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This is VAERS ID 339106

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

VAERS ID: 339106
VAERS Form:
Age:0.2
Sex:Female
Location:Washington
Vaccinated:2009-01-29
Onset:2009-02-02
Submitted:2009-02-05
Entered:2009-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3243AA / 0 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB531AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D03124 / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1357X / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apathy, Ascites, Blood culture positive, Cardiac murmur, Culture urine positive, Intussusception, Lethargy, Petechiae, Small intestinal obstruction, Vomiting, Enema administration, Ultrasound abdomen abnormal, Ultrasound scan abnormal, Barium double contrast abnormal

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: newborn jaundice. wt loss. recent URI
Allergies:
Diagnostic Lab Data: Ultrasound and contrast enema showed iliocolic intussusception, complete small bowel obstruction, ascites. Labs and diagnostics: Abd US (+) for IS. Contrast enema (+) for IS. Renal US (+) for ascites. Blood cx (+) for Staph, repeat (-).
CDC 'Split Type':

Write-up: Sudden onset of lethargy and vomiting. Hospitalized for lethargy, to rule out sepsis. Continued vomiting lead to diagnosis of intussussception. Successfully reduced by contrast enema. 3/5/09 MR received for DOS 2/3-5/2009 with D/C DX: Intussusception. Pt presented with lethargy and emesis. PE (+) for apathy, systolic murmur, increased bowel tone and petechaie on legs. IS dx by US and reduced by contrast enema. D/C when taking po well.


Changed on 3/2/2010

VAERS ID: 339106 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Washington
Vaccinated:2009-01-29
Onset:2009-02-02
Submitted:2009-02-05
Entered:2009-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3243AA / 0 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB531AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC D03124 / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1357X / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apathy, Ascites, Blood culture positive, Cardiac murmur, Culture urine positive, Intussusception, Lethargy, Petechiae, Small intestinal obstruction, Vomiting, Enema administration, Ultrasound abdomen abnormal, Ultrasound scan abnormal, Barium double contrast abnormal

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: newborn jaundice. wt loss. recent URI
Allergies:
Diagnostic Lab Data: Ultrasound and contrast enema showed iliocolic intussusception, complete small bowel obstruction, ascites. Labs and diagnostics: Abd US (+) for IS. Contrast enema (+) for IS. Renal US (+) for ascites. Blood cx (+) for Staph, repeat (-).
CDC 'Split Type':

Write-up: Sudden onset of lethargy and vomiting. Hospitalized for lethargy, to rule out sepsis. Continued vomiting lead to diagnosis of intussussception. Successfully reduced by contrast enema. 3/5/09 MR received for DOS 2/3-5/2009 with D/C DX: Intussusception. Pt presented with lethargy and emesis. PE (+) for apathy, systolic murmur, increased bowel tone and petechaie on legs. IS dx by US and reduced by contrast enema. D/C when taking po well.


Changed on 4/7/2010

VAERS ID: 339106 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Washington
Vaccinated:2009-01-29
Onset:2009-02-02
Submitted:2009-02-05
Entered:2009-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3243AA / 0 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB531AA / 1 RL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D03124 / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1357X / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apathy, Ascites, Blood culture positive, Cardiac murmur, Culture urine positive, Intussusception, Lethargy, Petechiae, Small intestinal obstruction, Vomiting, Enema administration, Ultrasound abdomen abnormal, Ultrasound scan abnormal, Barium double contrast abnormal

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: newborn jaundice. wt loss. recent URI
Allergies:
Diagnostic Lab Data: Ultrasound and contrast enema showed iliocolic intussusception, complete small bowel obstruction, ascites. Labs and diagnostics: Abd US (+) for IS. Contrast enema (+) for IS. Renal US (+) for ascites. Blood cx (+) for Staph, repeat (-).
CDC 'Split Type':

Write-up: Sudden onset of lethargy and vomiting. Hospitalized for lethargy, to rule out sepsis. Continued vomiting lead to diagnosis of intussussception. Successfully reduced by contrast enema. 3/5/09 MR received for DOS 2/3-5/2009 with D/C DX: Intussusception. Pt presented with lethargy and emesis. PE (+) for apathy, systolic murmur, increased bowel tone and petechaie on legs. IS dx by US and reduced by contrast enema. D/C when taking po well.


