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This is VAERS ID 270981

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 270981
VAERS Form:
Age:0.2
Gender:Male
Location:California
Vaccinated:2006-12-10
Onset:2007-01-08
Submitted:2007-01-23
Entered:2007-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1008R / - - / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 094JF / - - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Appendicectomy, Barium enema, Diarrhoea, Haematochezia, Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: PCV7 by Wyeth, lot B08675D. Pediarix by SKB, lot AC21BOY3AA
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Abdominal ultrasound and barium enema. Labs: Hgb 10.6, neutrophils 56, lymphocytes 30 chloride 110, anion gap 17.0. Abdominal US positive for intussusception.
CDC 'Split Type':

Write-up: Had bloody stools and vomiting on 1/8th night and 1/9th morning. He had intussusception which required surgical repair. I am not sure if this might be related to Rotavirus given on Dec. 9, 2006. 02/07/07-records received and reviewed for DOS 01/09-01/12/0"7 DC DX: Intussuception 3 mo old presented to hospital with BRBRP that began on 1/8/07-history of loose stool times 2 days. emesis began last night. Seen in ER and sent home. Returned with dec activity had 30 cc BRBPR in ED. Underwent barium enema reduct


Changed on 12/8/2009

VAERS ID: 270981 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:California
Vaccinated:2006-12-10
Onset:2007-01-08
Submitted:2007-01-23
Entered:2007-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1008R / - - / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 094JF / - - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Appendicectomy, Barium enema, Diarrhoea, Haematochezia, Intussusception, Vomiting, Ultrasound abdomen

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: PCV7 by Wyeth, lot B08675D. Pediarix by SKB, lot AC21BOY3AA
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Abdominal ultrasound and barium enema. Labs: Hgb 10.6, neutrophils 56, lymphocytes 30 chloride 110, anion gap 17.0. Abdominal US positive for intussusception.
CDC 'Split Type':

Write-up: Had bloody stools and vomiting on 1/8th night and 1/9th morning. He had intussusception which required surgical repair. I am not sure if this might be related to Rotavirus given on Dec. 9, 2006. 02/07/07-records received and reviewed for DOS 01/09-01/12/0"7 01/09-01/12/07 DC DX: Intussuception 3 mo old presented to hospital with BRBRP that began on 1/8/07-history of loose stool times 2 days. emesis began last night. Seen in ER and sent home. Returned with dec activity had 30 cc BRBPR in ED. Underwent barium enema reduct reduction attempt 3 times which reduced from sigmoid colon to ileocecal valve but not beyond valve. PMHX: none Underwent surgical correction for intussusception on 1/9/07- also performed appendectomy. On post op day 3 had mild abdominal distention but bowel sounds were present. BMs were normal. DC home.


Changed on 5/13/2013

VAERS ID: 270981 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:California
Vaccinated:2006-12-10
Onset:2007-01-08
Submitted:2007-01-23
Entered:2007-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1008R / - - / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 094JF / - - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 094JF / - - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Appendicectomy, Barium enema, Diarrhoea, Haematochezia, Intussusception, Vomiting, Ultrasound abdomen

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: PCV7 by Wyeth, lot B08675D. Pediarix by SKB, lot AC21BOY3AA
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Abdominal ultrasound and barium enema. Labs: Hgb 10.6, neutrophils 56, lymphocytes 30 chloride 110, anion gap 17.0. Abdominal US positive for intussusception.
CDC 'Split Type':

Write-up: Had bloody stools and vomiting on 1/8th night and 1/9th morning. He had intussusception which required surgical repair. I am not sure if this might be related to Rotavirus given on Dec. 9, 2006. 02/07/07-records received and reviewed for DOS 01/09-01/12/07 DC DX: Intussuception 3 mo old presented to hospital with BRBRP that began on 1/8/07-history of loose stool times 2 days. emesis began last night. Seen in ER and sent home. Returned with dec activity had 30 cc BRBPR in ED. Underwent barium enema reduction attempt 3 times which reduced from sigmoid colon to ileocecal valve but not beyond valve. PMHX: none Underwent surgical correction for intussusception on 1/9/07- also performed appendectomy. On post op day 3 had mild abdominal distention but bowel sounds were present. BMs were normal. DC home.


