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This is VAERS ID 326440

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 326440
VAERS Form:
Age:0.3
Sex:Female
Location:Florida
Vaccinated:2008-06-03
Onset:2008-07-08
Submitted:2008-09-29
Entered:2008-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF349AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C45887 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1830U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Constipation, Diarrhoea, Enema administration, Explorative laparotomy

Life Threatening? Yes
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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: REFLUX, BUT OFF MEDS AND DOING WELL
Allergies:
Diagnostic Lab Data: LABS: air enema (+) for IS but could not reduce.
CDC 'Split Type':

Write-up: INFANT DEVELOPED VOMITING, DIARRHEA, AND ABDOMINAL DISTENTION 1 MONTH AND 1 WEEK POST VACCINE ADMINISTRATION, AND WAS DIAGNOSED WITH INTRASUCCEPTION REQUIRING EMERGENCY SURGERY. 10/3/08 Reviewed hospital D/C summary of 7/11-7/17/2008. FINAL DX: Intussusc"eption, exp lap w/small bowel resection & primary anastomosis Records reveal patient experienced fever & persistent emesis x 3-4 days, constipation, lethargy, abdominal distended & taut, dark red stool. Findings in OR included small segment of necrotic b


Changed on 12/8/2009

VAERS ID: 326440 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:Florida
Vaccinated:2008-06-03
Onset:2008-07-08
Submitted:2008-09-29
Entered:2008-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 1 RL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF349AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C45887 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1830U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Constipation, Diarrhoea, Gastrointestinal necrosis, Haematochezia, Intensive care, Intussusception, Lethargy, Pyrexia, Small intestinal resection, Surgery, Vomiting, Enema administration, Parenteral nutrition, Necrotising colitis, Explorative laparotomy, Intestinal anastomosis

Life Threatening? Yes
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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: REFLUX, BUT OFF MEDS AND DOING WELL
Allergies:
Diagnostic Lab Data: LABS: air enema (+) for IS but could not reduce.
CDC 'Split Type':

Write-up: INFANT DEVELOPED VOMITING, DIARRHEA, AND ABDOMINAL DISTENTION 1 MONTH AND 1 WEEK POST VACCINE ADMINISTRATION, AND WAS DIAGNOSED WITH INTRASUCCEPTION REQUIRING EMERGENCY SURGERY. 10/3/08 Reviewed hospital D/C summary of 7/11-7/17/2008. FINAL DX: Intussusc"eption, Intussusception, exp lap w/small bowel resection & primary anastomosis Records reveal patient experienced fever & persistent emesis x 3-4 days, constipation, lethargy, abdominal distended & taut, dark red stool. Findings in OR included small segment of necrotic b bowel which was resected. Admitted PICU, PICC line placed & started on parenteral nutrition. Gradually returned to normal BMs & diet advanced fo full formula. D/C to home w/surgery clinic f/u. 10/17/08 Reviewed additional hospital records of 7/11-7/17/2008. Included path report which reveals necrotizing entercolitis.


Changed on 3/2/2010

VAERS ID: 326440 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:Florida
Vaccinated:2008-06-03
Onset:2008-07-08
Submitted:2008-09-29
Entered:2008-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF349AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC C45887 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1830U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Constipation, Diarrhoea, Gastrointestinal necrosis, Haematochezia, Intensive care, Intussusception, Lethargy, Pyrexia, Small intestinal resection, Surgery, Vomiting, Enema administration, Parenteral nutrition, Necrotising colitis, Explorative laparotomy, Intestinal anastomosis

Life Threatening? Yes
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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: REFLUX, BUT OFF MEDS AND DOING WELL
Allergies:
Diagnostic Lab Data: LABS: air enema (+) for IS but could not reduce.
CDC 'Split Type':

Write-up: INFANT DEVELOPED VOMITING, DIARRHEA, AND ABDOMINAL DISTENTION 1 MONTH AND 1 WEEK POST VACCINE ADMINISTRATION, AND WAS DIAGNOSED WITH INTRASUCCEPTION REQUIRING EMERGENCY SURGERY. 10/3/08 Reviewed hospital D/C summary of 7/11-7/17/2008. FINAL DX: Intussusception, exp lap w/small bowel resection & primary anastomosis Records reveal patient experienced fever & persistent emesis x 3-4 days, constipation, lethargy, abdominal distended & taut, dark red stool. Findings in OR included small segment of necrotic bowel which was resected. Admitted PICU, PICC line placed & started on parenteral nutrition. Gradually returned to normal BMs & diet advanced fo full formula. D/C to home w/surgery clinic f/u. 10/17/08 Reviewed additional hospital records of 7/11-7/17/2008. Included path report which reveals necrotizing entercolitis.


