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This is VAERS ID 312427

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 312427
VAERS Form:
Age:0.5
Sex:Female
Location:South Carolina
Vaccinated:2007-11-06
Onset:2008-03-10
Submitted:2008-05-15
Entered:2008-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B115CB / 2 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B70143H / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1192U / 2 - / PO

Administered by: Other      Purchased by: Unknown
Symptoms: Anion gap increased, Full blood count normal, Gastroenteritis, Enema administration, Gastrointestinal tube insertion

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: AUGMENTIN
Current Illness: Ear infection
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X-ray 03/12/08; diagnostic laboratory 03/10/08 - intussusception reduced by air 5/27/08-records received-Chemistry WNL, anion gap increased 16. CBC WNL, neutrophil percentage increased 61.6, lymphocyte percentage decreased 30.8. Urine cult
CDC 'Split Type':

Write-up: Information has been received from a registered nurse concerning a 10 month old female with an ear infection in February 2008, and no drug allergies who on 03-JUL-2007, 05-SEP-2007 and 06-NOV-2007 was vaccinated PO with her first, second and third doses o"f ROTATEQ (lot# 656391/0238U, 657049/0503U, 657518/1192U). Concomitant drug therapy included AUGMENTIN for the ear infection in February 2008. On 10-MAR-2008 the patient experienced vomiting and received a diagnosis of gastroenteritis and was subsequently


Changed on 12/8/2009

VAERS ID: 312427 Before After
VAERS Form:
Age:0.5
Sex:Female
Location:South Carolina
Vaccinated:2007-11-06
Onset:2008-03-10
Submitted:2008-05-15
Entered:2008-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B115CB / 2 LL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B115CB / 2 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B70143H / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1192U / 2 - / PO

Administered by: Other      Purchased by: Unknown Other
Symptoms: Anion gap increased, Full blood count normal, Gastroenteritis, Intussusception, Laboratory test abnormal, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Neutrophil percentage increased, Lymphocyte percentage decreased, Gastrointestinal tube insertion, Laboratory test normal, Urine analysis normal

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: AUGMENTIN
Current Illness: Ear infection
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X-ray 03/12/08; diagnostic laboratory 03/10/08 - intussusception reduced by air 5/27/08-records received-Chemistry WNL, anion gap increased 16. CBC WNL, neutrophil percentage increased 61.6, lymphocyte percentage decreased 30.8. Urine cult
CDC 'Split Type': (blank) WAES0805USA01055

Write-up: Information has been received from a registered nurse concerning a 10 month old female with an ear infection in February 2008, and no drug allergies who on 03-JUL-2007, 05-SEP-2007 and 06-NOV-2007 was vaccinated PO with her first, second and third doses o"f of ROTATEQ (lot# 656391/0238U, 657049/0503U, 657518/1192U). Concomitant drug therapy included AUGMENTIN for the ear infection in February 2008. On 10-MAR-2008 the patient experienced vomiting and received a diagnosis of gastroenteritis and was subsequently hospitalized. The nurse was reading the patient''s chart and also noted that the patient had intussusception which was "reduced by air." Laboratory diagnostic studies included flat x-ray on 12-MAR-2008. The patient was discharged from the hospital on 14-MAR-2008, but had no other information about the hospitalization. Subsequently the patient recovered. There was no product quality complaint. No other information available. Gastroenteritis and intussusception were also considered to be immediately life-threatening by the physician. Additional information has been requested. 5/27/08-records received for DOS 3/10-3/12/08-admitted with refractory vomiting for 3 days. Admitted for rehydration. NG placement. Transferred to speciality hospital. 7/15/08-records received for DOS 3/12/08-DX: intussusception. Ultrasound revealed intussusception.


