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This is VAERS ID 278302

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

278302
VAERS Form:
Age:0.6
Gender:Male
Location:Texas
Vaccinated:2007-03-24
Onset:2007-04-30
Submitted:2007-05-10
Entered:2007-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C249U0A / 1 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0240 / 1 - / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC 808672E / 1 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1109F / 2 - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Abdominal pain, Barium double contrast, Dehydration, Hyponatraemia, Decreased appetite

Life Threatening? Yes
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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: otitis media 8 days prior to admit
Allergies:
Diagnostic Lab Data: None LABS: initial Na 130, K 3.8, Cl 98, CO2 22. Guaiac + stools. KUB & air contrast enema revealed +IS which was successfully reduced by air contrast enema. Stool & urine c/s were neg.
CDC 'Split Type':

Write-up:Intussusception 37 days later (reduced successfully). 5/11/07 Received vax records from reporter which indicate RO received on 3/24/07 was 3rd dose & lot number correct as reported. 5/29/07 Received hospital medical records which reveal patient experienc"ed vomiting, decreased oral intake, abdominal pain & intermittent lethargy. Admitted 4/30-5/3/07. Tx w/IVF for dehydration. Surg consult done. Observed s/p reduction & progressed well. FINAL DX: vomiting, resolved; Intussusception s/p reduction w/ai


Changed on 12/8/2009

278302 Before After
VAERS Form:
Age:0.6
Gender:Male
Location:Texas
Vaccinated:2007-03-24
Onset:2007-04-30
Submitted:2007-05-10
Entered:2007-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C249U0A / 1 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0240 / 1 - / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC 808672E / 1 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1109F / 2 - / -

Administered by: Private      Purchased by: Unknown Other
Symptoms: Abdominal pain, Barium double contrast, Dehydration, Hyponatraemia, Intussusception, Lethargy, Urinary system X-ray, Vomiting, Decreased appetite, Occult blood positive

Life Threatening? Yes
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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: otitis media 8 days prior to admit
Allergies:
Diagnostic Lab Data: None LABS: initial Na 130, K 3.8, Cl 98, CO2 22. Guaiac + stools. KUB & air contrast enema revealed +IS which was successfully reduced by air contrast enema. Stool & urine c/s were neg.
CDC 'Split Type':

Write-up:Intussusception 37 days later (reduced successfully). 5/11/07 Received vax records from reporter which indicate RO received on 3/24/07 was 3rd dose & lot number correct as reported. 5/29/07 Received hospital medical records which reveal patient experienc"ed experienced vomiting, decreased oral intake, abdominal pain & intermittent lethargy. Admitted 4/30-5/3/07. Tx w/IVF for dehydration. Surg consult done. Observed s/p reduction & progressed well. FINAL DX: vomiting, resolved; Intussusception s/p reduction w/ai w/air contrast enema.


Changed on 3/2/2010

278302 Before After
VAERS Form:
Age:0.6
Gender:Male
Location:Texas
Vaccinated:2007-03-24
Onset:2007-04-30
Submitted:2007-05-10
Entered:2007-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C249U0A / 1 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0240 / 1 - / -
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC 808672E / 1 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1109F / 2 - / -

Administered by: Private      Purchased by: Other
Symptoms: Abdominal pain, Barium double contrast, Dehydration, Hyponatraemia, Intussusception, Lethargy, Urinary system X-ray, Vomiting, Decreased appetite, Occult blood positive

Life Threatening? Yes
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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: otitis media 8 days prior to admit
Allergies:
Diagnostic Lab Data: None LABS: initial Na 130, K 3.8, Cl 98, CO2 22. Guaiac + stools. KUB & air contrast enema revealed +IS which was successfully reduced by air contrast enema. Stool & urine c/s were neg.
CDC 'Split Type':

Write-up:Intussusception 37 days later (reduced successfully). 5/11/07 Received vax records from reporter which indicate RO received on 3/24/07 was 3rd dose & lot number correct as reported. 5/29/07 Received hospital medical records which reveal patient experienced vomiting, decreased oral intake, abdominal pain & intermittent lethargy. Admitted 4/30-5/3/07. Tx w/IVF for dehydration. Surg consult done. Observed s/p reduction & progressed well. FINAL DX: vomiting, resolved; Intussusception s/p reduction w/air contrast enema.


Changed on 4/7/2010

278302 Before After
VAERS Form:
Age:0.6
Gender:Male
Location:Texas
Vaccinated:2007-03-24
Onset:2007-04-30
Submitted:2007-05-10
Entered:2007-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C249U0A / 1 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0240 / 1 - / -
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC 808672E / 1 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1109F / 2 - / -

Administered by: Private      Purchased by: Other
Symptoms: Abdominal pain, Barium double contrast, Dehydration, Hyponatraemia, Intussusception, Lethargy, Urinary system X-ray, Vomiting, Decreased appetite, Occult blood positive

Life Threatening? Yes
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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: otitis media 8 days prior to admit
Allergies:
Diagnostic Lab Data: None LABS: initial Na 130, K 3.8, Cl 98, CO2 22. Guaiac + stools. KUB & air contrast enema revealed +IS which was successfully reduced by air contrast enema. Stool & urine c/s were neg.
CDC 'Split Type':

Write-up:Intussusception 37 days later (reduced successfully). 5/11/07 Received vax records from reporter which indicate RO received on 3/24/07 was 3rd dose & lot number correct as reported. 5/29/07 Received hospital medical records which reveal patient experienced vomiting, decreased oral intake, abdominal pain & intermittent lethargy. Admitted 4/30-5/3/07. Tx w/IVF for dehydration. Surg consult done. Observed s/p reduction & progressed well. FINAL DX: vomiting, resolved; Intussusception s/p reduction w/air contrast enema.