Changed on 4/7/2010

VAERS ID: 326440 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:Florida
Vaccinated:2008-06-03
Onset:2008-07-08
Submitted:2008-09-29
Entered:2008-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF349AA / 1 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C45887 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1830U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Constipation, Diarrhoea, Gastrointestinal necrosis, Haematochezia, Intensive care, Intussusception, Lethargy, Pyrexia, Small intestinal resection, Surgery, Vomiting, Enema administration, Parenteral nutrition, Necrotising colitis, Explorative laparotomy, Intestinal anastomosis

Life Threatening? Yes
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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: REFLUX, BUT OFF MEDS AND DOING WELL
Allergies:
Diagnostic Lab Data: LABS: air enema (+) for IS but could not reduce.
CDC 'Split Type':

Write-up: INFANT DEVELOPED VOMITING, DIARRHEA, AND ABDOMINAL DISTENTION 1 MONTH AND 1 WEEK POST VACCINE ADMINISTRATION, AND WAS DIAGNOSED WITH INTRASUCCEPTION REQUIRING EMERGENCY SURGERY. 10/3/08 Reviewed hospital D/C summary of 7/11-7/17/2008. FINAL DX: Intussusception, exp lap w/small bowel resection & primary anastomosis Records reveal patient experienced fever & persistent emesis x 3-4 days, constipation, lethargy, abdominal distended & taut, dark red stool. Findings in OR included small segment of necrotic bowel which was resected. Admitted PICU, PICC line placed & started on parenteral nutrition. Gradually returned to normal BMs & diet advanced fo full formula. D/C to home w/surgery clinic f/u. 10/17/08 Reviewed additional hospital records of 7/11-7/17/2008. Included path report which reveals necrotizing entercolitis.


Changed on 8/31/2010

VAERS ID: 326440 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:Florida
Vaccinated:2008-06-03
Onset:2008-07-08
Submitted:2008-09-29
Entered:2008-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF349AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH C45887 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1830U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Constipation, Diarrhoea, Gastrointestinal necrosis, Haematochezia, Intensive care, Intussusception, Lethargy, Pyrexia, Small intestinal resection, Surgery, Vomiting, Enema administration, Parenteral nutrition, Necrotising colitis, Explorative laparotomy, Intestinal anastomosis

Life Threatening? Yes
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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: REFLUX, BUT OFF MEDS AND DOING WELL
Allergies:
Diagnostic Lab Data: LABS: air enema (+) for IS but could not reduce.
CDC 'Split Type':

Write-up: INFANT DEVELOPED VOMITING, DIARRHEA, AND ABDOMINAL DISTENTION 1 MONTH AND 1 WEEK POST VACCINE ADMINISTRATION, AND WAS DIAGNOSED WITH INTRASUCCEPTION REQUIRING EMERGENCY SURGERY. 10/3/08 Reviewed hospital D/C summary of 7/11-7/17/2008. FINAL DX: Intussusception, exp lap w/small bowel resection & primary anastomosis Records reveal patient experienced fever & persistent emesis x 3-4 days, constipation, lethargy, abdominal distended & taut, dark red stool. Findings in OR included small segment of necrotic bowel which was resected. Admitted PICU, PICC line placed & started on parenteral nutrition. Gradually returned to normal BMs & diet advanced fo full formula. D/C to home w/surgery clinic f/u. 10/17/08 Reviewed additional hospital records of 7/11-7/17/2008. Included path report which reveals necrotizing entercolitis.


