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This is VAERS ID 267879

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 267879
VAERS Form:
Age:0.2
Gender:Male
Location:Texas
Vaccinated:2006-11-03
Onset:2006-11-24
Submitted:2006-11-28
Entered:2006-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / AVENTIS PASTEUR, INC. C2490AA / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0681F / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR, INC. Z0420 / 0 RL / IM
PNC: PNEUMO, 7-VALENT (PREVNAR) / LEDERLE LABORATORIES B08666H / 0 RL / IM
ROTHB5: ROTAVIRUS VACCINE, LIVE, ORAL, PENTAVALENT (ROTATEQ) / MERCK & CO. INC. 0979F / 0 LL / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Agitation, Crying, Haematochezia, Intussusception

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: Mild atopic dermatitis.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt visiting out of country with parents began with persistent crying on 11/25/06. On 11/26/06 awoke with diaper of blood. Diagnosed with intussusception and had partial small bowel resection performed emergency out of country. Unable to assess now.


Changed on 12/8/2009

VAERS ID: 267879 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Texas
Vaccinated:2006-11-03
Onset:2006-11-24
Submitted:2006-11-28
Entered:2006-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / AVENTIS PASTEUR, INC. SANOFI PASTEUR C2490AA / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0681F / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR, INC. SANOFI PASTEUR Z0420 / 0 RL / IM
PNC: PNEUMO, 7-VALENT (PREVNAR) PNEUMO (PREVNAR) / LEDERLE LABORATORIES WYETH PHARMACEUTICALS, INC B08666H / 0 RL / IM
ROTHB5: ROTAVIRUS VACCINE, LIVE, ORAL, PENTAVALENT (ROTATEQ) ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 0 LL / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Agitation, Crying, Haematochezia, Intussusception, Surgery, Intestinal resection

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

Write-up: Pt visiting out of country with parents began with persistent crying on 11/25/06. On 11/26/06 awoke with diaper of blood. Diagnosed with intussusception and had partial small bowel resection performed emergency out of country. Unable to assess now. Per 60 day follow up: Currently recovered, however, he did have to have bowel resected so potentially problems later with absorption.


Changed on 2/5/2010

VAERS ID: 267879 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Texas
Vaccinated:2006-11-03
Onset:2006-11-24
Submitted:2006-11-28
Entered:2006-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2490AA / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0681F / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0420 / 0 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08666H / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 0 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Crying, Haematochezia, Intussusception, Surgery, Intestinal resection

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: Mild atopic dermatitis.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt visiting out of country with parents began with persistent crying on 11/25/06. On 11/26/06 awoke with diaper of blood. Diagnosed with intussusception and had partial small bowel resection performed emergency out of country. Unable to assess now. Per 60 day follow up: Currently recovered, however, he did have to have bowel resected so potentially problems later with absorption.


Changed on 3/2/2010

VAERS ID: 267879 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Texas
Vaccinated:2006-11-03
Onset:2006-11-24
Submitted:2006-11-28
Entered:2006-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2490AA / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0681F / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0420 / 0 RL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B08666H / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 0 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Crying, Haematochezia, Intussusception

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: Mild atopic dermatitis.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt visiting out of country with parents began with persistent crying on 11/25/06. On 11/26/06 awoke with diaper of blood. Diagnosed with intussusception and had partial small bowel resection performed emergency out of country. Unable to assess now. Per 60 day follow up: Currently recovered, however, he did have to have bowel resected so potentially problems later with absorption.


Changed on 4/7/2010

VAERS ID: 267879 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Texas
Vaccinated:2006-11-03
Onset:2006-11-24
Submitted:2006-11-28
Entered:2006-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2490AA / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0681F / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0420 / 0 RL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08666H / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 0 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Crying, Haematochezia, Intussusception

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: Mild atopic dermatitis.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt visiting out of country with parents began with persistent crying on 11/25/06. On 11/26/06 awoke with diaper of blood. Diagnosed with intussusception and had partial small bowel resection performed emergency out of country. Unable to assess now. Per 60 day follow up: Currently recovered, however, he did have to have bowel resected so potentially problems later with absorption.


