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This is VAERS ID 341569

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

VAERS ID: 341569
VAERS Form:
Age:0.5
Sex:Female
Location:Alaska
Vaccinated:2008-10-20
Onset:2009-03-08
Submitted:2009-03-11
Entered:2009-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B150AA / 2 LL / IM
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2786GA / 0 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C94097 / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0274X / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain upper, Barium enema, Constipation, Gastroenteritis, Haematochezia, Haemoglobin decreased, Intussusception, Irritability, Pyrexia, Vomiting, White blood cell count normal, X-ray abnormal, Abdominal X-ray, Metabolic function test normal

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: no
Current Illness: no
Preexisting Conditions: no
Allergies:
Diagnostic Lab Data: 4/2/09-records received-Unremarkable CMP, normal white count, low hemoglobin 10.5, unremarkable differential. Barium enema releived intussuception. Abdominal x-ray series demonstrates fairly prominent soft tissue density in upper midabdomen
CDC 'Split Type':

Write-up: 10m 3 wk old had INTUSSUSCEPTION, had previously had 3 doses of Rotateq at correct schedule, last dose on 10/20/08 10/20/08-office visit-well baby exam. C/O constipation. 4/2/09-records received for DOS 3/9-3/9/09-DC DX:Febrile illness began on 3/6/09, seen in office normal physical exam, thought to have a viral infection. Fever broke and appeared fine. On day of admission woke up very irritable and acting like her stomach hurt, started vomiting, nonbilious. Seen in ED thought to have gastroenteritis. Returned later that afternoon after patient had a stool with bright red color and a second stool deeper red. Stool positive heme.


Changed on 3/2/2010

VAERS ID: 341569 Before After
VAERS Form:
Age:0.5
Sex:Female
Location:Alaska
Vaccinated:2008-10-20
Onset:2009-03-08
Submitted:2009-03-11
Entered:2009-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B150AA / 2 LL / IM
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2786GA / 0 RL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC C94097 / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0274X / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain upper, Barium enema, Constipation, Gastroenteritis, Haematochezia, Haemoglobin decreased, Intussusception, Irritability, Pyrexia, Vomiting, White blood cell count normal, X-ray abnormal, Abdominal X-ray, Metabolic function test normal

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: no
Current Illness: no
Preexisting Conditions: no
Allergies:
Diagnostic Lab Data: 4/2/09-records received-Unremarkable CMP, normal white count, low hemoglobin 10.5, unremarkable differential. Barium enema releived intussuception. Abdominal x-ray series demonstrates fairly prominent soft tissue density in upper midabdomen
CDC 'Split Type':

Write-up: 10m 3 wk old had INTUSSUSCEPTION, had previously had 3 doses of Rotateq at correct schedule, last dose on 10/20/08 10/20/08-office visit-well baby exam. C/O constipation. 4/2/09-records received for DOS 3/9-3/9/09-DC DX:Febrile illness began on 3/6/09, seen in office normal physical exam, thought to have a viral infection. Fever broke and appeared fine. On day of admission woke up very irritable and acting like her stomach hurt, started vomiting, nonbilious. Seen in ED thought to have gastroenteritis. Returned later that afternoon after patient had a stool with bright red color and a second stool deeper red. Stool positive heme.


Changed on 4/7/2010

VAERS ID: 341569 Before After
VAERS Form:
Age:0.5
Sex:Female
Location:Alaska
Vaccinated:2008-10-20
Onset:2009-03-08
Submitted:2009-03-11
Entered:2009-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B150AA / 2 LL / IM
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2786GA / 0 RL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C94097 / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0274X / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain upper, Barium enema, Constipation, Gastroenteritis, Haematochezia, Haemoglobin decreased, Intussusception, Irritability, Pyrexia, Vomiting, White blood cell count normal, X-ray abnormal, Abdominal X-ray, Metabolic function test normal

