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This is VAERS ID 346278

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

VAERS ID: 346278
VAERS Form:
Age:0.3
Gender:Female
Location:South Carolina
Vaccinated:2009-04-03
Onset:2009-05-10
Submitted:2009-05-13
Entered:2009-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B207AA / - RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF595AA / - LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C87338 / - LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA697A / - - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal pain, Barium double contrast, Crying, Gastritis, Haematochezia, Intussusception, Irritability, Lethargy, Nasal congestion, Pyrexia, Rectal haemorrhage, Surgery, Tachycardia, Vomiting, Skin turgor decreased, Intestinal resection, Bowel movement irregularity

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: no
Current Illness: no
Preexisting Conditions: newborn jaundice
Allergies:
Diagnostic Lab Data: 6/15/09 Hospital records received DOS 5/12/09. LABS and DIAGNOSTICS: Reduction of intussusception with air contrast enema unsuccessful.
CDC 'Split Type':

Write-up: Pt seen in hospital on May 11, 2009 with bilious emesis, and low grade fever. She was sent home with the diagnosis of acute gastritis. The patient presented to our clinic on Tuesday morning with same complaint and also report of no bowel movement for three days. When Dr. examined baby she had a palpable mass in her left lower abdomen. He then noted after examining her rectum, a grossly bloody stool. Patient was then sent to hospital where she was diagnosed with intussusception. She underwent bowel resection oon May 12, 2009. 6/15/09 Hospital records received DOS 5/12/09. Assessment: Intussusception. Patient presented with abdominal pain, bilious vomiting, crying, blood per rectum, bloody stool, fussy, lethargic. Congestion past 24hrs. Decreased skin turgidity. Tachycardia.6/22/09-ICD-9 codes received 560.0, 787.03. V 641. 9/28/09 Discharge summary received for date of service 5/12/09 to 5/17/09 DX: Successful surgical open reduction of the intussusception


Changed on 3/2/2010

VAERS ID: 346278 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:South Carolina
Vaccinated:2009-04-03
Onset:2009-05-10
Submitted:2009-05-13
Entered:2009-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B207AA / - RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF595AA / - LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC C87338 / - LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA697A / - - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal pain, Barium double contrast, Crying, Gastritis, Haematochezia, Intussusception, Irritability, Lethargy, Nasal congestion, Pyrexia, Rectal haemorrhage, Surgery, Tachycardia, Vomiting, Skin turgor decreased, Intestinal resection, Bowel movement irregularity

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: no
Current Illness: no
Preexisting Conditions: newborn jaundice
Allergies:
Diagnostic Lab Data: 6/15/09 Hospital records received DOS 5/12/09. LABS and DIAGNOSTICS: Reduction of intussusception with air contrast enema unsuccessful.
CDC 'Split Type':

Write-up: Pt seen in hospital on May 11, 2009 with bilious emesis, and low grade fever. She was sent home with the diagnosis of acute gastritis. The patient presented to our clinic on Tuesday morning with same complaint and also report of no bowel movement for three days. When Dr. examined baby she had a palpable mass in her left lower abdomen. He then noted after examining her rectum, a grossly bloody stool. Patient was then sent to hospital where she was diagnosed with intussusception. She underwent bowel resection oon May 12, 2009. 6/15/09 Hospital records received DOS 5/12/09. Assessment: Intussusception. Patient presented with abdominal pain, bilious vomiting, crying, blood per rectum, bloody stool, fussy, lethargic. Congestion past 24hrs. Decreased skin turgidity. Tachycardia.6/22/09-ICD-9 codes received 560.0, 787.03. V 641. 9/28/09 Discharge summary received for date of service 5/12/09 to 5/17/09 DX: Successful surgical open reduction of the intussusception


Changed on 4/7/2010

VAERS ID: 346278 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:South Carolina
Vaccinated:2009-04-03
Onset:2009-05-10
Submitted:2009-05-13
Entered:2009-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B207AA / - RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF595AA / - LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C87338 / - LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA697A / - - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal pain, Barium double contrast, Crying, Gastritis, Haematochezia, Intussusception, Irritability, Lethargy, Nasal congestion, Pyrexia, Rectal haemorrhage, Surgery, Tachycardia, Vomiting, Skin turgor decreased, Intestinal resection, Bowel movement irregularity

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: no
Current Illness: no
Preexisting Conditions: newborn jaundice
Allergies:
Diagnostic Lab Data: 6/15/09 Hospital records received DOS 5/12/09. LABS and DIAGNOSTICS: Reduction of intussusception with air contrast enema unsuccessful.
CDC 'Split Type':

