National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 265451

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 265451
VAERS Form:
Age:0.4
Gender:Male
Location:Nebraska
Vaccinated:2006-10-11
Onset:2006-10-14
Submitted:2006-10-26
Entered:2006-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / AVENTIS PASTEUR, INC. 20/08-08 SPC262 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 23/10-07 Y0991 / 1 RL / IM
IPV: POLIO VIRUS, INACT. (UNKNOWN MFR) / UNKNOWN MANUFACTURER 23/10-07 Y0991 / 1 LL / IM
PNC: PNEUMO, 7-VALENT (PREVNAR) / LEDERLE LABORATORIES 9/4-08 B08683H / 1 LL / IM
ROTHB5: ROTAVIRUS VACCINE, LIVE, ORAL, PENTAVALENT (ROTATEQ) / MERCK & CO. INC. ME0319F / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood bicarbonate decreased, Dehydration, Haematochezia, Haematocrit decreased, Haemoglobin decreased

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: 15     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: LABS and DIAGNOSTICS: 10/15/2006: Stool cultures were negative. WBCs were 14.2 with a left shift, Hgb was slightly low at 10.5. Metabolic panel WNL except bicarb low at 19 and glucose high at 134. LABS AND DIAGNOSTICS at time of this admi
CDC 'Split Type':

Write-up: Intussusception resulting in surgical procedure and partial bowel resection.


Changed on 12/8/2009

VAERS ID: 265451 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Nebraska
Vaccinated:2006-10-11
Onset:2006-10-14
Submitted:2006-10-26
Entered:2006-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / AVENTIS PASTEUR, INC. SANOFI PASTEUR 20/08-08 SPC262 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 23/10-07 Y0991 / 1 RL / IM
IPV: POLIO VIRUS, INACT. (UNKNOWN MFR) POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER 23/10-07 Y0991 / 1 LL / IM
PNC: PNEUMO, 7-VALENT (PREVNAR) PNEUMO (PREVNAR) / LEDERLE LABORATORIES WYETH PHARMACEUTICALS, INC 9/4-08 B08683H / 1 LL / IM
ROTHB5: ROTAVIRUS VACCINE, LIVE, ORAL, PENTAVALENT (ROTATEQ) ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. ME0319F / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood bicarbonate decreased, Dehydration, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Laboratory test abnormal, Pyrexia, Vomiting, White blood cell count increased, Platelet count increased

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: 15     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: none Nystatin cream
Current Illness: none
Preexisting Conditions: none thrush and yeast rash in the diaper area
Allergies:
Diagnostic Lab Data: LABS and DIAGNOSTICS: 10/15/2006: Stool cultures were negative. WBCs were 14.2 with a left shift, Hgb was slightly low at 10.5. Metabolic panel WNL except bicarb low at 19 and glucose high at 134. LABS AND DIAGNOSTICS at time of this admi
CDC 'Split Type':

Write-up: Intussusception resulting in surgical procedure and partial bowel resection. MR from pediatrician received which included hospital H&P from Oct. 16,2006 as well as a surgical pathology report dated Oct. 20, 2006. Well baby exams at 6 days, 3 weeks, 2 and 4 months significant only for thrush and yeast rash in the diaper area. Breast fed. Vax given 10/11/06 include DTaP, Comvax, IPV, Prevnar, and Rotateq. Bloody stools, fever, and vomiting began 10/15/2006 and infant was seen in the ER. F/U with pediatrician 10/16/06 resulted in a direct admission to the hospital for rehydration, with an admission assessment of "Fever with bloody diarrhea and at least 5% dehydration." Hospital MR received. Infant had been hospitalized at a local hospital (Columbus) prior to admission to Children''s on 10/20/06 for surgery due to new onset of bilious emesis. (Exploratory Laparotomy and a Ladd Procedure). Post-operatively, child became febrile on post-op day #3. Abd. X-ray negative. Antibiotics and TPN continued. Post op day #7, CT of the abd/pevis done due to child being febrile since post-op day#3 and 90cc output from NG tube of greenish fluid. No evidence for leak or obstruction found. Improvement began 10/29/06 and the infant was discharged on 10/31/2006. No discharge diagnosis written on discharge summary. Lot number obtained for Rotateq ME0319F exp. 1/11/2007 Per Hector I. (FDA) "please add lot number to VAERS report if not yet done". Lot # added.


