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This is VAERS ID 314724

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 314724
VAERS Form:
Age:0.4
Gender:Female
Location:New Hampshire
Vaccinated:2008-04-29
Onset:2008-05-12
Submitted:2008-05-23
Entered:2008-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 1 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF261AA / 1 UN / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C57536 / 1 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0018X / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Barium enema, Barium enema abnormal, Crying, Diarrhoea

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: none. PMH: none
Allergies:
Diagnostic Lab Data: Barium enema to reduce intussusception. Labs and Diagnostics: Barium Enema (+) for IS in the mid transverse colon. KUB (- for free air, Abd US (+) for IS.
CDC 'Split Type':

Write-up: Intussusception. Rec''''d vaccines 4/29/08 - vomiting/diar. Onset 5/12/08 ER -$g hospital 5/13/08 dc''''d 5/14/08. 6/12/2008 MR received for ER admit 5/13-14/2008 with DX: Intussusception. Infant presented from another hospital after unsuccessful atempt to"reduce IS with Barium Enema. Infant had presented with 2 day hx of vomiting, diarrhea and bloody stool. Decreased po intake, crying and cofee ground emesis noted. Air contrast enema was succssful at reduction. Admitted for o/n observation and D/c home


Changed on 12/8/2009

VAERS ID: 314724 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:New Hampshire
Vaccinated:2008-04-29
Onset:2008-05-12
Submitted:2008-05-23
Entered:2008-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 1 UN / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 1 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF261AA / 1 UN / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C57536 / 1 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0018X / 1 - / PO

Administered by: Unknown      Purchased by: Unknown Public
Symptoms: Barium double contrast, Barium enema, Barium enema abnormal, Crying, Diarrhoea, Haematemesis, Haematochezia, Intussusception, Large intestinal obstruction reduction, Urinary system X-ray, Vomiting, Enema administration, Ultrasound abdomen abnormal, Oral intake reduced

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: none. PMH: none
Allergies:
Diagnostic Lab Data: Barium enema to reduce intussusception. Labs and Diagnostics: Barium Enema (+) for IS in the mid transverse colon. KUB (- for free air, Abd US (+) for IS.
CDC 'Split Type':

Write-up: Intussusception. Rec''''d Rec''d vaccines 4/29/08 - vomiting/diar. Onset 5/12/08 ER -$g hospital 5/13/08 dc''''d dc''d 5/14/08. 6/12/2008 MR received for ER admit 5/13-14/2008 with DX: Intussusception. Infant presented from another hospital after unsuccessful atempt to"reduce to reduce IS with Barium Enema. Infant had presented with 2 day hx of vomiting, diarrhea and bloody stool. Decreased po intake, crying and cofee ground emesis noted. Air contrast enema was succssful at reduction. Admitted for o/n observation and D/c home


Changed on 3/2/2010

VAERS ID: 314724 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:New Hampshire
Vaccinated:2008-04-29
Onset:2008-05-12
Submitted:2008-05-23
Entered:2008-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 1 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF261AA / 1 UN / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC C57536 / 1 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0018X / 1 - / PO

Administered by: Unknown      Purchased by: Public
Symptoms: Barium double contrast, Barium enema, Barium enema abnormal, Crying, Diarrhoea, Haematemesis, Haematochezia, Intussusception, Large intestinal obstruction reduction, Urinary system X-ray, Vomiting, Enema administration, Ultrasound abdomen abnormal, Oral intake reduced

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: none. PMH: none
Allergies:
Diagnostic Lab Data: Barium enema to reduce intussusception. Labs and Diagnostics: Barium Enema (+) for IS in the mid transverse colon. KUB (- for free air, Abd US (+) for IS.
CDC 'Split Type':

Write-up: Intussusception. Rec''d vaccines 4/29/08 - vomiting/diar. Onset 5/12/08 ER -$g hospital 5/13/08 dc''d 5/14/08. 6/12/2008 MR received for ER admit 5/13-14/2008 with DX: Intussusception. Infant presented from another hospital after unsuccessful atempt to reduce IS with Barium Enema. Infant had presented with 2 day hx of vomiting, diarrhea and bloody stool. Decreased po intake, crying and cofee ground emesis noted. Air contrast enema was succssful at reduction. Admitted for o/n observation and D/c home


