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This is VAERS ID 286279

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 286279
VAERS Form:
Age:0.5
Gender:Male
Location:Pennsylvania
Vaccinated:2007-01-03
Onset:2007-06-05
Submitted:2007-07-26
Entered:2007-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ACZ1B04CA / 2 LL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC 1508670R / 2 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1034F / 2 - / PO

Administered by: Other      Purchased by: Unknown
Symptoms: Abdominal mass, Barium enema, Dehydration, Enema administration, Explorative laparotomy

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: surgery - had to be opened up to have a small piece of bowel removed, barium enema X-ray - but then had surgery
CDC 'Split Type':

Write-up: Information has been received from a physician concerning a male who was vaccinated with the first, second, and third doses of Rotateq (Lot #''''s not provided). Subsequently the patient experienced intussusception and was hospitalized. The patient received"an enema, but then had to be opened up to have a small piece of bowel removed. The length of the hospitalized was not provided. Subsequently, the patient recovered from intussusception. No additional information was provided. There was no product quality


Changed on 12/8/2009

VAERS ID: 286279 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Pennsylvania
Vaccinated:2007-01-03
Onset:2007-06-05
Submitted:2007-07-26
Entered:2007-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ACZ1B04CA / 2 LL / -
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ACZ1B04CA / 2 LL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC 1508670R / 2 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1034F / 2 - / PO

Administered by: Other      Purchased by: Unknown Other
Symptoms: Abdominal mass, Barium enema, Dehydration, Haematochezia, Intussusception, Irritability, Lethargy, Mucous stools, Small intestinal resection, Surgery, Vomiting, X-ray, Enema administration, Explorative laparotomy, Intestinal anastomosis

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: surgery - had to be opened up to have a small piece of bowel removed, barium enema X-ray - but then had surgery surgery. Labs and Diagnostics: Contrast enema with unsuccessful air insufflation reduction of distal intussusception extending into the
CDC 'Split Type': (blank) WAES0707USA03817

Write-up: Information has been received from a physician concerning a male who was vaccinated with the first, second, and third doses of Rotateq (Lot #''''s #''s not provided). Subsequently the patient experienced intussusception and was hospitalized. The patient received"an received an enema, but then had to be opened up to have a small piece of bowel removed. The length of the hospitalized was not provided. Subsequently, the patient recovered from intussusception. No additional information was provided. There was no product quality complaint. Additional information has been requested. 09/14/2007 MR received for hospital DOS 6/5-9/2007 for D/C DX of Intussusception S/P small bowel resection. Infant presented with 1 day hx of emesis and bloody mucus from the rectum. Pt fussy/irritable with intermittant lethagy. (+) dehydration on exam. Sausage shaped mass palpated in LLQ. Contrast enema unsuccessful in reducing IS. Taken to OR for Exploratory Lap with reduction of intussusception, ileocectomy, and primary anastomosis. D/C on POD #4. Surgical note reports pt doing well post-op following small and large bowel resection for an unreducible intussusception.


Changed on 3/2/2010

VAERS ID: 286279 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Pennsylvania
Vaccinated:2007-01-03
Onset:2007-06-05
Submitted:2007-07-26
Entered:2007-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ACZ1B04CA / 2 LL / -
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC 1508670R / 2 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1034F / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal mass, Barium enema, Dehydration, Haematochezia, Intussusception, Irritability, Lethargy, Mucous stools, Small intestinal resection, Surgery, Vomiting, X-ray, Enema administration, Explorative laparotomy, Intestinal anastomosis

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: surgery - had to be opened up to have a small piece of bowel removed, barium enema X-ray - but then had surgery. Labs and Diagnostics: Contrast enema with unsuccessful air insufflation reduction of distal intussusception extending into the
CDC 'Split Type': WAES0707USA03817

Write-up: Information has been received from a physician concerning a male who was vaccinated with the first, second, and third doses of Rotateq (Lot #''s not provided). Subsequently the patient experienced intussusception and was hospitalized. The patient received an enema, but then had to be opened up to have a small piece of bowel removed. The length of the hospitalized was not provided. Subsequently, the patient recovered from intussusception. No additional information was provided. There was no product quality complaint. Additional information has been requested. 09/14/2007 MR received for hospital DOS 6/5-9/2007 for D/C DX of Intussusception S/P small bowel resection. Infant presented with 1 day hx of emesis and bloody mucus from the rectum. Pt fussy/irritable with intermittant lethagy. (+) dehydration on exam. Sausage shaped mass palpated in LLQ. Contrast enema unsuccessful in reducing IS. Taken to OR for Exploratory Lap with reduction of intussusception, ileocectomy, and primary anastomosis. D/C on POD #4. Surgical note reports pt doing well post-op following small and large bowel resection for an unreducible intussusception.


