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This is VAERS ID 321669

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 321669
VAERS Form:
Age:0.2
Sex:Female
Location:Pennsylvania
Vaccinated:2008-08-01
Onset:2008-08-06
Submitted:2008-08-08
Entered:2008-08-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B192AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF261AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C63115 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0280X / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abnormal faeces, Barium double contrast, Barium enema abnormal, Blood culture negative

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: none
Current Illness: none
Preexisting Conditions: Port Wine Nevus Flammeus
Allergies:
Diagnostic Lab Data: surgery . Labs and Diagnostics: KUB showed no obstuction or free air. Air contrast enema (+) for IS. Stool Guaiac (+). Stool occult blood initially (-) then (+). Blood cx (-).
CDC 'Split Type':

Write-up: lethargy, fever, vomiting, currant jelly colored mucousy stools / confirmed proximal transverse colon intususception. 09/02/2008 MR received for DOS 8/7-8/2008 with D/C DX: Intussusception. Pt presented with 1 day hx of fever, vomiting and dark colored e"mesis as well as dark, foul smelling stool. In ER had Guaiac (+) currant jelly stool. Transfered to higher level of care. IS of the transverse colon was dx and reduced by air contrast enema. Pt remained stable, po progressed and d/c next day.


Changed on 12/8/2009

VAERS ID: 321669 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Pennsylvania
Vaccinated:2008-08-01
Onset:2008-08-06
Submitted:2008-08-08
Entered:2008-08-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B192AA / 0 LL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B192AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF261AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C63115 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0280X / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abnormal faeces, Barium double contrast, Barium enema abnormal, Blood culture negative, Faeces discoloured, Haematochezia, Intussusception, Lethargy, Mucous stools, Pyrexia, Urinary system X-ray, Vomiting, Enema administration, Occult blood positive

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: none
Current Illness: none
Preexisting Conditions: Port Wine Nevus Flammeus
Allergies:
Diagnostic Lab Data: surgery . Labs and Diagnostics: KUB showed no obstuction or free air. Air contrast enema (+) for IS. Stool Guaiac (+). Stool occult blood initially (-) then (+). Blood cx (-).
CDC 'Split Type':

Write-up: lethargy, fever, vomiting, currant jelly colored mucousy stools / confirmed proximal transverse colon intususception. 09/02/2008 MR received for DOS 8/7-8/2008 with D/C DX: Intussusception. Pt presented with 1 day hx of fever, vomiting and dark colored e"mesis emesis as well as dark, foul smelling stool. In ER had Guaiac (+) currant jelly stool. Transfered to higher level of care. IS of the transverse colon was dx and reduced by air contrast enema. Pt remained stable, po progressed and d/c next day.


Changed on 1/5/2010

VAERS ID: 321669 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Pennsylvania
Vaccinated:2008-08-01
Onset:2008-08-06
Submitted:2008-08-08
Entered:2008-08-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B192AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF261AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C63115 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0280X / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abnormal faeces, Barium double contrast, Barium enema abnormal, Blood culture negative, Faeces discoloured, Haematochezia, Intussusception, Lethargy, Mucous stools, Pyrexia, Urinary system X-ray, Vomiting, Enema administration, Occult blood positive

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No 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: none
Current Illness: none
Preexisting Conditions: Port Wine Nevus Flammeus
Allergies:
Diagnostic Lab Data: surgery . Labs and Diagnostics: KUB showed no obstuction or free air. Air contrast enema (+) for IS. Stool Guaiac (+). Stool occult blood initially (-) then (+). Blood cx (-).
CDC 'Split Type':

Write-up: lethargy, fever, vomiting, currant jelly colored mucousy stools / confirmed proximal transverse colon intususception. 09/02/2008 MR received for DOS 8/7-8/2008 with D/C DX: Intussusception. Pt presented with 1 day hx of fever, vomiting and dark colored emesis as well as dark, foul smelling stool. In ER had Guaiac (+) currant jelly stool. Transfered to higher level of care. IS of the transverse colon was dx and reduced by air contrast enema. Pt remained stable, po progressed and d/c next day.


