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This is VAERS ID 335078

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

VAERS ID: 335078
VAERS Form:
Age:0.3
Gender:Male
Location:Foreign
Vaccinated:2008-11-14
Onset:2008-11-17
Submitted:2008-12-11
Entered:2008-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPPHIB: DTP + IPV + ACT-HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - LL / IM
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal distension, Activated partial thromboplastin time shortened, Alanine aminotransferase, Aspartate aminotransferase normal, Blood albumin decreased, Blood chloride normal, Blood creatinine increased, Blood glucose increased, Blood potassium normal, Blood sodium normal, Blood urea increased, Dehydration, Haematochezia, Haematocrit decreased, Haemoglobin normal, Intussusception, Irritability, Pallor, Protein total decreased, Prothrombin time normal, Pyrexia, Surgery, Vomiting, White blood cell count normal, X-ray abnormal, Platelet count increased, Ultrasound abdomen abnormal, Neutrophil percentage, Abdominal X-ray, Food intolerance, Gastrointestinal sounds abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal X-ray; 20Nov2008, See text; Activated partial thromboplast, 20Nov2008, 26.2Sec; Alanine aminotransferase, 20Nov2008, 41IU/L; Albumin, 20Nov2008, 4.2g/dL; Aspartate aminotransferase, 20Nov2008, 44U/L; Blood glucose, 20Nov2008, 99mg
CDC 'Split Type': B0549365A

Write-up: This case was reported by a physician in the frame of a study and described the occurrence of intussusception in a 4-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). The subject had no relevant history or allergy. Concurrent vaccination included DTaP-IPV-HIB (manufacturer unspecified; intramuscular; unknown injection site) given on 14 November 2008; pneumococcal vaccine (manufacturer unspecified; intramuscular; unknown injection site) given on 14 November 2008. On 14 November 2008, the subject received 1st dose of ROTARIX (oral, lot number not provided). On 17 November 2008, 3 days after vaccination with ROTARIX, the subject experienced irritability, intolerance to oral feeding, gastro alimentary vomiting, bloody stools and fever. She received ambulatory treatment with clotrimazole, Acetaminophen and electrolytes without improvement. On 20 November 2008, the subject was hospitalised. Physical exam was with dehydration, pallor, abdominal distension and decreased bowel sounds. Lab tests were performed and showed the following: Glucose: 99 mg/dL; Urea: 60 mg/dL; Urea Nitrogen: 28 mg/dL; Creatinine: 0.7 mg/dL; Total Protein: 0.72 g/dL; Albumin: 4.2 g/dL; Alanine aminotransferase: 41 U/L; Aspartate aminotransferase: 44 U/L; Sodium: 137 mEq/L; Potassium, 4.4 mEq/L; Chloride: 99 mEq/L; Hemoglobin: 11 g/dL; Hematocrit: 33%; Platelet count: 597000/mm3; Leucocytes count: 13900/mm3; Neutrophils percentage: 59%; Prothrombin Time: 11.6 Sec; Partial Thromboplastin Time: 26.2 Sec. Abdominal X-ray was performed and showed air fluid levels and data of intestinal obstruction. Abdominal ultrasound was performed and showed right flank with tubular mass in longitudinal views (pseudo kidney) and a target appearance in transverse images probably ileocolonic intussusception, dilated bowels. On 20 November 2008, surgery was performed; ilececolic intussusception was found and reduced by taxis without complications. On 24 November 2008, the subject was discharged in good clinical conditions. On 24 November 2008, th


