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This is VAERS ID 360569

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

VAERS ID: 360569
VAERS Form:
Age:0.2
Gender:Female
Location:Michigan
Vaccinated:2009-09-28
Onset:2009-10-06
Submitted:2009-10-17
Entered:2009-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3427AA / 0 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB708A / 0 UN / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D57302 / 0 UN / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA860A / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal pain, Blood potassium decreased, Decreased activity, Dysuria, Faeces discoloured, Haemoglobin decreased, Hypotonia, Intestinal obstruction, Intussusception, Lethargy, Malaise, Mean cell haemoglobin decreased, Mean cell volume decreased, Monocyte count increased, Rhinorrhoea, Somnolence, Urine abnormality, Vomiting, X-ray abnormal, Platelet count increased, Neutrophil percentage increased, Lymphocyte percentage decreased, Gastrointestinal tube insertion, Abdominal X-ray, Hypophagia

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: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Xray study consistent with diagnosis above. 10/20/09 PCP medical records received service dates 9/28/09 to 10/6/09.LABS and DIAGNOSTICS: Abdominal X-ray - Abnormal, suspicious for bowel obstruction. 10/26/09 ED report received service d
CDC 'Split Type':

Write-up: Presented with vomiting. Dx: Intussusception per radiology report. Reduced and sent home. 10/20/09 PCP medical records received service dates 9/28/09 to 10/6/09. Assessment: Suspicious for bowel obstruction. Patient presents with abdominal pain and vomiting. 10/26/09 ED report received service date 10/6/09. Assessment: Vomiting (Possible small bowel obstruction). Patient presents with vomiting that started last night and is still present. Nausea and decreased oral intake. Black stools. Difficulty with urination, decreased activity, lethargic. Poor muscle tone. Sleepier that usual. Nasal discharge. Appears "sick''. Bilious vomiting. NGT placed. Transfer to higher level facility.


Changed on 1/5/2010

VAERS ID: 360569 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Michigan
Vaccinated:2009-09-28
Onset:2009-10-06
Submitted:2009-10-17
Entered:2009-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3427AA / 0 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB708A / 0 UN / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D57302 / 0 UN / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA860A / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal pain, Blood potassium decreased, Decreased activity, Dysuria, Faeces discoloured, Haemoglobin decreased, Hypotonia, Intestinal obstruction, Intussusception, Lethargy, Malaise, Mean cell haemoglobin decreased, Mean cell volume decreased, Monocyte count increased, Rhinorrhoea, Somnolence, Urine abnormality, Vomiting, X-ray abnormal, Platelet count increased, Neutrophil percentage increased, Lymphocyte percentage decreased, Gastrointestinal tube insertion, Abdominal X-ray, Hypophagia

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: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Xray study consistent with diagnosis above. 10/20/09 PCP medical records received service dates 9/28/09 to 10/6/09.LABS and DIAGNOSTICS: Abdominal X-ray - Abnormal, suspicious for bowel obstruction. 10/26/09 ED report received service d
CDC 'Split Type':

Write-up: Presented with vomiting. Dx: Intussusception per radiology report. Reduced and sent home. 10/20/09 PCP medical records received service dates 9/28/09 to 10/6/09. Assessment: Suspicious for bowel obstruction. Patient presents with abdominal pain and vomiting. 10/26/09 ED report received service date 10/6/09. Assessment: Vomiting (Possible small bowel obstruction). Patient presents with vomiting that started last night and is still present. Nausea and decreased oral intake. Black stools. Difficulty with urination, decreased activity, lethargic. Poor muscle tone. Sleepier that usual. Nasal discharge. Appears "sick''. Bilious vomiting. NGT placed. Transfer to higher level facility.


