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| History of Changes from the VAERS Wayback Machine |
| VAERS ID: | 291810 |
| VAERS Form: | |
| Age: | 0.4 |
| Gender: | Male |
| Location: | California |
| Vaccinated: | 2007-09-04 |
| Onset: | 2007-09-12 |
| Submitted: | 2007-10-01 |
| Entered: | 2007-10-02 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route |
| DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B124AA / 1 | LL / - |
| HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 1273F / 1 | RL / - |
| PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC | B9728313 / 1 | RL / - |
| ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0972U / 1 | - / PO |
Administered by: Public Purchased by: Unknown
Symptoms: Abdominal pain, Barium enema, Haematochezia, Intussusception
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? No
Previous Vaccinations:
Other Medications: None
Current Illness: 10/22/07-records received-well baby visits with c/o stuffy nose and cough.
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 10/15/07-records received-BE positive for intussusception without complete reduction. TX successful reduction by air enema.
CDC 'Split Type':
Write-up: Information has been received from a physician concerning a 5 month old male who on 04-SEP-2007 was vaccinated with a dose of Rotateq (no lot number provided). There was no concomitant medication. On 12-SEP-2007 the patient experienced intussusception. On"that same day, the patient was examined by a physician and taken to the ER. At the time of this report the outcome was unknown. Additional information has been requested. 10/15/07-records received from facility-for DOS 09/12/07-patient with 36 hour histor
| Vaccinated: | 2007-09-04 |
| Onset: | 2007-09-12 |
| Submitted: | 2007-10-01 |
| Entered: | 2007-10-02 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route |
| DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B124AA / 1 | LL / - |
| DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B124AA / 1 | LL / - |
| HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 1273F / 1 | RL / - |
| PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC | B9728313 / 1 | RL / - |
| ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0972U / 1 | - / PO |
Administered by: Public Purchased by: Unknown Other
Symptoms: Abdominal pain, Barium enema, Haematochezia, Intussusception
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? No
Previous Vaccinations:
Other Medications: None
Current Illness: 10/22/07-records received-well baby visits with c/o stuffy nose and cough.
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 10/15/07-records received-BE positive for intussusception without complete reduction. TX successful reduction by air enema.
CDC 'Split Type': (blank) WAES0709USA03910
Write-up: Information has been received from a physician concerning a 5 month old male who on 04-SEP-2007 was vaccinated with a dose of Rotateq (no lot number provided). There was no concomitant medication. On 12-SEP-2007 the patient experienced intussusception. On"that On that same day, the patient was examined by a physician and taken to the ER. At the time of this report the outcome was unknown. Additional information has been requested. 10/15/07-records received from facility-for DOS 09/12/07-patient with 36 hour histor history of abdominal pain, vomiting and passage of currant jelly stool times 1 today, BE positive for intussusception without complete reduction. TX successful reduction by air enema. 10/22/07-office notes received, lot#u055 included. well baby visits with c/o stuffy nose and cough.
| Vaccinated: | 2007-09-04 |
| Onset: | 2007-09-12 |
| Submitted: | 2007-10-01 |
| Entered: | 2007-10-02 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route |
| DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B124AA / 1 | LL / - |
| HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 1273F / 1 | RL / - |
| PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC | B9728313 / 1 | RL / - |
| ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0972U / 1 | - / PO |
Administered by: Public Purchased by: Other
Symptoms: Abdominal pain, Barium enema, Haematochezia, Intussusception
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? No
Previous Vaccinations:
Other Medications: None
Current Illness: 10/22/07-records received-well baby visits with c/o stuffy nose and cough.
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 10/15/07-records received-BE positive for intussusception without complete reduction. TX successful reduction by air enema.
CDC 'Split Type': WAES0709USA03910
Write-up: Information has been received from a physician concerning a 5 month old male who on 04-SEP-2007 was vaccinated with a dose of Rotateq (no lot number provided). There was no concomitant medication. On 12-SEP-2007 the patient experienced intussusception. On that same day, the patient was examined by a physician and taken to the ER. At the time of this report the outcome was unknown. Additional information has been requested. 10/15/07-records received from facility-for DOS 09/12/07-patient with 36 hour history of abdominal pain, vomiting and passage of currant jelly stool times 1 today, BE positive for intussusception without complete reduction. TX successful reduction by air enema. 10/22/07-office notes received, lot#u055 included. well baby visits with c/o stuffy nose and cough.
| Vaccinated: | 2007-09-04 |
| Onset: | 2007-09-12 |
| Submitted: | 2007-10-01 |
| Entered: | 2007-10-02 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route |
| DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B124AA / 1 | LL / - |
| HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 1273F / 1 | RL / - |
| PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC | B9728313 / 1 | RL / - |
| ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0972U / 1 | - / PO |
Administered by: Public Purchased by: Other
Symptoms: Abdominal pain, Barium enema, Haematochezia, Intussusception
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? No
Previous Vaccinations:
Other Medications: None
Current Illness: 10/22/07-records received-well baby visits with c/o stuffy nose and cough.
