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This is VAERS ID 314577

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 314577
VAERS Form:
Age:0.2
Sex:Female
Location:California
Vaccinated:2008-05-22
Onset:2008-05-28
Submitted:2008-05-29
Entered:2008-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2935AA / 0 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1372U / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF346AC / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A04742 / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C48894 / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1702U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium enema, Barium enema abnormal, Diarrhoea haemorrhagic, Full blood count normal

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: none
Allergies:
Diagnostic Lab Data: (1) KUB-stacking of bowel loops (2) Barium Enema. Labs and Diagnostics: KUB showed dilated bowel loops. Stool Guiac (+). Barium Enema (+) for colonic-colonic IS. CBC WNL. BMP WNL.
CDC 'Split Type':

Write-up: Presented with currant-jelly stool and lethargy and abdominal pain on 5/29/08- Found to have intussusception, Treated with Barium Enema at clinic. 6/12/2008 MR received for DOS 5/29-30/2008 with DX: Intussusception S/P reduction with Barium Enema. Infan"t presented to ER from PCP''''s office with vomiting, bloody diarrhea and currant jelly stool. Infant fussy. IS reduced with BE. No further problems and D/C next day.


Changed on 12/8/2009

VAERS ID: 314577 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:California
Vaccinated:2008-05-22
Onset:2008-05-28
Submitted:2008-05-29
Entered:2008-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2935AA / 0 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1372U / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF346AC / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A04742 / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C48894 / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1702U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium enema, Barium enema abnormal, Diarrhoea haemorrhagic, Full blood count normal, Haematochezia, Intussusception, Irritability, Large intestinal obstruction reduction, Lethargy, Mucous stools, Urinary system X-ray, Vomiting, X-ray abnormal, Occult blood positive, Metabolic function test normal

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: none
Allergies:
Diagnostic Lab Data: (1) KUB-stacking of bowel loops (2) Barium Enema. Labs and Diagnostics: KUB showed dilated bowel loops. Stool Guiac (+). Barium Enema (+) for colonic-colonic IS. CBC WNL. BMP WNL.
CDC 'Split Type':

Write-up: Presented with currant-jelly stool and lethargy and abdominal pain on 5/29/08- Found to have intussusception, Treated with Barium Enema at clinic. 6/12/2008 MR received for DOS 5/29-30/2008 with DX: Intussusception S/P reduction with Barium Enema. Infan"t Infant presented to ER from PCP''''s PCP''s office with vomiting, bloody diarrhea and currant jelly stool. Infant fussy. IS reduced with BE. No further problems and D/C next day.


Changed on 3/2/2010

VAERS ID: 314577 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:California
Vaccinated:2008-05-22
Onset:2008-05-28
Submitted:2008-05-29
Entered:2008-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2935AA / 0 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1372U / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF346AC / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A04742 / 0 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC C48894 / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1702U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium enema, Barium enema abnormal, Diarrhoea haemorrhagic, Full blood count normal, Haematochezia, Intussusception, Irritability, Large intestinal obstruction reduction, Lethargy, Mucous stools, Urinary system X-ray, Vomiting, X-ray abnormal, Occult blood positive, Metabolic function test normal

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: none
Allergies:
Diagnostic Lab Data: (1) KUB-stacking of bowel loops (2) Barium Enema. Labs and Diagnostics: KUB showed dilated bowel loops. Stool Guiac (+). Barium Enema (+) for colonic-colonic IS. CBC WNL. BMP WNL.
CDC 'Split Type':

Write-up: Presented with currant-jelly stool and lethargy and abdominal pain on 5/29/08- Found to have intussusception, Treated with Barium Enema at clinic. 6/12/2008 MR received for DOS 5/29-30/2008 with DX: Intussusception S/P reduction with Barium Enema. Infant presented to ER from PCP''s office with vomiting, bloody diarrhea and currant jelly stool. Infant fussy. IS reduced with BE. No further problems and D/C next day.