Changed on 3/2/2010

VAERS ID: 321669 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Pennsylvania
Vaccinated:2008-08-01
Onset:2008-08-06
Submitted:2008-08-08
Entered:2008-08-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B192AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF261AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC C63115 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0280X / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Faeces discoloured, Haematochezia, Intussusception, Lethargy, Mucous stools, Pyrexia, Vomiting

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: none
Current Illness: none
Preexisting Conditions: Port Wine Nevus Flammeus
Allergies:
Diagnostic Lab Data: surgery . Labs and Diagnostics: KUB showed no obstuction or free air. Air contrast enema (+) for IS. Stool Guaiac (+). Stool occult blood initially (-) then (+). Blood cx (-).
CDC 'Split Type':

Write-up: lethargy, fever, vomiting, currant jelly colored mucousy stools / confirmed proximal transverse colon intususception. 09/02/2008 MR received for DOS 8/7-8/2008 with D/C DX: Intussusception. Pt presented with 1 day hx of fever, vomiting and dark colored emesis as well as dark, foul smelling stool. In ER had Guaiac (+) currant jelly stool. Transfered to higher level of care. IS of the transverse colon was dx and reduced by air contrast enema. Pt remained stable, po progressed and d/c next day.


Changed on 4/7/2010

VAERS ID: 321669 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Pennsylvania
Vaccinated:2008-08-01
Onset:2008-08-06
Submitted:2008-08-08
Entered:2008-08-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B192AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF261AA / 0 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C63115 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0280X / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Faeces discoloured, Haematochezia, Intussusception, Lethargy, Mucous stools, Pyrexia, Vomiting

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: none
Current Illness: none
Preexisting Conditions: Port Wine Nevus Flammeus
Allergies:
Diagnostic Lab Data: surgery . Labs and Diagnostics: KUB showed no obstuction or free air. Air contrast enema (+) for IS. Stool Guaiac (+). Stool occult blood initially (-) then (+). Blood cx (-).
CDC 'Split Type':

Write-up: lethargy, fever, vomiting, currant jelly colored mucousy stools / confirmed proximal transverse colon intususception. 09/02/2008 MR received for DOS 8/7-8/2008 with D/C DX: Intussusception. Pt presented with 1 day hx of fever, vomiting and dark colored emesis as well as dark, foul smelling stool. In ER had Guaiac (+) currant jelly stool. Transfered to higher level of care. IS of the transverse colon was dx and reduced by air contrast enema. Pt remained stable, po progressed and d/c next day.


Changed on 8/31/2010

VAERS ID: 321669 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Pennsylvania
Vaccinated:2008-08-01
Onset:2008-08-06
Submitted:2008-08-08
Entered:2008-08-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B192AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF261AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH C63115 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0280X / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Faeces discoloured, Haematochezia, Intussusception, Lethargy, Mucous stools, Pyrexia, Vomiting

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: none
Current Illness: none
Preexisting Conditions: Port Wine Nevus Flammeus
Allergies:
Diagnostic Lab Data: surgery . Labs and Diagnostics: KUB showed no obstuction or free air. Air contrast enema (+) for IS. Stool Guaiac (+). Stool occult blood initially (-) then (+). Blood cx (-).
CDC 'Split Type':

Write-up: lethargy, fever, vomiting, currant jelly colored mucousy stools / confirmed proximal transverse colon intususception. 09/02/2008 MR received for DOS 8/7-8/2008 with D/C DX: Intussusception. Pt presented with 1 day hx of fever, vomiting and dark colored emesis as well as dark, foul smelling stool. In ER had Guaiac (+) currant jelly stool. Transfered to higher level of care. IS of the transverse colon was dx and reduced by air contrast enema. Pt remained stable, po progressed and d/c next day.


