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This is VAERS ID 271978

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 271978
VAERS Form:
Age:0.3
Gender:Male
Location:New Jersey
Vaccinated:2007-01-16
Onset:2007-01-29
Submitted:2007-02-08
Entered:2007-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UN / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / - UN / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC - / - UN / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 1 - / PO

Administered by: Other      Purchased by: Unknown
Symptoms: Abdominal pain, Haematochezia, Intussusception, Enema administration, Feeding disorder

Life Threatening? No
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: Axid
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type':

Write-up: Information has been received from a health professional concerning a 19 week old male, with no medical history and no allergies, who was vaccinated with a first and second 2 ml oral dose of Rotateq vaccine (human-bovine) (lot#/"08475 or possibility 08475"/") on 14-NOV-2006 and 16-JAN-2007, respectively. Concomitant vaccinations administered on 16-JAN-2007 included a dose Pediarix vaccine, a dose of Hib conj vaccine, a dose of Prevnar. Concomitant medication included Axid. On 29-JAN-2007 the patient came i

Changed on 12/8/2009

VAERS ID: 271978 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:New Jersey
Vaccinated:2007-01-16
Onset:2007-01-29
Submitted:2007-02-08
Entered:2007-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UN / -
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UN / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / - UN / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC - / - UN / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 1 - / PO

Administered by: Other      Purchased by: Unknown Other
Symptoms: Abdominal pain, Haematochezia, Intussusception, Irritability, Lethargy, Mucous stools, Enema administration, Feeding disorder

Life Threatening? No
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: Axid
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': (blank) WAES0702USA00218

Write-up: Information has been received from a health professional concerning a 19 week old male, with no medical history and no allergies, who was vaccinated with a first and second 2 ml oral dose of Rotateq vaccine (human-bovine) (lot#/"08475 (lot#"08475 or possibility 08475"/") 08475") on 14-NOV-2006 and 16-JAN-2007, respectively. Concomitant vaccinations administered on 16-JAN-2007 included a dose Pediarix vaccine, a dose of Hib conj vaccine, a dose of Prevnar. Concomitant medication included Axid. On 29-JAN-2007 the patient came i into the office cranky and would not take a bottle. The patient was transferred to the hospital on the same day and was admitted for intussusception. At the time of the report the reporter did not have any details about the patient''s hospital course or any treatments. No product quality complaint was involved. No other information was provided. Additional information has been requested. 2/9/07 Received info from CDC that patient had symptoms of intermittent pain and lethargy on 1/29/07 with subsequent currant jelly stool. Barium enema was diagnostic and therapeutic. Child was observed overnight and discharged. No specimens available.

Changed on 3/2/2010

VAERS ID: 271978 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:New Jersey
Vaccinated:2007-01-16
Onset:2007-01-29
Submitted:2007-02-08
Entered:2007-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UN / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / - UN / -
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC - / - UN / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Haematochezia, Intussusception, Irritability, Lethargy, Mucous stools, Enema administration, Feeding disorder

Life Threatening? No
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: Axid
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES0702USA00218

Write-up: Information has been received from a health professional concerning a 19 week old male, with no medical history and no allergies, who was vaccinated with a first and second 2 ml oral dose of Rotateq vaccine (human-bovine) (lot#"08475 or possibility 08475") on 14-NOV-2006 and 16-JAN-2007, respectively. Concomitant vaccinations administered on 16-JAN-2007 included a dose Pediarix vaccine, a dose of Hib conj vaccine, a dose of Prevnar. Concomitant medication included Axid. On 29-JAN-2007 the patient came into the office cranky and would not take a bottle. The patient was transferred to the hospital on the same day and was admitted for intussusception. At the time of the report the reporter did not have any details about the patient''s hospital course or any treatments. No product quality complaint was involved. No other information was provided. Additional information has been requested. 2/9/07 Received info from CDC that patient had symptoms of intermittent pain and lethargy on 1/29/07 with subsequent currant jelly stool. Barium enema was diagnostic and therapeutic. Child was observed overnight and discharged. No specimens available.

