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This is VAERS ID 311250

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

VAERS ID: 311250
VAERS Form:
Age:0.3
Gender:Female
Location:Foreign
Vaccinated:2007-12-11
Onset:2008-01-09
Submitted:2008-04-29
Entered:2008-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPH: DTAP + HIB (TRIHIBIT) / SANOFI PASTEUR - / - UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR - / - UN / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC - / - UN / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood pressure, Fatigue, Haematochezia, Heart rate, Intussusception, Irritability, Pain, Enema administration, Ultrasound scan abnormal

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: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: TIORFAN (ACETORPHAN), unknown, 08-Jan-2008; Advil (IBUPROFEN), unknown, 08-Jan-2008; DOLIPRANE (PARACETAMOL), unknown, 08-Jan-08
Current Illness: A concurrent history of gastroenteritis manifested by 10 liquid, glary and bloody stools per day, vomiting, fever at 38.7 C and
Preexisting Conditions: The patient had a past history of normal full-term newborn, a medical history of unspecified reflux, no history of allergy.
Allergies:
Diagnostic Lab Data: On 09-Jan-2008 test results were: ultrasound scan (results: acute intestinal intussusception suspected); heart rate (results: 156/min); and blood pressure (results: 107/77).
CDC 'Split Type': FRWYEG01473408

Write-up: Information regarding PREVENAR was received from a healthcare professional regarding a 4-month-old female patient who experienced acute intestinal intussusception. The patient received the second dose on 11-Dec-2007. On 09-Jan-2008, the patient was admitted to emergency unit due to pain and blood in stools. On admission the patient was tired and irritable. Physical examination was unremarkable, she had no fever and no sign of dehydration. Acute intestinal intussusception was suspected on ultrasound scan. The patient was hospitalized and intussusception was reduced with water-soluble enema. The patient recovered without sequelae. No additional information was available at the time of this report.


Changed on 3/2/2010

VAERS ID: 311250 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Foreign
Vaccinated:2007-12-11
Onset:2008-01-09
Submitted:2008-04-29
Entered:2008-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPH: DTAP + HIB (TRIHIBIT) / SANOFI PASTEUR - / - UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR - / - UN / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC - / - UN / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood pressure, Fatigue, Haematochezia, Heart rate, Intussusception, Irritability, Pain, Enema administration, Ultrasound scan abnormal

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: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: TIORFAN (ACETORPHAN), unknown, 08-Jan-2008; Advil (IBUPROFEN), unknown, 08-Jan-2008; DOLIPRANE (PARACETAMOL), unknown, 08-Jan-08
Current Illness: A concurrent history of gastroenteritis manifested by 10 liquid, glary and bloody stools per day, vomiting, fever at 38.7 C and
Preexisting Conditions: The patient had a past history of normal full-term newborn, a medical history of unspecified reflux, no history of allergy.
Allergies:
Diagnostic Lab Data: On 09-Jan-2008 test results were: ultrasound scan (results: acute intestinal intussusception suspected); heart rate (results: 156/min); and blood pressure (results: 107/77).
CDC 'Split Type': FRWYEG01473408

Write-up: Information regarding PREVENAR was received from a healthcare professional regarding a 4-month-old female patient who experienced acute intestinal intussusception. The patient received the second dose on 11-Dec-2007. On 09-Jan-2008, the patient was admitted to emergency unit due to pain and blood in stools. On admission the patient was tired and irritable. Physical examination was unremarkable, she had no fever and no sign of dehydration. Acute intestinal intussusception was suspected on ultrasound scan. The patient was hospitalized and intussusception was reduced with water-soluble enema. The patient recovered without sequelae. No additional information was available at the time of this report.


