National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 282652

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 282652
VAERS Form:
Age:0.5
Gender:Female
Location:Louisiana
Vaccinated:2007-01-08
Onset:2007-03-10
Submitted:2007-06-21
Entered:2007-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 2 RL / UN
FLU: INFLUENZA (FLUZONE 00-01) / AVENTIS PASTEUR UT2M4LA / 0 LL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08620K / 2 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1115F / 2 - / PO

Administered by: Other      Purchased by: Unknown
Symptoms: Blood culture negative, Computerised tomogram abnormal, Constipation, Enema administration, Abdominal X-ray

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Information has been received from a physician concerning a 6-month-old female with no medical history or allergies who on 15-SEP-2006 (Lot #655082/0779F), 02-NOV-2006 (Lot #655174/0848F) and 08-JAN-2007 (Lot #655407/1115F) was vaccinated PO with the firs"t, second and third doses, respectively, of ROTATEQ. Concomitant vaccinations administered on that same day included a dose of PREVNAR, a dose of PEDVAXHIB and a dose of PEDIARIX. The physician reported that two and a half weeks after receiving the third


Changed on 12/8/2009

VAERS ID: 282652 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Louisiana
Vaccinated:2007-01-08
Onset:2007-03-10
Submitted:2007-06-21
Entered:2007-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 2 RL / UN
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 2 RL / UN
FLU: INFLUENZA (FLUZONE 00-01) INFLUENZA (SEASONAL) (FLUZONE 00-01) / AVENTIS PASTEUR UT2M4LA / 0 LL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08620K / 2 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1115F / 2 - / PO

Administered by: Other      Purchased by: Unknown Other
Symptoms: Blood culture negative, Computerised tomogram abnormal, Constipation, Gastroenteritis, Intussusception, Melaena, Nausea, Pyrexia, Vomiting, Enema administration, Abdominal X-ray

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None PMH: otitis media 2 wks prior to admit. RSV 3-4 mos prior to admit.
Allergies:
Diagnostic Lab Data: Unknown LABS: Abdominal x-ray & CT scan c/w IS. Air enema reduced IS. Blood c/s neg.
CDC 'Split Type': (blank) WAES0706USA01914

Write-up: Information has been received from a physician concerning a 6-month-old female with no medical history or allergies who on 15-SEP-2006 (Lot #655082/0779F), 02-NOV-2006 (Lot #655174/0848F) and 08-JAN-2007 (Lot #655407/1115F) was vaccinated PO with the firs"t, first, second and third doses, respectively, of ROTATEQ. Concomitant vaccinations administered on that same day included a dose of PREVNAR, a dose of PEDVAXHIB and a dose of PEDIARIX. The physician reported that two and a half weeks after receiving the third dose , on approximately 25-JAN-2007, the patient developed intussusception. Unspecified medical attention was sought and the patient was subsequently hospitalized. While hospitalized, the intussusception was corrected without surgery by a "contrast procedure." The patient was hospitalized for an undetermined length of time and released on 15-MAR-2007. The patient was considered to be recovered. The physician also considered the intussusception to be an other important medical event due to the "contrast procedure." Additional information has been requested. 6/25/07 Received vax record from pcp which confirmed RO dose & lot # as reported. Also provided additional info on other vax received same date. VAERS database updated w/same. 7/20/07 Received t/c from reporters office w/MRN & corrected dates of admission which was 3/15-3/17/07. 8/14/07 Received hospital medical records which reveal patient experienced nausea 7 vomiting x 5 days. no stool x 4 days. Seen by PCP who noted tarry stool & sent to ER. Fever in ER. Admitted 3/15-3/17/07. FINAL DX: Intussusception, enema reduced; acute gastroenteritis.


