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This is VAERS ID 273760

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 273760
VAERS Form:
Age:0.2
Gender:Male
Location:Tennessee
Vaccinated:2007-02-14
Onset:2007-03-08
Submitted:2007-03-09
Entered:2007-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B028AA / 0 LL / IM
HIBV: HIB (HIBERIX) / GLAXOSMITHKLINE BIOLOGICALS 1015 / 0 RL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B36258C / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1033F / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Abnormal faeces, Barium double contrast, Bowel sounds abnormal, Dehydration, Abdominal X-ray

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: Meds: none.
Current Illness: NONE
Preexisting Conditions: NONE. PMH: none. Allergies: none.
Allergies:
Diagnostic Lab Data: abdominal u/s. Labs and Diagnsotics: X-ray of the abdomen revealed multiple dilated loops of small bowel. No free air noted. Findings suggestive of a small bowel obstruction. KUB showed a paucity of gas in the right colon. Ultrasound con
CDC 'Split Type':

Write-up: 28 days after administration of Rotateq vaccine, patient developed intussusception requiring surgical reduction. Questioned relation to Rotateq? 03/12/2007 MR received from treating hospital. Child was transfered from local hospital for a several day hi"story of intermittant vomiting and pain as shown by crying and curling up of his legs. Upon admission he was somnolent and lethargic. He has had episodes of bilious emesis and currant jelly stools. Also dehydrated. PE: revealed a soft, mildly distended


Changed on 12/8/2009

VAERS ID: 273760 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Tennessee
Vaccinated:2007-02-14
Onset:2007-03-08
Submitted:2007-03-09
Entered:2007-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B028AA / 0 LL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B028AA / 0 LL / IM
HIBV: HIB (HIBERIX) / GLAXOSMITHKLINE BIOLOGICALS 1015 / 0 RL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES WYETH PHARMACEUTICALS, INC B36258C / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1033F / 0 - / PO

Administered by: Private      Purchased by: Unknown Private
Symptoms: Abnormal faeces, Barium double contrast, Bowel sounds abnormal, Dehydration, Intestinal obstruction, Intussusception, Lethargy, Pain, Somnolence, Surgery, Tenderness, Urinary system X-ray, Vomiting, Ultrasound abdomen, Ultrasound abdomen abnormal, Abdominal X-ray

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: Meds: none.
Current Illness: NONE
Preexisting Conditions: NONE. PMH: none. Allergies: none.
Allergies:
Diagnostic Lab Data: abdominal u/s. Labs and Diagnsotics: X-ray of the abdomen revealed multiple dilated loops of small bowel. No free air noted. Findings suggestive of a small bowel obstruction. KUB showed a paucity of gas in the right colon. Ultrasound con
CDC 'Split Type':

Write-up: 28 days after administration of Rotateq vaccine, patient developed intussusception requiring surgical reduction. Questioned relation to Rotateq? 03/12/2007 MR received from treating hospital. Child was transfered from local hospital for a several day hi"story history of intermittant vomiting and pain as shown by crying and curling up of his legs. Upon admission he was somnolent and lethargic. He has had episodes of bilious emesis and currant jelly stools. Also dehydrated. PE: revealed a soft, mildly distended abdomen with tenderness to palpation in the right mid and lower abdomen. Hypoactive bowel sounds. No masses noted. Otherwise WNL. The child was taken to sugery for a laparoscopic reduction of intussusception. Post -operative DX: Intussusception.


Changed on 3/2/2010

VAERS ID: 273760 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Tennessee
Vaccinated:2007-02-14
Onset:2007-03-08
Submitted:2007-03-09
Entered:2007-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B028AA / 0 LL / IM
HIBV: HIB (HIBERIX) / GLAXOSMITHKLINE BIOLOGICALS 1015 / 0 RL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B36258C / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1033F / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abnormal faeces, Barium double contrast, Bowel sounds abnormal, Dehydration, Intestinal obstruction, Intussusception, Lethargy, Pain, Somnolence, Surgery, Tenderness, Urinary system X-ray, Vomiting, Ultrasound abdomen, Ultrasound abdomen abnormal, Abdominal X-ray