Changed on 8/31/2010

278302 Before After
VAERS Form:
Age:0.6
Gender:Male
Location:Texas
Vaccinated:2007-03-24
Onset:2007-04-30
Submitted:2007-05-10
Entered:2007-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C249U0A / 1 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0240 / 1 - / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 808672E / 1 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1109F / 2 - / -

Administered by: Private      Purchased by: Other
Symptoms: Abdominal pain, Barium double contrast, Dehydration, Hyponatraemia, Intussusception, Lethargy, Urinary system X-ray, Vomiting, Decreased appetite, Occult blood positive

Life Threatening? Yes
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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: otitis media 8 days prior to admit
Allergies:
Diagnostic Lab Data: None LABS: initial Na 130, K 3.8, Cl 98, CO2 22. Guaiac + stools. KUB & air contrast enema revealed +IS which was successfully reduced by air contrast enema. Stool & urine c/s were neg.
CDC 'Split Type':

Write-up:Intussusception 37 days later (reduced successfully). 5/11/07 Received vax records from reporter which indicate RO received on 3/24/07 was 3rd dose & lot number correct as reported. 5/29/07 Received hospital medical records which reveal patient experienced vomiting, decreased oral intake, abdominal pain & intermittent lethargy. Admitted 4/30-5/3/07. Tx w/IVF for dehydration. Surg consult done. Observed s/p reduction & progressed well. FINAL DX: vomiting, resolved; Intussusception s/p reduction w/air contrast enema.


Changed on 5/13/2013

278302 Before After
VAERS Form:
Age:0.6
Gender:Male
Location:Texas
Vaccinated:2007-03-24
Onset:2007-04-30
Submitted:2007-05-10
Entered:2007-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C249U0A / 1 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0240 / 1 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 808672E / 1 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1109F / 2 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1109F / 2 - / -

Administered by: Private      Purchased by: Other
Symptoms: Abdominal pain, Barium double contrast, Dehydration, Hyponatraemia, Intussusception, Lethargy, Urinary system X-ray, Vomiting, Decreased appetite, Occult blood positive

Life Threatening? Yes
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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: otitis media 8 days prior to admit
Allergies:
Diagnostic Lab Data: None LABS: initial Na 130, K 3.8, Cl 98, CO2 22. Guaiac + stools. KUB & air contrast enema revealed +IS which was successfully reduced by air contrast enema. Stool & urine c/s were neg.
CDC 'Split Type':

Write-up:Intussusception 37 days later (reduced successfully). 5/11/07 Received vax records from reporter which indicate RO received on 3/24/07 was 3rd dose & lot number correct as reported. 5/29/07 Received hospital medical records which reveal patient experienced vomiting, decreased oral intake, abdominal pain & intermittent lethargy. Admitted 4/30-5/3/07. Tx w/IVF for dehydration. Surg consult done. Observed s/p reduction & progressed well. FINAL DX: vomiting, resolved; Intussusception s/p reduction w/air contrast enema.


Changed on 5/14/2017

278302 Before After
VAERS Form:
Age:0.6
Gender:Male
Location:Texas
Vaccinated:2007-03-24
Onset:2007-04-30
Submitted:2007-05-10
Entered:2007-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C249U0A / 1 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0240 / 1 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 808672E / 1 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1109F / 2 - / -

Administered by: Private      Purchased by: Other
Symptoms: Abdominal pain, Barium double contrast, Dehydration, Hyponatraemia, Intussusception, Lethargy, Urinary system X-ray, Vomiting, Decreased appetite, Occult blood positive

Life Threatening? Yes
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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: otitis media 8 days prior to admit
Allergies:
Diagnostic Lab Data: None LABS: initial Na 130, K 3.8, Cl 98, CO2 22. Guaiac + stools. KUB & air contrast enema revealed +IS which was successfully reduced by air contrast enema. Stool & urine c/s were neg.
CDC 'Split Type':

Write-up:Intussusception 37 days later (reduced successfully). 5/11/07 Received vax records from reporter which indicate RO received on 3/24/07 was 3rd dose & lot number correct as reported. 5/29/07 Received hospital medical records which reveal patient experienced vomiting, decreased oral intake, abdominal pain & intermittent lethargy. Admitted 4/30-5/3/07. Tx w/IVF for dehydration. Surg consult done. Observed s/p reduction & progressed well. FINAL DX: vomiting, resolved; Intussusception s/p reduction w/air contrast enema.


Changed on 9/14/2017

278302 Before After
VAERS Form:(blank) 1
Age:0.6
Gender:Male
Location:Texas
Vaccinated:2007-03-24
Onset:2007-04-30
Submitted:2007-05-10
Entered:2007-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C249U0A / 1 2 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0240 / 1 2 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 808672E / 1 2 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1109F / 2 3 - / -

Administered by: Private      Purchased by: Other
Symptoms: 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)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: otitis media 8 days prior to admit
Allergies:
Diagnostic Lab Data: None LABS: initial Na 130, K 3.8, Cl 98, CO2 22. Guaiac + stools. KUB & air contrast enema revealed +IS which was successfully reduced by air contrast enema. Stool & urine c/s were neg.
CDC 'Split Type':

Write-up:Intussusception 37 days later (reduced successfully). 5/11/07 Received vax records from reporter which indicate RO received on 3/24/07 was 3rd dose & lot number correct as reported. 5/29/07 Received hospital medical records which reveal patient experienced vomiting, decreased oral intake, abdominal pain & intermittent lethargy. Admitted 4/30-5/3/07. Tx w/IVF for dehydration. Surg consult done. Observed s/p reduction & progressed well. FINAL DX: vomiting, resolved; Intussusception s/p reduction w/air contrast enema.


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