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This is VAERS ID 285685

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 285685
VAERS Form:
Age:0.5
Gender:Male
Location:Unknown
Vaccinated:2007-05-01
Onset:2007-05-28
Submitted:2007-07-23
Entered:2007-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / - UN / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC - / - UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 2 - / PO

Administered by: Other      Purchased by: Unknown
Symptoms: Intussusception, Surgery

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: surgery to correct the intussusception
CDC 'Split Type':

Write-up: Information has been received from a nurse practitioner concerning a 7-month-old male who on 01-MAY-2007 was vaccinated PO with a third 2mL dose of Rotateq. Concomitant therapy that day included a dose of PedvaxHIB, a dose of Pediarix, and a dose of Prevn"ar. On 28-MAY-2007 the patient developed intussusception and was hospitalized. It was noted that the patient underwent surgery. The reporter indicated that the patient is doing well, and has recovered. No additional information is available. Intussuscepti


Changed on 12/8/2009

VAERS ID: 285685 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Unknown
Vaccinated:2007-05-01
Onset:2007-05-28
Submitted:2007-07-23
Entered:2007-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UN / UN
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / - UN / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC - / - UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 2 - / PO

Administered by: Other      Purchased by: Unknown Other
Symptoms: Intussusception, Surgery

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: surgery to correct the intussusception
CDC 'Split Type': (blank) WAES0707USA02926

Write-up: Information has been received from a nurse practitioner concerning a 7-month-old male who on 01-MAY-2007 was vaccinated PO with a third 2mL dose of Rotateq. Concomitant therapy that day included a dose of PedvaxHIB, a dose of Pediarix, and a dose of Prevn"ar. Prevnar. On 28-MAY-2007 the patient developed intussusception and was hospitalized. It was noted that the patient underwent surgery. The reporter indicated that the patient is doing well, and has recovered. No additional information is available. Intussuscepti Intussusception was considered to be immediately life-threatening and an other important medical event by the reporter. Additional information has been requested.


Changed on 3/2/2010

VAERS ID: 285685 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Unknown
Vaccinated:2007-05-01
Onset:2007-05-28
Submitted:2007-07-23
Entered:2007-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / - UN / UN
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC - / - UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Surgery

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: surgery to correct the intussusception
CDC 'Split Type': WAES0707USA02926

Write-up: Information has been received from a nurse practitioner concerning a 7-month-old male who on 01-MAY-2007 was vaccinated PO with a third 2mL dose of Rotateq. Concomitant therapy that day included a dose of PedvaxHIB, a dose of Pediarix, and a dose of Prevnar. On 28-MAY-2007 the patient developed intussusception and was hospitalized. It was noted that the patient underwent surgery. The reporter indicated that the patient is doing well, and has recovered. No additional information is available. Intussusception was considered to be immediately life-threatening and an other important medical event by the reporter. Additional information has been requested.


Changed on 4/7/2010

VAERS ID: 285685 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Unknown
Vaccinated:2007-05-01
Onset:2007-05-28
Submitted:2007-07-23
Entered:2007-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / - UN / UN
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC - / - UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Surgery

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: surgery to correct the intussusception
CDC 'Split Type': WAES0707USA02926

Write-up: Information has been received from a nurse practitioner concerning a 7-month-old male who on 01-MAY-2007 was vaccinated PO with a third 2mL dose of Rotateq. Concomitant therapy that day included a dose of PedvaxHIB, a dose of Pediarix, and a dose of Prevnar. On 28-MAY-2007 the patient developed intussusception and was hospitalized. It was noted that the patient underwent surgery. The reporter indicated that the patient is doing well, and has recovered. No additional information is available. Intussusception was considered to be immediately life-threatening and an other important medical event by the reporter. Additional information has been requested.


Changed on 8/31/2010

VAERS ID: 285685 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Unknown
Vaccinated:2007-05-01
Onset:2007-05-28
Submitted:2007-07-23
Entered:2007-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / - UN / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH - / - UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Surgery

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: surgery to correct the intussusception
CDC 'Split Type': WAES0707USA02926

Write-up: Information has been received from a nurse practitioner concerning a 7-month-old male who on 01-MAY-2007 was vaccinated PO with a third 2mL dose of Rotateq. Concomitant therapy that day included a dose of PedvaxHIB, a dose of Pediarix, and a dose of Prevnar. On 28-MAY-2007 the patient developed intussusception and was hospitalized. It was noted that the patient underwent surgery. The reporter indicated that the patient is doing well, and has recovered. No additional information is available. Intussusception was considered to be immediately life-threatening and an other important medical event by the reporter. Additional information has been requested.


Changed on 5/13/2013

VAERS ID: 285685 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Unknown
Vaccinated:2007-05-01
Onset:2007-05-28
Submitted:2007-07-23
Entered:2007-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / - UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / - UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 2 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Surgery

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: surgery to correct the intussusception
CDC 'Split Type': WAES0707USA02926

Write-up: Information has been received from a nurse practitioner concerning a 7-month-old male who on 01-MAY-2007 was vaccinated PO with a third 2mL dose of Rotateq. Concomitant therapy that day included a dose of PedvaxHIB, a dose of Pediarix, and a dose of Prevnar. On 28-MAY-2007 the patient developed intussusception and was hospitalized. It was noted that the patient underwent surgery. The reporter indicated that the patient is doing well, and has recovered. No additional information is available. Intussusception was considered to be immediately life-threatening and an other important medical event by the reporter. Additional information has been requested.