Changed on 3/2/2010

VAERS ID: 282652 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Louisiana
Vaccinated:2007-01-08
Onset:2007-03-10
Submitted:2007-06-21
Entered:2007-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 2 RL / UN
FLU: INFLUENZA (SEASONAL) (FLUZONE 00-01) / AVENTIS PASTEUR UT2M4LA / 0 LL / -
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B08620K / 2 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1115F / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Blood culture negative, Computerised tomogram abnormal, Constipation, Gastroenteritis, Intussusception, Melaena, Nausea, Pyrexia, Vomiting, Enema administration, Abdominal X-ray

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None PMH: otitis media 2 wks prior to admit. RSV 3-4 mos prior to admit.
Allergies:
Diagnostic Lab Data: Unknown LABS: Abdominal x-ray & CT scan c/w IS. Air enema reduced IS. Blood c/s neg.
CDC 'Split Type': WAES0706USA01914

Write-up: Information has been received from a physician concerning a 6-month-old female with no medical history or allergies who on 15-SEP-2006 (Lot #655082/0779F), 02-NOV-2006 (Lot #655174/0848F) and 08-JAN-2007 (Lot #655407/1115F) was vaccinated PO with the first, second and third doses, respectively, of ROTATEQ. Concomitant vaccinations administered on that same day included a dose of PREVNAR, a dose of PEDVAXHIB and a dose of PEDIARIX. The physician reported that two and a half weeks after receiving the third dose , on approximately 25-JAN-2007, the patient developed intussusception. Unspecified medical attention was sought and the patient was subsequently hospitalized. While hospitalized, the intussusception was corrected without surgery by a "contrast procedure." The patient was hospitalized for an undetermined length of time and released on 15-MAR-2007. The patient was considered to be recovered. The physician also considered the intussusception to be an other important medical event due to the "contrast procedure." Additional information has been requested. 6/25/07 Received vax record from pcp which confirmed RO dose & lot # as reported. Also provided additional info on other vax received same date. VAERS database updated w/same. 7/20/07 Received t/c from reporters office w/MRN & corrected dates of admission which was 3/15-3/17/07. 8/14/07 Received hospital medical records which reveal patient experienced nausea 7 vomiting x 5 days. no stool x 4 days. Seen by PCP who noted tarry stool & sent to ER. Fever in ER. Admitted 3/15-3/17/07. FINAL DX: Intussusception, enema reduced; acute gastroenteritis.


Changed on 4/7/2010

VAERS ID: 282652 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Louisiana
Vaccinated:2007-01-08
Onset:2007-03-10
Submitted:2007-06-21
Entered:2007-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 2 RL / UN
FLU: INFLUENZA (SEASONAL) (FLUZONE 00-01) / AVENTIS PASTEUR UT2M4LA / 0 LL / -
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08620K / 2 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1115F / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Blood culture negative, Computerised tomogram abnormal, Constipation, Gastroenteritis, Intussusception, Melaena, Nausea, Pyrexia, Vomiting, Enema administration, Abdominal X-ray

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None PMH: otitis media 2 wks prior to admit. RSV 3-4 mos prior to admit.
Allergies:
Diagnostic Lab Data: Unknown LABS: Abdominal x-ray & CT scan c/w IS. Air enema reduced IS. Blood c/s neg.
CDC 'Split Type': WAES0706USA01914

Write-up: Information has been received from a physician concerning a 6-month-old female with no medical history or allergies who on 15-SEP-2006 (Lot #655082/0779F), 02-NOV-2006 (Lot #655174/0848F) and 08-JAN-2007 (Lot #655407/1115F) was vaccinated PO with the first, second and third doses, respectively, of ROTATEQ. Concomitant vaccinations administered on that same day included a dose of PREVNAR, a dose of PEDVAXHIB and a dose of PEDIARIX. The physician reported that two and a half weeks after receiving the third dose , on approximately 25-JAN-2007, the patient developed intussusception. Unspecified medical attention was sought and the patient was subsequently hospitalized. While hospitalized, the intussusception was corrected without surgery by a "contrast procedure." The patient was hospitalized for an undetermined length of time and released on 15-MAR-2007. The patient was considered to be recovered. The physician also considered the intussusception to be an other important medical event due to the "contrast procedure." Additional information has been requested. 6/25/07 Received vax record from pcp which confirmed RO dose & lot # as reported. Also provided additional info on other vax received same date. VAERS database updated w/same. 7/20/07 Received t/c from reporters office w/MRN & corrected dates of admission which was 3/15-3/17/07. 8/14/07 Received hospital medical records which reveal patient experienced nausea 7 vomiting x 5 days. no stool x 4 days. Seen by PCP who noted tarry stool & sent to ER. Fever in ER. Admitted 3/15-3/17/07. FINAL DX: Intussusception, enema reduced; acute gastroenteritis.