Changed on 8/31/2010

VAERS ID: 339106 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Washington
Vaccinated:2009-01-29
Onset:2009-02-02
Submitted:2009-02-05
Entered:2009-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3243AA / 0 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB531AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH D03124 / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1357X / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apathy, Ascites, Blood culture positive, Cardiac murmur, Culture urine positive, Intussusception, Lethargy, Petechiae, Small intestinal obstruction, Vomiting, Enema administration, Ultrasound abdomen abnormal, Ultrasound scan abnormal, Barium double contrast abnormal

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: newborn jaundice. wt loss. recent URI
Allergies:
Diagnostic Lab Data: Ultrasound and contrast enema showed iliocolic intussusception, complete small bowel obstruction, ascites. Labs and diagnostics: Abd US (+) for IS. Contrast enema (+) for IS. Renal US (+) for ascites. Blood cx (+) for Staph, repeat (-).
CDC 'Split Type':

Write-up: Sudden onset of lethargy and vomiting. Hospitalized for lethargy, to rule out sepsis. Continued vomiting lead to diagnosis of intussussception. Successfully reduced by contrast enema. 3/5/09 MR received for DOS 2/3-5/2009 with D/C DX: Intussusception. Pt presented with lethargy and emesis. PE (+) for apathy, systolic murmur, increased bowel tone and petechaie on legs. IS dx by US and reduced by contrast enema. D/C when taking po well.


Changed on 5/13/2013

VAERS ID: 339106 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Washington
Vaccinated:2009-01-29
Onset:2009-02-02
Submitted:2009-02-05
Entered:2009-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3243AA / 0 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB531AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D03124 / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1357X / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1357X / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apathy, Ascites, Blood culture positive, Cardiac murmur, Culture urine positive, Intussusception, Lethargy, Petechiae, Small intestinal obstruction, Vomiting, Enema administration, Ultrasound abdomen abnormal, Ultrasound scan abnormal, Barium double contrast abnormal

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: newborn jaundice. wt loss. recent URI
Allergies:
Diagnostic Lab Data: Ultrasound and contrast enema showed iliocolic intussusception, complete small bowel obstruction, ascites. Labs and diagnostics: Abd US (+) for IS. Contrast enema (+) for IS. Renal US (+) for ascites. Blood cx (+) for Staph, repeat (-).
CDC 'Split Type':

Write-up: Sudden onset of lethargy and vomiting. Hospitalized for lethargy, to rule out sepsis. Continued vomiting lead to diagnosis of intussussception. Successfully reduced by contrast enema. 3/5/09 MR received for DOS 2/3-5/2009 with D/C DX: Intussusception. Pt presented with lethargy and emesis. PE (+) for apathy, systolic murmur, increased bowel tone and petechaie on legs. IS dx by US and reduced by contrast enema. D/C when taking po well.


Changed on 4/14/2017

VAERS ID: 339106 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Washington
Vaccinated:2009-01-29
Onset:2009-02-02
Submitted:2009-02-05
Entered:2009-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3243AA / 0 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB531AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D03124 / 0 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1357X / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apathy, Ascites, Blood culture positive, Cardiac murmur, Culture urine positive, Intussusception, Lethargy, Petechiae, Small intestinal obstruction, Vomiting, Enema administration, Ultrasound abdomen abnormal, Ultrasound scan abnormal, Barium double contrast abnormal

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: newborn jaundice. wt loss. recent URI
Allergies:
Diagnostic Lab Data: Ultrasound and contrast enema showed iliocolic intussusception, complete small bowel obstruction, ascites. Labs and diagnostics: Abd US (+) for IS. Contrast enema (+) for IS. Renal US (+) for ascites. Blood cx (+) for Staph, repeat (-). UC (+) for lactobacillus.
CDC 'Split Type':

Write-up: Sudden onset of lethargy and vomiting. Hospitalized for lethargy, to rule out sepsis. Continued vomiting lead to diagnosis of intussussception. Successfully reduced by contrast enema. 3/5/09 MR received for DOS 2/3-5/2009 with D/C DX: Intussusception. Pt presented with lethargy and emesis. PE (+) for apathy, systolic murmur, increased bowel tone and petechaie on legs. IS dx by US and reduced by contrast enema. D/C when taking po well.


