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This is VAERS ID 323515

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 323515
VAERS Form:
Age:0.4
Gender:Female
Location:Hawaii
Vaccinated:2008-07-23
Onset:2008-08-24
Submitted:2008-08-27
Entered:2008-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B182AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF237AD / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C86138 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0277X / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Barium double contrast, Barium enema abnormal, Haematochezia, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vit A, D, C
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Ultrasound, Gastrografin enema under fluoroscopy 9/10/08-records received-Reduction of intussusception with gastrograph en enema. Labs and Diagnostics: US Abd (+) for IS in LLQ. Free fluid. Saline enema unsuccessful at reduction. Abd X
CDC 'Split Type':

Write-up: Onset 8/24/08 vomiting 9 PM. Seen at hospital where intussusception dx''''ed by abd ultrasound, failed enema reduction. Transferred to another hospital where laparoscopy was done - enlarged mesenteric node was resected. 9/10/08-hospital records received for"DOS 8/25-8/27/08-DC DX: Intussusception status post reduction. Dissection of large mesenteric lymph node. Laparoscopic resection of enlarged lymph node. At initial hospital, saline enema failed to reduce intussusception. Vomiting began on evening prior to


Changed on 12/8/2009

VAERS ID: 323515 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Hawaii
Vaccinated:2008-07-23
Onset:2008-08-24
Submitted:2008-08-27
Entered:2008-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B182AA / 1 RL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B182AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF237AD / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C86138 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0277X / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Barium double contrast, Barium enema abnormal, Haematochezia, Intussusception, Laparoscopy, Lymphadenitis, Vomiting, Enema administration, Ultrasound abdomen abnormal, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vit A, D, C
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Ultrasound, Gastrografin enema under fluoroscopy 9/10/08-records received-Reduction of intussusception with gastrograph en enema. Labs and Diagnostics: US Abd (+) for IS in LLQ. Free fluid. Saline enema unsuccessful at reduction. Abd X
CDC 'Split Type':

Write-up: Onset 8/24/08 vomiting 9 PM. Seen at hospital where intussusception dx''''ed dx''ed by abd ultrasound, failed enema reduction. Transferred to another hospital where laparoscopy was done - enlarged mesenteric node was resected. 9/10/08-hospital records received for"DOS for DOS 8/25-8/27/08-DC DX: Intussusception status post reduction. Dissection of large mesenteric lymph node. Laparoscopic resection of enlarged lymph node. At initial hospital, saline enema failed to reduce intussusception. Vomiting began on evening prior to admission, some blood in stools.


Changed on 3/2/2010

VAERS ID: 323515 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Hawaii
Vaccinated:2008-07-23
Onset:2008-08-24
Submitted:2008-08-27
Entered:2008-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B182AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF237AD / 1 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC C86138 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0277X / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Barium double contrast, Barium enema abnormal, Haematochezia, Intussusception, Laparoscopy, Lymphadenitis, Vomiting, Enema administration, Ultrasound abdomen abnormal, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vit A, D, C
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Ultrasound, Gastrografin enema under fluoroscopy 9/10/08-records received-Reduction of intussusception with gastrograph en enema. Labs and Diagnostics: US Abd (+) for IS in LLQ. Free fluid. Saline enema unsuccessful at reduction. Abd X
CDC 'Split Type':

Write-up: Onset 8/24/08 vomiting 9 PM. Seen at hospital where intussusception dx''ed by abd ultrasound, failed enema reduction. Transferred to another hospital where laparoscopy was done - enlarged mesenteric node was resected. 9/10/08-hospital records received for DOS 8/25-8/27/08-DC DX: Intussusception status post reduction. Dissection of large mesenteric lymph node. Laparoscopic resection of enlarged lymph node. At initial hospital, saline enema failed to reduce intussusception. Vomiting began on evening prior to admission, some blood in stools.


