This is VAERS ID 293275

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B11UAB / 1	LL / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER	0078U / 1	LL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC	B265108 / 1	RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	0770U / 1	- / PO

Administered by: Other      Purchased by: Unknown
Symptoms: Barium enema, Computerised tomogram abnormal, Haematochezia, Fontanelle depressed, Gastrointestinal sounds abnormal

Life Threatening? Yes
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: BACTRIM
Current Illness: Ear infection
Preexisting Conditions: PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: CT scan (+) for IS down to the level of the sigmoid colon and lymphadenopathy. Barium enema successfuly reduced IS.
CDC 'Split Type':

Write-up: Information has been received from a physician concerning a male who on 11-SEP-2007 was vaccinated with a second oral dose of Rotateq. Concomitant therapy included sulfamethoxazole/trimethoprim (BACTRIM) for an ear infection. Subsequently the patient expe"rienced intussusception. The patient was taken to the emergency room and was treated with an air enema reduction. It was reported that the patient recovered. The patient''''s intussusception was considered to be immediately life-threatening by the reporter.

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Changed on 12/8/2009

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B11UAB / 1	LL / -
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B11UAB / 1	LL / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER	0078U / 1	LL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC	B265108 / 1	RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	0770U / 1	- / PO

Administered by: Other      Purchased by: Unknown Other
Symptoms: Barium enema, Computerised tomogram abnormal, Haematochezia, Hypersomnia, Intussusception, Lethargy, Lymphadenopathy, Vomiting, Fontanelle depressed, Gastrointestinal sounds abnormal

Life Threatening? Yes
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: BACTRIM
Current Illness: Ear infection
Preexisting Conditions: PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: CT scan (+) for IS down to the level of the sigmoid colon and lymphadenopathy. Barium enema successfuly reduced IS.
CDC 'Split Type': (blank) WAES0710USA01435

Write-up: Information has been received from a physician concerning a male who on 11-SEP-2007 was vaccinated with a second oral dose of Rotateq. Concomitant therapy included sulfamethoxazole/trimethoprim (BACTRIM) for an ear infection. Subsequently the patient expe"rienced experienced intussusception. The patient was taken to the emergency room and was treated with an air enema reduction. It was reported that the patient recovered. The patient''''s patient''s intussusception was considered to be immediately life-threatening by the reporter. Additional information has been requested. 10/18/2007 Vax record recieved and info updated in VAERS database. 10/30/2007 MR received for hospital DOS 9/27-30/2007 for D/C DX of Reduced Intussusception on air enema. Infant presented to the ER with intractable vomiting and dark, bloody bowel movements as well as excessive sleep. PE (+) for lack of bowel sounds, lethargy, and depressed fontenelle. (+) Currant jelly stool in ER. Barium enema successfuly reduced IS.

---

Changed on 3/2/2010

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B11UAB / 1	LL / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER	0078U / 1	LL / -
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC	B265108 / 1	RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	0770U / 1	- / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema, Computerised tomogram abnormal, Haematochezia, Hypersomnia, Intussusception, Lethargy, Lymphadenopathy, Vomiting, Fontanelle depressed, Gastrointestinal sounds abnormal

Life Threatening? Yes
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: BACTRIM
Current Illness: Ear infection
Preexisting Conditions: PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: CT scan (+) for IS down to the level of the sigmoid colon and lymphadenopathy. Barium enema successfuly reduced IS.
CDC 'Split Type': WAES0710USA01435

Write-up: Information has been received from a physician concerning a male who on 11-SEP-2007 was vaccinated with a second oral dose of Rotateq. Concomitant therapy included sulfamethoxazole/trimethoprim (BACTRIM) for an ear infection. Subsequently the patient experienced intussusception. The patient was taken to the emergency room and was treated with an air enema reduction. It was reported that the patient recovered. The patient''s intussusception was considered to be immediately life-threatening by the reporter. Additional information has been requested. 10/18/2007 Vax record recieved and info updated in VAERS database. 10/30/2007 MR received for hospital DOS 9/27-30/2007 for D/C DX of Reduced Intussusception on air enema. Infant presented to the ER with intractable vomiting and dark, bloody bowel movements as well as excessive sleep. PE (+) for lack of bowel sounds, lethargy, and depressed fontenelle. (+) Currant jelly stool in ER. Barium enema successfuly reduced IS.