Changed on 8/31/2010

VAERS ID: 282652 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Louisiana
Vaccinated:2007-01-08
Onset:2007-03-10
Submitted:2007-06-21
Entered:2007-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 2 RL / UN
FLU: INFLUENZA (SEASONAL) (FLUZONE 00-01) INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR UT2M4LA / 0 LL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B08620K / 2 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1115F / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Blood culture negative, Computerised tomogram abnormal, Constipation, Gastroenteritis, Intussusception, Melaena, Nausea, Pyrexia, Vomiting, Enema administration, Abdominal X-ray

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None PMH: otitis media 2 wks prior to admit. RSV 3-4 mos prior to admit.
Allergies:
Diagnostic Lab Data: Unknown LABS: Abdominal x-ray & CT scan c/w IS. Air enema reduced IS. Blood c/s neg.
CDC 'Split Type': WAES0706USA01914

Write-up: Information has been received from a physician concerning a 6-month-old female with no medical history or allergies who on 15-SEP-2006 (Lot #655082/0779F), 02-NOV-2006 (Lot #655174/0848F) and 08-JAN-2007 (Lot #655407/1115F) was vaccinated PO with the first, second and third doses, respectively, of ROTATEQ. Concomitant vaccinations administered on that same day included a dose of PREVNAR, a dose of PEDVAXHIB and a dose of PEDIARIX. The physician reported that two and a half weeks after receiving the third dose , on approximately 25-JAN-2007, the patient developed intussusception. Unspecified medical attention was sought and the patient was subsequently hospitalized. While hospitalized, the intussusception was corrected without surgery by a "contrast procedure." The patient was hospitalized for an undetermined length of time and released on 15-MAR-2007. The patient was considered to be recovered. The physician also considered the intussusception to be an other important medical event due to the "contrast procedure." Additional information has been requested. 6/25/07 Received vax record from pcp which confirmed RO dose & lot # as reported. Also provided additional info on other vax received same date. VAERS database updated w/same. 7/20/07 Received t/c from reporters office w/MRN & corrected dates of admission which was 3/15-3/17/07. 8/14/07 Received hospital medical records which reveal patient experienced nausea 7 vomiting x 5 days. no stool x 4 days. Seen by PCP who noted tarry stool & sent to ER. Fever in ER. Admitted 3/15-3/17/07. FINAL DX: Intussusception, enema reduced; acute gastroenteritis.


Changed on 5/13/2013

VAERS ID: 282652 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Louisiana
Vaccinated:2007-01-08
Onset:2007-03-10
Submitted:2007-06-21
Entered:2007-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 2 RL / UN
FLU: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR UT2M4LA / 0 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08620K / 2 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1115F / 2 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1115F / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Blood culture negative, Computerised tomogram abnormal, Constipation, Gastroenteritis, Intussusception, Melaena, Nausea, Pyrexia, Vomiting, Enema administration, Abdominal X-ray

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None PMH: otitis media 2 wks prior to admit. RSV 3-4 mos prior to admit.
Allergies:
Diagnostic Lab Data: Unknown LABS: Abdominal x-ray & CT scan c/w IS. Air enema reduced IS. Blood c/s neg.
CDC 'Split Type': WAES0706USA01914

