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This is VAERS ID 324159

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 324159
VAERS Form:
Age:0.1
Gender:Female
Location:Alabama
Vaccinated:2008-07-14
Onset:2008-09-02
Submitted:2008-09-03
Entered:2008-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2934BA / 0 LL / IM
HEP: HEP B (HEPTAVAX) / MERCK & CO. INC. 1884U / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF373AB / 0 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A12182 / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C65042 / 0 UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0407X / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Barium double contrast, Blood albumin decreased, Blood chloride increased, Blood urea decreased, Enema administration

Life Threatening? Yes
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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Barium enema LABS: abdominal US revealed ileocolic IS & air contrast enema reduced it. WBC 14.55(N), neutros 65.2%(H), lymphs 28.1%(L), plts 471(H). Chloride 112(H), BUN 3(L), albumin 3.1(L).
CDC 'Split Type':

Write-up: Intussusception - reduced by air contrast enema (did not require surgery). Had vomiting/blood in stool - sent to hospital for treatment. 11/7/08 Reviewed hospital medical records of 9/2-9/3/2008. FINAL DX: Intussusception Records reveal patient experienc"ed vomiting & bloody stools x 1 day. Seen by PCP & was to be sleepy & lethargic. Admitted for observation s/p reduction of IS. Progressed well & d/c to home.


Changed on 12/8/2009

VAERS ID: 324159 Before After
VAERS Form:
Age:0.1
Gender:Female
Location:Alabama
Vaccinated:2008-07-14
Onset:2008-09-02
Submitted:2008-09-03
Entered:2008-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2934BA / 0 LL / IM
HEP: HEP B (HEPTAVAX) / MERCK & CO. INC. 1884U / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF373AB / 0 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A12182 / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C65042 / 0 UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0407X / 0 - / PO

Administered by: Private      Purchased by: Unknown Private
Symptoms: Barium double contrast, Blood albumin decreased, Blood chloride increased, Blood urea decreased, Haematochezia, Intussusception, Lethargy, Somnolence, Vomiting, White blood cell count, Enema administration, Platelet count increased, Ultrasound abdomen abnormal, Neutrophil percentage increased, Lymphocyte percentage decreased

Life Threatening? Yes
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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Barium enema LABS: abdominal US revealed ileocolic IS & air contrast enema reduced it. WBC 14.55(N), neutros 65.2%(H), lymphs 28.1%(L), plts 471(H). Chloride 112(H), BUN 3(L), albumin 3.1(L).
CDC 'Split Type':

Write-up: Intussusception - reduced by air contrast enema (did not require surgery). Had vomiting/blood in stool - sent to hospital for treatment. 11/7/08 Reviewed hospital medical records of 9/2-9/3/2008. FINAL DX: Intussusception Records reveal patient experienc"ed experienced vomiting & bloody stools x 1 day. Seen by PCP & was to be sleepy & lethargic. Admitted for observation s/p reduction of IS. Progressed well & d/c to home.


Changed on 3/2/2010

VAERS ID: 324159 Before After
VAERS Form:
Age:0.1
Gender:Female
Location:Alabama
Vaccinated:2008-07-14
Onset:2008-09-02
Submitted:2008-09-03
Entered:2008-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2934BA / 0 LL / IM
HEP: HEP B (HEPTAVAX) / MERCK & CO. INC. 1884U / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF373AB / 0 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A12182 / 0 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC C65042 / 0 UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0407X / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Blood albumin decreased, Blood chloride increased, Blood urea decreased, Haematochezia, Intussusception, Lethargy, Somnolence, Vomiting, White blood cell count, Enema administration, Platelet count increased, Ultrasound abdomen abnormal, Neutrophil percentage increased, Lymphocyte percentage decreased

Life Threatening? Yes
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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Barium enema LABS: abdominal US revealed ileocolic IS & air contrast enema reduced it. WBC 14.55(N), neutros 65.2%(H), lymphs 28.1%(L), plts 471(H). Chloride 112(H), BUN 3(L), albumin 3.1(L).
CDC 'Split Type':

Write-up: Intussusception - reduced by air contrast enema (did not require surgery). Had vomiting/blood in stool - sent to hospital for treatment. 11/7/08 Reviewed hospital medical records of 9/2-9/3/2008. FINAL DX: Intussusception Records reveal patient experienced vomiting & bloody stools x 1 day. Seen by PCP & was to be sleepy & lethargic. Admitted for observation s/p reduction of IS. Progressed well & d/c to home.