Changed on 4/7/2010

VAERS ID: 286279 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Pennsylvania
Vaccinated:2007-01-03
Onset:2007-06-05
Submitted:2007-07-26
Entered:2007-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ACZ1B04CA / 2 LL / -
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC 1508670R / 2 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1034F / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal mass, Barium enema, Dehydration, Haematochezia, Intussusception, Irritability, Lethargy, Mucous stools, Small intestinal resection, Surgery, Vomiting, X-ray, Enema administration, Explorative laparotomy, Intestinal anastomosis

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: surgery - had to be opened up to have a small piece of bowel removed, barium enema X-ray - but then had surgery. Labs and Diagnostics: Contrast enema with unsuccessful air insufflation reduction of distal intussusception extending into the
CDC 'Split Type': WAES0707USA03817

Write-up: Information has been received from a physician concerning a male who was vaccinated with the first, second, and third doses of Rotateq (Lot #''s not provided). Subsequently the patient experienced intussusception and was hospitalized. The patient received an enema, but then had to be opened up to have a small piece of bowel removed. The length of the hospitalized was not provided. Subsequently, the patient recovered from intussusception. No additional information was provided. There was no product quality complaint. Additional information has been requested. 09/14/2007 MR received for hospital DOS 6/5-9/2007 for D/C DX of Intussusception S/P small bowel resection. Infant presented with 1 day hx of emesis and bloody mucus from the rectum. Pt fussy/irritable with intermittant lethagy. (+) dehydration on exam. Sausage shaped mass palpated in LLQ. Contrast enema unsuccessful in reducing IS. Taken to OR for Exploratory Lap with reduction of intussusception, ileocectomy, and primary anastomosis. D/C on POD #4. Surgical note reports pt doing well post-op following small and large bowel resection for an unreducible intussusception.


Changed on 8/31/2010

VAERS ID: 286279 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Pennsylvania
Vaccinated:2007-01-03
Onset:2007-06-05
Submitted:2007-07-26
Entered:2007-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ACZ1B04CA / 2 LL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 1508670R / 2 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1034F / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal mass, Barium enema, Dehydration, Haematochezia, Intussusception, Irritability, Lethargy, Mucous stools, Small intestinal resection, Surgery, Vomiting, X-ray, Enema administration, Explorative laparotomy, Intestinal anastomosis

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: surgery - had to be opened up to have a small piece of bowel removed, barium enema X-ray - but then had surgery. Labs and Diagnostics: Contrast enema with unsuccessful air insufflation reduction of distal intussusception extending into the
CDC 'Split Type': WAES0707USA03817

Write-up: Information has been received from a physician concerning a male who was vaccinated with the first, second, and third doses of Rotateq (Lot #''s not provided). Subsequently the patient experienced intussusception and was hospitalized. The patient received an enema, but then had to be opened up to have a small piece of bowel removed. The length of the hospitalized was not provided. Subsequently, the patient recovered from intussusception. No additional information was provided. There was no product quality complaint. Additional information has been requested. 09/14/2007 MR received for hospital DOS 6/5-9/2007 for D/C DX of Intussusception S/P small bowel resection. Infant presented with 1 day hx of emesis and bloody mucus from the rectum. Pt fussy/irritable with intermittant lethagy. (+) dehydration on exam. Sausage shaped mass palpated in LLQ. Contrast enema unsuccessful in reducing IS. Taken to OR for Exploratory Lap with reduction of intussusception, ileocectomy, and primary anastomosis. D/C on POD #4. Surgical note reports pt doing well post-op following small and large bowel resection for an unreducible intussusception.


Changed on 5/13/2013

VAERS ID: 286279 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Pennsylvania
Vaccinated:2007-01-03
Onset:2007-06-05
Submitted:2007-07-26
Entered:2007-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ACZ1B04CA / 2 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 1508670R / 2 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1034F / 2 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1034F / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal mass, Barium enema, Dehydration, Haematochezia, Intussusception, Irritability, Lethargy, Mucous stools, Small intestinal resection, Surgery, Vomiting, X-ray, Enema administration, Explorative laparotomy, Intestinal anastomosis

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: surgery - had to be opened up to have a small piece of bowel removed, barium enema X-ray - but then had surgery. Labs and Diagnostics: Contrast enema with unsuccessful air insufflation reduction of distal intussusception extending into the
CDC 'Split Type': WAES0707USA03817

Write-up: Information has been received from a physician concerning a male who was vaccinated with the first, second, and third doses of Rotateq (Lot #''s not provided). Subsequently the patient experienced intussusception and was hospitalized. The patient received an enema, but then had to be opened up to have a small piece of bowel removed. The length of the hospitalized was not provided. Subsequently, the patient recovered from intussusception. No additional information was provided. There was no product quality complaint. Additional information has been requested. 09/14/2007 MR received for hospital DOS 6/5-9/2007 for D/C DX of Intussusception S/P small bowel resection. Infant presented with 1 day hx of emesis and bloody mucus from the rectum. Pt fussy/irritable with intermittant lethagy. (+) dehydration on exam. Sausage shaped mass palpated in LLQ. Contrast enema unsuccessful in reducing IS. Taken to OR for Exploratory Lap with reduction of intussusception, ileocectomy, and primary anastomosis. D/C on POD #4. Surgical note reports pt doing well post-op following small and large bowel resection for an unreducible intussusception.