---

Changed on 4/7/2010

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B11UAB / 1	LL / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER	0078U / 1	LL / -
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC	B265108 / 1	RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	0770U / 1	- / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema, Computerised tomogram abnormal, Haematochezia, Hypersomnia, Intussusception, Lethargy, Lymphadenopathy, Vomiting, Fontanelle depressed, Gastrointestinal sounds abnormal

Life Threatening? Yes
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: BACTRIM
Current Illness: Ear infection
Preexisting Conditions: PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: CT scan (+) for IS down to the level of the sigmoid colon and lymphadenopathy. Barium enema successfuly reduced IS.
CDC 'Split Type': WAES0710USA01435

Write-up: Information has been received from a physician concerning a male who on 11-SEP-2007 was vaccinated with a second oral dose of Rotateq. Concomitant therapy included sulfamethoxazole/trimethoprim (BACTRIM) for an ear infection. Subsequently the patient experienced intussusception. The patient was taken to the emergency room and was treated with an air enema reduction. It was reported that the patient recovered. The patient''s intussusception was considered to be immediately life-threatening by the reporter. Additional information has been requested. 10/18/2007 Vax record recieved and info updated in VAERS database. 10/30/2007 MR received for hospital DOS 9/27-30/2007 for D/C DX of Reduced Intussusception on air enema. Infant presented to the ER with intractable vomiting and dark, bloody bowel movements as well as excessive sleep. PE (+) for lack of bowel sounds, lethargy, and depressed fontenelle. (+) Currant jelly stool in ER. Barium enema successfuly reduced IS.

---

Changed on 8/31/2010

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B11UAB / 1	LL / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER	0078U / 1	LL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH	B265108 / 1	RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	0770U / 1	- / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema, Computerised tomogram abnormal, Haematochezia, Hypersomnia, Intussusception, Lethargy, Lymphadenopathy, Vomiting, Fontanelle depressed, Gastrointestinal sounds abnormal

Life Threatening? Yes
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: BACTRIM
Current Illness: Ear infection
Preexisting Conditions: PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: CT scan (+) for IS down to the level of the sigmoid colon and lymphadenopathy. Barium enema successfuly reduced IS.
CDC 'Split Type': WAES0710USA01435

Write-up: Information has been received from a physician concerning a male who on 11-SEP-2007 was vaccinated with a second oral dose of Rotateq. Concomitant therapy included sulfamethoxazole/trimethoprim (BACTRIM) for an ear infection. Subsequently the patient experienced intussusception. The patient was taken to the emergency room and was treated with an air enema reduction. It was reported that the patient recovered. The patient''s intussusception was considered to be immediately life-threatening by the reporter. Additional information has been requested. 10/18/2007 Vax record recieved and info updated in VAERS database. 10/30/2007 MR received for hospital DOS 9/27-30/2007 for D/C DX of Reduced Intussusception on air enema. Infant presented to the ER with intractable vomiting and dark, bloody bowel movements as well as excessive sleep. PE (+) for lack of bowel sounds, lethargy, and depressed fontenelle. (+) Currant jelly stool in ER. Barium enema successfuly reduced IS.

---

Changed on 4/13/2011

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B11UAB / 1	LL / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER	0078U / 1	LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH	B265108 / 1	RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	0770U / 1	- / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema, Computerised tomogram abnormal, Haematochezia, Hypersomnia, Intussusception, Lethargy, Lymphadenopathy, Vomiting, Fontanelle depressed, Gastrointestinal sounds abnormal

Life Threatening? Yes
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: BACTRIM
Current Illness: Ear infection
Preexisting Conditions: PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: CT scan (+) for IS down to the level of the sigmoid colon and lymphadenopathy. Barium enema successfuly reduced IS.
CDC 'Split Type': WAES0710USA01435

Write-up: Information has been received from a physician concerning a male who on 11-SEP-2007 was vaccinated with a second oral dose of Rotateq. Concomitant therapy included sulfamethoxazole/trimethoprim (BACTRIM) for an ear infection. Subsequently the patient experienced intussusception. The patient was taken to the emergency room and was treated with an air enema reduction. It was reported that the patient recovered. The patient''s intussusception was considered to be immediately life-threatening by the reporter. Additional information has been requested. 10/18/2007 Vax record recieved and info updated in VAERS database. 10/30/2007 MR received for hospital DOS 9/27-30/2007 for D/C DX of Reduced Intussusception on air enema. Infant presented to the ER with intractable vomiting and dark, bloody bowel movements as well as excessive sleep. PE (+) for lack of bowel sounds, lethargy, and depressed fontenelle. (+) Currant jelly stool in ER. Barium enema successfuly reduced IS.