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: no
Current Illness: no
Preexisting Conditions: no
Allergies:
Diagnostic Lab Data: 4/2/09-records received-Unremarkable CMP, normal white count, low hemoglobin 10.5, unremarkable differential. Barium enema releived intussuception. Abdominal x-ray series demonstrates fairly prominent soft tissue density in upper midabdomen
CDC 'Split Type':

Write-up: 10m 3 wk old had INTUSSUSCEPTION, had previously had 3 doses of Rotateq at correct schedule, last dose on 10/20/08 10/20/08-office visit-well baby exam. C/O constipation. 4/2/09-records received for DOS 3/9-3/9/09-DC DX:Febrile illness began on 3/6/09, seen in office normal physical exam, thought to have a viral infection. Fever broke and appeared fine. On day of admission woke up very irritable and acting like her stomach hurt, started vomiting, nonbilious. Seen in ED thought to have gastroenteritis. Returned later that afternoon after patient had a stool with bright red color and a second stool deeper red. Stool positive heme.


Changed on 8/31/2010

VAERS ID: 341569 Before After
VAERS Form:
Age:0.5
Sex:Female
Location:Alaska
Vaccinated:2008-10-20
Onset:2009-03-08
Submitted:2009-03-11
Entered:2009-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B150AA / 2 LL / IM
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2786GA / 0 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH C94097 / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0274X / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain upper, Barium enema, Constipation, Gastroenteritis, Haematochezia, Haemoglobin decreased, Intussusception, Irritability, Pyrexia, Vomiting, White blood cell count normal, X-ray abnormal, Abdominal X-ray, Metabolic function test normal

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: no
Current Illness: no
Preexisting Conditions: no
Allergies:
Diagnostic Lab Data: 4/2/09-records received-Unremarkable CMP, normal white count, low hemoglobin 10.5, unremarkable differential. Barium enema releived intussuception. Abdominal x-ray series demonstrates fairly prominent soft tissue density in upper midabdomen
CDC 'Split Type':

Write-up: 10m 3 wk old had INTUSSUSCEPTION, had previously had 3 doses of Rotateq at correct schedule, last dose on 10/20/08 10/20/08-office visit-well baby exam. C/O constipation. 4/2/09-records received for DOS 3/9-3/9/09-DC DX:Febrile illness began on 3/6/09, seen in office normal physical exam, thought to have a viral infection. Fever broke and appeared fine. On day of admission woke up very irritable and acting like her stomach hurt, started vomiting, nonbilious. Seen in ED thought to have gastroenteritis. Returned later that afternoon after patient had a stool with bright red color and a second stool deeper red. Stool positive heme.


Changed on 5/13/2013

VAERS ID: 341569 Before After
VAERS Form:
Age:0.5
Sex:Female
Location:Alaska
Vaccinated:2008-10-20
Onset:2009-03-08
Submitted:2009-03-11
Entered:2009-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B150AA / 2 LL / IM
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2786GA / 0 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C94097 / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0274X / 2 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0274X / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain upper, Barium enema, Constipation, Gastroenteritis, Haematochezia, Haemoglobin decreased, Intussusception, Irritability, Pyrexia, Vomiting, White blood cell count normal, X-ray abnormal, Abdominal X-ray, Metabolic function test normal

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: no
Current Illness: no
Preexisting Conditions: no
Allergies:
Diagnostic Lab Data: 4/2/09-records received-Unremarkable CMP, normal white count, low hemoglobin 10.5, unremarkable differential. Barium enema releived intussuception. Abdominal x-ray series demonstrates fairly prominent soft tissue density in upper midabdomen
CDC 'Split Type':

Write-up: 10m 3 wk old had INTUSSUSCEPTION, had previously had 3 doses of Rotateq at correct schedule, last dose on 10/20/08 10/20/08-office visit-well baby exam. C/O constipation. 4/2/09-records received for DOS 3/9-3/9/09-DC DX:Febrile illness began on 3/6/09, seen in office normal physical exam, thought to have a viral infection. Fever broke and appeared fine. On day of admission woke up very irritable and acting like her stomach hurt, started vomiting, nonbilious. Seen in ED thought to have gastroenteritis. Returned later that afternoon after patient had a stool with bright red color and a second stool deeper red. Stool positive heme.