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: Meds: none.
Current Illness: NONE
Preexisting Conditions: NONE. PMH: none. Allergies: none.
Allergies:
Diagnostic Lab Data: abdominal u/s. Labs and Diagnsotics: X-ray of the abdomen revealed multiple dilated loops of small bowel. No free air noted. Findings suggestive of a small bowel obstruction. KUB showed a paucity of gas in the right colon. Ultrasound con
CDC 'Split Type':

Write-up: 28 days after administration of Rotateq vaccine, patient developed intussusception requiring surgical reduction. Questioned relation to Rotateq? 03/12/2007 MR received from treating hospital. Child was transfered from local hospital for a several day history of intermittant vomiting and pain as shown by crying and curling up of his legs. Upon admission he was somnolent and lethargic. He has had episodes of bilious emesis and currant jelly stools. Also dehydrated. PE: revealed a soft, mildly distended abdomen with tenderness to palpation in the right mid and lower abdomen. Hypoactive bowel sounds. No masses noted. Otherwise WNL. The child was taken to sugery for a laparoscopic reduction of intussusception. Post -operative DX: Intussusception.


Changed on 4/7/2010

VAERS ID: 273760 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Tennessee
Vaccinated:2007-02-14
Onset:2007-03-08
Submitted:2007-03-09
Entered:2007-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B028AA / 0 LL / IM
HIBV: HIB (HIBERIX) / GLAXOSMITHKLINE BIOLOGICALS 1015 / 0 RL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B36258C / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1033F / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abnormal faeces, Barium double contrast, Bowel sounds abnormal, Dehydration, Intestinal obstruction, Intussusception, Lethargy, Pain, Somnolence, Surgery, Tenderness, Urinary system X-ray, Vomiting, Ultrasound abdomen, Ultrasound abdomen abnormal, Abdominal X-ray

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: Meds: none.
Current Illness: NONE
Preexisting Conditions: NONE. PMH: none. Allergies: none.
Allergies:
Diagnostic Lab Data: abdominal u/s. Labs and Diagnsotics: X-ray of the abdomen revealed multiple dilated loops of small bowel. No free air noted. Findings suggestive of a small bowel obstruction. KUB showed a paucity of gas in the right colon. Ultrasound con
CDC 'Split Type':

Write-up: 28 days after administration of Rotateq vaccine, patient developed intussusception requiring surgical reduction. Questioned relation to Rotateq? 03/12/2007 MR received from treating hospital. Child was transfered from local hospital for a several day history of intermittant vomiting and pain as shown by crying and curling up of his legs. Upon admission he was somnolent and lethargic. He has had episodes of bilious emesis and currant jelly stools. Also dehydrated. PE: revealed a soft, mildly distended abdomen with tenderness to palpation in the right mid and lower abdomen. Hypoactive bowel sounds. No masses noted. Otherwise WNL. The child was taken to sugery for a laparoscopic reduction of intussusception. Post -operative DX: Intussusception.


Changed on 8/31/2010

VAERS ID: 273760 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Tennessee
Vaccinated:2007-02-14
Onset:2007-03-08
Submitted:2007-03-09
Entered:2007-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B028AA / 0 LL / IM
HIBV: HIB (HIBERIX) / GLAXOSMITHKLINE BIOLOGICALS 1015 / 0 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B36258C / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1033F / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abnormal faeces, Barium double contrast, Bowel sounds abnormal, Dehydration, Intestinal obstruction, Intussusception, Lethargy, Pain, Somnolence, Surgery, Tenderness, Urinary system X-ray, Vomiting, Ultrasound abdomen, Ultrasound abdomen abnormal, Abdominal X-ray

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: Meds: none.
Current Illness: NONE
Preexisting Conditions: NONE. PMH: none. Allergies: none.
Allergies:
Diagnostic Lab Data: abdominal u/s. Labs and Diagnsotics: X-ray of the abdomen revealed multiple dilated loops of small bowel. No free air noted. Findings suggestive of a small bowel obstruction. KUB showed a paucity of gas in the right colon. Ultrasound con
CDC 'Split Type':

Write-up: 28 days after administration of Rotateq vaccine, patient developed intussusception requiring surgical reduction. Questioned relation to Rotateq? 03/12/2007 MR received from treating hospital. Child was transfered from local hospital for a several day history of intermittant vomiting and pain as shown by crying and curling up of his legs. Upon admission he was somnolent and lethargic. He has had episodes of bilious emesis and currant jelly stools. Also dehydrated. PE: revealed a soft, mildly distended abdomen with tenderness to palpation in the right mid and lower abdomen. Hypoactive bowel sounds. No masses noted. Otherwise WNL. The child was taken to sugery for a laparoscopic reduction of intussusception. Post -operative DX: Intussusception.