Changed on 4/7/2010

VAERS ID: 323515 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Hawaii
Vaccinated:2008-07-23
Onset:2008-08-24
Submitted:2008-08-27
Entered:2008-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B182AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF237AD / 1 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C86138 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0277X / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Barium double contrast, Barium enema abnormal, Haematochezia, Intussusception, Laparoscopy, Lymphadenitis, Vomiting, Enema administration, Ultrasound abdomen abnormal, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vit A, D, C
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Ultrasound, Gastrografin enema under fluoroscopy 9/10/08-records received-Reduction of intussusception with gastrograph en enema. Labs and Diagnostics: US Abd (+) for IS in LLQ. Free fluid. Saline enema unsuccessful at reduction. Abd X
CDC 'Split Type':

Write-up: Onset 8/24/08 vomiting 9 PM. Seen at hospital where intussusception dx''ed by abd ultrasound, failed enema reduction. Transferred to another hospital where laparoscopy was done - enlarged mesenteric node was resected. 9/10/08-hospital records received for DOS 8/25-8/27/08-DC DX: Intussusception status post reduction. Dissection of large mesenteric lymph node. Laparoscopic resection of enlarged lymph node. At initial hospital, saline enema failed to reduce intussusception. Vomiting began on evening prior to admission, some blood in stools.


Changed on 8/31/2010

VAERS ID: 323515 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Hawaii
Vaccinated:2008-07-23
Onset:2008-08-24
Submitted:2008-08-27
Entered:2008-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B182AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF237AD / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH C86138 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0277X / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Barium double contrast, Barium enema abnormal, Haematochezia, Intussusception, Laparoscopy, Lymphadenitis, Vomiting, Enema administration, Ultrasound abdomen abnormal, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vit A, D, C
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Ultrasound, Gastrografin enema under fluoroscopy 9/10/08-records received-Reduction of intussusception with gastrograph en enema. Labs and Diagnostics: US Abd (+) for IS in LLQ. Free fluid. Saline enema unsuccessful at reduction. Abd X
CDC 'Split Type':

Write-up: Onset 8/24/08 vomiting 9 PM. Seen at hospital where intussusception dx''ed by abd ultrasound, failed enema reduction. Transferred to another hospital where laparoscopy was done - enlarged mesenteric node was resected. 9/10/08-hospital records received for DOS 8/25-8/27/08-DC DX: Intussusception status post reduction. Dissection of large mesenteric lymph node. Laparoscopic resection of enlarged lymph node. At initial hospital, saline enema failed to reduce intussusception. Vomiting began on evening prior to admission, some blood in stools.


Changed on 5/13/2013

VAERS ID: 323515 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Hawaii
Vaccinated:2008-07-23
Onset:2008-08-24
Submitted:2008-08-27
Entered:2008-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B182AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF237AD / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C86138 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0277X / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0277X / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Barium double contrast, Barium enema abnormal, Haematochezia, Intussusception, Laparoscopy, Lymphadenitis, Vomiting, Enema administration, Ultrasound abdomen abnormal, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vit A, D, C
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Ultrasound, Gastrografin enema under fluoroscopy 9/10/08-records received-Reduction of intussusception with gastrograph en enema. Labs and Diagnostics: US Abd (+) for IS in LLQ. Free fluid. Saline enema unsuccessful at reduction. Abd X
CDC 'Split Type':

Write-up: Onset 8/24/08 vomiting 9 PM. Seen at hospital where intussusception dx''ed by abd ultrasound, failed enema reduction. Transferred to another hospital where laparoscopy was done - enlarged mesenteric node was resected. 9/10/08-hospital records received for DOS 8/25-8/27/08-DC DX: Intussusception status post reduction. Dissection of large mesenteric lymph node. Laparoscopic resection of enlarged lymph node. At initial hospital, saline enema failed to reduce intussusception. Vomiting began on evening prior to admission, some blood in stools.


Changed on 4/14/2017

VAERS ID: 323515 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Hawaii
Vaccinated:2008-07-23
Onset:2008-08-24
Submitted:2008-08-27
Entered:2008-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B182AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF237AD / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C86138 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0277X / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Barium double contrast, Barium enema abnormal, Haematochezia, Intussusception, Laparoscopy, Lymphadenitis, Vomiting, Enema administration, Ultrasound abdomen abnormal, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vit A, D, C
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Ultrasound, Gastrografin enema under fluoroscopy 9/10/08-records received-Reduction of intussusception with gastrograph en enema. Labs and Diagnostics: US Abd (+) for IS in LLQ. Free fluid. Saline enema unsuccessful at reduction. Abd X X-ray WNL
CDC 'Split Type':

Write-up: Onset 8/24/08 vomiting 9 PM. Seen at hospital where intussusception dx''ed by abd ultrasound, failed enema reduction. Transferred to another hospital where laparoscopy was done - enlarged mesenteric node was resected. 9/10/08-hospital records received for DOS 8/25-8/27/08-DC DX: Intussusception status post reduction. Dissection of large mesenteric lymph node. Laparoscopic resection of enlarged lymph node. At initial hospital, saline enema failed to reduce intussusception. Vomiting began on evening prior to admission, some blood in stools.


