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This is VAERS ID 378219

History of Changes from the VAERS Wayback Machine

First Appeared on 2/5/2010

VAERS ID: 378219
VAERS Form:
Age:0.3
Gender:Female
Location:Alabama
Vaccinated:2009-10-15
Onset:2010-01-01
Submitted:2010-01-19
Entered:2010-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3157AA / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF727AA / 1 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D0041 / 1 LL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D87185 / 1 LL / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA895A / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception, Lethargy, Vomiting, X-ray, Enema administration, Intestinal resection, Laparoscopic 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: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Finishing AMOXICILLIN
Current Illness: Resolving OM & bronchiolitis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X-ray, 2 air enemas
CDC 'Split Type':

Write-up: Pt started "violently vomiting after breakfast" on 01/01/10, acting lethargic. Went to ED - x-ray showed intussusception, tried air enema x 2 tried laparoscopic surgery, had to cut open and do bowel resection - took out 8 inches of bowel.


Changed on 3/2/2010

VAERS ID: 378219 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Alabama
Vaccinated:2009-10-15
Onset:2010-01-01
Submitted:2010-01-19
Entered:2010-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3157AA / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF727AA / 1 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D0041 / 1 LL / UN
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC D87185 / 1 LL / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA895A / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception, Lethargy, Vomiting, X-ray, Enema administration, Intestinal resection, Laparoscopic 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: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Finishing AMOXICILLIN
Current Illness: Resolving OM & bronchiolitis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X-ray, 2 air enemas
CDC 'Split Type':

Write-up: Pt started "violently vomiting after breakfast" on 01/01/10, acting lethargic. Went to ED - x-ray showed intussusception, tried air enema x 2 tried laparoscopic surgery, had to cut open and do bowel resection - took out 8 inches of bowel.


Changed on 4/7/2010

VAERS ID: 378219 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Alabama
Vaccinated:2009-10-15
Onset:2010-01-01
Submitted:2010-01-19
Entered:2010-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3157AA / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF727AA / 1 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D0041 / 1 LL / UN
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D87185 / 1 LL / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA895A / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception, Lethargy, Vomiting, X-ray, Enema administration, Intestinal resection, Laparoscopic 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: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Finishing AMOXICILLIN
Current Illness: Resolving OM & bronchiolitis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X-ray, 2 air enemas
CDC 'Split Type':

Write-up: Pt started "violently vomiting after breakfast" on 01/01/10, acting lethargic. Went to ED - x-ray showed intussusception, tried air enema x 2 tried laparoscopic surgery, had to cut open and do bowel resection - took out 8 inches of bowel.


Changed on 8/31/2010

VAERS ID: 378219 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Alabama
Vaccinated:2009-10-15
Onset:2010-01-01
Submitted:2010-01-19
Entered:2010-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3157AA / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF727AA / 1 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D0041 / 1 LL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH D87185 / 1 LL / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA895A / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception, Lethargy, Vomiting, X-ray, Enema administration, Intestinal resection, Laparoscopic 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: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Finishing AMOXICILLIN
Current Illness: Resolving OM & bronchiolitis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X-ray, 2 air enemas
CDC 'Split Type':

Write-up: Pt started "violently vomiting after breakfast" on 01/01/10, acting lethargic. Went to ED - x-ray showed intussusception, tried air enema x 2 tried laparoscopic surgery, had to cut open and do bowel resection - took out 8 inches of bowel.


Changed on 4/13/2011

VAERS ID: 378219 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Alabama
Vaccinated:2009-10-15
Onset:2010-01-01
Submitted:2010-01-19
Entered:2010-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3157AA / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF727AA / 1 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D0041 / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D87185 / 1 LL / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA895A / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Computerised tomogram abnormal, Intussusception, Lethargy, Vomiting, White blood cell count increased, X-ray, Enema administration, Intestinal resection, Laparoscopic 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: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Finishing AMOXICILLIN
Current Illness: Resolving OM & bronchiolitis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X-ray, 2 air enemas
CDC 'Split Type':

Write-up: Pt started "violently vomiting after breakfast" on 01/01/10, acting lethargic. Went to ED - x-ray showed intussusception, tried air enema x 2 tried laparoscopic surgery, had to cut open and do bowel resection - took out 8 inches of bowel.


Changed on 5/13/2011

VAERS ID: 378219 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Alabama
Vaccinated:2009-10-15
Onset:2010-01-01
Submitted:2010-01-19
Entered:2010-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3157AA / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF727AA / 1 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D0041 / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D87185 / 1 LL / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA895A / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Computerised tomogram abnormal, Intussusception, Lethargy, Vomiting, White blood cell count increased, X-ray, Enema administration, Intestinal resection, Laparoscopic 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: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Finishing AMOXICILLIN
Current Illness: Resolving OM & bronchiolitis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X-ray, 2 air enemas
CDC 'Split Type':

Write-up: Pt started "violently vomiting after breakfast" on 01/01/10, acting lethargic. Went to ED - x-ray showed intussusception, tried air enema x 2 tried laparoscopic surgery, had to cut open and do bowel resection - took out 8 inches of bowel.