Changed on 2/14/2017

VAERS ID: 286279 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Pennsylvania
Vaccinated:2007-01-03
Onset:2007-06-05
Submitted:2007-07-26
Entered:2007-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ACZ1B04CA / 2 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 1508670R / 2 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1034F / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal mass, Barium enema, Dehydration, Haematochezia, Intussusception, Irritability, Lethargy, Mucous stools, Small intestinal resection, Surgery, Vomiting, X-ray, Enema administration, Explorative laparotomy, Intestinal anastomosis

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: surgery - had to be opened up to have a small piece of bowel removed, barium enema X-ray - but then had surgery. Labs and Diagnostics: Contrast enema with unsuccessful air insufflation reduction of distal intussusception extending into the rectum.
CDC 'Split Type': WAES0707USA03817

Write-up: Information has been received from a physician concerning a male who was vaccinated with the first, second, and third doses of Rotateq (Lot #''s not provided). Subsequently the patient experienced intussusception and was hospitalized. The patient received an enema, but then had to be opened up to have a small piece of bowel removed. The length of the hospitalized was not provided. Subsequently, the patient recovered from intussusception. No additional information was provided. There was no product quality complaint. Additional information has been requested. 09/14/2007 MR received for hospital DOS 6/5-9/2007 for D/C DX of Intussusception S/P small bowel resection. Infant presented with 1 day hx of emesis and bloody mucus from the rectum. Pt fussy/irritable with intermittant lethagy. (+) dehydration on exam. Sausage shaped mass palpated in LLQ. Contrast enema unsuccessful in reducing IS. Taken to OR for Exploratory Lap with reduction of intussusception, ileocectomy, and primary anastomosis. D/C on POD #4. Surgical note reports pt doing well post-op following small and large bowel resection for an unreducible intussusception.


Changed on 9/14/2017

VAERS ID: 286279 Before After
VAERS Form:(blank) 1
Age:0.5
Gender:Male
Location:Pennsylvania
Vaccinated:2007-01-03
Onset:2007-06-05
Submitted:2007-07-26
Entered:2007-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ACZ1B04CA / 2 3 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 1508670R / 2 3 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1034F / 2 3 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema, Intussusception, Surgery, X-ray, Enema administration

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: surgery - had to be opened up to have a small piece of bowel removed, barium enema X-ray - but then had surgery. Labs and Diagnostics: Contrast enema with unsuccessful air insufflation reduction of distal intussusception extending into the rectum.
CDC 'Split Type': WAES0707USA03817

Write-up: Information has been received from a physician concerning a male who was vaccinated with the first, second, and third doses of Rotateq (Lot #''s not provided). Subsequently the patient experienced intussusception and was hospitalized. The patient received an enema, but then had to be opened up to have a small piece of bowel removed. The length of the hospitalized was not provided. Subsequently, the patient recovered from intussusception. No additional information was provided. There was no product quality complaint. Additional information has been requested. 09/14/2007 MR received for hospital DOS 6/5-9/2007 for D/C DX of Intussusception S/P small bowel resection. Infant presented with 1 day hx of emesis and bloody mucus from the rectum. Pt fussy/irritable with intermittant lethagy. (+) dehydration on exam. Sausage shaped mass palpated in LLQ. Contrast enema unsuccessful in reducing IS. Taken to OR for Exploratory Lap with reduction of intussusception, ileocectomy, and primary anastomosis. D/C on POD #4. Surgical note reports pt doing well post-op following small and large bowel resection for an unreducible intussusception.


Changed on 2/14/2018

VAERS ID: 286279 Before After
VAERS Form:1
Age:0.5
Gender:Male
Location:Pennsylvania
Vaccinated:2007-01-03
Onset:2007-06-05
Submitted:2007-07-26
Entered:2007-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ACZ1B04CA / 3 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 1508670R / 3 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1034F / 3 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema, Intussusception, Surgery, X-ray, Enema administration

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: surgery - had to be opened up to have a small piece of bowel removed, barium enema X-ray - but then had surgery. Labs and Diagnostics: Contrast enema with unsuccessful air insufflation reduction of distal intussusception extending into the rectum.
CDC 'Split Type': WAES0707USA03817

Write-up: Information has been received from a physician concerning a male who was vaccinated with the first, second, and third doses of Rotateq (Lot #''s not provided). Subsequently the patient experienced intussusception and was hospitalized. The patient received an enema, but then had to be opened up to have a small piece of bowel removed. The length of the hospitalized was not provided. Subsequently, the patient recovered from intussusception. No additional information was provided. There was no product quality complaint. Additional information has been requested. 09/14/2007 MR received for hospital DOS 6/5-9/2007 for D/C DX of Intussusception S/P small bowel resection. Infant presented with 1 day hx of emesis and bloody mucus from the rectum. Pt fussy/irritable with intermittant lethagy. (+) dehydration on exam. Sausage shaped mass palpated in LLQ. Contrast enema unsuccessful in reducing IS. Taken to OR for Exploratory Lap with reduction of intussusception, ileocectomy, and primary anastomosis. D/C on POD #4. Surgical note reports pt doing well post-op following small and large bowel resection for an unreducible intussusception.


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