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This is VAERS ID 323815

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 323815
VAERS Form:
Age:0.5
Gender:Female
Location:Virginia
Vaccinated:2007-07-19
Onset:2008-08-22
Submitted:2008-08-23
Entered:2008-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C25700AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE965AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B588458 / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1233F / 2 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Abdominal pain, Diarrhoea haemorrhagic, Foreign travel, Enema administration, Decreased appetite

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? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: ER - Admitted 9/3/08-records received-Stool culture negative. US revealed ileocolic intussusception at level of hepatic flexure.
CDC 'Split Type':

Write-up: ? Intussusception w/successful reduction by air enema 8/22/08. 9/3/08-records received for DOS 8/21/08-DX:Intussusception with successful reduction by air enema of US revealed ileocolic intussusception at level of hepatic flexure. Presented to ED with C/"O bloody diarrhea with blood and mucus noted in diaper. Fever 103 and decreased appetite. Lethargy. Abdominal cramping. Just returned 2 days prior from El Salvador.


Changed on 12/8/2009

VAERS ID: 323815 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Virginia
Vaccinated:2007-07-19
Onset:2008-08-22
Submitted:2008-08-23
Entered:2008-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C25700AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE965AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B588458 / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1233F / 2 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Abdominal pain, Diarrhoea haemorrhagic, Foreign travel, Intussusception, Mucous stools, Pyrexia, Enema administration, Ultrasound abdomen abnormal, Decreased appetite

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? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: ER - Admitted 9/3/08-records received-Stool culture negative. US revealed ileocolic intussusception at level of hepatic flexure.
CDC 'Split Type':

Write-up: ? Intussusception w/successful reduction by air enema 8/22/08. 9/3/08-records received for DOS 8/21/08-DX:Intussusception with successful reduction by air enema of US revealed ileocolic intussusception at level of hepatic flexure. Presented to ED with C/"O C/O bloody diarrhea with blood and mucus noted in diaper. Fever 103 and decreased appetite. Lethargy. Abdominal cramping. Just returned 2 days prior from El Salvador.


Changed on 3/2/2010

VAERS ID: 323815 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Virginia
Vaccinated:2007-07-19
Onset:2008-08-22
Submitted:2008-08-23
Entered:2008-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C25700AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE965AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B588458 / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1233F / 2 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Abdominal pain, Diarrhoea haemorrhagic, Foreign travel, Intussusception, Mucous stools, Pyrexia, Enema administration, Ultrasound abdomen abnormal, Decreased appetite

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? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: ER - Admitted 9/3/08-records received-Stool culture negative. US revealed ileocolic intussusception at level of hepatic flexure.
CDC 'Split Type':

Write-up: ? Intussusception w/successful reduction by air enema 8/22/08. 9/3/08-records received for DOS 8/21/08-DX:Intussusception with successful reduction by air enema of US revealed ileocolic intussusception at level of hepatic flexure. Presented to ED with C/O bloody diarrhea with blood and mucus noted in diaper. Fever 103 and decreased appetite. Lethargy. Abdominal cramping. Just returned 2 days prior from El Salvador.


Changed on 4/7/2010

VAERS ID: 323815 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Virginia
Vaccinated:2007-07-19
Onset:2008-08-22
Submitted:2008-08-23
Entered:2008-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C25700AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE965AA / 2 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B588458 / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1233F / 2 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Abdominal pain, Diarrhoea haemorrhagic, Foreign travel, Intussusception, Mucous stools, Pyrexia, Enema administration, Ultrasound abdomen abnormal, Decreased appetite

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? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: ER - Admitted 9/3/08-records received-Stool culture negative. US revealed ileocolic intussusception at level of hepatic flexure.
CDC 'Split Type':

Write-up: ? Intussusception w/successful reduction by air enema 8/22/08. 9/3/08-records received for DOS 8/21/08-DX:Intussusception with successful reduction by air enema of US revealed ileocolic intussusception at level of hepatic flexure. Presented to ED with C/O bloody diarrhea with blood and mucus noted in diaper. Fever 103 and decreased appetite. Lethargy. Abdominal cramping. Just returned 2 days prior from El Salvador.


Changed on 8/31/2010

VAERS ID: 323815 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Virginia
Vaccinated:2007-07-19
Onset:2008-08-22
Submitted:2008-08-23
Entered:2008-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C25700AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE965AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B588458 / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1233F / 2 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Abdominal pain, Diarrhoea haemorrhagic, Foreign travel, Intussusception, Mucous stools, Pyrexia, Enema administration, Ultrasound abdomen abnormal, Decreased appetite

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? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: ER - Admitted 9/3/08-records received-Stool culture negative. US revealed ileocolic intussusception at level of hepatic flexure.
CDC 'Split Type':

Write-up: ? Intussusception w/successful reduction by air enema 8/22/08. 9/3/08-records received for DOS 8/21/08-DX:Intussusception with successful reduction by air enema of US revealed ileocolic intussusception at level of hepatic flexure. Presented to ED with C/O bloody diarrhea with blood and mucus noted in diaper. Fever 103 and decreased appetite. Lethargy. Abdominal cramping. Just returned 2 days prior from El Salvador.


