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This is VAERS ID 337061

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

VAERS ID: 337061
VAERS Form:
Age:0.4
Sex:Female
Location:Pennsylvania
Vaccinated:2008-12-10
Onset:2009-01-08
Submitted:2009-01-12
Entered:2009-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF242AB / 1 RL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C87340 / 1 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032X / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal distension, Abdominal pain, Constipation, Crying, Intussusception, Lethargy, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Abdominal X-ray, Occult blood negative, Metabolic function test normal, Hypophagia

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: GERD PMH: recent OM.
Allergies:
Diagnostic Lab Data: Abdominal series LABS: Stool guiaic neg. abd x-ray & US abnormal. BMP WNL.
CDC 'Split Type':

Write-up: Intussusception. 2/23/09 Received hospital medical records of 1/8-1/9/2009. FINAL DX: Intussusception Records reveal patient experienced intermittent crying & lethargy x 5 days, periods of inconsolability, abdominal distention & pain, oral intake reduced, c.onstipation Surgery consult done. Tx w/water soluble contrast enema successfully. Admitted overnight for observation. Progressed well & d/c to home


Changed on 3/2/2010

VAERS ID: 337061 Before After
VAERS Form:
Age:0.4
Sex:Female
Location:Pennsylvania
Vaccinated:2008-12-10
Onset:2009-01-08
Submitted:2009-01-12
Entered:2009-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF242AB / 1 RL / UN
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC C87340 / 1 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032X / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal distension, Abdominal pain, Constipation, Crying, Intussusception, Lethargy, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Abdominal X-ray, Occult blood negative, Metabolic function test normal, Hypophagia

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: GERD PMH: recent OM.
Allergies:
Diagnostic Lab Data: Abdominal series LABS: Stool guiaic neg. abd x-ray & US abnormal. BMP WNL.
CDC 'Split Type':

Write-up: Intussusception. 2/23/09 Received hospital medical records of 1/8-1/9/2009. FINAL DX: Intussusception Records reveal patient experienced intermittent crying & lethargy x 5 days, periods of inconsolability, abdominal distention & pain, oral intake reduced, c.onstipation Surgery consult done. Tx w/water soluble contrast enema successfully. Admitted overnight for observation. Progressed well & d/c to home


Changed on 4/7/2010

VAERS ID: 337061 Before After
VAERS Form:
Age:0.4
Sex:Female
Location:Pennsylvania
Vaccinated:2008-12-10
Onset:2009-01-08
Submitted:2009-01-12
Entered:2009-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF242AB / 1 RL / UN
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C87340 / 1 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032X / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal distension, Abdominal pain, Constipation, Crying, Intussusception, Lethargy, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Abdominal X-ray, Occult blood negative, Metabolic function test normal, Hypophagia

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: GERD PMH: recent OM.
Allergies:
Diagnostic Lab Data: Abdominal series LABS: Stool guiaic neg. abd x-ray & US abnormal. BMP WNL.
CDC 'Split Type':

Write-up: Intussusception. 2/23/09 Received hospital medical records of 1/8-1/9/2009. FINAL DX: Intussusception Records reveal patient experienced intermittent crying & lethargy x 5 days, periods of inconsolability, abdominal distention & pain, oral intake reduced, c.onstipation Surgery consult done. Tx w/water soluble contrast enema successfully. Admitted overnight for observation. Progressed well & d/c to home


Changed on 8/31/2010

VAERS ID: 337061 Before After
VAERS Form:
Age:0.4
Sex:Female
Location:Pennsylvania
Vaccinated:2008-12-10
Onset:2009-01-08
Submitted:2009-01-12
Entered:2009-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF242AB / 1 RL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH C87340 / 1 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032X / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal distension, Abdominal pain, Constipation, Crying, Intussusception, Lethargy, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Abdominal X-ray, Occult blood negative, Metabolic function test normal, Hypophagia

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: GERD PMH: recent OM.
Allergies:
Diagnostic Lab Data: Abdominal series LABS: Stool guiaic neg. abd x-ray & US abnormal. BMP WNL.
CDC 'Split Type':

