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This is VAERS ID 280057

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 280057
VAERS Form:
Age:0.5
Gender:Male
Location:California
Vaccinated:2007-03-13
Onset:2007-05-16
Submitted:2007-05-30
Entered:2007-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2407AA / 2 LL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER VF019AA / 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER Z0324 / 2 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC 836258A / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0980F / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal tenderness, Barium enema, Bowel sounds abnormal, Faeces discoloured, Abnormal behaviour

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: KUB showed evidence of bowel obstruction. Barium enema attempted however pt. desaturated and became tachycardic.
CDC 'Split Type':

Write-up: Patient had 3 doses of Oral Rotavirus vaccine, at 2 mo, 4 mo and 6 mo of age. Patient was diagnosed with intussusception at 8mo of age. 5/16/07.


Changed on 12/8/2009

VAERS ID: 280057 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:California
Vaccinated:2007-03-13
Onset:2007-05-16
Submitted:2007-05-30
Entered:2007-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2407AA / 2 LL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER VF019AA / 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER Z0324 / 2 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC 836258A / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0980F / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal tenderness, Barium enema, Bowel sounds abnormal, Faeces discoloured, Fall, Intussusception, Large intestinal obstruction reduction, Urinary system X-ray, Vomiting, Fluid intake reduced, Abnormal behaviour

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: KUB showed evidence of bowel obstruction. Barium enema attempted however pt. desaturated and became tachycardic.
CDC 'Split Type':

Write-up: Patient had 3 doses of Oral Rotavirus vaccine, at 2 mo, 4 mo and 6 mo of age. Patient was diagnosed with intussusception at 8mo of age. 5/16/07. 06/12/2007 Hospital record received for admission 5/16-18/2007 Intussusception. Infant presented to ED with persistant vomiting, black stool, decreased po fluids, and not seeming quite himself. He may have fallen out of bed the morning of admission. PE: WNL except for tenderness of the abdomen with decreased BS. Hydrostatic reduction done under general anesthesia. D/C DX: Intussusception.


Changed on 3/2/2010

VAERS ID: 280057 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:California
Vaccinated:2007-03-13
Onset:2007-05-16
Submitted:2007-05-30
Entered:2007-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2407AA / 2 LL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER VF019AA / 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER Z0324 / 2 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC 836258A / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0980F / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal tenderness, Barium enema, Bowel sounds abnormal, Faeces discoloured, Fall, Intussusception, Large intestinal obstruction reduction, Urinary system X-ray, Vomiting, Fluid intake reduced, Abnormal behaviour

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: KUB showed evidence of bowel obstruction. Barium enema attempted however pt. desaturated and became tachycardic.
CDC 'Split Type':

Write-up: Patient had 3 doses of Oral Rotavirus vaccine, at 2 mo, 4 mo and 6 mo of age. Patient was diagnosed with intussusception at 8mo of age. 5/16/07. 06/12/2007 Hospital record received for admission 5/16-18/2007 Intussusception. Infant presented to ED with persistant vomiting, black stool, decreased po fluids, and not seeming quite himself. He may have fallen out of bed the morning of admission. PE: WNL except for tenderness of the abdomen with decreased BS. Hydrostatic reduction done under general anesthesia. D/C DX: Intussusception.


Changed on 4/7/2010

VAERS ID: 280057 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:California
Vaccinated:2007-03-13
Onset:2007-05-16
Submitted:2007-05-30
Entered:2007-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2407AA / 2 LL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER VF019AA / 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER Z0324 / 2 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC 836258A / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0980F / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal tenderness, Barium enema, Bowel sounds abnormal, Faeces discoloured, Fall, Intussusception, Large intestinal obstruction reduction, Urinary system X-ray, Vomiting, Fluid intake reduced, Abnormal behaviour

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: KUB showed evidence of bowel obstruction. Barium enema attempted however pt. desaturated and became tachycardic.
CDC 'Split Type':

Write-up: Patient had 3 doses of Oral Rotavirus vaccine, at 2 mo, 4 mo and 6 mo of age. Patient was diagnosed with intussusception at 8mo of age. 5/16/07. 06/12/2007 Hospital record received for admission 5/16-18/2007 Intussusception. Infant presented to ED with persistant vomiting, black stool, decreased po fluids, and not seeming quite himself. He may have fallen out of bed the morning of admission. PE: WNL except for tenderness of the abdomen with decreased BS. Hydrostatic reduction done under general anesthesia. D/C DX: Intussusception.


Changed on 8/31/2010

VAERS ID: 280057 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:California
Vaccinated:2007-03-13
Onset:2007-05-16
Submitted:2007-05-30
Entered:2007-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2407AA / 2 LL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER VF019AA / 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER Z0324 / 2 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 836258A / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0980F / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal tenderness, Barium enema, Bowel sounds abnormal, Faeces discoloured, Fall, Intussusception, Large intestinal obstruction reduction, Urinary system X-ray, Vomiting, Fluid intake reduced, Abnormal behaviour

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: KUB showed evidence of bowel obstruction. Barium enema attempted however pt. desaturated and became tachycardic.
CDC 'Split Type':

Write-up: Patient had 3 doses of Oral Rotavirus vaccine, at 2 mo, 4 mo and 6 mo of age. Patient was diagnosed with intussusception at 8mo of age. 5/16/07. 06/12/2007 Hospital record received for admission 5/16-18/2007 Intussusception. Infant presented to ED with persistant vomiting, black stool, decreased po fluids, and not seeming quite himself. He may have fallen out of bed the morning of admission. PE: WNL except for tenderness of the abdomen with decreased BS. Hydrostatic reduction done under general anesthesia. D/C DX: Intussusception.


