National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 286278

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 286278
VAERS Form:
Age:0.2
Gender:Male
Location:Unknown
Vaccinated:2007-05-31
Onset:2007-07-09
Submitted:2007-07-26
Entered:2007-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B101AA / 0 UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0205U / 0 UN / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08690A / 0 UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0407U / 0 - / PO

Administered by: Other      Purchased by: Unknown
Symptoms: Appendicectomy, Bacteraemia, Blood culture positive, Blood glucose increased, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Information has been received from a physician concerning a 15 week old male who on 31-MAY-2007 was vaccinated with Rotateq (Lot# 656833/0407U). Concomitant therapy included Pediarix, Hib conj vaccine (unspecified carrier) and Prevnar. The physician repor"ted that the child was vomiting profusely on the morning of 09-JUL-2007 and was taken to the hospital. The physician reported the child was transferred to another hospital. The child was found to have an intussusception. The physician reported that the pa


Changed on 12/8/2009

VAERS ID: 286278 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Unknown
Vaccinated:2007-05-31
Onset:2007-07-09
Submitted:2007-07-26
Entered:2007-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B101AA / 0 UN / UN
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B101AA / 0 UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0205U / 0 UN / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08690A / 0 UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0407U / 0 - / PO

Administered by: Other      Purchased by: Unknown Other
Symptoms: Appendicectomy, Bacteraemia, Blood culture positive, Blood glucose increased, Culture urine positive, Inappropriate schedule of drug administration, Intussusception, Pyelonephritis, Pyrexia, Salmonellosis, Sepsis, Small intestinal anastomosis, Small intestinal resection, Urinary tract infection, Vomiting, Enema administration, Ultrasound abdomen abnormal, Escherichia infection, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown records received 8/8/07-HX reflux.HX of bladder instrumentation by catheterization at outside facility
Allergies:
Diagnostic Lab Data: Unknown records received 8/7/07-Glucose 166, A/G ratio 2.4. Abdominal series: Paucity of bowel gas with appearance suggesting mass in right lower quadrant of abdomen corresponding to ultrasound findings of intussusception. No Pyloric steno
CDC 'Split Type': (blank) WAES0707USA02866

Write-up: Information has been received from a physician concerning a 15 week old male who on 31-MAY-2007 was vaccinated with Rotateq (Lot# 656833/0407U). Concomitant therapy included Pediarix, Hib conj vaccine (unspecified carrier) and Prevnar. The physician repor"ted reported that the child was vomiting profusely on the morning of 09-JUL-2007 and was taken to the hospital. The physician reported the child was transferred to another hospital. The child was found to have an intussusception. The physician reported that the pa patient sought medical attention to prevent serious criteria and was hospitalized because of the experience. Additional information has been requested. 8/8/07-records received from transferring facility for DOS 7/9/07-C/O vomiting. 8/24/07-records received for DOS 7/10-7/20/07-DX: Intussusception. Pyelonephritis. E.coli sepsis/bacteremia. Small bowel-small bowel intussuception noted not reducible by hydrostatic enema. Small bowel resection with anastomosis and incidental appendectomy. Post operative day 2 high fevers noted and urinalysis revealed urinary tract infection. 8/8/07-records received from transferring facility for DOS 7/9/07-C/O vomiting. HX reflux. 8/24/07-records received for DOS 7/10-7/20/07-DX: Intussusception. Pyelonephritis. E.coli sepsis/bacteremia. Gastrographin enema: intussusception. Small bowel-small bowel intussuception noted not reducible by hydrostatic enema. Small bowel resection with anastomosis and incidental appendectomy. Post operative day 2 high fevers noted


Changed on 1/5/2010

VAERS ID: 286278 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Unknown
Vaccinated:2007-05-31
Onset:2007-07-09
Submitted:2007-07-26
Entered:2007-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B101AA / 0 UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0205U / 0 UN / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08690A / 0 UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0407U / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Appendicectomy, Bacteraemia, Blood culture positive, Blood glucose increased, Culture urine positive, Inappropriate schedule of drug administration, Intussusception, Pyelonephritis, Pyrexia, Salmonellosis, Sepsis, Small intestinal anastomosis, Small intestinal resection, Urinary tract infection, Vomiting, Enema administration, Ultrasound abdomen abnormal, Escherichia infection, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown records received 8/8/07-HX reflux.HX of bladder instrumentation by catheterization at outside facility
Allergies:
Diagnostic Lab Data: Unknown records received 8/7/07-Glucose 166, A/G ratio 2.4. Abdominal series: Paucity of bowel gas with appearance suggesting mass in right lower quadrant of abdomen corresponding to ultrasound findings of intussusception. No Pyloric steno
CDC 'Split Type': WAES0707USA02866

Write-up: Information has been received from a physician concerning a 15 week old male who on 31-MAY-2007 was vaccinated with Rotateq (Lot# 656833/0407U). Concomitant therapy included Pediarix, Hib conj vaccine (unspecified carrier) and Prevnar. The physician reported that the child was vomiting profusely on the morning of 09-JUL-2007 and was taken to the hospital. The physician reported the child was transferred to another hospital. The child was found to have an intussusception. The physician reported that the patient sought medical attention to prevent serious criteria and was hospitalized because of the experience. Additional information has been requested. 8/8/07-records received from transferring facility for DOS 7/9/07-C/O vomiting. 8/24/07-records received for DOS 7/10-7/20/07-DX: Intussusception. Pyelonephritis. E.coli sepsis/bacteremia. Small bowel-small bowel intussuception noted not reducible by hydrostatic enema. Small bowel resection with anastomosis and incidental appendectomy. Post operative day 2 high fevers noted and urinalysis revealed urinary tract infection. 8/8/07-records received from transferring facility for DOS 7/9/07-C/O vomiting. HX reflux. 8/24/07-records received for DOS 7/10-7/20/07-DX: Intussusception. Pyelonephritis. E.coli sepsis/bacteremia. Gastrographin enema: intussusception. Small bowel-small bowel intussuception noted not reducible by hydrostatic enema. Small bowel resection with anastomosis and incidental appendectomy. Post operative day 2 high fevers noted


