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This is VAERS ID 286408

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 286408
VAERS Form:
Age:0.2
Gender:Male
Location:Unknown
Vaccinated:2007-05-11
Onset:2007-07-25
Submitted:2007-07-31
Entered:2007-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR - / - UN / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC - / - UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0029U / 1 UN / UN

Administered by: Other      Purchased by: Unknown
Symptoms: Abdominal pain, Appendicectomy, Barium enema abnormal, Intussusception, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Concomitant therapy included Prevnar, Pediarix and ActHib.
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Information has been received from a nurse concerning an /"approximately 5 month old/" male who on /"11-MAY-2007/" was vaccinated with a second dose of Rotateq (Lot # not provided). Concomitant therapy included PREVNAR, PEDIARIX and ACTHIB. Subsequently t"he patient experienced intussusception. Unspecified medical attention was sought. The patient''''s outcome was not reported. There was no product quality complaint involved. Upon internal review, intussusception is considered an other important medical even


Changed on 12/8/2009

VAERS ID: 286408 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Unknown
Vaccinated:2007-05-11
Onset:2007-07-25
Submitted:2007-07-31
Entered:2007-08-01
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 (ACTHIB) / SANOFI PASTEUR - / - UN / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC - / - UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0029U / 1 UN / UN

Administered by: Other      Purchased by: Unknown Other
Symptoms: Abdominal pain, Appendicectomy, Barium enema abnormal, Intussusception, Mucosal ulceration, Surgery, Vomiting, Lymphoid tissue hyperplasia, Abdominal X-ray, Occult blood positive

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Concomitant therapy included Prevnar, Pediarix and ActHib.
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 10/2/07-records received-Abdominal x-ray on day of admission showed abnormal gas pattern with possibility of bowel malrotation. Barium enema confirmed intussusception and it was partially reduced.
CDC 'Split Type': (blank) WAES0707USA04584

Write-up: Information has been received from a nurse concerning an /"approximately "approximately 5 month old/" old" male who on /"11-MAY-2007/" "11-MAY-2007" was vaccinated with a second dose of Rotateq (Lot # not provided). Concomitant therapy included PREVNAR, PEDIARIX and ACTHIB. Subsequently t"he the patient experienced intussusception. Unspecified medical attention was sought. The patient''''s patient''s outcome was not reported. There was no product quality complaint involved. Upon internal review, intussusception is considered an other important medical even event. Additional information has been requested. 10/02/07-records received for DOS 7/26-7/31/07-DC DX: Terminal ileum resection with cecal resection, appendix removal, partial right colon resection. lymphoid hyperplasia of the iliococal valve with intussusception and ulceration of overlying mucosa. Seen in ER for abdominal pain and discomfort for 3 days and started vomiting 2 days prior. Multiple episodes of bilious emesis. Evaluated for pyloric stenosis in June with upper GI that was normal. Had currant jelly stool.


Changed on 1/5/2010

VAERS ID: 286408 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Unknown
Vaccinated:2007-05-11
Onset:2007-07-25
Submitted:2007-07-31
Entered:2007-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR - / - UN / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC - / - UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0029U / 1 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Appendicectomy, Barium enema abnormal, Intussusception, Mucosal ulceration, Surgery, Vomiting, Lymphoid tissue hyperplasia, Abdominal X-ray, Occult blood positive

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Concomitant therapy included Prevnar, Pediarix and ActHib.
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 10/2/07-records received-Abdominal x-ray on day of admission showed abnormal gas pattern with possibility of bowel malrotation. Barium enema confirmed intussusception and it was partially reduced.
CDC 'Split Type': WAES0707USA04584

Write-up: Information has been received from a nurse concerning an "approximately 5 month old" male who on "11-MAY-2007" was vaccinated with a second dose of Rotateq (Lot # not provided). Concomitant therapy included PREVNAR, PEDIARIX and ACTHIB. Subsequently the patient experienced intussusception. Unspecified medical attention was sought. The patient''s outcome was not reported. There was no product quality complaint involved. Upon internal review, intussusception is considered an other important medical event. Additional information has been requested. 10/02/07-records received for DOS 7/26-7/31/07-DC DX: Terminal ileum resection with cecal resection, appendix removal, partial right colon resection. lymphoid hyperplasia of the iliococal valve with intussusception and ulceration of overlying mucosa. Seen in ER for abdominal pain and discomfort for 3 days and started vomiting 2 days prior. Multiple episodes of bilious emesis. Evaluated for pyloric stenosis in June with upper GI that was normal. Had currant jelly stool.