Changed on 3/2/2010

VAERS ID: 360569 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Michigan
Vaccinated:2009-09-28
Onset:2009-10-06
Submitted:2009-10-17
Entered:2009-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3427AA / 0 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB708A / 0 UN / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC D57302 / 0 UN / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA860A / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Vomiting, X-ray abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Xray study consistent with diagnosis above. 10/20/09 PCP medical records received service dates 9/28/09 to 10/6/09.LABS and DIAGNOSTICS: Abdominal X-ray - Abnormal, suspicious for bowel obstruction. 10/26/09 ED report received service d
CDC 'Split Type':

Write-up: Presented with vomiting. Dx: Intussusception per radiology report. Reduced and sent home. 10/20/09 PCP medical records received service dates 9/28/09 to 10/6/09. Assessment: Suspicious for bowel obstruction. Patient presents with abdominal pain and vomiting. 10/26/09 ED report received service date 10/6/09. Assessment: Vomiting (Possible small bowel obstruction). Patient presents with vomiting that started last night and is still present. Nausea and decreased oral intake. Black stools. Difficulty with urination, decreased activity, lethargic. Poor muscle tone. Sleepier that usual. Nasal discharge. Appears "sick''. Bilious vomiting. NGT placed. Transfer to higher level facility.


Changed on 4/7/2010

VAERS ID: 360569 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Michigan
Vaccinated:2009-09-28
Onset:2009-10-06
Submitted:2009-10-17
Entered:2009-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3427AA / 0 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB708A / 0 UN / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D57302 / 0 UN / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA860A / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Vomiting, X-ray abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Xray study consistent with diagnosis above. 10/20/09 PCP medical records received service dates 9/28/09 to 10/6/09.LABS and DIAGNOSTICS: Abdominal X-ray - Abnormal, suspicious for bowel obstruction. 10/26/09 ED report received service d
CDC 'Split Type':

Write-up: Presented with vomiting. Dx: Intussusception per radiology report. Reduced and sent home. 10/20/09 PCP medical records received service dates 9/28/09 to 10/6/09. Assessment: Suspicious for bowel obstruction. Patient presents with abdominal pain and vomiting. 10/26/09 ED report received service date 10/6/09. Assessment: Vomiting (Possible small bowel obstruction). Patient presents with vomiting that started last night and is still present. Nausea and decreased oral intake. Black stools. Difficulty with urination, decreased activity, lethargic. Poor muscle tone. Sleepier that usual. Nasal discharge. Appears "sick''. Bilious vomiting. NGT placed. Transfer to higher level facility.


Changed on 8/31/2010

VAERS ID: 360569 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Michigan
Vaccinated:2009-09-28
Onset:2009-10-06
Submitted:2009-10-17
Entered:2009-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3427AA / 0 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB708A / 0 UN / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH D57302 / 0 UN / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA860A / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Vomiting, X-ray abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Xray study consistent with diagnosis above. 10/20/09 PCP medical records received service dates 9/28/09 to 10/6/09.LABS and DIAGNOSTICS: Abdominal X-ray - Abnormal, suspicious for bowel obstruction. 10/26/09 ED report received service d
CDC 'Split Type':

Write-up: Presented with vomiting. Dx: Intussusception per radiology report. Reduced and sent home. 10/20/09 PCP medical records received service dates 9/28/09 to 10/6/09. Assessment: Suspicious for bowel obstruction. Patient presents with abdominal pain and vomiting. 10/26/09 ED report received service date 10/6/09. Assessment: Vomiting (Possible small bowel obstruction). Patient presents with vomiting that started last night and is still present. Nausea and decreased oral intake. Black stools. Difficulty with urination, decreased activity, lethargic. Poor muscle tone. Sleepier that usual. Nasal discharge. Appears "sick''. Bilious vomiting. NGT placed. Transfer to higher level facility.


Changed on 1/4/2011

VAERS ID: 360569 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Michigan
Vaccinated:2009-09-28
Onset:2009-10-06
Submitted:2009-10-17
Entered:2009-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3427AA / 0 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB708A / 0 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D57302 / 0 UN / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA860A / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Vomiting, X-ray abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Xray study consistent with diagnosis above. 10/20/09 PCP medical records received service dates 9/28/09 to 10/6/09.LABS and DIAGNOSTICS: Abdominal X-ray - Abnormal, suspicious for bowel obstruction. 10/26/09 ED report received service d date 10/6/09. LABS and DIAGNOSTICS: CBC - Neutrophils 52% (H) Lymphocytes 31% (L) ABS Monocytes 1.72 K/uL (H) HGB 12.8 g/dL (L) MCV 82 fL (L) MCH 28.6 pg (L) Platelets 533 K/uL (H). CHEM - Potassium 3.9 mEq/L (L). Abdominal X-ray - Abnormal, suspicious for obstruction, possible intussusception vs volvulus. Urinalysis - cloudy.
CDC 'Split Type':