Changed on 9/14/2017

VAERS ID: 339106 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Female
Location:Washington
Vaccinated:2009-01-29
Onset:2009-02-02
Submitted:2009-02-05
Entered:2009-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3243AA / 0 1 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB531AA / 1 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D03124 / 0 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1357X / 0 1 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Ascites, Intussusception, Lethargy, Small intestinal obstruction, Vomiting, Enema administration, Ultrasound abdomen abnormal, Ultrasound scan abnormal, Barium double contrast abnormal

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: newborn jaundice. wt loss. recent URI
Allergies:
Diagnostic Lab Data: Ultrasound and contrast enema showed iliocolic intussusception, complete small bowel obstruction, ascites. Labs and diagnostics: Abd US (+) for IS. Contrast enema (+) for IS. Renal US (+) for ascites. Blood cx (+) for Staph, repeat (-). UC (+) for lactobacillus.
CDC 'Split Type':

Write-up: Sudden onset of lethargy and vomiting. Hospitalized for lethargy, to rule out sepsis. Continued vomiting lead to diagnosis of intussussception. Successfully reduced by contrast enema. 3/5/09 MR received for DOS 2/3-5/2009 with D/C DX: Intussusception. Pt presented with lethargy and emesis. PE (+) for apathy, systolic murmur, increased bowel tone and petechaie on legs. IS dx by US and reduced by contrast enema. D/C when taking po well.


Changed on 2/14/2018

VAERS ID: 339106 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Washington
Vaccinated:2009-01-29
Onset:2009-02-02
Submitted:2009-02-05
Entered:2009-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3243AA / 1 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB531AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D03124 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1357X / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Ascites, Intussusception, Lethargy, Small intestinal obstruction, Vomiting, Enema administration, Ultrasound abdomen abnormal, Ultrasound scan abnormal, Barium double contrast abnormal

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: newborn jaundice. wt loss. recent URI
Allergies:
Diagnostic Lab Data: Ultrasound and contrast enema showed iliocolic intussusception, complete small bowel obstruction, ascites. Labs and diagnostics: Abd US (+) for IS. Contrast enema (+) for IS. Renal US (+) for ascites. Blood cx (+) for Staph, repeat (-). UC (+) for lactobacillus.
CDC 'Split Type':

Write-up: Sudden onset of lethargy and vomiting. Hospitalized for lethargy, to rule out sepsis. Continued vomiting lead to diagnosis of intussussception. Successfully reduced by contrast enema. 3/5/09 MR received for DOS 2/3-5/2009 with D/C DX: Intussusception. Pt presented with lethargy and emesis. PE (+) for apathy, systolic murmur, increased bowel tone and petechaie on legs. IS dx by US and reduced by contrast enema. D/C when taking po well.


Changed on 6/14/2018

VAERS ID: 339106 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Washington
Vaccinated:2009-01-29
Onset:2009-02-02
Submitted:2009-02-05
Entered:2009-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3243AA / 1 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB531AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D03124 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1357X / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Ascites, Intussusception, Lethargy, Small intestinal obstruction, Vomiting, Enema administration, Ultrasound abdomen abnormal, Ultrasound scan abnormal, Barium double contrast abnormal

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: newborn jaundice. wt loss. recent URI
Allergies:
Diagnostic Lab Data: Ultrasound and contrast enema showed iliocolic intussusception, complete small bowel obstruction, ascites. Labs and diagnostics: Abd US (+) for IS. Contrast enema (+) for IS. Renal US (+) for ascites. Blood cx (+) for Staph, repeat (-). UC (+) for lactobacillus.
CDC 'Split Type':

Write-up: Sudden onset of lethargy and vomiting. Hospitalized for lethargy, to rule out sepsis. Continued vomiting lead to diagnosis of intussussception. Successfully reduced by contrast enema. 3/5/09 MR received for DOS 2/3-5/2009 with D/C DX: Intussusception. Pt presented with lethargy and emesis. PE (+) for apathy, systolic murmur, increased bowel tone and petechaie on legs. IS dx by US and reduced by contrast enema. D/C when taking po well.