Changed on 4/7/2010

VAERS ID: 311250 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Foreign
Vaccinated:2007-12-11
Onset:2008-01-09
Submitted:2008-04-29
Entered:2008-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPH: DTAP + HIB (TRIHIBIT) / SANOFI PASTEUR - / - UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR - / - UN / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC - / - UN / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood pressure, Fatigue, Haematochezia, Heart rate, Intussusception, Irritability, Pain, Enema administration, Ultrasound scan abnormal

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: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: TIORFAN (ACETORPHAN), unknown, 08-Jan-2008; Advil (IBUPROFEN), unknown, 08-Jan-2008; DOLIPRANE (PARACETAMOL), unknown, 08-Jan-08
Current Illness: A concurrent history of gastroenteritis manifested by 10 liquid, glary and bloody stools per day, vomiting, fever at 38.7 C and
Preexisting Conditions: The patient had a past history of normal full-term newborn, a medical history of unspecified reflux, no history of allergy.
Allergies:
Diagnostic Lab Data: On 09-Jan-2008 test results were: ultrasound scan (results: acute intestinal intussusception suspected); heart rate (results: 156/min); and blood pressure (results: 107/77).
CDC 'Split Type': FRWYEG01473408

Write-up: Information regarding PREVENAR was received from a healthcare professional regarding a 4-month-old female patient who experienced acute intestinal intussusception. The patient received the second dose on 11-Dec-2007. On 09-Jan-2008, the patient was admitted to emergency unit due to pain and blood in stools. On admission the patient was tired and irritable. Physical examination was unremarkable, she had no fever and no sign of dehydration. Acute intestinal intussusception was suspected on ultrasound scan. The patient was hospitalized and intussusception was reduced with water-soluble enema. The patient recovered without sequelae. No additional information was available at the time of this report.


Changed on 8/31/2010

VAERS ID: 311250 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Foreign
Vaccinated:2007-12-11
Onset:2008-01-09
Submitted:2008-04-29
Entered:2008-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPH: DTAP + HIB (TRIHIBIT) / SANOFI PASTEUR - / - UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR - / - UN / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH - / - UN / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood pressure, Fatigue, Haematochezia, Heart rate, Intussusception, Irritability, Pain, Enema administration, Ultrasound scan abnormal

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: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: TIORFAN (ACETORPHAN), unknown, 08-Jan-2008; Advil (IBUPROFEN), unknown, 08-Jan-2008; DOLIPRANE (PARACETAMOL), unknown, 08-Jan-08
Current Illness: A concurrent history of gastroenteritis manifested by 10 liquid, glary and bloody stools per day, vomiting, fever at 38.7 C and
Preexisting Conditions: The patient had a past history of normal full-term newborn, a medical history of unspecified reflux, no history of allergy.
Allergies:
Diagnostic Lab Data: On 09-Jan-2008 test results were: ultrasound scan (results: acute intestinal intussusception suspected); heart rate (results: 156/min); and blood pressure (results: 107/77).
CDC 'Split Type': FRWYEG01473408

Write-up: Information regarding PREVENAR was received from a healthcare professional regarding a 4-month-old female patient who experienced acute intestinal intussusception. The patient received the second dose on 11-Dec-2007. On 09-Jan-2008, the patient was admitted to emergency unit due to pain and blood in stools. On admission the patient was tired and irritable. Physical examination was unremarkable, she had no fever and no sign of dehydration. Acute intestinal intussusception was suspected on ultrasound scan. The patient was hospitalized and intussusception was reduced with water-soluble enema. The patient recovered without sequelae. No additional information was available at the time of this report.


Changed on 5/13/2013

VAERS ID: 311250 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Foreign
Vaccinated:2007-12-11
Onset:2008-01-09
Submitted:2008-04-29
Entered:2008-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPH: DTAP + HIB (TRIHIBIT) / SANOFI PASTEUR - / - UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR - / - UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / - UN / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood pressure, Fatigue, Haematochezia, Heart rate, Intussusception, Irritability, Pain, Enema administration, Ultrasound scan abnormal

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: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: TIORFAN (ACETORPHAN), unknown, 08-Jan-2008; Advil (IBUPROFEN), unknown, 08-Jan-2008; DOLIPRANE (PARACETAMOL), unknown, 08-Jan-08
Current Illness: A concurrent history of gastroenteritis manifested by 10 liquid, glary and bloody stools per day, vomiting, fever at 38.7 C and
Preexisting Conditions: The patient had a past history of normal full-term newborn, a medical history of unspecified reflux, no history of allergy.
Allergies:
Diagnostic Lab Data: On 09-Jan-2008 test results were: ultrasound scan (results: acute intestinal intussusception suspected); heart rate (results: 156/min); and blood pressure (results: 107/77).
CDC 'Split Type': FRWYEG01473408

Write-up: Information regarding PREVENAR was received from a healthcare professional regarding a 4-month-old female patient who experienced acute intestinal intussusception. The patient received the second dose on 11-Dec-2007. On 09-Jan-2008, the patient was admitted to emergency unit due to pain and blood in stools. On admission the patient was tired and irritable. Physical examination was unremarkable, she had no fever and no sign of dehydration. Acute intestinal intussusception was suspected on ultrasound scan. The patient was hospitalized and intussusception was reduced with water-soluble enema. The patient recovered without sequelae. No additional information was available at the time of this report.


