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This is VAERS ID 288524

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 288524
VAERS Form:
Age:0.4
Gender:Male
Location:Georgia
Vaccinated:2007-06-28
Onset:2007-08-04
Submitted:2007-08-20
Entered:2007-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 1 LL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1274F / 1 RL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08690F / 1 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0410U / 1 - / PO

Administered by: Other      Purchased by: Unknown
Symptoms: Abdominal tenderness, Haematochezia, Intussusception, Enema administration, Abdominal X-ray

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? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Information has been received from a physician concerning a 20 week old male who on 20-APR-2007 and 28-JUN-2007 was vaccinated with the first and second oral doses of Rotateq. There was no concomitant medication. On approximately 04-AUG-2007 the patient e"xperienced intussusception. The patient was treated in the ER with an enema. Subsequently, the patient recovered. There was no product quality complaint. Upon internal review, intussusception was considered to be an other important medical event. Addition


Changed on 12/8/2009

VAERS ID: 288524 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Georgia
Vaccinated:2007-06-28
Onset:2007-08-04
Submitted:2007-08-20
Entered:2007-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 1 LL / -
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 1 LL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1274F / 1 RL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08690F / 1 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0410U / 1 - / PO

Administered by: Other      Purchased by: Unknown Other
Symptoms: Abdominal tenderness, Haematochezia, Intussusception, Lymphocyte count increased, Mucous stools, Vomiting, White blood cell count, Enema administration, Neutrophil percentage increased, Laboratory test normal, Abdominal X-ray

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? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown LABS: Air contrast enema x4 reduced IS. WBC 12.22, segs 80.3 (H), lymphs 15.2 (L). Chemistry WNL. Abdominal x-ray abnormal.
CDC 'Split Type': (blank) WAES0708USA02524

Write-up: Information has been received from a physician concerning a 20 week old male who on 20-APR-2007 and 28-JUN-2007 was vaccinated with the first and second oral doses of Rotateq. There was no concomitant medication. On approximately 04-AUG-2007 the patient e"xperienced experienced intussusception. The patient was treated in the ER with an enema. Subsequently, the patient recovered. There was no product quality complaint. Upon internal review, intussusception was considered to be an other important medical event. Addition Additional information has been requested. 9/5/07 Received vax record from pcp. Unable to read lot #s. T/C to provider to clarify. VAERS database updated with verbal confirmation of same. 9/18/07 Reviewed ER medical records from initial hospital which reveals patient seen 8/5/07 for vomiting, lethargy & abdominal tenderness. Transferred to higher level of care. ER FINAL DX: Intussusception. 9/28/07 Medical records faxed to CDC. 10/2/07 2nd Hospital medical records reviewed which reveal patient experienced lethargy, bilious vomiting & bloody mucousy stool. Transferred from outlying ER. Admitted 08/04-08/05/2007 for observation s/p enema administration to reduce IS. Progressed well & d/c to home. FINAL DX: Intussusception, air enema reduction.


Changed on 3/2/2010

VAERS ID: 288524 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Georgia
Vaccinated:2007-06-28
Onset:2007-08-04
Submitted:2007-08-20
Entered:2007-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 1 LL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1274F / 1 RL / -
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B08690F / 1 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0410U / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal tenderness, Haematochezia, Intussusception, Lymphocyte count increased, Mucous stools, Vomiting, White blood cell count, Enema administration, Neutrophil percentage increased, Laboratory test normal, Abdominal X-ray

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? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown LABS: Air contrast enema x4 reduced IS. WBC 12.22, segs 80.3 (H), lymphs 15.2 (L). Chemistry WNL. Abdominal x-ray abnormal.
CDC 'Split Type': WAES0708USA02524

Write-up: Information has been received from a physician concerning a 20 week old male who on 20-APR-2007 and 28-JUN-2007 was vaccinated with the first and second oral doses of Rotateq. There was no concomitant medication. On approximately 04-AUG-2007 the patient experienced intussusception. The patient was treated in the ER with an enema. Subsequently, the patient recovered. There was no product quality complaint. Upon internal review, intussusception was considered to be an other important medical event. Additional information has been requested. 9/5/07 Received vax record from pcp. Unable to read lot #s. T/C to provider to clarify. VAERS database updated with verbal confirmation of same. 9/18/07 Reviewed ER medical records from initial hospital which reveals patient seen 8/5/07 for vomiting, lethargy & abdominal tenderness. Transferred to higher level of care. ER FINAL DX: Intussusception. 9/28/07 Medical records faxed to CDC. 10/2/07 2nd Hospital medical records reviewed which reveal patient experienced lethargy, bilious vomiting & bloody mucousy stool. Transferred from outlying ER. Admitted 08/04-08/05/2007 for observation s/p enema administration to reduce IS. Progressed well & d/c to home. FINAL DX: Intussusception, air enema reduction.


