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This is VAERS ID 355481

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

VAERS ID: 355481
VAERS Form:
Age:0.2
Gender:Female
Location:Tennessee
Vaccinated:2009-08-20
Onset:2009-08-24
Submitted:2009-08-26
Entered:2009-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3295AA / 0 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB707AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D48928 / 0 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA802A / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Barium double contrast, Culture stool, Full blood count normal, Haematochezia, Intussusception, Pyrexia, Surgery, Urinary system X-ray, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Stool analysis, Abdominal X-ray, Occult blood positive, Metabolic function test normal, Gastrointestinal sounds abnormal

Life Threatening? No
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Nystatin oral susp
Current Illness: Thrush
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: CBC, stool for blood and culture, KUB and abdominal ultrasound 9/3/09 Received medical records w/LABS: Abdominal x-ray & US & KUB abnormal. CBC & CMP WNL. BE w/air contrast unable to reduce. Stool guiaic (+).
CDC 'Split Type':

Write-up: Patient received Rotarix oral vaccine on 08/20/09.Taken to East Tn Children''s Hospital ER on 08/24/09 with vomiting. Diagnosed with intussusception. 9/3/09 Received hospital records of 8/24-8/26/2009. FINAL DX: cecal intussusception, surgically reduced Records reveal patient experienced vomiting & fever x 1 day. Had bloody stool in ER w/abdominal distention & hypoactive bowel sounds. Tx w/IV antibiotics. Surg consult done when BE unable to reduce IS. Progressed well post op & d/c to home. ICD9 codes: 560.0


Changed on 3/2/2010

VAERS ID: 355481 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Tennessee
Vaccinated:2009-08-20
Onset:2009-08-24
Submitted:2009-08-26
Entered:2009-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3295AA / 0 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB707AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC D48928 / 0 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA802A / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Barium double contrast, Culture stool, Full blood count normal, Haematochezia, Intussusception, Pyrexia, Surgery, Urinary system X-ray, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Stool analysis, Abdominal X-ray, Occult blood positive, Metabolic function test normal, Gastrointestinal sounds abnormal

Life Threatening? No
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Nystatin oral susp
Current Illness: Thrush
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: CBC, stool for blood and culture, KUB and abdominal ultrasound 9/3/09 Received medical records w/LABS: Abdominal x-ray & US & KUB abnormal. CBC & CMP WNL. BE w/air contrast unable to reduce. Stool guiaic (+).
CDC 'Split Type':

Write-up: Patient received Rotarix oral vaccine on 08/20/09.Taken to East Tn Children''s Hospital ER on 08/24/09 with vomiting. Diagnosed with intussusception. 9/3/09 Received hospital records of 8/24-8/26/2009. FINAL DX: cecal intussusception, surgically reduced Records reveal patient experienced vomiting & fever x 1 day. Had bloody stool in ER w/abdominal distention & hypoactive bowel sounds. Tx w/IV antibiotics. Surg consult done when BE unable to reduce IS. Progressed well post op & d/c to home. ICD9 codes: 560.0


Changed on 4/7/2010

VAERS ID: 355481 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Tennessee
Vaccinated:2009-08-20
Onset:2009-08-24
Submitted:2009-08-26
Entered:2009-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3295AA / 0 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB707AA / 1 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D48928 / 0 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA802A / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Barium double contrast, Culture stool, Full blood count normal, Haematochezia, Intussusception, Pyrexia, Surgery, Urinary system X-ray, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Stool analysis, Abdominal X-ray, Occult blood positive, Metabolic function test normal, Gastrointestinal sounds abnormal

Life Threatening? No
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Nystatin oral susp
Current Illness: Thrush
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: CBC, stool for blood and culture, KUB and abdominal ultrasound 9/3/09 Received medical records w/LABS: Abdominal x-ray & US & KUB abnormal. CBC & CMP WNL. BE w/air contrast unable to reduce. Stool guiaic (+).
CDC 'Split Type':

Write-up: Patient received Rotarix oral vaccine on 08/20/09.Taken to East Tn Children''s Hospital ER on 08/24/09 with vomiting. Diagnosed with intussusception. 9/3/09 Received hospital records of 8/24-8/26/2009. FINAL DX: cecal intussusception, surgically reduced Records reveal patient experienced vomiting & fever x 1 day. Had bloody stool in ER w/abdominal distention & hypoactive bowel sounds. Tx w/IV antibiotics. Surg consult done when BE unable to reduce IS. Progressed well post op & d/c to home. ICD9 codes: 560.0