Changed on 3/2/2010

VAERS ID: 312427 Before After
VAERS Form:
Age:0.5
Sex:Female
Location:South Carolina
Vaccinated:2007-11-06
Onset:2008-03-10
Submitted:2008-05-15
Entered:2008-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B115CB / 2 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B70143H / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1192U / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Anion gap increased, Full blood count normal, Gastroenteritis, Intussusception, Laboratory test abnormal, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Neutrophil percentage increased, Lymphocyte percentage decreased, Gastrointestinal tube insertion, Laboratory test normal, Urine analysis normal

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: AUGMENTIN
Current Illness: Ear infection
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X-ray 03/12/08; diagnostic laboratory 03/10/08 - intussusception reduced by air 5/27/08-records received-Chemistry WNL, anion gap increased 16. CBC WNL, neutrophil percentage increased 61.6, lymphocyte percentage decreased 30.8. Urine cult
CDC 'Split Type': WAES0805USA01055

Write-up: Information has been received from a registered nurse concerning a 10 month old female with an ear infection in February 2008, and no drug allergies who on 03-JUL-2007, 05-SEP-2007 and 06-NOV-2007 was vaccinated PO with her first, second and third doses of ROTATEQ (lot# 656391/0238U, 657049/0503U, 657518/1192U). Concomitant drug therapy included AUGMENTIN for the ear infection in February 2008. On 10-MAR-2008 the patient experienced vomiting and received a diagnosis of gastroenteritis and was subsequently hospitalized. The nurse was reading the patient''s chart and also noted that the patient had intussusception which was "reduced by air." Laboratory diagnostic studies included flat x-ray on 12-MAR-2008. The patient was discharged from the hospital on 14-MAR-2008, but had no other information about the hospitalization. Subsequently the patient recovered. There was no product quality complaint. No other information available. Gastroenteritis and intussusception were also considered to be immediately life-threatening by the physician. Additional information has been requested. 5/27/08-records received for DOS 3/10-3/12/08-admitted with refractory vomiting for 3 days. Admitted for rehydration. NG placement. Transferred to speciality hospital. 7/15/08-records received for DOS 3/12/08-DX: intussusception. Ultrasound revealed intussusception.


Changed on 4/7/2010

VAERS ID: 312427 Before After
VAERS Form:
Age:0.5
Sex:Female
Location:South Carolina
Vaccinated:2007-11-06
Onset:2008-03-10
Submitted:2008-05-15
Entered:2008-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B115CB / 2 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B70143H / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1192U / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Anion gap increased, Full blood count normal, Gastroenteritis, Intussusception, Laboratory test abnormal, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Neutrophil percentage increased, Lymphocyte percentage decreased, Gastrointestinal tube insertion, Laboratory test normal, Urine analysis normal

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: AUGMENTIN
Current Illness: Ear infection
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X-ray 03/12/08; diagnostic laboratory 03/10/08 - intussusception reduced by air 5/27/08-records received-Chemistry WNL, anion gap increased 16. CBC WNL, neutrophil percentage increased 61.6, lymphocyte percentage decreased 30.8. Urine cult
CDC 'Split Type': WAES0805USA01055

Write-up: Information has been received from a registered nurse concerning a 10 month old female with an ear infection in February 2008, and no drug allergies who on 03-JUL-2007, 05-SEP-2007 and 06-NOV-2007 was vaccinated PO with her first, second and third doses of ROTATEQ (lot# 656391/0238U, 657049/0503U, 657518/1192U). Concomitant drug therapy included AUGMENTIN for the ear infection in February 2008. On 10-MAR-2008 the patient experienced vomiting and received a diagnosis of gastroenteritis and was subsequently hospitalized. The nurse was reading the patient''s chart and also noted that the patient had intussusception which was "reduced by air." Laboratory diagnostic studies included flat x-ray on 12-MAR-2008. The patient was discharged from the hospital on 14-MAR-2008, but had no other information about the hospitalization. Subsequently the patient recovered. There was no product quality complaint. No other information available. Gastroenteritis and intussusception were also considered to be immediately life-threatening by the physician. Additional information has been requested. 5/27/08-records received for DOS 3/10-3/12/08-admitted with refractory vomiting for 3 days. Admitted for rehydration. NG placement. Transferred to speciality hospital. 7/15/08-records received for DOS 3/12/08-DX: intussusception. Ultrasound revealed intussusception.