Changed on 9/14/2017

VAERS ID: 323515 Before After
VAERS Form:(blank) 1
Age:0.4
Gender:Female
Location:Hawaii
Vaccinated:2008-07-23
Onset:2008-08-24
Submitted:2008-08-27
Entered:2008-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B182AA / 1 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF237AD / 1 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C86138 / 1 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0277X / 1 2 - MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Barium enema abnormal, Intussusception, Laparoscopy, Lymphadenitis, Vomiting, Ultrasound abdomen abnormal

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: Vit A, D, C
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Ultrasound, Gastrografin enema under fluoroscopy 9/10/08-records received-Reduction of intussusception with gastrograph en enema. Labs and Diagnostics: US Abd (+) for IS in LLQ. Free fluid. Saline enema unsuccessful at reduction. Abd X-ray WNL
CDC 'Split Type':

Write-up: Onset 8/24/08 vomiting 9 PM. Seen at hospital where intussusception dx''ed by abd ultrasound, failed enema reduction. Transferred to another hospital where laparoscopy was done - enlarged mesenteric node was resected. 9/10/08-hospital records received for DOS 8/25-8/27/08-DC DX: Intussusception status post reduction. Dissection of large mesenteric lymph node. Laparoscopic resection of enlarged lymph node. At initial hospital, saline enema failed to reduce intussusception. Vomiting began on evening prior to admission, some blood in stools.


Changed on 2/14/2018

VAERS ID: 323515 Before After
VAERS Form:1
Age:0.4
Gender:Female
Location:Hawaii
Vaccinated:2008-07-23
Onset:2008-08-24
Submitted:2008-08-27
Entered:2008-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B182AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF237AD / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C86138 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0277X / 2 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Barium enema abnormal, Intussusception, Laparoscopy, Lymphadenitis, Vomiting, Ultrasound abdomen abnormal

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: Vit A, D, C
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Ultrasound, Gastrografin enema under fluoroscopy 9/10/08-records received-Reduction of intussusception with gastrograph en enema. Labs and Diagnostics: US Abd (+) for IS in LLQ. Free fluid. Saline enema unsuccessful at reduction. Abd X-ray WNL
CDC 'Split Type':

Write-up: Onset 8/24/08 vomiting 9 PM. Seen at hospital where intussusception dx''ed by abd ultrasound, failed enema reduction. Transferred to another hospital where laparoscopy was done - enlarged mesenteric node was resected. 9/10/08-hospital records received for DOS 8/25-8/27/08-DC DX: Intussusception status post reduction. Dissection of large mesenteric lymph node. Laparoscopic resection of enlarged lymph node. At initial hospital, saline enema failed to reduce intussusception. Vomiting began on evening prior to admission, some blood in stools.


Changed on 6/14/2018

VAERS ID: 323515 Before After
VAERS Form:1
Age:0.4
Gender:Female
Location:Hawaii
Vaccinated:2008-07-23
Onset:2008-08-24
Submitted:2008-08-27
Entered:2008-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B182AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF237AD / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C86138 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0277X / 2 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Barium enema abnormal, Intussusception, Laparoscopy, Lymphadenitis, Vomiting, Ultrasound abdomen abnormal

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: Vit A, D, C
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Ultrasound, Gastrografin enema under fluoroscopy 9/10/08-records received-Reduction of intussusception with gastrograph en enema. Labs and Diagnostics: US Abd (+) for IS in LLQ. Free fluid. Saline enema unsuccessful at reduction. Abd X-ray WNL
CDC 'Split Type':

Write-up: Onset 8/24/08 vomiting 9 PM. Seen at hospital where intussusception dx''ed by abd ultrasound, failed enema reduction. Transferred to another hospital where laparoscopy was done - enlarged mesenteric node was resected. 9/10/08-hospital records received for DOS 8/25-8/27/08-DC DX: Intussusception status post reduction. Dissection of large mesenteric lymph node. Laparoscopic resection of enlarged lymph node. At initial hospital, saline enema failed to reduce intussusception. Vomiting began on evening prior to admission, some blood in stools.