Changed on 8/31/2010

VAERS ID: 355481 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Tennessee
Vaccinated:2009-08-20
Onset:2009-08-24
Submitted:2009-08-26
Entered:2009-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3295AA / 0 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB707AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH D48928 / 0 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA802A / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Barium double contrast, Culture stool, Full blood count normal, Haematochezia, Intussusception, Pyrexia, Surgery, Urinary system X-ray, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Stool analysis, Abdominal X-ray, Occult blood positive, Metabolic function test normal, Gastrointestinal sounds abnormal

Life Threatening? No
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Nystatin oral susp
Current Illness: Thrush
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: CBC, stool for blood and culture, KUB and abdominal ultrasound 9/3/09 Received medical records w/LABS: Abdominal x-ray & US & KUB abnormal. CBC & CMP WNL. BE w/air contrast unable to reduce. Stool guiaic (+).
CDC 'Split Type':

Write-up: Patient received Rotarix oral vaccine on 08/20/09.Taken to East Tn Children''s Hospital ER on 08/24/09 with vomiting. Diagnosed with intussusception. 9/3/09 Received hospital records of 8/24-8/26/2009. FINAL DX: cecal intussusception, surgically reduced Records reveal patient experienced vomiting & fever x 1 day. Had bloody stool in ER w/abdominal distention & hypoactive bowel sounds. Tx w/IV antibiotics. Surg consult done when BE unable to reduce IS. Progressed well post op & d/c to home. ICD9 codes: 560.0


Changed on 1/7/2013

VAERS ID: 355481 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Tennessee
Vaccinated:2009-08-20
Onset:2009-08-24
Submitted:2009-08-26
Entered:2009-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3295AA / 0 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB707AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D48928 / 0 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA802A / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Barium double contrast, Culture stool, Full blood count normal, Haematochezia, Intussusception, Pyrexia, Surgery, Urinary system X-ray, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Stool analysis, Abdominal X-ray, Occult blood positive, Metabolic function test normal, Gastrointestinal sounds abnormal

Life Threatening? No
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Nystatin oral susp
Current Illness: Thrush
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: CBC, stool for blood and culture, KUB and abdominal ultrasound 9/3/09 Received medical records w/LABS: Abdominal x-ray & US & KUB abnormal. CBC & CMP WNL. BE w/air contrast unable to reduce. Stool guiaic (+).
CDC 'Split Type':

Write-up: Patient received Rotarix oral vaccine on 08/20/09.Taken 08/20/09. Taken to East Tn Children''s Hospital ER on 08/24/09 with vomiting. Diagnosed with intussusception. 9/3/09 Received hospital records of 8/24-8/26/2009. FINAL DX: cecal intussusception, surgically reduced Records reveal patient experienced vomiting & fever x 1 day. Had bloody stool in ER w/abdominal distention & hypoactive bowel sounds. Tx w/IV antibiotics. Surg consult done when BE unable to reduce IS. Progressed well post op & d/c to home. ICD9 codes: 560.0


Changed on 5/13/2013

VAERS ID: 355481 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Tennessee
Vaccinated:2009-08-20
Onset:2009-08-24
Submitted:2009-08-26
Entered:2009-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3295AA / 0 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB707AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D48928 / 0 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA802A / 1 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA802A / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Barium double contrast, Culture stool, Full blood count normal, Haematochezia, Intussusception, Pyrexia, Surgery, Urinary system X-ray, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Stool analysis, Abdominal X-ray, Occult blood positive, Metabolic function test normal, Gastrointestinal sounds abnormal

Life Threatening? No
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Nystatin oral susp
Current Illness: Thrush
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: CBC, stool for blood and culture, KUB and abdominal ultrasound 9/3/09 Received medical records w/LABS: Abdominal x-ray & US & KUB abnormal. CBC & CMP WNL. BE w/air contrast unable to reduce. Stool guiaic (+).
CDC 'Split Type':

Write-up: Patient received Rotarix oral vaccine on 08/20/09. Taken to ER on 08/24/09 with vomiting. Diagnosed with intussusception. 9/3/09 Received hospital records of 8/24-8/26/2009. FINAL DX: cecal intussusception, surgically reduced Records reveal patient experienced vomiting & fever x 1 day. Had bloody stool in ER w/abdominal distention & hypoactive bowel sounds. Tx w/IV antibiotics. Surg consult done when BE unable to reduce IS. Progressed well post op & d/c to home. ICD9 codes: 560.0


Changed on 6/14/2014

VAERS ID: 355481 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Tennessee
Vaccinated:2009-08-20
Onset:2009-08-24
Submitted:2009-08-26
Entered:2009-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3295AA / 0 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB707AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D48928 / 0 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA802A / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Barium double contrast, Culture stool, Full blood count normal, Haematochezia, Intussusception, Pyrexia, Surgery, Urinary system X-ray, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Stool analysis, Abdominal X-ray, Occult blood positive, Metabolic function test normal, Gastrointestinal sounds abnormal

