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VAERS ID: | 285152 |
VAERS Form: | |
Age: | 0.4 |
Sex: | Male |
Location: | California |
Vaccinated: | 2007-05-30 |
Onset: | 2007-07-03 |
Submitted: | 2007-07-18 |
Entered: | 2007-07-19 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B07AA / 1 | LL / UN |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 784F / 1 | RL / UN |
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC | B086665 / 1 | RL / UN |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1167F / 1 | - / PO |
Administered by: Other Purchased by: Unknown
Symptoms: Appendicectomy, Barium enema, Dehydration, Intussusception, Fontanelle depressed
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
Write-up: Information has been received from a physician concerning a 6 month old male who on 30-MAY-2007 was vaccinated with a second dose of Rotateq. Concomitant vaccinations received on the same day included Hib conj vaccine (unspecified carrier), DTaP (unspecif"ied) and poliovirus vaccine. On 03-Jul -2007 the patient experienced intussusception and was hospitalized until 11-JUL-2007. The patient had exploratory surgery but intussusception corrected without any surgical procedure. On 11-JUL-2007, the patient reco
Vaccinated: | 2007-05-30 |
Onset: | 2007-07-03 |
Submitted: | 2007-07-18 |
Entered: | 2007-07-19 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B07AA / 1 | LL / UN |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B07AA / 1 | LL / UN |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 784F / 1 | RL / UN |
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC | B086665 / 1 | RL / UN |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1167F / 1 | - / PO |
Administered by: Other Purchased by: Unknown Other
Symptoms: Appendicectomy, Barium enema, Dehydration, Intussusception, Laparotomy, Surgery, Vomiting projectile, Fontanelle depressed
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
Write-up: Information has been received from a physician concerning a 6 month old male who on 30-MAY-2007 was vaccinated with a second dose of Rotateq. Concomitant vaccinations received on the same day included Hib conj vaccine (unspecified carrier), DTaP (unspecif"ied) (unspecified) and poliovirus vaccine. On 03-Jul -2007 the patient experienced intussusception and was hospitalized until 11-JUL-2007. The patient had exploratory surgery but intussusception corrected without any surgical procedure. On 11-JUL-2007, the patient reco recovered from intussusception. There was no product quality complaint. Additional information has been requested. 8/15/07-records received from facility for DOS- 7/3-7/6/07-DC DX: Intussusception Reduction. Presented to ED with symtpoms of projectile vomiting times 4 days with every oral intake. Dehydration. No fever no diarrhea. Fontanelles depressed a little. Surgery. Laparotomy reduction of intussusception and appendectomy
Vaccinated: | 2007-05-30 |
Onset: | 2007-07-03 |
Submitted: | 2007-07-18 |
Entered: | 2007-07-19 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B07AA / 1 | LL / UN |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 784F / 1 | RL / UN |
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC | B086665 / 1 | RL / UN |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1167F / 1 | - / PO |
Administered by: Other Purchased by: Other
Symptoms: Appendicectomy, Barium enema, Dehydration, Intussusception, Laparotomy, Surgery, Vomiting projectile, Fontanelle depressed
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
Write-up: Information has been received from a physician concerning a 6 month old male who on 30-MAY-2007 was vaccinated with a second dose of Rotateq. Concomitant vaccinations received on the same day included Hib conj vaccine (unspecified carrier), DTaP (unspecified) and poliovirus vaccine. On 03-Jul -2007 the patient experienced intussusception and was hospitalized until 11-JUL-2007. The patient had exploratory surgery but intussusception corrected without any surgical procedure. On 11-JUL-2007, the patient recovered from intussusception. There was no product quality complaint. Additional information has been requested. 8/15/07-records received from facility for DOS- 7/3-7/6/07-DC DX: Intussusception Reduction. Presented to ED with symtpoms of projectile vomiting times 4 days with every oral intake. Dehydration. No fever no diarrhea. Fontanelles depressed a little. Surgery. Laparotomy reduction of intussusception and appendectomy
Vaccinated: | 2007-05-30 |
Onset: | 2007-07-03 |
