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This is VAERS ID 326271

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 326271
VAERS Form:
Age:0.4
Gender:Female
Location:Connecticut
Vaccinated:2008-09-15
Onset:2008-09-22
Submitted:2008-09-25
Entered:2008-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B156BA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF472AB / 1 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C50457 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0692X / 1 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: Abdominal distension, Abdominal pain, Barium double contrast, Enema administration, Endotracheal intubation

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 13     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None PMH: 35 wk preemie.
Allergies:
Diagnostic Lab Data: Radiologic confirmation of diagnosis LABS: US c/w IS. Multiple attempts to reduce IS w/air contrast enema unsuccessful. Abdominal x-ray abnormal w/dilated bowel loops & free air
CDC 'Split Type':

Write-up: Patient developed intussusception requiring surgical intervention on 6th day following vaccine admin. 11/25/08 Reviewed hospital medical record of 9/22-10/05/2008. FINAL DX: no d/c summary available. Admitted for intussusception; exp laparotomy w/ileoc"ecectomy w/primary anastamosis; inverted Meckel''''s diverticulum. Records reveal patient experienced bloody stools Tx w/parenteral nutrition, NGT, narcotic pain meds. Failed diet progression, developed firm abd distention, increased pain & irritability.


Changed on 12/8/2009

VAERS ID: 326271 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Connecticut
Vaccinated:2008-09-15
Onset:2008-09-22
Submitted:2008-09-25
Entered:2008-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B156BA / 1 LL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B156BA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF472AB / 1 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C50457 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0692X / 1 - / PO

Administered by: Public      Purchased by: Unknown Public
Symptoms: Abdominal distension, Abdominal pain, Barium double contrast, Extubation, Haematochezia, Ileus, Intensive care, Intussusception, Irritability, Surgery, Vomiting, X-ray abnormal, Enema administration, Parenteral nutrition, Ultrasound abdomen abnormal, Gastrointestinal tube insertion, Explorative laparotomy, Intestinal anastomosis, Vitello-intestinal duct remnant, Endotracheal intubation, Intestinal anastomosis complication

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 13     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None PMH: 35 wk preemie.
Allergies:
Diagnostic Lab Data: Radiologic confirmation of diagnosis LABS: US c/w IS. Multiple attempts to reduce IS w/air contrast enema unsuccessful. Abdominal x-ray abnormal w/dilated bowel loops & free air
CDC 'Split Type':

Write-up: Patient developed intussusception requiring surgical intervention on 6th day following vaccine admin. 11/25/08 Reviewed hospital medical record of 9/22-10/05/2008. FINAL DX: no d/c summary available. Admitted for intussusception; exp laparotomy w/ileoc"ecectomy w/ileocecectomy w/primary anastamosis; inverted Meckel''''s Meckel''s diverticulum. Records reveal patient experienced bloody stools Tx w/parenteral nutrition, NGT, narcotic pain meds. Failed diet progression, developed firm abd distention, increased pain & irritability. Dx w/postop ileus. Returned to OR for re-exploration & repair of anastamotic leak 9/28, remained intubated & admitted to PICU. Had bilious emesis prior to intubation & concerned for aspiration. Extubated by next day & transferred to regular floor. Progressed well, tolerated oral feeds, completed antibiotics & d/c to home .


Changed on 3/2/2010

VAERS ID: 326271 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Connecticut
Vaccinated:2008-09-15
Onset:2008-09-22
Submitted:2008-09-25
Entered:2008-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B156BA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF472AB / 1 RL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC C50457 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0692X / 1 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Abdominal distension, Abdominal pain, Barium double contrast, Extubation, Haematochezia, Ileus, Intensive care, Intussusception, Irritability, Surgery, Vomiting, X-ray abnormal, Enema administration, Parenteral nutrition, Ultrasound abdomen abnormal, Gastrointestinal tube insertion, Explorative laparotomy, Intestinal anastomosis, Vitello-intestinal duct remnant, Endotracheal intubation, Intestinal anastomosis complication

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 13     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None PMH: 35 wk preemie.
Allergies:
Diagnostic Lab Data: Radiologic confirmation of diagnosis LABS: US c/w IS. Multiple attempts to reduce IS w/air contrast enema unsuccessful. Abdominal x-ray abnormal w/dilated bowel loops & free air
CDC 'Split Type':