Changed on 3/2/2010

VAERS ID: 265451 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Nebraska
Vaccinated:2006-10-11
Onset:2006-10-14
Submitted:2006-10-26
Entered:2006-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR 20/08-08 SPC262 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 23/10-07 Y0991 / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER 23/10-07 Y0991 / 1 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC 9/4-08 B08683H / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. ME0319F / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood bicarbonate decreased, Dehydration, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Laboratory test abnormal, Pyrexia, Vomiting, White blood cell count increased, Platelet count increased

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: 15     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Nystatin cream
Current Illness: none
Preexisting Conditions: thrush and yeast rash in the diaper area
Allergies:
Diagnostic Lab Data: LABS and DIAGNOSTICS: 10/15/2006: Stool cultures were negative. WBCs were 14.2 with a left shift, Hgb was slightly low at 10.5. Metabolic panel WNL except bicarb low at 19 and glucose high at 134. LABS AND DIAGNOSTICS at time of this admi
CDC 'Split Type':

Write-up: Intussusception resulting in surgical procedure and partial bowel resection. MR from pediatrician received which included hospital H&P from Oct. 16,2006 as well as a surgical pathology report dated Oct. 20, 2006. Well baby exams at 6 days, 3 weeks, 2 and 4 months significant only for thrush and yeast rash in the diaper area. Breast fed. Vax given 10/11/06 include DTaP, Comvax, IPV, Prevnar, and Rotateq. Bloody stools, fever, and vomiting began 10/15/2006 and infant was seen in the ER. F/U with pediatrician 10/16/06 resulted in a direct admission to the hospital for rehydration, with an admission assessment of "Fever with bloody diarrhea and at least 5% dehydration." Hospital MR received. Infant had been hospitalized at a local hospital (Columbus) prior to admission to Children''s on 10/20/06 for surgery due to new onset of bilious emesis. (Exploratory Laparotomy and a Ladd Procedure). Post-operatively, child became febrile on post-op day #3. Abd. X-ray negative. Antibiotics and TPN continued. Post op day #7, CT of the abd/pevis done due to child being febrile since post-op day#3 and 90cc output from NG tube of greenish fluid. No evidence for leak or obstruction found. Improvement began 10/29/06 and the infant was discharged on 10/31/2006. No discharge diagnosis written on discharge summary. Lot number obtained for Rotateq ME0319F exp. 1/11/2007 Per Hector I. (FDA) "please add lot number to VAERS report if not yet done". Lot # added.


Changed on 4/7/2010

VAERS ID: 265451 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Nebraska
Vaccinated:2006-10-11
Onset:2006-10-14
Submitted:2006-10-26
Entered:2006-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR 20/08-08 SPC262 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 23/10-07 Y0991 / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER 23/10-07 Y0991 / 1 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC 9/4-08 B08683H / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. ME0319F / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood bicarbonate decreased, Dehydration, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Laboratory test abnormal, Pyrexia, Vomiting, White blood cell count increased, Platelet count increased

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: 15     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Nystatin cream
Current Illness: none
Preexisting Conditions: thrush and yeast rash in the diaper area
Allergies:
Diagnostic Lab Data: LABS and DIAGNOSTICS: 10/15/2006: Stool cultures were negative. WBCs were 14.2 with a left shift, Hgb was slightly low at 10.5. Metabolic panel WNL except bicarb low at 19 and glucose high at 134. LABS AND DIAGNOSTICS at time of this admi
CDC 'Split Type':

Write-up: Intussusception resulting in surgical procedure and partial bowel resection. MR from pediatrician received which included hospital H&P from Oct. 16,2006 as well as a surgical pathology report dated Oct. 20, 2006. Well baby exams at 6 days, 3 weeks, 2 and 4 months significant only for thrush and yeast rash in the diaper area. Breast fed. Vax given 10/11/06 include DTaP, Comvax, IPV, Prevnar, and Rotateq. Bloody stools, fever, and vomiting began 10/15/2006 and infant was seen in the ER. F/U with pediatrician 10/16/06 resulted in a direct admission to the hospital for rehydration, with an admission assessment of "Fever with bloody diarrhea and at least 5% dehydration." Hospital MR received. Infant had been hospitalized at a local hospital (Columbus) prior to admission to Children''s on 10/20/06 for surgery due to new onset of bilious emesis. (Exploratory Laparotomy and a Ladd Procedure). Post-operatively, child became febrile on post-op day #3. Abd. X-ray negative. Antibiotics and TPN continued. Post op day #7, CT of the abd/pevis done due to child being febrile since post-op day#3 and 90cc output from NG tube of greenish fluid. No evidence for leak or obstruction found. Improvement began 10/29/06 and the infant was discharged on 10/31/2006. No discharge diagnosis written on discharge summary. Lot number obtained for Rotateq ME0319F exp. 1/11/2007 Per Hector I. (FDA) "please add lot number to VAERS report if not yet done". Lot # added.