Changed on 4/7/2010

VAERS ID: 314577 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:California
Vaccinated:2008-05-22
Onset:2008-05-28
Submitted:2008-05-29
Entered:2008-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2935AA / 0 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1372U / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF346AC / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A04742 / 0 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C48894 / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1702U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium enema, Barium enema abnormal, Diarrhoea haemorrhagic, Full blood count normal, Haematochezia, Intussusception, Irritability, Large intestinal obstruction reduction, Lethargy, Mucous stools, Urinary system X-ray, Vomiting, X-ray abnormal, Occult blood positive, Metabolic function test normal

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: none
Allergies:
Diagnostic Lab Data: (1) KUB-stacking of bowel loops (2) Barium Enema. Labs and Diagnostics: KUB showed dilated bowel loops. Stool Guiac (+). Barium Enema (+) for colonic-colonic IS. CBC WNL. BMP WNL.
CDC 'Split Type':

Write-up: Presented with currant-jelly stool and lethargy and abdominal pain on 5/29/08- Found to have intussusception, Treated with Barium Enema at clinic. 6/12/2008 MR received for DOS 5/29-30/2008 with DX: Intussusception S/P reduction with Barium Enema. Infant presented to ER from PCP''s office with vomiting, bloody diarrhea and currant jelly stool. Infant fussy. IS reduced with BE. No further problems and D/C next day.


Changed on 8/31/2010

VAERS ID: 314577 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:California
Vaccinated:2008-05-22
Onset:2008-05-28
Submitted:2008-05-29
Entered:2008-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2935AA / 0 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1372U / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF346AC / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A04742 / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH C48894 / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1702U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium enema, Barium enema abnormal, Diarrhoea haemorrhagic, Full blood count normal, Haematochezia, Intussusception, Irritability, Large intestinal obstruction reduction, Lethargy, Mucous stools, Urinary system X-ray, Vomiting, X-ray abnormal, Occult blood positive, Metabolic function test normal

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: none
Allergies:
Diagnostic Lab Data: (1) KUB-stacking of bowel loops (2) Barium Enema. Labs and Diagnostics: KUB showed dilated bowel loops. Stool Guiac (+). Barium Enema (+) for colonic-colonic IS. CBC WNL. BMP WNL.
CDC 'Split Type':

Write-up: Presented with currant-jelly stool and lethargy and abdominal pain on 5/29/08- Found to have intussusception, Treated with Barium Enema at clinic. 6/12/2008 MR received for DOS 5/29-30/2008 with DX: Intussusception S/P reduction with Barium Enema. Infant presented to ER from PCP''s office with vomiting, bloody diarrhea and currant jelly stool. Infant fussy. IS reduced with BE. No further problems and D/C next day.


Changed on 5/13/2013

VAERS ID: 314577 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:California
Vaccinated:2008-05-22
Onset:2008-05-28
Submitted:2008-05-29
Entered:2008-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2935AA / 0 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1372U / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF346AC / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A04742 / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C48894 / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1702U / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1702U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium enema, Barium enema abnormal, Diarrhoea haemorrhagic, Full blood count normal, Haematochezia, Intussusception, Irritability, Large intestinal obstruction reduction, Lethargy, Mucous stools, Urinary system X-ray, Vomiting, X-ray abnormal, Occult blood positive, Metabolic function test normal

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: none
Allergies:
Diagnostic Lab Data: (1) KUB-stacking of bowel loops (2) Barium Enema. Labs and Diagnostics: KUB showed dilated bowel loops. Stool Guiac (+). Barium Enema (+) for colonic-colonic IS. CBC WNL. BMP WNL.
CDC 'Split Type':

Write-up: Presented with currant-jelly stool and lethargy and abdominal pain on 5/29/08- Found to have intussusception, Treated with Barium Enema at clinic. 6/12/2008 MR received for DOS 5/29-30/2008 with DX: Intussusception S/P reduction with Barium Enema. Infant presented to ER from PCP''s office with vomiting, bloody diarrhea and currant jelly stool. Infant fussy. IS reduced with BE. No further problems and D/C next day.