Write-up: Patient developed intussusception requiring surgical intervention on 6th day following vaccine admin. 11/25/08 Reviewed hospital medical record of 9/22-10/05/2008. FINAL DX: no d/c summary available. Admitted for intussusception; exp laparotomy w/ileocecectomy w/primary anastamosis; inverted Meckel''s diverticulum. Records reveal patient experienced bloody stools Tx w/parenteral nutrition, NGT, narcotic pain meds. Failed diet progression, developed firm abd distention, increased pain & irritability. Dx w/postop ileus. Returned to OR for re-exploration & repair of anastamotic leak 9/28, remained intubated & admitted to PICU. Had bilious emesis prior to intubation & concerned for aspiration. Extubated by next day & transferred to regular floor. Progressed well, tolerated oral feeds, completed antibiotics & d/c to home .


Changed on 4/7/2010

VAERS ID: 326271 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Connecticut
Vaccinated:2008-09-15
Onset:2008-09-22
Submitted:2008-09-25
Entered:2008-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B156BA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF472AB / 1 RL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C50457 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0692X / 1 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Abdominal distension, Abdominal pain, Barium double contrast, Extubation, Haematochezia, Ileus, Intensive care, Intussusception, Irritability, Surgery, Vomiting, X-ray abnormal, Enema administration, Parenteral nutrition, Ultrasound abdomen abnormal, Gastrointestinal tube insertion, Explorative laparotomy, Intestinal anastomosis, Vitello-intestinal duct remnant, Endotracheal intubation, Intestinal anastomosis complication

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 13     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None PMH: 35 wk preemie.
Allergies:
Diagnostic Lab Data: Radiologic confirmation of diagnosis LABS: US c/w IS. Multiple attempts to reduce IS w/air contrast enema unsuccessful. Abdominal x-ray abnormal w/dilated bowel loops & free air
CDC 'Split Type':

Write-up: Patient developed intussusception requiring surgical intervention on 6th day following vaccine admin. 11/25/08 Reviewed hospital medical record of 9/22-10/05/2008. FINAL DX: no d/c summary available. Admitted for intussusception; exp laparotomy w/ileocecectomy w/primary anastamosis; inverted Meckel''s diverticulum. Records reveal patient experienced bloody stools Tx w/parenteral nutrition, NGT, narcotic pain meds. Failed diet progression, developed firm abd distention, increased pain & irritability. Dx w/postop ileus. Returned to OR for re-exploration & repair of anastamotic leak 9/28, remained intubated & admitted to PICU. Had bilious emesis prior to intubation & concerned for aspiration. Extubated by next day & transferred to regular floor. Progressed well, tolerated oral feeds, completed antibiotics & d/c to home .


Changed on 8/31/2010

VAERS ID: 326271 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Connecticut
Vaccinated:2008-09-15
Onset:2008-09-22
Submitted:2008-09-25
Entered:2008-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B156BA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF472AB / 1 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH C50457 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0692X / 1 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Abdominal distension, Abdominal pain, Barium double contrast, Extubation, Haematochezia, Ileus, Intensive care, Intussusception, Irritability, Surgery, Vomiting, X-ray abnormal, Enema administration, Parenteral nutrition, Ultrasound abdomen abnormal, Gastrointestinal tube insertion, Explorative laparotomy, Intestinal anastomosis, Vitello-intestinal duct remnant, Endotracheal intubation, Intestinal anastomosis complication

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 13     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None PMH: 35 wk preemie.
Allergies:
Diagnostic Lab Data: Radiologic confirmation of diagnosis LABS: US c/w IS. Multiple attempts to reduce IS w/air contrast enema unsuccessful. Abdominal x-ray abnormal w/dilated bowel loops & free air
CDC 'Split Type':

Write-up: Patient developed intussusception requiring surgical intervention on 6th day following vaccine admin. 11/25/08 Reviewed hospital medical record of 9/22-10/05/2008. FINAL DX: no d/c summary available. Admitted for intussusception; exp laparotomy w/ileocecectomy w/primary anastamosis; inverted Meckel''s diverticulum. Records reveal patient experienced bloody stools Tx w/parenteral nutrition, NGT, narcotic pain meds. Failed diet progression, developed firm abd distention, increased pain & irritability. Dx w/postop ileus. Returned to OR for re-exploration & repair of anastamotic leak 9/28, remained intubated & admitted to PICU. Had bilious emesis prior to intubation & concerned for aspiration. Extubated by next day & transferred to regular floor. Progressed well, tolerated oral feeds, completed antibiotics & d/c to home .