Changed on 4/7/2010

VAERS ID: 314724 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:New Hampshire
Vaccinated:2008-04-29
Onset:2008-05-12
Submitted:2008-05-23
Entered:2008-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 1 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF261AA / 1 UN / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C57536 / 1 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0018X / 1 - / PO

Administered by: Unknown      Purchased by: Public
Symptoms: Barium double contrast, Barium enema, Barium enema abnormal, Crying, Diarrhoea, Haematemesis, Haematochezia, Intussusception, Large intestinal obstruction reduction, Urinary system X-ray, Vomiting, Enema administration, Ultrasound abdomen abnormal, Oral intake reduced

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: none. PMH: none
Allergies:
Diagnostic Lab Data: Barium enema to reduce intussusception. Labs and Diagnostics: Barium Enema (+) for IS in the mid transverse colon. KUB (- for free air, Abd US (+) for IS.
CDC 'Split Type':

Write-up: Intussusception. Rec''d vaccines 4/29/08 - vomiting/diar. Onset 5/12/08 ER -$g hospital 5/13/08 dc''d 5/14/08. 6/12/2008 MR received for ER admit 5/13-14/2008 with DX: Intussusception. Infant presented from another hospital after unsuccessful atempt to reduce IS with Barium Enema. Infant had presented with 2 day hx of vomiting, diarrhea and bloody stool. Decreased po intake, crying and cofee ground emesis noted. Air contrast enema was succssful at reduction. Admitted for o/n observation and D/c home


Changed on 7/31/2010

VAERS ID: 314724 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:New Hampshire
Vaccinated:2008-04-29
Onset:2008-05-12
Submitted:2008-05-23
Entered:2008-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 1 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF261AA / 1 UN / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C57536 / 1 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0018X / 1 - / PO

Administered by: Unknown      Purchased by: Public
Symptoms: Barium double contrast, Barium enema, Barium enema abnormal, Crying, Diarrhoea, Haematemesis, Haematochezia, Intussusception, Large intestinal obstruction reduction, Urinary system X-ray, Vomiting, Enema administration, Ultrasound abdomen abnormal, Oral intake reduced

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: none. PMH: none
Allergies:
Diagnostic Lab Data: Barium enema to reduce intussusception. Labs and Diagnostics: Barium Enema (+) for IS in the mid transverse colon. KUB (- for free air, Abd US (+) for IS.
CDC 'Split Type':

Write-up: Intussusception. Rec''d vaccines 4/29/08 - vomiting/diar. Onset 5/12/08 ER -$g hospital 5/13/08 dc''d 5/14/08. 6/12/2008 MR received for ER admit 5/13-14/2008 with DX: Intussusception. Infant presented from another hospital after unsuccessful atempt to reduce IS with Barium Enema. Infant had presented with 2 day hx of vomiting, diarrhea and bloody stool. Decreased po intake, crying and cofee ground emesis noted. Air contrast enema was succssful at reduction. Admitted for o/n observation and D/c home


Changed on 8/31/2010

VAERS ID: 314724 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:New Hampshire
Vaccinated:2008-04-29
Onset:2008-05-12
Submitted:2008-05-23
Entered:2008-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 1 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF261AA / 1 UN / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH C57536 / 1 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0018X / 1 - / PO

Administered by: Unknown      Purchased by: Public
Symptoms: Barium enema abnormal, Diarrhoea, Haematemesis, Intussusception, Vomiting, Enema administration

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: none. PMH: none
Allergies:
Diagnostic Lab Data: Barium enema to reduce intussusception. Labs and Diagnostics: Barium Enema (+) for IS in the mid transverse colon. KUB (- for free air, Abd US (+) for IS.
CDC 'Split Type':

Write-up: Intussusception. Rec''d vaccines 4/29/08 - vomiting/diar. Onset 5/12/08 ER -$g hospital 5/13/08 dc''d 5/14/08. 6/12/2008 MR received for ER admit 5/13-14/2008 with DX: Intussusception. Infant presented from another hospital after unsuccessful atempt to reduce IS with Barium Enema. Infant had presented with 2 day hx of vomiting, diarrhea and bloody stool. Decreased po intake, crying and cofee ground emesis noted. Air contrast enema was succssful at reduction. Admitted for o/n observation and D/c home


