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VAERS ID: | 292564 |
VAERS Form: | |
Age: | 0.4 |
Sex: | Male |
Location: | Georgia |
Vaccinated: | 2007-04-06 |
Onset: | 2007-10-03 |
Submitted: | 2007-10-04 |
Entered: | 2007-10-10 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B079BA / 1 | LL / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 0403F / 1 | RL / IM |
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC | B08691K / 1 | RL / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1233F / 1 | - / PO |
Administered by: Private Purchased by: Unknown
Symptoms: Abdominal pain, Barium enema, Chest X-ray, Crying, 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? Yes, days:
Write-up: 1st dose Rotateq given @ 2 mo 2/2/07 2nd dose Rotateq given @ 4 mo 4/6/07 Intussusception 6/18/07 no Rotateq given @ /"6 mo/" checkup done @ 6/29/07. 10/10/2007 VAERS report submitted with MR attached. Infant with PMH of intussusception in 6/2007 present"ed with crying and abdominal pain. A therapeutic enema was given with sucessful reduction of the ileocolic intussusception.
Vaccinated: | 2007-04-06 |
Onset: | 2007-10-03 |
Submitted: | 2007-10-04 |
Entered: | 2007-10-10 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B079BA / 1 | LL / IM |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B079BA / 1 | LL / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 0403F / 1 | RL / IM |
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC | B08691K / 1 | RL / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1233F / 1 | - / PO |
Administered by: Private Purchased by: Unknown Public
Symptoms: Abdominal pain, Barium enema, Chest X-ray, Crying, Haematochezia, Intussusception, Large intestinal obstruction reduction, Vomiting, Ultrasound abdomen abnormal, 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? Yes, days:
Write-up: 1st dose Rotateq given @ 2 mo 2/2/07 2nd dose Rotateq given @ 4 mo 4/6/07 Intussusception 6/18/07 no Rotateq given @ /"6 mo/" "6 mo" checkup done @ 6/29/07. 10/10/2007 VAERS report submitted with MR attached. Infant with PMH of intussusception in 6/2007 present"ed presented with crying and abdominal pain. pain on 10/3/2007. A therapeutic enema was given with sucessful successful reduction of the ileocolic intussusception. 10/24/2007 Vax record received. Rotateq Lot # 0403F added to database, otherwise correlates with VAERS submission. 11/05/2007 MR received for DOS 6/17/2007 for D/C DX Intussusception. Child presented to ER with vomiting, abdominal cramping x 12 hrs. Pt had a bloody stool in The ER. Pt had barium enema which sucessfully reduced the IS. D/Cd home same day in good condition. Repeat IS with BE reduction 10/3/07 as above.
Vaccinated: | 2007-04-06 |
Onset: | 2007-10-03 |
Submitted: | 2007-10-04 |
Entered: | 2007-10-10 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B079BA / 1 | LL / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 0403F / 1 | RL / IM |
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC | B08691K / 1 | RL / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1233F / 1 | - / PO |
Administered by: Private Purchased by: Public
Symptoms: Abdominal pain, Barium enema, Chest X-ray, Crying, Haematochezia, Intussusception, Large intestinal obstruction reduction, Vomiting, Ultrasound abdomen abnormal, 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? Yes, days:
Write-up: 1st dose Rotateq given @ 2 mo 2/2/07 2nd dose Rotateq given @ 4 mo 4/6/07 Intussusception 6/18/07 no Rotateq given @ "6 mo" checkup done @ 6/29/07. 10/10/2007 VAERS report submitted with MR attached. Infant with PMH of intussusception in 6/2007 presented with crying and abdominal pain on 10/3/2007. A therapeutic enema was given with successful reduction of the ileocolic intussusception. 10/24/2007 Vax record received. Rotateq Lot # 0403F added to database, otherwise correlates with VAERS submission. 11/05/2007 MR received for DOS 6/17/2007 for D/C DX Intussusception. Child presented to ER with vomiting, abdominal cramping x 12 hrs. Pt had a bloody stool in The ER. Pt had barium enema which sucessfully reduced the IS. D/Cd home same day in good condition. Repeat IS with BE reduction 10/3/07 as above.