Changed on 5/13/2013

VAERS ID: 326271 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Connecticut
Vaccinated:2008-09-15
Onset:2008-09-22
Submitted:2008-09-25
Entered:2008-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B156BA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF472AB / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C50457 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0692X / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0692X / 1 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Abdominal distension, Abdominal pain, Barium double contrast, Extubation, Haematochezia, Ileus, Intensive care, Intussusception, Irritability, Surgery, Vomiting, X-ray abnormal, Enema administration, Parenteral nutrition, Ultrasound abdomen abnormal, Gastrointestinal tube insertion, Explorative laparotomy, Intestinal anastomosis, Vitello-intestinal duct remnant, Endotracheal intubation, Intestinal anastomosis complication

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 13     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None PMH: 35 wk preemie.
Allergies:
Diagnostic Lab Data: Radiologic confirmation of diagnosis LABS: US c/w IS. Multiple attempts to reduce IS w/air contrast enema unsuccessful. Abdominal x-ray abnormal w/dilated bowel loops & free air
CDC 'Split Type':

Write-up: Patient developed intussusception requiring surgical intervention on 6th day following vaccine admin. 11/25/08 Reviewed hospital medical record of 9/22-10/05/2008. FINAL DX: no d/c summary available. Admitted for intussusception; exp laparotomy w/ileocecectomy w/primary anastamosis; inverted Meckel''s diverticulum. Records reveal patient experienced bloody stools Tx w/parenteral nutrition, NGT, narcotic pain meds. Failed diet progression, developed firm abd distention, increased pain & irritability. Dx w/postop ileus. Returned to OR for re-exploration & repair of anastamotic leak 9/28, remained intubated & admitted to PICU. Had bilious emesis prior to intubation & concerned for aspiration. Extubated by next day & transferred to regular floor. Progressed well, tolerated oral feeds, completed antibiotics & d/c to home .


Changed on 4/14/2017

VAERS ID: 326271 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Connecticut
Vaccinated:2008-09-15
Onset:2008-09-22
Submitted:2008-09-25
Entered:2008-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B156BA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF472AB / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C50457 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0692X / 1 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Abdominal distension, Abdominal pain, Barium double contrast, Extubation, Haematochezia, Ileus, Intensive care, Intussusception, Irritability, Surgery, Vomiting, X-ray abnormal, Enema administration, Parenteral nutrition, Ultrasound abdomen abnormal, Gastrointestinal tube insertion, Explorative laparotomy, Intestinal anastomosis, Vitello-intestinal duct remnant, Endotracheal intubation, Intestinal anastomosis complication

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 13     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None PMH: 35 wk preemie.
Allergies:
Diagnostic Lab Data: Radiologic confirmation of diagnosis LABS: US c/w IS. Multiple attempts to reduce IS w/air contrast enema unsuccessful. Abdominal x-ray abnormal w/dilated bowel loops & free air
CDC 'Split Type':

Write-up: Patient developed intussusception requiring surgical intervention on 6th day following vaccine admin. 11/25/08 Reviewed hospital medical record of 9/22-10/05/2008. FINAL DX: no d/c summary available. Admitted for intussusception; exp laparotomy w/ileocecectomy w/primary anastamosis; inverted Meckel''s diverticulum. Records reveal patient experienced bloody stools Tx w/parenteral nutrition, NGT, narcotic pain meds. Failed diet progression, developed firm abd distention, increased pain & irritability. Dx w/postop ileus. Returned to OR for re-exploration & repair of anastamotic leak 9/28, remained intubated & admitted to PICU. Had bilious emesis prior to intubation & concerned for aspiration. Extubated by next day & transferred to regular floor. Progressed well, tolerated oral feeds, completed antibiotics & d/c to home .


