This is VAERS ID 285152

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

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     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: physical examination 07/03/?/07
CDC 'Split Type':

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

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Changed on 12/8/2009

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     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: physical examination 07/03/?/07 records received 8/15/07-Barium enema findings of intussusception which was partially reducted to the level of cecum.
CDC 'Split Type': (blank) WAES0707USA02148

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

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Changed on 3/2/2010

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     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: physical examination 07/03/?/07 records received 8/15/07-Barium enema findings of intussusception which was partially reducted to the level of cecum.
CDC 'Split Type': WAES0707USA02148

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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Changed on 4/7/2010

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     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: physical examination 07/03/?/07 records received 8/15/07-Barium enema findings of intussusception which was partially reducted to the level of cecum.
CDC 'Split Type': WAES0707USA02148

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

---

Changed on 8/31/2010

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     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: physical examination 07/03/?/07 records received 8/15/07-Barium enema findings of intussusception which was partially reducted to the level of cecum.
CDC 'Split Type': WAES0707USA02148

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

---

Changed on 5/13/2013

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     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: physical examination 07/03/?/07 records received 8/15/07-Barium enema findings of intussusception which was partially reducted to the level of cecum.
CDC 'Split Type': WAES0707USA02148

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

---

Changed on 2/14/2017

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     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: physical examination 07/03/?/07 records received 8/15/07-Barium enema findings of intussusception which was partially reducted to the level of cecum.
CDC 'Split Type': WAES0707USA02148

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

---

Changed on 9/14/2017

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     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: physical examination 07/03/?/07 records received 8/15/07-Barium enema findings of intussusception which was partially reducted to the level of cecum.
CDC 'Split Type': WAES0707USA02148

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

---

Changed on 2/14/2018

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     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: physical examination 07/03/?/07 records received 8/15/07-Barium enema findings of intussusception which was partially reducted to the level of cecum.
CDC 'Split Type': WAES0707USA02148

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

---

Changed on 6/14/2018

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     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: physical examination 07/03/?/07 records received 8/15/07-Barium enema findings of intussusception which was partially reducted to the level of cecum.
CDC 'Split Type': WAES0707USA02148

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

---

Changed on 8/14/2018

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     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: physical examination 07/03/?/07 records received 8/15/07-Barium enema findings of intussusception which was partially reducted to the level of cecum.
CDC 'Split Type': WAES0707USA02148

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

---

Changed on 9/14/2018

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     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: physical examination 07/03/?/07 records received 8/15/07-Barium enema findings of intussusception which was partially reducted to the level of cecum.
CDC 'Split Type': WAES0707USA02148

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

---

Changed on 10/14/2018

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     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: physical examination 07/03/?/07 records received 8/15/07-Barium enema findings of intussusception which was partially reducted to the level of cecum.
CDC 'Split Type': WAES0707USA02148

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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