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History of Changes from the VAERS Wayback Machine |
First Appeared on 2/13/2013 |
VAERS ID: | 483887 |
VAERS Form: | |
Age: | 0.2 |
Gender: | Female |
Location: | California |
Vaccinated: | 2013-02-08 |
Onset: | 2013-02-08 |
Submitted: | 2013-02-10 |
Entered: | 2013-02-10 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B377AA / 0 | LL / IM |
HIBV: HIB (PROHIBIT) / SANOFI PASTEUR | UH691AA / 0 | RL / IM |
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH | G10784 / 0 | RL / IM |
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS | A41FB314A / - | - / PO |
Administered by: Private Purchased by: Private
Symptoms: Abdominal distension, Intussusception, Irritability, Somnolence, Vomiting, Ultrasound abdomen abnormal
Life Threatening? Yes
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:
Write-up: Pt with sleepiness, fussy, abd distention and vomiting. Diagnosed 2/9/13 with intussuception.
Vaccinated: | 2013-02-08 |
Onset: | 2013-02-08 |
Submitted: | 2013-02-10 |
Entered: | 2013-02-10 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B377AA / 0 | LL / IM |
HIBV: HIB (PROHIBIT) / SANOFI PASTEUR | UH691AA / 0 | RL / IM |
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH | G10784 / 0 | RL / IM |
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS | A41FB314A / - | - / PO |
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS | A41FB314A / - | - / PO |
Administered by: Private Purchased by: Private
Symptoms: Abdominal distension, Intussusception, Irritability, Somnolence, Vomiting, Ultrasound abdomen abnormal
Life Threatening? Yes
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:
Write-up: Pt with sleepiness, fussy, abd distention and vomiting. Diagnosed 2/9/13 with intussuception.
Vaccinated: | 2013-02-08 |
Onset: | 2013-02-08 |
Submitted: | 2013-02-10 |
Entered: | 2013-02-10 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B377AA / 0 | LL / IM |
HIBV: HIB (PROHIBIT) / SANOFI PASTEUR | UH691AA / 0 | RL / IM |
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH | G10784 / 0 | RL / IM |
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS | A41FB314A / - | - / PO |
Administered by: Private Purchased by: Private
Symptoms: Abdominal distension, Intussusception, Irritability, Somnolence, Vomiting, Ultrasound abdomen abnormal
Life Threatening? Yes
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: (blank) 4
Write-up: Pt with sleepiness, fussy, abd distention and vomiting. Diagnosed 2/9/13 with intussuception.
Vaccinated: | 2013-02-08 |
Onset: | 2013-02-08 |
Submitted: | 2013-02-10 |
Entered: | 2013-02-10 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B377AA / 0 | LL / IM |
HIBV: HIB (PROHIBIT) / SANOFI PASTEUR | UH691AA / 0 | RL / IM |
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH | G10784 / 0 | RL / IM |
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS | A41FB314A / - | - / PO |
Administered by: Private Purchased by: Private
Symptoms: Abdominal distension, Anion gap increased, Barium enema abnormal, Blood potassium increased, Gastrointestinal disorder, Haematochezia, Intussusception, Irritability, Laparotomy, Small intestinal resection, Somnolence, Vomiting, Vomiting projectile, White blood cell count normal, X-ray abnormal, Enema administration, Urine leukocyte esterase positive, Ultrasound abdomen abnormal, Neutrophil percentage decreased, Monocyte percentage increased, Lymphocyte percentage increased, Gastrointestinal tube insertion, Urine ketone body present, Laparoscopic surgery, Urine output decreased, Abdominal X-ray, Hypophagia
Life Threatening? Yes
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: 4
Write-up: Pt with sleepiness, fussy, abd distention and vomiting. Diagnosed 2/9/13 with intussuception. The following information was obtained through follow-up and/or provided by the government. 2/15/2013 PCP records received for DOS 2/8/2013. No information abstracted. 5/2/2013 hospital records received for DOS 2/10-14/2013. D/c Dx''s: 1) intestinal intussusception; 2) intestine duplication. Pt presented w/ 1 day hx projectile emesis, poor PO intake, fussiness, decreased wet diapers, abdominal distension. On admission pt had BM w/ streak of blood. Tx''t: enema administration, laparoscopic & mini laparotomy reduction w/ resection of small bowel duplication cyst, NG tube, pain control. Pt d/c''d home in stable condition w/ care & f/u instructions.