Changed on 7/7/2013

VAERS ID: 341569 Before After
VAERS Form:
Age:0.5
Sex:Female
Location:Alaska
Vaccinated:2008-10-20
Onset:2009-03-08
Submitted:2009-03-11
Entered:2009-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B150AA / 2 LL / IM
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2786GA / 0 RL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2786GA / 0 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C94097 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0274X / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain upper, Barium enema, Constipation, Gastroenteritis, Haematochezia, Haemoglobin decreased, Intussusception, Irritability, Pyrexia, Vomiting, White blood cell count normal, X-ray abnormal, Abdominal X-ray, Metabolic function test normal

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: no
Current Illness: no
Preexisting Conditions: no
Allergies:
Diagnostic Lab Data: 4/2/09-records received-Unremarkable CMP, normal white count, low hemoglobin 10.5, unremarkable differential. Barium enema releived intussuception. Abdominal x-ray series demonstrates fairly prominent soft tissue density in upper midabdomen
CDC 'Split Type':

Write-up: 10m 3 wk old had INTUSSUSCEPTION, had previously had 3 doses of Rotateq at correct schedule, last dose on 10/20/08 10/20/08-office visit-well baby exam. C/O constipation. 4/2/09-records received for DOS 3/9-3/9/09-DC DX:Febrile illness began on 3/6/09, seen in office normal physical exam, thought to have a viral infection. Fever broke and appeared fine. On day of admission woke up very irritable and acting like her stomach hurt, started vomiting, nonbilious. Seen in ED thought to have gastroenteritis. Returned later that afternoon after patient had a stool with bright red color and a second stool deeper red. Stool positive heme.


Changed on 4/14/2017

VAERS ID: 341569 Before After
VAERS Form:
Age:0.5
Sex:Female
Location:Alaska
Vaccinated:2008-10-20
Onset:2009-03-08
Submitted:2009-03-11
Entered:2009-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B150AA / 2 LL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2786GA / 0 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C94097 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0274X / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain upper, Barium enema, Constipation, Gastroenteritis, Haematochezia, Haemoglobin decreased, Intussusception, Irritability, Pyrexia, Vomiting, White blood cell count normal, X-ray abnormal, Abdominal X-ray, Metabolic function test normal

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: no
Current Illness: no
Preexisting Conditions: no
Allergies:
Diagnostic Lab Data: 4/2/09-records received-Unremarkable CMP, normal white count, low hemoglobin 10.5, unremarkable differential. Barium enema releived intussuception. Abdominal x-ray series demonstrates fairly prominent soft tissue density in upper midabdomen could represent changes of intussuception.
CDC 'Split Type':

Write-up: 10m 3 wk old had INTUSSUSCEPTION, had previously had 3 doses of Rotateq at correct schedule, last dose on 10/20/08 10/20/08-office visit-well baby exam. C/O constipation. 4/2/09-records received for DOS 3/9-3/9/09-DC DX:Febrile illness began on 3/6/09, seen in office normal physical exam, thought to have a viral infection. Fever broke and appeared fine. On day of admission woke up very irritable and acting like her stomach hurt, started vomiting, nonbilious. Seen in ED thought to have gastroenteritis. Returned later that afternoon after patient had a stool with bright red color and a second stool deeper red. Stool positive heme.


Changed on 9/14/2017

VAERS ID: 341569 Before After
VAERS Form:(blank) 1
Age:0.5
Sex:Female
Location:Alaska
Vaccinated:2008-10-20
Onset:2009-03-08
Submitted:2009-03-11
Entered:2009-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B150AA / 2 3 LL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2786GA / 0 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C94097 / 2 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0274X / 2 3 - MO / PO

Administered by: Unknown      Purchased by: Unknown
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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: no
Current Illness: no
Preexisting Conditions: no
Allergies:
Diagnostic Lab Data: 4/2/09-records received-Unremarkable CMP, normal white count, low hemoglobin 10.5, unremarkable differential. Barium enema releived intussuception. Abdominal x-ray series demonstrates fairly prominent soft tissue density in upper midabdomen could represent changes of intussuception.
CDC 'Split Type':