Changed on 4/7/2010

VAERS ID: 324159 Before After
VAERS Form:
Age:0.1
Gender:Female
Location:Alabama
Vaccinated:2008-07-14
Onset:2008-09-02
Submitted:2008-09-03
Entered:2008-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2934BA / 0 LL / IM
HEP: HEP B (HEPTAVAX) / MERCK & CO. INC. 1884U / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF373AB / 0 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A12182 / 0 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C65042 / 0 UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0407X / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Blood albumin decreased, Blood chloride increased, Blood urea decreased, Haematochezia, Intussusception, Lethargy, Somnolence, Vomiting, White blood cell count, Enema administration, Platelet count increased, Ultrasound abdomen abnormal, Neutrophil percentage increased, Lymphocyte percentage decreased

Life Threatening? Yes
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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Barium enema LABS: abdominal US revealed ileocolic IS & air contrast enema reduced it. WBC 14.55(N), neutros 65.2%(H), lymphs 28.1%(L), plts 471(H). Chloride 112(H), BUN 3(L), albumin 3.1(L).
CDC 'Split Type':

Write-up: Intussusception - reduced by air contrast enema (did not require surgery). Had vomiting/blood in stool - sent to hospital for treatment. 11/7/08 Reviewed hospital medical records of 9/2-9/3/2008. FINAL DX: Intussusception Records reveal patient experienced vomiting & bloody stools x 1 day. Seen by PCP & was to be sleepy & lethargic. Admitted for observation s/p reduction of IS. Progressed well & d/c to home.


Changed on 8/31/2010

VAERS ID: 324159 Before After
VAERS Form:
Age:0.1
Gender:Female
Location:Alabama
Vaccinated:2008-07-14
Onset:2008-09-02
Submitted:2008-09-03
Entered:2008-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2934BA / 0 LL / IM
HEP: HEP B (HEPTAVAX) HEP B (FOREIGN) / MERCK & CO. INC. 1884U / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF373AB / 0 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A12182 / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH C65042 / 0 UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0407X / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Blood albumin decreased, Blood chloride increased, Blood urea decreased, Haematochezia, Intussusception, Lethargy, Somnolence, Vomiting, White blood cell count, Enema administration, Platelet count increased, Ultrasound abdomen abnormal, Neutrophil percentage increased, Lymphocyte percentage decreased

Life Threatening? Yes
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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Barium enema LABS: abdominal US revealed ileocolic IS & air contrast enema reduced it. WBC 14.55(N), neutros 65.2%(H), lymphs 28.1%(L), plts 471(H). Chloride 112(H), BUN 3(L), albumin 3.1(L).
CDC 'Split Type':

Write-up: Intussusception - reduced by air contrast enema (did not require surgery). Had vomiting/blood in stool - sent to hospital for treatment. 11/7/08 Reviewed hospital medical records of 9/2-9/3/2008. FINAL DX: Intussusception Records reveal patient experienced vomiting & bloody stools x 1 day. Seen by PCP & was to be sleepy & lethargic. Admitted for observation s/p reduction of IS. Progressed well & d/c to home.


Changed on 5/13/2013

VAERS ID: 324159 Before After
VAERS Form:
Age:0.1
Gender:Female
Location:Alabama
Vaccinated:2008-07-14
Onset:2008-09-02
Submitted:2008-09-03
Entered:2008-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2934BA / 0 LL / IM
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 1884U / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF373AB / 0 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A12182 / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65042 / 0 UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0407X / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0407X / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Blood albumin decreased, Blood chloride increased, Blood urea decreased, Haematochezia, Intussusception, Lethargy, Somnolence, Vomiting, White blood cell count, Enema administration, Platelet count increased, Ultrasound abdomen abnormal, Neutrophil percentage increased, Lymphocyte percentage decreased

Life Threatening? Yes
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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Barium enema LABS: abdominal US revealed ileocolic IS & air contrast enema reduced it. WBC 14.55(N), neutros 65.2%(H), lymphs 28.1%(L), plts 471(H). Chloride 112(H), BUN 3(L), albumin 3.1(L).
CDC 'Split Type':

Write-up: Intussusception - reduced by air contrast enema (did not require surgery). Had vomiting/blood in stool - sent to hospital for treatment. 11/7/08 Reviewed hospital medical records of 9/2-9/3/2008. FINAL DX: Intussusception Records reveal patient experienced vomiting & bloody stools x 1 day. Seen by PCP & was to be sleepy & lethargic. Admitted for observation s/p reduction of IS. Progressed well & d/c to home.