Changed on 4/13/2011

VAERS ID: 321669 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Pennsylvania
Vaccinated:2008-08-01
Onset:2008-08-06
Submitted:2008-08-08
Entered:2008-08-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B192AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF261AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C63115 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0280X / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abnormal faeces, Barium double contrast, Barium enema abnormal, Blood culture negative, Faeces discoloured, Haematochezia, Intussusception, Lethargy, Mucous stools, Pyrexia, Urinary system X-ray, Vomiting, Enema administration, Occult blood positive

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: none
Current Illness: none
Preexisting Conditions: Port Wine Nevus Flammeus
Allergies:
Diagnostic Lab Data: surgery . Labs and Diagnostics: KUB showed no obstuction or free air. Air contrast enema (+) for IS. Stool Guaiac (+). Stool occult blood initially (-) then (+). Blood cx (-).
CDC 'Split Type':

Write-up: lethargy, fever, vomiting, currant jelly colored mucousy stools / confirmed proximal transverse colon intususception. 09/02/2008 MR received for DOS 8/7-8/2008 with D/C DX: Intussusception. Pt presented with 1 day hx of fever, vomiting and dark colored emesis as well as dark, foul smelling stool. In ER had Guaiac (+) currant jelly stool. Transfered to higher level of care. IS of the transverse colon was dx and reduced by air contrast enema. Pt remained stable, po progressed and d/c next day.


Changed on 5/13/2011

VAERS ID: 321669 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Pennsylvania
Vaccinated:2008-08-01
Onset:2008-08-06
Submitted:2008-08-08
Entered:2008-08-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B192AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF261AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C63115 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0280X / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abnormal faeces, Barium double contrast, Barium enema abnormal, Blood culture negative, Faeces discoloured, Haematochezia, Intussusception, Lethargy, Mucous stools, Pyrexia, Urinary system X-ray, Vomiting, Enema administration, Occult blood positive

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: none
Current Illness: none
Preexisting Conditions: Port Wine Nevus Flammeus
Allergies:
Diagnostic Lab Data: surgery . Labs and Diagnostics: KUB showed no obstuction or free air. Air contrast enema (+) for IS. Stool Guaiac (+). Stool occult blood initially (-) then (+). Blood cx (-).
CDC 'Split Type':

Write-up: lethargy, fever, vomiting, currant jelly colored mucousy stools / confirmed proximal transverse colon intususception. 09/02/2008 MR received for DOS 8/7-8/2008 with D/C DX: Intussusception. Pt presented with 1 day hx of fever, vomiting and dark colored emesis as well as dark, foul smelling stool. In ER had Guaiac (+) currant jelly stool. Transfered to higher level of care. IS of the transverse colon was dx and reduced by air contrast enema. Pt remained stable, po progressed and d/c next day.


Changed on 6/11/2011

VAERS ID: 321669 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Pennsylvania
Vaccinated:2008-08-01
Onset:2008-08-06
Submitted:2008-08-08
Entered:2008-08-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B192AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF261AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C63115 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0280X / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abnormal faeces, Barium double contrast, Barium enema abnormal, Blood culture negative, Faeces discoloured, Haematochezia, Intussusception, Lethargy, Mucous stools, Pyrexia, Urinary system X-ray, Vomiting, Enema administration, Occult blood positive

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: none
Current Illness: none
Preexisting Conditions: Port Wine Nevus Flammeus
Allergies:
Diagnostic Lab Data: surgery . Labs and Diagnostics: KUB showed no obstuction or free air. Air contrast enema (+) for IS. Stool Guaiac (+). Stool occult blood initially (-) then (+). Blood cx (-).
CDC 'Split Type':

Write-up: lethargy, fever, vomiting, currant jelly colored mucousy stools / confirmed proximal transverse colon intususception. 09/02/2008 MR received for DOS 8/7-8/2008 with D/C DX: Intussusception. Pt presented with 1 day hx of fever, vomiting and dark colored emesis as well as dark, foul smelling stool. In ER had Guaiac (+) currant jelly stool. Transfered to higher level of care. IS of the transverse colon was dx and reduced by air contrast enema. Pt remained stable, po progressed and d/c next day.