Changed on 2/14/2017

VAERS ID: 270981 Before After
VAERS Form:
Age:0.2 0.17
Gender:Male
Location:California
Vaccinated:2006-12-10
Onset:2007-01-08
Submitted:2007-01-23
Entered:2007-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1008R / - - / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 094JF / - - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Appendicectomy, Barium enema, Diarrhoea, Haematochezia, Intussusception, Vomiting, Ultrasound abdomen

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: PCV7 by Wyeth, lot B08675D. Pediarix by SKB, lot AC21BOY3AA
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Abdominal ultrasound and barium enema. Labs: Hgb 10.6, neutrophils 56, lymphocytes 30 chloride 110, anion gap 17.0. Abdominal US positive for intussusception.
CDC 'Split Type':

Write-up: Had bloody stools and vomiting on 1/8th night and 1/9th morning. He had intussusception which required surgical repair. I am not sure if this might be related to Rotavirus given on Dec. 9, 2006. 02/07/07-records received and reviewed for DOS 01/09-01/12/07 DC DX: Intussuception 3 mo old presented to hospital with BRBRP that began on 1/8/07-history of loose stool times 2 days. emesis began last night. Seen in ER and sent home. Returned with dec activity had 30 cc BRBPR in ED. Underwent barium enema reduction attempt 3 times which reduced from sigmoid colon to ileocecal valve but not beyond valve. PMHX: none Underwent surgical correction for intussusception on 1/9/07- also performed appendectomy. On post op day 3 had mild abdominal distention but bowel sounds were present. BMs were normal. DC home.


Changed on 5/14/2017

VAERS ID: 270981 Before After
VAERS Form:
Age:0.17
Gender:Male
Location:California
Vaccinated:2006-12-10
Onset:2007-01-08
Submitted:2007-01-23
Entered:2007-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1008R / - - / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 094JF / - - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Appendicectomy, Barium enema, Diarrhoea, Haematochezia, Intussusception, Vomiting, Ultrasound abdomen

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: PCV7 by Wyeth, lot B08675D. Pediarix by SKB, lot AC21BOY3AA
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Abdominal ultrasound and barium enema. Labs: Hgb 10.6, neutrophils 56, lymphocytes 30 chloride 110, anion gap 17.0. Abdominal US positive for intussusception.
CDC 'Split Type':

Write-up: Had bloody stools and vomiting on 1/8th night and 1/9th morning. He had intussusception which required surgical repair. I am not sure if this might be related to Rotavirus given on Dec. 9, 2006. 02/07/07-records received and reviewed for DOS 01/09-01/12/07 DC DX: Intussuception 3 mo old presented to hospital with BRBRP that began on 1/8/07-history of loose stool times 2 days. emesis began last night. Seen in ER and sent home. Returned with dec activity had 30 cc BRBPR in ED. Underwent barium enema reduction attempt 3 times which reduced from sigmoid colon to ileocecal valve but not beyond valve. PMHX: none Underwent surgical correction for intussusception on 1/9/07- also performed appendectomy. On post op day 3 had mild abdominal distention but bowel sounds were present. BMs were normal. DC home.