Submitted: | 2007-07-18 |
Entered: | 2007-07-19 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B07AA / 1 | LL / UN |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 784F / 1 | RL / UN |
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC | B086665 / 1 | RL / UN |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1167F / 1 | - / PO |
Administered by: Other Purchased by: Other
Symptoms: Appendicectomy, Barium enema, Dehydration, Intussusception, Laparotomy, Surgery, Vomiting projectile, Fontanelle depressed
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
Write-up: Information has been received from a physician concerning a 6 month old male who on 30-MAY-2007 was vaccinated with a second dose of Rotateq. Concomitant vaccinations received on the same day included Hib conj vaccine (unspecified carrier), DTaP (unspecified) and poliovirus vaccine. On 03-Jul -2007 the patient experienced intussusception and was hospitalized until 11-JUL-2007. The patient had exploratory surgery but intussusception corrected without any surgical procedure. On 11-JUL-2007, the patient recovered from intussusception. There was no product quality complaint. Additional information has been requested. 8/15/07-records received from facility for DOS- 7/3-7/6/07-DC DX: Intussusception Reduction. Presented to ED with symtpoms of projectile vomiting times 4 days with every oral intake. Dehydration. No fever no diarrhea. Fontanelles depressed a little. Surgery. Laparotomy reduction of intussusception and appendectomy
Vaccinated: | 2007-05-30 |
Onset: | 2007-07-03 |
Submitted: | 2007-07-18 |
Entered: | 2007-07-19 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B07AA / 1 | LL / UN |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 784F / 1 | RL / UN |
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH | B086665 / 1 | RL / UN |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1167F / 1 | - / PO |
Administered by: Other Purchased by: Other
Symptoms: Appendicectomy, Barium enema, Dehydration, Intussusception, Laparotomy, Surgery, Vomiting projectile, Fontanelle depressed
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
Write-up: Information has been received from a physician concerning a 6 month old male who on 30-MAY-2007 was vaccinated with a second dose of Rotateq. Concomitant vaccinations received on the same day included Hib conj vaccine (unspecified carrier), DTaP (unspecified) and poliovirus vaccine. On 03-Jul -2007 the patient experienced intussusception and was hospitalized until 11-JUL-2007. The patient had exploratory surgery but intussusception corrected without any surgical procedure. On 11-JUL-2007, the patient recovered from intussusception. There was no product quality complaint. Additional information has been requested. 8/15/07-records received from facility for DOS- 7/3-7/6/07-DC DX: Intussusception Reduction. Presented to ED with symtpoms of projectile vomiting times 4 days with every oral intake. Dehydration. No fever no diarrhea. Fontanelles depressed a little. Surgery. Laparotomy reduction of intussusception and appendectomy
Vaccinated: | 2007-05-30 |
Onset: | 2007-07-03 |
Submitted: | 2007-07-18 |
Entered: | 2007-07-19 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B07AA / 1 | LL / UN |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 784F / 1 | RL / UN |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B086665 / 1 | RL / UN |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1167F / 1 | - / PO |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1167F / 1 | - / PO |
Administered by: Other Purchased by: Other
Symptoms: Appendicectomy, Barium enema, Dehydration, Intussusception, Laparotomy, Surgery, Vomiting projectile, Fontanelle depressed
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
Write-up: Information has been received from a physician concerning a 6 month old male who on 30-MAY-2007 was vaccinated with a second dose of Rotateq. Concomitant vaccinations received on the same day included Hib conj vaccine (unspecified carrier), DTaP (unspecified) and poliovirus vaccine. On 03-Jul -2007 the patient experienced intussusception and was hospitalized until 11-JUL-2007. The patient had exploratory surgery but intussusception corrected without any surgical procedure. On 11-JUL-2007, the patient recovered from intussusception. There was no product quality complaint. Additional information has been requested. 8/15/07-records received from facility for DOS- 7/3-7/6/07-DC DX: Intussusception Reduction. Presented to ED with symtpoms of projectile vomiting times 4 days with every oral intake. Dehydration. No fever no diarrhea. Fontanelles depressed a little. Surgery. Laparotomy reduction of intussusception and appendectomy
