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This is VAERS ID 311011

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 311011
VAERS Form:
Age:0.5
Gender:Female
Location:Nebraska
Vaccinated:2008-03-14
Onset:2008-03-23
Submitted:2008-04-07
Entered:2008-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C45894 / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1664U / 2 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: Abdominal pain, Barium double contrast, Blood potassium decreased, Abdominal X-ray, Caecectomy

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None PMH: FT SVD, no complications.
Allergies:
Diagnostic Lab Data: LABS: Air contrast BE unsuccessful at reducing IS. WBC 20.83 (H), plts 561 (H), neutros # 13.53 (H). Potassium 3.5 (L).
CDC 'Split Type':

Write-up: Intussusception- pt had to have surgery to remove 3 inches of colon 10 days after she received the rotavirus vaccine. 5/6/08 Reviewed hospital medical records of 3/24-3/26/2008. FINAL DX: Intussusception w/ischemic bowel, ileal cecectomy w/primary anasto"mosis. Records reveal patient experienced abdominal pain, vomiting, lethargy & bloody mucoid stools x 1 day. Seen in outlying ER where abdominal x-ray suspicious for IS & transferred to higher level of care. Taken to OR for exp lap which was difficult t


Changed on 12/8/2009

VAERS ID: 311011 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Nebraska
Vaccinated:2008-03-14
Onset:2008-03-23
Submitted:2008-04-07
Entered:2008-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 2 LL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C45894 / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1664U / 2 - / PO

Administered by: Public      Purchased by: Unknown Public
Symptoms: Abdominal pain, Barium double contrast, Blood potassium decreased, Haematochezia, Intestinal ischaemia, Intussusception, Lethargy, Mucous stools, Neutrophil count increased, Vomiting, White blood cell count increased, X-ray abnormal, Platelet count increased, Explorative laparotomy, Intestinal anastomosis, Abdominal X-ray, Caecectomy, Gastrointestinal surgery

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None PMH: FT SVD, no complications.
Allergies:
Diagnostic Lab Data: LABS: Air contrast BE unsuccessful at reducing IS. WBC 20.83 (H), plts 561 (H), neutros # 13.53 (H). Potassium 3.5 (L).
CDC 'Split Type':

Write-up: Intussusception- pt had to have surgery to remove 3 inches of colon 10 days after she received the rotavirus vaccine. 5/6/08 Reviewed hospital medical records of 3/24-3/26/2008. FINAL DX: Intussusception w/ischemic bowel, ileal cecectomy w/primary anasto"mosis. anastomosis. Records reveal patient experienced abdominal pain, vomiting, lethargy & bloody mucoid stools x 1 day. Seen in outlying ER where abdominal x-ray suspicious for IS & transferred to higher level of care. Taken to OR for exp lap which was difficult t to reduce. Ileal cecectomy w/primary anastamosis done. Recovered well post operatively & d/c to home


Changed on 3/2/2010

VAERS ID: 311011 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Nebraska
Vaccinated:2008-03-14
Onset:2008-03-23
Submitted:2008-04-07
Entered:2008-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC C45894 / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1664U / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Abdominal pain, Barium double contrast, Blood potassium decreased, Haematochezia, Intestinal ischaemia, Intussusception, Lethargy, Mucous stools, Neutrophil count increased, Vomiting, White blood cell count increased, X-ray abnormal, Platelet count increased, Explorative laparotomy, Intestinal anastomosis, Abdominal X-ray, Caecectomy, Gastrointestinal surgery

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None PMH: FT SVD, no complications.
Allergies:
Diagnostic Lab Data: LABS: Air contrast BE unsuccessful at reducing IS. WBC 20.83 (H), plts 561 (H), neutros # 13.53 (H). Potassium 3.5 (L).
CDC 'Split Type':

Write-up: Intussusception- pt had to have surgery to remove 3 inches of colon 10 days after she received the rotavirus vaccine. 5/6/08 Reviewed hospital medical records of 3/24-3/26/2008. FINAL DX: Intussusception w/ischemic bowel, ileal cecectomy w/primary anastomosis. Records reveal patient experienced abdominal pain, vomiting, lethargy & bloody mucoid stools x 1 day. Seen in outlying ER where abdominal x-ray suspicious for IS & transferred to higher level of care. Taken to OR for exp lap which was difficult to reduce. Ileal cecectomy w/primary anastamosis done. Recovered well post operatively & d/c to home


