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This is VAERS ID 351299

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

VAERS ID: 351299
VAERS Form:
Age:0.6
Gender:Female
Location:South Carolina
Vaccinated:2009-05-28
Onset:2009-06-15
Submitted:2009-07-07
Entered:2009-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3224AA / 2 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB736AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC 034438 / 2 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA734A / 2 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium double contrast, Blood amylase, Blood culture, Chest X-ray, Full blood count, Intussusception, Lethargy, Nausea, Pyrexia, Rectal haemorrhage, Surgery, Urine analysis, Vomiting, Occult blood positive, Metabolic function test

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Well check up/constipation
Preexisting Conditions: None 12/10/09 Received medical records w/PMH: hernia repair. Allergies: NKDA
Allergies:
Diagnostic Lab Data: 12/10/09 Received medical records w/Labs: CBC, BMP, UA, Amylase, Lipase, Blood culture, no results noted, stools were guiac +. CXR norm, Air enema + for intussusception.
CDC 'Split Type':

Write-up: Intussusception requiring surgical reduction. 12/10/2009 Received ED records for 6/16-6/18/2009, patient with c/o''s nausea/vomiting, fever, lethargy, progressive sx x 3 days. Blood per rectum, Tx: IVF, IV ABX, Telemetry. Air enema partially reduced IS & patient transfered to higher level of care. Repeat air enema done. DC DX Intussusception which was successively reduced. ICD-9 560.0


Changed on 3/2/2010

VAERS ID: 351299 Before After
VAERS Form:
Age:0.6
Gender:Female
Location:South Carolina
Vaccinated:2009-05-28
Onset:2009-06-15
Submitted:2009-07-07
Entered:2009-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3224AA / 2 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB736AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC 034438 / 2 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA734A / 2 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium double contrast, Blood amylase, Blood culture, Chest X-ray, Full blood count, Intussusception, Lethargy, Nausea, Pyrexia, Rectal haemorrhage, Surgery, Urine analysis, Vomiting, Occult blood positive, Metabolic function test

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: 1 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Well check up/constipation
Preexisting Conditions: None 12/10/09 Received medical records w/PMH: hernia repair. Allergies: NKDA
Allergies:
Diagnostic Lab Data: 12/10/09 Received medical records w/Labs: CBC, BMP, UA, Amylase, Lipase, Blood culture, no results noted, stools were guiac +. CXR norm, Air enema + for intussusception.
CDC 'Split Type':

Write-up: Intussusception requiring surgical reduction. 12/10/2009 Received ED records for 6/16-6/18/2009, DC DX Intussusception which was successively reduced. ICD-9 560.0 patient with c/o''s nausea/vomiting, fever, lethargy, progressive sx x 3 days. Blood per rectum, Tx: IVF, IV ABX, Telemetry. Air enema partially reduced IS & patient transfered to higher level of care. Repeat air enema done. DC DX Intussusception which was successively reduced. ICD-9 560.0


Changed on 4/7/2010

VAERS ID: 351299 Before After
VAERS Form:
Age:0.6
Gender:Female
Location:South Carolina
Vaccinated:2009-05-28
Onset:2009-06-15
Submitted:2009-07-07
Entered:2009-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3224AA / 2 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB736AA / 2 RL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC 034438 / 2 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA734A / 2 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium double contrast, Blood amylase, Blood culture, Chest X-ray, Full blood count, Intussusception, Lethargy, Nausea, Pyrexia, Rectal haemorrhage, Surgery, Urine analysis, Vomiting, Occult blood positive, Metabolic function test

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Well check up/constipation
Preexisting Conditions: None 12/10/09 Received medical records w/PMH: hernia repair. Allergies: NKDA
Allergies:
Diagnostic Lab Data: 12/10/09 Received medical records w/Labs: CBC, BMP, UA, Amylase, Lipase, Blood culture, no results noted, stools were guiac +. CXR norm, Air enema + for intussusception.
CDC 'Split Type':

Write-up: Intussusception requiring surgical reduction. 12/10/2009 Received ED records for 6/16-6/18/2009, DC DX Intussusception which was successively reduced. ICD-9 560.0 patient with c/o''s nausea/vomiting, fever, lethargy, progressive sx x 3 days. Blood per rectum, Tx: IVF, IV ABX, Telemetry. Air enema partially reduced IS & patient transfered to higher level of care. Repeat air enema done.