Changed on 8/31/2010

VAERS ID: 312427 Before After
VAERS Form:
Age:0.5
Sex:Female
Location:South Carolina
Vaccinated:2007-11-06
Onset:2008-03-10
Submitted:2008-05-15
Entered:2008-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B115CB / 2 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B70143H / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1192U / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Anion gap increased, Full blood count normal, Gastroenteritis, Intussusception, Laboratory test abnormal, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Neutrophil percentage increased, Lymphocyte percentage decreased, Gastrointestinal tube insertion, Laboratory test normal, Urine analysis normal

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: AUGMENTIN
Current Illness: Ear infection
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X-ray 03/12/08; diagnostic laboratory 03/10/08 - intussusception reduced by air 5/27/08-records received-Chemistry WNL, anion gap increased 16. CBC WNL, neutrophil percentage increased 61.6, lymphocyte percentage decreased 30.8. Urine cult
CDC 'Split Type': WAES0805USA01055

Write-up: Information has been received from a registered nurse concerning a 10 month old female with an ear infection in February 2008, and no drug allergies who on 03-JUL-2007, 05-SEP-2007 and 06-NOV-2007 was vaccinated PO with her first, second and third doses of ROTATEQ (lot# 656391/0238U, 657049/0503U, 657518/1192U). Concomitant drug therapy included AUGMENTIN for the ear infection in February 2008. On 10-MAR-2008 the patient experienced vomiting and received a diagnosis of gastroenteritis and was subsequently hospitalized. The nurse was reading the patient''s chart and also noted that the patient had intussusception which was "reduced by air." Laboratory diagnostic studies included flat x-ray on 12-MAR-2008. The patient was discharged from the hospital on 14-MAR-2008, but had no other information about the hospitalization. Subsequently the patient recovered. There was no product quality complaint. No other information available. Gastroenteritis and intussusception were also considered to be immediately life-threatening by the physician. Additional information has been requested. 5/27/08-records received for DOS 3/10-3/12/08-admitted with refractory vomiting for 3 days. Admitted for rehydration. NG placement. Transferred to speciality hospital. 7/15/08-records received for DOS 3/12/08-DX: intussusception. Ultrasound revealed intussusception.


Changed on 5/13/2013

VAERS ID: 312427 Before After
VAERS Form:
Age:0.5
Sex:Female
Location:South Carolina
Vaccinated:2007-11-06
Onset:2008-03-10
Submitted:2008-05-15
Entered:2008-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B115CB / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70143H / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1192U / 2 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1192U / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Anion gap increased, Full blood count normal, Gastroenteritis, Intussusception, Laboratory test abnormal, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Neutrophil percentage increased, Lymphocyte percentage decreased, Gastrointestinal tube insertion, Laboratory test normal, Urine analysis normal

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: AUGMENTIN
Current Illness: Ear infection
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X-ray 03/12/08; diagnostic laboratory 03/10/08 - intussusception reduced by air 5/27/08-records received-Chemistry WNL, anion gap increased 16. CBC WNL, neutrophil percentage increased 61.6, lymphocyte percentage decreased 30.8. Urine cult
CDC 'Split Type': WAES0805USA01055

Write-up: Information has been received from a registered nurse concerning a 10 month old female with an ear infection in February 2008, and no drug allergies who on 03-JUL-2007, 05-SEP-2007 and 06-NOV-2007 was vaccinated PO with her first, second and third doses of ROTATEQ (lot# 656391/0238U, 657049/0503U, 657518/1192U). Concomitant drug therapy included AUGMENTIN for the ear infection in February 2008. On 10-MAR-2008 the patient experienced vomiting and received a diagnosis of gastroenteritis and was subsequently hospitalized. The nurse was reading the patient''s chart and also noted that the patient had intussusception which was "reduced by air." Laboratory diagnostic studies included flat x-ray on 12-MAR-2008. The patient was discharged from the hospital on 14-MAR-2008, but had no other information about the hospitalization. Subsequently the patient recovered. There was no product quality complaint. No other information available. Gastroenteritis and intussusception were also considered to be immediately life-threatening by the physician. Additional information has been requested. 5/27/08-records received for DOS 3/10-3/12/08-admitted with refractory vomiting for 3 days. Admitted for rehydration. NG placement. Transferred to speciality hospital. 7/15/08-records received for DOS 3/12/08-DX: intussusception. Ultrasound revealed intussusception.