Changed on 4/14/2017

VAERS ID: 324159 Before After
VAERS Form:
Age:0.1
Gender:Female
Location:Alabama
Vaccinated:2008-07-14
Onset:2008-09-02
Submitted:2008-09-03
Entered:2008-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2934BA / 0 LL / IM
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 1884U / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF373AB / 0 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A12182 / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65042 / 0 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0407X / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Blood albumin decreased, Blood chloride increased, Blood urea decreased, Haematochezia, Intussusception, Lethargy, Somnolence, Vomiting, White blood cell count, Enema administration, Platelet count increased, Ultrasound abdomen abnormal, Neutrophil percentage increased, Lymphocyte percentage decreased

Life Threatening? Yes
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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Barium enema LABS: abdominal US revealed ileocolic IS & air contrast enema reduced it. WBC 14.55(N), neutros 65.2%(H), lymphs 28.1%(L), plts 471(H). Chloride 112(H), BUN 3(L), albumin 3.1(L).
CDC 'Split Type':

Write-up: Intussusception - reduced by air contrast enema (did not require surgery). Had vomiting/blood in stool - sent to hospital for treatment. 11/7/08 Reviewed hospital medical records of 9/2-9/3/2008. FINAL DX: Intussusception Records reveal patient experienced vomiting & bloody stools x 1 day. Seen by PCP & was to be sleepy & lethargic. Admitted for observation s/p reduction of IS. Progressed well & d/c to home.


Changed on 9/14/2017

VAERS ID: 324159 Before After
VAERS Form:(blank) 1
Age:0.1
Gender:Female
Location:Alabama
Vaccinated:2008-07-14
Onset:2008-09-02
Submitted:2008-09-03
Entered:2008-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2934BA / 0 1 LL / IM
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 1884U / 1 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF373AB / 0 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A12182 / 0 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65042 / 0 1 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0407X / 0 1 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Haematochezia, Intussusception, Vomiting, Enema administration

Life Threatening? Yes
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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Barium enema LABS: abdominal US revealed ileocolic IS & air contrast enema reduced it. WBC 14.55(N), neutros 65.2%(H), lymphs 28.1%(L), plts 471(H). Chloride 112(H), BUN 3(L), albumin 3.1(L).
CDC 'Split Type':

Write-up: Intussusception - reduced by air contrast enema (did not require surgery). Had vomiting/blood in stool - sent to hospital for treatment. 11/7/08 Reviewed hospital medical records of 9/2-9/3/2008. FINAL DX: Intussusception Records reveal patient experienced vomiting & bloody stools x 1 day. Seen by PCP & was to be sleepy & lethargic. Admitted for observation s/p reduction of IS. Progressed well & d/c to home.


Changed on 2/14/2018

VAERS ID: 324159 Before After
VAERS Form:1
Age:0.1
Gender:Female
Location:Alabama
Vaccinated:2008-07-14
Onset:2008-09-02
Submitted:2008-09-03
Entered:2008-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2934BA / 1 LL / IM
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 1884U / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF373AB / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A12182 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65042 / 1 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0407X / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Haematochezia, Intussusception, Vomiting, Enema administration

Life Threatening? Yes
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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Barium enema LABS: abdominal US revealed ileocolic IS & air contrast enema reduced it. WBC 14.55(N), neutros 65.2%(H), lymphs 28.1%(L), plts 471(H). Chloride 112(H), BUN 3(L), albumin 3.1(L).
CDC 'Split Type':

Write-up: Intussusception - reduced by air contrast enema (did not require surgery). Had vomiting/blood in stool - sent to hospital for treatment. 11/7/08 Reviewed hospital medical records of 9/2-9/3/2008. FINAL DX: Intussusception Records reveal patient experienced vomiting & bloody stools x 1 day. Seen by PCP & was to be sleepy & lethargic. Admitted for observation s/p reduction of IS. Progressed well & d/c to home.