Changed on 5/13/2013

VAERS ID: 335078 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Foreign
Vaccinated:2008-11-14
Onset:2008-11-17
Submitted:2008-12-11
Entered:2008-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPPHIB: DTP + IPV + ACT-HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - LL / IM
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 0 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal distension, Activated partial thromboplastin time shortened, Alanine aminotransferase, Aspartate aminotransferase normal, Blood albumin decreased, Blood chloride normal, Blood creatinine increased, Blood glucose increased, Blood potassium normal, Blood sodium normal, Blood urea increased, Dehydration, Haematochezia, Haematocrit decreased, Haemoglobin normal, Intussusception, Irritability, Pallor, Protein total decreased, Prothrombin time normal, Pyrexia, Surgery, Vomiting, White blood cell count normal, X-ray abnormal, Platelet count increased, Ultrasound abdomen abnormal, Neutrophil percentage, Abdominal X-ray, Food intolerance, Gastrointestinal sounds abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal X-ray; 20Nov2008, See text; Activated partial thromboplast, 20Nov2008, 26.2Sec; Alanine aminotransferase, 20Nov2008, 41IU/L; Albumin, 20Nov2008, 4.2g/dL; Aspartate aminotransferase, 20Nov2008, 44U/L; Blood glucose, 20Nov2008, 99mg
CDC 'Split Type': B0549365A

Write-up: This case was reported by a physician in the frame of a study and described the occurrence of intussusception in a 4-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). The subject had no relevant history or allergy. Concurrent vaccination included DTaP-IPV-HIB (manufacturer unspecified; intramuscular; unknown injection site) given on 14 November 2008; pneumococcal vaccine (manufacturer unspecified; intramuscular; unknown injection site) given on 14 November 2008. On 14 November 2008, the subject received 1st dose of ROTARIX (oral, lot number not provided). On 17 November 2008, 3 days after vaccination with ROTARIX, the subject experienced irritability, intolerance to oral feeding, gastro alimentary vomiting, bloody stools and fever. She received ambulatory treatment with clotrimazole, Acetaminophen and electrolytes without improvement. On 20 November 2008, the subject was hospitalised. Physical exam was with dehydration, pallor, abdominal distension and decreased bowel sounds. Lab tests were performed and showed the following: Glucose: 99 mg/dL; Urea: 60 mg/dL; Urea Nitrogen: 28 mg/dL; Creatinine: 0.7 mg/dL; Total Protein: 0.72 g/dL; Albumin: 4.2 g/dL; Alanine aminotransferase: 41 U/L; Aspartate aminotransferase: 44 U/L; Sodium: 137 mEq/L; Potassium, 4.4 mEq/L; Chloride: 99 mEq/L; Hemoglobin: 11 g/dL; Hematocrit: 33%; Platelet count: 597000/mm3; Leucocytes count: 13900/mm3; Neutrophils percentage: 59%; Prothrombin Time: 11.6 Sec; Partial Thromboplastin Time: 26.2 Sec. Abdominal X-ray was performed and showed air fluid levels and data of intestinal obstruction. Abdominal ultrasound was performed and showed right flank with tubular mass in longitudinal views (pseudo kidney) and a target appearance in transverse images probably ileocolonic intussusception, dilated bowels. On 20 November 2008, surgery was performed; ilececolic intussusception was found and reduced by taxis without complications. On 24 November 2008, the subject was discharged in good clinical conditions. On 24 November 2008, th


Changed on 4/14/2017

VAERS ID: 335078 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Foreign
Vaccinated:2008-11-14
Onset:2008-11-17
Submitted:2008-12-11
Entered:2008-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPPHIB: DTP + IPV + ACT-HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - LL / IM
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal distension, Activated partial thromboplastin time shortened, Alanine aminotransferase, Aspartate aminotransferase normal, Blood albumin decreased, Blood chloride normal, Blood creatinine increased, Blood glucose increased, Blood potassium normal, Blood sodium normal, Blood urea increased, Dehydration, Haematochezia, Haematocrit decreased, Haemoglobin normal, Intussusception, Irritability, Pallor, Protein total decreased, Prothrombin time normal, Pyrexia, Surgery, Vomiting, White blood cell count normal, X-ray abnormal, Platelet count increased, Ultrasound abdomen abnormal, Neutrophil percentage, Abdominal X-ray, Food intolerance, Gastrointestinal sounds abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal X-ray; 20Nov2008, See text; Activated partial thromboplast, 20Nov2008, 26.2Sec; Alanine aminotransferase, 20Nov2008, 41IU/L; Albumin, 20Nov2008, 4.2g/dL; Aspartate aminotransferase, 20Nov2008, 44U/L; Blood glucose, 20Nov2008, 99mg 99mg/dL; Blood urea nitrogen, 20Nov2008, 28mg/dL; Chloride, 20Nov2008, 99mEq/L; Creatinine, 20Nov2008, 0.7mg/dL; Hematocrit, 20Nov2008, 33%; Hemoglobin, 20Nov2008, 11g/dL; Neutrophil percentage, 20Nov2008, 59%; Platelet count, 20Nov2008, 597000/mm3; Potassium, 20Nov2008, 4.4mEq/L; Protein total, 20Nov2008, 072g/dL; Prothrombin time, 20Nov2008, 11.6Sec; Sodium, 20Nov2008, 137mEq/L; Ultrasound abdomen, 20Nov2008, See text; Urea, 20Nov2008, 60mg/dL; White blood cell count, 20Nov2008, 13900/mm3
CDC 'Split Type': B0549365A