Changed on 4/7/2010

VAERS ID: 271978 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:New Jersey
Vaccinated:2007-01-16
Onset:2007-01-29
Submitted:2007-02-08
Entered:2007-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UN / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / - UN / -
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC - / - UN / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Haematochezia, Intussusception, Irritability, Lethargy, Mucous stools, Enema administration, Feeding disorder

Life Threatening? No
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: Axid
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES0702USA00218

Write-up: Information has been received from a health professional concerning a 19 week old male, with no medical history and no allergies, who was vaccinated with a first and second 2 ml oral dose of Rotateq vaccine (human-bovine) (lot#"08475 or possibility 08475") on 14-NOV-2006 and 16-JAN-2007, respectively. Concomitant vaccinations administered on 16-JAN-2007 included a dose Pediarix vaccine, a dose of Hib conj vaccine, a dose of Prevnar. Concomitant medication included Axid. On 29-JAN-2007 the patient came into the office cranky and would not take a bottle. The patient was transferred to the hospital on the same day and was admitted for intussusception. At the time of the report the reporter did not have any details about the patient''s hospital course or any treatments. No product quality complaint was involved. No other information was provided. Additional information has been requested. 2/9/07 Received info from CDC that patient had symptoms of intermittent pain and lethargy on 1/29/07 with subsequent currant jelly stool. Barium enema was diagnostic and therapeutic. Child was observed overnight and discharged. No specimens available.

Changed on 8/31/2010

VAERS ID: 271978 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:New Jersey
Vaccinated:2007-01-16
Onset:2007-01-29
Submitted:2007-02-08
Entered:2007-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UN / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / - UN / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH - / - UN / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Haematochezia, Intussusception, Irritability, Lethargy, Mucous stools, Enema administration, Feeding disorder

Life Threatening? No
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: Axid
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES0702USA00218

Write-up: Information has been received from a health professional concerning a 19 week old male, with no medical history and no allergies, who was vaccinated with a first and second 2 ml oral dose of Rotateq vaccine (human-bovine) (lot#"08475 or possibility 08475") on 14-NOV-2006 and 16-JAN-2007, respectively. Concomitant vaccinations administered on 16-JAN-2007 included a dose Pediarix vaccine, a dose of Hib conj vaccine, a dose of Prevnar. Concomitant medication included Axid. On 29-JAN-2007 the patient came into the office cranky and would not take a bottle. The patient was transferred to the hospital on the same day and was admitted for intussusception. At the time of the report the reporter did not have any details about the patient''s hospital course or any treatments. No product quality complaint was involved. No other information was provided. Additional information has been requested. 2/9/07 Received info from CDC that patient had symptoms of intermittent pain and lethargy on 1/29/07 with subsequent currant jelly stool. Barium enema was diagnostic and therapeutic. Child was observed overnight and discharged. No specimens available.

Changed on 5/13/2013

VAERS ID: 271978 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:New Jersey
Vaccinated:2007-01-16
Onset:2007-01-29
Submitted:2007-02-08
Entered:2007-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UN / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / - UN / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / - UN / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Haematochezia, Intussusception, Irritability, Lethargy, Mucous stools, Enema administration, Feeding disorder

Life Threatening? No
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: Axid
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES0702USA00218

Write-up: Information has been received from a health professional concerning a 19 week old male, with no medical history and no allergies, who was vaccinated with a first and second 2 ml oral dose of Rotateq vaccine (human-bovine) (lot#"08475 or possibility 08475") on 14-NOV-2006 and 16-JAN-2007, respectively. Concomitant vaccinations administered on 16-JAN-2007 included a dose Pediarix vaccine, a dose of Hib conj vaccine, a dose of Prevnar. Concomitant medication included Axid. On 29-JAN-2007 the patient came into the office cranky and would not take a bottle. The patient was transferred to the hospital on the same day and was admitted for intussusception. At the time of the report the reporter did not have any details about the patient''s hospital course or any treatments. No product quality complaint was involved. No other information was provided. Additional information has been requested. 2/9/07 Received info from CDC that patient had symptoms of intermittent pain and lethargy on 1/29/07 with subsequent currant jelly stool. Barium enema was diagnostic and therapeutic. Child was observed overnight and discharged. No specimens available.

Changed on 5/14/2017

VAERS ID: 271978 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:New Jersey
Vaccinated:2007-01-16
Onset:2007-01-29
Submitted:2007-02-08
Entered:2007-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UN / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / - UN / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / - UN / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Haematochezia, Intussusception, Irritability, Lethargy, Mucous stools, Enema administration, Feeding disorder

Life Threatening? No
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: Axid
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES0702USA00218

Write-up: Information has been received from a health professional concerning a 19 week old male, with no medical history and no allergies, who was vaccinated with a first and second 2 ml oral dose of Rotateq vaccine (human-bovine) (lot#"08475 or possibility 08475") on 14-NOV-2006 and 16-JAN-2007, respectively. Concomitant vaccinations administered on 16-JAN-2007 included a dose Pediarix vaccine, a dose of Hib conj vaccine, a dose of Prevnar. Concomitant medication included Axid. On 29-JAN-2007 the patient came into the office cranky and would not take a bottle. The patient was transferred to the hospital on the same day and was admitted for intussusception. At the time of the report the reporter did not have any details about the patient''s hospital course or any treatments. No product quality complaint was involved. No other information was provided. Additional information has been requested. 2/9/07 Received info from CDC that patient had symptoms of intermittent pain and lethargy on 1/29/07 with subsequent currant jelly stool. Barium enema was diagnostic and therapeutic. Child was observed overnight and discharged. No specimens available.