Write-up: Information has been received from a physician concerning a 6-month-old female with no medical history or allergies who on 15-SEP-2006 (Lot #655082/0779F), 02-NOV-2006 (Lot #655174/0848F) and 08-JAN-2007 (Lot #655407/1115F) was vaccinated PO with the first, second and third doses, respectively, of ROTATEQ. Concomitant vaccinations administered on that same day included a dose of PREVNAR, a dose of PEDVAXHIB and a dose of PEDIARIX. The physician reported that two and a half weeks after receiving the third dose , on approximately 25-JAN-2007, the patient developed intussusception. Unspecified medical attention was sought and the patient was subsequently hospitalized. While hospitalized, the intussusception was corrected without surgery by a "contrast procedure." The patient was hospitalized for an undetermined length of time and released on 15-MAR-2007. The patient was considered to be recovered. The physician also considered the intussusception to be an other important medical event due to the "contrast procedure." Additional information has been requested. 6/25/07 Received vax record from pcp which confirmed RO dose & lot # as reported. Also provided additional info on other vax received same date. VAERS database updated w/same. 7/20/07 Received t/c from reporters office w/MRN & corrected dates of admission which was 3/15-3/17/07. 8/14/07 Received hospital medical records which reveal patient experienced nausea 7 vomiting x 5 days. no stool x 4 days. Seen by PCP who noted tarry stool & sent to ER. Fever in ER. Admitted 3/15-3/17/07. FINAL DX: Intussusception, enema reduced; acute gastroenteritis.


Changed on 7/7/2013

VAERS ID: 282652 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Louisiana
Vaccinated:2007-01-08
Onset:2007-03-10
Submitted:2007-06-21
Entered:2007-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 2 RL / UN
FLU: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR UT2M4LA / 0 LL / -
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR UT2M4LA / 0 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08620K / 2 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1115F / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Blood culture negative, Computerised tomogram abnormal, Constipation, Gastroenteritis, Intussusception, Melaena, Nausea, Pyrexia, Vomiting, Enema administration, Abdominal X-ray

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None PMH: otitis media 2 wks prior to admit. RSV 3-4 mos prior to admit.
Allergies:
Diagnostic Lab Data: Unknown LABS: Abdominal x-ray & CT scan c/w IS. Air enema reduced IS. Blood c/s neg.
CDC 'Split Type': WAES0706USA01914

Write-up: Information has been received from a physician concerning a 6-month-old female with no medical history or allergies who on 15-SEP-2006 (Lot #655082/0779F), 02-NOV-2006 (Lot #655174/0848F) and 08-JAN-2007 (Lot #655407/1115F) was vaccinated PO with the first, second and third doses, respectively, of ROTATEQ. Concomitant vaccinations administered on that same day included a dose of PREVNAR, a dose of PEDVAXHIB and a dose of PEDIARIX. The physician reported that two and a half weeks after receiving the third dose , on approximately 25-JAN-2007, the patient developed intussusception. Unspecified medical attention was sought and the patient was subsequently hospitalized. While hospitalized, the intussusception was corrected without surgery by a "contrast procedure." The patient was hospitalized for an undetermined length of time and released on 15-MAR-2007. The patient was considered to be recovered. The physician also considered the intussusception to be an other important medical event due to the "contrast procedure." Additional information has been requested. 6/25/07 Received vax record from pcp which confirmed RO dose & lot # as reported. Also provided additional info on other vax received same date. VAERS database updated w/same. 7/20/07 Received t/c from reporters office w/MRN & corrected dates of admission which was 3/15-3/17/07. 8/14/07 Received hospital medical records which reveal patient experienced nausea 7 vomiting x 5 days. no stool x 4 days. Seen by PCP who noted tarry stool & sent to ER. Fever in ER. Admitted 3/15-3/17/07. FINAL DX: Intussusception, enema reduced; acute gastroenteritis.


Changed on 2/14/2017

VAERS ID: 282652 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Louisiana
Vaccinated:2007-01-08
Onset:2007-03-10
Submitted:2007-06-21
Entered:2007-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 2 RL / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR UT2M4LA / 0 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08620K / 2 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1115F / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Blood culture negative, Computerised tomogram abnormal, Constipation, Gastroenteritis, Intussusception, Melaena, Nausea, Pyrexia, Vomiting, Enema administration, Abdominal X-ray

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None PMH: otitis media 2 wks prior to admit. RSV 3-4 mos prior to admit.
Allergies:
Diagnostic Lab Data: Unknown LABS: Abdominal x-ray & CT scan c/w IS. Air enema reduced IS. Blood c/s neg.
CDC 'Split Type': WAES0706USA01914