Changed on 3/2/2010

VAERS ID: 286408 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Unknown
Vaccinated:2007-05-11
Onset:2007-07-25
Submitted:2007-07-31
Entered:2007-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR - / - UN / UN
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC - / - UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0029U / 1 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Concomitant therapy included Prevnar, Pediarix and ActHib.
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 10/2/07-records received-Abdominal x-ray on day of admission showed abnormal gas pattern with possibility of bowel malrotation. Barium enema confirmed intussusception and it was partially reduced.
CDC 'Split Type': WAES0707USA04584

Write-up: Information has been received from a nurse concerning an "approximately 5 month old" male who on "11-MAY-2007" was vaccinated with a second dose of Rotateq (Lot # not provided). Concomitant therapy included PREVNAR, PEDIARIX and ACTHIB. Subsequently the patient experienced intussusception. Unspecified medical attention was sought. The patient''s outcome was not reported. There was no product quality complaint involved. Upon internal review, intussusception is considered an other important medical event. Additional information has been requested. 10/02/07-records received for DOS 7/26-7/31/07-DC DX: Terminal ileum resection with cecal resection, appendix removal, partial right colon resection. lymphoid hyperplasia of the iliococal valve with intussusception and ulceration of overlying mucosa. Seen in ER for abdominal pain and discomfort for 3 days and started vomiting 2 days prior. Multiple episodes of bilious emesis. Evaluated for pyloric stenosis in June with upper GI that was normal. Had currant jelly stool.


Changed on 4/7/2010

VAERS ID: 286408 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Unknown
Vaccinated:2007-05-11
Onset:2007-07-25
Submitted:2007-07-31
Entered:2007-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR - / - UN / UN
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC - / - UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0029U / 1 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Concomitant therapy included Prevnar, Pediarix and ActHib.
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 10/2/07-records received-Abdominal x-ray on day of admission showed abnormal gas pattern with possibility of bowel malrotation. Barium enema confirmed intussusception and it was partially reduced.
CDC 'Split Type': WAES0707USA04584

Write-up: Information has been received from a nurse concerning an "approximately 5 month old" male who on "11-MAY-2007" was vaccinated with a second dose of Rotateq (Lot # not provided). Concomitant therapy included PREVNAR, PEDIARIX and ACTHIB. Subsequently the patient experienced intussusception. Unspecified medical attention was sought. The patient''s outcome was not reported. There was no product quality complaint involved. Upon internal review, intussusception is considered an other important medical event. Additional information has been requested. 10/02/07-records received for DOS 7/26-7/31/07-DC DX: Terminal ileum resection with cecal resection, appendix removal, partial right colon resection. lymphoid hyperplasia of the iliococal valve with intussusception and ulceration of overlying mucosa. Seen in ER for abdominal pain and discomfort for 3 days and started vomiting 2 days prior. Multiple episodes of bilious emesis. Evaluated for pyloric stenosis in June with upper GI that was normal. Had currant jelly stool.


Changed on 8/31/2010

VAERS ID: 286408 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Unknown
Vaccinated:2007-05-11
Onset:2007-07-25
Submitted:2007-07-31
Entered:2007-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR - / - UN / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH - / - UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0029U / 1 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Concomitant therapy included Prevnar, Pediarix and ActHib.
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 10/2/07-records received-Abdominal x-ray on day of admission showed abnormal gas pattern with possibility of bowel malrotation. Barium enema confirmed intussusception and it was partially reduced.
CDC 'Split Type': WAES0707USA04584

Write-up: Information has been received from a nurse concerning an "approximately 5 month old" male who on "11-MAY-2007" was vaccinated with a second dose of Rotateq (Lot # not provided). Concomitant therapy included PREVNAR, PEDIARIX and ACTHIB. Subsequently the patient experienced intussusception. Unspecified medical attention was sought. The patient''s outcome was not reported. There was no product quality complaint involved. Upon internal review, intussusception is considered an other important medical event. Additional information has been requested. 10/02/07-records received for DOS 7/26-7/31/07-DC DX: Terminal ileum resection with cecal resection, appendix removal, partial right colon resection. lymphoid hyperplasia of the iliococal valve with intussusception and ulceration of overlying mucosa. Seen in ER for abdominal pain and discomfort for 3 days and started vomiting 2 days prior. Multiple episodes of bilious emesis. Evaluated for pyloric stenosis in June with upper GI that was normal. Had currant jelly stool.


