National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 265698

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

265698
VAERS Form:
Age:0.2
Gender:Male
Location:Texas
Vaccinated:2006-10-25
Onset:2006-10-29
Submitted:2006-10-31
Entered:2006-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP HEPB IPV (PEDIARIX) / GLAXOSMITHKLINE AC21BO73AA / 0 RL / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR, INC. OE84AA / 0 LL / IM
PNC: PNEUMO, 7-VALENT (PREVNAR) / LEDERLE LABORATORIES BO862D / 0 LL / IM
ROTHB5: ROTAVIRUS VACCINE, LIVE, ORAL, PENTAVALENT (ROTATEQ) / MERCK & CO. INC. 0319F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Dehydration, Diarrhoea haemorrhagic, Intestinal obstruction, Decreased appetite

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: Acetaminophen
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: I ordered an abdominal CT which was suggestive of intussusception, this was confirmed with gastrographin enema which also reduced it. Pt did well after intervention, recovered and was discharged the following day
CDC 'Split Type':

Write-up:Pt. is a 2 mo infant that recived his immunizations on 10/25/06 (pediarix, HiB, PCV and Rotateq). He had 2 days with reported fever, improved by day 3, on day 5 his parents noticed irritability, decreased appetite and also reported 2 emesis and one epyso"de of diarrhea with blood and mucus. They presented to our office where I found a sick looking infant, lethargic and mildly dehydrated. On physical exam he had abdominal pain. Abdominal films revealed several air-fluid levels and distention. Pt was ad


Changed on 12/8/2009

265698 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Texas
Vaccinated:2006-10-25
Onset:2006-10-29
Submitted:2006-10-31
Entered:2006-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP HEPB IPV (PEDIARIX) / GLAXOSMITHKLINE AC21BO73AA / 0 RL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21BO73AA / 0 RL / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR, INC. AVENTIS PASTEUR OE84AA / 0 LL / IM
PNC: PNEUMO, 7-VALENT (PREVNAR) PNEUMO (PREVNAR) / LEDERLE LABORATORIES BO862D / 0 LL / IM
ROTHB5: ROTAVIRUS VACCINE, LIVE, ORAL, PENTAVALENT (ROTATEQ) ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0319F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Dehydration, Diarrhoea haemorrhagic, Intestinal obstruction, Intussusception, Irritability, Lethargy, Leukocytosis, Pyrexia, Vomiting, Decreased appetite

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: Acetaminophen
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: I ordered an abdominal CT which was suggestive of intussusception, this was confirmed with gastrographin enema which also reduced it. Pt did well after intervention, recovered and was discharged the following day day. Labs and Diagnostics: Ab
CDC 'Split Type':

Write-up:Pt. is a 2 mo infant that recived his immunizations on 10/25/06 (pediarix, HiB, PCV and Rotateq). He had 2 days with reported fever, improved by day 3, on day 5 his parents noticed irritability, decreased appetite and also reported 2 emesis and one epyso"de epysode of diarrhea with blood and mucus. They presented to our office where I found a sick looking infant, lethargic and mildly dehydrated. On physical exam he had abdominal pain. Abdominal films revealed several air-fluid levels and distention. Pt was ad admitted to hospital, I ordered an abdominal CT which was suggestive of intussusception, this was confirmed with gastrographin enema which also reduced it. Pt did well after intervention, recovered and was discharged the following day. 11/01/2006: MR received from PCP revealing well baby exam of October 25, 2006 where infant received Pediarix, pneumococcal vaccine, and Rotateq./pc 11/3/2006: MR received from overnight hospital stay documenting fever for several days post vax which resolved, and infant was doing well. Five days post vax infant became irritable and lethargic, with poor appetite, and was noted to have had one episode of bloody stool the day prior, and continued to have mucus in his stool. Infant was admitted to the hospital at this time to R/O intussusception. Gastrographin enema was performed which reduced the intussusception, and was confirmed by Abdominal X-ray the next day. Infant was discharged. No d/C summary dictated./pc Report received from pediatrician revealing F/U exam for intussusception on 11/2/2006: no fever, no vomiting, increased appetite. Stool to be sent to CDC for analysis/pc


