody/mucusy stool. PE (+) for lethargy and bloody stool in diaper. IS reduced by Air contrast Barium enema and d/c home next day.


Changed on 8/14/2018

VAERS ID: 308859 Before After
VAERS Form:1
Age:0.33
Sex:Female
Location:Kentucky
Vaccinated:2008-03-07
Onset:2008-03-14
Submitted:2008-04-03
Entered:2008-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C35172 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1195U / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Reduction of intussusception by air contrast enema. Labs and Diagnostics: Abdominal X-ray with mild stool load and non-obstructive bowel pattern. CXR WNL. Air Contrast Barium enema (+) for ileocolic Intussusception. Head CT (+) for sinus disease. CBC, UA, Chemistry unremarkable except Alk Phos 308. urine drug screen (-). Urine, stool and nasal cx (-).
CDC 'Split Type':

Write-up: 03/14/2008 ileocolic intussusception reduced by air contrast enema at Hospital. Admitted for observation and discharged home the following day. 4/23/2008 MR received for DOS 3/14-15/2008 with D/C DX: Intussusception. Infant presented to ER with somnolence/unresponsiveness following an episode of vomiting milk. Pt also had a spastic/shaking episode with bloody emesis and bloody/mucusy stool. PE (+) for lethargy and bloody stool in diaper. IS reduced by Air contrast Barium enema and d/c home next day.


Changed on 9/14/2018

VAERS ID: 308859 Before After
VAERS Form:1
Age:0.33
Sex:Female
Location:Kentucky
Vaccinated:2008-03-07
Onset:2008-03-14
Submitted:2008-04-03
Entered:2008-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C35172 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1195U / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Reduction of intussusception by air contrast enema. Labs and Diagnostics: Abdominal X-ray with mild stool load and non-obstructive bowel pattern. CXR WNL. Air Contrast Barium enema (+) for ileocolic Intussusception. Head CT (+) for sinus disease. CBC, UA, Chemistry unremarkable except Alk Phos 308. urine drug screen (-). Urine, stool and nasal cx (-).
CDC 'Split Type':

Write-up: 03/14/2008 ileocolic intussusception reduced by air contrast enema at Hospital. Admitted for observation and discharged home the following day. 4/23/2008 MR received for DOS 3/14-15/2008 with D/C DX: Intussusception. Infant presented to ER with somnolence/unresponsiveness following an episode of vomiting milk. Pt also had a spastic/shaking episode with bloody emesis and bloody/mucusy stool. PE (+) for lethargy and bloody stool in diaper. IS reduced by Air contrast Barium enema and d/c home next day.


Changed on 10/14/2018

VAERS ID: 308859 Before After
VAERS Form:1
Age:0.33
Sex:Female
Location:Kentucky
Vaccinated:2008-03-07
Onset:2008-03-14
Submitted:2008-04-03
Entered:2008-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C35172 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1195U / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Reduction of intussusception by air contrast enema. Labs and Diagnostics: Abdominal X-ray with mild stool load and non-obstructive bowel pattern. CXR WNL. Air Contrast Barium enema (+) for ileocolic Intussusception. Head CT (+) for sinus disease. CBC, UA, Chemistry unremarkable except Alk Phos 308. urine drug screen (-). Urine, stool and nasal cx (-).
CDC 'Split Type':

Write-up: 03/14/2008 ileocolic intussusception reduced by air contrast enema at Hospital. Admitted for observation and discharged home the following day. 4/23/2008 MR received for DOS 3/14-15/2008 with D/C DX: Intussusception. Infant presented to ER with somnolence/unresponsiveness following an episode of vomiting milk. Pt also had a spastic/shaking episode with bloody emesis and bloody/mucusy stool. PE (+) for lethargy and bloody stool in diaper. IS reduced by Air contrast Barium enema and d/c home next day.

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