Changed on 3/2/2010

VAERS ID: 286278 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Unknown
Vaccinated:2007-05-31
Onset:2007-07-09
Submitted:2007-07-26
Entered:2007-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B101AA / 0 UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0205U / 0 UN / UN
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B08690A / 0 UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0407U / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Inappropriate schedule of drug administration, Intussusception, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown records received 8/8/07-HX reflux.HX of bladder instrumentation by catheterization at outside facility
Allergies:
Diagnostic Lab Data: Unknown records received 8/7/07-Glucose 166, A/G ratio 2.4. Abdominal series: Paucity of bowel gas with appearance suggesting mass in right lower quadrant of abdomen corresponding to ultrasound findings of intussusception. No Pyloric steno
CDC 'Split Type': WAES0707USA02866

Write-up: Information has been received from a physician concerning a 15 week old male who on 31-MAY-2007 was vaccinated with Rotateq (Lot# 656833/0407U). Concomitant therapy included Pediarix, Hib conj vaccine (unspecified carrier) and Prevnar. The physician reported that the child was vomiting profusely on the morning of 09-JUL-2007 and was taken to the hospital. The physician reported the child was transferred to another hospital. The child was found to have an intussusception. The physician reported that the patient sought medical attention to prevent serious criteria and was hospitalized because of the experience. Additional information has been requested. 8/8/07-records received from transferring facility for DOS 7/9/07-C/O vomiting. 8/24/07-records received for DOS 7/10-7/20/07-DX: Intussusception. Pyelonephritis. E.coli sepsis/bacteremia. Small bowel-small bowel intussuception noted not reducible by hydrostatic enema. Small bowel resection with anastomosis and incidental appendectomy. Post operative day 2 high fevers noted and urinalysis revealed urinary tract infection. 8/8/07-records received from transferring facility for DOS 7/9/07-C/O vomiting. HX reflux. 8/24/07-records received for DOS 7/10-7/20/07-DX: Intussusception. Pyelonephritis. E.coli sepsis/bacteremia. Gastrographin enema: intussusception. Small bowel-small bowel intussuception noted not reducible by hydrostatic enema. Small bowel resection with anastomosis and incidental appendectomy. Post operative day 2 high fevers noted


Changed on 4/7/2010

VAERS ID: 286278 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Unknown
Vaccinated:2007-05-31
Onset:2007-07-09
Submitted:2007-07-26
Entered:2007-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B101AA / 0 UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0205U / 0 UN / UN
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08690A / 0 UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0407U / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Inappropriate schedule of drug administration, Intussusception, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown records received 8/8/07-HX reflux.HX of bladder instrumentation by catheterization at outside facility
Allergies:
Diagnostic Lab Data: Unknown records received 8/7/07-Glucose 166, A/G ratio 2.4. Abdominal series: Paucity of bowel gas with appearance suggesting mass in right lower quadrant of abdomen corresponding to ultrasound findings of intussusception. No Pyloric steno
CDC 'Split Type': WAES0707USA02866

Write-up: Information has been received from a physician concerning a 15 week old male who on 31-MAY-2007 was vaccinated with Rotateq (Lot# 656833/0407U). Concomitant therapy included Pediarix, Hib conj vaccine (unspecified carrier) and Prevnar. The physician reported that the child was vomiting profusely on the morning of 09-JUL-2007 and was taken to the hospital. The physician reported the child was transferred to another hospital. The child was found to have an intussusception. The physician reported that the patient sought medical attention to prevent serious criteria and was hospitalized because of the experience. Additional information has been requested. 8/8/07-records received from transferring facility for DOS 7/9/07-C/O vomiting. 8/24/07-records received for DOS 7/10-7/20/07-DX: Intussusception. Pyelonephritis. E.coli sepsis/bacteremia. Small bowel-small bowel intussuception noted not reducible by hydrostatic enema. Small bowel resection with anastomosis and incidental appendectomy. Post operative day 2 high fevers noted and urinalysis revealed urinary tract infection. 8/8/07-records received from transferring facility for DOS 7/9/07-C/O vomiting. HX reflux. 8/24/07-records received for DOS 7/10-7/20/07-DX: Intussusception. Pyelonephritis. E.coli sepsis/bacteremia. Gastrographin enema: intussusception. Small bowel-small bowel intussuception noted not reducible by hydrostatic enema. Small bowel resection with anastomosis and incidental appendectomy. Post operative day 2 high fevers noted


Changed on 8/31/2010

VAERS ID: 286278 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Unknown
Vaccinated:2007-05-31
Onset:2007-07-09
Submitted:2007-07-26
Entered:2007-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B101AA / 0 UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0205U / 0 UN / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B08690A / 0 UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0407U / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Inappropriate schedule of drug administration, Intussusception, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown records received 8/8/07-HX reflux.HX of bladder instrumentation by catheterization at outside facility
Allergies:
Diagnostic Lab Data: Unknown records received 8/7/07-Glucose 166, A/G ratio 2.4. Abdominal series: Paucity of bowel gas with appearance suggesting mass in right lower quadrant of abdomen corresponding to ultrasound findings of intussusception. No Pyloric steno
CDC 'Split Type': WAES0707USA02866