Changed on 3/2/2010

265698 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Texas
Vaccinated:2006-10-25
Onset:2006-10-29
Submitted:2006-10-31
Entered:2006-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21BO73AA / 0 RL / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR OE84AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / LEDERLE LABORATORIES BO862D / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0319F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Dehydration, Diarrhoea haemorrhagic, Intestinal obstruction, Intussusception, Irritability, Lethargy, Leukocytosis, Pyrexia, Vomiting, Decreased appetite

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: Acetaminophen
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: I ordered an abdominal CT which was suggestive of intussusception, this was confirmed with gastrographin enema which also reduced it. Pt did well after intervention, recovered and was discharged the following day. Labs and Diagnostics: Ab
CDC 'Split Type':

Write-up:Pt. is a 2 mo infant that recived his immunizations on 10/25/06 (pediarix, HiB, PCV and Rotateq). He had 2 days with reported fever, improved by day 3, on day 5 his parents noticed irritability, decreased appetite and also reported 2 emesis and one epysode of diarrhea with blood and mucus. They presented to our office where I found a sick looking infant, lethargic and mildly dehydrated. On physical exam he had abdominal pain. Abdominal films revealed several air-fluid levels and distention. Pt was admitted to hospital, I ordered an abdominal CT which was suggestive of intussusception, this was confirmed with gastrographin enema which also reduced it. Pt did well after intervention, recovered and was discharged the following day. 11/01/2006: MR received from PCP revealing well baby exam of October 25, 2006 where infant received Pediarix, pneumococcal vaccine, and Rotateq./pc 11/3/2006: MR received from overnight hospital stay documenting fever for several days post vax which resolved, and infant was doing well. Five days post vax infant became irritable and lethargic, with poor appetite, and was noted to have had one episode of bloody stool the day prior, and continued to have mucus in his stool. Infant was admitted to the hospital at this time to R/O intussusception. Gastrographin enema was performed which reduced the intussusception, and was confirmed by Abdominal X-ray the next day. Infant was discharged. No d/C summary dictated./pc Report received from pediatrician revealing F/U exam for intussusception on 11/2/2006: no fever, no vomiting, increased appetite. Stool to be sent to CDC for analysis/pc


Changed on 4/7/2010

265698 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Texas
Vaccinated:2006-10-25
Onset:2006-10-29
Submitted:2006-10-31
Entered:2006-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21BO73AA / 0 RL / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR OE84AA / 0 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / LEDERLE LABORATORIES BO862D / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0319F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Dehydration, Diarrhoea haemorrhagic, Intestinal obstruction, Intussusception, Irritability, Lethargy, Leukocytosis, Pyrexia, Vomiting, Decreased appetite

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: Acetaminophen
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: I ordered an abdominal CT which was suggestive of intussusception, this was confirmed with gastrographin enema which also reduced it. Pt did well after intervention, recovered and was discharged the following day. Labs and Diagnostics: Ab
CDC 'Split Type':

Write-up:Pt. is a 2 mo infant that recived his immunizations on 10/25/06 (pediarix, HiB, PCV and Rotateq). He had 2 days with reported fever, improved by day 3, on day 5 his parents noticed irritability, decreased appetite and also reported 2 emesis and one epysode of diarrhea with blood and mucus. They presented to our office where I found a sick looking infant, lethargic and mildly dehydrated. On physical exam he had abdominal pain. Abdominal films revealed several air-fluid levels and distention. Pt was admitted to hospital, I ordered an abdominal CT which was suggestive of intussusception, this was confirmed with gastrographin enema which also reduced it. Pt did well after intervention, recovered and was discharged the following day. 11/01/2006: MR received from PCP revealing well baby exam of October 25, 2006 where infant received Pediarix, pneumococcal vaccine, and Rotateq./pc 11/3/2006: MR received from overnight hospital stay documenting fever for several days post vax which resolved, and infant was doing well. Five days post vax infant became irritable and lethargic, with poor appetite, and was noted to have had one episode of bloody stool the day prior, and continued to have mucus in his stool. Infant was admitted to the hospital at this time to R/O intussusception. Gastrographin enema was performed which reduced the intussusception, and was confirmed by Abdominal X-ray the next day. Infant was discharged. No d/C summary dictated./pc Report received from pediatrician revealing F/U exam for intussusception on 11/2/2006: no fever, no vomiting, increased appetite. Stool to be sent to CDC for analysis/pc