Changed on 4/7/2010

VAERS ID: 311011 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Nebraska
Vaccinated:2008-03-14
Onset:2008-03-23
Submitted:2008-04-07
Entered:2008-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 2 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C45894 / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1664U / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Abdominal pain, Barium double contrast, Blood potassium decreased, Haematochezia, Intestinal ischaemia, Intussusception, Lethargy, Mucous stools, Neutrophil count increased, Vomiting, White blood cell count increased, X-ray abnormal, Platelet count increased, Explorative laparotomy, Intestinal anastomosis, Abdominal X-ray, Caecectomy, Gastrointestinal surgery

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None PMH: FT SVD, no complications.
Allergies:
Diagnostic Lab Data: LABS: Air contrast BE unsuccessful at reducing IS. WBC 20.83 (H), plts 561 (H), neutros # 13.53 (H). Potassium 3.5 (L).
CDC 'Split Type':

Write-up: Intussusception- pt had to have surgery to remove 3 inches of colon 10 days after she received the rotavirus vaccine. 5/6/08 Reviewed hospital medical records of 3/24-3/26/2008. FINAL DX: Intussusception w/ischemic bowel, ileal cecectomy w/primary anastomosis. Records reveal patient experienced abdominal pain, vomiting, lethargy & bloody mucoid stools x 1 day. Seen in outlying ER where abdominal x-ray suspicious for IS & transferred to higher level of care. Taken to OR for exp lap which was difficult to reduce. Ileal cecectomy w/primary anastamosis done. Recovered well post operatively & d/c to home


Changed on 8/31/2010

VAERS ID: 311011 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Nebraska
Vaccinated:2008-03-14
Onset:2008-03-23
Submitted:2008-04-07
Entered:2008-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH C45894 / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1664U / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Abdominal pain, Barium double contrast, Blood potassium decreased, Haematochezia, Intestinal ischaemia, Intussusception, Lethargy, Mucous stools, Neutrophil count increased, Vomiting, White blood cell count increased, X-ray abnormal, Platelet count increased, Explorative laparotomy, Intestinal anastomosis, Abdominal X-ray, Caecectomy, Gastrointestinal surgery

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None PMH: FT SVD, no complications.
Allergies:
Diagnostic Lab Data: LABS: Air contrast BE unsuccessful at reducing IS. WBC 20.83 (H), plts 561 (H), neutros # 13.53 (H). Potassium 3.5 (L).
CDC 'Split Type':

Write-up: Intussusception- pt had to have surgery to remove 3 inches of colon 10 days after she received the rotavirus vaccine. 5/6/08 Reviewed hospital medical records of 3/24-3/26/2008. FINAL DX: Intussusception w/ischemic bowel, ileal cecectomy w/primary anastomosis. Records reveal patient experienced abdominal pain, vomiting, lethargy & bloody mucoid stools x 1 day. Seen in outlying ER where abdominal x-ray suspicious for IS & transferred to higher level of care. Taken to OR for exp lap which was difficult to reduce. Ileal cecectomy w/primary anastamosis done. Recovered well post operatively & d/c to home


Changed on 4/13/2011

VAERS ID: 311011 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Nebraska
Vaccinated:2008-03-14
Onset:2008-03-23
Submitted:2008-04-07
Entered:2008-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45894 / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1664U / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Abdominal pain, Barium double contrast, Blood potassium decreased, Haematochezia, Intestinal ischaemia, Intussusception, Lethargy, Mucous stools, Neutrophil count increased, Vomiting, White blood cell count increased, X-ray abnormal, Platelet count increased, Explorative laparotomy, Intestinal anastomosis, Abdominal X-ray, Caecectomy, Gastrointestinal surgery

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None PMH: FT SVD, no complications.
Allergies:
Diagnostic Lab Data: LABS: Air contrast BE unsuccessful at reducing IS. WBC 20.83 (H), plts 561 (H), neutros # 13.53 (H). Potassium 3.5 (L).
CDC 'Split Type':

Write-up: Intussusception- pt had to have surgery to remove 3 inches of colon 10 days after she received the rotavirus vaccine. 5/6/08 Reviewed hospital medical records of 3/24-3/26/2008. FINAL DX: Intussusception w/ischemic bowel, ileal cecectomy w/primary anastomosis. Records reveal patient experienced abdominal pain, vomiting, lethargy & bloody mucoid stools x 1 day. Seen in outlying ER where abdominal x-ray suspicious for IS & transferred to higher level of care. Taken to OR for exp lap which was difficult to reduce. Ileal cecectomy w/primary anastamosis done. Recovered well post operatively & d/c to home