Write-up: Information has been received from a physician concerning a 15 week old male who on 31-MAY-2007 was vaccinated with Rotateq (Lot# 656833/0407U). Concomitant therapy included Pediarix, Hib conj vaccine (unspecified carrier) and Prevnar. The physician reported that the child was vomiting profusely on the morning of 09-JUL-2007 and was taken to the hospital. The physician reported the child was transferred to another hospital. The child was found to have an intussusception. The physician reported that the patient sought medical attention to prevent serious criteria and was hospitalized because of the experience. Additional information has been requested. 8/8/07-records received from transferring facility for DOS 7/9/07-C/O vomiting. 8/24/07-records received for DOS 7/10-7/20/07-DX: Intussusception. Pyelonephritis. E.coli sepsis/bacteremia. Small bowel-small bowel intussuception noted not reducible by hydrostatic enema. Small bowel resection with anastomosis and incidental appendectomy. Post operative day 2 high fevers noted and urinalysis revealed urinary tract infection. 8/8/07-records received from transferring facility for DOS 7/9/07-C/O vomiting. HX reflux. 8/24/07-records received for DOS 7/10-7/20/07-DX: Intussusception. Pyelonephritis. E.coli sepsis/bacteremia. Gastrographin enema: intussusception. Small bowel-small bowel intussuception noted not reducible by hydrostatic enema. Small bowel resection with anastomosis and incidental appendectomy. Post operative day 2 high fevers noted


Changed on 1/4/2011

VAERS ID: 286278 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Unknown
Vaccinated:2007-05-31
Onset:2007-07-09
Submitted:2007-07-26
Entered:2007-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B101AA / 0 UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0205U / 0 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08690A / 0 UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0407U / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Inappropriate schedule of drug administration, Intussusception, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown records received 8/8/07-HX reflux.HX of bladder instrumentation by catheterization at outside facility
Allergies:
Diagnostic Lab Data: Unknown records received 8/7/07-Glucose 166, A/G ratio 2.4. Abdominal series: Paucity of bowel gas with appearance suggesting mass in right lower quadrant of abdomen corresponding to ultrasound findings of intussusception. No Pyloric steno stenosis. Pyelonephritis cultures later grew out salmonella in urine and E. coli in blood. 8/8/07-records received urinalysis revealed urinary tract infection. Blood cultures revealed gram negative bacteremia. Pyelonephritis cultures later grew out salmonella in urine and E. coli in blood. Gastrographin enema: intussusception.Blood cultures revealed gram negative bacteremia. Glucose 166, A/G ratio 2.4. Abdominal series: Paucity of bowel gas with appearance suggesting mass in right lower quadrant of abdomen cor
CDC 'Split Type': WAES0707USA02866

Write-up: Information has been received from a physician concerning a 15 week old male who on 31-MAY-2007 was vaccinated with Rotateq (Lot# 656833/0407U). Concomitant therapy included Pediarix, Hib conj vaccine (unspecified carrier) and Prevnar. The physician reported that the child was vomiting profusely on the morning of 09-JUL-2007 and was taken to the hospital. The physician reported the child was transferred to another hospital. The child was found to have an intussusception. The physician reported that the patient sought medical attention to prevent serious criteria and was hospitalized because of the experience. Additional information has been requested. 8/8/07-records received from transferring facility for DOS 7/9/07-C/O vomiting. 8/24/07-records received for DOS 7/10-7/20/07-DX: Intussusception. Pyelonephritis. E.coli sepsis/bacteremia. Small bowel-small bowel intussuception noted not reducible by hydrostatic enema. Small bowel resection with anastomosis and incidental appendectomy. Post operative day 2 high fevers noted and urinalysis revealed urinary tract infection. 8/8/07-records received from transferring facility for DOS 7/9/07-C/O vomiting. HX reflux. 8/24/07-records received for DOS 7/10-7/20/07-DX: Intussusception. Pyelonephritis. E.coli sepsis/bacteremia. Gastrographin enema: intussusception. Small bowel-small bowel intussuception noted not reducible by hydrostatic enema. Small bowel resection with anastomosis and incidental appendectomy. Post operative day 2 high fevers noted


Changed on 4/13/2011

VAERS ID: 286278 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Unknown
Vaccinated:2007-05-31
Onset:2007-07-09
Submitted:2007-07-26
Entered:2007-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B101AA / 0 UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0205U / 0 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08690A / 0 UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0407U / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Appendicectomy, Bacteraemia, Blood culture positive, Blood glucose increased, Culture urine positive, Inappropriate schedule of drug administration, Intussusception, Pyelonephritis, Pyrexia, Salmonellosis, Sepsis, Small intestinal anastomosis, Small intestinal resection, Urinary tract infection, Vomiting, Enema administration, Ultrasound abdomen abnormal, Escherichia infection, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown records received 8/8/07-HX reflux.HX of bladder instrumentation by catheterization at outside facility
Allergies:
Diagnostic Lab Data: Unknown records received 8/7/07-Glucose 166, A/G ratio 2.4. Abdominal series: Paucity of bowel gas with appearance suggesting mass in right lower quadrant of abdomen corresponding to ultrasound findings of intussusception. No Pyloric stenosis. Pyelonephritis cultures later grew out salmonella in urine and E. coli in blood. 8/8/07-records received urinalysis revealed urinary tract infection. Blood cultures revealed gram negative bacteremia. Pyelonephritis cultures later grew out salmonella in urine and E. coli in blood. Gastrographin enema: intussusception.Blood cultures revealed gram negative bacteremia. Glucose 166, A/G ratio 2.4. Abdominal series: Paucity of bowel gas with appearance suggesting mass in right lower quadrant of abdomen cor
CDC 'Split Type': WAES0707USA02866