Vaccinated: | 2013-02-08 |
Onset: | 2013-02-08 |
Submitted: | 2013-02-10 |
Entered: | 2013-02-10 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B377AA / 0 | LL / IM |
HIBV: HIB (PROHIBIT) / SANOFI PASTEUR | UH691AA / 0 | RL / IM |
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH | G10784 / 0 | RL / IM |
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS | A41FB314A / - | - / PO |
Administered by: Private Purchased by: Private
Symptoms: Abdominal distension, Anion gap increased, Barium enema abnormal, Blood potassium increased, Gastrointestinal disorder, Haematochezia, Intussusception, Irritability, Laparotomy, Small intestinal resection, Somnolence, Vomiting, Vomiting projectile, White blood cell count normal, X-ray abnormal, Enema administration, Urine leukocyte esterase positive, Ultrasound abdomen abnormal, Neutrophil percentage decreased, Monocyte percentage increased, Lymphocyte percentage increased, Gastrointestinal tube insertion, Urine ketone body present, Laparoscopic surgery, Urine output decreased, Abdominal X-ray, Hypophagia
Life Threatening? Yes
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: 4
Write-up: Pt with sleepiness, fussy, abd distention and vomiting. Diagnosed 2/9/13 with intussuception. The following information was obtained through follow-up and/or provided by the government. 2/15/2013 PCP records received for DOS 2/8/2013. No information abstracted. 5/2/2013 hospital records received for DOS 2/10-14/2013. D/c Dx''s: 1) intestinal intussusception; 2) intestine duplication. Pt presented w/ 1 day hx projectile emesis, poor PO intake, fussiness, decreased wet diapers, abdominal distension. On admission pt had BM w/ streak of blood. Tx''t: enema administration, laparoscopic & mini laparotomy reduction w/ resection of small bowel duplication cyst, NG tube, pain control. Pt d/c''d home in stable condition w/ care & f/u instructions.
Vaccinated: | 2013-02-08 |
Onset: | 2013-02-08 |
Submitted: | 2013-02-10 |
Entered: | 2013-02-10 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B377AA / 0 | LL / IM |
HIBV: HIB (PROHIBIT) / SANOFI PASTEUR | UH691AA / 0 | RL / IM |
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH | G10784 / 0 | RL / IM |
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS | A41FB314A / - | - / PO |
Administered by: Private Purchased by: Private
Symptoms: Abdominal distension, Intussusception, Irritability, Somnolence, Vomiting, Ultrasound abdomen abnormal
Life Threatening? Yes
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: 4
Write-up: Pt with sleepiness, fussy, abd distention and vomiting. Diagnosed 2/9/13 with intussuception.
Vaccinated: | 2013-02-08 |
Onset: | 2013-02-08 |
Submitted: | 2013-02-10 |
Entered: | 2013-02-10 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B377AA / 0 1 | LL / IM |
HIBV: HIB (PROHIBIT) / SANOFI PASTEUR | UH691AA / 0 1 | RL / IM |
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH | G10784 / 0 1 | RL / IM |
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS | A41FB314A / - UNK | - MO / PO |
Administered by: Private Purchased by: Private
Symptoms: Abdominal distension, Intussusception, Irritability, Somnolence, Vomiting, Ultrasound abdomen abnormal
Life Threatening? Yes
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: 4
Write-up: Pt with sleepiness, fussy, abd distention and vomiting. Diagnosed 2/9/13 with intussuception.
Vaccinated: | 2013-02-08 |
Onset: | 2013-02-08 |
Submitted: | 2013-02-10 |
Entered: | 2013-02-10 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B377AA / 1 | LL / IM |
HIBV: HIB (PROHIBIT) / SANOFI PASTEUR | UH691AA / 1 | RL / IM |
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH | G10784 / 1 | RL / IM |
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS | A41FB314A / UNK | MO / PO |
Administered by: Private Purchased by: Private
Symptoms: Abdominal distension, Intussusception, Irritability, Somnolence, Vomiting, Ultrasound abdomen abnormal
Life Threatening? Yes
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: 4
Write-up: Pt with sleepiness, fussy, abd distention and vomiting. Diagnosed 2/9/13 with intussuception.
Link To This Search Result:
http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=483887&WAYBACKHISTORY=ON
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