Write-up: Presented with vomiting. Dx: Intussusception per radiology report. Reduced and sent home. 10/20/09 PCP medical records received service dates 9/28/09 to 10/6/09. Assessment: Suspicious for bowel obstruction. Patient presents with abdominal pain and vomiting. 10/26/09 ED report received service date 10/6/09. Assessment: Vomiting (Possible small bowel obstruction). Patient presents with vomiting that started last night and is still present. Nausea and decreased oral intake. Black stools. Difficulty with urination, decreased activity, lethargic. Poor muscle tone. Sleepier that usual. Nasal discharge. Appears "sick''. Bilious vomiting. NGT placed. Transfer to higher level facility.


Changed on 4/13/2011

VAERS ID: 360569 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Michigan
Vaccinated:2009-09-28
Onset:2009-10-06
Submitted:2009-10-17
Entered:2009-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3427AA / 0 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB708A / 0 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D57302 / 0 UN / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA860A / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal pain, Blood potassium decreased, Decreased activity, Dysuria, Faeces discoloured, Haemoglobin decreased, Hypotonia, Intestinal obstruction, Intussusception, Lethargy, Malaise, Mean cell haemoglobin decreased, Mean cell volume decreased, Monocyte count increased, Rhinorrhoea, Somnolence, Urine abnormality, Vomiting, X-ray abnormal, Platelet count increased, Ultrasound abdomen abnormal, Neutrophil percentage increased, Lymphocyte percentage decreased, Gastrointestinal tube insertion, Abdominal X-ray, Occult blood positive, Hypophagia

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: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Xray study consistent with diagnosis above. 10/20/09 PCP medical records received service dates 9/28/09 to 10/6/09.LABS and DIAGNOSTICS: Abdominal X-ray - Abnormal, suspicious for bowel obstruction. 10/26/09 ED report received service date 10/6/09. LABS and DIAGNOSTICS: CBC - Neutrophils 52% (H) Lymphocytes 31% (L) ABS Monocytes 1.72 K/uL (H) HGB 12.8 g/dL (L) MCV 82 fL (L) MCH 28.6 pg (L) Platelets 533 K/uL (H). CHEM - Potassium 3.9 mEq/L (L). Abdominal X-ray - Abnormal, suspicious for obstruction, possible intussusception vs volvulus. Urinalysis - cloudy.
CDC 'Split Type':

Write-up: Presented with vomiting. Dx: Intussusception per radiology report. Reduced and sent home. 10/20/09 PCP medical records received service dates 9/28/09 to 10/6/09. Assessment: Suspicious for bowel obstruction. Patient presents with abdominal pain and vomiting. 10/26/09 ED report received service date 10/6/09. Assessment: Vomiting (Possible small bowel obstruction). Patient presents with vomiting that started last night and is still present. Nausea and decreased oral intake. Black stools. Difficulty with urination, decreased activity, lethargic. Poor muscle tone. Sleepier that usual. Nasal discharge. Appears "sick''. Bilious vomiting. NGT placed. Transfer to higher level facility.


Changed on 5/13/2011

VAERS ID: 360569 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Michigan
Vaccinated:2009-09-28
Onset:2009-10-06
Submitted:2009-10-17
Entered:2009-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3427AA / 0 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB708A / 0 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D57302 / 0 UN / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA860A / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal pain, Blood potassium decreased, Decreased activity, Dysuria, Faeces discoloured, Haemoglobin decreased, Hypotonia, Intestinal obstruction, Intussusception, Lethargy, Malaise, Mean cell haemoglobin decreased, Mean cell volume decreased, Monocyte count increased, Rhinorrhoea, Somnolence, Urine abnormality, Vomiting, X-ray abnormal, Platelet count increased, Ultrasound abdomen abnormal, Neutrophil percentage increased, Lymphocyte percentage decreased, Gastrointestinal tube insertion, Abdominal X-ray, Occult blood positive, Hypophagia