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 10/15/07-records received-BE positive for intussusception without complete reduction. TX successful reduction by air enema.
CDC 'Split Type': WAES0709USA03910
Write-up: Information has been received from a physician concerning a 5 month old male who on 04-SEP-2007 was vaccinated with a dose of Rotateq (no lot number provided). There was no concomitant medication. On 12-SEP-2007 the patient experienced intussusception. On that same day, the patient was examined by a physician and taken to the ER. At the time of this report the outcome was unknown. Additional information has been requested. 10/15/07-records received from facility-for DOS 09/12/07-patient with 36 hour history of abdominal pain, vomiting and passage of currant jelly stool times 1 today, BE positive for intussusception without complete reduction. TX successful reduction by air enema. 10/22/07-office notes received, lot#u055 included. well baby visits with c/o stuffy nose and cough.
| Vaccinated: | 2007-09-04 |
| Onset: | 2007-09-12 |
| Submitted: | 2007-10-01 |
| Entered: | 2007-10-02 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route |
| DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B124AA / 1 | LL / - |
| HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 1273F / 1 | RL / - |
| PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH | B9728313 / 1 | RL / - |
| ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0972U / 1 | - / PO |
Administered by: Public Purchased by: Other
Symptoms: Abdominal pain, Barium enema, Haematochezia, Intussusception
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? No
Previous Vaccinations:
Other Medications: None
Current Illness: 10/22/07-records received-well baby visits with c/o stuffy nose and cough.
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 10/15/07-records received-BE positive for intussusception without complete reduction. TX successful reduction by air enema.
CDC 'Split Type': WAES0709USA03910
Write-up: Information has been received from a physician concerning a 5 month old male who on 04-SEP-2007 was vaccinated with a dose of Rotateq (no lot number provided). There was no concomitant medication. On 12-SEP-2007 the patient experienced intussusception. On that same day, the patient was examined by a physician and taken to the ER. At the time of this report the outcome was unknown. Additional information has been requested. 10/15/07-records received from facility-for DOS 09/12/07-patient with 36 hour history of abdominal pain, vomiting and passage of currant jelly stool times 1 today, BE positive for intussusception without complete reduction. TX successful reduction by air enema. 10/22/07-office notes received, lot#u055 included. well baby visits with c/o stuffy nose and cough.
| Vaccinated: | 2007-09-04 |
| Onset: | 2007-09-12 |
| Submitted: | 2007-10-01 |
| Entered: | 2007-10-02 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route |
| DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B124AA / 1 | LL / - |
| HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 1273F / 1 | RL / - |
| PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B9728313 / 1 | RL / - |
| ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0972U / 1 | - / PO |
| RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0972U / 1 | - / PO |
Administered by: Public Purchased by: Other
Symptoms: Abdominal pain, Barium enema, Haematochezia, Intussusception
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? No
Previous Vaccinations:
Other Medications: None
Current Illness: 10/22/07-records received-well baby visits with c/o stuffy nose and cough.
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 10/15/07-records received-BE positive for intussusception without complete reduction. TX successful reduction by air enema.
CDC 'Split Type': WAES0709USA03910
Write-up: Information has been received from a physician concerning a 5 month old male who on 04-SEP-2007 was vaccinated with a dose of Rotateq (no lot number provided). There was no concomitant medication. On 12-SEP-2007 the patient experienced intussusception. On that same day, the patient was examined by a physician and taken to the ER. At the time of this report the outcome was unknown. Additional information has been requested. 10/15/07-records received from facility-for DOS 09/12/07-patient with 36 hour history of abdominal pain, vomiting and passage of currant jelly stool times 1 today, BE positive for intussusception without complete reduction. TX successful reduction by air enema. 10/22/07-office notes received, lot#u055 included. well baby visits with c/o stuffy nose and cough.
| Vaccinated: | 2007-09-04 |
| Onset: | 2007-09-12 |
| Submitted: | 2007-10-01 |
| Entered: | 2007-10-02 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route |
| DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B124AA / 1 | LL / - |
| HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 1273F / 1 | RL / - |
| PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B9728313 / 1 | RL / - |
| RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0972U / 1 | - / PO |
Administered by: Public Purchased by: Other
Symptoms: Abdominal pain, Barium enema, Haematochezia, Intussusception
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? No
Previous Vaccinations:
Other Medications: None
Current Illness: 10/22/07-records received-well baby visits with c/o stuffy nose and cough.