Changed on 9/14/2017

VAERS ID: 326271 Before After
VAERS Form:(blank) 1
Age:0.4
Gender:Female
Location:Connecticut
Vaccinated:2008-09-15
Onset:2008-09-22
Submitted:2008-09-25
Entered:2008-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B156BA / 1 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF472AB / 1 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C50457 / 1 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0692X / 1 2 - MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Intussusception, Surgery, X-ray 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 13     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None PMH: 35 wk preemie.
Allergies:
Diagnostic Lab Data: Radiologic confirmation of diagnosis LABS: US c/w IS. Multiple attempts to reduce IS w/air contrast enema unsuccessful. Abdominal x-ray abnormal w/dilated bowel loops & free air
CDC 'Split Type':

Write-up: Patient developed intussusception requiring surgical intervention on 6th day following vaccine admin. 11/25/08 Reviewed hospital medical record of 9/22-10/05/2008. FINAL DX: no d/c summary available. Admitted for intussusception; exp laparotomy w/ileocecectomy w/primary anastamosis; inverted Meckel''s diverticulum. Records reveal patient experienced bloody stools Tx w/parenteral nutrition, NGT, narcotic pain meds. Failed diet progression, developed firm abd distention, increased pain & irritability. Dx w/postop ileus. Returned to OR for re-exploration & repair of anastamotic leak 9/28, remained intubated & admitted to PICU. Had bilious emesis prior to intubation & concerned for aspiration. Extubated by next day & transferred to regular floor. Progressed well, tolerated oral feeds, completed antibiotics & d/c to home .


Changed on 2/14/2018

VAERS ID: 326271 Before After
VAERS Form:1
Age:0.4
Gender:Female
Location:Connecticut
Vaccinated:2008-09-15
Onset:2008-09-22
Submitted:2008-09-25
Entered:2008-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B156BA / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF472AB / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C50457 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0692X / 2 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Intussusception, Surgery, X-ray 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 13     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None PMH: 35 wk preemie.
Allergies:
Diagnostic Lab Data: Radiologic confirmation of diagnosis LABS: US c/w IS. Multiple attempts to reduce IS w/air contrast enema unsuccessful. Abdominal x-ray abnormal w/dilated bowel loops & free air
CDC 'Split Type':

Write-up: Patient developed intussusception requiring surgical intervention on 6th day following vaccine admin. 11/25/08 Reviewed hospital medical record of 9/22-10/05/2008. FINAL DX: no d/c summary available. Admitted for intussusception; exp laparotomy w/ileocecectomy w/primary anastamosis; inverted Meckel''s diverticulum. Records reveal patient experienced bloody stools Tx w/parenteral nutrition, NGT, narcotic pain meds. Failed diet progression, developed firm abd distention, increased pain & irritability. Dx w/postop ileus. Returned to OR for re-exploration & repair of anastamotic leak 9/28, remained intubated & admitted to PICU. Had bilious emesis prior to intubation & concerned for aspiration. Extubated by next day & transferred to regular floor. Progressed well, tolerated oral feeds, completed antibiotics & d/c to home .


Changed on 6/14/2018

VAERS ID: 326271 Before After
VAERS Form:1
Age:0.4
Gender:Female
Location:Connecticut
Vaccinated:2008-09-15
Onset:2008-09-22
Submitted:2008-09-25
Entered:2008-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B156BA / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF472AB / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C50457 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0692X / 2 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Intussusception, Surgery, X-ray 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 13     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None PMH: 35 wk preemie.
Allergies:
Diagnostic Lab Data: Radiologic confirmation of diagnosis LABS: US c/w IS. Multiple attempts to reduce IS w/air contrast enema unsuccessful. Abdominal x-ray abnormal w/dilated bowel loops & free air
CDC 'Split Type':

Write-up: Patient developed intussusception requiring surgical intervention on 6th day following vaccine admin. 11/25/08 Reviewed hospital medical record of 9/22-10/05/2008. FINAL DX: no d/c summary available. Admitted for intussusception; exp laparotomy w/ileocecectomy w/primary anastamosis; inverted Meckel''s diverticulum. Records reveal patient experienced bloody stools Tx w/parenteral nutrition, NGT, narcotic pain meds. Failed diet progression, developed firm abd distention, increased pain & irritability. Dx w/postop ileus. Returned to OR for re-exploration & repair of anastamotic leak 9/28, remained intubated & admitted to PICU. Had bilious emesis prior to intubation & concerned for aspiration. Extubated by next day & transferred to regular floor. Progressed well, tolerated oral feeds, completed antibiotics & d/c to home .