Changed on 2/14/2017

VAERS ID: 312427 Before After
VAERS Form:
Age:0.5
Sex:Female
Location:South Carolina
Vaccinated:2007-11-06
Onset:2008-03-10
Submitted:2008-05-15
Entered:2008-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B115CB / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70143H / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1192U / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Anion gap increased, Full blood count normal, Gastroenteritis, Intussusception, Laboratory test abnormal, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Neutrophil percentage increased, Lymphocyte percentage decreased, Gastrointestinal tube insertion, Laboratory test normal, Urine analysis normal

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: AUGMENTIN
Current Illness: Ear infection
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X-ray 03/12/08; diagnostic laboratory 03/10/08 - intussusception reduced by air 5/27/08-records received-Chemistry WNL, anion gap increased 16. CBC WNL, neutrophil percentage increased 61.6, lymphocyte percentage decreased 30.8. Urine cult culture no growth. Urinalysis WNL. KUB:one distended small bowel loop. No gas seen over rectum. An early obstruction cannot be excluded. 7/15/08-records received-Abdominal x-ray small bowel distention with minimal colonic gas. Air reduction of mid-transverse colon successful.
CDC 'Split Type': WAES0805USA01055

Write-up: Information has been received from a registered nurse concerning a 10 month old female with an ear infection in February 2008, and no drug allergies who on 03-JUL-2007, 05-SEP-2007 and 06-NOV-2007 was vaccinated PO with her first, second and third doses of ROTATEQ (lot# 656391/0238U, 657049/0503U, 657518/1192U). Concomitant drug therapy included AUGMENTIN for the ear infection in February 2008. On 10-MAR-2008 the patient experienced vomiting and received a diagnosis of gastroenteritis and was subsequently hospitalized. The nurse was reading the patient''s chart and also noted that the patient had intussusception which was "reduced by air." Laboratory diagnostic studies included flat x-ray on 12-MAR-2008. The patient was discharged from the hospital on 14-MAR-2008, but had no other information about the hospitalization. Subsequently the patient recovered. There was no product quality complaint. No other information available. Gastroenteritis and intussusception were also considered to be immediately life-threatening by the physician. Additional information has been requested. 5/27/08-records received for DOS 3/10-3/12/08-admitted with refractory vomiting for 3 days. Admitted for rehydration. NG placement. Transferred to speciality hospital. 7/15/08-records received for DOS 3/12/08-DX: intussusception. Ultrasound revealed intussusception.


Changed on 9/14/2017

VAERS ID: 312427 Before After
VAERS Form:(blank) 1
Age:0.5
Sex:Female
Location:South Carolina
Vaccinated:2007-11-06
Onset:2008-03-10
Submitted:2008-05-15
Entered:2008-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B115CB / 2 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70143H / 2 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1192U / 2 3 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Gastroenteritis, Intussusception, Laboratory test abnormal, Vomiting, X-ray abnormal, Enema administration

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: AUGMENTIN
Current Illness: Ear infection
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X-ray 03/12/08; diagnostic laboratory 03/10/08 - intussusception reduced by air 5/27/08-records received-Chemistry WNL, anion gap increased 16. CBC WNL, neutrophil percentage increased 61.6, lymphocyte percentage decreased 30.8. Urine culture no growth. Urinalysis WNL. KUB:one distended small bowel loop. No gas seen over rectum. An early obstruction cannot be excluded. 7/15/08-records received-Abdominal x-ray small bowel distention with minimal colonic gas. Air reduction of mid-transverse colon successful.
CDC 'Split Type': WAES0805USA01055