Changed on 9/14/2017

VAERS ID: 285685 Before After
VAERS Form:(blank) 1
Age:0.5
Gender:Male
Location:Unknown
Vaccinated:2007-05-01
Onset:2007-05-28
Submitted:2007-07-23
Entered:2007-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UNK UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / - UNK UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / - UNK UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 2 3 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Surgery

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: surgery to correct the intussusception
CDC 'Split Type': WAES0707USA02926

Write-up: Information has been received from a nurse practitioner concerning a 7-month-old male who on 01-MAY-2007 was vaccinated PO with a third 2mL dose of Rotateq. Concomitant therapy that day included a dose of PedvaxHIB, a dose of Pediarix, and a dose of Prevnar. On 28-MAY-2007 the patient developed intussusception and was hospitalized. It was noted that the patient underwent surgery. The reporter indicated that the patient is doing well, and has recovered. No additional information is available. Intussusception was considered to be immediately life-threatening and an other important medical event by the reporter. Additional information has been requested.


Changed on 2/14/2018

VAERS ID: 285685 Before After
VAERS Form:1
Age:0.5
Gender:Male
Location:Unknown
Vaccinated:2007-05-01
Onset:2007-05-28
Submitted:2007-07-23
Entered:2007-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / UNK UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 3 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Surgery

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: surgery to correct the intussusception
CDC 'Split Type': WAES0707USA02926

Write-up: Information has been received from a nurse practitioner concerning a 7-month-old male who on 01-MAY-2007 was vaccinated PO with a third 2mL dose of Rotateq. Concomitant therapy that day included a dose of PedvaxHIB, a dose of Pediarix, and a dose of Prevnar. On 28-MAY-2007 the patient developed intussusception and was hospitalized. It was noted that the patient underwent surgery. The reporter indicated that the patient is doing well, and has recovered. No additional information is available. Intussusception was considered to be immediately life-threatening and an other important medical event by the reporter. Additional information has been requested.


Changed on 6/14/2018

VAERS ID: 285685 Before After
VAERS Form:1
Age:0.5
Gender:Male
Location:Unknown
Vaccinated:2007-05-01
Onset:2007-05-28
Submitted:2007-07-23
Entered:2007-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / UNK UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 3 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Surgery

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: surgery to correct the intussusception
CDC 'Split Type': WAES0707USA02926

Write-up: Information has been received from a nurse practitioner concerning a 7-month-old male who on 01-MAY-2007 was vaccinated PO with a third 2mL dose of Rotateq. Concomitant therapy that day included a dose of PedvaxHIB, a dose of Pediarix, and a dose of Prevnar. On 28-MAY-2007 the patient developed intussusception and was hospitalized. It was noted that the patient underwent surgery. The reporter indicated that the patient is doing well, and has recovered. No additional information is available. Intussusception was considered to be immediately life-threatening and an other important medical event by the reporter. Additional information has been requested.


Changed on 8/14/2018

VAERS ID: 285685 Before After
VAERS Form:1
Age:0.5
Gender:Male
Location:Unknown
Vaccinated:2007-05-01
Onset:2007-05-28
Submitted:2007-07-23
Entered:2007-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / UNK UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 3 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Surgery

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: surgery to correct the intussusception
CDC 'Split Type': WAES0707USA02926

Write-up: Information has been received from a nurse practitioner concerning a 7-month-old male who on 01-MAY-2007 was vaccinated PO with a third 2mL dose of Rotateq. Concomitant therapy that day included a dose of PedvaxHIB, a dose of Pediarix, and a dose of Prevnar. On 28-MAY-2007 the patient developed intussusception and was hospitalized. It was noted that the patient underwent surgery. The reporter indicated that the patient is doing well, and has recovered. No additional information is available. Intussusception was considered to be immediately life-threatening and an other important medical event by the reporter. Additional information has been requested.


Changed on 9/14/2018

VAERS ID: 285685 Before After
VAERS Form:1
Age:0.5
Gender:Male
Location:Unknown
Vaccinated:2007-05-01
Onset:2007-05-28
Submitted:2007-07-23
Entered:2007-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / UNK UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 3 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Surgery

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: surgery to correct the intussusception
CDC 'Split Type': WAES0707USA02926

Write-up: Information has been received from a nurse practitioner concerning a 7-month-old male who on 01-MAY-2007 was vaccinated PO with a third 2mL dose of Rotateq. Concomitant therapy that day included a dose of PedvaxHIB, a dose of Pediarix, and a dose of Prevnar. On 28-MAY-2007 the patient developed intussusception and was hospitalized. It was noted that the patient underwent surgery. The reporter indicated that the patient is doing well, and has recovered. No additional information is available. Intussusception was considered to be immediately life-threatening and an other important medical event by the reporter. Additional information has been requested.


Changed on 10/14/2018

VAERS ID: 285685 Before After
VAERS Form:1
Age:0.5
Gender:Male
Location:Unknown
Vaccinated:2007-05-01
Onset:2007-05-28
Submitted:2007-07-23
Entered:2007-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. - / UNK UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 3 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Surgery

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: surgery to correct the intussusception
CDC 'Split Type': WAES0707USA02926

Write-up: Information has been received from a nurse practitioner concerning a 7-month-old male who on 01-MAY-2007 was vaccinated PO with a third 2mL dose of Rotateq. Concomitant therapy that day included a dose of PedvaxHIB, a dose of Pediarix, and a dose of Prevnar. On 28-MAY-2007 the patient developed intussusception and was hospitalized. It was noted that the patient underwent surgery. The reporter indicated that the patient is doing well, and has recovered. No additional information is available. Intussusception was considered to be immediately life-threatening and an other important medical event by the reporter. Additional information has been requested.

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