Write-up: This case was reported by a physician in the frame of a study and described the occurrence of intussusception in a 4-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). The subject had no relevant history or allergy. Concurrent vaccination included DTaP-IPV-HIB (manufacturer unspecified; intramuscular; unknown injection site) given on 14 November 2008; pneumococcal vaccine (manufacturer unspecified; intramuscular; unknown injection site) given on 14 November 2008. On 14 November 2008, the subject received 1st dose of ROTARIX (oral, lot number not provided). On 17 November 2008, 3 days after vaccination with ROTARIX, the subject experienced irritability, intolerance to oral feeding, gastro alimentary vomiting, bloody stools and fever. She received ambulatory treatment with clotrimazole, Acetaminophen and electrolytes without improvement. On 20 November 2008, the subject was hospitalised. Physical exam was with dehydration, pallor, abdominal distension and decreased bowel sounds. Lab tests were performed and showed the following: Glucose: 99 mg/dL; Urea: 60 mg/dL; Urea Nitrogen: 28 mg/dL; Creatinine: 0.7 mg/dL; Total Protein: 0.72 g/dL; Albumin: 4.2 g/dL; Alanine aminotransferase: 41 U/L; Aspartate aminotransferase: 44 U/L; Sodium: 137 mEq/L; Potassium, 4.4 mEq/L; Chloride: 99 mEq/L; Hemoglobin: 11 g/dL; Hematocrit: 33%; Platelet count: 597000/mm3; Leucocytes count: 13900/mm3; Neutrophils percentage: 59%; Prothrombin Time: 11.6 Sec; Partial Thromboplastin Time: 26.2 Sec. Abdominal X-ray was performed and showed air fluid levels and data of intestinal obstruction. Abdominal ultrasound was performed and showed right flank with tubular mass in longitudinal views (pseudo kidney) and a target appearance in transverse images probably ileocolonic intussusception, dilated bowels. On 20 November 2008, surgery was performed; ilececolic intussusception was found and reduced by taxis without complications. On 24 November 2008, the subject was discharged in good clinical conditions. On 24 November 2008, th the events were resolved. The physician considered the events were possibly related to vaccination with ROTARIX.