Changed on 5/13/2013

VAERS ID: 326440 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:Florida
Vaccinated:2008-06-03
Onset:2008-07-08
Submitted:2008-09-29
Entered:2008-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF349AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45887 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1830U / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1830U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Constipation, Diarrhoea, Gastrointestinal necrosis, Haematochezia, Intensive care, Intussusception, Lethargy, Pyrexia, Small intestinal resection, Surgery, Vomiting, Enema administration, Parenteral nutrition, Necrotising colitis, Explorative laparotomy, Intestinal anastomosis

Life Threatening? Yes
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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: REFLUX, BUT OFF MEDS AND DOING WELL
Allergies:
Diagnostic Lab Data: LABS: air enema (+) for IS but could not reduce.
CDC 'Split Type':

Write-up: INFANT DEVELOPED VOMITING, DIARRHEA, AND ABDOMINAL DISTENTION 1 MONTH AND 1 WEEK POST VACCINE ADMINISTRATION, AND WAS DIAGNOSED WITH INTRASUCCEPTION REQUIRING EMERGENCY SURGERY. 10/3/08 Reviewed hospital D/C summary of 7/11-7/17/2008. FINAL DX: Intussusception, exp lap w/small bowel resection & primary anastomosis Records reveal patient experienced fever & persistent emesis x 3-4 days, constipation, lethargy, abdominal distended & taut, dark red stool. Findings in OR included small segment of necrotic bowel which was resected. Admitted PICU, PICC line placed & started on parenteral nutrition. Gradually returned to normal BMs & diet advanced fo full formula. D/C to home w/surgery clinic f/u. 10/17/08 Reviewed additional hospital records of 7/11-7/17/2008. Included path report which reveals necrotizing entercolitis.


Changed on 4/14/2017

VAERS ID: 326440 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:Florida
Vaccinated:2008-06-03
Onset:2008-07-08
Submitted:2008-09-29
Entered:2008-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF349AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45887 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1830U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Constipation, Diarrhoea, Gastrointestinal necrosis, Haematochezia, Intensive care, Intussusception, Lethargy, Pyrexia, Small intestinal resection, Surgery, Vomiting, Enema administration, Parenteral nutrition, Necrotising colitis, Explorative laparotomy, Intestinal anastomosis

Life Threatening? Yes
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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: REFLUX, BUT OFF MEDS AND DOING WELL
Allergies:
Diagnostic Lab Data: LABS: air enema (+) for IS but could not reduce.
CDC 'Split Type':

Write-up: INFANT DEVELOPED VOMITING, DIARRHEA, AND ABDOMINAL DISTENTION 1 MONTH AND 1 WEEK POST VACCINE ADMINISTRATION, AND WAS DIAGNOSED WITH INTRASUCCEPTION REQUIRING EMERGENCY SURGERY. 10/3/08 Reviewed hospital D/C summary of 7/11-7/17/2008. FINAL DX: Intussusception, exp lap w/small bowel resection & primary anastomosis Records reveal patient experienced fever & persistent emesis x 3-4 days, constipation, lethargy, abdominal distended & taut, dark red stool. Findings in OR included small segment of necrotic bowel which was resected. Admitted PICU, PICC line placed & started on parenteral nutrition. Gradually returned to normal BMs & diet advanced fo full formula. D/C to home w/surgery clinic f/u. 10/17/08 Reviewed additional hospital records of 7/11-7/17/2008. Included path report which reveals necrotizing entercolitis.


Changed on 9/14/2017

VAERS ID: 326440 Before After
VAERS Form:(blank) 1
Age:0.3
Sex:Female
Location:Florida
Vaccinated:2008-06-03
Onset:2008-07-08
Submitted:2008-09-29
Entered:2008-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 1 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF349AA / 1 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45887 / 1 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1830U / 1 2 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Diarrhoea, Intussusception, Surgery, Vomiting

Life Threatening? Yes
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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: REFLUX, BUT OFF MEDS AND DOING WELL
Allergies:
Diagnostic Lab Data: LABS: air enema (+) for IS but could not reduce.
CDC 'Split Type':