Write-up: Information has been received from a registered nurse concerning a 10 month old female with an ear infection in February 2008, and no drug allergies who on 03-JUL-2007, 05-SEP-2007 and 06-NOV-2007 was vaccinated PO with her first, second and third doses of ROTATEQ (lot# 656391/0238U, 657049/0503U, 657518/1192U). Concomitant drug therapy included AUGMENTIN for the ear infection in February 2008. On 10-MAR-2008 the patient experienced vomiting and received a diagnosis of gastroenteritis and was subsequently hospitalized. The nurse was reading the patient''s chart and also noted that the patient had intussusception which was "reduced by air." Laboratory diagnostic studies included flat x-ray on 12-MAR-2008. The patient was discharged from the hospital on 14-MAR-2008, but had no other information about the hospitalization. Subsequently the patient recovered. There was no product quality complaint. No other information available. Gastroenteritis and intussusception were also considered to be immediately life-threatening by the physician. Additional information has been requested. 5/27/08-records received for DOS 3/10-3/12/08-admitted with refractory vomiting for 3 days. Admitted for rehydration. NG placement. Transferred to speciality hospital. 7/15/08-records received for DOS 3/12/08-DX: intussusception. Ultrasound revealed intussusception.


Changed on 2/14/2018

VAERS ID: 312427 Before After
VAERS Form:1
Age:0.5
Sex:Female
Location:South Carolina
Vaccinated:2007-11-06
Onset:2008-03-10
Submitted:2008-05-15
Entered:2008-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B115CB / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70143H / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1192U / 3 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Gastroenteritis, Intussusception, Laboratory test abnormal, Vomiting, X-ray abnormal, Enema administration

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: AUGMENTIN
Current Illness: Ear infection
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X-ray 03/12/08; diagnostic laboratory 03/10/08 - intussusception reduced by air 5/27/08-records received-Chemistry WNL, anion gap increased 16. CBC WNL, neutrophil percentage increased 61.6, lymphocyte percentage decreased 30.8. Urine culture no growth. Urinalysis WNL. KUB:one distended small bowel loop. No gas seen over rectum. An early obstruction cannot be excluded. 7/15/08-records received-Abdominal x-ray small bowel distention with minimal colonic gas. Air reduction of mid-transverse colon successful.
CDC 'Split Type': WAES0805USA01055

Write-up: Information has been received from a registered nurse concerning a 10 month old female with an ear infection in February 2008, and no drug allergies who on 03-JUL-2007, 05-SEP-2007 and 06-NOV-2007 was vaccinated PO with her first, second and third doses of ROTATEQ (lot# 656391/0238U, 657049/0503U, 657518/1192U). Concomitant drug therapy included AUGMENTIN for the ear infection in February 2008. On 10-MAR-2008 the patient experienced vomiting and received a diagnosis of gastroenteritis and was subsequently hospitalized. The nurse was reading the patient''s chart and also noted that the patient had intussusception which was "reduced by air." Laboratory diagnostic studies included flat x-ray on 12-MAR-2008. The patient was discharged from the hospital on 14-MAR-2008, but had no other information about the hospitalization. Subsequently the patient recovered. There was no product quality complaint. No other information available. Gastroenteritis and intussusception were also considered to be immediately life-threatening by the physician. Additional information has been requested. 5/27/08-records received for DOS 3/10-3/12/08-admitted with refractory vomiting for 3 days. Admitted for rehydration. NG placement. Transferred to speciality hospital. 7/15/08-records received for DOS 3/12/08-DX: intussusception. Ultrasound revealed intussusception.


Changed on 6/14/2018

VAERS ID: 312427 Before After
VAERS Form:1
Age:0.5
Sex:Female
Location:South Carolina
Vaccinated:2007-11-06
Onset:2008-03-10
Submitted:2008-05-15
Entered:2008-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B115CB / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70143H / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1192U / 3 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Gastroenteritis, Intussusception, Laboratory test abnormal, Vomiting, X-ray abnormal, Enema administration

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: AUGMENTIN
Current Illness: Ear infection
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X-ray 03/12/08; diagnostic laboratory 03/10/08 - intussusception reduced by air 5/27/08-records received-Chemistry WNL, anion gap increased 16. CBC WNL, neutrophil percentage increased 61.6, lymphocyte percentage decreased 30.8. Urine culture no growth. Urinalysis WNL. KUB:one distended small bowel loop. No gas seen over rectum. An early obstruction cannot be excluded. 7/15/08-records received-Abdominal x-ray small bowel distention with minimal colonic gas. Air reduction of mid-transverse colon successful.
CDC 'Split Type': WAES0805USA01055