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 10/15/07-records received-BE positive for intussusception without complete reduction. TX successful reduction by air enema.
CDC 'Split Type': WAES0709USA03910
Write-up: Information has been received from a physician concerning a 5 month old male who on 04-SEP-2007 was vaccinated with a dose of Rotateq (no lot number provided). There was no concomitant medication. On 12-SEP-2007 the patient experienced intussusception. On that same day, the patient was examined by a physician and taken to the ER. At the time of this report the outcome was unknown. Additional information has been requested. 10/15/07-records received from facility-for DOS 09/12/07-patient with 36 hour history of abdominal pain, vomiting and passage of currant jelly stool times 1 today, BE positive for intussusception without complete reduction. TX successful reduction by air enema. 10/22/07-office notes received, lot#u055 included. well baby visits with c/o stuffy nose and cough.
| Vaccinated: | 2007-09-04 |
| Onset: | 2007-09-12 |
| Submitted: | 2007-10-01 |
| Entered: | 2007-10-02 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route |
| DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B124AA / 1 2 | LL / - |
| HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 1273F / 1 2 | RL / - |
| PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B9728313 / 1 2 | RL / - |
| RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0972U / 1 2 | - MO / PO |
Administered by: Public Purchased by: Other
Symptoms: Intussusception
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? No
Previous Vaccinations:
Other Medications: None
Current Illness: 10/22/07-records received-well baby visits with c/o stuffy nose and cough.
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 10/15/07-records received-BE positive for intussusception without complete reduction. TX successful reduction by air enema.
CDC 'Split Type': WAES0709USA03910
Write-up: Information has been received from a physician concerning a 5 month old male who on 04-SEP-2007 was vaccinated with a dose of Rotateq (no lot number provided). There was no concomitant medication. On 12-SEP-2007 the patient experienced intussusception. On that same day, the patient was examined by a physician and taken to the ER. At the time of this report the outcome was unknown. Additional information has been requested. 10/15/07-records received from facility-for DOS 09/12/07-patient with 36 hour history of abdominal pain, vomiting and passage of currant jelly stool times 1 today, BE positive for intussusception without complete reduction. TX successful reduction by air enema. 10/22/07-office notes received, lot#u055 included. well baby visits with c/o stuffy nose and cough.
| Vaccinated: | 2007-09-04 |
| Onset: | 2007-09-12 |
| Submitted: | 2007-10-01 |
| Entered: | 2007-10-02 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route |
| DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B124AA / 2 | LL / - |
| HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 1273F / 2 | RL / - |
| PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B9728313 / 2 | RL / - |
| RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0972U / 2 | MO / PO |
Administered by: Public Purchased by: Other
Symptoms: Intussusception
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? No
Previous Vaccinations:
Other Medications: None
Current Illness: 10/22/07-records received-well baby visits with c/o stuffy nose and cough.
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 10/15/07-records received-BE positive for intussusception without complete reduction. TX successful reduction by air enema.
CDC 'Split Type': WAES0709USA03910
Write-up: Information has been received from a physician concerning a 5 month old male who on 04-SEP-2007 was vaccinated with a dose of Rotateq (no lot number provided). There was no concomitant medication. On 12-SEP-2007 the patient experienced intussusception. On that same day, the patient was examined by a physician and taken to the ER. At the time of this report the outcome was unknown. Additional information has been requested. 10/15/07-records received from facility-for DOS 09/12/07-patient with 36 hour history of abdominal pain, vomiting and passage of currant jelly stool times 1 today, BE positive for intussusception without complete reduction. TX successful reduction by air enema. 10/22/07-office notes received, lot#u055 included. well baby visits with c/o stuffy nose and cough.
| Vaccinated: | 2007-09-04 |
| Onset: | 2007-09-12 |
| Submitted: | 2007-10-01 |
| Entered: | 2007-10-02 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route |
| DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B124AA / 2 | LL / - |
| HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 1273F / 2 | RL / - |
| PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B9728313 / 2 | RL / - |
| RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0972U / 2 | MO / PO |
Administered by: Public Purchased by: Other
Symptoms: Intussusception
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? No
Previous Vaccinations:
Other Medications: None
Current Illness: 10/22/07-records received-well baby visits with c/o stuffy nose and cough.
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 10/15/07-records received-BE positive for intussusception without complete reduction. TX successful reduction by air enema.