Changed on 4/13/2011

VAERS ID: 286408 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Unknown
Vaccinated:2007-05-11
Onset:2007-07-25
Submitted:2007-07-31
Entered:2007-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR - / - UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / - UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0029U / 1 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Appendicectomy, Barium enema abnormal, Intussusception, Mucosal ulceration, Surgery, Vomiting, Lymphoid tissue hyperplasia, Abdominal X-ray, Occult blood positive

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Concomitant therapy included Prevnar, Pediarix and ActHib.
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 10/2/07-records received-Abdominal x-ray on day of admission showed abnormal gas pattern with possibility of bowel malrotation. Barium enema confirmed intussusception and it was partially reduced.
CDC 'Split Type': WAES0707USA04584

Write-up: Information has been received from a nurse concerning an "approximately 5 month old" male who on "11-MAY-2007" was vaccinated with a second dose of Rotateq (Lot # not provided). Concomitant therapy included PREVNAR, PEDIARIX and ACTHIB. Subsequently the patient experienced intussusception. Unspecified medical attention was sought. The patient''s outcome was not reported. There was no product quality complaint involved. Upon internal review, intussusception is considered an other important medical event. Additional information has been requested. 10/02/07-records received for DOS 7/26-7/31/07-DC DX: Terminal ileum resection with cecal resection, appendix removal, partial right colon resection. lymphoid hyperplasia of the iliococal valve with intussusception and ulceration of overlying mucosa. Seen in ER for abdominal pain and discomfort for 3 days and started vomiting 2 days prior. Multiple episodes of bilious emesis. Evaluated for pyloric stenosis in June with upper GI that was normal. Had currant jelly stool.


Changed on 5/13/2011

VAERS ID: 286408 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Unknown
Vaccinated:2007-05-11
Onset:2007-07-25
Submitted:2007-07-31
Entered:2007-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR - / - UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / - UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0029U / 1 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Appendicectomy, Barium enema abnormal, Intussusception, Mucosal ulceration, Surgery, Vomiting, Lymphoid tissue hyperplasia, Abdominal X-ray, Occult blood positive

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Concomitant therapy included Prevnar, Pediarix and ActHib.
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 10/2/07-records received-Abdominal x-ray on day of admission showed abnormal gas pattern with possibility of bowel malrotation. Barium enema confirmed intussusception and it was partially reduced.
CDC 'Split Type': WAES0707USA04584

Write-up: Information has been received from a nurse concerning an "approximately 5 month old" male who on "11-MAY-2007" was vaccinated with a second dose of Rotateq (Lot # not provided). Concomitant therapy included PREVNAR, PEDIARIX and ACTHIB. Subsequently the patient experienced intussusception. Unspecified medical attention was sought. The patient''s outcome was not reported. There was no product quality complaint involved. Upon internal review, intussusception is considered an other important medical event. Additional information has been requested. 10/02/07-records received for DOS 7/26-7/31/07-DC DX: Terminal ileum resection with cecal resection, appendix removal, partial right colon resection. lymphoid hyperplasia of the iliococal valve with intussusception and ulceration of overlying mucosa. Seen in ER for abdominal pain and discomfort for 3 days and started vomiting 2 days prior. Multiple episodes of bilious emesis. Evaluated for pyloric stenosis in June with upper GI that was normal. Had currant jelly stool.


Changed on 6/11/2011

VAERS ID: 286408 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Unknown
Vaccinated:2007-05-11
Onset:2007-07-25
Submitted:2007-07-31
Entered:2007-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR - / - UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / - UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0029U / 1 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Appendicectomy, Barium enema abnormal, Intussusception, Mucosal ulceration, Surgery, Vomiting, Lymphoid tissue hyperplasia, Abdominal X-ray, Occult blood positive

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Concomitant therapy included Prevnar, Pediarix and ActHib.
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 10/2/07-records received-Abdominal x-ray on day of admission showed abnormal gas pattern with possibility of bowel malrotation. Barium enema confirmed intussusception and it was partially reduced.
CDC 'Split Type': WAES0707USA04584