Changed on 5/13/2013

265698 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Texas
Vaccinated:2006-10-25
Onset:2006-10-29
Submitted:2006-10-31
Entered:2006-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21BO73AA / 0 RL / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR OE84AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES BO862D / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0319F / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0319F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Dehydration, Diarrhoea haemorrhagic, Intestinal obstruction, Intussusception, Irritability, Lethargy, Leukocytosis, Pyrexia, Vomiting, Decreased appetite

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: Acetaminophen
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: I ordered an abdominal CT which was suggestive of intussusception, this was confirmed with gastrographin enema which also reduced it. Pt did well after intervention, recovered and was discharged the following day. Labs and Diagnostics: Ab
CDC 'Split Type':

Write-up:Pt. is a 2 mo infant that recived his immunizations on 10/25/06 (pediarix, HiB, PCV and Rotateq). He had 2 days with reported fever, improved by day 3, on day 5 his parents noticed irritability, decreased appetite and also reported 2 emesis and one epysode of diarrhea with blood and mucus. They presented to our office where I found a sick looking infant, lethargic and mildly dehydrated. On physical exam he had abdominal pain. Abdominal films revealed several air-fluid levels and distention. Pt was admitted to hospital, I ordered an abdominal CT which was suggestive of intussusception, this was confirmed with gastrographin enema which also reduced it. Pt did well after intervention, recovered and was discharged the following day. 11/01/2006: MR received from PCP revealing well baby exam of October 25, 2006 where infant received Pediarix, pneumococcal vaccine, and Rotateq./pc 11/3/2006: MR received from overnight hospital stay documenting fever for several days post vax which resolved, and infant was doing well. Five days post vax infant became irritable and lethargic, with poor appetite, and was noted to have had one episode of bloody stool the day prior, and continued to have mucus in his stool. Infant was admitted to the hospital at this time to R/O intussusception. Gastrographin enema was performed which reduced the intussusception, and was confirmed by Abdominal X-ray the next day. Infant was discharged. No d/C summary dictated./pc Report received from pediatrician revealing F/U exam for intussusception on 11/2/2006: no fever, no vomiting, increased appetite. Stool to be sent to CDC for analysis/pc


Changed on 2/14/2017

265698 Before After
VAERS Form:
Age:0.2 0.17
Gender:Male
Location:Texas
Vaccinated:2006-10-25
Onset:2006-10-29
Submitted:2006-10-31
Entered:2006-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21BO73AA / 0 RL / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR SANOFI PASTEUR OE84AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES PFIZER/WYETH BO862D / 0 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0319F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Dehydration, Diarrhoea haemorrhagic, Intestinal obstruction, Intussusception, Irritability, Lethargy, Leukocytosis, Pyrexia, Vomiting, Decreased appetite

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: Acetaminophen
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: I ordered an abdominal CT which was suggestive of intussusception, this was confirmed with gastrographin enema which also reduced it. Pt did well after intervention, recovered and was discharged the following day. Labs and Diagnostics: Ab Abdominal X-ray showed diffuse distention of the bowel with several air fluid levels CBC remarkable for mild/moderate leukocytosis. CT of Abdomen showed a "sausage like, target like structure" in the RLQ worrisome for intussusception as well as a pattern of obstructive bowel which was dilated with fluid levels. Gastrographin enema was performed which reduced the intussusception, and was confirmed by Abdominal X-ray the next day.
CDC 'Split Type':