Changed on 1/7/2013

VAERS ID: 323815 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Virginia
Vaccinated:2007-07-19
Onset:2008-08-22
Submitted:2008-08-23
Entered:2008-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C25700AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE965AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B588458 / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1233F / 2 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Abdominal pain, Diarrhoea haemorrhagic, Foreign travel, Intussusception, Mucous stools, Pyrexia, Enema administration, Ultrasound abdomen abnormal, Decreased appetite

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? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: ER - Admitted 9/3/08-records received-Stool culture negative. US revealed ileocolic intussusception at level of hepatic flexure.
CDC 'Split Type':

Write-up: ? Intussusception w/successful reduction by air enema 8/22/08. 9/3/08-records received for DOS 8/21/08-DX:Intussusception with successful reduction by air enema of US revealed ileocolic intussusception at level of hepatic flexure. Presented to ED with C/O bloody diarrhea with blood and mucus noted in diaper. Fever 103 and decreased appetite. Lethargy. Abdominal cramping. Just returned 2 days prior from El Salvador. another country.


Changed on 5/13/2013

VAERS ID: 323815 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Virginia
Vaccinated:2007-07-19
Onset:2008-08-22
Submitted:2008-08-23
Entered:2008-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C25700AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE965AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B588458 / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1233F / 2 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1233F / 2 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Abdominal pain, Diarrhoea haemorrhagic, Foreign travel, Intussusception, Mucous stools, Pyrexia, Enema administration, Ultrasound abdomen abnormal, Decreased appetite

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? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: ER - Admitted 9/3/08-records received-Stool culture negative. US revealed ileocolic intussusception at level of hepatic flexure.
CDC 'Split Type':

Write-up: ? Intussusception w/successful reduction by air enema 8/22/08. 9/3/08-records received for DOS 8/21/08-DX:Intussusception with successful reduction by air enema of US revealed ileocolic intussusception at level of hepatic flexure. Presented to ED with C/O bloody diarrhea with blood and mucus noted in diaper. Fever 103 and decreased appetite. Lethargy. Abdominal cramping. Just returned 2 days prior from another country.


Changed on 2/14/2017

VAERS ID: 323815 Before After
VAERS Form:
Age:0.5 0.54
Gender:Female
Location:Virginia
Vaccinated:2007-07-19
Onset:2008-08-22
Submitted:2008-08-23
Entered:2008-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C25700AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE965AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B588458 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1233F / 2 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Abdominal pain, Diarrhoea haemorrhagic, Foreign travel, Intussusception, Mucous stools, Pyrexia, Enema administration, Ultrasound abdomen abnormal, Decreased appetite

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? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: ER - Admitted 9/3/08-records received-Stool culture negative. US revealed ileocolic intussusception at level of hepatic flexure.
CDC 'Split Type':

Write-up: ? Intussusception w/successful reduction by air enema 8/22/08. 9/3/08-records received for DOS 8/21/08-DX:Intussusception with successful reduction by air enema of US revealed ileocolic intussusception at level of hepatic flexure. Presented to ED with C/O bloody diarrhea with blood and mucus noted in diaper. Fever 103 and decreased appetite. Lethargy. Abdominal cramping. Just returned 2 days prior from another country.


Changed on 9/14/2017

VAERS ID: 323815 Before After
VAERS Form:(blank) 1
Age:0.54
Gender:Female
Location:Virginia
Vaccinated:2007-07-19
Onset:2008-08-22
Submitted:2008-08-23
Entered:2008-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C25700AA / 2 3 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE965AA / 2 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B588458 / 2 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1233F / 2 3 - MO / PO

Administered by: Private      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? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: ER - Admitted 9/3/08-records received-Stool culture negative. US revealed ileocolic intussusception at level of hepatic flexure.
CDC 'Split Type':

Write-up: ? Intussusception w/successful reduction by air enema 8/22/08. 9/3/08-records received for DOS 8/21/08-DX:Intussusception with successful reduction by air enema of US revealed ileocolic intussusception at level of hepatic flexure. Presented to ED with C/O bloody diarrhea with blood and mucus noted in diaper. Fever 103 and decreased appetite. Lethargy. Abdominal cramping. Just returned 2 days prior from another country.