Changed on 5/11/2010

VAERS ID: 351299 Before After
VAERS Form:
Age:0.6
Gender:Female
Location:South Carolina
Vaccinated:2009-05-28
Onset:2009-06-15
Submitted:2009-07-07
Entered:2009-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3224AA / 2 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB736AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC 034438 D34438 / 2 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA734A / 2 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium double contrast, Blood amylase, Blood culture, Chest X-ray, Full blood count, Intussusception, Lethargy, Nausea, Pyrexia, Rectal haemorrhage, Surgery, Urine analysis, Vomiting, Occult blood positive, Metabolic function test

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Well check up/constipation
Preexisting Conditions: None 12/10/09 Received medical records w/PMH: hernia repair. Allergies: NKDA
Allergies:
Diagnostic Lab Data: 12/10/09 Received medical records w/Labs: CBC, BMP, UA, Amylase, Lipase, Blood culture, no results noted, stools were guiac +. CXR norm, Air enema + for intussusception.
CDC 'Split Type':

Write-up: Intussusception requiring surgical reduction. 12/10/2009 Received ED records for 6/16-6/18/2009, DC DX Intussusception which was successively reduced. ICD-9 560.0 patient with c/o''s nausea/vomiting, fever, lethargy, progressive sx x 3 days. Blood per rectum, Tx: IVF, IV ABX, Telemetry. Air enema partially reduced IS & patient transfered to higher level of care. Repeat air enema done.


Changed on 8/31/2010

VAERS ID: 351299 Before After
VAERS Form:
Age:0.6
Gender:Female
Location:South Carolina
Vaccinated:2009-05-28
Onset:2009-06-15
Submitted:2009-07-07
Entered:2009-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3224AA / 2 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB736AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH D34438 / 2 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA734A / 2 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Surgery

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Well check up/constipation
Preexisting Conditions: None 12/10/09 Received medical records w/PMH: hernia repair. Allergies: NKDA
Allergies:
Diagnostic Lab Data: 12/10/09 Received medical records w/Labs: CBC, BMP, UA, Amylase, Lipase, Blood culture, no results noted, stools were guiac +. CXR norm, Air enema + for intussusception.
CDC 'Split Type':

Write-up: Intussusception requiring surgical reduction. 12/10/2009 Received ED records for 6/16-6/18/2009, DC DX Intussusception which was successively reduced. ICD-9 560.0 patient with c/o''s nausea/vomiting, fever, lethargy, progressive sx x 3 days. Blood per rectum, Tx: IVF, IV ABX, Telemetry. Air enema partially reduced IS & patient transfered to higher level of care. Repeat air enema done.


Changed on 4/13/2011

VAERS ID: 351299 Before After
VAERS Form:
Age:0.6
Gender:Female
Location:South Carolina
Vaccinated:2009-05-28
Onset:2009-06-15
Submitted:2009-07-07
Entered:2009-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3224AA / 2 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB736AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D34438 / 2 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA734A / 2 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium double contrast, Blood amylase, Blood culture, Chest X-ray, Full blood count, Intussusception, Lethargy, Nausea, Pyrexia, Rectal haemorrhage, Surgery, Urine analysis, Vomiting, Occult blood positive, Metabolic function test

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Well check up/constipation
Preexisting Conditions: None 12/10/09 Received medical records w/PMH: hernia repair. Allergies: NKDA
Allergies:
Diagnostic Lab Data: 12/10/09 Received medical records w/Labs: CBC, BMP, UA, Amylase, Lipase, Blood culture, no results noted, stools were guiac +. CXR norm, Air enema + for intussusception.
CDC 'Split Type':

Write-up: Intussusception requiring surgical reduction. 12/10/2009 Received ED records for 6/16-6/18/2009, DC DX Intussusception which was successively reduced. ICD-9 560.0 patient with c/o''s nausea/vomiting, fever, lethargy, progressive sx x 3 days. Blood per rectum, Tx: IVF, IV ABX, Telemetry. Air enema partially reduced IS & patient transfered to higher level of care. Repeat air enema done.


Changed on 5/13/2011

VAERS ID: 351299 Before After
VAERS Form:
Age:0.6
Gender:Female
Location:South Carolina
Vaccinated:2009-05-28
Onset:2009-06-15
Submitted:2009-07-07
Entered:2009-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3224AA / 2 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB736AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D34438 / 2 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA734A / 2 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium double contrast, Blood amylase, Blood culture, Chest X-ray, Full blood count, Intussusception, Lethargy, Nausea, Pyrexia, Rectal haemorrhage, Surgery, Urine analysis, Vomiting, Occult blood positive, Metabolic function test

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Well check up/constipation
Preexisting Conditions: None 12/10/09 Received medical records w/PMH: hernia repair. Allergies: NKDA
Allergies:
Diagnostic Lab Data: 12/10/09 Received medical records w/Labs: CBC, BMP, UA, Amylase, Lipase, Blood culture, no results noted, stools were guiac +. CXR norm, Air enema + for intussusception.
CDC 'Split Type':

Write-up: Intussusception requiring surgical reduction. 12/10/2009 Received ED records for 6/16-6/18/2009, DC DX Intussusception which was successively reduced. ICD-9 560.0 patient with c/o''s nausea/vomiting, fever, lethargy, progressive sx x 3 days. Blood per rectum, Tx: IVF, IV ABX, Telemetry. Air enema partially reduced IS & patient transfered to higher level of care. Repeat air enema done.