Vaccinated: | 2007-04-06 |
Onset: | 2007-10-03 |
Submitted: | 2007-10-04 |
Entered: | 2007-10-10 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B079BA / 1 | LL / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 0403F / 1 | RL / IM |
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC | B08691K / 1 | RL / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1233F / 1 | - / PO |
Administered by: Private Purchased by: Public
Symptoms: Abdominal pain, Barium enema, Chest X-ray, Crying, Haematochezia, Intussusception, Large intestinal obstruction reduction, Vomiting, Ultrasound abdomen abnormal, 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? Yes, days:
Write-up: 1st dose Rotateq given @ 2 mo 2/2/07 2nd dose Rotateq given @ 4 mo 4/6/07 Intussusception 6/18/07 no Rotateq given @ "6 mo" checkup done @ 6/29/07. 10/10/2007 VAERS report submitted with MR attached. Infant with PMH of intussusception in 6/2007 presented with crying and abdominal pain on 10/3/2007. A therapeutic enema was given with successful reduction of the ileocolic intussusception. 10/24/2007 Vax record received. Rotateq Lot # 0403F added to database, otherwise correlates with VAERS submission. 11/05/2007 MR received for DOS 6/17/2007 for D/C DX Intussusception. Child presented to ER with vomiting, abdominal cramping x 12 hrs. Pt had a bloody stool in The ER. Pt had barium enema which sucessfully reduced the IS. D/Cd home same day in good condition. Repeat IS with BE reduction 10/3/07 as above.
Vaccinated: | 2007-04-06 |
Onset: | 2007-10-03 |
Submitted: | 2007-10-04 |
Entered: | 2007-10-10 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B079BA / 1 | LL / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 0403F / 1 | RL / IM |
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH | B08691K / 1 | RL / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1233F / 1 | - / PO |
Administered by: Private Purchased by: Public
Symptoms: Abdominal pain, Barium enema, Chest X-ray, Crying, Haematochezia, Intussusception, Large intestinal obstruction reduction, Vomiting, Ultrasound abdomen abnormal, 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? Yes, days:
Write-up: 1st dose Rotateq given @ 2 mo 2/2/07 2nd dose Rotateq given @ 4 mo 4/6/07 Intussusception 6/18/07 no Rotateq given @ "6 mo" checkup done @ 6/29/07. 10/10/2007 VAERS report submitted with MR attached. Infant with PMH of intussusception in 6/2007 presented with crying and abdominal pain on 10/3/2007. A therapeutic enema was given with successful reduction of the ileocolic intussusception. 10/24/2007 Vax record received. Rotateq Lot # 0403F added to database, otherwise correlates with VAERS submission. 11/05/2007 MR received for DOS 6/17/2007 for D/C DX Intussusception. Child presented to ER with vomiting, abdominal cramping x 12 hrs. Pt had a bloody stool in The ER. Pt had barium enema which sucessfully reduced the IS. D/Cd home same day in good condition. Repeat IS with BE reduction 10/3/07 as above.
Vaccinated: | 2007-04-06 |
Onset: | 2007-10-03 |
Submitted: | 2007-10-04 |
Entered: | 2007-10-10 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B079BA / 1 | LL / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 0403F / 1 | RL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B08691K / 1 | RL / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1233F / 1 | - / PO |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1233F / 1 | - / PO |
Administered by: Private Purchased by: Public
Symptoms: Abdominal pain, Barium enema, Chest X-ray, Crying, Haematochezia, Intussusception, Large intestinal obstruction reduction, Vomiting, Ultrasound abdomen abnormal, 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? Yes, days:
Write-up: 1st dose Rotateq given @ 2 mo 2/2/07 2nd dose Rotateq given @ 4 mo 4/6/07 Intussusception 6/18/07 no Rotateq given @ "6 mo" checkup done @ 6/29/07. 10/10/2007 VAERS report submitted with MR attached. Infant with PMH of intussusception in 6/2007 presented with crying and abdominal pain on 10/3/2007. A therapeutic enema was given with successful reduction of the ileocolic intussusception. 10/24/2007 Vax record received. Rotateq Lot # 0403F added to database, otherwise correlates with VAERS submission. 11/05/2007 MR received for DOS 6/17/2007 for D/C DX Intussusception. Child presented to ER with vomiting, abdominal cramping x 12 hrs. Pt had a bloody stool in The ER. Pt had barium enema which sucessfully reduced the IS. D/Cd home same day in good condition. Repeat IS with BE reduction 10/3/07 as above.