Vaccinated: | 2007-05-30 |
Onset: | 2007-07-03 |
Submitted: | 2007-07-18 |
Entered: | 2007-07-19 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B07AA / 1 | LL / UN |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 784F / 1 | RL / UN |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B086665 / 1 | RL / UN |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1167F / 1 | - / PO |
Administered by: Other Purchased by: Other
Symptoms: Appendicectomy, Barium enema, Dehydration, Intussusception, Laparotomy, Surgery, Vomiting projectile, Fontanelle depressed
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
Write-up: Information has been received from a physician concerning a 6 month old male who on 30-MAY-2007 was vaccinated with a second dose of Rotateq. Concomitant vaccinations received on the same day included Hib conj vaccine (unspecified carrier), DTaP (unspecified) and poliovirus vaccine. On 03-Jul -2007 the patient experienced intussusception and was hospitalized until 11-JUL-2007. The patient had exploratory surgery but intussusception corrected without any surgical procedure. On 11-JUL-2007, the patient recovered from intussusception. There was no product quality complaint. Additional information has been requested. 8/15/07-records received from facility for DOS- 7/3-7/6/07-DC DX: Intussusception Reduction. Presented to ED with symtpoms of projectile vomiting times 4 days with every oral intake. Dehydration. No fever no diarrhea. Fontanelles depressed a little. Surgery. Laparotomy reduction of intussusception and appendectomy
Vaccinated: | 2007-05-30 |
Onset: | 2007-07-03 |
Submitted: | 2007-07-18 |
Entered: | 2007-07-19 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B07AA / 1 2 | LL / UN |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 784F / 1 2 | RL / UN |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B086665 / 1 2 | RL / UN |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1167F / 1 2 | - MO / PO |
Administered by: Other Purchased by: Other
Symptoms: Intussusception, Surgery
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
Write-up: Information has been received from a physician concerning a 6 month old male who on 30-MAY-2007 was vaccinated with a second dose of Rotateq. Concomitant vaccinations received on the same day included Hib conj vaccine (unspecified carrier), DTaP (unspecified) and poliovirus vaccine. On 03-Jul -2007 the patient experienced intussusception and was hospitalized until 11-JUL-2007. The patient had exploratory surgery but intussusception corrected without any surgical procedure. On 11-JUL-2007, the patient recovered from intussusception. There was no product quality complaint. Additional information has been requested. 8/15/07-records received from facility for DOS- 7/3-7/6/07-DC DX: Intussusception Reduction. Presented to ED with symtpoms of projectile vomiting times 4 days with every oral intake. Dehydration. No fever no diarrhea. Fontanelles depressed a little. Surgery. Laparotomy reduction of intussusception and appendectomy
Vaccinated: | 2007-05-30 |
Onset: | 2007-07-03 |
Submitted: | 2007-07-18 |
Entered: | 2007-07-19 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B07AA / 2 | LL / UN |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 784F / 2 | RL / UN |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B086665 / 2 | RL / UN |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1167F / 2 | MO / PO |
Administered by: Other Purchased by: Other
Symptoms: Intussusception, Surgery
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
Write-up: Information has been received from a physician concerning a 6 month old male who on 30-MAY-2007 was vaccinated with a second dose of Rotateq. Concomitant vaccinations received on the same day included Hib conj vaccine (unspecified carrier), DTaP (unspecified) and poliovirus vaccine. On 03-Jul -2007 the patient experienced intussusception and was hospitalized until 11-JUL-2007. The patient had exploratory surgery but intussusception corrected without any surgical procedure. On 11-JUL-2007, the patient recovered from intussusception. There was no product quality complaint. Additional information has been requested. 8/15/07-records received from facility for DOS- 7/3-7/6/07-DC DX: Intussusception Reduction. Presented to ED with symtpoms of projectile vomiting times 4 days with every oral intake. Dehydration. No fever no diarrhea. Fontanelles depressed a little. Surgery. Laparotomy reduction of intussusception and appendectomy
