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This is VAERS ID 383903

History of Changes from the VAERS Wayback Machine

First Appeared on 4/7/2010

VAERS ID: 383903
VAERS Form:
Age:0.3
Gender:Female
Location:North Carolina
Vaccinated:2010-03-18
Onset:2010-03-25
Submitted:2010-03-29
Entered:2010-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3542AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D888183 / 1 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB057A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Enema administration, Intestinal mass, Abdominal operation

Life Threatening? No
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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Intussusception - failed enema reduction X3. Abd surgery to reduce, also found mass (duplication of cecum). Final Dx intussusception duplicate cecum.


Changed on 8/31/2010

VAERS ID: 383903 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:North Carolina
Vaccinated:2010-03-18
Onset:2010-03-25
Submitted:2010-03-29
Entered:2010-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3542AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH D888183 / 1 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB057A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Enema administration, Intestinal mass, Abdominal operation

Life Threatening? No
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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Intussusception - failed enema reduction X3. Abd surgery to reduce, also found mass (duplication of cecum). Final Dx intussusception duplicate cecum.


Changed on 4/13/2011

VAERS ID: 383903 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:North Carolina
Vaccinated:2010-03-18
Onset:2010-03-25
Submitted:2010-03-29
Entered:2010-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3542AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D888183 / 1 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB057A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal distension, Diarrhoea, Intussusception, Laparotomy, Vomiting, White blood cell count increased, Enema administration, Platelet count increased, Ultrasound abdomen abnormal, Intestinal mass, Abdominal operation, Pathology test

Life Threatening? No
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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Intussusception - failed enema reduction X3. Abd surgery to reduce, also found mass (duplication of cecum). Final Dx intussusception duplicate cecum.


Changed on 5/13/2011

VAERS ID: 383903 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:North Carolina
Vaccinated:2010-03-18
Onset:2010-03-25
Submitted:2010-03-29
Entered:2010-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3542AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D888183 / 1 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB057A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal distension, Diarrhoea, Intussusception, Laparotomy, Vomiting, White blood cell count increased, Enema administration, Platelet count increased, Ultrasound abdomen abnormal, Intestinal mass, Abdominal operation, Pathology test

Life Threatening? No
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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Intussusception - failed enema reduction X3. Abd surgery to reduce, also found mass (duplication of cecum). Final Dx intussusception duplicate cecum.


Changed on 6/11/2011

VAERS ID: 383903 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:North Carolina
Vaccinated:2010-03-18
Onset:2010-03-25
Submitted:2010-03-29
Entered:2010-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3542AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D888183 / 1 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB057A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal distension, Diarrhoea, Intussusception, Laparotomy, Vomiting, White blood cell count increased, Enema administration, Platelet count increased, Ultrasound abdomen abnormal, Intestinal mass, Abdominal operation, Pathology test

Life Threatening? No
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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Intussusception - failed enema reduction X3. Abd surgery to reduce, also found mass (duplication of cecum). Final Dx intussusception duplicate cecum.


Changed on 5/13/2013

VAERS ID: 383903 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:North Carolina
Vaccinated:2010-03-18
Onset:2010-03-25
Submitted:2010-03-29
Entered:2010-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3542AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D888183 / 1 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB057A / 1 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB057A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal distension, Diarrhoea, Intussusception, Laparotomy, Vomiting, White blood cell count increased, Enema administration, Platelet count increased, Ultrasound abdomen abnormal, Intestinal mass, Abdominal operation, Pathology test

Life Threatening? No
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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Intussusception - failed enema reduction X3. Abd surgery to reduce, also found mass (duplication of cecum). Final Dx intussusception duplicate cecum.


Changed on 6/14/2014

VAERS ID: 383903 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:North Carolina
Vaccinated:2010-03-18
Onset:2010-03-25
Submitted:2010-03-29
Entered:2010-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3542AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D888183 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB057A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal distension, Diarrhoea, Intussusception, Laparotomy, Vomiting, White blood cell count increased, Enema administration, Platelet count increased, Ultrasound abdomen abnormal, Intestinal mass, Abdominal operation, Pathology test

Life Threatening? No
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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Intussusception - failed enema reduction X3. Abd surgery to reduce, also found mass (duplication of cecum). Final Dx intussusception duplicate cecum.