Changed on 8/31/2010

VAERS ID: 265451 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Nebraska
Vaccinated:2006-10-11
Onset:2006-10-14
Submitted:2006-10-26
Entered:2006-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR 20/08-08 SPC262 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 23/10-07 Y0991 / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER 23/10-07 Y0991 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 9/4-08 B08683H / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. ME0319F / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood bicarbonate decreased, Dehydration, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Laboratory test abnormal, Pyrexia, Vomiting, White blood cell count increased, Platelet count increased

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: 15     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Nystatin cream
Current Illness: none
Preexisting Conditions: thrush and yeast rash in the diaper area
Allergies:
Diagnostic Lab Data: LABS and DIAGNOSTICS: 10/15/2006: Stool cultures were negative. WBCs were 14.2 with a left shift, Hgb was slightly low at 10.5. Metabolic panel WNL except bicarb low at 19 and glucose high at 134. LABS AND DIAGNOSTICS at time of this admi
CDC 'Split Type':

Write-up: Intussusception resulting in surgical procedure and partial bowel resection. MR from pediatrician received which included hospital H&P from Oct. 16,2006 as well as a surgical pathology report dated Oct. 20, 2006. Well baby exams at 6 days, 3 weeks, 2 and 4 months significant only for thrush and yeast rash in the diaper area. Breast fed. Vax given 10/11/06 include DTaP, Comvax, IPV, Prevnar, and Rotateq. Bloody stools, fever, and vomiting began 10/15/2006 and infant was seen in the ER. F/U with pediatrician 10/16/06 resulted in a direct admission to the hospital for rehydration, with an admission assessment of "Fever with bloody diarrhea and at least 5% dehydration." Hospital MR received. Infant had been hospitalized at a local hospital (Columbus) prior to admission to Children''s on 10/20/06 for surgery due to new onset of bilious emesis. (Exploratory Laparotomy and a Ladd Procedure). Post-operatively, child became febrile on post-op day #3. Abd. X-ray negative. Antibiotics and TPN continued. Post op day #7, CT of the abd/pevis done due to child being febrile since post-op day#3 and 90cc output from NG tube of greenish fluid. No evidence for leak or obstruction found. Improvement began 10/29/06 and the infant was discharged on 10/31/2006. No discharge diagnosis written on discharge summary. Lot number obtained for Rotateq ME0319F exp. 1/11/2007 Per Hector I. (FDA) "please add lot number to VAERS report if not yet done". Lot # added.


Changed on 1/7/2013

VAERS ID: 265451 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Nebraska
Vaccinated:2006-10-11
Onset:2006-10-14
Submitted:2006-10-26
Entered:2006-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR 20/08-08 SPC262 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 23/10-07 Y0991 / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER 23/10-07 Y0991 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 9/4-08 B08683H / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. ME0319F / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood bicarbonate decreased, Dehydration, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Laboratory test abnormal, Pyrexia, Vomiting, White blood cell count increased, Platelet count increased

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: 15     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Nystatin cream
Current Illness: none
Preexisting Conditions: thrush and yeast rash in the diaper area
Allergies:
Diagnostic Lab Data: LABS and DIAGNOSTICS: 10/15/2006: Stool cultures were negative. WBCs were 14.2 with a left shift, Hgb was slightly low at 10.5. Metabolic panel WNL except bicarb low at 19 and glucose high at 134. LABS AND DIAGNOSTICS at time of this admi admission 10/16/2006: showed an increased WBC count of 22,000, Hg 9.8, Hct. 28.9, Plt. 593,000. AST 22, ALT 34 and C-reactive protein up to 2.5, urine and Blood cultures (-). Upper GI suggestive of malroatation with probable volvulus with differential including Ladd''s band. Surgical pathology report of 10/20/2006 is for an Ileocecal resection with focal transmural ischemic necrosis. Intussusception with transmural suppurative inflammation.
CDC 'Split Type':