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: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Xray study consistent with diagnosis above. 10/20/09 PCP medical records received service dates 9/28/09 to 10/6/09.LABS and DIAGNOSTICS: Abdominal X-ray - Abnormal, suspicious for bowel obstruction. 10/26/09 ED report received service date 10/6/09. LABS and DIAGNOSTICS: CBC - Neutrophils 52% (H) Lymphocytes 31% (L) ABS Monocytes 1.72 K/uL (H) HGB 12.8 g/dL (L) MCV 82 fL (L) MCH 28.6 pg (L) Platelets 533 K/uL (H). CHEM - Potassium 3.9 mEq/L (L). Abdominal X-ray - Abnormal, suspicious for obstruction, possible intussusception vs volvulus. Urinalysis - cloudy.
CDC 'Split Type':

Write-up: Presented with vomiting. Dx: Intussusception per radiology report. Reduced and sent home. 10/20/09 PCP medical records received service dates 9/28/09 to 10/6/09. Assessment: Suspicious for bowel obstruction. Patient presents with abdominal pain and vomiting. 10/26/09 ED report received service date 10/6/09. Assessment: Vomiting (Possible small bowel obstruction). Patient presents with vomiting that started last night and is still present. Nausea and decreased oral intake. Black stools. Difficulty with urination, decreased activity, lethargic. Poor muscle tone. Sleepier that usual. Nasal discharge. Appears "sick''. Bilious vomiting. NGT placed. Transfer to higher level facility.


Changed on 6/11/2011

VAERS ID: 360569 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Michigan
Vaccinated:2009-09-28
Onset:2009-10-06
Submitted:2009-10-17
Entered:2009-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3427AA / 0 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB708A / 0 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D57302 / 0 UN / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA860A / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal pain, Blood potassium decreased, Decreased activity, Dysuria, Faeces discoloured, Haemoglobin decreased, Hypotonia, Intestinal obstruction, Intussusception, Lethargy, Malaise, Mean cell haemoglobin decreased, Mean cell volume decreased, Monocyte count increased, Rhinorrhoea, Somnolence, Urine abnormality, Vomiting, X-ray abnormal, Platelet count increased, Ultrasound abdomen abnormal, Neutrophil percentage increased, Lymphocyte percentage decreased, Gastrointestinal tube insertion, Abdominal X-ray, Occult blood positive, Hypophagia

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: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Xray study consistent with diagnosis above. 10/20/09 PCP medical records received service dates 9/28/09 to 10/6/09.LABS and DIAGNOSTICS: Abdominal X-ray - Abnormal, suspicious for bowel obstruction. 10/26/09 ED report received service date 10/6/09. LABS and DIAGNOSTICS: CBC - Neutrophils 52% (H) Lymphocytes 31% (L) ABS Monocytes 1.72 K/uL (H) HGB 12.8 g/dL (L) MCV 82 fL (L) MCH 28.6 pg (L) Platelets 533 K/uL (H). CHEM - Potassium 3.9 mEq/L (L). Abdominal X-ray - Abnormal, suspicious for obstruction, possible intussusception vs volvulus. Urinalysis - cloudy.
CDC 'Split Type':

Write-up: Presented with vomiting. Dx: Intussusception per radiology report. Reduced and sent home. 10/20/09 PCP medical records received service dates 9/28/09 to 10/6/09. Assessment: Suspicious for bowel obstruction. Patient presents with abdominal pain and vomiting. 10/26/09 ED report received service date 10/6/09. Assessment: Vomiting (Possible small bowel obstruction). Patient presents with vomiting that started last night and is still present. Nausea and decreased oral intake. Black stools. Difficulty with urination, decreased activity, lethargic. Poor muscle tone. Sleepier that usual. Nasal discharge. Appears "sick''. Bilious vomiting. NGT placed. Transfer to higher level facility.