Vaccinated: | 2007-05-30 |
Onset: | 2007-07-03 |
Submitted: | 2007-07-18 |
Entered: | 2007-07-19 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B07AA / 2 | LL / UN |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 784F / 2 | RL / UN |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B086665 / 2 | RL / UN |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1167F / 2 | MO / PO |
Administered by: Other Purchased by: Other
Symptoms: Intussusception, Surgery
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
Write-up: Information has been received from a physician concerning a 6 month old male who on 30-MAY-2007 was vaccinated with a second dose of Rotateq. Concomitant vaccinations received on the same day included Hib conj vaccine (unspecified carrier), DTaP (unspecified) and poliovirus vaccine. On 03-Jul -2007 the patient experienced intussusception and was hospitalized until 11-JUL-2007. The patient had exploratory surgery but intussusception corrected without any surgical procedure. On 11-JUL-2007, the patient recovered from intussusception. There was no product quality complaint. Additional information has been requested. 8/15/07-records received from facility for DOS- 7/3-7/6/07-DC DX: Intussusception Reduction. Presented to ED with symtpoms of projectile vomiting times 4 days with every oral intake. Dehydration. No fever no diarrhea. Fontanelles depressed a little. Surgery. Laparotomy reduction of intussusception and appendectomy
Vaccinated: | 2007-05-30 |
Onset: | 2007-07-03 |
Submitted: | 2007-07-18 |
Entered: | 2007-07-19 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B07AA / 2 | LL / UN |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 784F / 2 | RL / UN |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B086665 / 2 | RL / UN |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1167F / 2 | MO / PO |
Administered by: Other Purchased by: Other
Symptoms: Intussusception, Surgery
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
Write-up: Information has been received from a physician concerning a 6 month old male who on 30-MAY-2007 was vaccinated with a second dose of Rotateq. Concomitant vaccinations received on the same day included Hib conj vaccine (unspecified carrier), DTaP (unspecified) and poliovirus vaccine. On 03-Jul -2007 the patient experienced intussusception and was hospitalized until 11-JUL-2007. The patient had exploratory surgery but intussusception corrected without any surgical procedure. On 11-JUL-2007, the patient recovered from intussusception. There was no product quality complaint. Additional information has been requested. 8/15/07-records received from facility for DOS- 7/3-7/6/07-DC DX: Intussusception Reduction. Presented to ED with symtpoms of projectile vomiting times 4 days with every oral intake. Dehydration. No fever no diarrhea. Fontanelles depressed a little. Surgery. Laparotomy reduction of intussusception and appendectomy
Vaccinated: | 2007-05-30 |
Onset: | 2007-07-03 |
Submitted: | 2007-07-18 |
Entered: | 2007-07-19 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B07AA / 2 | LL / UN |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 784F / 2 | RL / UN |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B086665 / 2 | RL / UN |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1167F / 2 | MO / PO |
Administered by: Other Purchased by: Other
Symptoms: Intussusception, Surgery
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
Write-up: Information has been received from a physician concerning a 6 month old male who on 30-MAY-2007 was vaccinated with a second dose of Rotateq. Concomitant vaccinations received on the same day included Hib conj vaccine (unspecified carrier), DTaP (unspecified) and poliovirus vaccine. On 03-Jul -2007 the patient experienced intussusception and was hospitalized until 11-JUL-2007. The patient had exploratory surgery but intussusception corrected without any surgical procedure. On 11-JUL-2007, the patient recovered from intussusception. There was no product quality complaint. Additional information has been requested. 8/15/07-records received from facility for DOS- 7/3-7/6/07-DC DX: Intussusception Reduction. Presented to ED with symtpoms of projectile vomiting times 4 days with every oral intake. Dehydration. No fever no diarrhea. Fontanelles depressed a little. Surgery. Laparotomy reduction of intussusception and appendectomy