Changed on 4/7/2010

VAERS ID: 288524 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Georgia
Vaccinated:2007-06-28
Onset:2007-08-04
Submitted:2007-08-20
Entered:2007-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 1 LL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1274F / 1 RL / -
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08690F / 1 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0410U / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal tenderness, Haematochezia, Intussusception, Lymphocyte count increased, Mucous stools, Vomiting, White blood cell count, Enema administration, Neutrophil percentage increased, Laboratory test normal, Abdominal X-ray

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? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown LABS: Air contrast enema x4 reduced IS. WBC 12.22, segs 80.3 (H), lymphs 15.2 (L). Chemistry WNL. Abdominal x-ray abnormal.
CDC 'Split Type': WAES0708USA02524

Write-up: Information has been received from a physician concerning a 20 week old male who on 20-APR-2007 and 28-JUN-2007 was vaccinated with the first and second oral doses of Rotateq. There was no concomitant medication. On approximately 04-AUG-2007 the patient experienced intussusception. The patient was treated in the ER with an enema. Subsequently, the patient recovered. There was no product quality complaint. Upon internal review, intussusception was considered to be an other important medical event. Additional information has been requested. 9/5/07 Received vax record from pcp. Unable to read lot #s. T/C to provider to clarify. VAERS database updated with verbal confirmation of same. 9/18/07 Reviewed ER medical records from initial hospital which reveals patient seen 8/5/07 for vomiting, lethargy & abdominal tenderness. Transferred to higher level of care. ER FINAL DX: Intussusception. 9/28/07 Medical records faxed to CDC. 10/2/07 2nd Hospital medical records reviewed which reveal patient experienced lethargy, bilious vomiting & bloody mucousy stool. Transferred from outlying ER. Admitted 08/04-08/05/2007 for observation s/p enema administration to reduce IS. Progressed well & d/c to home. FINAL DX: Intussusception, air enema reduction.


Changed on 8/31/2010

VAERS ID: 288524 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Georgia
Vaccinated:2007-06-28
Onset:2007-08-04
Submitted:2007-08-20
Entered:2007-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 1 LL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1274F / 1 RL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B08690F / 1 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0410U / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal tenderness, Haematochezia, Intussusception, Lymphocyte count increased, Mucous stools, Vomiting, White blood cell count, Enema administration, Neutrophil percentage increased, Laboratory test normal, Abdominal X-ray

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? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown LABS: Air contrast enema x4 reduced IS. WBC 12.22, segs 80.3 (H), lymphs 15.2 (L). Chemistry WNL. Abdominal x-ray abnormal.
CDC 'Split Type': WAES0708USA02524

Write-up: Information has been received from a physician concerning a 20 week old male who on 20-APR-2007 and 28-JUN-2007 was vaccinated with the first and second oral doses of Rotateq. There was no concomitant medication. On approximately 04-AUG-2007 the patient experienced intussusception. The patient was treated in the ER with an enema. Subsequently, the patient recovered. There was no product quality complaint. Upon internal review, intussusception was considered to be an other important medical event. Additional information has been requested. 9/5/07 Received vax record from pcp. Unable to read lot #s. T/C to provider to clarify. VAERS database updated with verbal confirmation of same. 9/18/07 Reviewed ER medical records from initial hospital which reveals patient seen 8/5/07 for vomiting, lethargy & abdominal tenderness. Transferred to higher level of care. ER FINAL DX: Intussusception. 9/28/07 Medical records faxed to CDC. 10/2/07 2nd Hospital medical records reviewed which reveal patient experienced lethargy, bilious vomiting & bloody mucousy stool. Transferred from outlying ER. Admitted 08/04-08/05/2007 for observation s/p enema administration to reduce IS. Progressed well & d/c to home. FINAL DX: Intussusception, air enema reduction.