Write-up: Pt seen in hospital on May 11, 2009 with bilious emesis, and low grade fever. She was sent home with the diagnosis of acute gastritis. The patient presented to our clinic on Tuesday morning with same complaint and also report of no bowel movement for three days. When Dr. examined baby she had a palpable mass in her left lower abdomen. He then noted after examining her rectum, a grossly bloody stool. Patient was then sent to hospital where she was diagnosed with intussusception. She underwent bowel resection oon May 12, 2009. 6/15/09 Hospital records received DOS 5/12/09. Assessment: Intussusception. Patient presented with abdominal pain, bilious vomiting, crying, blood per rectum, bloody stool, fussy, lethargic. Congestion past 24hrs. Decreased skin turgidity. Tachycardia.6/22/09-ICD-9 codes received 560.0, 787.03. V 641. 9/28/09 Discharge summary received for date of service 5/12/09 to 5/17/09 DX: Successful surgical open reduction of the intussusception


Changed on 8/31/2010

VAERS ID: 346278 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:South Carolina
Vaccinated:2009-04-03
Onset:2009-05-10
Submitted:2009-05-13
Entered:2009-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B207AA / - RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF595AA / - LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH C87338 / - LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA697A / - - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal pain, Barium double contrast, Crying, Gastritis, Haematochezia, Intussusception, Irritability, Lethargy, Nasal congestion, Pyrexia, Rectal haemorrhage, Surgery, Tachycardia, Vomiting, Skin turgor decreased, Intestinal resection, Bowel movement irregularity

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: no
Current Illness: no
Preexisting Conditions: newborn jaundice
Allergies:
Diagnostic Lab Data: 6/15/09 Hospital records received DOS 5/12/09. LABS and DIAGNOSTICS: Reduction of intussusception with air contrast enema unsuccessful.
CDC 'Split Type':

Write-up: Pt seen in hospital on May 11, 2009 with bilious emesis, and low grade fever. She was sent home with the diagnosis of acute gastritis. The patient presented to our clinic on Tuesday morning with same complaint and also report of no bowel movement for three days. When Dr. examined baby she had a palpable mass in her left lower abdomen. He then noted after examining her rectum, a grossly bloody stool. Patient was then sent to hospital where she was diagnosed with intussusception. She underwent bowel resection oon May 12, 2009. 6/15/09 Hospital records received DOS 5/12/09. Assessment: Intussusception. Patient presented with abdominal pain, bilious vomiting, crying, blood per rectum, bloody stool, fussy, lethargic. Congestion past 24hrs. Decreased skin turgidity. Tachycardia.6/22/09-ICD-9 codes received 560.0, 787.03. V 641. 9/28/09 Discharge summary received for date of service 5/12/09 to 5/17/09 DX: Successful surgical open reduction of the intussusception


Changed on 5/13/2013

VAERS ID: 346278 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:South Carolina
Vaccinated:2009-04-03
Onset:2009-05-10
Submitted:2009-05-13
Entered:2009-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B207AA / - RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF595AA / - LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C87338 / - LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA697A / - - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA697A / - - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal pain, Barium double contrast, Crying, Gastritis, Haematochezia, Intussusception, Irritability, Lethargy, Nasal congestion, Pyrexia, Rectal haemorrhage, Surgery, Tachycardia, Vomiting, Skin turgor decreased, Intestinal resection, Bowel movement irregularity

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: no
Current Illness: no
Preexisting Conditions: newborn jaundice
Allergies:
Diagnostic Lab Data: 6/15/09 Hospital records received DOS 5/12/09. LABS and DIAGNOSTICS: Reduction of intussusception with air contrast enema unsuccessful.
CDC 'Split Type':

Write-up: Pt seen in hospital on May 11, 2009 with bilious emesis, and low grade fever. She was sent home with the diagnosis of acute gastritis. The patient presented to our clinic on Tuesday morning with same complaint and also report of no bowel movement for three days. When Dr. examined baby she had a palpable mass in her left lower abdomen. He then noted after examining her rectum, a grossly bloody stool. Patient was then sent to hospital where she was diagnosed with intussusception. She underwent bowel resection oon May 12, 2009. 6/15/09 Hospital records received DOS 5/12/09. Assessment: Intussusception. Patient presented with abdominal pain, bilious vomiting, crying, blood per rectum, bloody stool, fussy, lethargic. Congestion past 24hrs. Decreased skin turgidity. Tachycardia.6/22/09-ICD-9 codes received 560.0, 787.03. V 641. 9/28/09 Discharge summary received for date of service 5/12/09 to 5/17/09 DX: Successful surgical open reduction of the intussusception


Changed on 4/14/2017

VAERS ID: 346278 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:South Carolina
Vaccinated:2009-04-03
Onset:2009-05-10
Submitted:2009-05-13
Entered:2009-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B207AA / - RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF595AA / - LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C87338 / - LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA697A / - - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal pain, Barium double contrast, Crying, Gastritis, Haematochezia, Intussusception, Irritability, Lethargy, Nasal congestion, Pyrexia, Rectal haemorrhage, Surgery, Tachycardia, Vomiting, Skin turgor decreased, Intestinal resection, Bowel movement irregularity