Changed on 8/31/2010

VAERS ID: 267879 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Texas
Vaccinated:2006-11-03
Onset:2006-11-24
Submitted:2006-11-28
Entered:2006-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2490AA / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0681F / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0420 / 0 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B08666H / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 0 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Crying, Haematochezia, Intussusception

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: Mild atopic dermatitis.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt visiting out of country with parents began with persistent crying on 11/25/06. On 11/26/06 awoke with diaper of blood. Diagnosed with intussusception and had partial small bowel resection performed emergency out of country. Unable to assess now. Per 60 day follow up: Currently recovered, however, he did have to have bowel resected so potentially problems later with absorption.


Changed on 4/13/2011

VAERS ID: 267879 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Texas
Vaccinated:2006-11-03
Onset:2006-11-24
Submitted:2006-11-28
Entered:2006-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2490AA / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0681F / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0420 / 0 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08666H / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 0 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Crying, Haematochezia, Intussusception, Surgery, Intestinal resection

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: Mild atopic dermatitis.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt visiting out of country with parents began with persistent crying on 11/25/06. On 11/26/06 awoke with diaper of blood. Diagnosed with intussusception and had partial small bowel resection performed emergency out of country. Unable to assess now. Per 60 day follow up: Currently recovered, however, he did have to have bowel resected so potentially problems later with absorption.


Changed on 5/13/2011

VAERS ID: 267879 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Texas
Vaccinated:2006-11-03
Onset:2006-11-24
Submitted:2006-11-28
Entered:2006-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2490AA / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0681F / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0420 / 0 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08666H / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 0 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Crying, Haematochezia, Intussusception, Surgery, Intestinal resection

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: Mild atopic dermatitis.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt visiting out of country with parents began with persistent crying on 11/25/06. On 11/26/06 awoke with diaper of blood. Diagnosed with intussusception and had partial small bowel resection performed emergency out of country. Unable to assess now. Per 60 day follow up: Currently recovered, however, he did have to have bowel resected so potentially problems later with absorption.


Changed on 6/11/2011

VAERS ID: 267879 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Texas
Vaccinated:2006-11-03
Onset:2006-11-24
Submitted:2006-11-28
Entered:2006-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2490AA / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0681F / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0420 / 0 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08666H / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 0 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Crying, Haematochezia, Intussusception, Surgery, Intestinal resection

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: Mild atopic dermatitis.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt visiting out of country with parents began with persistent crying on 11/25/06. On 11/26/06 awoke with diaper of blood. Diagnosed with intussusception and had partial small bowel resection performed emergency out of country. Unable to assess now. Per 60 day follow up: Currently recovered, however, he did have to have bowel resected so potentially problems later with absorption.


Changed on 5/13/2013

VAERS ID: 267879 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Texas
Vaccinated:2006-11-03
Onset:2006-11-24
Submitted:2006-11-28
Entered:2006-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2490AA / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0681F / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0420 / 0 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08666H / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 0 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 0 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Crying, Haematochezia, Intussusception, Surgery, Intestinal resection

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: Mild atopic dermatitis.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt visiting out of country with parents began with persistent crying on 11/25/06. On 11/26/06 awoke with diaper of blood. Diagnosed with intussusception and had partial small bowel resection performed emergency out of country. Unable to assess now. Per 60 day follow up: Currently recovered, however, he did have to have bowel resected so potentially problems later with absorption.


Changed on 6/14/2014

VAERS ID: 267879 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Texas
Vaccinated:2006-11-03
Onset:2006-11-24
Submitted:2006-11-28
Entered:2006-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2490AA / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0681F / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0420 / 0 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08666H / 0 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 0 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Crying, Haematochezia, Intussusception, Surgery, Intestinal resection

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: Mild atopic dermatitis.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt visiting out of country with parents began with persistent crying on 11/25/06. On 11/26/06 awoke with diaper of blood. Diagnosed with intussusception and had partial small bowel resection performed emergency out of country. Unable to assess now. Per 60 day follow up: Currently recovered, however, he did have to have bowel resected so potentially problems later with absorption.


Changed on 2/14/2017

VAERS ID: 267879 Before After
VAERS Form:
Age:0.2 0.16
Gender:Male
Location:Texas
Vaccinated:2006-11-03
Onset:2006-11-24
Submitted:2006-11-28
Entered:2006-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2490AA / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0681F / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0420 / 0 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08666H / 0 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 0 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Crying, Haematochezia, Intussusception, Surgery, Intestinal resection

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Mild atopic dermatitis.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt visiting out of country with parents began with persistent crying on 11/25/06. On 11/26/06 awoke with diaper of blood. Diagnosed with intussusception and had partial small bowel resection performed emergency out of country. Unable to assess now. Per 60 day follow up: Currently recovered, however, he did have to have bowel resected so potentially problems later with absorption.