Changed on 5/13/2013

VAERS ID: 360569 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:Michigan
Vaccinated:2009-09-28
Onset:2009-10-06
Submitted:2009-10-17
Entered:2009-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3427AA / 0 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB708A / 0 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D57302 / 0 UN / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA860A / 0 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA860A / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal pain, Blood potassium decreased, Decreased activity, Dysuria, Faeces discoloured, Haemoglobin decreased, Hypotonia, Intestinal obstruction, Intussusception, Lethargy, Malaise, Mean cell haemoglobin decreased, Mean cell volume decreased, Monocyte count increased, Rhinorrhoea, Somnolence, Urine abnormality, Vomiting, X-ray abnormal, Platelet count increased, Ultrasound abdomen abnormal, Neutrophil percentage increased, Lymphocyte percentage decreased, Gastrointestinal tube insertion, Abdominal X-ray, Occult blood positive, Hypophagia

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: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Xray study consistent with diagnosis above. 10/20/09 PCP medical records received service dates 9/28/09 to 10/6/09.LABS and DIAGNOSTICS: Abdominal X-ray - Abnormal, suspicious for bowel obstruction. 10/26/09 ED report received service date 10/6/09. LABS and DIAGNOSTICS: CBC - Neutrophils 52% (H) Lymphocytes 31% (L) ABS Monocytes 1.72 K/uL (H) HGB 12.8 g/dL (L) MCV 82 fL (L) MCH 28.6 pg (L) Platelets 533 K/uL (H). CHEM - Potassium 3.9 mEq/L (L). Abdominal X-ray - Abnormal, suspicious for obstruction, possible intussusception vs volvulus. Urinalysis - cloudy.
CDC 'Split Type':

Write-up: Presented with vomiting. Dx: Intussusception per radiology report. Reduced and sent home. 10/20/09 PCP medical records received service dates 9/28/09 to 10/6/09. Assessment: Suspicious for bowel obstruction. Patient presents with abdominal pain and vomiting. 10/26/09 ED report received service date 10/6/09. Assessment: Vomiting (Possible small bowel obstruction). Patient presents with vomiting that started last night and is still present. Nausea and decreased oral intake. Black stools. Difficulty with urination, decreased activity, lethargic. Poor muscle tone. Sleepier that usual. Nasal discharge. Appears "sick''. Bilious vomiting. NGT placed. Transfer to higher level facility.


Changed on 2/14/2017

VAERS ID: 360569 Before After
VAERS Form:
Age:0.2 0.17
Gender:Female
Location:Michigan
Vaccinated:2009-09-28
Onset:2009-10-06
Submitted:2009-10-17
Entered:2009-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3427AA / 0 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB708A / 0 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D57302 / 0 UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA860A / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal pain, Blood potassium decreased, Decreased activity, Dysuria, Faeces discoloured, Haemoglobin decreased, Hypotonia, Intestinal obstruction, Intussusception, Lethargy, Malaise, Mean cell haemoglobin decreased, Mean cell volume decreased, Monocyte count increased, Rhinorrhoea, Somnolence, Urine abnormality, Vomiting, X-ray abnormal, Platelet count increased, Ultrasound abdomen abnormal, Neutrophil percentage increased, Lymphocyte percentage decreased, Gastrointestinal tube insertion, Abdominal X-ray, Occult blood positive, Hypophagia

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: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Xray study consistent with diagnosis above. 10/20/09 PCP medical records received service dates 9/28/09 to 10/6/09.LABS and DIAGNOSTICS: Abdominal X-ray - Abnormal, suspicious for bowel obstruction. 10/26/09 ED report received service date 10/6/09. LABS and DIAGNOSTICS: CBC - Neutrophils 52% (H) Lymphocytes 31% (L) ABS Monocytes 1.72 K/uL (H) HGB 12.8 g/dL (L) MCV 82 fL (L) MCH 28.6 pg (L) Platelets 533 K/uL (H). CHEM - Potassium 3.9 mEq/L (L). Abdominal X-ray - Abnormal, suspicious for obstruction, possible intussusception vs volvulus. Urinalysis - cloudy.
CDC 'Split Type':

Write-up: Presented with vomiting. Dx: Intussusception per radiology report. Reduced and sent home. 10/20/09 PCP medical records received service dates 9/28/09 to 10/6/09. Assessment: Suspicious for bowel obstruction. Patient presents with abdominal pain and vomiting. 10/26/09 ED report received service date 10/6/09. Assessment: Vomiting (Possible small bowel obstruction). Patient presents with vomiting that started last night and is still present. Nausea and decreased oral intake. Black stools. Difficulty with urination, decreased activity, lethargic. Poor muscle tone. Sleepier that usual. Nasal discharge. Appears "sick''. Bilious vomiting. NGT placed. Transfer to higher level facility.