Changed on 4/14/2017

VAERS ID: 311250 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Foreign
Vaccinated:2007-12-11
Onset:2008-01-09
Submitted:2008-04-29
Entered:2008-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPH: DTAP + HIB (TRIHIBIT) / SANOFI PASTEUR - / - UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR - / - UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / - UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood pressure, Fatigue, Haematochezia, Heart rate, Intussusception, Irritability, Pain, Enema administration, Ultrasound scan abnormal

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: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: TIORFAN (ACETORPHAN), unknown, 08-Jan-2008; Advil (IBUPROFEN), unknown, 08-Jan-2008; DOLIPRANE (PARACETAMOL), unknown, 08-Jan-08
Current Illness: A concurrent history of gastroenteritis manifested by 10 liquid, glary and bloody stools per day, vomiting, fever at 38.7 C and weight loss of 4%, began on 08-Jan-2008 whereas members of her family had gastroenteritis. She was started on Tiorfan, Advil, Doliprane solution for rehydration.
Preexisting Conditions: The patient had a past history of normal full-term newborn, a medical history of unspecified reflux, no history of allergy.
Allergies:
Diagnostic Lab Data: On 09-Jan-2008 test results were: ultrasound scan (results: acute intestinal intussusception suspected); heart rate (results: 156/min); and blood pressure (results: 107/77).
CDC 'Split Type': FRWYEG01473408

Write-up: Information regarding PREVENAR was received from a healthcare professional regarding a 4-month-old female patient who experienced acute intestinal intussusception. The patient received the second dose on 11-Dec-2007. On 09-Jan-2008, the patient was admitted to emergency unit due to pain and blood in stools. On admission the patient was tired and irritable. Physical examination was unremarkable, she had no fever and no sign of dehydration. Acute intestinal intussusception was suspected on ultrasound scan. The patient was hospitalized and intussusception was reduced with water-soluble enema. The patient recovered without sequelae. No additional information was available at the time of this report.


Changed on 9/14/2017

VAERS ID: 311250 Before After
VAERS Form:(blank) 1
Age:0.3
Gender:Female
Location:Foreign
Vaccinated:2007-12-11
Onset:2008-01-09
Submitted:2008-04-29
Entered:2008-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPH: DTAP + HIB (TRIHIBIT) / SANOFI PASTEUR - / - UNK UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR - / - UNK UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / - UNK UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UNK - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood pressure, Fatigue, Haematochezia, Heart rate, Intussusception, Irritability, Pain, Enema administration, Ultrasound scan abnormal

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: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: TIORFAN (ACETORPHAN), unknown, 08-Jan-2008; Advil (IBUPROFEN), unknown, 08-Jan-2008; DOLIPRANE (PARACETAMOL), unknown, 08-Jan-08
Current Illness: A concurrent history of gastroenteritis manifested by 10 liquid, glary and bloody stools per day, vomiting, fever at 38.7 C and weight loss of 4%, began on 08-Jan-2008 whereas members of her family had gastroenteritis. She was started on Tiorfan, Advil, Doliprane solution for rehydration.
Preexisting Conditions: The patient had a past history of normal full-term newborn, a medical history of unspecified reflux, no history of allergy.
Allergies:
Diagnostic Lab Data: On 09-Jan-2008 test results were: ultrasound scan (results: acute intestinal intussusception suspected); heart rate (results: 156/min); and blood pressure (results: 107/77).
CDC 'Split Type': FRWYEG01473408

Write-up: Information regarding PREVENAR was received from a healthcare professional regarding a 4-month-old female patient who experienced acute intestinal intussusception. The patient received the second dose on 11-Dec-2007. On 09-Jan-2008, the patient was admitted to emergency unit due to pain and blood in stools. On admission the patient was tired and irritable. Physical examination was unremarkable, she had no fever and no sign of dehydration. Acute intestinal intussusception was suspected on ultrasound scan. The patient was hospitalized and intussusception was reduced with water-soluble enema. The patient recovered without sequelae. No additional information was available at the time of this report.