Changed on 3/14/2015

VAERS ID: 383903 Before After
VAERS Form:
Age:0.3
Gender:Female
Location:North Carolina
Vaccinated:2010-03-18
Onset:2010-03-25
Submitted:2010-03-29
Entered:2010-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3542AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D888183 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB057A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal distension, Diarrhoea, Intussusception, Laparotomy, Vomiting, White blood cell count increased, Enema administration, Platelet count increased, Ultrasound abdomen abnormal, Intestinal mass, Abdominal operation, Pathology test

Life Threatening? No
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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Intussusception - failed enema reduction X3. Abd surgery to reduce, also found mass (duplication of cecum). Final Dx intussusception duplicate cecum.


Changed on 2/14/2017

VAERS ID: 383903 Before After
VAERS Form:
Age:0.3 0.33
Gender:Female
Location:North Carolina
Vaccinated:2010-03-18
Onset:2010-03-25
Submitted:2010-03-29
Entered:2010-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3542AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D888183 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB057A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Enema administration, Intestinal mass, Abdominal operation

Life Threatening? No
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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Intussusception - failed enema reduction X3. Abd surgery to reduce, also found mass (duplication of cecum). Final Dx intussusception duplicate cecum.


Changed on 4/14/2017

VAERS ID: 383903 Before After
VAERS Form:
Age:0.33
Gender:Female
Location:North Carolina
Vaccinated:2010-03-18
Onset:2010-03-25
Submitted:2010-03-29
Entered:2010-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3542AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D888183 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB057A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Enema administration, Intestinal mass, Abdominal operation

Life Threatening? No
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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Intussusception - failed enema reduction X3. Abd surgery to reduce, also found mass (duplication of cecum). Final Dx intussusception duplicate cecum.


Changed on 9/14/2017

VAERS ID: 383903 Before After
VAERS Form:(blank) 1
Age:0.33
Gender:Female
Location:North Carolina
Vaccinated:2010-03-18
Onset:2010-03-25
Submitted:2010-03-29
Entered:2010-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3542AA / 1 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D888183 / 1 2 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB057A / 1 2 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Enema administration, Intestinal mass, Abdominal operation

Life Threatening? No
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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Intussusception - failed enema reduction X3. Abd surgery to reduce, also found mass (duplication of cecum). Final Dx intussusception duplicate cecum.


Changed on 2/14/2018

VAERS ID: 383903 Before After
VAERS Form:1
Age:0.33
Gender:Female
Location:North Carolina
Vaccinated:2010-03-18
Onset:2010-03-25
Submitted:2010-03-29
Entered:2010-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3542AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D888183 / 2 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB057A / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Enema administration, Intestinal mass, Abdominal operation

Life Threatening? No
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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Intussusception - failed enema reduction X3. Abd surgery to reduce, also found mass (duplication of cecum). Final Dx intussusception duplicate cecum.


Changed on 6/14/2018

VAERS ID: 383903 Before After
VAERS Form:1
Age:0.33
Gender:Female
Location:North Carolina
Vaccinated:2010-03-18
Onset:2010-03-25
Submitted:2010-03-29
Entered:2010-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3542AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D888183 / 2 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB057A / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Enema administration, Intestinal mass, Abdominal operation

Life Threatening? No
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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Intussusception - failed enema reduction X3. Abd surgery to reduce, also found mass (duplication of cecum). Final Dx intussusception duplicate cecum.


Changed on 8/14/2018

VAERS ID: 383903 Before After
VAERS Form:1
Age:0.33
Gender:Female
Location:North Carolina
Vaccinated:2010-03-18
Onset:2010-03-25
Submitted:2010-03-29
Entered:2010-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3542AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D888183 / 2 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB057A / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Enema administration, Intestinal mass, Abdominal operation

Life Threatening? No
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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Intussusception - failed enema reduction X3. Abd surgery to reduce, also found mass (duplication of cecum). Final Dx intussusception duplicate cecum.


Changed on 9/14/2018

VAERS ID: 383903 Before After
VAERS Form:1
Age:0.33
Gender:Female
Location:North Carolina
Vaccinated:2010-03-18
Onset:2010-03-25
Submitted:2010-03-29
Entered:2010-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3542AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D888183 / 2 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB057A / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Intussusception, Enema administration, Intestinal mass, Abdominal operation

Life Threatening? No
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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Intussusception - failed enema reduction X3. Abd surgery to reduce, also found mass (duplication of cecum). Final Dx intussusception duplicate cecum.

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