Changed on 4/14/2017

VAERS ID: 360569 Before After
VAERS Form:
Age:0.17
Gender:Female
Location:Michigan
Vaccinated:2009-09-28
Onset:2009-10-06
Submitted:2009-10-17
Entered:2009-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3427AA / 0 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB708A / 0 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D57302 / 0 UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA860A / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal pain, Blood potassium decreased, Decreased activity, Dysuria, Faeces discoloured, Haemoglobin decreased, Hypotonia, Intestinal obstruction, Intussusception, Lethargy, Malaise, Mean cell haemoglobin decreased, Mean cell volume decreased, Monocyte count increased, Rhinorrhoea, Somnolence, Urine abnormality, Vomiting, X-ray abnormal, Platelet count increased, Ultrasound abdomen abnormal, Neutrophil percentage increased, Lymphocyte percentage decreased, Gastrointestinal tube insertion, Abdominal X-ray, Occult blood positive, Hypophagia

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: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Xray study consistent with diagnosis above. 10/20/09 PCP medical records received service dates 9/28/09 to 10/6/09.LABS and DIAGNOSTICS: Abdominal X-ray - Abnormal, suspicious for bowel obstruction. 10/26/09 ED report received service date 10/6/09. LABS and DIAGNOSTICS: CBC - Neutrophils 52% (H) Lymphocytes 31% (L) ABS Monocytes 1.72 K/uL (H) HGB 12.8 g/dL (L) MCV 82 fL (L) MCH 28.6 pg (L) Platelets 533 K/uL (H). CHEM - Potassium 3.9 mEq/L (L). Abdominal X-ray - Abnormal, suspicious for obstruction, possible intussusception vs volvulus. Urinalysis - cloudy.
CDC 'Split Type':

Write-up: Presented with vomiting. Dx: Intussusception per radiology report. Reduced and sent home. 10/20/09 PCP medical records received service dates 9/28/09 to 10/6/09. Assessment: Suspicious for bowel obstruction. Patient presents with abdominal pain and vomiting. 10/26/09 ED report received service date 10/6/09. Assessment: Vomiting (Possible small bowel obstruction). Patient presents with vomiting that started last night and is still present. Nausea and decreased oral intake. Black stools. Difficulty with urination, decreased activity, lethargic. Poor muscle tone. Sleepier that usual. Nasal discharge. Appears "sick''. Bilious vomiting. NGT placed. Transfer to higher level facility.


Changed on 9/14/2017

VAERS ID: 360569 Before After
VAERS Form:(blank) 1
Age:0.17
Gender:Female
Location:Michigan
Vaccinated:2009-09-28
Onset:2009-10-06
Submitted:2009-10-17
Entered:2009-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3427AA / 0 1 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB708A / 0 1 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D57302 / 0 1 UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA860A / 0 1 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Vomiting, X-ray abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Xray study consistent with diagnosis above. 10/20/09 PCP medical records received service dates 9/28/09 to 10/6/09.LABS and DIAGNOSTICS: Abdominal X-ray - Abnormal, suspicious for bowel obstruction. 10/26/09 ED report received service date 10/6/09. LABS and DIAGNOSTICS: CBC - Neutrophils 52% (H) Lymphocytes 31% (L) ABS Monocytes 1.72 K/uL (H) HGB 12.8 g/dL (L) MCV 82 fL (L) MCH 28.6 pg (L) Platelets 533 K/uL (H). CHEM - Potassium 3.9 mEq/L (L). Abdominal X-ray - Abnormal, suspicious for obstruction, possible intussusception vs volvulus. Urinalysis - cloudy.
CDC 'Split Type':

Write-up: Presented with vomiting. Dx: Intussusception per radiology report. Reduced and sent home. 10/20/09 PCP medical records received service dates 9/28/09 to 10/6/09. Assessment: Suspicious for bowel obstruction. Patient presents with abdominal pain and vomiting. 10/26/09 ED report received service date 10/6/09. Assessment: Vomiting (Possible small bowel obstruction). Patient presents with vomiting that started last night and is still present. Nausea and decreased oral intake. Black stools. Difficulty with urination, decreased activity, lethargic. Poor muscle tone. Sleepier that usual. Nasal discharge. Appears "sick''. Bilious vomiting. NGT placed. Transfer to higher level facility.


