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This is VAERS ID 273520

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 273520
VAERS Form:
Age:0.4
Gender:Male
Location:Alabama
Vaccinated:2006-12-13
Onset:2007-02-26
Submitted:2007-02-27
Entered:2007-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U1891BA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 6086F / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1032 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08675K / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0319F / 2 - / PO

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

Life Threatening? Yes
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: 11-7-06 Polytrim opthalmic drops
Current Illness: Well check up
Preexisting Conditions: Heart murmur 9-11-06
Allergies:
Diagnostic Lab Data: BE diagnosis
CDC 'Split Type':

Write-up: Pt had signs of alternating lethargy, fussiness and a bloody stool. Diagnosed with intussusception by BE which failed to reduce it. Went to surgery and his appendix was lead point. Doubt due to Rotateq 2 mos after dose and appendix lead point.

Changed on 12/8/2009

VAERS ID: 273520 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Alabama
Vaccinated:2006-12-13
Onset:2007-02-26
Submitted:2007-02-27
Entered:2007-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U1891BA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 6086F / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1032 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08675K / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0319F / 2 - / PO

Administered by: Private      Purchased by: Unknown Private
Symptoms: Agitation, Appendicectomy, Barium enema, Haematochezia, Intussusception, Laparotomy, Lethargy, Surgery, Vomiting

Life Threatening? Yes
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: 11-7-06 Polytrim opthalmic drops
Current Illness: Well check up
Preexisting Conditions: Heart murmur 9-11-06
Allergies:
Diagnostic Lab Data: BE diagnosis Records received 5/15/07-Barium enema revealed intussusception. Unsuccessful in reduction.
CDC 'Split Type':

Write-up: Pt had signs of alternating lethargy, fussiness and a bloody stool. Diagnosed with intussusception by BE which failed to reduce it. Went to surgery and his appendix was lead point. Doubt due to Rotateq 2 mos after dose and appendix lead point. 05/15/07-records received for DOS 2/26-3/2/07. DC DX: Intussusception.Several hour history of sleeping a lot waking up crying not eating well. Vomited once. No diarrhea. Rectal exam revealed hempositive secretions. Barium enema revealed intussusception. Unsuccessful in reduction. Surgical reduction revealed appendix in the middle of the intussusception.

Changed on 3/2/2010

VAERS ID: 273520 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Alabama
Vaccinated:2006-12-13
Onset:2007-02-26
Submitted:2007-02-27
Entered:2007-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U1891BA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 6086F / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1032 / 1 RL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B08675K / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0319F / 2 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Appendicectomy, Barium enema, Haematochezia, Intussusception, Laparotomy, Lethargy, Surgery, Vomiting

Life Threatening? Yes
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: 11-7-06 Polytrim opthalmic drops
Current Illness: Well check up
Preexisting Conditions: Heart murmur 9-11-06
Allergies:
Diagnostic Lab Data: BE diagnosis Records received 5/15/07-Barium enema revealed intussusception. Unsuccessful in reduction.
CDC 'Split Type':

Write-up: Pt had signs of alternating lethargy, fussiness and a bloody stool. Diagnosed with intussusception by BE which failed to reduce it. Went to surgery and his appendix was lead point. Doubt due to Rotateq 2 mos after dose and appendix lead point. 05/15/07-records received for DOS 2/26-3/2/07. DC DX: Intussusception.Several hour history of sleeping a lot waking up crying not eating well. Vomited once. No diarrhea. Rectal exam revealed hempositive secretions. Barium enema revealed intussusception. Unsuccessful in reduction. Surgical reduction revealed appendix in the middle of the intussusception.

Changed on 4/7/2010

VAERS ID: 273520 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Alabama
Vaccinated:2006-12-13
Onset:2007-02-26
Submitted:2007-02-27
Entered:2007-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U1891BA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 6086F / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1032 / 1 RL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08675K / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0319F / 2 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Appendicectomy, Barium enema, Haematochezia, Intussusception, Laparotomy, Lethargy, Surgery, Vomiting

Life Threatening? Yes
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: 11-7-06 Polytrim opthalmic drops
Current Illness: Well check up
Preexisting Conditions: Heart murmur 9-11-06
Allergies:
Diagnostic Lab Data: BE diagnosis Records received 5/15/07-Barium enema revealed intussusception. Unsuccessful in reduction.
CDC 'Split Type':

Write-up: Pt had signs of alternating lethargy, fussiness and a bloody stool. Diagnosed with intussusception by BE which failed to reduce it. Went to surgery and his appendix was lead point. Doubt due to Rotateq 2 mos after dose and appendix lead point. 05/15/07-records received for DOS 2/26-3/2/07. DC DX: Intussusception.Several hour history of sleeping a lot waking up crying not eating well. Vomited once. No diarrhea. Rectal exam revealed hempositive secretions. Barium enema revealed intussusception. Unsuccessful in reduction. Surgical reduction revealed appendix in the middle of the intussusception.