Write-up: Information has been received from a physician concerning a 15 week old male who on 31-MAY-2007 was vaccinated with Rotateq (Lot# 656833/0407U). Concomitant therapy included Pediarix, Hib conj vaccine (unspecified carrier) and Prevnar. The physician reported that the child was vomiting profusely on the morning of 09-JUL-2007 and was taken to the hospital. The physician reported the child was transferred to another hospital. The child was found to have an intussusception. The physician reported that the patient sought medical attention to prevent serious criteria and was hospitalized because of the experience. Additional information has been requested. 8/8/07-records received from transferring facility for DOS 7/9/07-C/O vomiting. 8/24/07-records received for DOS 7/10-7/20/07-DX: Intussusception. Pyelonephritis. E.coli sepsis/bacteremia. Small bowel-small bowel intussuception noted not reducible by hydrostatic enema. Small bowel resection with anastomosis and incidental appendectomy. Post operative day 2 high fevers noted and urinalysis revealed urinary tract infection. 8/8/07-records received from transferring facility for DOS 7/9/07-C/O vomiting. HX reflux. 8/24/07-records received for DOS 7/10-7/20/07-DX: Intussusception. Pyelonephritis. E.coli sepsis/bacteremia. Gastrographin enema: intussusception. Small bowel-small bowel intussuception noted not reducible by hydrostatic enema. Small bowel resection with anastomosis and incidental appendectomy. Post operative day 2 high fevers noted


Changed on 5/13/2011

VAERS ID: 286278 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Unknown
Vaccinated:2007-05-31
Onset:2007-07-09
Submitted:2007-07-26
Entered:2007-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B101AA / 0 UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0205U / 0 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08690A / 0 UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0407U / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Appendicectomy, Bacteraemia, Blood culture positive, Blood glucose increased, Culture urine positive, Inappropriate schedule of drug administration, Intussusception, Pyelonephritis, Pyrexia, Salmonellosis, Sepsis, Small intestinal anastomosis, Small intestinal resection, Urinary tract infection, Vomiting, Enema administration, Ultrasound abdomen abnormal, Escherichia infection, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown records received 8/8/07-HX reflux.HX of bladder instrumentation by catheterization at outside facility
Allergies:
Diagnostic Lab Data: Unknown records received 8/7/07-Glucose 166, A/G ratio 2.4. Abdominal series: Paucity of bowel gas with appearance suggesting mass in right lower quadrant of abdomen corresponding to ultrasound findings of intussusception. No Pyloric stenosis. Pyelonephritis cultures later grew out salmonella in urine and E. coli in blood. 8/8/07-records received urinalysis revealed urinary tract infection. Blood cultures revealed gram negative bacteremia. Pyelonephritis cultures later grew out salmonella in urine and E. coli in blood. Gastrographin enema: intussusception.Blood cultures revealed gram negative bacteremia. Glucose 166, A/G ratio 2.4. Abdominal series: Paucity of bowel gas with appearance suggesting mass in right lower quadrant of abdomen cor
CDC 'Split Type': WAES0707USA02866

Write-up: Information has been received from a physician concerning a 15 week old male who on 31-MAY-2007 was vaccinated with Rotateq (Lot# 656833/0407U). Concomitant therapy included Pediarix, Hib conj vaccine (unspecified carrier) and Prevnar. The physician reported that the child was vomiting profusely on the morning of 09-JUL-2007 and was taken to the hospital. The physician reported the child was transferred to another hospital. The child was found to have an intussusception. The physician reported that the patient sought medical attention to prevent serious criteria and was hospitalized because of the experience. Additional information has been requested. 8/8/07-records received from transferring facility for DOS 7/9/07-C/O vomiting. 8/24/07-records received for DOS 7/10-7/20/07-DX: Intussusception. Pyelonephritis. E.coli sepsis/bacteremia. Small bowel-small bowel intussuception noted not reducible by hydrostatic enema. Small bowel resection with anastomosis and incidental appendectomy. Post operative day 2 high fevers noted and urinalysis revealed urinary tract infection. 8/8/07-records received from transferring facility for DOS 7/9/07-C/O vomiting. HX reflux. 8/24/07-records received for DOS 7/10-7/20/07-DX: Intussusception. Pyelonephritis. E.coli sepsis/bacteremia. Gastrographin enema: intussusception. Small bowel-small bowel intussuception noted not reducible by hydrostatic enema. Small bowel resection with anastomosis and incidental appendectomy. Post operative day 2 high fevers noted


Changed on 6/11/2011

VAERS ID: 286278 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Unknown
Vaccinated:2007-05-31
Onset:2007-07-09
Submitted:2007-07-26
Entered:2007-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B101AA / 0 UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0205U / 0 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08690A / 0 UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0407U / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Appendicectomy, Bacteraemia, Blood culture positive, Blood glucose increased, Culture urine positive, Inappropriate schedule of drug administration, Intussusception, Pyelonephritis, Pyrexia, Salmonellosis, Sepsis, Small intestinal anastomosis, Small intestinal resection, Urinary tract infection, Vomiting, Enema administration, Ultrasound abdomen abnormal, Escherichia infection, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown records received 8/8/07-HX reflux.HX of bladder instrumentation by catheterization at outside facility
Allergies:
Diagnostic Lab Data: Unknown records received 8/7/07-Glucose 166, A/G ratio 2.4. Abdominal series: Paucity of bowel gas with appearance suggesting mass in right lower quadrant of abdomen corresponding to ultrasound findings of intussusception. No Pyloric stenosis. Pyelonephritis cultures later grew out salmonella in urine and E. coli in blood. 8/8/07-records received urinalysis revealed urinary tract infection. Blood cultures revealed gram negative bacteremia. Pyelonephritis cultures later grew out salmonella in urine and E. coli in blood. Gastrographin enema: intussusception.Blood cultures revealed gram negative bacteremia. Glucose 166, A/G ratio 2.4. Abdominal series: Paucity of bowel gas with appearance suggesting mass in right lower quadrant of abdomen cor
CDC 'Split Type': WAES0707USA02866