Changed on 2/14/2018

VAERS ID: 360569 Before After
VAERS Form:1
Age:0.17
Gender:Female
Location:Michigan
Vaccinated:2009-09-28
Onset:2009-10-06
Submitted:2009-10-17
Entered:2009-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3427AA / 1 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB708A / 1 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D57302 / 1 UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA860A / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Vomiting, X-ray abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Xray study consistent with diagnosis above. 10/20/09 PCP medical records received service dates 9/28/09 to 10/6/09.LABS and DIAGNOSTICS: Abdominal X-ray - Abnormal, suspicious for bowel obstruction. 10/26/09 ED report received service date 10/6/09. LABS and DIAGNOSTICS: CBC - Neutrophils 52% (H) Lymphocytes 31% (L) ABS Monocytes 1.72 K/uL (H) HGB 12.8 g/dL (L) MCV 82 fL (L) MCH 28.6 pg (L) Platelets 533 K/uL (H). CHEM - Potassium 3.9 mEq/L (L). Abdominal X-ray - Abnormal, suspicious for obstruction, possible intussusception vs volvulus. Urinalysis - cloudy.
CDC 'Split Type':

Write-up: Presented with vomiting. Dx: Intussusception per radiology report. Reduced and sent home. 10/20/09 PCP medical records received service dates 9/28/09 to 10/6/09. Assessment: Suspicious for bowel obstruction. Patient presents with abdominal pain and vomiting. 10/26/09 ED report received service date 10/6/09. Assessment: Vomiting (Possible small bowel obstruction). Patient presents with vomiting that started last night and is still present. Nausea and decreased oral intake. Black stools. Difficulty with urination, decreased activity, lethargic. Poor muscle tone. Sleepier that usual. Nasal discharge. Appears "sick''. Bilious vomiting. NGT placed. Transfer to higher level facility.


Changed on 6/14/2018

VAERS ID: 360569 Before After
VAERS Form:1
Age:0.17
Gender:Female
Location:Michigan
Vaccinated:2009-09-28
Onset:2009-10-06
Submitted:2009-10-17
Entered:2009-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3427AA / 1 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB708A / 1 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D57302 / 1 UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA860A / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Vomiting, X-ray abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Xray study consistent with diagnosis above. 10/20/09 PCP medical records received service dates 9/28/09 to 10/6/09.LABS and DIAGNOSTICS: Abdominal X-ray - Abnormal, suspicious for bowel obstruction. 10/26/09 ED report received service date 10/6/09. LABS and DIAGNOSTICS: CBC - Neutrophils 52% (H) Lymphocytes 31% (L) ABS Monocytes 1.72 K/uL (H) HGB 12.8 g/dL (L) MCV 82 fL (L) MCH 28.6 pg (L) Platelets 533 K/uL (H). CHEM - Potassium 3.9 mEq/L (L). Abdominal X-ray - Abnormal, suspicious for obstruction, possible intussusception vs volvulus. Urinalysis - cloudy.
CDC 'Split Type':

Write-up: Presented with vomiting. Dx: Intussusception per radiology report. Reduced and sent home. 10/20/09 PCP medical records received service dates 9/28/09 to 10/6/09. Assessment: Suspicious for bowel obstruction. Patient presents with abdominal pain and vomiting. 10/26/09 ED report received service date 10/6/09. Assessment: Vomiting (Possible small bowel obstruction). Patient presents with vomiting that started last night and is still present. Nausea and decreased oral intake. Black stools. Difficulty with urination, decreased activity, lethargic. Poor muscle tone. Sleepier that usual. Nasal discharge. Appears "sick''. Bilious vomiting. NGT placed. Transfer to higher level facility.

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