Write-up: Intussusception resulting in surgical procedure and partial bowel resection. MR from pediatrician received which included hospital H&P from Oct. 16,2006 as well as a surgical pathology report dated Oct. 20, 2006. Well baby exams at 6 days, 3 weeks, 2 and 4 months significant only for thrush and yeast rash in the diaper area. Breast fed. Vax given 10/11/06 include DTaP, Comvax, IPV, Prevnar, and Rotateq. Bloody stools, fever, and vomiting began 10/15/2006 and infant was seen in the ER. F/U with pediatrician 10/16/06 resulted in a direct admission to the hospital for rehydration, with an admission assessment of "Fever with bloody diarrhea and at least 5% dehydration." Hospital MR received. Infant had been hospitalized at a local hospital (Columbus) prior to admission to Children''s another hospital on 10/20/06 for surgery due to new onset of bilious emesis. (Exploratory Laparotomy and a Ladd Procedure). Post-operatively, child became febrile on post-op day #3. Abd. X-ray negative. Antibiotics and TPN continued. Post op day #7, CT of the abd/pevis done due to child being febrile since post-op day#3 and 90cc output from NG tube of greenish fluid. No evidence for leak or obstruction found. Improvement began 10/29/06 and the infant was discharged on 10/31/2006. No discharge diagnosis written on discharge summary. Lot number obtained for Rotateq ME0319F exp. 1/11/2007 Per Hector I. (FDA) "please add lot number to VAERS report if not yet done". Lot # added.


Changed on 5/13/2013

VAERS ID: 265451 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Nebraska
Vaccinated:2006-10-11
Onset:2006-10-14
Submitted:2006-10-26
Entered:2006-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR 20/08-08 SPC262 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 23/10-07 Y0991 / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER 23/10-07 Y0991 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 9/4-08 B08683H / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. ME0319F / - - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. ME0319F / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood bicarbonate decreased, Dehydration, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Laboratory test abnormal, Pyrexia, Vomiting, White blood cell count increased, Platelet count increased

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: 15     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Nystatin cream
Current Illness: none
Preexisting Conditions: thrush and yeast rash in the diaper area
Allergies:
Diagnostic Lab Data: LABS and DIAGNOSTICS: 10/15/2006: Stool cultures were negative. WBCs were 14.2 with a left shift, Hgb was slightly low at 10.5. Metabolic panel WNL except bicarb low at 19 and glucose high at 134. LABS AND DIAGNOSTICS at time of this admission 10/16/2006: showed an increased WBC count of 22,000, Hg 9.8, Hct. 28.9, Plt. 593,000. AST 22, ALT 34 and C-reactive protein up to 2.5, urine and Blood cultures (-). Upper GI suggestive of malroatation with probable volvulus with differential including Ladd''s band. Surgical pathology report of 10/20/2006 is for an Ileocecal resection with focal transmural ischemic necrosis. Intussusception with transmural suppurative inflammation.
CDC 'Split Type':

Write-up: Intussusception resulting in surgical procedure and partial bowel resection. MR from pediatrician received which included hospital H&P from Oct. 16,2006 as well as a surgical pathology report dated Oct. 20, 2006. Well baby exams at 6 days, 3 weeks, 2 and 4 months significant only for thrush and yeast rash in the diaper area. Breast fed. Vax given 10/11/06 include DTaP, Comvax, IPV, Prevnar, and Rotateq. Bloody stools, fever, and vomiting began 10/15/2006 and infant was seen in the ER. F/U with pediatrician 10/16/06 resulted in a direct admission to the hospital for rehydration, with an admission assessment of "Fever with bloody diarrhea and at least 5% dehydration." Hospital MR received. Infant had been hospitalized at a local hospital prior to admission to another hospital on 10/20/06 for surgery due to new onset of bilious emesis. (Exploratory Laparotomy and a Ladd Procedure). Post-operatively, child became febrile on post-op day #3. Abd. X-ray negative. Antibiotics and TPN continued. Post op day #7, CT of the abd/pevis done due to child being febrile since post-op day#3 and 90cc output from NG tube of greenish fluid. No evidence for leak or obstruction found. Improvement began 10/29/06 and the infant was discharged on 10/31/2006. No discharge diagnosis written on discharge summary. Lot number obtained for Rotateq ME0319F exp. 1/11/2007 Per (FDA) "please add lot number to VAERS report if not yet done". Lot # added.