Changed on 5/13/2013

VAERS ID: 273760 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Tennessee
Vaccinated:2007-02-14
Onset:2007-03-08
Submitted:2007-03-09
Entered:2007-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B028AA / 0 LL / IM
HIBV: HIB (HIBERIX) / GLAXOSMITHKLINE BIOLOGICALS 1015 / 0 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B36258C / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1033F / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1033F / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abnormal faeces, Barium double contrast, Bowel sounds abnormal, Dehydration, Intestinal obstruction, Intussusception, Lethargy, Pain, Somnolence, Surgery, Tenderness, Urinary system X-ray, Vomiting, Ultrasound abdomen, Ultrasound abdomen abnormal, Abdominal X-ray

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: Meds: none.
Current Illness: NONE
Preexisting Conditions: NONE. PMH: none. Allergies: none.
Allergies:
Diagnostic Lab Data: abdominal u/s. Labs and Diagnsotics: X-ray of the abdomen revealed multiple dilated loops of small bowel. No free air noted. Findings suggestive of a small bowel obstruction. KUB showed a paucity of gas in the right colon. Ultrasound con
CDC 'Split Type':

Write-up: 28 days after administration of Rotateq vaccine, patient developed intussusception requiring surgical reduction. Questioned relation to Rotateq? 03/12/2007 MR received from treating hospital. Child was transfered from local hospital for a several day history of intermittant vomiting and pain as shown by crying and curling up of his legs. Upon admission he was somnolent and lethargic. He has had episodes of bilious emesis and currant jelly stools. Also dehydrated. PE: revealed a soft, mildly distended abdomen with tenderness to palpation in the right mid and lower abdomen. Hypoactive bowel sounds. No masses noted. Otherwise WNL. The child was taken to sugery for a laparoscopic reduction of intussusception. Post -operative DX: Intussusception.


Changed on 2/14/2017

VAERS ID: 273760 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Tennessee
Vaccinated:2007-02-14
Onset:2007-03-08
Submitted:2007-03-09
Entered:2007-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B028AA / 0 LL / IM
HIBV: HIB (HIBERIX) / GLAXOSMITHKLINE BIOLOGICALS 1015 / 0 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B36258C / 0 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1033F / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abnormal faeces, Barium double contrast, Bowel sounds abnormal, Dehydration, Intestinal obstruction, Intussusception, Lethargy, Pain, Somnolence, Surgery, Tenderness, Urinary system X-ray, Vomiting, Ultrasound abdomen, Ultrasound abdomen abnormal, Abdominal X-ray

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: Meds: none.
Current Illness: NONE
Preexisting Conditions: NONE. PMH: none. Allergies: none.
Allergies:
Diagnostic Lab Data: abdominal u/s. Labs and Diagnsotics: X-ray of the abdomen revealed multiple dilated loops of small bowel. No free air noted. Findings suggestive of a small bowel obstruction. KUB showed a paucity of gas in the right colon. Ultrasound con confirmed intussusception. A contrast enema was done and partially reduced the intussusception, but not completely.
CDC 'Split Type':

Write-up: 28 days after administration of Rotateq vaccine, patient developed intussusception requiring surgical reduction. Questioned relation to Rotateq? 03/12/2007 MR received from treating hospital. Child was transfered from local hospital for a several day history of intermittant vomiting and pain as shown by crying and curling up of his legs. Upon admission he was somnolent and lethargic. He has had episodes of bilious emesis and currant jelly stools. Also dehydrated. PE: revealed a soft, mildly distended abdomen with tenderness to palpation in the right mid and lower abdomen. Hypoactive bowel sounds. No masses noted. Otherwise WNL. The child was taken to sugery for a laparoscopic reduction of intussusception. Post -operative DX: Intussusception.