Vaccinated: | 2007-05-30 |
Onset: | 2007-07-03 |
Submitted: | 2007-07-18 |
Entered: | 2007-07-19 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B07AA / 2 | LL / UN |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 784F / 2 | RL / UN |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B086665 / 2 | RL / UN |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1167F / 2 | MO / PO |
Administered by: Other Purchased by: Other
Symptoms: Intussusception, Surgery
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
Write-up: Information has been received from a physician concerning a 6 month old male who on 30-MAY-2007 was vaccinated with a second dose of Rotateq. Concomitant vaccinations received on the same day included Hib conj vaccine (unspecified carrier), DTaP (unspecified) and poliovirus vaccine. On 03-Jul -2007 the patient experienced intussusception and was hospitalized until 11-JUL-2007. The patient had exploratory surgery but intussusception corrected without any surgical procedure. On 11-JUL-2007, the patient recovered from intussusception. There was no product quality complaint. Additional information has been requested. 8/15/07-records received from facility for DOS- 7/3-7/6/07-DC DX: Intussusception Reduction. Presented to ED with symtpoms of projectile vomiting times 4 days with every oral intake. Dehydration. No fever no diarrhea. Fontanelles depressed a little. Surgery. Laparotomy reduction of intussusception and appendectomy
Vaccinated: | 2007-05-30 |
Onset: | 2007-07-03 |
Submitted: | 2007-07-18 |
Entered: | 2007-07-19 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B07AA / 2 | LL / UN |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 784F / 2 | RL / UN |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B086665 / 2 | RL / UN |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1167F / 2 | MO / PO |
Administered by: Other Purchased by: Other
Symptoms: Intussusception, Surgery
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
Write-up: Information has been received from a physician concerning a 6 month old male who on 30-MAY-2007 was vaccinated with a second dose of Rotateq. Concomitant vaccinations received on the same day included Hib conj vaccine (unspecified carrier), DTaP (unspecified) and poliovirus vaccine. On 03-Jul -2007 the patient experienced intussusception and was hospitalized until 11-JUL-2007. The patient had exploratory surgery but intussusception corrected without any surgical procedure. On 11-JUL-2007, the patient recovered from intussusception. There was no product quality complaint. Additional information has been requested. 8/15/07-records received from facility for DOS- 7/3-7/6/07-DC DX: Intussusception Reduction. Presented to ED with symtpoms of projectile vomiting times 4 days with every oral intake. Dehydration. No fever no diarrhea. Fontanelles depressed a little. Surgery. Laparotomy reduction of intussusception and appendectomy
Vaccinated: | 2007-05-30 |
Onset: | 2007-07-03 |
Submitted: | 2007-07-18 |
Entered: | 2007-07-19 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B07AA / 2 | LL / UN |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 784F / 2 | RL / UN |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B086665 / 2 | RL / UN |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1167F / 2 | MO / PO |
Administered by: Other Purchased by: Other
Symptoms: Intussusception, Surgery
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
Write-up: Information has been received from a physician concerning a 6 month old male who on 30-MAY-2007 was vaccinated with a second dose of Rotateq. Concomitant vaccinations received on the same day included Hib conj vaccine (unspecified carrier), DTaP (unspecified) and poliovirus vaccine. On 03-Jul -2007 the patient experienced intussusception and was hospitalized until 11-JUL-2007. The patient had exploratory surgery but intussusception corrected without any surgical procedure. On 11-JUL-2007, the patient recovered from intussusception. There was no product quality complaint. Additional information has been requested. 8/15/07-records received from facility for DOS- 7/3-7/6/07-DC DX: Intussusception Reduction. Presented to ED with symtpoms of projectile vomiting times 4 days with every oral intake. Dehydration. No fever no diarrhea. Fontanelles depressed a little. Surgery. Laparotomy reduction of intussusception and appendectomy
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