Changed on 8/31/2010

VAERS ID: 273520 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Alabama
Vaccinated:2006-12-13
Onset:2007-02-26
Submitted:2007-02-27
Entered:2007-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U1891BA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 6086F / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1032 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B08675K / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0319F / 2 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Appendicectomy, Barium enema, Haematochezia, Intussusception, Laparotomy, Lethargy, Surgery, Vomiting

Life Threatening? Yes
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: 11-7-06 Polytrim opthalmic drops
Current Illness: Well check up
Preexisting Conditions: Heart murmur 9-11-06
Allergies:
Diagnostic Lab Data: BE diagnosis Records received 5/15/07-Barium enema revealed intussusception. Unsuccessful in reduction.
CDC 'Split Type':

Write-up: Pt had signs of alternating lethargy, fussiness and a bloody stool. Diagnosed with intussusception by BE which failed to reduce it. Went to surgery and his appendix was lead point. Doubt due to Rotateq 2 mos after dose and appendix lead point. 05/15/07-records received for DOS 2/26-3/2/07. DC DX: Intussusception.Several hour history of sleeping a lot waking up crying not eating well. Vomited once. No diarrhea. Rectal exam revealed hempositive secretions. Barium enema revealed intussusception. Unsuccessful in reduction. Surgical reduction revealed appendix in the middle of the intussusception.

Changed on 5/13/2013

VAERS ID: 273520 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Alabama
Vaccinated:2006-12-13
Onset:2007-02-26
Submitted:2007-02-27
Entered:2007-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U1891BA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 6086F / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1032 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08675K / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0319F / 2 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0319F / 2 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Appendicectomy, Barium enema, Haematochezia, Intussusception, Laparotomy, Lethargy, Surgery, Vomiting

Life Threatening? Yes
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: 11-7-06 Polytrim opthalmic drops
Current Illness: Well check up
Preexisting Conditions: Heart murmur 9-11-06
Allergies:
Diagnostic Lab Data: BE diagnosis Records received 5/15/07-Barium enema revealed intussusception. Unsuccessful in reduction.
CDC 'Split Type':

Write-up: Pt had signs of alternating lethargy, fussiness and a bloody stool. Diagnosed with intussusception by BE which failed to reduce it. Went to surgery and his appendix was lead point. Doubt due to Rotateq 2 mos after dose and appendix lead point. 05/15/07-records received for DOS 2/26-3/2/07. DC DX: Intussusception.Several hour history of sleeping a lot waking up crying not eating well. Vomited once. No diarrhea. Rectal exam revealed hempositive secretions. Barium enema revealed intussusception. Unsuccessful in reduction. Surgical reduction revealed appendix in the middle of the intussusception.

Changed on 2/14/2017

VAERS ID: 273520 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Alabama
Vaccinated:2006-12-13
Onset:2007-02-26
Submitted:2007-02-27
Entered:2007-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U1891BA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 6086F / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1032 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08675K / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0319F / 2 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Appendicectomy, Barium enema, Haematochezia, Intussusception, Laparotomy, Lethargy, Surgery, Vomiting

Life Threatening? Yes
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: 11-7-06 Polytrim opthalmic drops
Current Illness: Well check up
Preexisting Conditions: Heart murmur 9-11-06
Allergies:
Diagnostic Lab Data: BE diagnosis Records received 5/15/07-Barium enema revealed intussusception. Unsuccessful in reduction.
CDC 'Split Type':

Write-up: Pt had signs of alternating lethargy, fussiness and a bloody stool. Diagnosed with intussusception by BE which failed to reduce it. Went to surgery and his appendix was lead point. Doubt due to Rotateq 2 mos after dose and appendix lead point. 05/15/07-records received for DOS 2/26-3/2/07. DC DX: Intussusception.Several hour history of sleeping a lot waking up crying not eating well. Vomited once. No diarrhea. Rectal exam revealed hempositive secretions. Barium enema revealed intussusception. Unsuccessful in reduction. Surgical reduction revealed appendix in the middle of the intussusception.