CDC 'Split Type': WAES0709USA03910
Write-up: Information has been received from a physician concerning a 5 month old male who on 04-SEP-2007 was vaccinated with a dose of Rotateq (no lot number provided). There was no concomitant medication. On 12-SEP-2007 the patient experienced intussusception. On that same day, the patient was examined by a physician and taken to the ER. At the time of this report the outcome was unknown. Additional information has been requested. 10/15/07-records received from facility-for DOS 09/12/07-patient with 36 hour history of abdominal pain, vomiting and passage of currant jelly stool times 1 today, BE positive for intussusception without complete reduction. TX successful reduction by air enema. 10/22/07-office notes received, lot#u055 included. well baby visits with c/o stuffy nose and cough.
| Vaccinated: | 2007-09-04 |
| Onset: | 2007-09-12 |
| Submitted: | 2007-10-01 |
| Entered: | 2007-10-02 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route |
| DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B124AA / 2 | LL / - |
| HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 1273F / 2 | RL / - |
| PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B9728313 / 2 | RL / - |
| RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0972U / 2 | MO / PO |
Administered by: Public Purchased by: Other
Symptoms: Intussusception
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? No
Previous Vaccinations:
Other Medications: None
Current Illness: 10/22/07-records received-well baby visits with c/o stuffy nose and cough.
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 10/15/07-records received-BE positive for intussusception without complete reduction. TX successful reduction by air enema.
CDC 'Split Type': WAES0709USA03910
Write-up: Information has been received from a physician concerning a 5 month old male who on 04-SEP-2007 was vaccinated with a dose of Rotateq (no lot number provided). There was no concomitant medication. On 12-SEP-2007 the patient experienced intussusception. On that same day, the patient was examined by a physician and taken to the ER. At the time of this report the outcome was unknown. Additional information has been requested. 10/15/07-records received from facility-for DOS 09/12/07-patient with 36 hour history of abdominal pain, vomiting and passage of currant jelly stool times 1 today, BE positive for intussusception without complete reduction. TX successful reduction by air enema. 10/22/07-office notes received, lot#u055 included. well baby visits with c/o stuffy nose and cough.
| Vaccinated: | 2007-09-04 |
| Onset: | 2007-09-12 |
| Submitted: | 2007-10-01 |
| Entered: | 2007-10-02 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route |
| DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B124AA / 2 | LL / - |
| HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 1273F / 2 | RL / - |
| PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B9728313 / 2 | RL / - |
| RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0972U / 2 | MO / PO |
Administered by: Public Purchased by: Other
Symptoms: Intussusception
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? No
Previous Vaccinations:
Other Medications: None
Current Illness: 10/22/07-records received-well baby visits with c/o stuffy nose and cough.
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 10/15/07-records received-BE positive for intussusception without complete reduction. TX successful reduction by air enema.
CDC 'Split Type': WAES0709USA03910
Write-up: Information has been received from a physician concerning a 5 month old male who on 04-SEP-2007 was vaccinated with a dose of Rotateq (no lot number provided). There was no concomitant medication. On 12-SEP-2007 the patient experienced intussusception. On that same day, the patient was examined by a physician and taken to the ER. At the time of this report the outcome was unknown. Additional information has been requested. 10/15/07-records received from facility-for DOS 09/12/07-patient with 36 hour history of abdominal pain, vomiting and passage of currant jelly stool times 1 today, BE positive for intussusception without complete reduction. TX successful reduction by air enema. 10/22/07-office notes received, lot#u055 included. well baby visits with c/o stuffy nose and cough.
| Vaccinated: | 2007-09-04 |
| Onset: | 2007-09-12 |
| Submitted: | 2007-10-01 |
| Entered: | 2007-10-02 |
| Vaccination / Manufacturer | Lot / Dose | Site / Route |
| DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B124AA / 2 | LL / - |
| HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 1273F / 2 | RL / - |
| PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B9728313 / 2 | RL / - |
| RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0972U / 2 | MO / PO |
Administered by: Public Purchased by: Other
Symptoms: Intussusception
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? No
Previous Vaccinations:
Other Medications: None
Current Illness: 10/22/07-records received-well baby visits with c/o stuffy nose and cough.
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 10/15/07-records received-BE positive for intussusception without complete reduction. TX successful reduction by air enema.
CDC 'Split Type': WAES0709USA03910
Write-up: Information has been received from a physician concerning a 5 month old male who on 04-SEP-2007 was vaccinated with a dose of Rotateq (no lot number provided). There was no concomitant medication. On 12-SEP-2007 the patient experienced intussusception. On that same day, the patient was examined by a physician and taken to the ER. At the time of this report the outcome was unknown. Additional information has been requested. 10/15/07-records received from facility-for DOS 09/12/07-patient with 36 hour history of abdominal pain, vomiting and passage of currant jelly stool times 1 today, BE positive for intussusception without complete reduction. TX successful reduction by air enema. 10/22/07-office notes received, lot#u055 included. well baby visits with c/o stuffy nose and cough.
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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=291810&WAYBACKHISTORY=ON
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