---

Changed on 5/13/2011

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B11UAB / 1	LL / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER	0078U / 1	LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH	B265108 / 1	RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	0770U / 1	- / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema, Computerised tomogram abnormal, Haematochezia, Hypersomnia, Intussusception, Lethargy, Lymphadenopathy, Vomiting, Fontanelle depressed, Gastrointestinal sounds abnormal

Life Threatening? Yes
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: BACTRIM
Current Illness: Ear infection
Preexisting Conditions: PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: CT scan (+) for IS down to the level of the sigmoid colon and lymphadenopathy. Barium enema successfuly reduced IS.
CDC 'Split Type': WAES0710USA01435

Write-up: Information has been received from a physician concerning a male who on 11-SEP-2007 was vaccinated with a second oral dose of Rotateq. Concomitant therapy included sulfamethoxazole/trimethoprim (BACTRIM) for an ear infection. Subsequently the patient experienced intussusception. The patient was taken to the emergency room and was treated with an air enema reduction. It was reported that the patient recovered. The patient''s intussusception was considered to be immediately life-threatening by the reporter. Additional information has been requested. 10/18/2007 Vax record recieved and info updated in VAERS database. 10/30/2007 MR received for hospital DOS 9/27-30/2007 for D/C DX of Reduced Intussusception on air enema. Infant presented to the ER with intractable vomiting and dark, bloody bowel movements as well as excessive sleep. PE (+) for lack of bowel sounds, lethargy, and depressed fontenelle. (+) Currant jelly stool in ER. Barium enema successfuly reduced IS.

---

Changed on 6/11/2011

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B11UAB / 1	LL / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER	0078U / 1	LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH	B265108 / 1	RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	0770U / 1	- / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema, Computerised tomogram abnormal, Haematochezia, Hypersomnia, Intussusception, Lethargy, Lymphadenopathy, Vomiting, Fontanelle depressed, Gastrointestinal sounds abnormal

Life Threatening? Yes
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: BACTRIM
Current Illness: Ear infection
Preexisting Conditions: PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: CT scan (+) for IS down to the level of the sigmoid colon and lymphadenopathy. Barium enema successfuly reduced IS.
CDC 'Split Type': WAES0710USA01435

Write-up: Information has been received from a physician concerning a male who on 11-SEP-2007 was vaccinated with a second oral dose of Rotateq. Concomitant therapy included sulfamethoxazole/trimethoprim (BACTRIM) for an ear infection. Subsequently the patient experienced intussusception. The patient was taken to the emergency room and was treated with an air enema reduction. It was reported that the patient recovered. The patient''s intussusception was considered to be immediately life-threatening by the reporter. Additional information has been requested. 10/18/2007 Vax record recieved and info updated in VAERS database. 10/30/2007 MR received for hospital DOS 9/27-30/2007 for D/C DX of Reduced Intussusception on air enema. Infant presented to the ER with intractable vomiting and dark, bloody bowel movements as well as excessive sleep. PE (+) for lack of bowel sounds, lethargy, and depressed fontenelle. (+) Currant jelly stool in ER. Barium enema successfuly reduced IS.

---

Changed on 5/13/2013

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B11UAB / 1	LL / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER	0078U / 1	LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH	B265108 / 1	RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	0770U / 1	- / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	0770U / 1	- / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema, Computerised tomogram abnormal, Haematochezia, Hypersomnia, Intussusception, Lethargy, Lymphadenopathy, Vomiting, Fontanelle depressed, Gastrointestinal sounds abnormal

Life Threatening? Yes
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: BACTRIM
Current Illness: Ear infection
Preexisting Conditions: PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: CT scan (+) for IS down to the level of the sigmoid colon and lymphadenopathy. Barium enema successfuly reduced IS.
CDC 'Split Type': WAES0710USA01435

Write-up: Information has been received from a physician concerning a male who on 11-SEP-2007 was vaccinated with a second oral dose of Rotateq. Concomitant therapy included sulfamethoxazole/trimethoprim (BACTRIM) for an ear infection. Subsequently the patient experienced intussusception. The patient was taken to the emergency room and was treated with an air enema reduction. It was reported that the patient recovered. The patient''s intussusception was considered to be immediately life-threatening by the reporter. Additional information has been requested. 10/18/2007 Vax record recieved and info updated in VAERS database. 10/30/2007 MR received for hospital DOS 9/27-30/2007 for D/C DX of Reduced Intussusception on air enema. Infant presented to the ER with intractable vomiting and dark, bloody bowel movements as well as excessive sleep. PE (+) for lack of bowel sounds, lethargy, and depressed fontenelle. (+) Currant jelly stool in ER. Barium enema successfuly reduced IS.