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: no
Current Illness: no
Preexisting Conditions: newborn jaundice
Allergies:
Diagnostic Lab Data: 6/15/09 Hospital records received DOS 5/12/09. LABS and DIAGNOSTICS: Reduction of intussusception with air contrast enema unsuccessful.
CDC 'Split Type':

Write-up: Pt seen in hospital on May 11, 2009 with bilious emesis, and low grade fever. She was sent home with the diagnosis of acute gastritis. The patient presented to our clinic on Tuesday morning with same complaint and also report of no bowel movement for three days. When Dr. examined baby she had a palpable mass in her left lower abdomen. He then noted after examining her rectum, a grossly bloody stool. Patient was then sent to hospital where she was diagnosed with intussusception. She underwent bowel resection oon May 12, 2009. 6/15/09 Hospital records received DOS 5/12/09. Assessment: Intussusception. Patient presented with abdominal pain, bilious vomiting, crying, blood per rectum, bloody stool, fussy, lethargic. Congestion past 24hrs. Decreased skin turgidity. Tachycardia.6/22/09-ICD-9 codes received 560.0, 787.03. V 641. 9/28/09 Discharge summary received for date of service 5/12/09 to 5/17/09 DX: Successful surgical open reduction of the intussusception


Changed on 9/14/2017

VAERS ID: 346278 Before After
VAERS Form:(blank) 1
Age:0.3
Gender:Female
Location:South Carolina
Vaccinated:2009-04-03
Onset:2009-05-10
Submitted:2009-05-13
Entered:2009-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B207AA / - UNK RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF595AA / - UNK LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C87338 / - UNK LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA697A / - UNK - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Gastritis, Haematochezia, Intussusception, Pyrexia, Vomiting, Intestinal resection, Bowel movement irregularity

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: no
Current Illness: no
Preexisting Conditions: newborn jaundice
Allergies:
Diagnostic Lab Data: 6/15/09 Hospital records received DOS 5/12/09. LABS and DIAGNOSTICS: Reduction of intussusception with air contrast enema unsuccessful.
CDC 'Split Type':

Write-up: Pt seen in hospital on May 11, 2009 with bilious emesis, and low grade fever. She was sent home with the diagnosis of acute gastritis. The patient presented to our clinic on Tuesday morning with same complaint and also report of no bowel movement for three days. When Dr. examined baby she had a palpable mass in her left lower abdomen. He then noted after examining her rectum, a grossly bloody stool. Patient was then sent to hospital where she was diagnosed with intussusception. She underwent bowel resection oon May 12, 2009. 6/15/09 Hospital records received DOS 5/12/09. Assessment: Intussusception. Patient presented with abdominal pain, bilious vomiting, crying, blood per rectum, bloody stool, fussy, lethargic. Congestion past 24hrs. Decreased skin turgidity. Tachycardia.6/22/09-ICD-9 codes received 560.0, 787.03. V 641. 9/28/09 Discharge summary received for date of service 5/12/09 to 5/17/09 DX: Successful surgical open reduction of the intussusception


Changed on 2/14/2018

VAERS ID: 346278 Before After
VAERS Form:1
Age:0.3
Gender:Female
Location:South Carolina
Vaccinated:2009-04-03
Onset:2009-05-10
Submitted:2009-05-13
Entered:2009-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B207AA / UNK RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF595AA / UNK LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C87338 / UNK LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA697A / UNK MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Gastritis, Haematochezia, Intussusception, Pyrexia, Vomiting, Intestinal resection, Bowel movement irregularity

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: no
Current Illness: no
Preexisting Conditions: newborn jaundice
Allergies:
Diagnostic Lab Data: 6/15/09 Hospital records received DOS 5/12/09. LABS and DIAGNOSTICS: Reduction of intussusception with air contrast enema unsuccessful.
CDC 'Split Type':

Write-up: Pt seen in hospital on May 11, 2009 with bilious emesis, and low grade fever. She was sent home with the diagnosis of acute gastritis. The patient presented to our clinic on Tuesday morning with same complaint and also report of no bowel movement for three days. When Dr. examined baby she had a palpable mass in her left lower abdomen. He then noted after examining her rectum, a grossly bloody stool. Patient was then sent to hospital where she was diagnosed with intussusception. She underwent bowel resection oon May 12, 2009. 6/15/09 Hospital records received DOS 5/12/09. Assessment: Intussusception. Patient presented with abdominal pain, bilious vomiting, crying, blood per rectum, bloody stool, fussy, lethargic. Congestion past 24hrs. Decreased skin turgidity. Tachycardia.6/22/09-ICD-9 codes received 560.0, 787.03. V 641. 9/28/09 Discharge summary received for date of service 5/12/09 to 5/17/09 DX: Successful surgical open reduction of the intussusception

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