Changed on 6/11/2011

VAERS ID: 378219 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Alabama
Vaccinated:2009-10-15
Onset:2010-01-01
Submitted:2010-01-19
Entered:2010-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3157AA / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF727AA / 1 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D0041 / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D87185 / 1 LL / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA895A / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Computerised tomogram abnormal, Intussusception, Lethargy, Vomiting, White blood cell count increased, X-ray, Enema administration, Intestinal resection, Laparoscopic 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: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Finishing AMOXICILLIN
Current Illness: Resolving OM & bronchiolitis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X-ray, 2 air enemas
CDC 'Split Type':

Write-up: Pt started "violently vomiting after breakfast" on 01/01/10, acting lethargic. Went to ED - x-ray showed intussusception, tried air enema x 2 tried laparoscopic surgery, had to cut open and do bowel resection - took out 8 inches of bowel.


Changed on 5/13/2013

VAERS ID: 378219 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Alabama
Vaccinated:2009-10-15
Onset:2010-01-01
Submitted:2010-01-19
Entered:2010-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3157AA / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF727AA / 1 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D0041 / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D87185 / 1 LL / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA895A / 1 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA895A / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Computerised tomogram abnormal, Intussusception, Lethargy, Vomiting, White blood cell count increased, X-ray, Enema administration, Intestinal resection, Laparoscopic 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: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Finishing AMOXICILLIN
Current Illness: Resolving OM & bronchiolitis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X-ray, 2 air enemas
CDC 'Split Type':

Write-up: Pt started "violently vomiting after breakfast" on 01/01/10, acting lethargic. Went to ED - x-ray showed intussusception, tried air enema x 2 tried laparoscopic surgery, had to cut open and do bowel resection - took out 8 inches of bowel.


Changed on 6/14/2014

VAERS ID: 378219 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Alabama
Vaccinated:2009-10-15
Onset:2010-01-01
Submitted:2010-01-19
Entered:2010-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3157AA / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF727AA / 1 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D0041 / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D87185 / 1 LL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA895A / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Computerised tomogram abnormal, Intussusception, Lethargy, Vomiting, White blood cell count increased, X-ray, Enema administration, Intestinal resection, Laparoscopic 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: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Finishing AMOXICILLIN
Current Illness: Resolving OM & bronchiolitis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X-ray, 2 air enemas
CDC 'Split Type':

Write-up: Pt started "violently vomiting after breakfast" on 01/01/10, acting lethargic. Went to ED - x-ray showed intussusception, tried air enema x 2 tried laparoscopic surgery, had to cut open and do bowel resection - took out 8 inches of bowel.


Changed on 3/14/2015

VAERS ID: 378219 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:Alabama
Vaccinated:2009-10-15
Onset:2010-01-01
Submitted:2010-01-19
Entered:2010-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3157AA / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF727AA / 1 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D0041 / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D87185 / 1 LL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA895A / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Computerised tomogram abnormal, Intussusception, Lethargy, Vomiting, White blood cell count increased, X-ray, Enema administration, Intestinal resection, Laparoscopic 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: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Resolving OM & bronchiolitis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X-ray, 2 air enemas
CDC 'Split Type':

Write-up: Pt started "violently vomiting after breakfast" on 01/01/10, acting lethargic. Went to ED - x-ray showed intussusception, tried air enema x 2 tried laparoscopic surgery, had to cut open and do bowel resection - took out 8 inches of bowel.


Changed on 2/14/2017

VAERS ID: 378219 Before After
VAERS Form:
Age:0.3 0.33
Gender:Female
Location:Alabama
Vaccinated:2009-10-15
Onset:2010-01-01
Submitted:2010-01-19
Entered:2010-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3157AA / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF727AA / 1 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D0041 / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D87185 / 1 LL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA895A / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception, Lethargy, Vomiting, X-ray, Enema administration, Intestinal resection, Laparoscopic 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: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Resolving OM & bronchiolitis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X-ray, 2 air enemas
CDC 'Split Type':

Write-up: Pt started "violently vomiting after breakfast" on 01/01/10, acting lethargic. Went to ED - x-ray showed intussusception, tried air enema x 2 tried laparoscopic surgery, had to cut open and do bowel resection - took out 8 inches of bowel.