Changed on 5/13/2013

VAERS ID: 288524 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Georgia
Vaccinated:2007-06-28
Onset:2007-08-04
Submitted:2007-08-20
Entered:2007-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 1 LL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1274F / 1 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08690F / 1 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0410U / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0410U / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal tenderness, Haematochezia, Intussusception, Lymphocyte count increased, Mucous stools, Vomiting, White blood cell count, Enema administration, Neutrophil percentage increased, Laboratory test normal, Abdominal X-ray

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? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown LABS: Air contrast enema x4 reduced IS. WBC 12.22, segs 80.3 (H), lymphs 15.2 (L). Chemistry WNL. Abdominal x-ray abnormal.
CDC 'Split Type': WAES0708USA02524

Write-up: Information has been received from a physician concerning a 20 week old male who on 20-APR-2007 and 28-JUN-2007 was vaccinated with the first and second oral doses of Rotateq. There was no concomitant medication. On approximately 04-AUG-2007 the patient experienced intussusception. The patient was treated in the ER with an enema. Subsequently, the patient recovered. There was no product quality complaint. Upon internal review, intussusception was considered to be an other important medical event. Additional information has been requested. 9/5/07 Received vax record from pcp. Unable to read lot #s. T/C to provider to clarify. VAERS database updated with verbal confirmation of same. 9/18/07 Reviewed ER medical records from initial hospital which reveals patient seen 8/5/07 for vomiting, lethargy & abdominal tenderness. Transferred to higher level of care. ER FINAL DX: Intussusception. 9/28/07 Medical records faxed to CDC. 10/2/07 2nd Hospital medical records reviewed which reveal patient experienced lethargy, bilious vomiting & bloody mucousy stool. Transferred from outlying ER. Admitted 08/04-08/05/2007 for observation s/p enema administration to reduce IS. Progressed well & d/c to home. FINAL DX: Intussusception, air enema reduction.


Changed on 2/14/2017

VAERS ID: 288524 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Georgia
Vaccinated:2007-06-28
Onset:2007-08-04
Submitted:2007-08-20
Entered:2007-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 1 LL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1274F / 1 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08690F / 1 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0410U / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal tenderness, Haematochezia, Intussusception, Lymphocyte count increased, Mucous stools, Vomiting, White blood cell count, Enema administration, Neutrophil percentage increased, Laboratory test normal, Abdominal X-ray

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? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown LABS: Air contrast enema x4 reduced IS. WBC 12.22, segs 80.3 (H), lymphs 15.2 (L). Chemistry WNL. Abdominal x-ray abnormal.
CDC 'Split Type': WAES0708USA02524

Write-up: Information has been received from a physician concerning a 20 week old male who on 20-APR-2007 and 28-JUN-2007 was vaccinated with the first and second oral doses of Rotateq. There was no concomitant medication. On approximately 04-AUG-2007 the patient experienced intussusception. The patient was treated in the ER with an enema. Subsequently, the patient recovered. There was no product quality complaint. Upon internal review, intussusception was considered to be an other important medical event. Additional information has been requested. 9/5/07 Received vax record from pcp. Unable to read lot #s. T/C to provider to clarify. VAERS database updated with verbal confirmation of same. 9/18/07 Reviewed ER medical records from initial hospital which reveals patient seen 8/5/07 for vomiting, lethargy & abdominal tenderness. Transferred to higher level of care. ER FINAL DX: Intussusception. 9/28/07 Medical records faxed to CDC. 10/2/07 2nd Hospital medical records reviewed which reveal patient experienced lethargy, bilious vomiting & bloody mucousy stool. Transferred from outlying ER. Admitted 08/04-08/05/2007 for observation s/p enema administration to reduce IS. Progressed well & d/c to home. FINAL DX: Intussusception, air enema reduction.