Changed on 8/14/2018

VAERS ID: 326271 Before After
VAERS Form:1
Age:0.4
Gender:Female
Location:Connecticut
Vaccinated:2008-09-15
Onset:2008-09-22
Submitted:2008-09-25
Entered:2008-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B156BA / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF472AB / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C50457 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0692X / 2 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Intussusception, Surgery, X-ray 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 13     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None PMH: 35 wk preemie.
Allergies:
Diagnostic Lab Data: Radiologic confirmation of diagnosis LABS: US c/w IS. Multiple attempts to reduce IS w/air contrast enema unsuccessful. Abdominal x-ray abnormal w/dilated bowel loops & free air
CDC 'Split Type':

Write-up: Patient developed intussusception requiring surgical intervention on 6th day following vaccine admin. 11/25/08 Reviewed hospital medical record of 9/22-10/05/2008. FINAL DX: no d/c summary available. Admitted for intussusception; exp laparotomy w/ileocecectomy w/primary anastamosis; inverted Meckel''s diverticulum. Records reveal patient experienced bloody stools Tx w/parenteral nutrition, NGT, narcotic pain meds. Failed diet progression, developed firm abd distention, increased pain & irritability. Dx w/postop ileus. Returned to OR for re-exploration & repair of anastamotic leak 9/28, remained intubated & admitted to PICU. Had bilious emesis prior to intubation & concerned for aspiration. Extubated by next day & transferred to regular floor. Progressed well, tolerated oral feeds, completed antibiotics & d/c to home .


Changed on 9/14/2018

VAERS ID: 326271 Before After
VAERS Form:1
Age:0.4
Gender:Female
Location:Connecticut
Vaccinated:2008-09-15
Onset:2008-09-22
Submitted:2008-09-25
Entered:2008-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B156BA / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF472AB / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C50457 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0692X / 2 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Intussusception, Surgery, X-ray 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 13     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None PMH: 35 wk preemie.
Allergies:
Diagnostic Lab Data: Radiologic confirmation of diagnosis LABS: US c/w IS. Multiple attempts to reduce IS w/air contrast enema unsuccessful. Abdominal x-ray abnormal w/dilated bowel loops & free air
CDC 'Split Type':

Write-up: Patient developed intussusception requiring surgical intervention on 6th day following vaccine admin. 11/25/08 Reviewed hospital medical record of 9/22-10/05/2008. FINAL DX: no d/c summary available. Admitted for intussusception; exp laparotomy w/ileocecectomy w/primary anastamosis; inverted Meckel''s diverticulum. Records reveal patient experienced bloody stools Tx w/parenteral nutrition, NGT, narcotic pain meds. Failed diet progression, developed firm abd distention, increased pain & irritability. Dx w/postop ileus. Returned to OR for re-exploration & repair of anastamotic leak 9/28, remained intubated & admitted to PICU. Had bilious emesis prior to intubation & concerned for aspiration. Extubated by next day & transferred to regular floor. Progressed well, tolerated oral feeds, completed antibiotics & d/c to home .


Changed on 10/14/2018

VAERS ID: 326271 Before After
VAERS Form:1
Age:0.4
Gender:Female
Location:Connecticut
Vaccinated:2008-09-15
Onset:2008-09-22
Submitted:2008-09-25
Entered:2008-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B156BA / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF472AB / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C50457 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0692X / 2 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Intussusception, Surgery, X-ray 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 13     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None PMH: 35 wk preemie.
Allergies:
Diagnostic Lab Data: Radiologic confirmation of diagnosis LABS: US c/w IS. Multiple attempts to reduce IS w/air contrast enema unsuccessful. Abdominal x-ray abnormal w/dilated bowel loops & free air
CDC 'Split Type':

Write-up: Patient developed intussusception requiring surgical intervention on 6th day following vaccine admin. 11/25/08 Reviewed hospital medical record of 9/22-10/05/2008. FINAL DX: no d/c summary available. Admitted for intussusception; exp laparotomy w/ileocecectomy w/primary anastamosis; inverted Meckel''s diverticulum. Records reveal patient experienced bloody stools Tx w/parenteral nutrition, NGT, narcotic pain meds. Failed diet progression, developed firm abd distention, increased pain & irritability. Dx w/postop ileus. Returned to OR for re-exploration & repair of anastamotic leak 9/28, remained intubated & admitted to PICU. Had bilious emesis prior to intubation & concerned for aspiration. Extubated by next day & transferred to regular floor. Progressed well, tolerated oral feeds, completed antibiotics & d/c to home .

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