Write-up: Information has been received from a nurse concerning an "approximately 5 month old" male who on "11-MAY-2007" was vaccinated with a second dose of Rotateq (Lot # not provided). Concomitant therapy included PREVNAR, PEDIARIX and ACTHIB. Subsequently the patient experienced intussusception. Unspecified medical attention was sought. The patient''s outcome was not reported. There was no product quality complaint involved. Upon internal review, intussusception is considered an other important medical event. Additional information has been requested. 10/02/07-records received for DOS 7/26-7/31/07-DC DX: Terminal ileum resection with cecal resection, appendix removal, partial right colon resection. lymphoid hyperplasia of the iliococal valve with intussusception and ulceration of overlying mucosa. Seen in ER for abdominal pain and discomfort for 3 days and started vomiting 2 days prior. Multiple episodes of bilious emesis. Evaluated for pyloric stenosis in June with upper GI that was normal. Had currant jelly stool.


Changed on 5/13/2013

VAERS ID: 286408 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Unknown
Vaccinated:2007-05-11
Onset:2007-07-25
Submitted:2007-07-31
Entered:2007-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR - / - UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / - UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0029U / 1 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0029U / 1 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Appendicectomy, Barium enema abnormal, Intussusception, Mucosal ulceration, Surgery, Vomiting, Lymphoid tissue hyperplasia, Abdominal X-ray, Occult blood positive

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Concomitant therapy included Prevnar, Pediarix and ActHib.
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 10/2/07-records received-Abdominal x-ray on day of admission showed abnormal gas pattern with possibility of bowel malrotation. Barium enema confirmed intussusception and it was partially reduced.
CDC 'Split Type': WAES0707USA04584

Write-up: Information has been received from a nurse concerning an "approximately 5 month old" male who on "11-MAY-2007" was vaccinated with a second dose of Rotateq (Lot # not provided). Concomitant therapy included PREVNAR, PEDIARIX and ACTHIB. Subsequently the patient experienced intussusception. Unspecified medical attention was sought. The patient''s outcome was not reported. There was no product quality complaint involved. Upon internal review, intussusception is considered an other important medical event. Additional information has been requested. 10/02/07-records received for DOS 7/26-7/31/07-DC DX: Terminal ileum resection with cecal resection, appendix removal, partial right colon resection. lymphoid hyperplasia of the iliococal valve with intussusception and ulceration of overlying mucosa. Seen in ER for abdominal pain and discomfort for 3 days and started vomiting 2 days prior. Multiple episodes of bilious emesis. Evaluated for pyloric stenosis in June with upper GI that was normal. Had currant jelly stool.


Changed on 6/14/2014

VAERS ID: 286408 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Unknown
Vaccinated:2007-05-11
Onset:2007-07-25
Submitted:2007-07-31
Entered:2007-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR - / - UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / - UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0029U / 1 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Appendicectomy, Barium enema abnormal, Intussusception, Mucosal ulceration, Surgery, Vomiting, Lymphoid tissue hyperplasia, Abdominal X-ray, Occult blood positive

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Concomitant therapy included Prevnar, Pediarix and ActHib.
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 10/2/07-records received-Abdominal x-ray on day of admission showed abnormal gas pattern with possibility of bowel malrotation. Barium enema confirmed intussusception and it was partially reduced.
CDC 'Split Type': WAES0707USA04584

Write-up: Information has been received from a nurse concerning an "approximately 5 month old" male who on "11-MAY-2007" was vaccinated with a second dose of Rotateq (Lot # not provided). Concomitant therapy included PREVNAR, PEDIARIX and ACTHIB. Subsequently the patient experienced intussusception. Unspecified medical attention was sought. The patient''s outcome was not reported. There was no product quality complaint involved. Upon internal review, intussusception is considered an other important medical event. Additional information has been requested. 10/02/07-records received for DOS 7/26-7/31/07-DC DX: Terminal ileum resection with cecal resection, appendix removal, partial right colon resection. lymphoid hyperplasia of the iliococal valve with intussusception and ulceration of overlying mucosa. Seen in ER for abdominal pain and discomfort for 3 days and started vomiting 2 days prior. Multiple episodes of bilious emesis. Evaluated for pyloric stenosis in June with upper GI that was normal. Had currant jelly stool.