Changed on 4/14/2017

VAERS ID: 314577 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:California
Vaccinated:2008-05-22
Onset:2008-05-28
Submitted:2008-05-29
Entered:2008-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2935AA / 0 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1372U / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF346AC / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A04742 / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C48894 / 0 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1702U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium enema, Barium enema abnormal, Diarrhoea haemorrhagic, Full blood count normal, Haematochezia, Intussusception, Irritability, Large intestinal obstruction reduction, Lethargy, Mucous stools, Urinary system X-ray, Vomiting, X-ray abnormal, Occult blood positive, Metabolic function test normal

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: none
Allergies:
Diagnostic Lab Data: (1) KUB-stacking of bowel loops (2) Barium Enema. Labs and Diagnostics: KUB showed dilated bowel loops. Stool Guiac (+). Barium Enema (+) for colonic-colonic IS. CBC WNL. BMP WNL.
CDC 'Split Type':

Write-up: Presented with currant-jelly stool and lethargy and abdominal pain on 5/29/08- Found to have intussusception, Treated with Barium Enema at clinic. 6/12/2008 MR received for DOS 5/29-30/2008 with DX: Intussusception S/P reduction with Barium Enema. Infant presented to ER from PCP''s office with vomiting, bloody diarrhea and currant jelly stool. Infant fussy. IS reduced with BE. No further problems and D/C next day.


Changed on 9/14/2017

VAERS ID: 314577 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Female
Location:California
Vaccinated:2008-05-22
Onset:2008-05-28
Submitted:2008-05-29
Entered:2008-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2935AA / 0 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1372U / 1 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF346AC / 0 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A04742 / 0 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C48894 / 0 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1702U / 0 1 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Intussusception, Lethargy, Mucous stools, Urinary system 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: none
Allergies:
Diagnostic Lab Data: (1) KUB-stacking of bowel loops (2) Barium Enema. Labs and Diagnostics: KUB showed dilated bowel loops. Stool Guiac (+). Barium Enema (+) for colonic-colonic IS. CBC WNL. BMP WNL.
CDC 'Split Type':

Write-up: Presented with currant-jelly stool and lethargy and abdominal pain on 5/29/08- Found to have intussusception, Treated with Barium Enema at clinic. 6/12/2008 MR received for DOS 5/29-30/2008 with DX: Intussusception S/P reduction with Barium Enema. Infant presented to ER from PCP''s office with vomiting, bloody diarrhea and currant jelly stool. Infant fussy. IS reduced with BE. No further problems and D/C next day.


Changed on 2/14/2018

VAERS ID: 314577 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:California
Vaccinated:2008-05-22
Onset:2008-05-28
Submitted:2008-05-29
Entered:2008-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2935AA / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1372U / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF346AC / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A04742 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C48894 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1702U / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Intussusception, Lethargy, Mucous stools, Urinary system 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: none
Allergies:
Diagnostic Lab Data: (1) KUB-stacking of bowel loops (2) Barium Enema. Labs and Diagnostics: KUB showed dilated bowel loops. Stool Guiac (+). Barium Enema (+) for colonic-colonic IS. CBC WNL. BMP WNL.
CDC 'Split Type':

Write-up: Presented with currant-jelly stool and lethargy and abdominal pain on 5/29/08- Found to have intussusception, Treated with Barium Enema at clinic. 6/12/2008 MR received for DOS 5/29-30/2008 with DX: Intussusception S/P reduction with Barium Enema. Infant presented to ER from PCP''s office with vomiting, bloody diarrhea and currant jelly stool. Infant fussy. IS reduced with BE. No further problems and D/C next day.