Changed on 6/14/2014

VAERS ID: 265451 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Nebraska
Vaccinated:2006-10-11
Onset:2006-10-14
Submitted:2006-10-26
Entered:2006-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR 20/08-08 SPC262 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 23/10-07 Y0991 / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER 23/10-07 Y0991 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 9/4-08 B08683H / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. ME0319F / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood bicarbonate decreased, Dehydration, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Laboratory test abnormal, Pyrexia, Vomiting, White blood cell count increased, Platelet count increased

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: 15     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Nystatin cream
Current Illness: none
Preexisting Conditions: thrush and yeast rash in the diaper area
Allergies:
Diagnostic Lab Data: LABS and DIAGNOSTICS: 10/15/2006: Stool cultures were negative. WBCs were 14.2 with a left shift, Hgb was slightly low at 10.5. Metabolic panel WNL except bicarb low at 19 and glucose high at 134. LABS AND DIAGNOSTICS at time of this admission 10/16/2006: showed an increased WBC count of 22,000, Hg 9.8, Hct. 28.9, Plt. 593,000. AST 22, ALT 34 and C-reactive protein up to 2.5, urine and Blood cultures (-). Upper GI suggestive of malroatation with probable volvulus with differential including Ladd''s band. Surgical pathology report of 10/20/2006 is for an Ileocecal resection with focal transmural ischemic necrosis. Intussusception with transmural suppurative inflammation.
CDC 'Split Type':

Write-up: Intussusception resulting in surgical procedure and partial bowel resection. MR from pediatrician received which included hospital H&P from Oct. 16,2006 as well as a surgical pathology report dated Oct. 20, 2006. Well baby exams at 6 days, 3 weeks, 2 and 4 months significant only for thrush and yeast rash in the diaper area. Breast fed. Vax given 10/11/06 include DTaP, Comvax, IPV, Prevnar, and Rotateq. Bloody stools, fever, and vomiting began 10/15/2006 and infant was seen in the ER. F/U with pediatrician 10/16/06 resulted in a direct admission to the hospital for rehydration, with an admission assessment of "Fever with bloody diarrhea and at least 5% dehydration." Hospital MR received. Infant had been hospitalized at a local hospital prior to admission to another hospital on 10/20/06 for surgery due to new onset of bilious emesis. (Exploratory Laparotomy and a Ladd Procedure). Post-operatively, child became febrile on post-op day #3. Abd. X-ray negative. Antibiotics and TPN continued. Post op day #7, CT of the abd/pevis done due to child being febrile since post-op day#3 and 90cc output from NG tube of greenish fluid. No evidence for leak or obstruction found. Improvement began 10/29/06 and the infant was discharged on 10/31/2006. No discharge diagnosis written on discharge summary. Lot number obtained for Rotateq ME0319F exp. 1/11/2007 Per (FDA) "please add lot number to VAERS report if not yet done". Lot # added.


Changed on 3/14/2015

VAERS ID: 265451 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Nebraska
Vaccinated:2006-10-11
Onset:2006-10-14
Submitted:2006-10-26
Entered:2006-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR 20/08-08 SPC262 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 23/10-07 Y0991 / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER 23/10-07 Y0991 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 9/4-08 B08683H / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. ME0319F / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood bicarbonate decreased, Dehydration, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Laboratory test abnormal, Pyrexia, Vomiting, White blood cell count increased, Platelet count increased

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: 15     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Nystatin cream
Current Illness: none
Preexisting Conditions: thrush and yeast rash in the diaper area
Allergies:
Diagnostic Lab Data: LABS and DIAGNOSTICS: 10/15/2006: Stool cultures were negative. WBCs were 14.2 with a left shift, Hgb was slightly low at 10.5. Metabolic panel WNL except bicarb low at 19 and glucose high at 134. LABS AND DIAGNOSTICS at time of this admission 10/16/2006: showed an increased WBC count of 22,000, Hg 9.8, Hct. 28.9, Plt. 593,000. AST 22, ALT 34 and C-reactive protein up to 2.5, urine and Blood cultures (-). Upper GI suggestive of malroatation with probable volvulus with differential including Ladd''s band. Surgical pathology report of 10/20/2006 is for an Ileocecal resection with focal transmural ischemic necrosis. Intussusception with transmural suppurative inflammation.
CDC 'Split Type':

