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This is VAERS ID 382144

History of Changes from the VAERS Wayback Machine

First Appeared on 4/7/2010

VAERS ID: 382144
VAERS Form:
Age:0.2
Sex:Female
Location:North Carolina
Vaccinated:2010-02-19
Onset:2010-03-08
Submitted:2010-03-09
Entered:2010-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U3009BA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF745AA / 0 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D04132 / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D87187 / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1180Y / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal distension, Barium enema, Blood chloride decreased, Blood culture, Blood potassium decreased, Carbon dioxide decreased, Cough, Diarrhoea, Full blood count, Intussusception, Pyrexia, Rectal haemorrhage, Screaming, Platelet count increased, Mean platelet volume decreased, Laboratory test, Occult blood positive

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE.
Allergies:
Diagnostic Lab Data: BARIUM ENEMA, CBC, CHEM 7, BLOOD CULTURE.
CDC 'Split Type':

Write-up: INTUSSUSCEPTION, FEVER.


Changed on 7/31/2010

VAERS ID: 382144 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:North Carolina
Vaccinated:2010-02-19
Onset:2010-03-08
Submitted:2010-03-09
Entered:2010-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U3009BA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF745AA / 0 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D04132 / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D87187 / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1180Y / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal distension, Barium enema, Blood chloride decreased, Blood culture, Blood potassium decreased, Carbon dioxide decreased, Cough, Diarrhoea, Full blood count, Intussusception, Pyrexia, Rectal haemorrhage, Screaming, Platelet count increased, Mean platelet volume decreased, Laboratory test, Occult blood positive

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE.
Allergies:
Diagnostic Lab Data: BARIUM ENEMA, CBC, CHEM 7, BLOOD CULTURE.
CDC 'Split Type':

Write-up: INTUSSUSCEPTION, FEVER.


Changed on 8/31/2010

VAERS ID: 382144 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:North Carolina
Vaccinated:2010-02-19
Onset:2010-03-08
Submitted:2010-03-09
Entered:2010-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U3009BA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF745AA / 0 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D04132 / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH D87187 / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1180Y / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Blood culture, Full blood count, Intussusception, Pyrexia, Laboratory test

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE.
Allergies:
Diagnostic Lab Data: BARIUM ENEMA, CBC, CHEM 7, BLOOD CULTURE.
CDC 'Split Type':

Write-up: INTUSSUSCEPTION, FEVER.


Changed on 1/4/2011

VAERS ID: 382144 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:North Carolina
Vaccinated:2010-02-19
Onset:2010-03-08
Submitted:2010-03-09
Entered:2010-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U3009BA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF745AA / 0 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D04132 / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D87187 / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1180Y / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Blood culture, Full blood count, Intussusception, Pyrexia, Laboratory test

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE.
Allergies:
Diagnostic Lab Data: BARIUM ENEMA, CBC, CHEM 7, BLOOD CULTURE.
CDC 'Split Type':

Write-up: INTUSSUSCEPTION, FEVER.


Changed on 4/13/2011

VAERS ID: 382144 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:North Carolina
Vaccinated:2010-02-19
Onset:2010-03-08
Submitted:2010-03-09
Entered:2010-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U3009BA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF745AA / 0 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D04132 / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D87187 / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1180Y / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal distension, Barium enema, Blood chloride decreased, Blood culture, Blood potassium decreased, Carbon dioxide decreased, Cough, Diarrhoea, Full blood count, Intussusception, Pyrexia, Rectal haemorrhage, Screaming, Platelet count increased, Mean platelet volume decreased, Laboratory test, Occult blood positive

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE.
Allergies:
Diagnostic Lab Data: BARIUM ENEMA, CBC, CHEM 7, BLOOD CULTURE.
CDC 'Split Type':

Write-up: INTUSSUSCEPTION, FEVER.