Write-up: Intussusception. 2/23/09 Received hospital medical records of 1/8-1/9/2009. FINAL DX: Intussusception Records reveal patient experienced intermittent crying & lethargy x 5 days, periods of inconsolability, abdominal distention & pain, oral intake reduced, c.onstipation Surgery consult done. Tx w/water soluble contrast enema successfully. Admitted overnight for observation. Progressed well & d/c to home


Changed on 5/13/2013

VAERS ID: 337061 Before After
VAERS Form:
Age:0.4
Sex:Female
Location:Pennsylvania
Vaccinated:2008-12-10
Onset:2009-01-08
Submitted:2009-01-12
Entered:2009-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF242AB / 1 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C87340 / 1 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032X / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032X / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal distension, Abdominal pain, Constipation, Crying, Intussusception, Lethargy, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Abdominal X-ray, Occult blood negative, Metabolic function test normal, Hypophagia

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: GERD PMH: recent OM.
Allergies:
Diagnostic Lab Data: Abdominal series LABS: Stool guiaic neg. abd x-ray & US abnormal. BMP WNL.
CDC 'Split Type':

Write-up: Intussusception. 2/23/09 Received hospital medical records of 1/8-1/9/2009. FINAL DX: Intussusception Records reveal patient experienced intermittent crying & lethargy x 5 days, periods of inconsolability, abdominal distention & pain, oral intake reduced, c.onstipation Surgery consult done. Tx w/water soluble contrast enema successfully. Admitted overnight for observation. Progressed well & d/c to home


Changed on 4/14/2017

VAERS ID: 337061 Before After
VAERS Form:
Age:0.4
Sex:Female
Location:Pennsylvania
Vaccinated:2008-12-10
Onset:2009-01-08
Submitted:2009-01-12
Entered:2009-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF242AB / 1 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C87340 / 1 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032X / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal distension, Abdominal pain, Constipation, Crying, Intussusception, Lethargy, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Abdominal X-ray, Occult blood negative, Metabolic function test normal, Hypophagia

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: GERD PMH: recent OM.
Allergies:
Diagnostic Lab Data: Abdominal series LABS: Stool guiaic neg. abd x-ray & US abnormal. BMP WNL.
CDC 'Split Type':

Write-up: Intussusception. 2/23/09 Received hospital medical records of 1/8-1/9/2009. FINAL DX: Intussusception Records reveal patient experienced intermittent crying & lethargy x 5 days, periods of inconsolability, abdominal distention & pain, oral intake reduced, c.onstipation Surgery consult done. Tx w/water soluble contrast enema successfully. Admitted overnight for observation. Progressed well & d/c to home


Changed on 9/14/2017

VAERS ID: 337061 Before After
VAERS Form:(blank) 1
Age:0.4
Sex:Female
Location:Pennsylvania
Vaccinated:2008-12-10
Onset:2009-01-08
Submitted:2009-01-12
Entered:2009-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 1 2 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF242AB / 1 2 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C87340 / 1 2 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032X / 1 2 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: GERD PMH: recent OM.
Allergies:
Diagnostic Lab Data: Abdominal series LABS: Stool guiaic neg. abd x-ray & US abnormal. BMP WNL.
CDC 'Split Type':

Write-up: Intussusception. 2/23/09 Received hospital medical records of 1/8-1/9/2009. FINAL DX: Intussusception Records reveal patient experienced intermittent crying & lethargy x 5 days, periods of inconsolability, abdominal distention & pain, oral intake reduced, c.onstipation Surgery consult done. Tx w/water soluble contrast enema successfully. Admitted overnight for observation. Progressed well & d/c to home


Changed on 2/14/2018

VAERS ID: 337061 Before After
VAERS Form:1
Age:0.4
Sex:Female
Location:Pennsylvania
Vaccinated:2008-12-10
Onset:2009-01-08
Submitted:2009-01-12
Entered:2009-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 2 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF242AB / 2 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C87340 / 2 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032X / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: GERD PMH: recent OM.
Allergies:
Diagnostic Lab Data: Abdominal series LABS: Stool guiaic neg. abd x-ray & US abnormal. BMP WNL.
CDC 'Split Type':