Vaccinated: | 2007-04-06 |
Onset: | 2007-10-03 |
Submitted: | 2007-10-04 |
Entered: | 2007-10-10 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B079BA / 1 | LL / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 0403F / 1 | RL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B08691K / 1 | RL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1233F / 1 | - / PO |
Administered by: Private Purchased by: Public
Symptoms: Abdominal pain, Barium enema, Chest X-ray, Crying, Haematochezia, Intussusception, Large intestinal obstruction reduction, Vomiting, Ultrasound abdomen abnormal, 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? Yes, days:
Write-up: 1st dose Rotateq given @ 2 mo 2/2/07 2nd dose Rotateq given @ 4 mo 4/6/07 Intussusception 6/18/07 no Rotateq given @ "6 mo" checkup done @ 6/29/07. 10/10/2007 VAERS report submitted with MR attached. Infant with PMH of intussusception in 6/2007 presented with crying and abdominal pain on 10/3/2007. A therapeutic enema was given with successful reduction of the ileocolic intussusception. 10/24/2007 Vax record received. Rotateq Lot # 0403F added to database, otherwise correlates with VAERS submission. 11/05/2007 MR received for DOS 6/17/2007 for D/C DX Intussusception. Child presented to ER with vomiting, abdominal cramping x 12 hrs. Pt had a bloody stool in The ER. Pt had barium enema which sucessfully reduced the IS. D/Cd home same day in good condition. Repeat IS with BE reduction 10/3/07 as above.
Vaccinated: | 2007-04-06 |
Onset: | 2007-10-03 |
Submitted: | 2007-10-04 |
Entered: | 2007-10-10 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B079BA / 1 2 | LL / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 0403F / 1 2 | RL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B08691K / 1 2 | RL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1233F / 1 2 | - MO / PO |
Administered by: Private Purchased by: Public
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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:
Write-up: 1st dose Rotateq given @ 2 mo 2/2/07 2nd dose Rotateq given @ 4 mo 4/6/07 Intussusception 6/18/07 no Rotateq given @ "6 mo" checkup done @ 6/29/07. 10/10/2007 VAERS report submitted with MR attached. Infant with PMH of intussusception in 6/2007 presented with crying and abdominal pain on 10/3/2007. A therapeutic enema was given with successful reduction of the ileocolic intussusception. 10/24/2007 Vax record received. Rotateq Lot # 0403F added to database, otherwise correlates with VAERS submission. 11/05/2007 MR received for DOS 6/17/2007 for D/C DX Intussusception. Child presented to ER with vomiting, abdominal cramping x 12 hrs. Pt had a bloody stool in The ER. Pt had barium enema which sucessfully reduced the IS. D/Cd home same day in good condition. Repeat IS with BE reduction 10/3/07 as above.
Vaccinated: | 2007-04-06 |
Onset: | 2007-10-03 |
Submitted: | 2007-10-04 |
Entered: | 2007-10-10 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B079BA / 2 | LL / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 0403F / 2 | RL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B08691K / 2 | RL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1233F / 2 | MO / PO |
Administered by: Private Purchased by: Public
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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:
Write-up: 1st dose Rotateq given @ 2 mo 2/2/07 2nd dose Rotateq given @ 4 mo 4/6/07 Intussusception 6/18/07 no Rotateq given @ "6 mo" checkup done @ 6/29/07. 10/10/2007 VAERS report submitted with MR attached. Infant with PMH of intussusception in 6/2007 presented with crying and abdominal pain on 10/3/2007. A therapeutic enema was given with successful reduction of the ileocolic intussusception. 10/24/2007 Vax record received. Rotateq Lot # 0403F added to database, otherwise correlates with VAERS submission. 11/05/2007 MR received for DOS 6/17/2007 for D/C DX Intussusception. Child presented to ER with vomiting, abdominal cramping x 12 hrs. Pt had a bloody stool in The ER. Pt had barium enema which sucessfully reduced the IS. D/Cd home same day in good condition. Repeat IS with BE reduction 10/3/07 as above.