Changed on 5/13/2013

VAERS ID: 321669 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Pennsylvania
Vaccinated:2008-08-01
Onset:2008-08-06
Submitted:2008-08-08
Entered:2008-08-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B192AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF261AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C63115 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0280X / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0280X / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abnormal faeces, Barium double contrast, Barium enema abnormal, Blood culture negative, Faeces discoloured, Haematochezia, Intussusception, Lethargy, Mucous stools, Pyrexia, Urinary system X-ray, Vomiting, Enema administration, Occult blood positive

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: none
Current Illness: none
Preexisting Conditions: Port Wine Nevus Flammeus
Allergies:
Diagnostic Lab Data: surgery . Labs and Diagnostics: KUB showed no obstuction or free air. Air contrast enema (+) for IS. Stool Guaiac (+). Stool occult blood initially (-) then (+). Blood cx (-).
CDC 'Split Type':

Write-up: lethargy, fever, vomiting, currant jelly colored mucousy stools / confirmed proximal transverse colon intususception. 09/02/2008 MR received for DOS 8/7-8/2008 with D/C DX: Intussusception. Pt presented with 1 day hx of fever, vomiting and dark colored emesis as well as dark, foul smelling stool. In ER had Guaiac (+) currant jelly stool. Transfered to higher level of care. IS of the transverse colon was dx and reduced by air contrast enema. Pt remained stable, po progressed and d/c next day.


Changed on 6/14/2014

VAERS ID: 321669 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Pennsylvania
Vaccinated:2008-08-01
Onset:2008-08-06
Submitted:2008-08-08
Entered:2008-08-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B192AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF261AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C63115 / 0 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0280X / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abnormal faeces, Barium double contrast, Barium enema abnormal, Blood culture negative, Faeces discoloured, Haematochezia, Intussusception, Lethargy, Mucous stools, Pyrexia, Urinary system X-ray, Vomiting, Enema administration, Occult blood positive

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: none
Current Illness: none
Preexisting Conditions: Port Wine Nevus Flammeus
Allergies:
Diagnostic Lab Data: surgery . Labs and Diagnostics: KUB showed no obstuction or free air. Air contrast enema (+) for IS. Stool Guaiac (+). Stool occult blood initially (-) then (+). Blood cx (-).
CDC 'Split Type':

Write-up: lethargy, fever, vomiting, currant jelly colored mucousy stools / confirmed proximal transverse colon intususception. 09/02/2008 MR received for DOS 8/7-8/2008 with D/C DX: Intussusception. Pt presented with 1 day hx of fever, vomiting and dark colored emesis as well as dark, foul smelling stool. In ER had Guaiac (+) currant jelly stool. Transfered to higher level of care. IS of the transverse colon was dx and reduced by air contrast enema. Pt remained stable, po progressed and d/c next day.


Changed on 2/14/2017

VAERS ID: 321669 Before After
VAERS Form:
Age:0.2 0.21
Sex:Female
Location:Pennsylvania
Vaccinated:2008-08-01
Onset:2008-08-06
Submitted:2008-08-08
Entered:2008-08-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B192AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF261AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C63115 / 0 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0280X / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abnormal faeces, Barium double contrast, Barium enema abnormal, Blood culture negative, Faeces discoloured, Haematochezia, Intussusception, Lethargy, Mucous stools, Pyrexia, Urinary system X-ray, Vomiting, Enema administration, Occult blood positive

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: none
Current Illness: none
Preexisting Conditions: Port Wine Nevus Flammeus
Allergies:
Diagnostic Lab Data: surgery . Labs and Diagnostics: KUB showed no obstuction or free air. Air contrast enema (+) for IS. Stool Guaiac (+). Stool occult blood initially (-) then (+). Blood cx (-).
CDC 'Split Type':

Write-up: lethargy, fever, vomiting, currant jelly colored mucousy stools / confirmed proximal transverse colon intususception. 09/02/2008 MR received for DOS 8/7-8/2008 with D/C DX: Intussusception. Pt presented with 1 day hx of fever, vomiting and dark colored emesis as well as dark, foul smelling stool. In ER had Guaiac (+) currant jelly stool. Transfered to higher level of care. IS of the transverse colon was dx and reduced by air contrast enema. Pt remained stable, po progressed and d/c next day.