Changed on 9/14/2017

VAERS ID: 273520 Before After
VAERS Form:(blank) 1
Age:0.4
Gender:Male
Location:Alabama
Vaccinated:2006-12-13
Onset:2007-02-26
Submitted:2007-02-27
Entered:2007-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U1891BA / 1 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 6086F / 1 2 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1032 / 1 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08675K / 1 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0319F / 2 3 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Barium enema, Haematochezia, Intussusception, Lethargy, Surgery

Life Threatening? Yes
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: 11-7-06 Polytrim opthalmic drops
Current Illness: Well check up
Preexisting Conditions: Heart murmur 9-11-06
Allergies:
Diagnostic Lab Data: BE diagnosis Records received 5/15/07-Barium enema revealed intussusception. Unsuccessful in reduction.
CDC 'Split Type':

Write-up: Pt had signs of alternating lethargy, fussiness and a bloody stool. Diagnosed with intussusception by BE which failed to reduce it. Went to surgery and his appendix was lead point. Doubt due to Rotateq 2 mos after dose and appendix lead point. 05/15/07-records received for DOS 2/26-3/2/07. DC DX: Intussusception.Several hour history of sleeping a lot waking up crying not eating well. Vomited once. No diarrhea. Rectal exam revealed hempositive secretions. Barium enema revealed intussusception. Unsuccessful in reduction. Surgical reduction revealed appendix in the middle of the intussusception.

Changed on 2/14/2018

VAERS ID: 273520 Before After
VAERS Form:1
Age:0.4
Gender:Male
Location:Alabama
Vaccinated:2006-12-13
Onset:2007-02-26
Submitted:2007-02-27
Entered:2007-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U1891BA / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 6086F / 2 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1032 / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08675K / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0319F / 3 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Barium enema, Haematochezia, Intussusception, Lethargy, Surgery

Life Threatening? Yes
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: 11-7-06 Polytrim opthalmic drops
Current Illness: Well check up
Preexisting Conditions: Heart murmur 9-11-06
Allergies:
Diagnostic Lab Data: BE diagnosis Records received 5/15/07-Barium enema revealed intussusception. Unsuccessful in reduction.
CDC 'Split Type':

Write-up: Pt had signs of alternating lethargy, fussiness and a bloody stool. Diagnosed with intussusception by BE which failed to reduce it. Went to surgery and his appendix was lead point. Doubt due to Rotateq 2 mos after dose and appendix lead point. 05/15/07-records received for DOS 2/26-3/2/07. DC DX: Intussusception.Several hour history of sleeping a lot waking up crying not eating well. Vomited once. No diarrhea. Rectal exam revealed hempositive secretions. Barium enema revealed intussusception. Unsuccessful in reduction. Surgical reduction revealed appendix in the middle of the intussusception.

Changed on 6/14/2018

VAERS ID: 273520 Before After
VAERS Form:1
Age:0.4
Gender:Male
Location:Alabama
Vaccinated:2006-12-13
Onset:2007-02-26
Submitted:2007-02-27
Entered:2007-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U1891BA / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 6086F / 2 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1032 / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08675K / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0319F / 3 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Agitation, Barium enema, Haematochezia, Intussusception, Lethargy, Surgery

Life Threatening? Yes
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: 11-7-06 Polytrim opthalmic drops
Current Illness: Well check up
Preexisting Conditions: Heart murmur 9-11-06
Allergies:
Diagnostic Lab Data: BE diagnosis Records received 5/15/07-Barium enema revealed intussusception. Unsuccessful in reduction.
CDC 'Split Type':

Write-up: Pt had signs of alternating lethargy, fussiness and a bloody stool. Diagnosed with intussusception by BE which failed to reduce it. Went to surgery and his appendix was lead point. Doubt due to Rotateq 2 mos after dose and appendix lead point. 05/15/07-records received for DOS 2/26-3/2/07. DC DX: Intussusception.Several hour history of sleeping a lot waking up crying not eating well. Vomited once. No diarrhea. Rectal exam revealed hempositive secretions. Barium enema revealed intussusception. Unsuccessful in reduction. Surgical reduction revealed appendix in the middle of the intussusception.

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