Changed on 9/14/2017

VAERS ID: 273760 Before After
VAERS Form:(blank) 1
Age:0.2
Gender:Male
Location:Tennessee
Vaccinated:2007-02-14
Onset:2007-03-08
Submitted:2007-03-09
Entered:2007-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B028AA / 0 1 LL / IM
HIBV: HIB (HIBERIX) / GLAXOSMITHKLINE BIOLOGICALS 1015 / 0 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B36258C / 0 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1033F / 0 1 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception, Surgery, Ultrasound abdomen

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: Meds: none.
Current Illness: NONE
Preexisting Conditions: NONE. PMH: none. Allergies: none.
Allergies:
Diagnostic Lab Data: abdominal u/s. Labs and Diagnsotics: X-ray of the abdomen revealed multiple dilated loops of small bowel. No free air noted. Findings suggestive of a small bowel obstruction. KUB showed a paucity of gas in the right colon. Ultrasound confirmed intussusception. A contrast enema was done and partially reduced the intussusception, but not completely.
CDC 'Split Type':

Write-up: 28 days after administration of Rotateq vaccine, patient developed intussusception requiring surgical reduction. Questioned relation to Rotateq? 03/12/2007 MR received from treating hospital. Child was transfered from local hospital for a several day history of intermittant vomiting and pain as shown by crying and curling up of his legs. Upon admission he was somnolent and lethargic. He has had episodes of bilious emesis and currant jelly stools. Also dehydrated. PE: revealed a soft, mildly distended abdomen with tenderness to palpation in the right mid and lower abdomen. Hypoactive bowel sounds. No masses noted. Otherwise WNL. The child was taken to sugery for a laparoscopic reduction of intussusception. Post -operative DX: Intussusception.


Changed on 2/14/2018

VAERS ID: 273760 Before After
VAERS Form:1
Age:0.2
Gender:Male
Location:Tennessee
Vaccinated:2007-02-14
Onset:2007-03-08
Submitted:2007-03-09
Entered:2007-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B028AA / 1 LL / IM
HIBV: HIB (HIBERIX) / GLAXOSMITHKLINE BIOLOGICALS 1015 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B36258C / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1033F / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception, Surgery, Ultrasound abdomen

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: Meds: none.
Current Illness: NONE
Preexisting Conditions: NONE. PMH: none. Allergies: none.
Allergies:
Diagnostic Lab Data: abdominal u/s. Labs and Diagnsotics: X-ray of the abdomen revealed multiple dilated loops of small bowel. No free air noted. Findings suggestive of a small bowel obstruction. KUB showed a paucity of gas in the right colon. Ultrasound confirmed intussusception. A contrast enema was done and partially reduced the intussusception, but not completely.
CDC 'Split Type':

Write-up: 28 days after administration of Rotateq vaccine, patient developed intussusception requiring surgical reduction. Questioned relation to Rotateq? 03/12/2007 MR received from treating hospital. Child was transfered from local hospital for a several day history of intermittant vomiting and pain as shown by crying and curling up of his legs. Upon admission he was somnolent and lethargic. He has had episodes of bilious emesis and currant jelly stools. Also dehydrated. PE: revealed a soft, mildly distended abdomen with tenderness to palpation in the right mid and lower abdomen. Hypoactive bowel sounds. No masses noted. Otherwise WNL. The child was taken to sugery for a laparoscopic reduction of intussusception. Post -operative DX: Intussusception.


Changed on 6/14/2018

VAERS ID: 273760 Before After
VAERS Form:1
Age:0.2
Gender:Male
Location:Tennessee
Vaccinated:2007-02-14
Onset:2007-03-08
Submitted:2007-03-09
Entered:2007-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B028AA / 1 LL / IM
HIBV: HIB (HIBERIX) / GLAXOSMITHKLINE BIOLOGICALS 1015 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B36258C / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1033F / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception, Surgery, Ultrasound abdomen

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: Meds: none.
Current Illness: NONE
Preexisting Conditions: NONE. PMH: none. Allergies: none.
Allergies:
Diagnostic Lab Data: abdominal u/s. Labs and Diagnsotics: X-ray of the abdomen revealed multiple dilated loops of small bowel. No free air noted. Findings suggestive of a small bowel obstruction. KUB showed a paucity of gas in the right colon. Ultrasound confirmed intussusception. A contrast enema was done and partially reduced the intussusception, but not completely.
CDC 'Split Type':

