This is VAERS ID 273046

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B092AA / 2	- / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC	B36258D / 2	- / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	1233F / 2	- / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Appendicectomy, Diarrhoea haemorrhagic, Intussusception, Mucous stools, Enema administration

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: surgery
CDC 'Split Type':

Write-up: He started vomiting at midnight 2/24/07, then had mucus and blood in a diarrhea stool was admitted to the hospital and had surgery for intusussecption. Could not be reduced by an enema.

---

Changed on 12/8/2009

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B092AA / 2	- / -
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B092AA / 2	- / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC	B36258D / 2	- / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	1233F / 2	- / PO

Administered by: Private      Purchased by: Unknown Private
Symptoms: Appendicectomy, Diarrhoea haemorrhagic, Intussusception, Mucous stools, Surgery, Vomiting, Enema administration

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: surgery LABS: air contrast enema revealed +IS to sigmoid but was unable to completely resolve.
CDC 'Split Type':

Write-up: He started vomiting at midnight 2/24/07, then had mucus and blood in a diarrhea stool was admitted to the hospital and had surgery for intusussecption. Could not be reduced by an enema. 3/15/07 Received medical records from hospital which reveal patient experienced a 2 day history of bloody diarrhea. Had been seen at outlying ER & transferred for higher level of care. Taken to OR for exp lap for bowel obstruction. Intussusception reduced & appendectomy was performed. Held overnight for observation. Did well & d/c to home. FINAL DX: Intussusception, surgically reduced.

---

Changed on 3/2/2010

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B092AA / 2	- / -
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC	B36258D / 2	- / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	1233F / 2	- / PO

Administered by: Private      Purchased by: Private
Symptoms: Appendicectomy, Diarrhoea haemorrhagic, Intussusception, Mucous stools, Surgery, Vomiting, Enema administration

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: surgery LABS: air contrast enema revealed +IS to sigmoid but was unable to completely resolve.
CDC 'Split Type':

Write-up: He started vomiting at midnight 2/24/07, then had mucus and blood in a diarrhea stool was admitted to the hospital and had surgery for intusussecption. Could not be reduced by an enema. 3/15/07 Received medical records from hospital which reveal patient experienced a 2 day history of bloody diarrhea. Had been seen at outlying ER & transferred for higher level of care. Taken to OR for exp lap for bowel obstruction. Intussusception reduced & appendectomy was performed. Held overnight for observation. Did well & d/c to home. FINAL DX: Intussusception, surgically reduced.

---

Changed on 4/7/2010

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B092AA / 2	- / -
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC	B36258D / 2	- / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	1233F / 2	- / PO

Administered by: Private      Purchased by: Private
Symptoms: Appendicectomy, Diarrhoea haemorrhagic, Intussusception, Mucous stools, Surgery, Vomiting, Enema administration

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: surgery LABS: air contrast enema revealed +IS to sigmoid but was unable to completely resolve.
CDC 'Split Type':

Write-up: He started vomiting at midnight 2/24/07, then had mucus and blood in a diarrhea stool was admitted to the hospital and had surgery for intusussecption. Could not be reduced by an enema. 3/15/07 Received medical records from hospital which reveal patient experienced a 2 day history of bloody diarrhea. Had been seen at outlying ER & transferred for higher level of care. Taken to OR for exp lap for bowel obstruction. Intussusception reduced & appendectomy was performed. Held overnight for observation. Did well & d/c to home. FINAL DX: Intussusception, surgically reduced.