Changed on 5/13/2011

VAERS ID: 311011 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Nebraska
Vaccinated:2008-03-14
Onset:2008-03-23
Submitted:2008-04-07
Entered:2008-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45894 / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1664U / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Abdominal pain, Barium double contrast, Blood potassium decreased, Haematochezia, Intestinal ischaemia, Intussusception, Lethargy, Mucous stools, Neutrophil count increased, Vomiting, White blood cell count increased, X-ray abnormal, Platelet count increased, Explorative laparotomy, Intestinal anastomosis, Abdominal X-ray, Caecectomy, Gastrointestinal surgery

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None PMH: FT SVD, no complications.
Allergies:
Diagnostic Lab Data: LABS: Air contrast BE unsuccessful at reducing IS. WBC 20.83 (H), plts 561 (H), neutros # 13.53 (H). Potassium 3.5 (L).
CDC 'Split Type':

Write-up: Intussusception- pt had to have surgery to remove 3 inches of colon 10 days after she received the rotavirus vaccine. 5/6/08 Reviewed hospital medical records of 3/24-3/26/2008. FINAL DX: Intussusception w/ischemic bowel, ileal cecectomy w/primary anastomosis. Records reveal patient experienced abdominal pain, vomiting, lethargy & bloody mucoid stools x 1 day. Seen in outlying ER where abdominal x-ray suspicious for IS & transferred to higher level of care. Taken to OR for exp lap which was difficult to reduce. Ileal cecectomy w/primary anastamosis done. Recovered well post operatively & d/c to home


Changed on 6/11/2011

VAERS ID: 311011 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Nebraska
Vaccinated:2008-03-14
Onset:2008-03-23
Submitted:2008-04-07
Entered:2008-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45894 / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1664U / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Abdominal pain, Barium double contrast, Blood potassium decreased, Haematochezia, Intestinal ischaemia, Intussusception, Lethargy, Mucous stools, Neutrophil count increased, Vomiting, White blood cell count increased, X-ray abnormal, Platelet count increased, Explorative laparotomy, Intestinal anastomosis, Abdominal X-ray, Caecectomy, Gastrointestinal surgery

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None PMH: FT SVD, no complications.
Allergies:
Diagnostic Lab Data: LABS: Air contrast BE unsuccessful at reducing IS. WBC 20.83 (H), plts 561 (H), neutros # 13.53 (H). Potassium 3.5 (L).
CDC 'Split Type':

Write-up: Intussusception- pt had to have surgery to remove 3 inches of colon 10 days after she received the rotavirus vaccine. 5/6/08 Reviewed hospital medical records of 3/24-3/26/2008. FINAL DX: Intussusception w/ischemic bowel, ileal cecectomy w/primary anastomosis. Records reveal patient experienced abdominal pain, vomiting, lethargy & bloody mucoid stools x 1 day. Seen in outlying ER where abdominal x-ray suspicious for IS & transferred to higher level of care. Taken to OR for exp lap which was difficult to reduce. Ileal cecectomy w/primary anastamosis done. Recovered well post operatively & d/c to home


Changed on 5/13/2013

VAERS ID: 311011 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Nebraska
Vaccinated:2008-03-14
Onset:2008-03-23
Submitted:2008-04-07
Entered:2008-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45894 / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1664U / 2 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1664U / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Abdominal pain, Barium double contrast, Blood potassium decreased, Haematochezia, Intestinal ischaemia, Intussusception, Lethargy, Mucous stools, Neutrophil count increased, Vomiting, White blood cell count increased, X-ray abnormal, Platelet count increased, Explorative laparotomy, Intestinal anastomosis, Abdominal X-ray, Caecectomy, Gastrointestinal surgery

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None PMH: FT SVD, no complications.
Allergies:
Diagnostic Lab Data: LABS: Air contrast BE unsuccessful at reducing IS. WBC 20.83 (H), plts 561 (H), neutros # 13.53 (H). Potassium 3.5 (L).
CDC 'Split Type':

Write-up: Intussusception- pt had to have surgery to remove 3 inches of colon 10 days after she received the rotavirus vaccine. 5/6/08 Reviewed hospital medical records of 3/24-3/26/2008. FINAL DX: Intussusception w/ischemic bowel, ileal cecectomy w/primary anastomosis. Records reveal patient experienced abdominal pain, vomiting, lethargy & bloody mucoid stools x 1 day. Seen in outlying ER where abdominal x-ray suspicious for IS & transferred to higher level of care. Taken to OR for exp lap which was difficult to reduce. Ileal cecectomy w/primary anastamosis done. Recovered well post operatively & d/c to home