Changed on 9/14/2017

VAERS ID: 271978 Before After
VAERS Form:(blank) 1
Age:0.3
Gender:Male
Location:New Jersey
Vaccinated:2007-01-16
Onset:2007-01-29
Submitted:2007-02-08
Entered:2007-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UNK UN / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / - UNK UN / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / - UNK UN / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 1 2 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Irritability, Feeding disorder

Life Threatening? No
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: Axid
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES0702USA00218

Write-up: Information has been received from a health professional concerning a 19 week old male, with no medical history and no allergies, who was vaccinated with a first and second 2 ml oral dose of Rotateq vaccine (human-bovine) (lot#"08475 or possibility 08475") on 14-NOV-2006 and 16-JAN-2007, respectively. Concomitant vaccinations administered on 16-JAN-2007 included a dose Pediarix vaccine, a dose of Hib conj vaccine, a dose of Prevnar. Concomitant medication included Axid. On 29-JAN-2007 the patient came into the office cranky and would not take a bottle. The patient was transferred to the hospital on the same day and was admitted for intussusception. At the time of the report the reporter did not have any details about the patient''s hospital course or any treatments. No product quality complaint was involved. No other information was provided. Additional information has been requested. 2/9/07 Received info from CDC that patient had symptoms of intermittent pain and lethargy on 1/29/07 with subsequent currant jelly stool. Barium enema was diagnostic and therapeutic. Child was observed overnight and discharged. No specimens available.

Changed on 2/14/2018

VAERS ID: 271978 Before After
VAERS Form:1
Age:0.3
Gender:Male
Location:New Jersey
Vaccinated:2007-01-16
Onset:2007-01-29
Submitted:2007-02-08
Entered:2007-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK UN / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / UNK UN / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK UN / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Irritability, Feeding disorder

Life Threatening? No
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: Axid
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES0702USA00218

Write-up: Information has been received from a health professional concerning a 19 week old male, with no medical history and no allergies, who was vaccinated with a first and second 2 ml oral dose of Rotateq vaccine (human-bovine) (lot#"08475 or possibility 08475") on 14-NOV-2006 and 16-JAN-2007, respectively. Concomitant vaccinations administered on 16-JAN-2007 included a dose Pediarix vaccine, a dose of Hib conj vaccine, a dose of Prevnar. Concomitant medication included Axid. On 29-JAN-2007 the patient came into the office cranky and would not take a bottle. The patient was transferred to the hospital on the same day and was admitted for intussusception. At the time of the report the reporter did not have any details about the patient''s hospital course or any treatments. No product quality complaint was involved. No other information was provided. Additional information has been requested. 2/9/07 Received info from CDC that patient had symptoms of intermittent pain and lethargy on 1/29/07 with subsequent currant jelly stool. Barium enema was diagnostic and therapeutic. Child was observed overnight and discharged. No specimens available.

Changed on 6/14/2018

VAERS ID: 271978 Before After
VAERS Form:1
Age:0.3
Gender:Male
Location:New Jersey
Vaccinated:2007-01-16
Onset:2007-01-29
Submitted:2007-02-08
Entered:2007-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK UN / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / UNK UN / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK UN / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Irritability, Feeding disorder

Life Threatening? No
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: Axid
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES0702USA00218

Write-up: Information has been received from a health professional concerning a 19 week old male, with no medical history and no allergies, who was vaccinated with a first and second 2 ml oral dose of Rotateq vaccine (human-bovine) (lot#"08475 or possibility 08475") on 14-NOV-2006 and 16-JAN-2007, respectively. Concomitant vaccinations administered on 16-JAN-2007 included a dose Pediarix vaccine, a dose of Hib conj vaccine, a dose of Prevnar. Concomitant medication included Axid. On 29-JAN-2007 the patient came into the office cranky and would not take a bottle. The patient was transferred to the hospital on the same day and was admitted for intussusception. At the time of the report the reporter did not have any details about the patient''s hospital course or any treatments. No product quality complaint was involved. No other information was provided. Additional information has been requested. 2/9/07 Received info from CDC that patient had symptoms of intermittent pain and lethargy on 1/29/07 with subsequent currant jelly stool. Barium enema was diagnostic and therapeutic. Child was observed overnight and discharged. No specimens available.

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