Changed on 8/14/2018

VAERS ID: 339106 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Washington
Vaccinated:2009-01-29
Onset:2009-02-02
Submitted:2009-02-05
Entered:2009-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3243AA / 1 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB531AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D03124 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1357X / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Ascites, Intussusception, Lethargy, Small intestinal obstruction, Vomiting, Enema administration, Ultrasound abdomen abnormal, Ultrasound scan abnormal, Barium double contrast abnormal

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: newborn jaundice. wt loss. recent URI
Allergies:
Diagnostic Lab Data: Ultrasound and contrast enema showed iliocolic intussusception, complete small bowel obstruction, ascites. Labs and diagnostics: Abd US (+) for IS. Contrast enema (+) for IS. Renal US (+) for ascites. Blood cx (+) for Staph, repeat (-). UC (+) for lactobacillus.
CDC 'Split Type':

Write-up: Sudden onset of lethargy and vomiting. Hospitalized for lethargy, to rule out sepsis. Continued vomiting lead to diagnosis of intussussception. Successfully reduced by contrast enema. 3/5/09 MR received for DOS 2/3-5/2009 with D/C DX: Intussusception. Pt presented with lethargy and emesis. PE (+) for apathy, systolic murmur, increased bowel tone and petechaie on legs. IS dx by US and reduced by contrast enema. D/C when taking po well.


Changed on 9/14/2018

VAERS ID: 339106 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Washington
Vaccinated:2009-01-29
Onset:2009-02-02
Submitted:2009-02-05
Entered:2009-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3243AA / 1 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB531AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D03124 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1357X / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Ascites, Intussusception, Lethargy, Small intestinal obstruction, Vomiting, Enema administration, Ultrasound abdomen abnormal, Ultrasound scan abnormal, Barium double contrast abnormal

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: newborn jaundice. wt loss. recent URI
Allergies:
Diagnostic Lab Data: Ultrasound and contrast enema showed iliocolic intussusception, complete small bowel obstruction, ascites. Labs and diagnostics: Abd US (+) for IS. Contrast enema (+) for IS. Renal US (+) for ascites. Blood cx (+) for Staph, repeat (-). UC (+) for lactobacillus.
CDC 'Split Type':

Write-up: Sudden onset of lethargy and vomiting. Hospitalized for lethargy, to rule out sepsis. Continued vomiting lead to diagnosis of intussussception. Successfully reduced by contrast enema. 3/5/09 MR received for DOS 2/3-5/2009 with D/C DX: Intussusception. Pt presented with lethargy and emesis. PE (+) for apathy, systolic murmur, increased bowel tone and petechaie on legs. IS dx by US and reduced by contrast enema. D/C when taking po well.


Changed on 10/14/2018

VAERS ID: 339106 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Washington
Vaccinated:2009-01-29
Onset:2009-02-02
Submitted:2009-02-05
Entered:2009-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3243AA / 1 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB531AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D03124 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1357X / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Ascites, Intussusception, Lethargy, Small intestinal obstruction, Vomiting, Enema administration, Ultrasound abdomen abnormal, Ultrasound scan abnormal, Barium double contrast abnormal

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: newborn jaundice. wt loss. recent URI
Allergies:
Diagnostic Lab Data: Ultrasound and contrast enema showed iliocolic intussusception, complete small bowel obstruction, ascites. Labs and diagnostics: Abd US (+) for IS. Contrast enema (+) for IS. Renal US (+) for ascites. Blood cx (+) for Staph, repeat (-). UC (+) for lactobacillus.
CDC 'Split Type':

Write-up: Sudden onset of lethargy and vomiting. Hospitalized for lethargy, to rule out sepsis. Continued vomiting lead to diagnosis of intussussception. Successfully reduced by contrast enema. 3/5/09 MR received for DOS 2/3-5/2009 with D/C DX: Intussusception. Pt presented with lethargy and emesis. PE (+) for apathy, systolic murmur, increased bowel tone and petechaie on legs. IS dx by US and reduced by contrast enema. D/C when taking po well.

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