Changed on 2/14/2018

VAERS ID: 323815 Before After
VAERS Form:1
Age:0.54
Gender:Female
Location:Virginia
Vaccinated:2007-07-19
Onset:2008-08-22
Submitted:2008-08-23
Entered:2008-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C25700AA / 3 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE965AA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B588458 / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1233F / 3 MO / PO

Administered by: Private      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? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: ER - Admitted 9/3/08-records received-Stool culture negative. US revealed ileocolic intussusception at level of hepatic flexure.
CDC 'Split Type':

Write-up: ? Intussusception w/successful reduction by air enema 8/22/08. 9/3/08-records received for DOS 8/21/08-DX:Intussusception with successful reduction by air enema of US revealed ileocolic intussusception at level of hepatic flexure. Presented to ED with C/O bloody diarrhea with blood and mucus noted in diaper. Fever 103 and decreased appetite. Lethargy. Abdominal cramping. Just returned 2 days prior from another country.


Changed on 6/14/2018

VAERS ID: 323815 Before After
VAERS Form:1
Age:0.54
Gender:Female
Location:Virginia
Vaccinated:2007-07-19
Onset:2008-08-22
Submitted:2008-08-23
Entered:2008-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C25700AA / 3 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE965AA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B588458 / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1233F / 3 MO / PO

Administered by: Private      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? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: ER - Admitted 9/3/08-records received-Stool culture negative. US revealed ileocolic intussusception at level of hepatic flexure.
CDC 'Split Type':

Write-up: ? Intussusception w/successful reduction by air enema 8/22/08. 9/3/08-records received for DOS 8/21/08-DX:Intussusception with successful reduction by air enema of US revealed ileocolic intussusception at level of hepatic flexure. Presented to ED with C/O bloody diarrhea with blood and mucus noted in diaper. Fever 103 and decreased appetite. Lethargy. Abdominal cramping. Just returned 2 days prior from another country.


Changed on 8/14/2018

VAERS ID: 323815 Before After
VAERS Form:1
Age:0.54
Gender:Female
Location:Virginia
Vaccinated:2007-07-19
Onset:2008-08-22
Submitted:2008-08-23
Entered:2008-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C25700AA / 3 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE965AA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B588458 / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1233F / 3 MO / PO

Administered by: Private      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? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: ER - Admitted 9/3/08-records received-Stool culture negative. US revealed ileocolic intussusception at level of hepatic flexure.
CDC 'Split Type':

Write-up: ? Intussusception w/successful reduction by air enema 8/22/08. 9/3/08-records received for DOS 8/21/08-DX:Intussusception with successful reduction by air enema of US revealed ileocolic intussusception at level of hepatic flexure. Presented to ED with C/O bloody diarrhea with blood and mucus noted in diaper. Fever 103 and decreased appetite. Lethargy. Abdominal cramping. Just returned 2 days prior from another country.


Changed on 9/14/2018

VAERS ID: 323815 Before After
VAERS Form:1
Age:0.54
Gender:Female
Location:Virginia
Vaccinated:2007-07-19
Onset:2008-08-22
Submitted:2008-08-23
Entered:2008-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C25700AA / 3 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE965AA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B588458 / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1233F / 3 MO / PO

Administered by: Private      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? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: ER - Admitted 9/3/08-records received-Stool culture negative. US revealed ileocolic intussusception at level of hepatic flexure.
CDC 'Split Type':

Write-up: ? Intussusception w/successful reduction by air enema 8/22/08. 9/3/08-records received for DOS 8/21/08-DX:Intussusception with successful reduction by air enema of US revealed ileocolic intussusception at level of hepatic flexure. Presented to ED with C/O bloody diarrhea with blood and mucus noted in diaper. Fever 103 and decreased appetite. Lethargy. Abdominal cramping. Just returned 2 days prior from another country.


Changed on 10/14/2018

VAERS ID: 323815 Before After
VAERS Form:1
Age:0.54
Gender:Female
Location:Virginia
Vaccinated:2007-07-19
Onset:2008-08-22
Submitted:2008-08-23
Entered:2008-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C25700AA / 3 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE965AA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B588458 / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1233F / 3 MO / PO

Administered by: Private      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? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: ER - Admitted 9/3/08-records received-Stool culture negative. US revealed ileocolic intussusception at level of hepatic flexure.
CDC 'Split Type':

Write-up: ? Intussusception w/successful reduction by air enema 8/22/08. 9/3/08-records received for DOS 8/21/08-DX:Intussusception with successful reduction by air enema of US revealed ileocolic intussusception at level of hepatic flexure. Presented to ED with C/O bloody diarrhea with blood and mucus noted in diaper. Fever 103 and decreased appetite. Lethargy. Abdominal cramping. Just returned 2 days prior from another country.

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