Write-up: Information has been received from a physician concerning a 6-month-old female with no medical history or allergies who on 15-SEP-2006 (Lot #655082/0779F), 02-NOV-2006 (Lot #655174/0848F) and 08-JAN-2007 (Lot #655407/1115F) was vaccinated PO with the first, second and third doses, respectively, of ROTATEQ. Concomitant vaccinations administered on that same day included a dose of PREVNAR, a dose of PEDVAXHIB and a dose of PEDIARIX. The physician reported that two and a half weeks after receiving the third dose , on approximately 25-JAN-2007, the patient developed intussusception. Unspecified medical attention was sought and the patient was subsequently hospitalized. While hospitalized, the intussusception was corrected without surgery by a "contrast procedure." The patient was hospitalized for an undetermined length of time and released on 15-MAR-2007. The patient was considered to be recovered. The physician also considered the intussusception to be an other important medical event due to the "contrast procedure." Additional information has been requested. 6/25/07 Received vax record from pcp which confirmed RO dose & lot # as reported. Also provided additional info on other vax received same date. VAERS database updated w/same. 7/20/07 Received t/c from reporters office w/MRN & corrected dates of admission which was 3/15-3/17/07. 8/14/07 Received hospital medical records which reveal patient experienced nausea 7 vomiting x 5 days. no stool x 4 days. Seen by PCP who noted tarry stool & sent to ER. Fever in ER. Admitted 3/15-3/17/07. FINAL DX: Intussusception, enema reduced; acute gastroenteritis.


Changed on 9/14/2017

VAERS ID: 282652 Before After
VAERS Form:(blank) 1
Age:0.5
Gender:Female
Location:Louisiana
Vaccinated:2007-01-08
Onset:2007-03-10
Submitted:2007-06-21
Entered:2007-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 2 3 RL / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR UT2M4LA / 0 1 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08620K / 2 3 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1115F / 2 3 - MO / PO

Administered by: Other      Purchased by: Other
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None PMH: otitis media 2 wks prior to admit. RSV 3-4 mos prior to admit.
Allergies:
Diagnostic Lab Data: Unknown LABS: Abdominal x-ray & CT scan c/w IS. Air enema reduced IS. Blood c/s neg.
CDC 'Split Type': WAES0706USA01914

Write-up: Information has been received from a physician concerning a 6-month-old female with no medical history or allergies who on 15-SEP-2006 (Lot #655082/0779F), 02-NOV-2006 (Lot #655174/0848F) and 08-JAN-2007 (Lot #655407/1115F) was vaccinated PO with the first, second and third doses, respectively, of ROTATEQ. Concomitant vaccinations administered on that same day included a dose of PREVNAR, a dose of PEDVAXHIB and a dose of PEDIARIX. The physician reported that two and a half weeks after receiving the third dose , on approximately 25-JAN-2007, the patient developed intussusception. Unspecified medical attention was sought and the patient was subsequently hospitalized. While hospitalized, the intussusception was corrected without surgery by a "contrast procedure." The patient was hospitalized for an undetermined length of time and released on 15-MAR-2007. The patient was considered to be recovered. The physician also considered the intussusception to be an other important medical event due to the "contrast procedure." Additional information has been requested. 6/25/07 Received vax record from pcp which confirmed RO dose & lot # as reported. Also provided additional info on other vax received same date. VAERS database updated w/same. 7/20/07 Received t/c from reporters office w/MRN & corrected dates of admission which was 3/15-3/17/07. 8/14/07 Received hospital medical records which reveal patient experienced nausea 7 vomiting x 5 days. no stool x 4 days. Seen by PCP who noted tarry stool & sent to ER. Fever in ER. Admitted 3/15-3/17/07. FINAL DX: Intussusception, enema reduced; acute gastroenteritis.