Changed on 9/14/2017

VAERS ID: 335078 Before After
VAERS Form:(blank) 1
Age:0.3
Gender:Male
Location:Foreign
Vaccinated:2008-11-14
Onset:2008-11-17
Submitted:2008-12-11
Entered:2008-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPPHIB: DTP + IPV + ACT-HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK LL / IM
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 0 1 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal distension, Activated partial thromboplastin time shortened, Alanine aminotransferase, Aspartate aminotransferase normal, Blood albumin decreased, Blood chloride normal, Blood creatinine increased, Blood glucose increased, Blood potassium normal, Blood sodium normal, Blood urea increased, Dehydration, Haematochezia, Haematocrit decreased, Haemoglobin normal, Intussusception, Irritability, Pallor, Protein total decreased, Prothrombin time normal, Pyrexia, Surgery, Vomiting, White blood cell count normal, X-ray abnormal, Platelet count increased, Ultrasound abdomen abnormal, Neutrophil percentage, Abdominal X-ray, Food intolerance, Gastrointestinal sounds abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal X-ray; 20Nov2008, See text; Activated partial thromboplast, 20Nov2008, 26.2Sec; Alanine aminotransferase, 20Nov2008, 41IU/L; Albumin, 20Nov2008, 4.2g/dL; Aspartate aminotransferase, 20Nov2008, 44U/L; Blood glucose, 20Nov2008, 99mg/dL; Blood urea nitrogen, 20Nov2008, 28mg/dL; Chloride, 20Nov2008, 99mEq/L; Creatinine, 20Nov2008, 0.7mg/dL; Hematocrit, 20Nov2008, 33%; Hemoglobin, 20Nov2008, 11g/dL; Neutrophil percentage, 20Nov2008, 59%; Platelet count, 20Nov2008, 597000/mm3; Potassium, 20Nov2008, 4.4mEq/L; Protein total, 20Nov2008, 072g/dL; Prothrombin time, 20Nov2008, 11.6Sec; Sodium, 20Nov2008, 137mEq/L; Ultrasound abdomen, 20Nov2008, See text; Urea, 20Nov2008, 60mg/dL; White blood cell count, 20Nov2008, 13900/mm3
CDC 'Split Type': B0549365A

Write-up: This case was reported by a physician in the frame of a study and described the occurrence of intussusception in a 4-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). The subject had no relevant history or allergy. Concurrent vaccination included DTaP-IPV-HIB (manufacturer unspecified; intramuscular; unknown injection site) given on 14 November 2008; pneumococcal vaccine (manufacturer unspecified; intramuscular; unknown injection site) given on 14 November 2008. On 14 November 2008, the subject received 1st dose of ROTARIX (oral, lot number not provided). On 17 November 2008, 3 days after vaccination with ROTARIX, the subject experienced irritability, intolerance to oral feeding, gastro alimentary vomiting, bloody stools and fever. She received ambulatory treatment with clotrimazole, Acetaminophen and electrolytes without improvement. On 20 November 2008, the subject was hospitalised. Physical exam was with dehydration, pallor, abdominal distension and decreased bowel sounds. Lab tests were performed and showed the following: Glucose: 99 mg/dL; Urea: 60 mg/dL; Urea Nitrogen: 28 mg/dL; Creatinine: 0.7 mg/dL; Total Protein: 0.72 g/dL; Albumin: 4.2 g/dL; Alanine aminotransferase: 41 U/L; Aspartate aminotransferase: 44 U/L; Sodium: 137 mEq/L; Potassium, 4.4 mEq/L; Chloride: 99 mEq/L; Hemoglobin: 11 g/dL; Hematocrit: 33%; Platelet count: 597000/mm3; Leucocytes count: 13900/mm3; Neutrophils percentage: 59%; Prothrombin Time: 11.6 Sec; Partial Thromboplastin Time: 26.2 Sec. Abdominal X-ray was performed and showed air fluid levels and data of intestinal obstruction. Abdominal ultrasound was performed and showed right flank with tubular mass in longitudinal views (pseudo kidney) and a target appearance in transverse images probably ileocolonic intussusception, dilated bowels. On 20 November 2008, surgery was performed; ilececolic intussusception was found and reduced by taxis without complications. On 24 November 2008, the subject was discharged in good clinical conditions. On 24 November 2008, the events were resolved. The physician considered the events were possibly related to vaccination with ROTARIX.