---

Changed on 8/31/2010

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B092AA / 2	- / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH	B36258D / 2	- / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	1233F / 2	- / PO

Administered by: Private      Purchased by: Private
Symptoms: Appendicectomy, Diarrhoea haemorrhagic, Intussusception, Mucous stools, Surgery, Vomiting, Enema administration

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: surgery LABS: air contrast enema revealed +IS to sigmoid but was unable to completely resolve.
CDC 'Split Type':

Write-up: He started vomiting at midnight 2/24/07, then had mucus and blood in a diarrhea stool was admitted to the hospital and had surgery for intusussecption. Could not be reduced by an enema. 3/15/07 Received medical records from hospital which reveal patient experienced a 2 day history of bloody diarrhea. Had been seen at outlying ER & transferred for higher level of care. Taken to OR for exp lap for bowel obstruction. Intussusception reduced & appendectomy was performed. Held overnight for observation. Did well & d/c to home. FINAL DX: Intussusception, surgically reduced.

---

Changed on 5/13/2013

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B092AA / 2	- / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH	B36258D / 2	- / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	1233F / 2	- / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	1233F / 2	- / PO

Administered by: Private      Purchased by: Private
Symptoms: Appendicectomy, Diarrhoea haemorrhagic, Intussusception, Mucous stools, Surgery, Vomiting, Enema administration

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: surgery LABS: air contrast enema revealed +IS to sigmoid but was unable to completely resolve.
CDC 'Split Type':

Write-up: He started vomiting at midnight 2/24/07, then had mucus and blood in a diarrhea stool was admitted to the hospital and had surgery for intusussecption. Could not be reduced by an enema. 3/15/07 Received medical records from hospital which reveal patient experienced a 2 day history of bloody diarrhea. Had been seen at outlying ER & transferred for higher level of care. Taken to OR for exp lap for bowel obstruction. Intussusception reduced & appendectomy was performed. Held overnight for observation. Did well & d/c to home. FINAL DX: Intussusception, surgically reduced.

---

Changed on 2/14/2017

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B092AA / 2	- / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH	B36258D / 2	- / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	1233F / 2	- / PO

Administered by: Private      Purchased by: Private
Symptoms: Appendicectomy, Diarrhoea haemorrhagic, Intussusception, Mucous stools, Surgery, Vomiting, Enema administration

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: surgery LABS: air contrast enema revealed +IS to sigmoid but was unable to completely resolve.
CDC 'Split Type':

Write-up: He started vomiting at midnight 2/24/07, then had mucus and blood in a diarrhea stool was admitted to the hospital and had surgery for intusussecption. Could not be reduced by an enema. 3/15/07 Received medical records from hospital which reveal patient experienced a 2 day history of bloody diarrhea. Had been seen at outlying ER & transferred for higher level of care. Taken to OR for exp lap for bowel obstruction. Intussusception reduced & appendectomy was performed. Held overnight for observation. Did well & d/c to home. FINAL DX: Intussusception, surgically reduced.

---

Changed on 9/14/2017

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B092AA / 2 3	- / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH	B36258D / 2 3	- / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	1233F / 2 3	- MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Diarrhoea haemorrhagic, Intussusception, Mucous stools, Surgery, Vomiting

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: surgery LABS: air contrast enema revealed +IS to sigmoid but was unable to completely resolve.
CDC 'Split Type':

Write-up: He started vomiting at midnight 2/24/07, then had mucus and blood in a diarrhea stool was admitted to the hospital and had surgery for intusussecption. Could not be reduced by an enema. 3/15/07 Received medical records from hospital which reveal patient experienced a 2 day history of bloody diarrhea. Had been seen at outlying ER & transferred for higher level of care. Taken to OR for exp lap for bowel obstruction. Intussusception reduced & appendectomy was performed. Held overnight for observation. Did well & d/c to home. FINAL DX: Intussusception, surgically reduced.

---

Changed on 2/14/2018

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B092AA / 3	- / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH	B36258D / 3	- / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	1233F / 3	MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Diarrhoea haemorrhagic, Intussusception, Mucous stools, Surgery, Vomiting

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: surgery LABS: air contrast enema revealed +IS to sigmoid but was unable to completely resolve.
CDC 'Split Type':

Write-up: He started vomiting at midnight 2/24/07, then had mucus and blood in a diarrhea stool was admitted to the hospital and had surgery for intusussecption. Could not be reduced by an enema. 3/15/07 Received medical records from hospital which reveal patient experienced a 2 day history of bloody diarrhea. Had been seen at outlying ER & transferred for higher level of care. Taken to OR for exp lap for bowel obstruction. Intussusception reduced & appendectomy was performed. Held overnight for observation. Did well & d/c to home. FINAL DX: Intussusception, surgically reduced.