---

Changed on 2/14/2017

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B11UAB / 1	LL / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER	0078U / 1	LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH	B265108 / 1	RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	0770U / 1	- / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema, Computerised tomogram abnormal, Haematochezia, Hypersomnia, Intussusception, Lethargy, Lymphadenopathy, Vomiting, Fontanelle depressed, Gastrointestinal sounds abnormal

Life Threatening? Yes
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: BACTRIM
Current Illness: Ear infection
Preexisting Conditions: PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: CT scan (+) for IS down to the level of the sigmoid colon and lymphadenopathy. Barium enema successfuly reduced IS.
CDC 'Split Type': WAES0710USA01435

Write-up: Information has been received from a physician concerning a male who on 11-SEP-2007 was vaccinated with a second oral dose of Rotateq. Concomitant therapy included sulfamethoxazole/trimethoprim (BACTRIM) for an ear infection. Subsequently the patient experienced intussusception. The patient was taken to the emergency room and was treated with an air enema reduction. It was reported that the patient recovered. The patient''s intussusception was considered to be immediately life-threatening by the reporter. Additional information has been requested. 10/18/2007 Vax record recieved and info updated in VAERS database. 10/30/2007 MR received for hospital DOS 9/27-30/2007 for D/C DX of Reduced Intussusception on air enema. Infant presented to the ER with intractable vomiting and dark, bloody bowel movements as well as excessive sleep. PE (+) for lack of bowel sounds, lethargy, and depressed fontenelle. (+) Currant jelly stool in ER. Barium enema successfuly reduced IS.

---

Changed on 9/14/2017

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B11UAB / 1 2	LL / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER	0078U / 1 2	LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH	B265108 / 1 2	RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	0770U / 1 2	- MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception

Life Threatening? Yes
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: BACTRIM
Current Illness: Ear infection
Preexisting Conditions: PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: CT scan (+) for IS down to the level of the sigmoid colon and lymphadenopathy. Barium enema successfuly reduced IS.
CDC 'Split Type': WAES0710USA01435

Write-up: Information has been received from a physician concerning a male who on 11-SEP-2007 was vaccinated with a second oral dose of Rotateq. Concomitant therapy included sulfamethoxazole/trimethoprim (BACTRIM) for an ear infection. Subsequently the patient experienced intussusception. The patient was taken to the emergency room and was treated with an air enema reduction. It was reported that the patient recovered. The patient''s intussusception was considered to be immediately life-threatening by the reporter. Additional information has been requested. 10/18/2007 Vax record recieved and info updated in VAERS database. 10/30/2007 MR received for hospital DOS 9/27-30/2007 for D/C DX of Reduced Intussusception on air enema. Infant presented to the ER with intractable vomiting and dark, bloody bowel movements as well as excessive sleep. PE (+) for lack of bowel sounds, lethargy, and depressed fontenelle. (+) Currant jelly stool in ER. Barium enema successfuly reduced IS.

---

Changed on 2/14/2018

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B11UAB / 2	LL / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER	0078U / 2	LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH	B265108 / 2	RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	0770U / 2	MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception

Life Threatening? Yes
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: BACTRIM
Current Illness: Ear infection
Preexisting Conditions: PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: CT scan (+) for IS down to the level of the sigmoid colon and lymphadenopathy. Barium enema successfuly reduced IS.
CDC 'Split Type': WAES0710USA01435

Write-up: Information has been received from a physician concerning a male who on 11-SEP-2007 was vaccinated with a second oral dose of Rotateq. Concomitant therapy included sulfamethoxazole/trimethoprim (BACTRIM) for an ear infection. Subsequently the patient experienced intussusception. The patient was taken to the emergency room and was treated with an air enema reduction. It was reported that the patient recovered. The patient''s intussusception was considered to be immediately life-threatening by the reporter. Additional information has been requested. 10/18/2007 Vax record recieved and info updated in VAERS database. 10/30/2007 MR received for hospital DOS 9/27-30/2007 for D/C DX of Reduced Intussusception on air enema. Infant presented to the ER with intractable vomiting and dark, bloody bowel movements as well as excessive sleep. PE (+) for lack of bowel sounds, lethargy, and depressed fontenelle. (+) Currant jelly stool in ER. Barium enema successfuly reduced IS.