Changed on 9/14/2017

VAERS ID: 321669 Before After
VAERS Form:(blank) 1
Age:0.21
Sex:Female
Location:Pennsylvania
Vaccinated:2008-08-01
Onset:2008-08-06
Submitted:2008-08-08
Entered:2008-08-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B192AA / 0 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF261AA / 0 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C63115 / 0 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0280X / 0 1 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Faeces discoloured, Haematochezia, Intussusception, Lethargy, Mucous stools, Pyrexia, Vomiting

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: none
Current Illness: none
Preexisting Conditions: Port Wine Nevus Flammeus
Allergies:
Diagnostic Lab Data: surgery . Labs and Diagnostics: KUB showed no obstuction or free air. Air contrast enema (+) for IS. Stool Guaiac (+). Stool occult blood initially (-) then (+). Blood cx (-).
CDC 'Split Type':

Write-up: lethargy, fever, vomiting, currant jelly colored mucousy stools / confirmed proximal transverse colon intususception. 09/02/2008 MR received for DOS 8/7-8/2008 with D/C DX: Intussusception. Pt presented with 1 day hx of fever, vomiting and dark colored emesis as well as dark, foul smelling stool. In ER had Guaiac (+) currant jelly stool. Transfered to higher level of care. IS of the transverse colon was dx and reduced by air contrast enema. Pt remained stable, po progressed and d/c next day.


Changed on 2/14/2018

VAERS ID: 321669 Before After
VAERS Form:1
Age:0.21
Sex:Female
Location:Pennsylvania
Vaccinated:2008-08-01
Onset:2008-08-06
Submitted:2008-08-08
Entered:2008-08-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B192AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF261AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C63115 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0280X / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Faeces discoloured, Haematochezia, Intussusception, Lethargy, Mucous stools, Pyrexia, Vomiting

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: none
Current Illness: none
Preexisting Conditions: Port Wine Nevus Flammeus
Allergies:
Diagnostic Lab Data: surgery . Labs and Diagnostics: KUB showed no obstuction or free air. Air contrast enema (+) for IS. Stool Guaiac (+). Stool occult blood initially (-) then (+). Blood cx (-).
CDC 'Split Type':

Write-up: lethargy, fever, vomiting, currant jelly colored mucousy stools / confirmed proximal transverse colon intususception. 09/02/2008 MR received for DOS 8/7-8/2008 with D/C DX: Intussusception. Pt presented with 1 day hx of fever, vomiting and dark colored emesis as well as dark, foul smelling stool. In ER had Guaiac (+) currant jelly stool. Transfered to higher level of care. IS of the transverse colon was dx and reduced by air contrast enema. Pt remained stable, po progressed and d/c next day.


Changed on 6/14/2018

VAERS ID: 321669 Before After
VAERS Form:1
Age:0.21
Sex:Female
Location:Pennsylvania
Vaccinated:2008-08-01
Onset:2008-08-06
Submitted:2008-08-08
Entered:2008-08-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B192AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF261AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C63115 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0280X / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Faeces discoloured, Haematochezia, Intussusception, Lethargy, Mucous stools, Pyrexia, Vomiting

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: none
Current Illness: none
Preexisting Conditions: Port Wine Nevus Flammeus
Allergies:
Diagnostic Lab Data: surgery . Labs and Diagnostics: KUB showed no obstuction or free air. Air contrast enema (+) for IS. Stool Guaiac (+). Stool occult blood initially (-) then (+). Blood cx (-).
CDC 'Split Type':

Write-up: lethargy, fever, vomiting, currant jelly colored mucousy stools / confirmed proximal transverse colon intususception. 09/02/2008 MR received for DOS 8/7-8/2008 with D/C DX: Intussusception. Pt presented with 1 day hx of fever, vomiting and dark colored emesis as well as dark, foul smelling stool. In ER had Guaiac (+) currant jelly stool. Transfered to higher level of care. IS of the transverse colon was dx and reduced by air contrast enema. Pt remained stable, po progressed and d/c next day.