Vaccinated: | 2007-04-06 |
Onset: | 2007-10-03 |
Submitted: | 2007-10-04 |
Entered: | 2007-10-10 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B079BA / 2 | LL / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 0403F / 2 | RL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B08691K / 2 | RL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1233F / 2 | MO / PO |
Administered by: Private Purchased by: Public
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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:
Write-up: 1st dose Rotateq given @ 2 mo 2/2/07 2nd dose Rotateq given @ 4 mo 4/6/07 Intussusception 6/18/07 no Rotateq given @ "6 mo" checkup done @ 6/29/07. 10/10/2007 VAERS report submitted with MR attached. Infant with PMH of intussusception in 6/2007 presented with crying and abdominal pain on 10/3/2007. A therapeutic enema was given with successful reduction of the ileocolic intussusception. 10/24/2007 Vax record received. Rotateq Lot # 0403F added to database, otherwise correlates with VAERS submission. 11/05/2007 MR received for DOS 6/17/2007 for D/C DX Intussusception. Child presented to ER with vomiting, abdominal cramping x 12 hrs. Pt had a bloody stool in The ER. Pt had barium enema which sucessfully reduced the IS. D/Cd home same day in good condition. Repeat IS with BE reduction 10/3/07 as above.
Vaccinated: | 2007-04-06 |
Onset: | 2007-10-03 |
Submitted: | 2007-10-04 |
Entered: | 2007-10-10 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B079BA / 2 | LL / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 0403F / 2 | RL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B08691K / 2 | RL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1233F / 2 | MO / PO |
Administered by: Private Purchased by: Public
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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:
Write-up: 1st dose Rotateq given @ 2 mo 2/2/07 2nd dose Rotateq given @ 4 mo 4/6/07 Intussusception 6/18/07 no Rotateq given @ "6 mo" checkup done @ 6/29/07. 10/10/2007 VAERS report submitted with MR attached. Infant with PMH of intussusception in 6/2007 presented with crying and abdominal pain on 10/3/2007. A therapeutic enema was given with successful reduction of the ileocolic intussusception. 10/24/2007 Vax record received. Rotateq Lot # 0403F added to database, otherwise correlates with VAERS submission. 11/05/2007 MR received for DOS 6/17/2007 for D/C DX Intussusception. Child presented to ER with vomiting, abdominal cramping x 12 hrs. Pt had a bloody stool in The ER. Pt had barium enema which sucessfully reduced the IS. D/Cd home same day in good condition. Repeat IS with BE reduction 10/3/07 as above.
Vaccinated: | 2007-04-06 |
Onset: | 2007-10-03 |
Submitted: | 2007-10-04 |
Entered: | 2007-10-10 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B079BA / 2 | LL / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 0403F / 2 | RL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B08691K / 2 | RL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1233F / 2 | MO / PO |
Administered by: Private Purchased by: Public
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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:
Write-up: 1st dose Rotateq given @ 2 mo 2/2/07 2nd dose Rotateq given @ 4 mo 4/6/07 Intussusception 6/18/07 no Rotateq given @ "6 mo" checkup done @ 6/29/07. 10/10/2007 VAERS report submitted with MR attached. Infant with PMH of intussusception in 6/2007 presented with crying and abdominal pain on 10/3/2007. A therapeutic enema was given with successful reduction of the ileocolic intussusception. 10/24/2007 Vax record received. Rotateq Lot # 0403F added to database, otherwise correlates with VAERS submission. 11/05/2007 MR received for DOS 6/17/2007 for D/C DX Intussusception. Child presented to ER with vomiting, abdominal cramping x 12 hrs. Pt had a bloody stool in The ER. Pt had barium enema which sucessfully reduced the IS. D/Cd home same day in good condition. Repeat IS with BE reduction 10/3/07 as above.