Changed on 4/14/2017

VAERS ID: 311011 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Nebraska
Vaccinated:2008-03-14
Onset:2008-03-23
Submitted:2008-04-07
Entered:2008-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45894 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1664U / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Abdominal pain, Barium double contrast, Blood potassium decreased, Haematochezia, Intestinal ischaemia, Intussusception, Lethargy, Mucous stools, Neutrophil count increased, Vomiting, White blood cell count increased, X-ray abnormal, Platelet count increased, Explorative laparotomy, Intestinal anastomosis, Abdominal X-ray, Caecectomy, Gastrointestinal surgery

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None PMH: FT SVD, no complications.
Allergies:
Diagnostic Lab Data: LABS: Air contrast BE unsuccessful at reducing IS. WBC 20.83 (H), plts 561 (H), neutros # 13.53 (H). Potassium 3.5 (L).
CDC 'Split Type':

Write-up: Intussusception- pt had to have surgery to remove 3 inches of colon 10 days after she received the rotavirus vaccine. 5/6/08 Reviewed hospital medical records of 3/24-3/26/2008. FINAL DX: Intussusception w/ischemic bowel, ileal cecectomy w/primary anastomosis. Records reveal patient experienced abdominal pain, vomiting, lethargy & bloody mucoid stools x 1 day. Seen in outlying ER where abdominal x-ray suspicious for IS & transferred to higher level of care. Taken to OR for exp lap which was difficult to reduce. Ileal cecectomy w/primary anastamosis done. Recovered well post operatively & d/c to home


Changed on 9/14/2017

VAERS ID: 311011 Before After
VAERS Form:(blank) 1
Age:0.5
Gender:Female
Location:Nebraska
Vaccinated:2008-03-14
Onset:2008-03-23
Submitted:2008-04-07
Entered:2008-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 2 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45894 / 2 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1664U / 2 3 - MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Intussusception, Gastrointestinal surgery

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None PMH: FT SVD, no complications.
Allergies:
Diagnostic Lab Data: LABS: Air contrast BE unsuccessful at reducing IS. WBC 20.83 (H), plts 561 (H), neutros # 13.53 (H). Potassium 3.5 (L).
CDC 'Split Type':

Write-up: Intussusception- pt had to have surgery to remove 3 inches of colon 10 days after she received the rotavirus vaccine. 5/6/08 Reviewed hospital medical records of 3/24-3/26/2008. FINAL DX: Intussusception w/ischemic bowel, ileal cecectomy w/primary anastomosis. Records reveal patient experienced abdominal pain, vomiting, lethargy & bloody mucoid stools x 1 day. Seen in outlying ER where abdominal x-ray suspicious for IS & transferred to higher level of care. Taken to OR for exp lap which was difficult to reduce. Ileal cecectomy w/primary anastamosis done. Recovered well post operatively & d/c to home


Changed on 2/14/2018

VAERS ID: 311011 Before After
VAERS Form:1
Age:0.5
Gender:Female
Location:Nebraska
Vaccinated:2008-03-14
Onset:2008-03-23
Submitted:2008-04-07
Entered:2008-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45894 / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1664U / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Intussusception, Gastrointestinal surgery

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None PMH: FT SVD, no complications.
Allergies:
Diagnostic Lab Data: LABS: Air contrast BE unsuccessful at reducing IS. WBC 20.83 (H), plts 561 (H), neutros # 13.53 (H). Potassium 3.5 (L).
CDC 'Split Type':

Write-up: Intussusception- pt had to have surgery to remove 3 inches of colon 10 days after she received the rotavirus vaccine. 5/6/08 Reviewed hospital medical records of 3/24-3/26/2008. FINAL DX: Intussusception w/ischemic bowel, ileal cecectomy w/primary anastomosis. Records reveal patient experienced abdominal pain, vomiting, lethargy & bloody mucoid stools x 1 day. Seen in outlying ER where abdominal x-ray suspicious for IS & transferred to higher level of care. Taken to OR for exp lap which was difficult to reduce. Ileal cecectomy w/primary anastamosis done. Recovered well post operatively & d/c to home


Changed on 6/14/2018

VAERS ID: 311011 Before After
VAERS Form:1
Age:0.5
Gender:Female
Location:Nebraska
Vaccinated:2008-03-14
Onset:2008-03-23
Submitted:2008-04-07
Entered:2008-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45894 / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1664U / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Intussusception, Gastrointestinal surgery

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None PMH: FT SVD, no complications.
Allergies:
Diagnostic Lab Data: LABS: Air contrast BE unsuccessful at reducing IS. WBC 20.83 (H), plts 561 (H), neutros # 13.53 (H). Potassium 3.5 (L).
CDC 'Split Type':