Write-up: Intussusception resulting in surgical procedure and partial bowel resection. MR from pediatrician received which included hospital H&P from Oct. 16,2006 as well as a surgical pathology report dated Oct. 20, 2006. Well baby exams at 6 days, 3 weeks, 2 and 4 months significant only for thrush and yeast rash in the diaper area. Breast fed. Vax given 10/11/06 include DTaP, Comvax, IPV, Prevnar, and Rotateq. Bloody stools, fever, and vomiting began 10/15/2006 and infant was seen in the ER. F/U with pediatrician 10/16/06 resulted in a direct admission to the hospital for rehydration, with an admission assessment of "Fever with bloody diarrhea and at least 5% dehydration." Hospital MR received. Infant had been hospitalized at a local hospital prior to admission to another hospital on 10/20/06 for surgery due to new onset of bilious emesis. (Exploratory Laparotomy and a Ladd Procedure). Post-operatively, child became febrile on post-op day #3. Abd. X-ray negative. Antibiotics and TPN continued. Post op day #7, CT of the abd/pevis done due to child being febrile since post-op day#3 and 90cc output from NG tube of greenish fluid. No evidence for leak or obstruction found. Improvement began 10/29/06 and the infant was discharged on 10/31/2006. No discharge diagnosis written on discharge summary. Lot number obtained for Rotateq ME0319F exp. 1/11/2007 Per (FDA) "please add lot number to VAERS report if not yet done". Lot # added.


Changed on 2/14/2017

VAERS ID: 265451 Before After
VAERS Form:
Age:0.4 0.36
Gender:Male
Location:Nebraska
Vaccinated:2006-10-11
Onset:2006-10-14
Submitted:2006-10-26
Entered:2006-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR 20/08-08 SPC262 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 23/10-07 Y0991 / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER 23/10-07 Y0991 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 9/4-08 B08683H / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. ME0319F / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood bicarbonate decreased, Dehydration, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Laboratory test abnormal, Pyrexia, Vomiting, White blood cell count increased, Platelet count increased

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: 15     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Nystatin cream
Current Illness: none
Preexisting Conditions: thrush and yeast rash in the diaper area
Allergies:
Diagnostic Lab Data: LABS and DIAGNOSTICS: 10/15/2006: Stool cultures were negative. WBCs were 14.2 with a left shift, Hgb was slightly low at 10.5. Metabolic panel WNL except bicarb low at 19 and glucose high at 134. LABS AND DIAGNOSTICS at time of this admission 10/16/2006: showed an increased WBC count of 22,000, Hg 9.8, Hct. 28.9, Plt. 593,000. AST 22, ALT 34 and C-reactive protein up to 2.5, urine and Blood cultures (-). Upper GI suggestive of malroatation with probable volvulus with differential including Ladd''s band. Surgical pathology report of 10/20/2006 is for an Ileocecal resection with focal transmural ischemic necrosis. Intussusception with transmural suppurative inflammation.
CDC 'Split Type':

Write-up: Intussusception resulting in surgical procedure and partial bowel resection. MR from pediatrician received which included hospital H&P from Oct. 16,2006 as well as a surgical pathology report dated Oct. 20, 2006. Well baby exams at 6 days, 3 weeks, 2 and 4 months significant only for thrush and yeast rash in the diaper area. Breast fed. Vax given 10/11/06 include DTaP, Comvax, IPV, Prevnar, and Rotateq. Bloody stools, fever, and vomiting began 10/15/2006 and infant was seen in the ER. F/U with pediatrician 10/16/06 resulted in a direct admission to the hospital for rehydration, with an admission assessment of "Fever with bloody diarrhea and at least 5% dehydration." Hospital MR received. Infant had been hospitalized at a local hospital prior to admission to another hospital on 10/20/06 for surgery due to new onset of bilious emesis. (Exploratory Laparotomy and a Ladd Procedure). Post-operatively, child became febrile on post-op day #3. Abd. X-ray negative. Antibiotics and TPN continued. Post op day #7, CT of the abd/pevis done due to child being febrile since post-op day#3 and 90cc output from NG tube of greenish fluid. No evidence for leak or obstruction found. Improvement began 10/29/06 and the infant was discharged on 10/31/2006. No discharge diagnosis written on discharge summary. Lot number obtained for Rotateq ME0319F exp. 1/11/2007 Per (FDA) "please add lot number to VAERS report if not yet done". Lot # added.