Write-up: 10m 3 wk old had INTUSSUSCEPTION, had previously had 3 doses of Rotateq at correct schedule, last dose on 10/20/08 10/20/08-office visit-well baby exam. C/O constipation. 4/2/09-records received for DOS 3/9-3/9/09-DC DX:Febrile illness began on 3/6/09, seen in office normal physical exam, thought to have a viral infection. Fever broke and appeared fine. On day of admission woke up very irritable and acting like her stomach hurt, started vomiting, nonbilious. Seen in ED thought to have gastroenteritis. Returned later that afternoon after patient had a stool with bright red color and a second stool deeper red. Stool positive heme.


Changed on 2/14/2018

VAERS ID: 341569 Before After
VAERS Form:1
Age:0.5
Sex:Female
Location:Alaska
Vaccinated:2008-10-20
Onset:2009-03-08
Submitted:2009-03-11
Entered:2009-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B150AA / 3 LL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2786GA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C94097 / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0274X / 3 MO / PO

Administered by: Unknown      Purchased by: Unknown
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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: no
Current Illness: no
Preexisting Conditions: no
Allergies:
Diagnostic Lab Data: 4/2/09-records received-Unremarkable CMP, normal white count, low hemoglobin 10.5, unremarkable differential. Barium enema releived intussuception. Abdominal x-ray series demonstrates fairly prominent soft tissue density in upper midabdomen could represent changes of intussuception.
CDC 'Split Type':

Write-up: 10m 3 wk old had INTUSSUSCEPTION, had previously had 3 doses of Rotateq at correct schedule, last dose on 10/20/08 10/20/08-office visit-well baby exam. C/O constipation. 4/2/09-records received for DOS 3/9-3/9/09-DC DX:Febrile illness began on 3/6/09, seen in office normal physical exam, thought to have a viral infection. Fever broke and appeared fine. On day of admission woke up very irritable and acting like her stomach hurt, started vomiting, nonbilious. Seen in ED thought to have gastroenteritis. Returned later that afternoon after patient had a stool with bright red color and a second stool deeper red. Stool positive heme.


Changed on 6/14/2018

VAERS ID: 341569 Before After
VAERS Form:1
Age:0.5
Sex:Female
Location:Alaska
Vaccinated:2008-10-20
Onset:2009-03-08
Submitted:2009-03-11
Entered:2009-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B150AA / 3 LL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2786GA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C94097 / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0274X / 3 MO / PO

Administered by: Unknown      Purchased by: Unknown
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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: no
Current Illness: no
Preexisting Conditions: no
Allergies:
Diagnostic Lab Data: 4/2/09-records received-Unremarkable CMP, normal white count, low hemoglobin 10.5, unremarkable differential. Barium enema releived intussuception. Abdominal x-ray series demonstrates fairly prominent soft tissue density in upper midabdomen could represent changes of intussuception.
CDC 'Split Type':

Write-up: 10m 3 wk old had INTUSSUSCEPTION, had previously had 3 doses of Rotateq at correct schedule, last dose on 10/20/08 10/20/08-office visit-well baby exam. C/O constipation. 4/2/09-records received for DOS 3/9-3/9/09-DC DX:Febrile illness began on 3/6/09, seen in office normal physical exam, thought to have a viral infection. Fever broke and appeared fine. On day of admission woke up very irritable and acting like her stomach hurt, started vomiting, nonbilious. Seen in ED thought to have gastroenteritis. Returned later that afternoon after patient had a stool with bright red color and a second stool deeper red. Stool positive heme.