Changed on 8/14/2018

VAERS ID: 323515 Before After
VAERS Form:1
Age:0.4
Gender:Female
Location:Hawaii
Vaccinated:2008-07-23
Onset:2008-08-24
Submitted:2008-08-27
Entered:2008-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B182AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF237AD / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C86138 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0277X / 2 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Barium enema abnormal, Intussusception, Laparoscopy, Lymphadenitis, Vomiting, Ultrasound abdomen abnormal

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: Vit A, D, C
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Ultrasound, Gastrografin enema under fluoroscopy 9/10/08-records received-Reduction of intussusception with gastrograph en enema. Labs and Diagnostics: US Abd (+) for IS in LLQ. Free fluid. Saline enema unsuccessful at reduction. Abd X-ray WNL
CDC 'Split Type':

Write-up: Onset 8/24/08 vomiting 9 PM. Seen at hospital where intussusception dx''ed by abd ultrasound, failed enema reduction. Transferred to another hospital where laparoscopy was done - enlarged mesenteric node was resected. 9/10/08-hospital records received for DOS 8/25-8/27/08-DC DX: Intussusception status post reduction. Dissection of large mesenteric lymph node. Laparoscopic resection of enlarged lymph node. At initial hospital, saline enema failed to reduce intussusception. Vomiting began on evening prior to admission, some blood in stools.


Changed on 9/14/2018

VAERS ID: 323515 Before After
VAERS Form:1
Age:0.4
Gender:Female
Location:Hawaii
Vaccinated:2008-07-23
Onset:2008-08-24
Submitted:2008-08-27
Entered:2008-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B182AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF237AD / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C86138 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0277X / 2 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Barium enema abnormal, Intussusception, Laparoscopy, Lymphadenitis, Vomiting, Ultrasound abdomen abnormal

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: Vit A, D, C
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Ultrasound, Gastrografin enema under fluoroscopy 9/10/08-records received-Reduction of intussusception with gastrograph en enema. Labs and Diagnostics: US Abd (+) for IS in LLQ. Free fluid. Saline enema unsuccessful at reduction. Abd X-ray WNL
CDC 'Split Type':

Write-up: Onset 8/24/08 vomiting 9 PM. Seen at hospital where intussusception dx''ed by abd ultrasound, failed enema reduction. Transferred to another hospital where laparoscopy was done - enlarged mesenteric node was resected. 9/10/08-hospital records received for DOS 8/25-8/27/08-DC DX: Intussusception status post reduction. Dissection of large mesenteric lymph node. Laparoscopic resection of enlarged lymph node. At initial hospital, saline enema failed to reduce intussusception. Vomiting began on evening prior to admission, some blood in stools.


Changed on 10/14/2018

VAERS ID: 323515 Before After
VAERS Form:1
Age:0.4
Gender:Female
Location:Hawaii
Vaccinated:2008-07-23
Onset:2008-08-24
Submitted:2008-08-27
Entered:2008-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B182AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF237AD / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C86138 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0277X / 2 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Barium enema abnormal, Intussusception, Laparoscopy, Lymphadenitis, Vomiting, Ultrasound abdomen abnormal

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: Vit A, D, C
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Ultrasound, Gastrografin enema under fluoroscopy 9/10/08-records received-Reduction of intussusception with gastrograph en enema. Labs and Diagnostics: US Abd (+) for IS in LLQ. Free fluid. Saline enema unsuccessful at reduction. Abd X-ray WNL
CDC 'Split Type':

Write-up: Onset 8/24/08 vomiting 9 PM. Seen at hospital where intussusception dx''ed by abd ultrasound, failed enema reduction. Transferred to another hospital where laparoscopy was done - enlarged mesenteric node was resected. 9/10/08-hospital records received for DOS 8/25-8/27/08-DC DX: Intussusception status post reduction. Dissection of large mesenteric lymph node. Laparoscopic resection of enlarged lymph node. At initial hospital, saline enema failed to reduce intussusception. Vomiting began on evening prior to admission, some blood in stools.

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