Life Threatening? No
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Nystatin oral susp
Current Illness: Thrush
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: CBC, stool for blood and culture, KUB and abdominal ultrasound 9/3/09 Received medical records w/LABS: Abdominal x-ray & US & KUB abnormal. CBC & CMP WNL. BE w/air contrast unable to reduce. Stool guiaic (+).
CDC 'Split Type':

Write-up: Patient received Rotarix oral vaccine on 08/20/09. Taken to ER on 08/24/09 with vomiting. Diagnosed with intussusception. 9/3/09 Received hospital records of 8/24-8/26/2009. FINAL DX: cecal intussusception, surgically reduced Records reveal patient experienced vomiting & fever x 1 day. Had bloody stool in ER w/abdominal distention & hypoactive bowel sounds. Tx w/IV antibiotics. Surg consult done when BE unable to reduce IS. Progressed well post op & d/c to home. ICD9 codes: 560.0


Changed on 3/14/2015

VAERS ID: 355481 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Tennessee
Vaccinated:2009-08-20
Onset:2009-08-24
Submitted:2009-08-26
Entered:2009-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3295AA / 0 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB707AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D48928 / 0 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA802A / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Barium double contrast, Culture stool, Full blood count normal, Haematochezia, Intussusception, Pyrexia, Surgery, Urinary system X-ray, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Stool analysis, Abdominal X-ray, Occult blood positive, Metabolic function test normal, Gastrointestinal sounds abnormal

Life Threatening? No
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Nystatin oral susp
Current Illness: Thrush
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: CBC, stool for blood and culture, KUB and abdominal ultrasound 9/3/09 Received medical records w/LABS: Abdominal x-ray & US & KUB abnormal. CBC & CMP WNL. BE w/air contrast unable to reduce. Stool guiaic (+).
CDC 'Split Type':

Write-up: Patient received Rotarix oral vaccine on 08/20/09. Taken to ER on 08/24/09 with vomiting. Diagnosed with intussusception. 9/3/09 Received hospital records of 8/24-8/26/2009. FINAL DX: cecal intussusception, surgically reduced Records reveal patient experienced vomiting & fever x 1 day. Had bloody stool in ER w/abdominal distention & hypoactive bowel sounds. Tx w/IV antibiotics. Surg consult done when BE unable to reduce IS. Progressed well post op & d/c to home. ICD9 codes: 560.0


Changed on 2/14/2017

VAERS ID: 355481 Before After
VAERS Form:
Age:0.2 0.21
Gender:Female
Location:Tennessee
Vaccinated:2009-08-20
Onset:2009-08-24
Submitted:2009-08-26
Entered:2009-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3295AA / 0 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB707AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D48928 / 0 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA802A / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Barium double contrast, Culture stool, Full blood count normal, Haematochezia, Intussusception, Pyrexia, Surgery, Urinary system X-ray, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Stool analysis, Abdominal X-ray, Occult blood positive, Metabolic function test normal, Gastrointestinal sounds abnormal

Life Threatening? No
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Nystatin oral susp
Current Illness: Thrush
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: CBC, stool for blood and culture, KUB and abdominal ultrasound 9/3/09 Received medical records w/LABS: Abdominal x-ray & US & KUB abnormal. CBC & CMP WNL. BE w/air contrast unable to reduce. Stool guiaic (+).
CDC 'Split Type':

Write-up: Patient received Rotarix oral vaccine on 08/20/09. Taken to ER on 08/24/09 with vomiting. Diagnosed with intussusception. 9/3/09 Received hospital records of 8/24-8/26/2009. FINAL DX: cecal intussusception, surgically reduced Records reveal patient experienced vomiting & fever x 1 day. Had bloody stool in ER w/abdominal distention & hypoactive bowel sounds. Tx w/IV antibiotics. Surg consult done when BE unable to reduce IS. Progressed well post op & d/c to home. ICD9 codes: 560.0


Changed on 4/14/2017

VAERS ID: 355481 Before After
VAERS Form:
Age:0.21
Gender:Female
Location:Tennessee
Vaccinated:2009-08-20
Onset:2009-08-24
Submitted:2009-08-26
Entered:2009-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3295AA / 0 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB707AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D48928 / 0 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA802A / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal distension, Barium double contrast, Culture stool, Full blood count normal, Haematochezia, Intussusception, Pyrexia, Surgery, Urinary system X-ray, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Stool analysis, Abdominal X-ray, Occult blood positive, Metabolic function test normal, Gastrointestinal sounds abnormal

Life Threatening? No
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Nystatin oral susp
Current Illness: Thrush
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: CBC, stool for blood and culture, KUB and abdominal ultrasound 9/3/09 Received medical records w/LABS: Abdominal x-ray & US & KUB abnormal. CBC & CMP WNL. BE w/air contrast unable to reduce. Stool guiaic (+).
CDC 'Split Type':