Write-up:Pt. is a 2 mo infant that recived his immunizations on 10/25/06 (pediarix, HiB, PCV and Rotateq). He had 2 days with reported fever, improved by day 3, on day 5 his parents noticed irritability, decreased appetite and also reported 2 emesis and one epysode of diarrhea with blood and mucus. They presented to our office where I found a sick looking infant, lethargic and mildly dehydrated. On physical exam he had abdominal pain. Abdominal films revealed several air-fluid levels and distention. Pt was admitted to hospital, I ordered an abdominal CT which was suggestive of intussusception, this was confirmed with gastrographin enema which also reduced it. Pt did well after intervention, recovered and was discharged the following day. 11/01/2006: MR received from PCP revealing well baby exam of October 25, 2006 where infant received Pediarix, pneumococcal vaccine, and Rotateq./pc 11/3/2006: MR received from overnight hospital stay documenting fever for several days post vax which resolved, and infant was doing well. Five days post vax infant became irritable and lethargic, with poor appetite, and was noted to have had one episode of bloody stool the day prior, and continued to have mucus in his stool. Infant was admitted to the hospital at this time to R/O intussusception. Gastrographin enema was performed which reduced the intussusception, and was confirmed by Abdominal X-ray the next day. Infant was discharged. No d/C summary dictated./pc Report received from pediatrician revealing F/U exam for intussusception on 11/2/2006: no fever, no vomiting, increased appetite. Stool to be sent to CDC for analysis/pc


Changed on 9/14/2017

265698 Before After
VAERS Form:(blank) 1
Age:0.17
Gender:Male
Location:Texas
Vaccinated:2006-10-25
Onset:2006-10-29
Submitted:2006-10-31
Entered:2006-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21BO73AA / 0 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR OE84AA / 0 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH BO862D / 0 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0319F / 0 1 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Dehydration, Diarrhoea haemorrhagic, Intestinal obstruction, Intussusception, Irritability, Lethargy, Leukocytosis, Pyrexia, Vomiting, Decreased appetite

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: Acetaminophen
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: I ordered an abdominal CT which was suggestive of intussusception, this was confirmed with gastrographin enema which also reduced it. Pt did well after intervention, recovered and was discharged the following day. Labs and Diagnostics: Abdominal X-ray showed diffuse distention of the bowel with several air fluid levels CBC remarkable for mild/moderate leukocytosis. CT of Abdomen showed a "sausage like, target like structure" in the RLQ worrisome for intussusception as well as a pattern of obstructive bowel which was dilated with fluid levels. Gastrographin enema was performed which reduced the intussusception, and was confirmed by Abdominal X-ray the next day.
CDC 'Split Type':

Write-up:Pt. is a 2 mo infant that recived his immunizations on 10/25/06 (pediarix, HiB, PCV and Rotateq). He had 2 days with reported fever, improved by day 3, on day 5 his parents noticed irritability, decreased appetite and also reported 2 emesis and one epysode of diarrhea with blood and mucus. They presented to our office where I found a sick looking infant, lethargic and mildly dehydrated. On physical exam he had abdominal pain. Abdominal films revealed several air-fluid levels and distention. Pt was admitted to hospital, I ordered an abdominal CT which was suggestive of intussusception, this was confirmed with gastrographin enema which also reduced it. Pt did well after intervention, recovered and was discharged the following day. 11/01/2006: MR received from PCP revealing well baby exam of October 25, 2006 where infant received Pediarix, pneumococcal vaccine, and Rotateq./pc 11/3/2006: MR received from overnight hospital stay documenting fever for several days post vax which resolved, and infant was doing well. Five days post vax infant became irritable and lethargic, with poor appetite, and was noted to have had one episode of bloody stool the day prior, and continued to have mucus in his stool. Infant was admitted to the hospital at this time to R/O intussusception. Gastrographin enema was performed which reduced the intussusception, and was confirmed by Abdominal X-ray the next day. Infant was discharged. No d/C summary dictated./pc Report received from pediatrician revealing F/U exam for intussusception on 11/2/2006: no fever, no vomiting, increased appetite. Stool to be sent to CDC for analysis/pc


New Search

Link To This Search Result:

http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=265698&WAYBACKHISTORY=ON


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