Write-up: INFANT DEVELOPED VOMITING, DIARRHEA, AND ABDOMINAL DISTENTION 1 MONTH AND 1 WEEK POST VACCINE ADMINISTRATION, AND WAS DIAGNOSED WITH INTRASUCCEPTION REQUIRING EMERGENCY SURGERY. 10/3/08 Reviewed hospital D/C summary of 7/11-7/17/2008. FINAL DX: Intussusception, exp lap w/small bowel resection & primary anastomosis Records reveal patient experienced fever & persistent emesis x 3-4 days, constipation, lethargy, abdominal distended & taut, dark red stool. Findings in OR included small segment of necrotic bowel which was resected. Admitted PICU, PICC line placed & started on parenteral nutrition. Gradually returned to normal BMs & diet advanced fo full formula. D/C to home w/surgery clinic f/u. 10/17/08 Reviewed additional hospital records of 7/11-7/17/2008. Included path report which reveals necrotizing entercolitis.


Changed on 2/14/2018

VAERS ID: 326440 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:Florida
Vaccinated:2008-06-03
Onset:2008-07-08
Submitted:2008-09-29
Entered:2008-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF349AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45887 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1830U / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Diarrhoea, Intussusception, Surgery, Vomiting

Life Threatening? Yes
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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: REFLUX, BUT OFF MEDS AND DOING WELL
Allergies:
Diagnostic Lab Data: LABS: air enema (+) for IS but could not reduce.
CDC 'Split Type':

Write-up: INFANT DEVELOPED VOMITING, DIARRHEA, AND ABDOMINAL DISTENTION 1 MONTH AND 1 WEEK POST VACCINE ADMINISTRATION, AND WAS DIAGNOSED WITH INTRASUCCEPTION REQUIRING EMERGENCY SURGERY. 10/3/08 Reviewed hospital D/C summary of 7/11-7/17/2008. FINAL DX: Intussusception, exp lap w/small bowel resection & primary anastomosis Records reveal patient experienced fever & persistent emesis x 3-4 days, constipation, lethargy, abdominal distended & taut, dark red stool. Findings in OR included small segment of necrotic bowel which was resected. Admitted PICU, PICC line placed & started on parenteral nutrition. Gradually returned to normal BMs & diet advanced fo full formula. D/C to home w/surgery clinic f/u. 10/17/08 Reviewed additional hospital records of 7/11-7/17/2008. Included path report which reveals necrotizing entercolitis.


Changed on 6/14/2018

VAERS ID: 326440 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:Florida
Vaccinated:2008-06-03
Onset:2008-07-08
Submitted:2008-09-29
Entered:2008-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF349AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45887 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1830U / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Diarrhoea, Intussusception, Surgery, Vomiting

Life Threatening? Yes
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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: REFLUX, BUT OFF MEDS AND DOING WELL
Allergies:
Diagnostic Lab Data: LABS: air enema (+) for IS but could not reduce.
CDC 'Split Type':

Write-up: INFANT DEVELOPED VOMITING, DIARRHEA, AND ABDOMINAL DISTENTION 1 MONTH AND 1 WEEK POST VACCINE ADMINISTRATION, AND WAS DIAGNOSED WITH INTRASUCCEPTION REQUIRING EMERGENCY SURGERY. 10/3/08 Reviewed hospital D/C summary of 7/11-7/17/2008. FINAL DX: Intussusception, exp lap w/small bowel resection & primary anastomosis Records reveal patient experienced fever & persistent emesis x 3-4 days, constipation, lethargy, abdominal distended & taut, dark red stool. Findings in OR included small segment of necrotic bowel which was resected. Admitted PICU, PICC line placed & started on parenteral nutrition. Gradually returned to normal BMs & diet advanced fo full formula. D/C to home w/surgery clinic f/u. 10/17/08 Reviewed additional hospital records of 7/11-7/17/2008. Included path report which reveals necrotizing entercolitis.