Write-up: 28 days after administration of Rotateq vaccine, patient developed intussusception requiring surgical reduction. Questioned relation to Rotateq? 03/12/2007 MR received from treating hospital. Child was transfered from local hospital for a several day history of intermittant vomiting and pain as shown by crying and curling up of his legs. Upon admission he was somnolent and lethargic. He has had episodes of bilious emesis and currant jelly stools. Also dehydrated. PE: revealed a soft, mildly distended abdomen with tenderness to palpation in the right mid and lower abdomen. Hypoactive bowel sounds. No masses noted. Otherwise WNL. The child was taken to sugery for a laparoscopic reduction of intussusception. Post -operative DX: Intussusception.


Changed on 8/14/2018

VAERS ID: 273760 Before After
VAERS Form:1
Age:0.2
Gender:Male
Location:Tennessee
Vaccinated:2007-02-14
Onset:2007-03-08
Submitted:2007-03-09
Entered:2007-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B028AA / 1 LL / IM
HIBV: HIB (HIBERIX) / GLAXOSMITHKLINE BIOLOGICALS 1015 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B36258C / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1033F / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception, Surgery, Ultrasound abdomen

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: Meds: none.
Current Illness: NONE
Preexisting Conditions: NONE. PMH: none. Allergies: none.
Allergies:
Diagnostic Lab Data: abdominal u/s. Labs and Diagnsotics: X-ray of the abdomen revealed multiple dilated loops of small bowel. No free air noted. Findings suggestive of a small bowel obstruction. KUB showed a paucity of gas in the right colon. Ultrasound confirmed intussusception. A contrast enema was done and partially reduced the intussusception, but not completely.
CDC 'Split Type':

Write-up: 28 days after administration of Rotateq vaccine, patient developed intussusception requiring surgical reduction. Questioned relation to Rotateq? 03/12/2007 MR received from treating hospital. Child was transfered from local hospital for a several day history of intermittant vomiting and pain as shown by crying and curling up of his legs. Upon admission he was somnolent and lethargic. He has had episodes of bilious emesis and currant jelly stools. Also dehydrated. PE: revealed a soft, mildly distended abdomen with tenderness to palpation in the right mid and lower abdomen. Hypoactive bowel sounds. No masses noted. Otherwise WNL. The child was taken to sugery for a laparoscopic reduction of intussusception. Post -operative DX: Intussusception.


Changed on 9/14/2018

VAERS ID: 273760 Before After
VAERS Form:1
Age:0.2
Gender:Male
Location:Tennessee
Vaccinated:2007-02-14
Onset:2007-03-08
Submitted:2007-03-09
Entered:2007-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B028AA / 1 LL / IM
HIBV: HIB (HIBERIX) / GLAXOSMITHKLINE BIOLOGICALS 1015 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B36258C / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1033F / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intussusception, Surgery, Ultrasound abdomen

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: Meds: none.
Current Illness: NONE
Preexisting Conditions: NONE. PMH: none. Allergies: none.
Allergies:
Diagnostic Lab Data: abdominal u/s. Labs and Diagnsotics: X-ray of the abdomen revealed multiple dilated loops of small bowel. No free air noted. Findings suggestive of a small bowel obstruction. KUB showed a paucity of gas in the right colon. Ultrasound confirmed intussusception. A contrast enema was done and partially reduced the intussusception, but not completely.
CDC 'Split Type':

Write-up: 28 days after administration of Rotateq vaccine, patient developed intussusception requiring surgical reduction. Questioned relation to Rotateq? 03/12/2007 MR received from treating hospital. Child was transfered from local hospital for a several day history of intermittant vomiting and pain as shown by crying and curling up of his legs. Upon admission he was somnolent and lethargic. He has had episodes of bilious emesis and currant jelly stools. Also dehydrated. PE: revealed a soft, mildly distended abdomen with tenderness to palpation in the right mid and lower abdomen. Hypoactive bowel sounds. No masses noted. Otherwise WNL. The child was taken to sugery for a laparoscopic reduction of intussusception. Post -operative DX: Intussusception.

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