Write-up: Information has been received from a physician concerning a 15 week old male who on 31-MAY-2007 was vaccinated with Rotateq (Lot# 656833/0407U). Concomitant therapy included Pediarix, Hib conj vaccine (unspecified carrier) and Prevnar. The physician reported that the child was vomiting profusely on the morning of 09-JUL-2007 and was taken to the hospital. The physician reported the child was transferred to another hospital. The child was found to have an intussusception. The physician reported that the patient sought medical attention to prevent serious criteria and was hospitalized because of the experience. Additional information has been requested. 8/8/07-records received from transferring facility for DOS 7/9/07-C/O vomiting. 8/24/07-records received for DOS 7/10-7/20/07-DX: Intussusception. Pyelonephritis. E.coli sepsis/bacteremia. Small bowel-small bowel intussuception noted not reducible by hydrostatic enema. Small bowel resection with anastomosis and incidental appendectomy. Post operative day 2 high fevers noted and urinalysis revealed urinary tract infection. 8/8/07-records received from transferring facility for DOS 7/9/07-C/O vomiting. HX reflux. 8/24/07-records received for DOS 7/10-7/20/07-DX: Intussusception. Pyelonephritis. E.coli sepsis/bacteremia. Gastrographin enema: intussusception. Small bowel-small bowel intussuception noted not reducible by hydrostatic enema. Small bowel resection with anastomosis and incidental appendectomy. Post operative day 2 high fevers noted


Changed on 5/13/2013

VAERS ID: 286278 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Unknown
Vaccinated:2007-05-31
Onset:2007-07-09
Submitted:2007-07-26
Entered:2007-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B101AA / 0 UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0205U / 0 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08690A / 0 UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0407U / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0407U / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Appendicectomy, Bacteraemia, Blood culture positive, Blood glucose increased, Culture urine positive, Inappropriate schedule of drug administration, Intussusception, Pyelonephritis, Pyrexia, Salmonellosis, Sepsis, Small intestinal anastomosis, Small intestinal resection, Urinary tract infection, Vomiting, Enema administration, Ultrasound abdomen abnormal, Escherichia infection, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown records received 8/8/07-HX reflux.HX of bladder instrumentation by catheterization at outside facility
Allergies:
Diagnostic Lab Data: Unknown records received 8/7/07-Glucose 166, A/G ratio 2.4. Abdominal series: Paucity of bowel gas with appearance suggesting mass in right lower quadrant of abdomen corresponding to ultrasound findings of intussusception. No Pyloric stenosis. Pyelonephritis cultures later grew out salmonella in urine and E. coli in blood. 8/8/07-records received urinalysis revealed urinary tract infection. Blood cultures revealed gram negative bacteremia. Pyelonephritis cultures later grew out salmonella in urine and E. coli in blood. Gastrographin enema: intussusception.Blood cultures revealed gram negative bacteremia. Glucose 166, A/G ratio 2.4. Abdominal series: Paucity of bowel gas with appearance suggesting mass in right lower quadrant of abdomen cor
CDC 'Split Type': WAES0707USA02866

Write-up: Information has been received from a physician concerning a 15 week old male who on 31-MAY-2007 was vaccinated with Rotateq (Lot# 656833/0407U). Concomitant therapy included Pediarix, Hib conj vaccine (unspecified carrier) and Prevnar. The physician reported that the child was vomiting profusely on the morning of 09-JUL-2007 and was taken to the hospital. The physician reported the child was transferred to another hospital. The child was found to have an intussusception. The physician reported that the patient sought medical attention to prevent serious criteria and was hospitalized because of the experience. Additional information has been requested. 8/8/07-records received from transferring facility for DOS 7/9/07-C/O vomiting. 8/24/07-records received for DOS 7/10-7/20/07-DX: Intussusception. Pyelonephritis. E.coli sepsis/bacteremia. Small bowel-small bowel intussuception noted not reducible by hydrostatic enema. Small bowel resection with anastomosis and incidental appendectomy. Post operative day 2 high fevers noted and urinalysis revealed urinary tract infection. 8/8/07-records received from transferring facility for DOS 7/9/07-C/O vomiting. HX reflux. 8/24/07-records received for DOS 7/10-7/20/07-DX: Intussusception. Pyelonephritis. E.coli sepsis/bacteremia. Gastrographin enema: intussusception. Small bowel-small bowel intussuception noted not reducible by hydrostatic enema. Small bowel resection with anastomosis and incidental appendectomy. Post operative day 2 high fevers noted