Changed on 6/14/2018

VAERS ID: 324159 Before After
VAERS Form:1
Age:0.1
Gender:Female
Location:Alabama
Vaccinated:2008-07-14
Onset:2008-09-02
Submitted:2008-09-03
Entered:2008-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2934BA / 1 LL / IM
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 1884U / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF373AB / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A12182 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65042 / 1 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0407X / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Haematochezia, Intussusception, Vomiting, Enema administration

Life Threatening? Yes
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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Barium enema LABS: abdominal US revealed ileocolic IS & air contrast enema reduced it. WBC 14.55(N), neutros 65.2%(H), lymphs 28.1%(L), plts 471(H). Chloride 112(H), BUN 3(L), albumin 3.1(L).
CDC 'Split Type':

Write-up: Intussusception - reduced by air contrast enema (did not require surgery). Had vomiting/blood in stool - sent to hospital for treatment. 11/7/08 Reviewed hospital medical records of 9/2-9/3/2008. FINAL DX: Intussusception Records reveal patient experienced vomiting & bloody stools x 1 day. Seen by PCP & was to be sleepy & lethargic. Admitted for observation s/p reduction of IS. Progressed well & d/c to home.


Changed on 8/14/2018

VAERS ID: 324159 Before After
VAERS Form:1
Age:0.1
Gender:Female
Location:Alabama
Vaccinated:2008-07-14
Onset:2008-09-02
Submitted:2008-09-03
Entered:2008-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2934BA / 1 LL / IM
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 1884U / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF373AB / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A12182 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65042 / 1 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0407X / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Haematochezia, Intussusception, Vomiting, Enema administration

Life Threatening? Yes
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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Barium enema LABS: abdominal US revealed ileocolic IS & air contrast enema reduced it. WBC 14.55(N), neutros 65.2%(H), lymphs 28.1%(L), plts 471(H). Chloride 112(H), BUN 3(L), albumin 3.1(L).
CDC 'Split Type':

Write-up: Intussusception - reduced by air contrast enema (did not require surgery). Had vomiting/blood in stool - sent to hospital for treatment. 11/7/08 Reviewed hospital medical records of 9/2-9/3/2008. FINAL DX: Intussusception Records reveal patient experienced vomiting & bloody stools x 1 day. Seen by PCP & was to be sleepy & lethargic. Admitted for observation s/p reduction of IS. Progressed well & d/c to home.


Changed on 9/14/2018

VAERS ID: 324159 Before After
VAERS Form:1
Age:0.1
Gender:Female
Location:Alabama
Vaccinated:2008-07-14
Onset:2008-09-02
Submitted:2008-09-03
Entered:2008-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2934BA / 1 LL / IM
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 1884U / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF373AB / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A12182 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65042 / 1 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0407X / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Haematochezia, Intussusception, Vomiting, Enema administration

Life Threatening? Yes
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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Barium enema LABS: abdominal US revealed ileocolic IS & air contrast enema reduced it. WBC 14.55(N), neutros 65.2%(H), lymphs 28.1%(L), plts 471(H). Chloride 112(H), BUN 3(L), albumin 3.1(L).
CDC 'Split Type':

Write-up: Intussusception - reduced by air contrast enema (did not require surgery). Had vomiting/blood in stool - sent to hospital for treatment. 11/7/08 Reviewed hospital medical records of 9/2-9/3/2008. FINAL DX: Intussusception Records reveal patient experienced vomiting & bloody stools x 1 day. Seen by PCP & was to be sleepy & lethargic. Admitted for observation s/p reduction of IS. Progressed well & d/c to home.


Changed on 10/14/2018

VAERS ID: 324159 Before After
VAERS Form:1
Age:0.1
Gender:Female
Location:Alabama
Vaccinated:2008-07-14
Onset:2008-09-02
Submitted:2008-09-03
Entered:2008-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2934BA / 1 LL / IM
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 1884U / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF373AB / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A12182 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65042 / 1 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0407X / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Haematochezia, Intussusception, Vomiting, Enema administration

Life Threatening? Yes
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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Barium enema LABS: abdominal US revealed ileocolic IS & air contrast enema reduced it. WBC 14.55(N), neutros 65.2%(H), lymphs 28.1%(L), plts 471(H). Chloride 112(H), BUN 3(L), albumin 3.1(L).
CDC 'Split Type':

Write-up: Intussusception - reduced by air contrast enema (did not require surgery). Had vomiting/blood in stool - sent to hospital for treatment. 11/7/08 Reviewed hospital medical records of 9/2-9/3/2008. FINAL DX: Intussusception Records reveal patient experienced vomiting & bloody stools x 1 day. Seen by PCP & was to be sleepy & lethargic. Admitted for observation s/p reduction of IS. Progressed well & d/c to home.

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