Changed on 8/14/2018

VAERS ID: 321669 Before After
VAERS Form:1
Age:0.21
Sex:Female
Location:Pennsylvania
Vaccinated:2008-08-01
Onset:2008-08-06
Submitted:2008-08-08
Entered:2008-08-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B192AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF261AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C63115 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0280X / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Faeces discoloured, Haematochezia, Intussusception, Lethargy, Mucous stools, Pyrexia, Vomiting

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: none
Current Illness: none
Preexisting Conditions: Port Wine Nevus Flammeus
Allergies:
Diagnostic Lab Data: surgery . Labs and Diagnostics: KUB showed no obstuction or free air. Air contrast enema (+) for IS. Stool Guaiac (+). Stool occult blood initially (-) then (+). Blood cx (-).
CDC 'Split Type':

Write-up: lethargy, fever, vomiting, currant jelly colored mucousy stools / confirmed proximal transverse colon intususception. 09/02/2008 MR received for DOS 8/7-8/2008 with D/C DX: Intussusception. Pt presented with 1 day hx of fever, vomiting and dark colored emesis as well as dark, foul smelling stool. In ER had Guaiac (+) currant jelly stool. Transfered to higher level of care. IS of the transverse colon was dx and reduced by air contrast enema. Pt remained stable, po progressed and d/c next day.


Changed on 9/14/2018

VAERS ID: 321669 Before After
VAERS Form:1
Age:0.21
Sex:Female
Location:Pennsylvania
Vaccinated:2008-08-01
Onset:2008-08-06
Submitted:2008-08-08
Entered:2008-08-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B192AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF261AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C63115 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0280X / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Faeces discoloured, Haematochezia, Intussusception, Lethargy, Mucous stools, Pyrexia, Vomiting

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: none
Current Illness: none
Preexisting Conditions: Port Wine Nevus Flammeus
Allergies:
Diagnostic Lab Data: surgery . Labs and Diagnostics: KUB showed no obstuction or free air. Air contrast enema (+) for IS. Stool Guaiac (+). Stool occult blood initially (-) then (+). Blood cx (-).
CDC 'Split Type':

Write-up: lethargy, fever, vomiting, currant jelly colored mucousy stools / confirmed proximal transverse colon intususception. 09/02/2008 MR received for DOS 8/7-8/2008 with D/C DX: Intussusception. Pt presented with 1 day hx of fever, vomiting and dark colored emesis as well as dark, foul smelling stool. In ER had Guaiac (+) currant jelly stool. Transfered to higher level of care. IS of the transverse colon was dx and reduced by air contrast enema. Pt remained stable, po progressed and d/c next day.


Changed on 10/14/2018

VAERS ID: 321669 Before After
VAERS Form:1
Age:0.21
Sex:Female
Location:Pennsylvania
Vaccinated:2008-08-01
Onset:2008-08-06
Submitted:2008-08-08
Entered:2008-08-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B192AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF261AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C63115 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0280X / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Faeces discoloured, Haematochezia, Intussusception, Lethargy, Mucous stools, Pyrexia, Vomiting

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: none
Current Illness: none
Preexisting Conditions: Port Wine Nevus Flammeus
Allergies:
Diagnostic Lab Data: surgery . Labs and Diagnostics: KUB showed no obstuction or free air. Air contrast enema (+) for IS. Stool Guaiac (+). Stool occult blood initially (-) then (+). Blood cx (-).
CDC 'Split Type':

Write-up: lethargy, fever, vomiting, currant jelly colored mucousy stools / confirmed proximal transverse colon intususception. 09/02/2008 MR received for DOS 8/7-8/2008 with D/C DX: Intussusception. Pt presented with 1 day hx of fever, vomiting and dark colored emesis as well as dark, foul smelling stool. In ER had Guaiac (+) currant jelly stool. Transfered to higher level of care. IS of the transverse colon was dx and reduced by air contrast enema. Pt remained stable, po progressed and d/c next day.

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