Write-up: Intussusception- pt had to have surgery to remove 3 inches of colon 10 days after she received the rotavirus vaccine. 5/6/08 Reviewed hospital medical records of 3/24-3/26/2008. FINAL DX: Intussusception w/ischemic bowel, ileal cecectomy w/primary anastomosis. Records reveal patient experienced abdominal pain, vomiting, lethargy & bloody mucoid stools x 1 day. Seen in outlying ER where abdominal x-ray suspicious for IS & transferred to higher level of care. Taken to OR for exp lap which was difficult to reduce. Ileal cecectomy w/primary anastamosis done. Recovered well post operatively & d/c to home


Changed on 8/14/2018

VAERS ID: 311011 Before After
VAERS Form:1
Age:0.5
Gender:Female
Location:Nebraska
Vaccinated:2008-03-14
Onset:2008-03-23
Submitted:2008-04-07
Entered:2008-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45894 / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1664U / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Intussusception, Gastrointestinal surgery

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None PMH: FT SVD, no complications.
Allergies:
Diagnostic Lab Data: LABS: Air contrast BE unsuccessful at reducing IS. WBC 20.83 (H), plts 561 (H), neutros # 13.53 (H). Potassium 3.5 (L).
CDC 'Split Type':

Write-up: Intussusception- pt had to have surgery to remove 3 inches of colon 10 days after she received the rotavirus vaccine. 5/6/08 Reviewed hospital medical records of 3/24-3/26/2008. FINAL DX: Intussusception w/ischemic bowel, ileal cecectomy w/primary anastomosis. Records reveal patient experienced abdominal pain, vomiting, lethargy & bloody mucoid stools x 1 day. Seen in outlying ER where abdominal x-ray suspicious for IS & transferred to higher level of care. Taken to OR for exp lap which was difficult to reduce. Ileal cecectomy w/primary anastamosis done. Recovered well post operatively & d/c to home


Changed on 9/14/2018

VAERS ID: 311011 Before After
VAERS Form:1
Age:0.5
Gender:Female
Location:Nebraska
Vaccinated:2008-03-14
Onset:2008-03-23
Submitted:2008-04-07
Entered:2008-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45894 / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1664U / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Intussusception, Gastrointestinal surgery

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None PMH: FT SVD, no complications.
Allergies:
Diagnostic Lab Data: LABS: Air contrast BE unsuccessful at reducing IS. WBC 20.83 (H), plts 561 (H), neutros # 13.53 (H). Potassium 3.5 (L).
CDC 'Split Type':

Write-up: Intussusception- pt had to have surgery to remove 3 inches of colon 10 days after she received the rotavirus vaccine. 5/6/08 Reviewed hospital medical records of 3/24-3/26/2008. FINAL DX: Intussusception w/ischemic bowel, ileal cecectomy w/primary anastomosis. Records reveal patient experienced abdominal pain, vomiting, lethargy & bloody mucoid stools x 1 day. Seen in outlying ER where abdominal x-ray suspicious for IS & transferred to higher level of care. Taken to OR for exp lap which was difficult to reduce. Ileal cecectomy w/primary anastamosis done. Recovered well post operatively & d/c to home


Changed on 10/14/2018

VAERS ID: 311011 Before After
VAERS Form:1
Age:0.5
Gender:Female
Location:Nebraska
Vaccinated:2008-03-14
Onset:2008-03-23
Submitted:2008-04-07
Entered:2008-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45894 / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1664U / 3 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Intussusception, Gastrointestinal surgery

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None PMH: FT SVD, no complications.
Allergies:
Diagnostic Lab Data: LABS: Air contrast BE unsuccessful at reducing IS. WBC 20.83 (H), plts 561 (H), neutros # 13.53 (H). Potassium 3.5 (L).
CDC 'Split Type':

Write-up: Intussusception- pt had to have surgery to remove 3 inches of colon 10 days after she received the rotavirus vaccine. 5/6/08 Reviewed hospital medical records of 3/24-3/26/2008. FINAL DX: Intussusception w/ischemic bowel, ileal cecectomy w/primary anastomosis. Records reveal patient experienced abdominal pain, vomiting, lethargy & bloody mucoid stools x 1 day. Seen in outlying ER where abdominal x-ray suspicious for IS & transferred to higher level of care. Taken to OR for exp lap which was difficult to reduce. Ileal cecectomy w/primary anastamosis done. Recovered well post operatively & d/c to home

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