Changed on 6/11/2011

VAERS ID: 351299 Before After
VAERS Form:
Age:0.6
Gender:Female
Location:South Carolina
Vaccinated:2009-05-28
Onset:2009-06-15
Submitted:2009-07-07
Entered:2009-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3224AA / 2 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB736AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D34438 / 2 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA734A / 2 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium double contrast, Blood amylase, Blood culture, Chest X-ray, Full blood count, Intussusception, Lethargy, Nausea, Pyrexia, Rectal haemorrhage, Surgery, Urine analysis, Vomiting, Occult blood positive, Metabolic function test

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Well check up/constipation
Preexisting Conditions: None 12/10/09 Received medical records w/PMH: hernia repair. Allergies: NKDA
Allergies:
Diagnostic Lab Data: 12/10/09 Received medical records w/Labs: CBC, BMP, UA, Amylase, Lipase, Blood culture, no results noted, stools were guiac +. CXR norm, Air enema + for intussusception.
CDC 'Split Type':

Write-up: Intussusception requiring surgical reduction. 12/10/2009 Received ED records for 6/16-6/18/2009, DC DX Intussusception which was successively reduced. ICD-9 560.0 patient with c/o''s nausea/vomiting, fever, lethargy, progressive sx x 3 days. Blood per rectum, Tx: IVF, IV ABX, Telemetry. Air enema partially reduced IS & patient transfered to higher level of care. Repeat air enema done.


Changed on 5/13/2013

VAERS ID: 351299 Before After
VAERS Form:
Age:0.6
Gender:Female
Location:South Carolina
Vaccinated:2009-05-28
Onset:2009-06-15
Submitted:2009-07-07
Entered:2009-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3224AA / 2 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB736AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D34438 / 2 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA734A / 2 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA734A / 2 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium double contrast, Blood amylase, Blood culture, Chest X-ray, Full blood count, Intussusception, Lethargy, Nausea, Pyrexia, Rectal haemorrhage, Surgery, Urine analysis, Vomiting, Occult blood positive, Metabolic function test

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Well check up/constipation
Preexisting Conditions: None 12/10/09 Received medical records w/PMH: hernia repair. Allergies: NKDA
Allergies:
Diagnostic Lab Data: 12/10/09 Received medical records w/Labs: CBC, BMP, UA, Amylase, Lipase, Blood culture, no results noted, stools were guiac +. CXR norm, Air enema + for intussusception.
CDC 'Split Type':

Write-up: Intussusception requiring surgical reduction. 12/10/2009 Received ED records for 6/16-6/18/2009, DC DX Intussusception which was successively reduced. ICD-9 560.0 patient with c/o''s nausea/vomiting, fever, lethargy, progressive sx x 3 days. Blood per rectum, Tx: IVF, IV ABX, Telemetry. Air enema partially reduced IS & patient transfered to higher level of care. Repeat air enema done.


Changed on 6/14/2014

VAERS ID: 351299 Before After
VAERS Form:
Age:0.6
Gender:Female
Location:South Carolina
Vaccinated:2009-05-28
Onset:2009-06-15
Submitted:2009-07-07
Entered:2009-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3224AA / 2 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB736AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D34438 / 2 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA734A / 2 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium double contrast, Blood amylase, Blood culture, Chest X-ray, Full blood count, Intussusception, Lethargy, Nausea, Pyrexia, Rectal haemorrhage, Surgery, Urine analysis, Vomiting, Occult blood positive, Metabolic function test

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Well check up/constipation
Preexisting Conditions: None 12/10/09 Received medical records w/PMH: hernia repair. Allergies: NKDA
Allergies:
Diagnostic Lab Data: 12/10/09 Received medical records w/Labs: CBC, BMP, UA, Amylase, Lipase, Blood culture, no results noted, stools were guiac +. CXR norm, Air enema + for intussusception.
CDC 'Split Type':

Write-up: Intussusception requiring surgical reduction. 12/10/2009 Received ED records for 6/16-6/18/2009, DC DX Intussusception which was successively reduced. ICD-9 560.0 patient with c/o''s nausea/vomiting, fever, lethargy, progressive sx x 3 days. Blood per rectum, Tx: IVF, IV ABX, Telemetry. Air enema partially reduced IS & patient transfered to higher level of care. Repeat air enema done.