Changed on 2/14/2017

VAERS ID: 286278 Before After
VAERS Form:
Age:0.2 0.18
Gender:Male
Location:Unknown
Vaccinated:2007-05-31
Onset:2007-07-09
Submitted:2007-07-26
Entered:2007-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B101AA / 0 UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0205U / 0 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08690A / 0 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0407U / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Appendicectomy, Bacteraemia, Blood culture positive, Blood glucose increased, Culture urine positive, Inappropriate schedule of drug administration, Intussusception, Pyelonephritis, Pyrexia, Salmonellosis, Sepsis, Small intestinal anastomosis, Small intestinal resection, Urinary tract infection, Vomiting, Enema administration, Ultrasound abdomen abnormal, Escherichia infection, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown records received 8/8/07-HX reflux.HX of bladder instrumentation by catheterization at outside facility
Allergies:
Diagnostic Lab Data: Unknown records received 8/7/07-Glucose 166, A/G ratio 2.4. Abdominal series: Paucity of bowel gas with appearance suggesting mass in right lower quadrant of abdomen corresponding to ultrasound findings of intussusception. No Pyloric stenosis. Pyelonephritis cultures later grew out salmonella in urine and E. coli in blood. 8/8/07-records received urinalysis revealed urinary tract infection. Blood cultures revealed gram negative bacteremia. Pyelonephritis cultures later grew out salmonella in urine and E. coli in blood. Gastrographin enema: intussusception.Blood cultures revealed gram negative bacteremia. Glucose 166, A/G ratio 2.4. Abdominal series: Paucity of bowel gas with appearance suggesting mass in right lower quadrant of abdomen cor
CDC 'Split Type': WAES0707USA02866

Write-up: Information has been received from a physician concerning a 15 week old male who on 31-MAY-2007 was vaccinated with Rotateq (Lot# 656833/0407U). Concomitant therapy included Pediarix, Hib conj vaccine (unspecified carrier) and Prevnar. The physician reported that the child was vomiting profusely on the morning of 09-JUL-2007 and was taken to the hospital. The physician reported the child was transferred to another hospital. The child was found to have an intussusception. The physician reported that the patient sought medical attention to prevent serious criteria and was hospitalized because of the experience. Additional information has been requested. 8/8/07-records received from transferring facility for DOS 7/9/07-C/O vomiting. 8/24/07-records received for DOS 7/10-7/20/07-DX: Intussusception. Pyelonephritis. E.coli sepsis/bacteremia. Small bowel-small bowel intussuception noted not reducible by hydrostatic enema. Small bowel resection with anastomosis and incidental appendectomy. Post operative day 2 high fevers noted and urinalysis revealed urinary tract infection. 8/8/07-records received from transferring facility for DOS 7/9/07-C/O vomiting. HX reflux. 8/24/07-records received for DOS 7/10-7/20/07-DX: Intussusception. Pyelonephritis. E.coli sepsis/bacteremia. Gastrographin enema: intussusception. Small bowel-small bowel intussuception noted not reducible by hydrostatic enema. Small bowel resection with anastomosis and incidental appendectomy. Post operative day 2 high fevers noted


Changed on 9/14/2017

VAERS ID: 286278 Before After
VAERS Form:(blank) 1
Age:0.18
Gender:Male
Location:Unknown
Vaccinated:2007-05-31
Onset:2007-07-09
Submitted:2007-07-26
Entered:2007-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B101AA / 0 1 UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0205U / 0 1 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08690A / 0 1 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0407U / 0 1 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Inappropriate schedule of drug administration, Intussusception, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown records received 8/8/07-HX reflux.HX of bladder instrumentation by catheterization at outside facility
Allergies:
Diagnostic Lab Data: Unknown records received 8/7/07-Glucose 166, A/G ratio 2.4. Abdominal series: Paucity of bowel gas with appearance suggesting mass in right lower quadrant of abdomen corresponding to ultrasound findings of intussusception. No Pyloric stenosis. Pyelonephritis cultures later grew out salmonella in urine and E. coli in blood. 8/8/07-records received urinalysis revealed urinary tract infection. Blood cultures revealed gram negative bacteremia. Pyelonephritis cultures later grew out salmonella in urine and E. coli in blood. Gastrographin enema: intussusception.Blood cultures revealed gram negative bacteremia. Glucose 166, A/G ratio 2.4. Abdominal series: Paucity of bowel gas with appearance suggesting mass in right lower quadrant of abdomen cor corresponding to ultrasound findings of intussusception. No Pyloric stenosis.
CDC 'Split Type': WAES0707USA02866

Write-up: Information has been received from a physician concerning a 15 week old male who on 31-MAY-2007 was vaccinated with Rotateq (Lot# 656833/0407U). Concomitant therapy included Pediarix, Hib conj vaccine (unspecified carrier) and Prevnar. The physician reported that the child was vomiting profusely on the morning of 09-JUL-2007 and was taken to the hospital. The physician reported the child was transferred to another hospital. The child was found to have an intussusception. The physician reported that the patient sought medical attention to prevent serious criteria and was hospitalized because of the experience. Additional information has been requested. 8/8/07-records received from transferring facility for DOS 7/9/07-C/O vomiting. 8/24/07-records received for DOS 7/10-7/20/07-DX: Intussusception. Pyelonephritis. E.coli sepsis/bacteremia. Small bowel-small bowel intussuception noted not reducible by hydrostatic enema. Small bowel resection with anastomosis and incidental appendectomy. Post operative day 2 high fevers noted and urinalysis revealed urinary tract infection. 8/8/07-records received from transferring facility for DOS 7/9/07-C/O vomiting. HX reflux. 8/24/07-records received for DOS 7/10-7/20/07-DX: Intussusception. Pyelonephritis. E.coli sepsis/bacteremia. Gastrographin enema: intussusception. Small bowel-small bowel intussuception noted not reducible by hydrostatic enema. Small bowel resection with anastomosis and incidental appendectomy. Post operative day 2 high fevers noted