Changed on 2/14/2018

VAERS ID: 282652 Before After
VAERS Form:1
Age:0.5
Gender:Female
Location:Louisiana
Vaccinated:2007-01-08
Onset:2007-03-10
Submitted:2007-06-21
Entered:2007-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 3 RL / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR UT2M4LA / 1 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08620K / 3 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1115F / 3 MO / PO

Administered by: Other      Purchased by: Other
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None PMH: otitis media 2 wks prior to admit. RSV 3-4 mos prior to admit.
Allergies:
Diagnostic Lab Data: Unknown LABS: Abdominal x-ray & CT scan c/w IS. Air enema reduced IS. Blood c/s neg.
CDC 'Split Type': WAES0706USA01914

Write-up: Information has been received from a physician concerning a 6-month-old female with no medical history or allergies who on 15-SEP-2006 (Lot #655082/0779F), 02-NOV-2006 (Lot #655174/0848F) and 08-JAN-2007 (Lot #655407/1115F) was vaccinated PO with the first, second and third doses, respectively, of ROTATEQ. Concomitant vaccinations administered on that same day included a dose of PREVNAR, a dose of PEDVAXHIB and a dose of PEDIARIX. The physician reported that two and a half weeks after receiving the third dose , on approximately 25-JAN-2007, the patient developed intussusception. Unspecified medical attention was sought and the patient was subsequently hospitalized. While hospitalized, the intussusception was corrected without surgery by a "contrast procedure." The patient was hospitalized for an undetermined length of time and released on 15-MAR-2007. The patient was considered to be recovered. The physician also considered the intussusception to be an other important medical event due to the "contrast procedure." Additional information has been requested. 6/25/07 Received vax record from pcp which confirmed RO dose & lot # as reported. Also provided additional info on other vax received same date. VAERS database updated w/same. 7/20/07 Received t/c from reporters office w/MRN & corrected dates of admission which was 3/15-3/17/07. 8/14/07 Received hospital medical records which reveal patient experienced nausea 7 vomiting x 5 days. no stool x 4 days. Seen by PCP who noted tarry stool & sent to ER. Fever in ER. Admitted 3/15-3/17/07. FINAL DX: Intussusception, enema reduced; acute gastroenteritis.


Changed on 6/14/2018

VAERS ID: 282652 Before After
VAERS Form:1
Age:0.5
Gender:Female
Location:Louisiana
Vaccinated:2007-01-08
Onset:2007-03-10
Submitted:2007-06-21
Entered:2007-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 3 RL / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR UT2M4LA / 1 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08620K / 3 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1115F / 3 MO / PO

Administered by: Other      Purchased by: Other
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None PMH: otitis media 2 wks prior to admit. RSV 3-4 mos prior to admit.
Allergies:
Diagnostic Lab Data: Unknown LABS: Abdominal x-ray & CT scan c/w IS. Air enema reduced IS. Blood c/s neg.
CDC 'Split Type': WAES0706USA01914

Write-up: Information has been received from a physician concerning a 6-month-old female with no medical history or allergies who on 15-SEP-2006 (Lot #655082/0779F), 02-NOV-2006 (Lot #655174/0848F) and 08-JAN-2007 (Lot #655407/1115F) was vaccinated PO with the first, second and third doses, respectively, of ROTATEQ. Concomitant vaccinations administered on that same day included a dose of PREVNAR, a dose of PEDVAXHIB and a dose of PEDIARIX. The physician reported that two and a half weeks after receiving the third dose , on approximately 25-JAN-2007, the patient developed intussusception. Unspecified medical attention was sought and the patient was subsequently hospitalized. While hospitalized, the intussusception was corrected without surgery by a "contrast procedure." The patient was hospitalized for an undetermined length of time and released on 15-MAR-2007. The patient was considered to be recovered. The physician also considered the intussusception to be an other important medical event due to the "contrast procedure." Additional information has been requested. 6/25/07 Received vax record from pcp which confirmed RO dose & lot # as reported. Also provided additional info on other vax received same date. VAERS database updated w/same. 7/20/07 Received t/c from reporters office w/MRN & corrected dates of admission which was 3/15-3/17/07. 8/14/07 Received hospital medical records which reveal patient experienced nausea 7 vomiting x 5 days. no stool x 4 days. Seen by PCP who noted tarry stool & sent to ER. Fever in ER. Admitted 3/15-3/17/07. FINAL DX: Intussusception, enema reduced; acute gastroenteritis.

New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=282652&WAYBACKHISTORY=ON


Copyright © 2018 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166