Changed on 6/14/2018

VAERS ID: 314577 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:California
Vaccinated:2008-05-22
Onset:2008-05-28
Submitted:2008-05-29
Entered:2008-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2935AA / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1372U / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF346AC / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A04742 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C48894 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1702U / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Intussusception, Lethargy, Mucous stools, Urinary system 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: none
Allergies:
Diagnostic Lab Data: (1) KUB-stacking of bowel loops (2) Barium Enema. Labs and Diagnostics: KUB showed dilated bowel loops. Stool Guiac (+). Barium Enema (+) for colonic-colonic IS. CBC WNL. BMP WNL.
CDC 'Split Type':

Write-up: Presented with currant-jelly stool and lethargy and abdominal pain on 5/29/08- Found to have intussusception, Treated with Barium Enema at clinic. 6/12/2008 MR received for DOS 5/29-30/2008 with DX: Intussusception S/P reduction with Barium Enema. Infant presented to ER from PCP''s office with vomiting, bloody diarrhea and currant jelly stool. Infant fussy. IS reduced with BE. No further problems and D/C next day.


Changed on 8/14/2018

VAERS ID: 314577 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:California
Vaccinated:2008-05-22
Onset:2008-05-28
Submitted:2008-05-29
Entered:2008-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2935AA / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1372U / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF346AC / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A04742 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C48894 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1702U / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Intussusception, Lethargy, Mucous stools, Urinary system 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: none
Allergies:
Diagnostic Lab Data: (1) KUB-stacking of bowel loops (2) Barium Enema. Labs and Diagnostics: KUB showed dilated bowel loops. Stool Guiac (+). Barium Enema (+) for colonic-colonic IS. CBC WNL. BMP WNL.
CDC 'Split Type':

Write-up: Presented with currant-jelly stool and lethargy and abdominal pain on 5/29/08- Found to have intussusception, Treated with Barium Enema at clinic. 6/12/2008 MR received for DOS 5/29-30/2008 with DX: Intussusception S/P reduction with Barium Enema. Infant presented to ER from PCP''s office with vomiting, bloody diarrhea and currant jelly stool. Infant fussy. IS reduced with BE. No further problems and D/C next day.


Changed on 9/14/2018

VAERS ID: 314577 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:California
Vaccinated:2008-05-22
Onset:2008-05-28
Submitted:2008-05-29
Entered:2008-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2935AA / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1372U / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF346AC / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A04742 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C48894 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1702U / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Intussusception, Lethargy, Mucous stools, Urinary system 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: none
Allergies:
Diagnostic Lab Data: (1) KUB-stacking of bowel loops (2) Barium Enema. Labs and Diagnostics: KUB showed dilated bowel loops. Stool Guiac (+). Barium Enema (+) for colonic-colonic IS. CBC WNL. BMP WNL.
CDC 'Split Type':

Write-up: Presented with currant-jelly stool and lethargy and abdominal pain on 5/29/08- Found to have intussusception, Treated with Barium Enema at clinic. 6/12/2008 MR received for DOS 5/29-30/2008 with DX: Intussusception S/P reduction with Barium Enema. Infant presented to ER from PCP''s office with vomiting, bloody diarrhea and currant jelly stool. Infant fussy. IS reduced with BE. No further problems and D/C next day.


Changed on 10/14/2018

VAERS ID: 314577 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:California
Vaccinated:2008-05-22
Onset:2008-05-28
Submitted:2008-05-29
Entered:2008-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2935AA / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1372U / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF346AC / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A04742 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C48894 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1702U / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Intussusception, Lethargy, Mucous stools, Urinary system 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: none
Allergies:
Diagnostic Lab Data: (1) KUB-stacking of bowel loops (2) Barium Enema. Labs and Diagnostics: KUB showed dilated bowel loops. Stool Guiac (+). Barium Enema (+) for colonic-colonic IS. CBC WNL. BMP WNL.
CDC 'Split Type':

Write-up: Presented with currant-jelly stool and lethargy and abdominal pain on 5/29/08- Found to have intussusception, Treated with Barium Enema at clinic. 6/12/2008 MR received for DOS 5/29-30/2008 with DX: Intussusception S/P reduction with Barium Enema. Infant presented to ER from PCP''s office with vomiting, bloody diarrhea and currant jelly stool. Infant fussy. IS reduced with BE. No further problems and D/C next day.

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