Changed on 2/14/2018

VAERS ID: 286278 Before After
VAERS Form:1
Age:0.18
Gender:Male
Location:Unknown
Vaccinated:2007-05-31
Onset:2007-07-09
Submitted:2007-07-26
Entered:2007-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B101AA / 1 UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0205U / 1 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08690A / 1 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0407U / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Inappropriate schedule of drug administration, Intussusception, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown records received 8/8/07-HX reflux.HX of bladder instrumentation by catheterization at outside facility
Allergies:
Diagnostic Lab Data: Unknown records received 8/7/07-Glucose 166, A/G ratio 2.4. Abdominal series: Paucity of bowel gas with appearance suggesting mass in right lower quadrant of abdomen corresponding to ultrasound findings of intussusception. No Pyloric stenosis. Pyelonephritis cultures later grew out salmonella in urine and E. coli in blood. 8/8/07-records received urinalysis revealed urinary tract infection. Blood cultures revealed gram negative bacteremia. Pyelonephritis cultures later grew out salmonella in urine and E. coli in blood. Gastrographin enema: intussusception.Blood cultures revealed gram negative bacteremia. Glucose 166, A/G ratio 2.4. Abdominal series: Paucity of bowel gas with appearance suggesting mass in right lower quadrant of abdomen corresponding to ultrasound findings of intussusception. No Pyloric stenosis.
CDC 'Split Type': WAES0707USA02866

Write-up: Information has been received from a physician concerning a 15 week old male who on 31-MAY-2007 was vaccinated with Rotateq (Lot# 656833/0407U). Concomitant therapy included Pediarix, Hib conj vaccine (unspecified carrier) and Prevnar. The physician reported that the child was vomiting profusely on the morning of 09-JUL-2007 and was taken to the hospital. The physician reported the child was transferred to another hospital. The child was found to have an intussusception. The physician reported that the patient sought medical attention to prevent serious criteria and was hospitalized because of the experience. Additional information has been requested. 8/8/07-records received from transferring facility for DOS 7/9/07-C/O vomiting. 8/24/07-records received for DOS 7/10-7/20/07-DX: Intussusception. Pyelonephritis. E.coli sepsis/bacteremia. Small bowel-small bowel intussuception noted not reducible by hydrostatic enema. Small bowel resection with anastomosis and incidental appendectomy. Post operative day 2 high fevers noted and urinalysis revealed urinary tract infection. 8/8/07-records received from transferring facility for DOS 7/9/07-C/O vomiting. HX reflux. 8/24/07-records received for DOS 7/10-7/20/07-DX: Intussusception. Pyelonephritis. E.coli sepsis/bacteremia. Gastrographin enema: intussusception. Small bowel-small bowel intussuception noted not reducible by hydrostatic enema. Small bowel resection with anastomosis and incidental appendectomy. Post operative day 2 high fevers noted


Changed on 6/14/2018

VAERS ID: 286278 Before After
VAERS Form:1
Age:0.18
Gender:Male
Location:Unknown
Vaccinated:2007-05-31
Onset:2007-07-09
Submitted:2007-07-26
Entered:2007-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B101AA / 1 UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0205U / 1 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08690A / 1 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0407U / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Inappropriate schedule of drug administration, Intussusception, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown records received 8/8/07-HX reflux.HX of bladder instrumentation by catheterization at outside facility
Allergies:
Diagnostic Lab Data: Unknown records received 8/7/07-Glucose 166, A/G ratio 2.4. Abdominal series: Paucity of bowel gas with appearance suggesting mass in right lower quadrant of abdomen corresponding to ultrasound findings of intussusception. No Pyloric stenosis. Pyelonephritis cultures later grew out salmonella in urine and E. coli in blood. 8/8/07-records received urinalysis revealed urinary tract infection. Blood cultures revealed gram negative bacteremia. Pyelonephritis cultures later grew out salmonella in urine and E. coli in blood. Gastrographin enema: intussusception.Blood cultures revealed gram negative bacteremia. Glucose 166, A/G ratio 2.4. Abdominal series: Paucity of bowel gas with appearance suggesting mass in right lower quadrant of abdomen corresponding to ultrasound findings of intussusception. No Pyloric stenosis.
CDC 'Split Type': WAES0707USA02866

Write-up: Information has been received from a physician concerning a 15 week old male who on 31-MAY-2007 was vaccinated with Rotateq (Lot# 656833/0407U). Concomitant therapy included Pediarix, Hib conj vaccine (unspecified carrier) and Prevnar. The physician reported that the child was vomiting profusely on the morning of 09-JUL-2007 and was taken to the hospital. The physician reported the child was transferred to another hospital. The child was found to have an intussusception. The physician reported that the patient sought medical attention to prevent serious criteria and was hospitalized because of the experience. Additional information has been requested. 8/8/07-records received from transferring facility for DOS 7/9/07-C/O vomiting. 8/24/07-records received for DOS 7/10-7/20/07-DX: Intussusception. Pyelonephritis. E.coli sepsis/bacteremia. Small bowel-small bowel intussuception noted not reducible by hydrostatic enema. Small bowel resection with anastomosis and incidental appendectomy. Post operative day 2 high fevers noted and urinalysis revealed urinary tract infection. 8/8/07-records received from transferring facility for DOS 7/9/07-C/O vomiting. HX reflux. 8/24/07-records received for DOS 7/10-7/20/07-DX: Intussusception. Pyelonephritis. E.coli sepsis/bacteremia. Gastrographin enema: intussusception. Small bowel-small bowel intussuception noted not reducible by hydrostatic enema. Small bowel resection with anastomosis and incidental appendectomy. Post operative day 2 high fevers noted