Changed on 5/13/2013

VAERS ID: 280057 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:California
Vaccinated:2007-03-13
Onset:2007-05-16
Submitted:2007-05-30
Entered:2007-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2407AA / 2 LL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER VF019AA / 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER Z0324 / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 836258A / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0980F / 2 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0980F / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal tenderness, Barium enema, Bowel sounds abnormal, Faeces discoloured, Fall, Intussusception, Large intestinal obstruction reduction, Urinary system X-ray, Vomiting, Fluid intake reduced, Abnormal behaviour

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: KUB showed evidence of bowel obstruction. Barium enema attempted however pt. desaturated and became tachycardic.
CDC 'Split Type':

Write-up: Patient had 3 doses of Oral Rotavirus vaccine, at 2 mo, 4 mo and 6 mo of age. Patient was diagnosed with intussusception at 8mo of age. 5/16/07. 06/12/2007 Hospital record received for admission 5/16-18/2007 Intussusception. Infant presented to ED with persistant vomiting, black stool, decreased po fluids, and not seeming quite himself. He may have fallen out of bed the morning of admission. PE: WNL except for tenderness of the abdomen with decreased BS. Hydrostatic reduction done under general anesthesia. D/C DX: Intussusception.


Changed on 2/14/2017

VAERS ID: 280057 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:California
Vaccinated:2007-03-13
Onset:2007-05-16
Submitted:2007-05-30
Entered:2007-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2407AA / 2 LL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER VF019AA / 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER Z0324 / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 836258A / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0980F / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal tenderness, Barium enema, Bowel sounds abnormal, Faeces discoloured, Fall, Intussusception, Large intestinal obstruction reduction, Urinary system X-ray, Vomiting, Fluid intake reduced, Abnormal behaviour

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: KUB showed evidence of bowel obstruction. Barium enema attempted however pt. desaturated and became tachycardic.
CDC 'Split Type':

Write-up: Patient had 3 doses of Oral Rotavirus vaccine, at 2 mo, 4 mo and 6 mo of age. Patient was diagnosed with intussusception at 8mo of age. 5/16/07. 06/12/2007 Hospital record received for admission 5/16-18/2007 Intussusception. Infant presented to ED with persistant vomiting, black stool, decreased po fluids, and not seeming quite himself. He may have fallen out of bed the morning of admission. PE: WNL except for tenderness of the abdomen with decreased BS. Hydrostatic reduction done under general anesthesia. D/C DX: Intussusception.


Changed on 9/14/2017

VAERS ID: 280057 Before After
VAERS Form:(blank) 1
Age:0.5
Gender:Male
Location:California
Vaccinated:2007-03-13
Onset:2007-05-16
Submitted:2007-05-30
Entered:2007-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2407AA / 2 3 LL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER VF019AA / 2 3 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER Z0324 / 2 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 836258A / 2 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0980F / 2 3 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: KUB showed evidence of bowel obstruction. Barium enema attempted however pt. desaturated and became tachycardic.
CDC 'Split Type':

Write-up: Patient had 3 doses of Oral Rotavirus vaccine, at 2 mo, 4 mo and 6 mo of age. Patient was diagnosed with intussusception at 8mo of age. 5/16/07. 06/12/2007 Hospital record received for admission 5/16-18/2007 Intussusception. Infant presented to ED with persistant vomiting, black stool, decreased po fluids, and not seeming quite himself. He may have fallen out of bed the morning of admission. PE: WNL except for tenderness of the abdomen with decreased BS. Hydrostatic reduction done under general anesthesia. D/C DX: Intussusception.


Changed on 2/14/2018

VAERS ID: 280057 Before After
VAERS Form:1
Age:0.5
Gender:Male
Location:California
Vaccinated:2007-03-13
Onset:2007-05-16
Submitted:2007-05-30
Entered:2007-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER C2407AA / 3 LL / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER VF019AA / 3 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER Z0324 / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 836258A / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0980F / 3 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: KUB showed evidence of bowel obstruction. Barium enema attempted however pt. desaturated and became tachycardic.
CDC 'Split Type':

Write-up: Patient had 3 doses of Oral Rotavirus vaccine, at 2 mo, 4 mo and 6 mo of age. Patient was diagnosed with intussusception at 8mo of age. 5/16/07. 06/12/2007 Hospital record received for admission 5/16-18/2007 Intussusception. Infant presented to ED with persistant vomiting, black stool, decreased po fluids, and not seeming quite himself. He may have fallen out of bed the morning of admission. PE: WNL except for tenderness of the abdomen with decreased BS. Hydrostatic reduction done under general anesthesia. D/C DX: Intussusception.

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