Changed on 8/14/2018

VAERS ID: 326440 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:Florida
Vaccinated:2008-06-03
Onset:2008-07-08
Submitted:2008-09-29
Entered:2008-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF349AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45887 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1830U / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Diarrhoea, Intussusception, Surgery, Vomiting

Life Threatening? Yes
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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: REFLUX, BUT OFF MEDS AND DOING WELL
Allergies:
Diagnostic Lab Data: LABS: air enema (+) for IS but could not reduce.
CDC 'Split Type':

Write-up: INFANT DEVELOPED VOMITING, DIARRHEA, AND ABDOMINAL DISTENTION 1 MONTH AND 1 WEEK POST VACCINE ADMINISTRATION, AND WAS DIAGNOSED WITH INTRASUCCEPTION REQUIRING EMERGENCY SURGERY. 10/3/08 Reviewed hospital D/C summary of 7/11-7/17/2008. FINAL DX: Intussusception, exp lap w/small bowel resection & primary anastomosis Records reveal patient experienced fever & persistent emesis x 3-4 days, constipation, lethargy, abdominal distended & taut, dark red stool. Findings in OR included small segment of necrotic bowel which was resected. Admitted PICU, PICC line placed & started on parenteral nutrition. Gradually returned to normal BMs & diet advanced fo full formula. D/C to home w/surgery clinic f/u. 10/17/08 Reviewed additional hospital records of 7/11-7/17/2008. Included path report which reveals necrotizing entercolitis.


Changed on 9/14/2018

VAERS ID: 326440 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:Florida
Vaccinated:2008-06-03
Onset:2008-07-08
Submitted:2008-09-29
Entered:2008-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF349AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45887 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1830U / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Diarrhoea, Intussusception, Surgery, Vomiting

Life Threatening? Yes
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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: REFLUX, BUT OFF MEDS AND DOING WELL
Allergies:
Diagnostic Lab Data: LABS: air enema (+) for IS but could not reduce.
CDC 'Split Type':

Write-up: INFANT DEVELOPED VOMITING, DIARRHEA, AND ABDOMINAL DISTENTION 1 MONTH AND 1 WEEK POST VACCINE ADMINISTRATION, AND WAS DIAGNOSED WITH INTRASUCCEPTION REQUIRING EMERGENCY SURGERY. 10/3/08 Reviewed hospital D/C summary of 7/11-7/17/2008. FINAL DX: Intussusception, exp lap w/small bowel resection & primary anastomosis Records reveal patient experienced fever & persistent emesis x 3-4 days, constipation, lethargy, abdominal distended & taut, dark red stool. Findings in OR included small segment of necrotic bowel which was resected. Admitted PICU, PICC line placed & started on parenteral nutrition. Gradually returned to normal BMs & diet advanced fo full formula. D/C to home w/surgery clinic f/u. 10/17/08 Reviewed additional hospital records of 7/11-7/17/2008. Included path report which reveals necrotizing entercolitis.


Changed on 10/14/2018

VAERS ID: 326440 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:Florida
Vaccinated:2008-06-03
Onset:2008-07-08
Submitted:2008-09-29
Entered:2008-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF349AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45887 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1830U / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Diarrhoea, Intussusception, Surgery, Vomiting

Life Threatening? Yes
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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: REFLUX, BUT OFF MEDS AND DOING WELL
Allergies:
Diagnostic Lab Data: LABS: air enema (+) for IS but could not reduce.
CDC 'Split Type':

Write-up: INFANT DEVELOPED VOMITING, DIARRHEA, AND ABDOMINAL DISTENTION 1 MONTH AND 1 WEEK POST VACCINE ADMINISTRATION, AND WAS DIAGNOSED WITH INTRASUCCEPTION REQUIRING EMERGENCY SURGERY. 10/3/08 Reviewed hospital D/C summary of 7/11-7/17/2008. FINAL DX: Intussusception, exp lap w/small bowel resection & primary anastomosis Records reveal patient experienced fever & persistent emesis x 3-4 days, constipation, lethargy, abdominal distended & taut, dark red stool. Findings in OR included small segment of necrotic bowel which was resected. Admitted PICU, PICC line placed & started on parenteral nutrition. Gradually returned to normal BMs & diet advanced fo full formula. D/C to home w/surgery clinic f/u. 10/17/08 Reviewed additional hospital records of 7/11-7/17/2008. Included path report which reveals necrotizing entercolitis.

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