Changed on 1/4/2011

VAERS ID: 314724 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:New Hampshire
Vaccinated:2008-04-29
Onset:2008-05-12
Submitted:2008-05-23
Entered:2008-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 1 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF261AA / 1 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C57536 / 1 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0018X / 1 - / PO

Administered by: Unknown      Purchased by: Public
Symptoms: Barium enema abnormal, Diarrhoea, Haematemesis, Intussusception, Vomiting, Enema administration

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: none. PMH: none
Allergies:
Diagnostic Lab Data: Barium enema to reduce intussusception. Labs and Diagnostics: Barium Enema (+) for IS in the mid transverse colon. KUB (- for free air, Abd US (+) for IS.
CDC 'Split Type':

Write-up: Intussusception. Rec''d vaccines 4/29/08 - vomiting/diar. Onset 5/12/08 ER -$g hospital 5/13/08 dc''d 5/14/08. 6/12/2008 MR received for ER admit 5/13-14/2008 with DX: Intussusception. Infant presented from another hospital after unsuccessful atempt to reduce IS with Barium Enema. Infant had presented with 2 day hx of vomiting, diarrhea and bloody stool. Decreased po intake, crying and cofee ground emesis noted. Air contrast enema was succssful at reduction. Admitted for o/n observation and D/c home


Changed on 4/13/2011

VAERS ID: 314724 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:New Hampshire
Vaccinated:2008-04-29
Onset:2008-05-12
Submitted:2008-05-23
Entered:2008-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 1 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF261AA / 1 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C57536 / 1 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0018X / 1 - / PO

Administered by: Unknown      Purchased by: Public
Symptoms: Barium double contrast, Barium enema, Barium enema abnormal, Crying, Diarrhoea, Haematemesis, Haematochezia, Intussusception, Large intestinal obstruction reduction, Urinary system X-ray, Vomiting, Enema administration, Ultrasound abdomen abnormal, Oral intake reduced

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: none. PMH: none
Allergies:
Diagnostic Lab Data: Barium enema to reduce intussusception. Labs and Diagnostics: Barium Enema (+) for IS in the mid transverse colon. KUB (- for free air, Abd US (+) for IS.
CDC 'Split Type':

Write-up: Intussusception. Rec''d vaccines 4/29/08 - vomiting/diar. Onset 5/12/08 ER -$g hospital 5/13/08 dc''d 5/14/08. 6/12/2008 MR received for ER admit 5/13-14/2008 with DX: Intussusception. Infant presented from another hospital after unsuccessful atempt to reduce IS with Barium Enema. Infant had presented with 2 day hx of vomiting, diarrhea and bloody stool. Decreased po intake, crying and cofee ground emesis noted. Air contrast enema was succssful at reduction. Admitted for o/n observation and D/c home


Changed on 5/13/2011

VAERS ID: 314724 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:New Hampshire
Vaccinated:2008-04-29
Onset:2008-05-12
Submitted:2008-05-23
Entered:2008-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 1 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF261AA / 1 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C57536 / 1 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0018X / 1 - / PO

Administered by: Unknown      Purchased by: Public
Symptoms: Barium double contrast, Barium enema, Barium enema abnormal, Crying, Diarrhoea, Haematemesis, Haematochezia, Intussusception, Large intestinal obstruction reduction, Urinary system X-ray, Vomiting, Enema administration, Ultrasound abdomen abnormal, Oral intake reduced

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: none. PMH: none
Allergies:
Diagnostic Lab Data: Barium enema to reduce intussusception. Labs and Diagnostics: Barium Enema (+) for IS in the mid transverse colon. KUB (- for free air, Abd US (+) for IS.
CDC 'Split Type':

Write-up: Intussusception. Rec''d vaccines 4/29/08 - vomiting/diar. Onset 5/12/08 ER -$g hospital 5/13/08 dc''d 5/14/08. 6/12/2008 MR received for ER admit 5/13-14/2008 with DX: Intussusception. Infant presented from another hospital after unsuccessful atempt to reduce IS with Barium Enema. Infant had presented with 2 day hx of vomiting, diarrhea and bloody stool. Decreased po intake, crying and cofee ground emesis noted. Air contrast enema was succssful at reduction. Admitted for o/n observation and D/c home