Changed on 9/14/2017

VAERS ID: 265451 Before After
VAERS Form:(blank) 1
Age:0.36
Gender:Male
Location:Nebraska
Vaccinated:2006-10-11
Onset:2006-10-14
Submitted:2006-10-26
Entered:2006-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR 20/08-08 SPC262 / 1 2 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 23/10-07 Y0991 / 1 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER 23/10-07 Y0991 / 1 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 9/4-08 B08683H / 1 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. ME0319F / - UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood bicarbonate decreased, Dehydration, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Laboratory test abnormal, Pyrexia, Vomiting, White blood cell count increased, Platelet count increased

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: 15     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Nystatin cream
Current Illness: none
Preexisting Conditions: thrush and yeast rash in the diaper area
Allergies:
Diagnostic Lab Data: LABS and DIAGNOSTICS: 10/15/2006: Stool cultures were negative. WBCs were 14.2 with a left shift, Hgb was slightly low at 10.5. Metabolic panel WNL except bicarb low at 19 and glucose high at 134. LABS AND DIAGNOSTICS at time of this admission 10/16/2006: showed an increased WBC count of 22,000, Hg 9.8, Hct. 28.9, Plt. 593,000. AST 22, ALT 34 and C-reactive protein up to 2.5, urine and Blood cultures (-). Upper GI suggestive of malroatation with probable volvulus with differential including Ladd''s band. Surgical pathology report of 10/20/2006 is for an Ileocecal resection with focal transmural ischemic necrosis. Intussusception with transmural suppurative inflammation.
CDC 'Split Type':

Write-up: Intussusception resulting in surgical procedure and partial bowel resection. MR from pediatrician received which included hospital H&P from Oct. 16,2006 as well as a surgical pathology report dated Oct. 20, 2006. Well baby exams at 6 days, 3 weeks, 2 and 4 months significant only for thrush and yeast rash in the diaper area. Breast fed. Vax given 10/11/06 include DTaP, Comvax, IPV, Prevnar, and Rotateq. Bloody stools, fever, and vomiting began 10/15/2006 and infant was seen in the ER. F/U with pediatrician 10/16/06 resulted in a direct admission to the hospital for rehydration, with an admission assessment of "Fever with bloody diarrhea and at least 5% dehydration." Hospital MR received. Infant had been hospitalized at a local hospital prior to admission to another hospital on 10/20/06 for surgery due to new onset of bilious emesis. (Exploratory Laparotomy and a Ladd Procedure). Post-operatively, child became febrile on post-op day #3. Abd. X-ray negative. Antibiotics and TPN continued. Post op day #7, CT of the abd/pevis done due to child being febrile since post-op day#3 and 90cc output from NG tube of greenish fluid. No evidence for leak or obstruction found. Improvement began 10/29/06 and the infant was discharged on 10/31/2006. No discharge diagnosis written on discharge summary. Lot number obtained for Rotateq ME0319F exp. 1/11/2007 Per (FDA) "please add lot number to VAERS report if not yet done". Lot # added.


Changed on 2/14/2018

VAERS ID: 265451 Before After
VAERS Form:1
Age:0.36
Gender:Male
Location:Nebraska
Vaccinated:2006-10-11
Onset:2006-10-14
Submitted:2006-10-26
Entered:2006-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR 20/08-08 SPC262 / 2 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 23/10-07 Y0991 / 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER 23/10-07 Y0991 / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 9/4-08 B08683H / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. ME0319F / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood bicarbonate decreased, Dehydration, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Laboratory test abnormal, Pyrexia, Vomiting, White blood cell count increased, Platelet count increased

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: 15     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Nystatin cream
Current Illness: none
Preexisting Conditions: thrush and yeast rash in the diaper area
Allergies:
Diagnostic Lab Data: LABS and DIAGNOSTICS: 10/15/2006: Stool cultures were negative. WBCs were 14.2 with a left shift, Hgb was slightly low at 10.5. Metabolic panel WNL except bicarb low at 19 and glucose high at 134. LABS AND DIAGNOSTICS at time of this admission 10/16/2006: showed an increased WBC count of 22,000, Hg 9.8, Hct. 28.9, Plt. 593,000. AST 22, ALT 34 and C-reactive protein up to 2.5, urine and Blood cultures (-). Upper GI suggestive of malroatation with probable volvulus with differential including Ladd''s band. Surgical pathology report of 10/20/2006 is for an Ileocecal resection with focal transmural ischemic necrosis. Intussusception with transmural suppurative inflammation.
CDC 'Split Type':