Changed on 9/14/2017

VAERS ID: 288524 Before After
VAERS Form:(blank) 1
Age:0.4
Gender:Male
Location:Georgia
Vaccinated:2007-06-28
Onset:2007-08-04
Submitted:2007-08-20
Entered:2007-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 1 2 LL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1274F / 1 2 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08690F / 1 2 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0410U / 1 2 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, 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? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown LABS: Air contrast enema x4 reduced IS. WBC 12.22, segs 80.3 (H), lymphs 15.2 (L). Chemistry WNL. Abdominal x-ray abnormal.
CDC 'Split Type': WAES0708USA02524

Write-up: Information has been received from a physician concerning a 20 week old male who on 20-APR-2007 and 28-JUN-2007 was vaccinated with the first and second oral doses of Rotateq. There was no concomitant medication. On approximately 04-AUG-2007 the patient experienced intussusception. The patient was treated in the ER with an enema. Subsequently, the patient recovered. There was no product quality complaint. Upon internal review, intussusception was considered to be an other important medical event. Additional information has been requested. 9/5/07 Received vax record from pcp. Unable to read lot #s. T/C to provider to clarify. VAERS database updated with verbal confirmation of same. 9/18/07 Reviewed ER medical records from initial hospital which reveals patient seen 8/5/07 for vomiting, lethargy & abdominal tenderness. Transferred to higher level of care. ER FINAL DX: Intussusception. 9/28/07 Medical records faxed to CDC. 10/2/07 2nd Hospital medical records reviewed which reveal patient experienced lethargy, bilious vomiting & bloody mucousy stool. Transferred from outlying ER. Admitted 08/04-08/05/2007 for observation s/p enema administration to reduce IS. Progressed well & d/c to home. FINAL DX: Intussusception, air enema reduction.


Changed on 2/14/2018

VAERS ID: 288524 Before After
VAERS Form:1
Age:0.4
Gender:Male
Location:Georgia
Vaccinated:2007-06-28
Onset:2007-08-04
Submitted:2007-08-20
Entered:2007-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 2 LL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1274F / 2 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08690F / 2 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0410U / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, 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? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown LABS: Air contrast enema x4 reduced IS. WBC 12.22, segs 80.3 (H), lymphs 15.2 (L). Chemistry WNL. Abdominal x-ray abnormal.
CDC 'Split Type': WAES0708USA02524

Write-up: Information has been received from a physician concerning a 20 week old male who on 20-APR-2007 and 28-JUN-2007 was vaccinated with the first and second oral doses of Rotateq. There was no concomitant medication. On approximately 04-AUG-2007 the patient experienced intussusception. The patient was treated in the ER with an enema. Subsequently, the patient recovered. There was no product quality complaint. Upon internal review, intussusception was considered to be an other important medical event. Additional information has been requested. 9/5/07 Received vax record from pcp. Unable to read lot #s. T/C to provider to clarify. VAERS database updated with verbal confirmation of same. 9/18/07 Reviewed ER medical records from initial hospital which reveals patient seen 8/5/07 for vomiting, lethargy & abdominal tenderness. Transferred to higher level of care. ER FINAL DX: Intussusception. 9/28/07 Medical records faxed to CDC. 10/2/07 2nd Hospital medical records reviewed which reveal patient experienced lethargy, bilious vomiting & bloody mucousy stool. Transferred from outlying ER. Admitted 08/04-08/05/2007 for observation s/p enema administration to reduce IS. Progressed well & d/c to home. FINAL DX: Intussusception, air enema reduction.


Changed on 6/14/2018

VAERS ID: 288524 Before After
VAERS Form:1
Age:0.4
Gender:Male
Location:Georgia
Vaccinated:2007-06-28
Onset:2007-08-04
Submitted:2007-08-20
Entered:2007-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 2 LL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1274F / 2 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08690F / 2 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0410U / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, 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? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown LABS: Air contrast enema x4 reduced IS. WBC 12.22, segs 80.3 (H), lymphs 15.2 (L). Chemistry WNL. Abdominal x-ray abnormal.
CDC 'Split Type': WAES0708USA02524