Changed on 6/11/2011

VAERS ID: 314724 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:New Hampshire
Vaccinated:2008-04-29
Onset:2008-05-12
Submitted:2008-05-23
Entered:2008-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 1 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF261AA / 1 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C57536 / 1 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0018X / 1 - / PO

Administered by: Unknown      Purchased by: Public
Symptoms: Barium double contrast, Barium enema, Barium enema abnormal, Crying, Diarrhoea, Haematemesis, Haematochezia, Intussusception, Large intestinal obstruction reduction, Urinary system X-ray, Vomiting, Enema administration, Ultrasound abdomen abnormal, Oral intake reduced

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: none. PMH: none
Allergies:
Diagnostic Lab Data: Barium enema to reduce intussusception. Labs and Diagnostics: Barium Enema (+) for IS in the mid transverse colon. KUB (- for free air, Abd US (+) for IS.
CDC 'Split Type':

Write-up: Intussusception. Rec''d vaccines 4/29/08 - vomiting/diar. Onset 5/12/08 ER -$g hospital 5/13/08 dc''d 5/14/08. 6/12/2008 MR received for ER admit 5/13-14/2008 with DX: Intussusception. Infant presented from another hospital after unsuccessful atempt to reduce IS with Barium Enema. Infant had presented with 2 day hx of vomiting, diarrhea and bloody stool. Decreased po intake, crying and cofee ground emesis noted. Air contrast enema was succssful at reduction. Admitted for o/n observation and D/c home


Changed on 5/13/2013

VAERS ID: 314724 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:New Hampshire
Vaccinated:2008-04-29
Onset:2008-05-12
Submitted:2008-05-23
Entered:2008-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 1 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF261AA / 1 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C57536 / 1 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0018X / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0018X / 1 - / PO

Administered by: Unknown      Purchased by: Public
Symptoms: Barium double contrast, Barium enema, Barium enema abnormal, Crying, Diarrhoea, Haematemesis, Haematochezia, Intussusception, Large intestinal obstruction reduction, Urinary system X-ray, Vomiting, Enema administration, Ultrasound abdomen abnormal, Oral intake reduced

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: none. PMH: none
Allergies:
Diagnostic Lab Data: Barium enema to reduce intussusception. Labs and Diagnostics: Barium Enema (+) for IS in the mid transverse colon. KUB (- for free air, Abd US (+) for IS.
CDC 'Split Type':

Write-up: Intussusception. Rec''d vaccines 4/29/08 - vomiting/diar. Onset 5/12/08 ER -$g hospital 5/13/08 dc''d 5/14/08. 6/12/2008 MR received for ER admit 5/13-14/2008 with DX: Intussusception. Infant presented from another hospital after unsuccessful atempt to reduce IS with Barium Enema. Infant had presented with 2 day hx of vomiting, diarrhea and bloody stool. Decreased po intake, crying and cofee ground emesis noted. Air contrast enema was succssful at reduction. Admitted for o/n observation and D/c home


Changed on 2/14/2017

VAERS ID: 314724 Before After
VAERS Form:
Age:0.4 0.37
Gender:Female
Location:New Hampshire
Vaccinated:2008-04-29
Onset:2008-05-12
Submitted:2008-05-23
Entered:2008-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 1 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF261AA / 1 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C57536 / 1 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0018X / 1 - / PO

Administered by: Unknown      Purchased by: Public
Symptoms: Barium double contrast, Barium enema, Barium enema abnormal, Crying, Diarrhoea, Haematemesis, Haematochezia, Intussusception, Large intestinal obstruction reduction, Urinary system X-ray, Vomiting, Enema administration, Ultrasound abdomen abnormal, Oral intake reduced

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: none. PMH: none
Allergies:
Diagnostic Lab Data: Barium enema to reduce intussusception. Labs and Diagnostics: Barium Enema (+) for IS in the mid transverse colon. KUB (- for free air, Abd US (+) for IS.
CDC 'Split Type':

Write-up: Intussusception. Rec''d vaccines 4/29/08 - vomiting/diar. Onset 5/12/08 ER -$g hospital 5/13/08 dc''d 5/14/08. 6/12/2008 MR received for ER admit 5/13-14/2008 with DX: Intussusception. Infant presented from another hospital after unsuccessful atempt to reduce IS with Barium Enema. Infant had presented with 2 day hx of vomiting, diarrhea and bloody stool. Decreased po intake, crying and cofee ground emesis noted. Air contrast enema was succssful at reduction. Admitted for o/n observation and D/c home


