National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 319695

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 319695
VAERS Form:
Age:0.5
Sex:Female
Location:Texas
Vaccinated:2008-03-20
Onset:2008-05-23
Submitted:2008-07-18
Entered:2008-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF329AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B70145C / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1205U / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Barium enema abnormal, Culture urine positive, Dehydration, Abdominal 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Air contrast enema (+) for IS. Abd X-ray with non-specific bowel gas pattern. UC (+) for E coli. Stool cx (-).
CDC 'Split Type':

Write-up: 2 months following the vaccine, Malayah was diagnosed with intussusception. It was reduced by air contrast enema and the infant was observed in the hospital overnight. She has had no issues related to the intussusception since. 8/12/2008 MR received fo"r DOS 5/23-24/2008 with D/C DX: Intussusception. 2ndary DX: Infectious enteritis. Pt presented with hx of vomiting and diarrhea and eventually a bloody stool. Initial impression: dehydration & vomiting. Air contrast enema dx and reduced the IS with no fur


Changed on 12/8/2009

VAERS ID: 319695 Before After
VAERS Form:
Age:0.5
Sex:Female
Location:Texas
Vaccinated:2008-03-20
Onset:2008-05-23
Submitted:2008-07-18
Entered:2008-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 2 LL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF329AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B70145C / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1205U / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Barium enema abnormal, Culture urine positive, Dehydration, Diarrhoea, Enteritis, Haematochezia, Intussusception, Vomiting, Enema administration, Abdominal 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Air contrast enema (+) for IS. Abd X-ray with non-specific bowel gas pattern. UC (+) for E coli. Stool cx (-).
CDC 'Split Type':

Write-up: 2 months following the vaccine, Malayah was diagnosed with intussusception. It was reduced by air contrast enema and the infant was observed in the hospital overnight. She has had no issues related to the intussusception since. 8/12/2008 MR received fo"r for DOS 5/23-24/2008 with D/C DX: Intussusception. 2ndary DX: Infectious enteritis. Pt presented with hx of vomiting and diarrhea and eventually a bloody stool. Initial impression: dehydration & vomiting. Air contrast enema dx and reduced the IS with no fur further problems.


Changed on 3/2/2010

VAERS ID: 319695 Before After
VAERS Form:
Age:0.5
Sex:Female
Location:Texas
Vaccinated:2008-03-20
Onset:2008-05-23
Submitted:2008-07-18
Entered:2008-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF329AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B70145C / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1205U / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Barium enema abnormal, Culture urine positive, Dehydration, Diarrhoea, Enteritis, Haematochezia, Intussusception, Vomiting, Enema administration, Abdominal 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Air contrast enema (+) for IS. Abd X-ray with non-specific bowel gas pattern. UC (+) for E coli. Stool cx (-).
CDC 'Split Type':

Write-up: 2 months following the vaccine, Malayah was diagnosed with intussusception. It was reduced by air contrast enema and the infant was observed in the hospital overnight. She has had no issues related to the intussusception since. 8/12/2008 MR received for DOS 5/23-24/2008 with D/C DX: Intussusception. 2ndary DX: Infectious enteritis. Pt presented with hx of vomiting and diarrhea and eventually a bloody stool. Initial impression: dehydration & vomiting. Air contrast enema dx and reduced the IS with no further problems.


Changed on 4/7/2010

VAERS ID: 319695 Before After
VAERS Form:
Age:0.5
Sex:Female
Location:Texas
Vaccinated:2008-03-20
Onset:2008-05-23
Submitted:2008-07-18
Entered:2008-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF329AA / 2 RL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B70145C / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1205U / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Barium enema abnormal, Culture urine positive, Dehydration, Diarrhoea, Enteritis, Haematochezia, Intussusception, Vomiting, Enema administration, Abdominal 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Air contrast enema (+) for IS. Abd X-ray with non-specific bowel gas pattern. UC (+) for E coli. Stool cx (-).
CDC 'Split Type':

Write-up: 2 months following the vaccine, Malayah was diagnosed with intussusception. It was reduced by air contrast enema and the infant was observed in the hospital overnight. She has had no issues related to the intussusception since. 8/12/2008 MR received for DOS 5/23-24/2008 with D/C DX: Intussusception. 2ndary DX: Infectious enteritis. Pt presented with hx of vomiting and diarrhea and eventually a bloody stool. Initial impression: dehydration & vomiting. Air contrast enema dx and reduced the IS with no further problems.