Vaccinated: | 2007-04-06 |
Onset: | 2007-10-03 |
Submitted: | 2007-10-04 |
Entered: | 2007-10-10 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B079BA / 2 | LL / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 0403F / 2 | RL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B08691K / 2 | RL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1233F / 2 | MO / PO |
Administered by: Private Purchased by: Public
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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:
Write-up: 1st dose Rotateq given @ 2 mo 2/2/07 2nd dose Rotateq given @ 4 mo 4/6/07 Intussusception 6/18/07 no Rotateq given @ "6 mo" checkup done @ 6/29/07. 10/10/2007 VAERS report submitted with MR attached. Infant with PMH of intussusception in 6/2007 presented with crying and abdominal pain on 10/3/2007. A therapeutic enema was given with successful reduction of the ileocolic intussusception. 10/24/2007 Vax record received. Rotateq Lot # 0403F added to database, otherwise correlates with VAERS submission. 11/05/2007 MR received for DOS 6/17/2007 for D/C DX Intussusception. Child presented to ER with vomiting, abdominal cramping x 12 hrs. Pt had a bloody stool in The ER. Pt had barium enema which sucessfully reduced the IS. D/Cd home same day in good condition. Repeat IS with BE reduction 10/3/07 as above.
Vaccinated: | 2007-04-06 |
Onset: | 2007-10-03 |
Submitted: | 2007-10-04 |
Entered: | 2007-10-10 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B079BA / 2 | LL / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 0403F / 2 | RL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B08691K / 2 | RL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1233F / 2 | MO / PO |
Administered by: Private Purchased by: Public
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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:
Write-up: 1st dose Rotateq given @ 2 mo 2/2/07 2nd dose Rotateq given @ 4 mo 4/6/07 Intussusception 6/18/07 no Rotateq given @ "6 mo" checkup done @ 6/29/07. 10/10/2007 VAERS report submitted with MR attached. Infant with PMH of intussusception in 6/2007 presented with crying and abdominal pain on 10/3/2007. A therapeutic enema was given with successful reduction of the ileocolic intussusception. 10/24/2007 Vax record received. Rotateq Lot # 0403F added to database, otherwise correlates with VAERS submission. 11/05/2007 MR received for DOS 6/17/2007 for D/C DX Intussusception. Child presented to ER with vomiting, abdominal cramping x 12 hrs. Pt had a bloody stool in The ER. Pt had barium enema which sucessfully reduced the IS. D/Cd home same day in good condition. Repeat IS with BE reduction 10/3/07 as above.
Vaccinated: | 2007-04-06 |
Onset: | 2007-10-03 |
Submitted: | 2007-10-04 |
Entered: | 2007-10-10 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B079BA / 2 | LL / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 0403F / 2 | RL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B08691K / 2 | RL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 1233F / 2 | MO / PO |
Administered by: Private Purchased by: Public
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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:
Write-up: 1st dose Rotateq given @ 2 mo 2/2/07 2nd dose Rotateq given @ 4 mo 4/6/07 Intussusception 6/18/07 no Rotateq given @ "6 mo" checkup done @ 6/29/07. 10/10/2007 VAERS report submitted with MR attached. Infant with PMH of intussusception in 6/2007 presented with crying and abdominal pain on 10/3/2007. A therapeutic enema was given with successful reduction of the ileocolic intussusception. 10/24/2007 Vax record received. Rotateq Lot # 0403F added to database, otherwise correlates with VAERS submission. 11/05/2007 MR received for DOS 6/17/2007 for D/C DX Intussusception. Child presented to ER with vomiting, abdominal cramping x 12 hrs. Pt had a bloody stool in The ER. Pt had barium enema which sucessfully reduced the IS. D/Cd home same day in good condition. Repeat IS with BE reduction 10/3/07 as above.
Link To This Search Result:
https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=292564&WAYBACKHISTORY=ON
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