Changed on 4/14/2017

VAERS ID: 314724 Before After
VAERS Form:
Age:0.37
Gender:Female
Location:New Hampshire
Vaccinated:2008-04-29
Onset:2008-05-12
Submitted:2008-05-23
Entered:2008-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 1 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF261AA / 1 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C57536 / 1 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0018X / 1 - / PO

Administered by: Unknown      Purchased by: Public
Symptoms: Barium double contrast, Barium enema, Barium enema abnormal, Crying, Diarrhoea, Haematemesis, Haematochezia, Intussusception, Large intestinal obstruction reduction, Urinary system X-ray, Vomiting, Enema administration, Ultrasound abdomen abnormal, Oral intake reduced

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: none. PMH: none
Allergies:
Diagnostic Lab Data: Barium enema to reduce intussusception. Labs and Diagnostics: Barium Enema (+) for IS in the mid transverse colon. KUB (- for free air, Abd US (+) for IS.
CDC 'Split Type':

Write-up: Intussusception. Rec''d vaccines 4/29/08 - vomiting/diar. Onset 5/12/08 ER -$g hospital 5/13/08 dc''d 5/14/08. 6/12/2008 MR received for ER admit 5/13-14/2008 with DX: Intussusception. Infant presented from another hospital after unsuccessful atempt to reduce IS with Barium Enema. Infant had presented with 2 day hx of vomiting, diarrhea and bloody stool. Decreased po intake, crying and cofee ground emesis noted. Air contrast enema was succssful at reduction. Admitted for o/n observation and D/c home


Changed on 9/14/2017

VAERS ID: 314724 Before After
VAERS Form:(blank) 1
Age:0.37
Gender:Female
Location:New Hampshire
Vaccinated:2008-04-29
Onset:2008-05-12
Submitted:2008-05-23
Entered:2008-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 1 2 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF261AA / 1 2 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C57536 / 1 2 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0018X / 1 2 - MO / PO

Administered by: Unknown      Purchased by: Public
Symptoms: Barium enema abnormal, Diarrhoea, Intussusception, Vomiting, Enema administration

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: none. PMH: none
Allergies:
Diagnostic Lab Data: Barium enema to reduce intussusception. Labs and Diagnostics: Barium Enema (+) for IS in the mid transverse colon. KUB (- for free air, Abd US (+) for IS.
CDC 'Split Type':

Write-up: Intussusception. Rec''d vaccines 4/29/08 - vomiting/diar. Onset 5/12/08 ER -$g hospital 5/13/08 dc''d 5/14/08. 6/12/2008 MR received for ER admit 5/13-14/2008 with DX: Intussusception. Infant presented from another hospital after unsuccessful atempt to reduce IS with Barium Enema. Infant had presented with 2 day hx of vomiting, diarrhea and bloody stool. Decreased po intake, crying and cofee ground emesis noted. Air contrast enema was succssful at reduction. Admitted for o/n observation and D/c home


Changed on 2/14/2018

VAERS ID: 314724 Before After
VAERS Form:1
Age:0.37
Gender:Female
Location:New Hampshire
Vaccinated:2008-04-29
Onset:2008-05-12
Submitted:2008-05-23
Entered:2008-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 2 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF261AA / 2 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C57536 / 2 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0018X / 2 MO / PO

Administered by: Unknown      Purchased by: Public
Symptoms: Barium enema abnormal, Diarrhoea, Intussusception, Vomiting, Enema administration

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: none. PMH: none
Allergies:
Diagnostic Lab Data: Barium enema to reduce intussusception. Labs and Diagnostics: Barium Enema (+) for IS in the mid transverse colon. KUB (- for free air, Abd US (+) for IS.
CDC 'Split Type':

Write-up: Intussusception. Rec''d vaccines 4/29/08 - vomiting/diar. Onset 5/12/08 ER -$g hospital 5/13/08 dc''d 5/14/08. 6/12/2008 MR received for ER admit 5/13-14/2008 with DX: Intussusception. Infant presented from another hospital after unsuccessful atempt to reduce IS with Barium Enema. Infant had presented with 2 day hx of vomiting, diarrhea and bloody stool. Decreased po intake, crying and cofee ground emesis noted. Air contrast enema was succssful at reduction. Admitted for o/n observation and D/c home