Changed on 2/14/2018

VAERS ID: 311250 Before After
VAERS Form:1
Age:0.3
Gender:Female
Location:Foreign
Vaccinated:2007-12-11
Onset:2008-01-09
Submitted:2008-04-29
Entered:2008-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPH: DTAP + HIB (TRIHIBIT) / SANOFI PASTEUR - / UNK UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR - / UNK UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood pressure, Fatigue, Haematochezia, Heart rate, Intussusception, Irritability, Pain, Enema administration, Ultrasound scan abnormal

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: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: TIORFAN (ACETORPHAN), unknown, 08-Jan-2008; Advil (IBUPROFEN), unknown, 08-Jan-2008; DOLIPRANE (PARACETAMOL), unknown, 08-Jan-08
Current Illness: A concurrent history of gastroenteritis manifested by 10 liquid, glary and bloody stools per day, vomiting, fever at 38.7 C and weight loss of 4%, began on 08-Jan-2008 whereas members of her family had gastroenteritis. She was started on Tiorfan, Advil, Doliprane solution for rehydration.
Preexisting Conditions: The patient had a past history of normal full-term newborn, a medical history of unspecified reflux, no history of allergy.
Allergies:
Diagnostic Lab Data: On 09-Jan-2008 test results were: ultrasound scan (results: acute intestinal intussusception suspected); heart rate (results: 156/min); and blood pressure (results: 107/77).
CDC 'Split Type': FRWYEG01473408

Write-up: Information regarding PREVENAR was received from a healthcare professional regarding a 4-month-old female patient who experienced acute intestinal intussusception. The patient received the second dose on 11-Dec-2007. On 09-Jan-2008, the patient was admitted to emergency unit due to pain and blood in stools. On admission the patient was tired and irritable. Physical examination was unremarkable, she had no fever and no sign of dehydration. Acute intestinal intussusception was suspected on ultrasound scan. The patient was hospitalized and intussusception was reduced with water-soluble enema. The patient recovered without sequelae. No additional information was available at the time of this report.


Changed on 6/14/2018

VAERS ID: 311250 Before After
VAERS Form:1
Age:0.3
Gender:Female
Location:Foreign
Vaccinated:2007-12-11
Onset:2008-01-09
Submitted:2008-04-29
Entered:2008-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPH: DTAP + HIB (TRIHIBIT) / SANOFI PASTEUR - / UNK UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR - / UNK UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood pressure, Fatigue, Haematochezia, Heart rate, Intussusception, Irritability, Pain, Enema administration, Ultrasound scan abnormal

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: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: TIORFAN (ACETORPHAN), unknown, 08-Jan-2008; Advil (IBUPROFEN), unknown, 08-Jan-2008; DOLIPRANE (PARACETAMOL), unknown, 08-Jan-08
Current Illness: A concurrent history of gastroenteritis manifested by 10 liquid, glary and bloody stools per day, vomiting, fever at 38.7 C and weight loss of 4%, began on 08-Jan-2008 whereas members of her family had gastroenteritis. She was started on Tiorfan, Advil, Doliprane solution for rehydration.
Preexisting Conditions: The patient had a past history of normal full-term newborn, a medical history of unspecified reflux, no history of allergy.
Allergies:
Diagnostic Lab Data: On 09-Jan-2008 test results were: ultrasound scan (results: acute intestinal intussusception suspected); heart rate (results: 156/min); and blood pressure (results: 107/77).
CDC 'Split Type': FRWYEG01473408

Write-up: Information regarding PREVENAR was received from a healthcare professional regarding a 4-month-old female patient who experienced acute intestinal intussusception. The patient received the second dose on 11-Dec-2007. On 09-Jan-2008, the patient was admitted to emergency unit due to pain and blood in stools. On admission the patient was tired and irritable. Physical examination was unremarkable, she had no fever and no sign of dehydration. Acute intestinal intussusception was suspected on ultrasound scan. The patient was hospitalized and intussusception was reduced with water-soluble enema. The patient recovered without sequelae. No additional information was available at the time of this report.

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