Write-up: Information has been received from a registered nurse concerning a 10 month old female with an ear infection in February 2008, and no drug allergies who on 03-JUL-2007, 05-SEP-2007 and 06-NOV-2007 was vaccinated PO with her first, second and third doses of ROTATEQ (lot# 656391/0238U, 657049/0503U, 657518/1192U). Concomitant drug therapy included AUGMENTIN for the ear infection in February 2008. On 10-MAR-2008 the patient experienced vomiting and received a diagnosis of gastroenteritis and was subsequently hospitalized. The nurse was reading the patient''s chart and also noted that the patient had intussusception which was "reduced by air." Laboratory diagnostic studies included flat x-ray on 12-MAR-2008. The patient was discharged from the hospital on 14-MAR-2008, but had no other information about the hospitalization. Subsequently the patient recovered. There was no product quality complaint. No other information available. Gastroenteritis and intussusception were also considered to be immediately life-threatening by the physician. Additional information has been requested. 5/27/08-records received for DOS 3/10-3/12/08-admitted with refractory vomiting for 3 days. Admitted for rehydration. NG placement. Transferred to speciality hospital. 7/15/08-records received for DOS 3/12/08-DX: intussusception. Ultrasound revealed intussusception.


Changed on 8/14/2018

VAERS ID: 312427 Before After
VAERS Form:1
Age:0.5
Sex:Female
Location:South Carolina
Vaccinated:2007-11-06
Onset:2008-03-10
Submitted:2008-05-15
Entered:2008-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B115CB / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70143H / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1192U / 3 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Gastroenteritis, Intussusception, Laboratory test abnormal, Vomiting, X-ray abnormal, Enema administration

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: AUGMENTIN
Current Illness: Ear infection
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X-ray 03/12/08; diagnostic laboratory 03/10/08 - intussusception reduced by air 5/27/08-records received-Chemistry WNL, anion gap increased 16. CBC WNL, neutrophil percentage increased 61.6, lymphocyte percentage decreased 30.8. Urine culture no growth. Urinalysis WNL. KUB:one distended small bowel loop. No gas seen over rectum. An early obstruction cannot be excluded. 7/15/08-records received-Abdominal x-ray small bowel distention with minimal colonic gas. Air reduction of mid-transverse colon successful.
CDC 'Split Type': WAES0805USA01055

Write-up: Information has been received from a registered nurse concerning a 10 month old female with an ear infection in February 2008, and no drug allergies who on 03-JUL-2007, 05-SEP-2007 and 06-NOV-2007 was vaccinated PO with her first, second and third doses of ROTATEQ (lot# 656391/0238U, 657049/0503U, 657518/1192U). Concomitant drug therapy included AUGMENTIN for the ear infection in February 2008. On 10-MAR-2008 the patient experienced vomiting and received a diagnosis of gastroenteritis and was subsequently hospitalized. The nurse was reading the patient''s chart and also noted that the patient had intussusception which was "reduced by air." Laboratory diagnostic studies included flat x-ray on 12-MAR-2008. The patient was discharged from the hospital on 14-MAR-2008, but had no other information about the hospitalization. Subsequently the patient recovered. There was no product quality complaint. No other information available. Gastroenteritis and intussusception were also considered to be immediately life-threatening by the physician. Additional information has been requested. 5/27/08-records received for DOS 3/10-3/12/08-admitted with refractory vomiting for 3 days. Admitted for rehydration. NG placement. Transferred to speciality hospital. 7/15/08-records received for DOS 3/12/08-DX: intussusception. Ultrasound revealed intussusception.