Write-up: Intussusception resulting in surgical procedure and partial bowel resection. MR from pediatrician received which included hospital H&P from Oct. 16,2006 as well as a surgical pathology report dated Oct. 20, 2006. Well baby exams at 6 days, 3 weeks, 2 and 4 months significant only for thrush and yeast rash in the diaper area. Breast fed. Vax given 10/11/06 include DTaP, Comvax, IPV, Prevnar, and Rotateq. Bloody stools, fever, and vomiting began 10/15/2006 and infant was seen in the ER. F/U with pediatrician 10/16/06 resulted in a direct admission to the hospital for rehydration, with an admission assessment of "Fever with bloody diarrhea and at least 5% dehydration." Hospital MR received. Infant had been hospitalized at a local hospital prior to admission to another hospital on 10/20/06 for surgery due to new onset of bilious emesis. (Exploratory Laparotomy and a Ladd Procedure). Post-operatively, child became febrile on post-op day #3. Abd. X-ray negative. Antibiotics and TPN continued. Post op day #7, CT of the abd/pevis done due to child being febrile since post-op day#3 and 90cc output from NG tube of greenish fluid. No evidence for leak or obstruction found. Improvement began 10/29/06 and the infant was discharged on 10/31/2006. No discharge diagnosis written on discharge summary. Lot number obtained for Rotateq ME0319F exp. 1/11/2007 Per (FDA) "please add lot number to VAERS report if not yet done". Lot # added.


Changed on 6/14/2018

VAERS ID: 265451 Before After
VAERS Form:1
Age:0.36
Gender:Male
Location:Nebraska
Vaccinated:2006-10-11
Onset:2006-10-14
Submitted:2006-10-26
Entered:2006-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR 20/08-08 SPC262 / 2 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 23/10-07 Y0991 / 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER 23/10-07 Y0991 / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 9/4-08 B08683H / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. ME0319F / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood bicarbonate decreased, Dehydration, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Laboratory test abnormal, Pyrexia, Vomiting, White blood cell count increased, Platelet count increased

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: 15     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Nystatin cream
Current Illness: none
Preexisting Conditions: thrush and yeast rash in the diaper area
Allergies:
Diagnostic Lab Data: LABS and DIAGNOSTICS: 10/15/2006: Stool cultures were negative. WBCs were 14.2 with a left shift, Hgb was slightly low at 10.5. Metabolic panel WNL except bicarb low at 19 and glucose high at 134. LABS AND DIAGNOSTICS at time of this admission 10/16/2006: showed an increased WBC count of 22,000, Hg 9.8, Hct. 28.9, Plt. 593,000. AST 22, ALT 34 and C-reactive protein up to 2.5, urine and Blood cultures (-). Upper GI suggestive of malroatation with probable volvulus with differential including Ladd''s band. Surgical pathology report of 10/20/2006 is for an Ileocecal resection with focal transmural ischemic necrosis. Intussusception with transmural suppurative inflammation.
CDC 'Split Type':

Write-up: Intussusception resulting in surgical procedure and partial bowel resection. MR from pediatrician received which included hospital H&P from Oct. 16,2006 as well as a surgical pathology report dated Oct. 20, 2006. Well baby exams at 6 days, 3 weeks, 2 and 4 months significant only for thrush and yeast rash in the diaper area. Breast fed. Vax given 10/11/06 include DTaP, Comvax, IPV, Prevnar, and Rotateq. Bloody stools, fever, and vomiting began 10/15/2006 and infant was seen in the ER. F/U with pediatrician 10/16/06 resulted in a direct admission to the hospital for rehydration, with an admission assessment of "Fever with bloody diarrhea and at least 5% dehydration." Hospital MR received. Infant had been hospitalized at a local hospital prior to admission to another hospital on 10/20/06 for surgery due to new onset of bilious emesis. (Exploratory Laparotomy and a Ladd Procedure). Post-operatively, child became febrile on post-op day #3. Abd. X-ray negative. Antibiotics and TPN continued. Post op day #7, CT of the abd/pevis done due to child being febrile since post-op day#3 and 90cc output from NG tube of greenish fluid. No evidence for leak or obstruction found. Improvement began 10/29/06 and the infant was discharged on 10/31/2006. No discharge diagnosis written on discharge summary. Lot number obtained for Rotateq ME0319F exp. 1/11/2007 Per (FDA) "please add lot number to VAERS report if not yet done". Lot # added.

New Search

Link To This Search Result:

http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=265451&WAYBACKHISTORY=ON


Copyright © 2018 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166