Changed on 8/14/2018

VAERS ID: 341569 Before After
VAERS Form:1
Age:0.5
Sex:Female
Location:Alaska
Vaccinated:2008-10-20
Onset:2009-03-08
Submitted:2009-03-11
Entered:2009-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B150AA / 3 LL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2786GA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C94097 / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0274X / 3 MO / PO

Administered by: Unknown      Purchased by: Unknown
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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: no
Current Illness: no
Preexisting Conditions: no
Allergies:
Diagnostic Lab Data: 4/2/09-records received-Unremarkable CMP, normal white count, low hemoglobin 10.5, unremarkable differential. Barium enema releived intussuception. Abdominal x-ray series demonstrates fairly prominent soft tissue density in upper midabdomen could represent changes of intussuception.
CDC 'Split Type':

Write-up: 10m 3 wk old had INTUSSUSCEPTION, had previously had 3 doses of Rotateq at correct schedule, last dose on 10/20/08 10/20/08-office visit-well baby exam. C/O constipation. 4/2/09-records received for DOS 3/9-3/9/09-DC DX:Febrile illness began on 3/6/09, seen in office normal physical exam, thought to have a viral infection. Fever broke and appeared fine. On day of admission woke up very irritable and acting like her stomach hurt, started vomiting, nonbilious. Seen in ED thought to have gastroenteritis. Returned later that afternoon after patient had a stool with bright red color and a second stool deeper red. Stool positive heme.


Changed on 9/14/2018

VAERS ID: 341569 Before After
VAERS Form:1
Age:0.5
Sex:Female
Location:Alaska
Vaccinated:2008-10-20
Onset:2009-03-08
Submitted:2009-03-11
Entered:2009-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B150AA / 3 LL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2786GA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C94097 / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0274X / 3 MO / PO

Administered by: Unknown      Purchased by: Unknown
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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: no
Current Illness: no
Preexisting Conditions: no
Allergies:
Diagnostic Lab Data: 4/2/09-records received-Unremarkable CMP, normal white count, low hemoglobin 10.5, unremarkable differential. Barium enema releived intussuception. Abdominal x-ray series demonstrates fairly prominent soft tissue density in upper midabdomen could represent changes of intussuception.
CDC 'Split Type':

Write-up: 10m 3 wk old had INTUSSUSCEPTION, had previously had 3 doses of Rotateq at correct schedule, last dose on 10/20/08 10/20/08-office visit-well baby exam. C/O constipation. 4/2/09-records received for DOS 3/9-3/9/09-DC DX:Febrile illness began on 3/6/09, seen in office normal physical exam, thought to have a viral infection. Fever broke and appeared fine. On day of admission woke up very irritable and acting like her stomach hurt, started vomiting, nonbilious. Seen in ED thought to have gastroenteritis. Returned later that afternoon after patient had a stool with bright red color and a second stool deeper red. Stool positive heme.


Changed on 10/14/2018

VAERS ID: 341569 Before After
VAERS Form:1
Age:0.5
Sex:Female
Location:Alaska
Vaccinated:2008-10-20
Onset:2009-03-08
Submitted:2009-03-11
Entered:2009-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B150AA / 3 LL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT2786GA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C94097 / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0274X / 3 MO / PO

Administered by: Unknown      Purchased by: Unknown
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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: no
Current Illness: no
Preexisting Conditions: no
Allergies:
Diagnostic Lab Data: 4/2/09-records received-Unremarkable CMP, normal white count, low hemoglobin 10.5, unremarkable differential. Barium enema releived intussuception. Abdominal x-ray series demonstrates fairly prominent soft tissue density in upper midabdomen could represent changes of intussuception.
CDC 'Split Type':

Write-up: 10m 3 wk old had INTUSSUSCEPTION, had previously had 3 doses of Rotateq at correct schedule, last dose on 10/20/08 10/20/08-office visit-well baby exam. C/O constipation. 4/2/09-records received for DOS 3/9-3/9/09-DC DX:Febrile illness began on 3/6/09, seen in office normal physical exam, thought to have a viral infection. Fever broke and appeared fine. On day of admission woke up very irritable and acting like her stomach hurt, started vomiting, nonbilious. Seen in ED thought to have gastroenteritis. Returned later that afternoon after patient had a stool with bright red color and a second stool deeper red. Stool positive heme.

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