Changed on 9/14/2017

VAERS ID: 270981 Before After
VAERS Form:(blank) 1
Age:0.17
Gender:Male
Location:California
Vaccinated:2006-12-10
Onset:2007-01-08
Submitted:2007-01-23
Entered:2007-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1008R / - UNK - / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 094JF / - UNK - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Haematochezia, Intussusception, Vomiting, Ultrasound abdomen

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: PCV7 by Wyeth, lot B08675D. Pediarix by SKB, lot AC21BOY3AA
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Abdominal ultrasound and barium enema. Labs: Hgb 10.6, neutrophils 56, lymphocytes 30 chloride 110, anion gap 17.0. Abdominal US positive for intussusception.
CDC 'Split Type':

Write-up: Had bloody stools and vomiting on 1/8th night and 1/9th morning. He had intussusception which required surgical repair. I am not sure if this might be related to Rotavirus given on Dec. 9, 2006. 02/07/07-records received and reviewed for DOS 01/09-01/12/07 DC DX: Intussuception 3 mo old presented to hospital with BRBRP that began on 1/8/07-history of loose stool times 2 days. emesis began last night. Seen in ER and sent home. Returned with dec activity had 30 cc BRBPR in ED. Underwent barium enema reduction attempt 3 times which reduced from sigmoid colon to ileocecal valve but not beyond valve. PMHX: none Underwent surgical correction for intussusception on 1/9/07- also performed appendectomy. On post op day 3 had mild abdominal distention but bowel sounds were present. BMs were normal. DC home.


Changed on 2/14/2018

VAERS ID: 270981 Before After
VAERS Form:1
Age:0.17
Gender:Male
Location:California
Vaccinated:2006-12-10
Onset:2007-01-08
Submitted:2007-01-23
Entered:2007-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1008R / UNK - / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 094JF / UNK MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Haematochezia, Intussusception, Vomiting, Ultrasound abdomen

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: PCV7 by Wyeth, lot B08675D. Pediarix by SKB, lot AC21BOY3AA
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Abdominal ultrasound and barium enema. Labs: Hgb 10.6, neutrophils 56, lymphocytes 30 chloride 110, anion gap 17.0. Abdominal US positive for intussusception.
CDC 'Split Type':

Write-up: Had bloody stools and vomiting on 1/8th night and 1/9th morning. He had intussusception which required surgical repair. I am not sure if this might be related to Rotavirus given on Dec. 9, 2006. 02/07/07-records received and reviewed for DOS 01/09-01/12/07 DC DX: Intussuception 3 mo old presented to hospital with BRBRP that began on 1/8/07-history of loose stool times 2 days. emesis began last night. Seen in ER and sent home. Returned with dec activity had 30 cc BRBPR in ED. Underwent barium enema reduction attempt 3 times which reduced from sigmoid colon to ileocecal valve but not beyond valve. PMHX: none Underwent surgical correction for intussusception on 1/9/07- also performed appendectomy. On post op day 3 had mild abdominal distention but bowel sounds were present. BMs were normal. DC home.


Changed on 6/14/2018

VAERS ID: 270981 Before After
VAERS Form:1
Age:0.17
Gender:Male
Location:California
Vaccinated:2006-12-10
Onset:2007-01-08
Submitted:2007-01-23
Entered:2007-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1008R / UNK - / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 094JF / UNK MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium enema, Haematochezia, Intussusception, Vomiting, Ultrasound abdomen

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: PCV7 by Wyeth, lot B08675D. Pediarix by SKB, lot AC21BOY3AA
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Abdominal ultrasound and barium enema. Labs: Hgb 10.6, neutrophils 56, lymphocytes 30 chloride 110, anion gap 17.0. Abdominal US positive for intussusception.
CDC 'Split Type':

Write-up: Had bloody stools and vomiting on 1/8th night and 1/9th morning. He had intussusception which required surgical repair. I am not sure if this might be related to Rotavirus given on Dec. 9, 2006. 02/07/07-records received and reviewed for DOS 01/09-01/12/07 DC DX: Intussuception 3 mo old presented to hospital with BRBRP that began on 1/8/07-history of loose stool times 2 days. emesis began last night. Seen in ER and sent home. Returned with dec activity had 30 cc BRBPR in ED. Underwent barium enema reduction attempt 3 times which reduced from sigmoid colon to ileocecal valve but not beyond valve. PMHX: none Underwent surgical correction for intussusception on 1/9/07- also performed appendectomy. On post op day 3 had mild abdominal distention but bowel sounds were present. BMs were normal. DC home.

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