Changed on 2/14/2017

VAERS ID: 351299 Before After
VAERS Form:
Age:0.6 0.58
Gender:Female
Location:South Carolina
Vaccinated:2009-05-28
Onset:2009-06-15
Submitted:2009-07-07
Entered:2009-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3224AA / 2 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB736AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D34438 / 2 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA734A / 2 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium double contrast, Blood amylase, Blood culture, Chest X-ray, Full blood count, Intussusception, Lethargy, Nausea, Pyrexia, Rectal haemorrhage, Surgery, Urine analysis, Vomiting, Occult blood positive, Metabolic function test

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Well check up/constipation
Preexisting Conditions: None 12/10/09 Received medical records w/PMH: hernia repair. Allergies: NKDA
Allergies:
Diagnostic Lab Data: 12/10/09 Received medical records w/Labs: CBC, BMP, UA, Amylase, Lipase, Blood culture, no results noted, stools were guiac +. CXR norm, Air enema + for intussusception.
CDC 'Split Type':

Write-up: Intussusception requiring surgical reduction. 12/10/2009 Received ED records for 6/16-6/18/2009, DC DX Intussusception which was successively reduced. ICD-9 560.0 patient with c/o''s nausea/vomiting, fever, lethargy, progressive sx x 3 days. Blood per rectum, Tx: IVF, IV ABX, Telemetry. Air enema partially reduced IS & patient transfered to higher level of care. Repeat air enema done.


Changed on 4/14/2017

VAERS ID: 351299 Before After
VAERS Form:
Age:0.58
Gender:Female
Location:South Carolina
Vaccinated:2009-05-28
Onset:2009-06-15
Submitted:2009-07-07
Entered:2009-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3224AA / 2 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB736AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D34438 / 2 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA734A / 2 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium double contrast, Blood amylase, Blood culture, Chest X-ray, Full blood count, Intussusception, Lethargy, Nausea, Pyrexia, Rectal haemorrhage, Surgery, Urine analysis, Vomiting, Occult blood positive, Metabolic function test

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Well check up/constipation
Preexisting Conditions: None 12/10/09 Received medical records w/PMH: hernia repair. Allergies: NKDA
Allergies:
Diagnostic Lab Data: 12/10/09 Received medical records w/Labs: CBC, BMP, UA, Amylase, Lipase, Blood culture, no results noted, stools were guiac +. CXR norm, Air enema + for intussusception.
CDC 'Split Type':

Write-up: Intussusception requiring surgical reduction. 12/10/2009 Received ED records for 6/16-6/18/2009, DC DX Intussusception which was successively reduced. ICD-9 560.0 patient with c/o''s nausea/vomiting, fever, lethargy, progressive sx x 3 days. Blood per rectum, Tx: IVF, IV ABX, Telemetry. Air enema partially reduced IS & patient transfered to higher level of care. Repeat air enema done.


Changed on 9/14/2017

VAERS ID: 351299 Before After
VAERS Form:(blank) 1
Age:0.58
Gender:Female
Location:South Carolina
Vaccinated:2009-05-28
Onset:2009-06-15
Submitted:2009-07-07
Entered:2009-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3224AA / 2 3 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB736AA / 2 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D34438 / 2 3 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA734A / 2 3 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Surgery

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Well check up/constipation
Preexisting Conditions: None 12/10/09 Received medical records w/PMH: hernia repair. Allergies: NKDA
Allergies:
Diagnostic Lab Data: 12/10/09 Received medical records w/Labs: CBC, BMP, UA, Amylase, Lipase, Blood culture, no results noted, stools were guiac +. CXR norm, Air enema + for intussusception.
CDC 'Split Type':

Write-up: Intussusception requiring surgical reduction. 12/10/2009 Received ED records for 6/16-6/18/2009, DC DX Intussusception which was successively reduced. ICD-9 560.0 patient with c/o''s nausea/vomiting, fever, lethargy, progressive sx x 3 days. Blood per rectum, Tx: IVF, IV ABX, Telemetry. Air enema partially reduced IS & patient transfered to higher level of care. Repeat air enema done.