---

Changed on 6/14/2018

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B092AA / 3	- / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH	B36258D / 3	- / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	1233F / 3	MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Diarrhoea haemorrhagic, Intussusception, Mucous stools, Surgery, Vomiting

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: surgery LABS: air contrast enema revealed +IS to sigmoid but was unable to completely resolve.
CDC 'Split Type':

Write-up: He started vomiting at midnight 2/24/07, then had mucus and blood in a diarrhea stool was admitted to the hospital and had surgery for intusussecption. Could not be reduced by an enema. 3/15/07 Received medical records from hospital which reveal patient experienced a 2 day history of bloody diarrhea. Had been seen at outlying ER & transferred for higher level of care. Taken to OR for exp lap for bowel obstruction. Intussusception reduced & appendectomy was performed. Held overnight for observation. Did well & d/c to home. FINAL DX: Intussusception, surgically reduced.

---

Changed on 8/14/2018

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B092AA / 3	- / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH	B36258D / 3	- / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	1233F / 3	MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Diarrhoea haemorrhagic, Intussusception, Mucous stools, Surgery, Vomiting

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: surgery LABS: air contrast enema revealed +IS to sigmoid but was unable to completely resolve.
CDC 'Split Type':

Write-up: He started vomiting at midnight 2/24/07, then had mucus and blood in a diarrhea stool was admitted to the hospital and had surgery for intusussecption. Could not be reduced by an enema. 3/15/07 Received medical records from hospital which reveal patient experienced a 2 day history of bloody diarrhea. Had been seen at outlying ER & transferred for higher level of care. Taken to OR for exp lap for bowel obstruction. Intussusception reduced & appendectomy was performed. Held overnight for observation. Did well & d/c to home. FINAL DX: Intussusception, surgically reduced.

---

Changed on 9/14/2018

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B092AA / 3	- / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH	B36258D / 3	- / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	1233F / 3	MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Diarrhoea haemorrhagic, Intussusception, Mucous stools, Surgery, Vomiting

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: surgery LABS: air contrast enema revealed +IS to sigmoid but was unable to completely resolve.
CDC 'Split Type':

Write-up: He started vomiting at midnight 2/24/07, then had mucus and blood in a diarrhea stool was admitted to the hospital and had surgery for intusussecption. Could not be reduced by an enema. 3/15/07 Received medical records from hospital which reveal patient experienced a 2 day history of bloody diarrhea. Had been seen at outlying ER & transferred for higher level of care. Taken to OR for exp lap for bowel obstruction. Intussusception reduced & appendectomy was performed. Held overnight for observation. Did well & d/c to home. FINAL DX: Intussusception, surgically reduced.

---

Changed on 10/14/2018

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B092AA / 3	- / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH	B36258D / 3	- / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	1233F / 3	MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Diarrhoea haemorrhagic, Intussusception, Mucous stools, Surgery, Vomiting

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: surgery LABS: air contrast enema revealed +IS to sigmoid but was unable to completely resolve.
CDC 'Split Type':

Write-up: He started vomiting at midnight 2/24/07, then had mucus and blood in a diarrhea stool was admitted to the hospital and had surgery for intusussecption. Could not be reduced by an enema. 3/15/07 Received medical records from hospital which reveal patient experienced a 2 day history of bloody diarrhea. Had been seen at outlying ER & transferred for higher level of care. Taken to OR for exp lap for bowel obstruction. Intussusception reduced & appendectomy was performed. Held overnight for observation. Did well & d/c to home. FINAL DX: Intussusception, surgically reduced.

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