Changed on 8/31/2010

VAERS ID: 319695 Before After
VAERS Form:
Age:0.5
Sex:Female
Location:Texas
Vaccinated:2008-03-20
Onset:2008-05-23
Submitted:2008-07-18
Entered:2008-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF329AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B70145C / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1205U / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Barium enema abnormal, Culture urine positive, Dehydration, Diarrhoea, Enteritis, Haematochezia, Intussusception, Vomiting, Enema administration, Abdominal 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Air contrast enema (+) for IS. Abd X-ray with non-specific bowel gas pattern. UC (+) for E coli. Stool cx (-).
CDC 'Split Type':

Write-up: 2 months following the vaccine, Malayah was diagnosed with intussusception. It was reduced by air contrast enema and the infant was observed in the hospital overnight. She has had no issues related to the intussusception since. 8/12/2008 MR received for DOS 5/23-24/2008 with D/C DX: Intussusception. 2ndary DX: Infectious enteritis. Pt presented with hx of vomiting and diarrhea and eventually a bloody stool. Initial impression: dehydration & vomiting. Air contrast enema dx and reduced the IS with no further problems.


Changed on 5/13/2013

VAERS ID: 319695 Before After
VAERS Form:
Age:0.5
Sex:Female
Location:Texas
Vaccinated:2008-03-20
Onset:2008-05-23
Submitted:2008-07-18
Entered:2008-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF329AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70145C / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1205U / 2 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1205U / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Barium enema abnormal, Culture urine positive, Dehydration, Diarrhoea, Enteritis, Haematochezia, Intussusception, Vomiting, Enema administration, Abdominal 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Air contrast enema (+) for IS. Abd X-ray with non-specific bowel gas pattern. UC (+) for E coli. Stool cx (-).
CDC 'Split Type':

Write-up: 2 months following the vaccine, Malayah was diagnosed with intussusception. It was reduced by air contrast enema and the infant was observed in the hospital overnight. She has had no issues related to the intussusception since. 8/12/2008 MR received for DOS 5/23-24/2008 with D/C DX: Intussusception. 2ndary DX: Infectious enteritis. Pt presented with hx of vomiting and diarrhea and eventually a bloody stool. Initial impression: dehydration & vomiting. Air contrast enema dx and reduced the IS with no further problems.


Changed on 4/14/2017

VAERS ID: 319695 Before After
VAERS Form:
Age:0.5
Sex:Female
Location:Texas
Vaccinated:2008-03-20
Onset:2008-05-23
Submitted:2008-07-18
Entered:2008-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF329AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70145C / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1205U / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Barium enema abnormal, Culture urine positive, Dehydration, Diarrhoea, Enteritis, Haematochezia, Intussusception, Vomiting, Enema administration, Abdominal 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Air contrast enema (+) for IS. Abd X-ray with non-specific bowel gas pattern. UC (+) for E coli. Stool cx (-).
CDC 'Split Type':

Write-up: 2 months following the vaccine, Malayah was diagnosed with intussusception. It was reduced by air contrast enema and the infant was observed in the hospital overnight. She has had no issues related to the intussusception since. 8/12/2008 MR received for DOS 5/23-24/2008 with D/C DX: Intussusception. 2ndary DX: Infectious enteritis. Pt presented with hx of vomiting and diarrhea and eventually a bloody stool. Initial impression: dehydration & vomiting. Air contrast enema dx and reduced the IS with no further problems.


Changed on 9/14/2017

VAERS ID: 319695 Before After
VAERS Form:(blank) 1
Age:0.5
Sex:Female
Location:Texas
Vaccinated:2008-03-20
Onset:2008-05-23
Submitted:2008-07-18
Entered:2008-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 2 3 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF329AA / 2 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70145C / 2 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1205U / 2 3 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Air contrast enema (+) for IS. Abd X-ray with non-specific bowel gas pattern. UC (+) for E coli. Stool cx (-).
CDC 'Split Type':

Write-up: 2 months following the vaccine, Malayah was diagnosed with intussusception. It was reduced by air contrast enema and the infant was observed in the hospital overnight. She has had no issues related to the intussusception since. 8/12/2008 MR received for DOS 5/23-24/2008 with D/C DX: Intussusception. 2ndary DX: Infectious enteritis. Pt presented with hx of vomiting and diarrhea and eventually a bloody stool. Initial impression: dehydration & vomiting. Air contrast enema dx and reduced the IS with no further problems.