Changed on 8/14/2018

VAERS ID: 286278 Before After
VAERS Form:1
Age:0.18
Gender:Male
Location:Unknown
Vaccinated:2007-05-31
Onset:2007-07-09
Submitted:2007-07-26
Entered:2007-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B101AA / 1 UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0205U / 1 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08690A / 1 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0407U / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Inappropriate schedule of drug administration, Intussusception, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown records received 8/8/07-HX reflux.HX of bladder instrumentation by catheterization at outside facility
Allergies:
Diagnostic Lab Data: Unknown records received 8/7/07-Glucose 166, A/G ratio 2.4. Abdominal series: Paucity of bowel gas with appearance suggesting mass in right lower quadrant of abdomen corresponding to ultrasound findings of intussusception. No Pyloric stenosis. Pyelonephritis cultures later grew out salmonella in urine and E. coli in blood. 8/8/07-records received urinalysis revealed urinary tract infection. Blood cultures revealed gram negative bacteremia. Pyelonephritis cultures later grew out salmonella in urine and E. coli in blood. Gastrographin enema: intussusception.Blood cultures revealed gram negative bacteremia. Glucose 166, A/G ratio 2.4. Abdominal series: Paucity of bowel gas with appearance suggesting mass in right lower quadrant of abdomen corresponding to ultrasound findings of intussusception. No Pyloric stenosis.
CDC 'Split Type': WAES0707USA02866

Write-up: Information has been received from a physician concerning a 15 week old male who on 31-MAY-2007 was vaccinated with Rotateq (Lot# 656833/0407U). Concomitant therapy included Pediarix, Hib conj vaccine (unspecified carrier) and Prevnar. The physician reported that the child was vomiting profusely on the morning of 09-JUL-2007 and was taken to the hospital. The physician reported the child was transferred to another hospital. The child was found to have an intussusception. The physician reported that the patient sought medical attention to prevent serious criteria and was hospitalized because of the experience. Additional information has been requested. 8/8/07-records received from transferring facility for DOS 7/9/07-C/O vomiting. 8/24/07-records received for DOS 7/10-7/20/07-DX: Intussusception. Pyelonephritis. E.coli sepsis/bacteremia. Small bowel-small bowel intussuception noted not reducible by hydrostatic enema. Small bowel resection with anastomosis and incidental appendectomy. Post operative day 2 high fevers noted and urinalysis revealed urinary tract infection. 8/8/07-records received from transferring facility for DOS 7/9/07-C/O vomiting. HX reflux. 8/24/07-records received for DOS 7/10-7/20/07-DX: Intussusception. Pyelonephritis. E.coli sepsis/bacteremia. Gastrographin enema: intussusception. Small bowel-small bowel intussuception noted not reducible by hydrostatic enema. Small bowel resection with anastomosis and incidental appendectomy. Post operative day 2 high fevers noted


Changed on 9/14/2018

VAERS ID: 286278 Before After
VAERS Form:1
Age:0.18
Gender:Male
Location:Unknown
Vaccinated:2007-05-31
Onset:2007-07-09
Submitted:2007-07-26
Entered:2007-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B101AA / 1 UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0205U / 1 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08690A / 1 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0407U / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Inappropriate schedule of drug administration, Intussusception, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown records received 8/8/07-HX reflux.HX of bladder instrumentation by catheterization at outside facility
Allergies:
Diagnostic Lab Data: Unknown records received 8/7/07-Glucose 166, A/G ratio 2.4. Abdominal series: Paucity of bowel gas with appearance suggesting mass in right lower quadrant of abdomen corresponding to ultrasound findings of intussusception. No Pyloric stenosis. Pyelonephritis cultures later grew out salmonella in urine and E. coli in blood. 8/8/07-records received urinalysis revealed urinary tract infection. Blood cultures revealed gram negative bacteremia. Pyelonephritis cultures later grew out salmonella in urine and E. coli in blood. Gastrographin enema: intussusception.Blood cultures revealed gram negative bacteremia. Glucose 166, A/G ratio 2.4. Abdominal series: Paucity of bowel gas with appearance suggesting mass in right lower quadrant of abdomen corresponding to ultrasound findings of intussusception. No Pyloric stenosis.
CDC 'Split Type': WAES0707USA02866

Write-up: Information has been received from a physician concerning a 15 week old male who on 31-MAY-2007 was vaccinated with Rotateq (Lot# 656833/0407U). Concomitant therapy included Pediarix, Hib conj vaccine (unspecified carrier) and Prevnar. The physician reported that the child was vomiting profusely on the morning of 09-JUL-2007 and was taken to the hospital. The physician reported the child was transferred to another hospital. The child was found to have an intussusception. The physician reported that the patient sought medical attention to prevent serious criteria and was hospitalized because of the experience. Additional information has been requested. 8/8/07-records received from transferring facility for DOS 7/9/07-C/O vomiting. 8/24/07-records received for DOS 7/10-7/20/07-DX: Intussusception. Pyelonephritis. E.coli sepsis/bacteremia. Small bowel-small bowel intussuception noted not reducible by hydrostatic enema. Small bowel resection with anastomosis and incidental appendectomy. Post operative day 2 high fevers noted and urinalysis revealed urinary tract infection. 8/8/07-records received from transferring facility for DOS 7/9/07-C/O vomiting. HX reflux. 8/24/07-records received for DOS 7/10-7/20/07-DX: Intussusception. Pyelonephritis. E.coli sepsis/bacteremia. Gastrographin enema: intussusception. Small bowel-small bowel intussuception noted not reducible by hydrostatic enema. Small bowel resection with anastomosis and incidental appendectomy. Post operative day 2 high fevers noted

New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=286278&WAYBACKHISTORY=ON


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