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This is VAERS ID 403352

History of Changes from the VAERS Wayback Machine

First Appeared on 11/3/2010

VAERS ID: 403352
VAERS Form:
Age:0.4
Gender:Female
Location:Missouri
Vaccinated:2010-08-10
Onset:2010-08-31
Submitted:2010-10-14
Entered:2010-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B187AA / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0235Z / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E52353 / 1 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DB058A / 0 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Abdominal distension, Intussusception, Surgery, Vomiting, Ileectomy, Ultrasound scan abnormal, Colectomy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
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: had ultrasound and then surgery
CDC 'Split Type':

Write-up: Pt went to hospital with abdominal distention and vomiting. Was dx with intussusception. Was taken to operating room on 8/31/2010 and they preformed a resection of the terminal ileum and right hemicolectomy for non reducible intussusception. Pt had two doses of rotavirus. One was Rotateq on 6/10/2010 the other dose on 8/10/2010.


Changed on 1/4/2011

VAERS ID: 403352 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Missouri
Vaccinated:2010-08-10
Onset:2010-08-31
Submitted:2010-10-14
Entered:2010-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B187AA / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0235Z / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E52353 / 1 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DB058A / 0 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Abdominal distension, Intussusception, Surgery, Vomiting, Ileectomy, Ultrasound scan abnormal, Colectomy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: had ultrasound and then surgery
CDC 'Split Type':

Write-up: Pt went to hospital with abdominal distention and vomiting. Was dx with intussusception. Was taken to operating room on 8/31/2010 and they preformed a resection of the terminal ileum and right hemicolectomy for non reducible intussusception. Pt had two doses of rotavirus. One was Rotateq on 6/10/2010 the other dose on 8/10/2010.


Changed on 4/13/2011

VAERS ID: 403352 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Missouri
Vaccinated:2010-08-10
Onset:2010-08-31
Submitted:2010-10-14
Entered:2010-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B187AA / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0235Z / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E52353 / 1 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DB058A / 0 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Abdominal distension, Appendicectomy, Blood chloride decreased, Blood sodium decreased, Constipation, Gastrointestinal necrosis, Intestinal perforation, Intussusception, Large intestinal ulcer, Lymphadenitis, Lymphocyte count decreased, Neutrophil count increased, Surgery, Vomiting, Ultrasound abdomen abnormal, Explorative laparotomy, Ileectomy, Intestinal anastomosis, Gastrointestinal oedema, Ultrasound scan abnormal, Colectomy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: had ultrasound and then surgery
CDC 'Split Type':

Write-up: Pt went to hospital with abdominal distention and vomiting. Was dx with intussusception. Was taken to operating room on 8/31/2010 and they preformed a resection of the terminal ileum and right hemicolectomy for non reducible intussusception. Pt had two doses of rotavirus. One was Rotateq on 6/10/2010 the other dose on 8/10/2010.


Changed on 5/13/2011

VAERS ID: 403352 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Missouri
Vaccinated:2010-08-10
Onset:2010-08-31
Submitted:2010-10-14
Entered:2010-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B187AA / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0235Z / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E52353 / 1 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DB058A / 0 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Abdominal distension, Appendicectomy, Blood chloride decreased, Blood sodium decreased, Constipation, Gastrointestinal necrosis, Intestinal perforation, Intussusception, Large intestinal ulcer, Lymphadenitis, Lymphocyte count decreased, Neutrophil count increased, Surgery, Vomiting, Ultrasound abdomen abnormal, Explorative laparotomy, Ileectomy, Intestinal anastomosis, Gastrointestinal oedema, Ultrasound scan abnormal, Colectomy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: had ultrasound and then surgery
CDC 'Split Type':

Write-up: Pt went to hospital with abdominal distention and vomiting. Was dx with intussusception. Was taken to operating room on 8/31/2010 and they preformed a resection of the terminal ileum and right hemicolectomy for non reducible intussusception. Pt had two doses of rotavirus. One was Rotateq on 6/10/2010 the other dose on 8/10/2010.


Changed on 5/13/2013

VAERS ID: 403352 Before After
VAERS Form:
Age:0.4
Gender:Female
Location:Missouri
Vaccinated:2010-08-10
Onset:2010-08-31
Submitted:2010-10-14
Entered:2010-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B187AA / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0235Z / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E52353 / 1 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DB058A / 0 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DB058A / 0 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Abdominal distension, Intussusception, Surgery, Vomiting, Ileectomy, Ultrasound scan abnormal, Colectomy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: had ultrasound and then surgery
CDC 'Split Type':

Write-up: Pt went to hospital with abdominal distention and vomiting. Was dx with intussusception. Was taken to operating room on 8/31/2010 and they preformed a resection of the terminal ileum and right hemicolectomy for non reducible intussusception. Pt had two doses of rotavirus. One was Rotateq on 6/10/2010 the other dose on 8/10/2010.


Changed on 2/14/2017

VAERS ID: 403352 Before After
VAERS Form:
Age:0.4 0.36
Gender:Female
Location:Missouri
Vaccinated:2010-08-10
Onset:2010-08-31
Submitted:2010-10-14
Entered:2010-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B187AA / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0235Z / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E52353 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DB058A / 0 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Abdominal distension, Intussusception, Surgery, Vomiting, Ileectomy, Ultrasound scan abnormal, Colectomy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: had ultrasound and then surgery
CDC 'Split Type':

Write-up: Pt went to hospital with abdominal distention and vomiting. Was dx with intussusception. Was taken to operating room on 8/31/2010 and they preformed a resection of the terminal ileum and right hemicolectomy for non reducible intussusception. Pt had two doses of rotavirus. One was Rotateq on 6/10/2010 the other dose on 8/10/2010.


Changed on 9/14/2017

VAERS ID: 403352 Before After
VAERS Form:(blank) 1
Age:0.36
Gender:Female
Location:Missouri
Vaccinated:2010-08-10
Onset:2010-08-31
Submitted:2010-10-14
Entered:2010-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B187AA / 1 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0235Z / 1 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E52353 / 1 2 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DB058A / 0 1 - MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Abdominal distension, Intussusception, Surgery, Vomiting, Ileectomy, Ultrasound scan abnormal, Colectomy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: had ultrasound and then surgery
CDC 'Split Type':

Write-up: Pt went to hospital with abdominal distention and vomiting. Was dx with intussusception. Was taken to operating room on 8/31/2010 and they preformed a resection of the terminal ileum and right hemicolectomy for non reducible intussusception. Pt had two doses of rotavirus. One was Rotateq on 6/10/2010 the other dose on 8/10/2010.


Changed on 2/14/2018

VAERS ID: 403352 Before After
VAERS Form:1
Age:0.36
Gender:Female
Location:Missouri
Vaccinated:2010-08-10
Onset:2010-08-31
Submitted:2010-10-14
Entered:2010-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B187AA / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0235Z / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E52353 / 2 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DB058A / 1 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Abdominal distension, Intussusception, Surgery, Vomiting, Ileectomy, Ultrasound scan abnormal, Colectomy

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: had ultrasound and then surgery
CDC 'Split Type':

Write-up: Pt went to hospital with abdominal distention and vomiting. Was dx with intussusception. Was taken to operating room on 8/31/2010 and they preformed a resection of the terminal ileum and right hemicolectomy for non reducible intussusception. Pt had two doses of rotavirus. One was Rotateq on 6/10/2010 the other dose on 8/10/2010.

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