Changed on 5/13/2011

VAERS ID: 382144 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:North Carolina
Vaccinated:2010-02-19
Onset:2010-03-08
Submitted:2010-03-09
Entered:2010-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U3009BA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF745AA / 0 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D04132 / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D87187 / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1180Y / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal distension, Barium enema, Blood chloride decreased, Blood culture, Blood potassium decreased, Carbon dioxide decreased, Cough, Diarrhoea, Full blood count, Intussusception, Pyrexia, Rectal haemorrhage, Screaming, Platelet count increased, Mean platelet volume decreased, Laboratory test, Occult blood positive

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE.
Allergies:
Diagnostic Lab Data: BARIUM ENEMA, CBC, CHEM 7, BLOOD CULTURE.
CDC 'Split Type':

Write-up: INTUSSUSCEPTION, FEVER.


Changed on 6/11/2011

VAERS ID: 382144 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:North Carolina
Vaccinated:2010-02-19
Onset:2010-03-08
Submitted:2010-03-09
Entered:2010-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U3009BA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF745AA / 0 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D04132 / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D87187 / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1180Y / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal distension, Barium enema, Blood chloride decreased, Blood culture, Blood potassium decreased, Carbon dioxide decreased, Cough, Diarrhoea, Full blood count, Intussusception, Pyrexia, Rectal haemorrhage, Screaming, Platelet count increased, Mean platelet volume decreased, Laboratory test, Occult blood positive

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE.
Allergies:
Diagnostic Lab Data: BARIUM ENEMA, CBC, CHEM 7, BLOOD CULTURE.
CDC 'Split Type':

Write-up: INTUSSUSCEPTION, FEVER.


Changed on 5/13/2013

VAERS ID: 382144 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:North Carolina
Vaccinated:2010-02-19
Onset:2010-03-08
Submitted:2010-03-09
Entered:2010-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U3009BA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF745AA / 0 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D04132 / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D87187 / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1180Y / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1180Y / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal distension, Barium enema, Blood chloride decreased, Blood culture, Blood potassium decreased, Carbon dioxide decreased, Cough, Diarrhoea, Full blood count, Intussusception, Pyrexia, Rectal haemorrhage, Screaming, Platelet count increased, Mean platelet volume decreased, Laboratory test, Occult blood positive

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE.
Allergies:
Diagnostic Lab Data: BARIUM ENEMA, CBC, CHEM 7, BLOOD CULTURE.
CDC 'Split Type':

Write-up: INTUSSUSCEPTION, FEVER.


Changed on 3/14/2015

VAERS ID: 382144 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:North Carolina
Vaccinated:2010-02-19
Onset:2010-03-08
Submitted:2010-03-09
Entered:2010-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U3009BA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF745AA / 0 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D04132 / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D87187 / 0 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1180Y / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal distension, Barium enema, Blood chloride decreased, Blood culture, Blood potassium decreased, Carbon dioxide decreased, Cough, Diarrhoea, Full blood count, Intussusception, Pyrexia, Rectal haemorrhage, Screaming, Platelet count increased, Mean platelet volume decreased, Laboratory test, Occult blood positive

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE.
Allergies:
Diagnostic Lab Data: BARIUM ENEMA, CBC, CHEM 7, BLOOD CULTURE.
CDC 'Split Type':

Write-up: INTUSSUSCEPTION, FEVER.


Changed on 2/14/2017

VAERS ID: 382144 Before After
VAERS Form:
Age:0.2 0.18
Sex:Female
Location:North Carolina
Vaccinated:2010-02-19
Onset:2010-03-08
Submitted:2010-03-09
Entered:2010-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U3009BA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF745AA / 0 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D04132 / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D87187 / 0 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1180Y / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Blood culture, Full blood count, Intussusception, Pyrexia, Laboratory test

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE.
Allergies:
Diagnostic Lab Data: BARIUM ENEMA, CBC, CHEM 7, BLOOD CULTURE.
CDC 'Split Type':

Write-up: INTUSSUSCEPTION, FEVER.