Changed on 6/14/2018

VAERS ID: 314724 Before After
VAERS Form:1
Age:0.37
Gender:Female
Location:New Hampshire
Vaccinated:2008-04-29
Onset:2008-05-12
Submitted:2008-05-23
Entered:2008-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 2 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF261AA / 2 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C57536 / 2 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0018X / 2 MO / PO

Administered by: Unknown      Purchased by: Public
Symptoms: Barium enema abnormal, Diarrhoea, Intussusception, Vomiting, Enema administration

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: none. PMH: none
Allergies:
Diagnostic Lab Data: Barium enema to reduce intussusception. Labs and Diagnostics: Barium Enema (+) for IS in the mid transverse colon. KUB (- for free air, Abd US (+) for IS.
CDC 'Split Type':

Write-up: Intussusception. Rec''d vaccines 4/29/08 - vomiting/diar. Onset 5/12/08 ER -$g hospital 5/13/08 dc''d 5/14/08. 6/12/2008 MR received for ER admit 5/13-14/2008 with DX: Intussusception. Infant presented from another hospital after unsuccessful atempt to reduce IS with Barium Enema. Infant had presented with 2 day hx of vomiting, diarrhea and bloody stool. Decreased po intake, crying and cofee ground emesis noted. Air contrast enema was succssful at reduction. Admitted for o/n observation and D/c home


Changed on 8/14/2018

VAERS ID: 314724 Before After
VAERS Form:1
Age:0.37
Gender:Female
Location:New Hampshire
Vaccinated:2008-04-29
Onset:2008-05-12
Submitted:2008-05-23
Entered:2008-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 2 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF261AA / 2 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C57536 / 2 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0018X / 2 MO / PO

Administered by: Unknown      Purchased by: Public
Symptoms: Barium enema abnormal, Diarrhoea, Intussusception, Vomiting, Enema administration

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: none. PMH: none
Allergies:
Diagnostic Lab Data: Barium enema to reduce intussusception. Labs and Diagnostics: Barium Enema (+) for IS in the mid transverse colon. KUB (- for free air, Abd US (+) for IS.
CDC 'Split Type':

Write-up: Intussusception. Rec''d vaccines 4/29/08 - vomiting/diar. Onset 5/12/08 ER -$g hospital 5/13/08 dc''d 5/14/08. 6/12/2008 MR received for ER admit 5/13-14/2008 with DX: Intussusception. Infant presented from another hospital after unsuccessful atempt to reduce IS with Barium Enema. Infant had presented with 2 day hx of vomiting, diarrhea and bloody stool. Decreased po intake, crying and cofee ground emesis noted. Air contrast enema was succssful at reduction. Admitted for o/n observation and D/c home


Changed on 9/14/2018

VAERS ID: 314724 Before After
VAERS Form:1
Age:0.37
Gender:Female
Location:New Hampshire
Vaccinated:2008-04-29
Onset:2008-05-12
Submitted:2008-05-23
Entered:2008-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 2 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF261AA / 2 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C57536 / 2 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0018X / 2 MO / PO

Administered by: Unknown      Purchased by: Public
Symptoms: Barium enema abnormal, Diarrhoea, Intussusception, Vomiting, Enema administration

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: none. PMH: none
Allergies:
Diagnostic Lab Data: Barium enema to reduce intussusception. Labs and Diagnostics: Barium Enema (+) for IS in the mid transverse colon. KUB (- for free air, Abd US (+) for IS.
CDC 'Split Type':

Write-up: Intussusception. Rec''d vaccines 4/29/08 - vomiting/diar. Onset 5/12/08 ER -$g hospital 5/13/08 dc''d 5/14/08. 6/12/2008 MR received for ER admit 5/13-14/2008 with DX: Intussusception. Infant presented from another hospital after unsuccessful atempt to reduce IS with Barium Enema. Infant had presented with 2 day hx of vomiting, diarrhea and bloody stool. Decreased po intake, crying and cofee ground emesis noted. Air contrast enema was succssful at reduction. Admitted for o/n observation and D/c home

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