Changed on 2/14/2018

VAERS ID: 319695 Before After
VAERS Form:1
Age:0.5
Sex:Female
Location:Texas
Vaccinated:2008-03-20
Onset:2008-05-23
Submitted:2008-07-18
Entered:2008-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 3 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF329AA / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70145C / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1205U / 3 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Air contrast enema (+) for IS. Abd X-ray with non-specific bowel gas pattern. UC (+) for E coli. Stool cx (-).
CDC 'Split Type':

Write-up: 2 months following the vaccine, Malayah was diagnosed with intussusception. It was reduced by air contrast enema and the infant was observed in the hospital overnight. She has had no issues related to the intussusception since. 8/12/2008 MR received for DOS 5/23-24/2008 with D/C DX: Intussusception. 2ndary DX: Infectious enteritis. Pt presented with hx of vomiting and diarrhea and eventually a bloody stool. Initial impression: dehydration & vomiting. Air contrast enema dx and reduced the IS with no further problems.


Changed on 6/14/2018

VAERS ID: 319695 Before After
VAERS Form:1
Age:0.5
Sex:Female
Location:Texas
Vaccinated:2008-03-20
Onset:2008-05-23
Submitted:2008-07-18
Entered:2008-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 3 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF329AA / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70145C / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1205U / 3 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Air contrast enema (+) for IS. Abd X-ray with non-specific bowel gas pattern. UC (+) for E coli. Stool cx (-).
CDC 'Split Type':

Write-up: 2 months following the vaccine, Malayah was diagnosed with intussusception. It was reduced by air contrast enema and the infant was observed in the hospital overnight. She has had no issues related to the intussusception since. 8/12/2008 MR received for DOS 5/23-24/2008 with D/C DX: Intussusception. 2ndary DX: Infectious enteritis. Pt presented with hx of vomiting and diarrhea and eventually a bloody stool. Initial impression: dehydration & vomiting. Air contrast enema dx and reduced the IS with no further problems.


Changed on 8/14/2018

VAERS ID: 319695 Before After
VAERS Form:1
Age:0.5
Sex:Female
Location:Texas
Vaccinated:2008-03-20
Onset:2008-05-23
Submitted:2008-07-18
Entered:2008-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 3 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF329AA / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70145C / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1205U / 3 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Air contrast enema (+) for IS. Abd X-ray with non-specific bowel gas pattern. UC (+) for E coli. Stool cx (-).
CDC 'Split Type':

Write-up: 2 months following the vaccine, Malayah was diagnosed with intussusception. It was reduced by air contrast enema and the infant was observed in the hospital overnight. She has had no issues related to the intussusception since. 8/12/2008 MR received for DOS 5/23-24/2008 with D/C DX: Intussusception. 2ndary DX: Infectious enteritis. Pt presented with hx of vomiting and diarrhea and eventually a bloody stool. Initial impression: dehydration & vomiting. Air contrast enema dx and reduced the IS with no further problems.


Changed on 9/14/2018

VAERS ID: 319695 Before After
VAERS Form:1
Age:0.5
Sex:Female
Location:Texas
Vaccinated:2008-03-20
Onset:2008-05-23
Submitted:2008-07-18
Entered:2008-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 3 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF329AA / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70145C / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1205U / 3 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Air contrast enema (+) for IS. Abd X-ray with non-specific bowel gas pattern. UC (+) for E coli. Stool cx (-).
CDC 'Split Type':

Write-up: 2 months following the vaccine, Malayah was diagnosed with intussusception. It was reduced by air contrast enema and the infant was observed in the hospital overnight. She has had no issues related to the intussusception since. 8/12/2008 MR received for DOS 5/23-24/2008 with D/C DX: Intussusception. 2ndary DX: Infectious enteritis. Pt presented with hx of vomiting and diarrhea and eventually a bloody stool. Initial impression: dehydration & vomiting. Air contrast enema dx and reduced the IS with no further problems.


Changed on 10/14/2018

VAERS ID: 319695 Before After
VAERS Form:1
Age:0.5
Sex:Female
Location:Texas
Vaccinated:2008-03-20
Onset:2008-05-23
Submitted:2008-07-18
Entered:2008-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 3 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF329AA / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70145C / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1205U / 3 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Air contrast enema (+) for IS. Abd X-ray with non-specific bowel gas pattern. UC (+) for E coli. Stool cx (-).
CDC 'Split Type':

Write-up: 2 months following the vaccine, Malayah was diagnosed with intussusception. It was reduced by air contrast enema and the infant was observed in the hospital overnight. She has had no issues related to the intussusception since. 8/12/2008 MR received for DOS 5/23-24/2008 with D/C DX: Intussusception. 2ndary DX: Infectious enteritis. Pt presented with hx of vomiting and diarrhea and eventually a bloody stool. Initial impression: dehydration & vomiting. Air contrast enema dx and reduced the IS with no further problems.

New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=319695&WAYBACKHISTORY=ON


Copyright © 2020 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166