Changed on 9/14/2017

VAERS ID: 382144 Before After
VAERS Form:(blank) 1
Age:0.18
Sex:Female
Location:North Carolina
Vaccinated:2010-02-19
Onset:2010-03-08
Submitted:2010-03-09
Entered:2010-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U3009BA / 0 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF745AA / 0 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D04132 / 0 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D87187 / 0 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1180Y / 0 1 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Blood culture, Full blood count, Intussusception, Pyrexia, Laboratory test

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE.
Allergies:
Diagnostic Lab Data: BARIUM ENEMA, CBC, CHEM 7, BLOOD CULTURE.
CDC 'Split Type':

Write-up: INTUSSUSCEPTION, FEVER.


Changed on 2/14/2018

VAERS ID: 382144 Before After
VAERS Form:1
Age:0.18
Sex:Female
Location:North Carolina
Vaccinated:2010-02-19
Onset:2010-03-08
Submitted:2010-03-09
Entered:2010-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U3009BA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF745AA / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D04132 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D87187 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1180Y / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Blood culture, Full blood count, Intussusception, Pyrexia, Laboratory test

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE.
Allergies:
Diagnostic Lab Data: BARIUM ENEMA, CBC, CHEM 7, BLOOD CULTURE.
CDC 'Split Type':

Write-up: INTUSSUSCEPTION, FEVER.


Changed on 6/14/2018

VAERS ID: 382144 Before After
VAERS Form:1
Age:0.18
Sex:Female
Location:North Carolina
Vaccinated:2010-02-19
Onset:2010-03-08
Submitted:2010-03-09
Entered:2010-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U3009BA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF745AA / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D04132 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D87187 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1180Y / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Blood culture, Full blood count, Intussusception, Pyrexia, Laboratory test

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE.
Allergies:
Diagnostic Lab Data: BARIUM ENEMA, CBC, CHEM 7, BLOOD CULTURE.
CDC 'Split Type':

Write-up: INTUSSUSCEPTION, FEVER.


Changed on 8/14/2018

VAERS ID: 382144 Before After
VAERS Form:1
Age:0.18
Sex:Female
Location:North Carolina
Vaccinated:2010-02-19
Onset:2010-03-08
Submitted:2010-03-09
Entered:2010-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U3009BA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF745AA / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D04132 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D87187 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1180Y / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Blood culture, Full blood count, Intussusception, Pyrexia, Laboratory test

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE.
Allergies:
Diagnostic Lab Data: BARIUM ENEMA, CBC, CHEM 7, BLOOD CULTURE.
CDC 'Split Type':

Write-up: INTUSSUSCEPTION, FEVER.


Changed on 9/14/2018

VAERS ID: 382144 Before After
VAERS Form:1
Age:0.18
Sex:Female
Location:North Carolina
Vaccinated:2010-02-19
Onset:2010-03-08
Submitted:2010-03-09
Entered:2010-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U3009BA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF745AA / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D04132 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D87187 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1180Y / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Blood culture, Full blood count, Intussusception, Pyrexia, Laboratory test

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE.
Allergies:
Diagnostic Lab Data: BARIUM ENEMA, CBC, CHEM 7, BLOOD CULTURE.
CDC 'Split Type':

Write-up: INTUSSUSCEPTION, FEVER.


Changed on 10/14/2018

VAERS ID: 382144 Before After
VAERS Form:1
Age:0.18
Sex:Female
Location:North Carolina
Vaccinated:2010-02-19
Onset:2010-03-08
Submitted:2010-03-09
Entered:2010-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U3009BA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF745AA / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D04132 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D87187 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1180Y / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Barium enema, Blood culture, Full blood count, Intussusception, Pyrexia, Laboratory test

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE.
Allergies:
Diagnostic Lab Data: BARIUM ENEMA, CBC, CHEM 7, BLOOD CULTURE.
CDC 'Split Type':

Write-up: INTUSSUSCEPTION, FEVER.

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