Write-up: Patient received Rotarix oral vaccine on 08/20/09. Taken to ER on 08/24/09 with vomiting. Diagnosed with intussusception. 9/3/09 Received hospital records of 8/24-8/26/2009. FINAL DX: cecal intussusception, surgically reduced Records reveal patient experienced vomiting & fever x 1 day. Had bloody stool in ER w/abdominal distention & hypoactive bowel sounds. Tx w/IV antibiotics. Surg consult done when BE unable to reduce IS. Progressed well post op & d/c to home. ICD9 codes: 560.0


Changed on 9/14/2017

VAERS ID: 355481 Before After
VAERS Form:(blank) 1
Age:0.21
Gender:Female
Location:Tennessee
Vaccinated:2009-08-20
Onset:2009-08-24
Submitted:2009-08-26
Entered:2009-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3295AA / 0 1 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB707AA / 1 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D48928 / 0 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA802A / 1 2 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Culture stool, Intussusception, Urinary system X-ray, Vomiting, Stool analysis

Life Threatening? No
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Nystatin oral susp
Current Illness: Thrush
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: CBC, stool for blood and culture, KUB and abdominal ultrasound 9/3/09 Received medical records w/LABS: Abdominal x-ray & US & KUB abnormal. CBC & CMP WNL. BE w/air contrast unable to reduce. Stool guiaic (+).
CDC 'Split Type':

Write-up: Patient received Rotarix oral vaccine on 08/20/09. Taken to ER on 08/24/09 with vomiting. Diagnosed with intussusception. 9/3/09 Received hospital records of 8/24-8/26/2009. FINAL DX: cecal intussusception, surgically reduced Records reveal patient experienced vomiting & fever x 1 day. Had bloody stool in ER w/abdominal distention & hypoactive bowel sounds. Tx w/IV antibiotics. Surg consult done when BE unable to reduce IS. Progressed well post op & d/c to home. ICD9 codes: 560.0


Changed on 2/14/2018

VAERS ID: 355481 Before After
VAERS Form:1
Age:0.21
Gender:Female
Location:Tennessee
Vaccinated:2009-08-20
Onset:2009-08-24
Submitted:2009-08-26
Entered:2009-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3295AA / 1 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB707AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D48928 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA802A / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Culture stool, Intussusception, Urinary system X-ray, Vomiting, Stool analysis

Life Threatening? No
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Nystatin oral susp
Current Illness: Thrush
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: CBC, stool for blood and culture, KUB and abdominal ultrasound 9/3/09 Received medical records w/LABS: Abdominal x-ray & US & KUB abnormal. CBC & CMP WNL. BE w/air contrast unable to reduce. Stool guiaic (+).
CDC 'Split Type':

Write-up: Patient received Rotarix oral vaccine on 08/20/09. Taken to ER on 08/24/09 with vomiting. Diagnosed with intussusception. 9/3/09 Received hospital records of 8/24-8/26/2009. FINAL DX: cecal intussusception, surgically reduced Records reveal patient experienced vomiting & fever x 1 day. Had bloody stool in ER w/abdominal distention & hypoactive bowel sounds. Tx w/IV antibiotics. Surg consult done when BE unable to reduce IS. Progressed well post op & d/c to home. ICD9 codes: 560.0


Changed on 6/14/2018

VAERS ID: 355481 Before After
VAERS Form:1
Age:0.21
Gender:Female
Location:Tennessee
Vaccinated:2009-08-20
Onset:2009-08-24
Submitted:2009-08-26
Entered:2009-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3295AA / 1 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB707AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D48928 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA802A / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Culture stool, Intussusception, Urinary system X-ray, Vomiting, Stool analysis

Life Threatening? No
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Nystatin oral susp
Current Illness: Thrush
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: CBC, stool for blood and culture, KUB and abdominal ultrasound 9/3/09 Received medical records w/LABS: Abdominal x-ray & US & KUB abnormal. CBC & CMP WNL. BE w/air contrast unable to reduce. Stool guiaic (+).
CDC 'Split Type':

Write-up: Patient received Rotarix oral vaccine on 08/20/09. Taken to ER on 08/24/09 with vomiting. Diagnosed with intussusception. 9/3/09 Received hospital records of 8/24-8/26/2009. FINAL DX: cecal intussusception, surgically reduced Records reveal patient experienced vomiting & fever x 1 day. Had bloody stool in ER w/abdominal distention & hypoactive bowel sounds. Tx w/IV antibiotics. Surg consult done when BE unable to reduce IS. Progressed well post op & d/c to home. ICD9 codes: 560.0

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