Changed on 5/14/2017

VAERS ID: 286408 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Unknown
Vaccinated:2007-05-11
Onset:2007-07-25
Submitted:2007-07-31
Entered:2007-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR - / - UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / - UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0029U / 1 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Appendicectomy, Barium enema abnormal, Intussusception, Mucosal ulceration, Surgery, Vomiting, Lymphoid tissue hyperplasia, Abdominal X-ray, Occult blood positive

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Concomitant therapy included Prevnar, Pediarix and ActHib.
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 10/2/07-records received-Abdominal x-ray on day of admission showed abnormal gas pattern with possibility of bowel malrotation. Barium enema confirmed intussusception and it was partially reduced.
CDC 'Split Type': WAES0707USA04584

Write-up: Information has been received from a nurse concerning an "approximately 5 month old" male who on "11-MAY-2007" was vaccinated with a second dose of Rotateq (Lot # not provided). Concomitant therapy included PREVNAR, PEDIARIX and ACTHIB. Subsequently the patient experienced intussusception. Unspecified medical attention was sought. The patient''s outcome was not reported. There was no product quality complaint involved. Upon internal review, intussusception is considered an other important medical event. Additional information has been requested. 10/02/07-records received for DOS 7/26-7/31/07-DC DX: Terminal ileum resection with cecal resection, appendix removal, partial right colon resection. lymphoid hyperplasia of the iliococal valve with intussusception and ulceration of overlying mucosa. Seen in ER for abdominal pain and discomfort for 3 days and started vomiting 2 days prior. Multiple episodes of bilious emesis. Evaluated for pyloric stenosis in June with upper GI that was normal. Had currant jelly stool.


Changed on 9/14/2017

VAERS ID: 286408 Before After
VAERS Form:(blank) 1
Age:0.2
Gender:Male
Location:Unknown
Vaccinated:2007-05-11
Onset:2007-07-25
Submitted:2007-07-31
Entered:2007-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UNK UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR - / - UNK UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / - UNK UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0029U / 1 2 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Concomitant therapy included Prevnar, Pediarix and ActHib.
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 10/2/07-records received-Abdominal x-ray on day of admission showed abnormal gas pattern with possibility of bowel malrotation. Barium enema confirmed intussusception and it was partially reduced.
CDC 'Split Type': WAES0707USA04584

Write-up: Information has been received from a nurse concerning an "approximately 5 month old" male who on "11-MAY-2007" was vaccinated with a second dose of Rotateq (Lot # not provided). Concomitant therapy included PREVNAR, PEDIARIX and ACTHIB. Subsequently the patient experienced intussusception. Unspecified medical attention was sought. The patient''s outcome was not reported. There was no product quality complaint involved. Upon internal review, intussusception is considered an other important medical event. Additional information has been requested. 10/02/07-records received for DOS 7/26-7/31/07-DC DX: Terminal ileum resection with cecal resection, appendix removal, partial right colon resection. lymphoid hyperplasia of the iliococal valve with intussusception and ulceration of overlying mucosa. Seen in ER for abdominal pain and discomfort for 3 days and started vomiting 2 days prior. Multiple episodes of bilious emesis. Evaluated for pyloric stenosis in June with upper GI that was normal. Had currant jelly stool.


Changed on 2/14/2018

VAERS ID: 286408 Before After
VAERS Form:1
Age:0.2
Gender:Male
Location:Unknown
Vaccinated:2007-05-11
Onset:2007-07-25
Submitted:2007-07-31
Entered:2007-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR - / UNK UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0029U / 2 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Intussusception

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Concomitant therapy included Prevnar, Pediarix and ActHib.
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 10/2/07-records received-Abdominal x-ray on day of admission showed abnormal gas pattern with possibility of bowel malrotation. Barium enema confirmed intussusception and it was partially reduced.
CDC 'Split Type': WAES0707USA04584

Write-up: Information has been received from a nurse concerning an "approximately 5 month old" male who on "11-MAY-2007" was vaccinated with a second dose of Rotateq (Lot # not provided). Concomitant therapy included PREVNAR, PEDIARIX and ACTHIB. Subsequently the patient experienced intussusception. Unspecified medical attention was sought. The patient''s outcome was not reported. There was no product quality complaint involved. Upon internal review, intussusception is considered an other important medical event. Additional information has been requested. 10/02/07-records received for DOS 7/26-7/31/07-DC DX: Terminal ileum resection with cecal resection, appendix removal, partial right colon resection. lymphoid hyperplasia of the iliococal valve with intussusception and ulceration of overlying mucosa. Seen in ER for abdominal pain and discomfort for 3 days and started vomiting 2 days prior. Multiple episodes of bilious emesis. Evaluated for pyloric stenosis in June with upper GI that was normal. Had currant jelly stool.


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