Changed on 4/14/2017

VAERS ID: 378219 Before After
VAERS Form:
Age:0.33
Gender:Female
Location:Alabama
Vaccinated:2009-10-15
Onset:2010-01-01
Submitted:2010-01-19
Entered:2010-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3157AA / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF727AA / 1 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D0041 / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D87185 / 1 LL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA895A / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception, Lethargy, Vomiting, X-ray, Enema administration, Intestinal resection, Laparoscopic 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: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Finishing AMOXICILLIN
Current Illness: Resolving OM & bronchiolitis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X-ray, 2 air enemas
CDC 'Split Type':

Write-up: Pt started "violently vomiting after breakfast" on 01/01/10, acting lethargic. Went to ED - x-ray showed intussusception, tried air enema x 2 tried laparoscopic surgery, had to cut open and do bowel resection - took out 8 inches of bowel.


Changed on 9/14/2017

VAERS ID: 378219 Before After
VAERS Form:(blank) 1
Age:0.33
Gender:Female
Location:Alabama
Vaccinated:2009-10-15
Onset:2010-01-01
Submitted:2010-01-19
Entered:2010-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3157AA / 1 2 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF727AA / 1 2 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D0041 / 1 2 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D87185 / 1 2 LL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA895A / 1 2 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception, Lethargy, Vomiting, X-ray, Enema administration, Intestinal resection, Laparoscopic 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: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Finishing AMOXICILLIN
Current Illness: Resolving OM & bronchiolitis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X-ray, 2 air enemas
CDC 'Split Type':

Write-up: Pt started "violently vomiting after breakfast" on 01/01/10, acting lethargic. Went to ED - x-ray showed intussusception, tried air enema x 2 tried laparoscopic surgery, had to cut open and do bowel resection - took out 8 inches of bowel.


Changed on 2/14/2018

VAERS ID: 378219 Before After
VAERS Form:1
Age:0.33
Gender:Female
Location:Alabama
Vaccinated:2009-10-15
Onset:2010-01-01
Submitted:2010-01-19
Entered:2010-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3157AA / 2 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF727AA / 2 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D0041 / 2 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D87185 / 2 LL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA895A / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception, Lethargy, Vomiting, X-ray, Enema administration, Intestinal resection, Laparoscopic 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: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Finishing AMOXICILLIN
Current Illness: Resolving OM & bronchiolitis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X-ray, 2 air enemas
CDC 'Split Type':

Write-up: Pt started "violently vomiting after breakfast" on 01/01/10, acting lethargic. Went to ED - x-ray showed intussusception, tried air enema x 2 tried laparoscopic surgery, had to cut open and do bowel resection - took out 8 inches of bowel.


Changed on 6/14/2018

VAERS ID: 378219 Before After
VAERS Form:1
Age:0.33
Gender:Female
Location:Alabama
Vaccinated:2009-10-15
Onset:2010-01-01
Submitted:2010-01-19
Entered:2010-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3157AA / 2 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF727AA / 2 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D0041 / 2 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D87185 / 2 LL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA895A / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception, Lethargy, Vomiting, X-ray, Enema administration, Intestinal resection, Laparoscopic 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: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Finishing AMOXICILLIN
Current Illness: Resolving OM & bronchiolitis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X-ray, 2 air enemas
CDC 'Split Type':

Write-up: Pt started "violently vomiting after breakfast" on 01/01/10, acting lethargic. Went to ED - x-ray showed intussusception, tried air enema x 2 tried laparoscopic surgery, had to cut open and do bowel resection - took out 8 inches of bowel.


Changed on 8/14/2018

VAERS ID: 378219 Before After
VAERS Form:1
Age:0.33
Gender:Female
Location:Alabama
Vaccinated:2009-10-15
Onset:2010-01-01
Submitted:2010-01-19
Entered:2010-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3157AA / 2 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF727AA / 2 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D0041 / 2 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D87185 / 2 LL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA895A / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception, Lethargy, Vomiting, X-ray, Enema administration, Intestinal resection, Laparoscopic 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: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Finishing AMOXICILLIN
Current Illness: Resolving OM & bronchiolitis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X-ray, 2 air enemas
CDC 'Split Type':

Write-up: Pt started "violently vomiting after breakfast" on 01/01/10, acting lethargic. Went to ED - x-ray showed intussusception, tried air enema x 2 tried laparoscopic surgery, had to cut open and do bowel resection - took out 8 inches of bowel.


Changed on 9/14/2018

VAERS ID: 378219 Before After
VAERS Form:1
Age:0.33
Gender:Female
Location:Alabama
Vaccinated:2009-10-15
Onset:2010-01-01
Submitted:2010-01-19
Entered:2010-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3157AA / 2 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF727AA / 2 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D0041 / 2 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D87185 / 2 LL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA895A / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception, Lethargy, Vomiting, X-ray, Enema administration, Intestinal resection, Laparoscopic 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: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Finishing AMOXICILLIN
Current Illness: Resolving OM & bronchiolitis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: X-ray, 2 air enemas
CDC 'Split Type':

Write-up: Pt started "violently vomiting after breakfast" on 01/01/10, acting lethargic. Went to ED - x-ray showed intussusception, tried air enema x 2 tried laparoscopic surgery, had to cut open and do bowel resection - took out 8 inches of bowel.

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