Changed on 2/14/2018

VAERS ID: 351299 Before After
VAERS Form:1
Age:0.58
Gender:Female
Location:South Carolina
Vaccinated:2009-05-28
Onset:2009-06-15
Submitted:2009-07-07
Entered:2009-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3224AA / 3 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB736AA / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D34438 / 3 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA734A / 3 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Surgery

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Well check up/constipation
Preexisting Conditions: None 12/10/09 Received medical records w/PMH: hernia repair. Allergies: NKDA
Allergies:
Diagnostic Lab Data: 12/10/09 Received medical records w/Labs: CBC, BMP, UA, Amylase, Lipase, Blood culture, no results noted, stools were guiac +. CXR norm, Air enema + for intussusception.
CDC 'Split Type':

Write-up: Intussusception requiring surgical reduction. 12/10/2009 Received ED records for 6/16-6/18/2009, DC DX Intussusception which was successively reduced. ICD-9 560.0 patient with c/o''s nausea/vomiting, fever, lethargy, progressive sx x 3 days. Blood per rectum, Tx: IVF, IV ABX, Telemetry. Air enema partially reduced IS & patient transfered to higher level of care. Repeat air enema done.


Changed on 6/14/2018

VAERS ID: 351299 Before After
VAERS Form:1
Age:0.58
Gender:Female
Location:South Carolina
Vaccinated:2009-05-28
Onset:2009-06-15
Submitted:2009-07-07
Entered:2009-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3224AA / 3 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB736AA / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D34438 / 3 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA734A / 3 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Surgery

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Well check up/constipation
Preexisting Conditions: None 12/10/09 Received medical records w/PMH: hernia repair. Allergies: NKDA
Allergies:
Diagnostic Lab Data: 12/10/09 Received medical records w/Labs: CBC, BMP, UA, Amylase, Lipase, Blood culture, no results noted, stools were guiac +. CXR norm, Air enema + for intussusception.
CDC 'Split Type':

Write-up: Intussusception requiring surgical reduction. 12/10/2009 Received ED records for 6/16-6/18/2009, DC DX Intussusception which was successively reduced. ICD-9 560.0 patient with c/o''s nausea/vomiting, fever, lethargy, progressive sx x 3 days. Blood per rectum, Tx: IVF, IV ABX, Telemetry. Air enema partially reduced IS & patient transfered to higher level of care. Repeat air enema done.


Changed on 8/14/2018

VAERS ID: 351299 Before After
VAERS Form:1
Age:0.58
Gender:Female
Location:South Carolina
Vaccinated:2009-05-28
Onset:2009-06-15
Submitted:2009-07-07
Entered:2009-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3224AA / 3 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB736AA / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D34438 / 3 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA734A / 3 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Surgery

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Well check up/constipation
Preexisting Conditions: None 12/10/09 Received medical records w/PMH: hernia repair. Allergies: NKDA
Allergies:
Diagnostic Lab Data: 12/10/09 Received medical records w/Labs: CBC, BMP, UA, Amylase, Lipase, Blood culture, no results noted, stools were guiac +. CXR norm, Air enema + for intussusception.
CDC 'Split Type':

Write-up: Intussusception requiring surgical reduction. 12/10/2009 Received ED records for 6/16-6/18/2009, DC DX Intussusception which was successively reduced. ICD-9 560.0 patient with c/o''s nausea/vomiting, fever, lethargy, progressive sx x 3 days. Blood per rectum, Tx: IVF, IV ABX, Telemetry. Air enema partially reduced IS & patient transfered to higher level of care. Repeat air enema done.


Changed on 9/14/2018

VAERS ID: 351299 Before After
VAERS Form:1
Age:0.58
Gender:Female
Location:South Carolina
Vaccinated:2009-05-28
Onset:2009-06-15
Submitted:2009-07-07
Entered:2009-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3224AA / 3 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB736AA / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D34438 / 3 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA734A / 3 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Surgery

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Well check up/constipation
Preexisting Conditions: None 12/10/09 Received medical records w/PMH: hernia repair. Allergies: NKDA
Allergies:
Diagnostic Lab Data: 12/10/09 Received medical records w/Labs: CBC, BMP, UA, Amylase, Lipase, Blood culture, no results noted, stools were guiac +. CXR norm, Air enema + for intussusception.
CDC 'Split Type':

Write-up: Intussusception requiring surgical reduction. 12/10/2009 Received ED records for 6/16-6/18/2009, DC DX Intussusception which was successively reduced. ICD-9 560.0 patient with c/o''s nausea/vomiting, fever, lethargy, progressive sx x 3 days. Blood per rectum, Tx: IVF, IV ABX, Telemetry. Air enema partially reduced IS & patient transfered to higher level of care. Repeat air enema done.

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