Changed on 2/14/2018

VAERS ID: 335078 Before After
VAERS Form:1
Age:0.3
Gender:Male
Location:Foreign
Vaccinated:2008-11-14
Onset:2008-11-17
Submitted:2008-12-11
Entered:2008-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPPHIB: DTP + IPV + ACT-HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK LL / IM
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal distension, Activated partial thromboplastin time shortened, Alanine aminotransferase, Aspartate aminotransferase normal, Blood albumin decreased, Blood chloride normal, Blood creatinine increased, Blood glucose increased, Blood potassium normal, Blood sodium normal, Blood urea increased, Dehydration, Haematochezia, Haematocrit decreased, Haemoglobin normal, Intussusception, Irritability, Pallor, Protein total decreased, Prothrombin time normal, Pyrexia, Surgery, Vomiting, White blood cell count normal, X-ray abnormal, Platelet count increased, Ultrasound abdomen abnormal, Neutrophil percentage, Abdominal X-ray, Food intolerance, Gastrointestinal sounds abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal X-ray; 20Nov2008, See text; Activated partial thromboplast, 20Nov2008, 26.2Sec; Alanine aminotransferase, 20Nov2008, 41IU/L; Albumin, 20Nov2008, 4.2g/dL; Aspartate aminotransferase, 20Nov2008, 44U/L; Blood glucose, 20Nov2008, 99mg/dL; Blood urea nitrogen, 20Nov2008, 28mg/dL; Chloride, 20Nov2008, 99mEq/L; Creatinine, 20Nov2008, 0.7mg/dL; Hematocrit, 20Nov2008, 33%; Hemoglobin, 20Nov2008, 11g/dL; Neutrophil percentage, 20Nov2008, 59%; Platelet count, 20Nov2008, 597000/mm3; Potassium, 20Nov2008, 4.4mEq/L; Protein total, 20Nov2008, 072g/dL; Prothrombin time, 20Nov2008, 11.6Sec; Sodium, 20Nov2008, 137mEq/L; Ultrasound abdomen, 20Nov2008, See text; Urea, 20Nov2008, 60mg/dL; White blood cell count, 20Nov2008, 13900/mm3
CDC 'Split Type': B0549365A

Write-up: This case was reported by a physician in the frame of a study and described the occurrence of intussusception in a 4-month-old male subject who was vaccinated with ROTARIX (GlaxoSmithKline). The subject had no relevant history or allergy. Concurrent vaccination included DTaP-IPV-HIB (manufacturer unspecified; intramuscular; unknown injection site) given on 14 November 2008; pneumococcal vaccine (manufacturer unspecified; intramuscular; unknown injection site) given on 14 November 2008. On 14 November 2008, the subject received 1st dose of ROTARIX (oral, lot number not provided). On 17 November 2008, 3 days after vaccination with ROTARIX, the subject experienced irritability, intolerance to oral feeding, gastro alimentary vomiting, bloody stools and fever. She received ambulatory treatment with clotrimazole, Acetaminophen and electrolytes without improvement. On 20 November 2008, the subject was hospitalised. Physical exam was with dehydration, pallor, abdominal distension and decreased bowel sounds. Lab tests were performed and showed the following: Glucose: 99 mg/dL; Urea: 60 mg/dL; Urea Nitrogen: 28 mg/dL; Creatinine: 0.7 mg/dL; Total Protein: 0.72 g/dL; Albumin: 4.2 g/dL; Alanine aminotransferase: 41 U/L; Aspartate aminotransferase: 44 U/L; Sodium: 137 mEq/L; Potassium, 4.4 mEq/L; Chloride: 99 mEq/L; Hemoglobin: 11 g/dL; Hematocrit: 33%; Platelet count: 597000/mm3; Leucocytes count: 13900/mm3; Neutrophils percentage: 59%; Prothrombin Time: 11.6 Sec; Partial Thromboplastin Time: 26.2 Sec. Abdominal X-ray was performed and showed air fluid levels and data of intestinal obstruction. Abdominal ultrasound was performed and showed right flank with tubular mass in longitudinal views (pseudo kidney) and a target appearance in transverse images probably ileocolonic intussusception, dilated bowels. On 20 November 2008, surgery was performed; ilececolic intussusception was found and reduced by taxis without complications. On 24 November 2008, the subject was discharged in good clinical conditions. On 24 November 2008, the events were resolved. The physician considered the events were possibly related to vaccination with ROTARIX.


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