Write-up: Intussusception. 2/23/09 Received hospital medical records of 1/8-1/9/2009. FINAL DX: Intussusception Records reveal patient experienced intermittent crying & lethargy x 5 days, periods of inconsolability, abdominal distention & pain, oral intake reduced, c.onstipation Surgery consult done. Tx w/water soluble contrast enema successfully. Admitted overnight for observation. Progressed well & d/c to home


Changed on 6/14/2018

VAERS ID: 337061 Before After
VAERS Form:1
Age:0.4
Sex:Female
Location:Pennsylvania
Vaccinated:2008-12-10
Onset:2009-01-08
Submitted:2009-01-12
Entered:2009-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 2 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF242AB / 2 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C87340 / 2 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032X / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: GERD PMH: recent OM.
Allergies:
Diagnostic Lab Data: Abdominal series LABS: Stool guiaic neg. abd x-ray & US abnormal. BMP WNL.
CDC 'Split Type':

Write-up: Intussusception. 2/23/09 Received hospital medical records of 1/8-1/9/2009. FINAL DX: Intussusception Records reveal patient experienced intermittent crying & lethargy x 5 days, periods of inconsolability, abdominal distention & pain, oral intake reduced, c.onstipation Surgery consult done. Tx w/water soluble contrast enema successfully. Admitted overnight for observation. Progressed well & d/c to home


Changed on 8/14/2018

VAERS ID: 337061 Before After
VAERS Form:1
Age:0.4
Sex:Female
Location:Pennsylvania
Vaccinated:2008-12-10
Onset:2009-01-08
Submitted:2009-01-12
Entered:2009-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 2 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF242AB / 2 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C87340 / 2 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032X / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: GERD PMH: recent OM.
Allergies:
Diagnostic Lab Data: Abdominal series LABS: Stool guiaic neg. abd x-ray & US abnormal. BMP WNL.
CDC 'Split Type':

Write-up: Intussusception. 2/23/09 Received hospital medical records of 1/8-1/9/2009. FINAL DX: Intussusception Records reveal patient experienced intermittent crying & lethargy x 5 days, periods of inconsolability, abdominal distention & pain, oral intake reduced, c.onstipation Surgery consult done. Tx w/water soluble contrast enema successfully. Admitted overnight for observation. Progressed well & d/c to home


Changed on 9/14/2018

VAERS ID: 337061 Before After
VAERS Form:1
Age:0.4
Sex:Female
Location:Pennsylvania
Vaccinated:2008-12-10
Onset:2009-01-08
Submitted:2009-01-12
Entered:2009-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 2 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF242AB / 2 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C87340 / 2 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032X / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: GERD PMH: recent OM.
Allergies:
Diagnostic Lab Data: Abdominal series LABS: Stool guiaic neg. abd x-ray & US abnormal. BMP WNL.
CDC 'Split Type':

Write-up: Intussusception. 2/23/09 Received hospital medical records of 1/8-1/9/2009. FINAL DX: Intussusception Records reveal patient experienced intermittent crying & lethargy x 5 days, periods of inconsolability, abdominal distention & pain, oral intake reduced, c.onstipation Surgery consult done. Tx w/water soluble contrast enema successfully. Admitted overnight for observation. Progressed well & d/c to home


Changed on 10/14/2018

VAERS ID: 337061 Before After
VAERS Form:1
Age:0.4
Sex:Female
Location:Pennsylvania
Vaccinated:2008-12-10
Onset:2009-01-08
Submitted:2009-01-12
Entered:2009-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 2 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF242AB / 2 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C87340 / 2 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032X / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: GERD PMH: recent OM.
Allergies:
Diagnostic Lab Data: Abdominal series LABS: Stool guiaic neg. abd x-ray & US abnormal. BMP WNL.
CDC 'Split Type':

Write-up: Intussusception. 2/23/09 Received hospital medical records of 1/8-1/9/2009. FINAL DX: Intussusception Records reveal patient experienced intermittent crying & lethargy x 5 days, periods of inconsolability, abdominal distention & pain, oral intake reduced, c.onstipation Surgery consult done. Tx w/water soluble contrast enema successfully. Admitted overnight for observation. Progressed well & d/c to home

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