Changed on 9/14/2018

VAERS ID: 312427 Before After
VAERS Form:1
Age:0.5
Sex:Female
Location:South Carolina
Vaccinated:2007-11-06
Onset:2008-03-10
Submitted:2008-05-15
Entered:2008-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B115CB / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70143H / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1192U / 3 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Gastroenteritis, Intussusception, Laboratory test abnormal, Vomiting, X-ray abnormal, Enema administration

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: AUGMENTIN
Current Illness: Ear infection
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X-ray 03/12/08; diagnostic laboratory 03/10/08 - intussusception reduced by air 5/27/08-records received-Chemistry WNL, anion gap increased 16. CBC WNL, neutrophil percentage increased 61.6, lymphocyte percentage decreased 30.8. Urine culture no growth. Urinalysis WNL. KUB:one distended small bowel loop. No gas seen over rectum. An early obstruction cannot be excluded. 7/15/08-records received-Abdominal x-ray small bowel distention with minimal colonic gas. Air reduction of mid-transverse colon successful.
CDC 'Split Type': WAES0805USA01055

Write-up: Information has been received from a registered nurse concerning a 10 month old female with an ear infection in February 2008, and no drug allergies who on 03-JUL-2007, 05-SEP-2007 and 06-NOV-2007 was vaccinated PO with her first, second and third doses of ROTATEQ (lot# 656391/0238U, 657049/0503U, 657518/1192U). Concomitant drug therapy included AUGMENTIN for the ear infection in February 2008. On 10-MAR-2008 the patient experienced vomiting and received a diagnosis of gastroenteritis and was subsequently hospitalized. The nurse was reading the patient''s chart and also noted that the patient had intussusception which was "reduced by air." Laboratory diagnostic studies included flat x-ray on 12-MAR-2008. The patient was discharged from the hospital on 14-MAR-2008, but had no other information about the hospitalization. Subsequently the patient recovered. There was no product quality complaint. No other information available. Gastroenteritis and intussusception were also considered to be immediately life-threatening by the physician. Additional information has been requested. 5/27/08-records received for DOS 3/10-3/12/08-admitted with refractory vomiting for 3 days. Admitted for rehydration. NG placement. Transferred to speciality hospital. 7/15/08-records received for DOS 3/12/08-DX: intussusception. Ultrasound revealed intussusception.


Changed on 10/14/2018

VAERS ID: 312427 Before After
VAERS Form:1
Age:0.5
Sex:Female
Location:South Carolina
Vaccinated:2007-11-06
Onset:2008-03-10
Submitted:2008-05-15
Entered:2008-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B115CB / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70143H / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1192U / 3 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Gastroenteritis, Intussusception, Laboratory test abnormal, Vomiting, X-ray abnormal, Enema administration

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: AUGMENTIN
Current Illness: Ear infection
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X-ray 03/12/08; diagnostic laboratory 03/10/08 - intussusception reduced by air 5/27/08-records received-Chemistry WNL, anion gap increased 16. CBC WNL, neutrophil percentage increased 61.6, lymphocyte percentage decreased 30.8. Urine culture no growth. Urinalysis WNL. KUB:one distended small bowel loop. No gas seen over rectum. An early obstruction cannot be excluded. 7/15/08-records received-Abdominal x-ray small bowel distention with minimal colonic gas. Air reduction of mid-transverse colon successful.
CDC 'Split Type': WAES0805USA01055

Write-up: Information has been received from a registered nurse concerning a 10 month old female with an ear infection in February 2008, and no drug allergies who on 03-JUL-2007, 05-SEP-2007 and 06-NOV-2007 was vaccinated PO with her first, second and third doses of ROTATEQ (lot# 656391/0238U, 657049/0503U, 657518/1192U). Concomitant drug therapy included AUGMENTIN for the ear infection in February 2008. On 10-MAR-2008 the patient experienced vomiting and received a diagnosis of gastroenteritis and was subsequently hospitalized. The nurse was reading the patient''s chart and also noted that the patient had intussusception which was "reduced by air." Laboratory diagnostic studies included flat x-ray on 12-MAR-2008. The patient was discharged from the hospital on 14-MAR-2008, but had no other information about the hospitalization. Subsequently the patient recovered. There was no product quality complaint. No other information available. Gastroenteritis and intussusception were also considered to be immediately life-threatening by the physician. Additional information has been requested. 5/27/08-records received for DOS 3/10-3/12/08-admitted with refractory vomiting for 3 days. Admitted for rehydration. NG placement. Transferred to speciality hospital. 7/15/08-records received for DOS 3/12/08-DX: intussusception. Ultrasound revealed intussusception.

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