Write-up: Information has been received from a physician concerning a 20 week old male who on 20-APR-2007 and 28-JUN-2007 was vaccinated with the first and second oral doses of Rotateq. There was no concomitant medication. On approximately 04-AUG-2007 the patient experienced intussusception. The patient was treated in the ER with an enema. Subsequently, the patient recovered. There was no product quality complaint. Upon internal review, intussusception was considered to be an other important medical event. Additional information has been requested. 9/5/07 Received vax record from pcp. Unable to read lot #s. T/C to provider to clarify. VAERS database updated with verbal confirmation of same. 9/18/07 Reviewed ER medical records from initial hospital which reveals patient seen 8/5/07 for vomiting, lethargy & abdominal tenderness. Transferred to higher level of care. ER FINAL DX: Intussusception. 9/28/07 Medical records faxed to CDC. 10/2/07 2nd Hospital medical records reviewed which reveal patient experienced lethargy, bilious vomiting & bloody mucousy stool. Transferred from outlying ER. Admitted 08/04-08/05/2007 for observation s/p enema administration to reduce IS. Progressed well & d/c to home. FINAL DX: Intussusception, air enema reduction.


Changed on 8/14/2018

VAERS ID: 288524 Before After
VAERS Form:1
Age:0.4
Gender:Male
Location:Georgia
Vaccinated:2007-06-28
Onset:2007-08-04
Submitted:2007-08-20
Entered:2007-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 2 LL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1274F / 2 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08690F / 2 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0410U / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, 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? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown LABS: Air contrast enema x4 reduced IS. WBC 12.22, segs 80.3 (H), lymphs 15.2 (L). Chemistry WNL. Abdominal x-ray abnormal.
CDC 'Split Type': WAES0708USA02524

Write-up: Information has been received from a physician concerning a 20 week old male who on 20-APR-2007 and 28-JUN-2007 was vaccinated with the first and second oral doses of Rotateq. There was no concomitant medication. On approximately 04-AUG-2007 the patient experienced intussusception. The patient was treated in the ER with an enema. Subsequently, the patient recovered. There was no product quality complaint. Upon internal review, intussusception was considered to be an other important medical event. Additional information has been requested. 9/5/07 Received vax record from pcp. Unable to read lot #s. T/C to provider to clarify. VAERS database updated with verbal confirmation of same. 9/18/07 Reviewed ER medical records from initial hospital which reveals patient seen 8/5/07 for vomiting, lethargy & abdominal tenderness. Transferred to higher level of care. ER FINAL DX: Intussusception. 9/28/07 Medical records faxed to CDC. 10/2/07 2nd Hospital medical records reviewed which reveal patient experienced lethargy, bilious vomiting & bloody mucousy stool. Transferred from outlying ER. Admitted 08/04-08/05/2007 for observation s/p enema administration to reduce IS. Progressed well & d/c to home. FINAL DX: Intussusception, air enema reduction.


Changed on 9/14/2018

VAERS ID: 288524 Before After
VAERS Form:1
Age:0.4
Gender:Male
Location:Georgia
Vaccinated:2007-06-28
Onset:2007-08-04
Submitted:2007-08-20
Entered:2007-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B097AB / 2 LL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1274F / 2 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08690F / 2 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0410U / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, 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? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown LABS: Air contrast enema x4 reduced IS. WBC 12.22, segs 80.3 (H), lymphs 15.2 (L). Chemistry WNL. Abdominal x-ray abnormal.
CDC 'Split Type': WAES0708USA02524

Write-up: Information has been received from a physician concerning a 20 week old male who on 20-APR-2007 and 28-JUN-2007 was vaccinated with the first and second oral doses of Rotateq. There was no concomitant medication. On approximately 04-AUG-2007 the patient experienced intussusception. The patient was treated in the ER with an enema. Subsequently, the patient recovered. There was no product quality complaint. Upon internal review, intussusception was considered to be an other important medical event. Additional information has been requested. 9/5/07 Received vax record from pcp. Unable to read lot #s. T/C to provider to clarify. VAERS database updated with verbal confirmation of same. 9/18/07 Reviewed ER medical records from initial hospital which reveals patient seen 8/5/07 for vomiting, lethargy & abdominal tenderness. Transferred to higher level of care. ER FINAL DX: Intussusception. 9/28/07 Medical records faxed to CDC. 10/2/07 2nd Hospital medical records reviewed which reveal patient experienced lethargy, bilious vomiting & bloody mucousy stool. Transferred from outlying ER. Admitted 08/04-08/05/2007 for observation s/p enema administration to reduce IS. Progressed well & d/c to home. FINAL DX: Intussusception, air enema reduction.

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