Changed on 5/14/2017

VAERS ID: 267879 Before After
VAERS Form:
Age:0.16
Gender:Male
Location:Texas
Vaccinated:2006-11-03
Onset:2006-11-24
Submitted:2006-11-28
Entered:2006-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2490AA / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0681F / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0420 / 0 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08666H / 0 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 0 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Crying, Haematochezia, Intussusception, Surgery, Intestinal resection

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: Mild atopic dermatitis.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt visiting out of country with parents began with persistent crying on 11/25/06. On 11/26/06 awoke with diaper of blood. Diagnosed with intussusception and had partial small bowel resection performed emergency out of country. Unable to assess now. Per 60 day follow up: Currently recovered, however, he did have to have bowel resected so potentially problems later with absorption.


Changed on 9/14/2017

VAERS ID: 267879 Before After
VAERS Form:(blank) 1
Age:0.16
Gender:Male
Location:Texas
Vaccinated:2006-11-03
Onset:2006-11-24
Submitted:2006-11-28
Entered:2006-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2490AA / 0 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0681F / 0 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0420 / 0 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08666H / 0 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 0 1 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Crying, Haematochezia, Intussusception

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: Mild atopic dermatitis.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt visiting out of country with parents began with persistent crying on 11/25/06. On 11/26/06 awoke with diaper of blood. Diagnosed with intussusception and had partial small bowel resection performed emergency out of country. Unable to assess now. Per 60 day follow up: Currently recovered, however, he did have to have bowel resected so potentially problems later with absorption.


Changed on 2/14/2018

VAERS ID: 267879 Before After
VAERS Form:1
Age:0.16
Gender:Male
Location:Texas
Vaccinated:2006-11-03
Onset:2006-11-24
Submitted:2006-11-28
Entered:2006-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2490AA / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0681F / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0420 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08666H / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 1 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Crying, Haematochezia, Intussusception

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: Mild atopic dermatitis.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt visiting out of country with parents began with persistent crying on 11/25/06. On 11/26/06 awoke with diaper of blood. Diagnosed with intussusception and had partial small bowel resection performed emergency out of country. Unable to assess now. Per 60 day follow up: Currently recovered, however, he did have to have bowel resected so potentially problems later with absorption.


Changed on 6/14/2018

VAERS ID: 267879 Before After
VAERS Form:1
Age:0.16
Gender:Male
Location:Texas
Vaccinated:2006-11-03
Onset:2006-11-24
Submitted:2006-11-28
Entered:2006-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2490AA / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0681F / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0420 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08666H / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 1 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Crying, Haematochezia, Intussusception

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: Mild atopic dermatitis.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt visiting out of country with parents began with persistent crying on 11/25/06. On 11/26/06 awoke with diaper of blood. Diagnosed with intussusception and had partial small bowel resection performed emergency out of country. Unable to assess now. Per 60 day follow up: Currently recovered, however, he did have to have bowel resected so potentially problems later with absorption.


Changed on 8/14/2018

VAERS ID: 267879 Before After
VAERS Form:1
Age:0.16
Gender:Male
Location:Texas
Vaccinated:2006-11-03
Onset:2006-11-24
Submitted:2006-11-28
Entered:2006-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2490AA / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0681F / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0420 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08666H / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 1 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Crying, Haematochezia, Intussusception

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: Mild atopic dermatitis.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt visiting out of country with parents began with persistent crying on 11/25/06. On 11/26/06 awoke with diaper of blood. Diagnosed with intussusception and had partial small bowel resection performed emergency out of country. Unable to assess now. Per 60 day follow up: Currently recovered, however, he did have to have bowel resected so potentially problems later with absorption.


Changed on 9/14/2018

VAERS ID: 267879 Before After
VAERS Form:1
Age:0.16
Gender:Male
Location:Texas
Vaccinated:2006-11-03
Onset:2006-11-24
Submitted:2006-11-28
Entered:2006-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2490AA / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0681F / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0420 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08666H / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0979F / 1 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Crying, Haematochezia, Intussusception

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: Mild atopic dermatitis.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt visiting out of country with parents began with persistent crying on 11/25/06. On 11/26/06 awoke with diaper of blood. Diagnosed with intussusception and had partial small bowel resection performed emergency out of country. Unable to assess now. Per 60 day follow up: Currently recovered, however, he did have to have bowel resected so potentially problems later with absorption.

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