---

Changed on 6/14/2018

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B11UAB / 2	LL / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER	0078U / 2	LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH	B265108 / 2	RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	0770U / 2	MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception

Life Threatening? Yes
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: BACTRIM
Current Illness: Ear infection
Preexisting Conditions: PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: CT scan (+) for IS down to the level of the sigmoid colon and lymphadenopathy. Barium enema successfuly reduced IS.
CDC 'Split Type': WAES0710USA01435

Write-up: Information has been received from a physician concerning a male who on 11-SEP-2007 was vaccinated with a second oral dose of Rotateq. Concomitant therapy included sulfamethoxazole/trimethoprim (BACTRIM) for an ear infection. Subsequently the patient experienced intussusception. The patient was taken to the emergency room and was treated with an air enema reduction. It was reported that the patient recovered. The patient''s intussusception was considered to be immediately life-threatening by the reporter. Additional information has been requested. 10/18/2007 Vax record recieved and info updated in VAERS database. 10/30/2007 MR received for hospital DOS 9/27-30/2007 for D/C DX of Reduced Intussusception on air enema. Infant presented to the ER with intractable vomiting and dark, bloody bowel movements as well as excessive sleep. PE (+) for lack of bowel sounds, lethargy, and depressed fontenelle. (+) Currant jelly stool in ER. Barium enema successfuly reduced IS.

---

Changed on 8/14/2018

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B11UAB / 2	LL / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER	0078U / 2	LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH	B265108 / 2	RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	0770U / 2	MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception

Life Threatening? Yes
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: BACTRIM
Current Illness: Ear infection
Preexisting Conditions: PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: CT scan (+) for IS down to the level of the sigmoid colon and lymphadenopathy. Barium enema successfuly reduced IS.
CDC 'Split Type': WAES0710USA01435

Write-up: Information has been received from a physician concerning a male who on 11-SEP-2007 was vaccinated with a second oral dose of Rotateq. Concomitant therapy included sulfamethoxazole/trimethoprim (BACTRIM) for an ear infection. Subsequently the patient experienced intussusception. The patient was taken to the emergency room and was treated with an air enema reduction. It was reported that the patient recovered. The patient''s intussusception was considered to be immediately life-threatening by the reporter. Additional information has been requested. 10/18/2007 Vax record recieved and info updated in VAERS database. 10/30/2007 MR received for hospital DOS 9/27-30/2007 for D/C DX of Reduced Intussusception on air enema. Infant presented to the ER with intractable vomiting and dark, bloody bowel movements as well as excessive sleep. PE (+) for lack of bowel sounds, lethargy, and depressed fontenelle. (+) Currant jelly stool in ER. Barium enema successfuly reduced IS.

---

Changed on 9/14/2018

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B11UAB / 2	LL / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER	0078U / 2	LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH	B265108 / 2	RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	0770U / 2	MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception

Life Threatening? Yes
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: BACTRIM
Current Illness: Ear infection
Preexisting Conditions: PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: CT scan (+) for IS down to the level of the sigmoid colon and lymphadenopathy. Barium enema successfuly reduced IS.
CDC 'Split Type': WAES0710USA01435

Write-up: Information has been received from a physician concerning a male who on 11-SEP-2007 was vaccinated with a second oral dose of Rotateq. Concomitant therapy included sulfamethoxazole/trimethoprim (BACTRIM) for an ear infection. Subsequently the patient experienced intussusception. The patient was taken to the emergency room and was treated with an air enema reduction. It was reported that the patient recovered. The patient''s intussusception was considered to be immediately life-threatening by the reporter. Additional information has been requested. 10/18/2007 Vax record recieved and info updated in VAERS database. 10/30/2007 MR received for hospital DOS 9/27-30/2007 for D/C DX of Reduced Intussusception on air enema. Infant presented to the ER with intractable vomiting and dark, bloody bowel movements as well as excessive sleep. PE (+) for lack of bowel sounds, lethargy, and depressed fontenelle. (+) Currant jelly stool in ER. Barium enema successfuly reduced IS.

---

Changed on 10/14/2018

Vaccin­ation / Manu­facturer	Lot / Dose	Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS	AC21B11UAB / 2	LL / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER	0078U / 2	LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH	B265108 / 2	RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.	0770U / 2	MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception

Life Threatening? Yes
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: BACTRIM
Current Illness: Ear infection
Preexisting Conditions: PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: CT scan (+) for IS down to the level of the sigmoid colon and lymphadenopathy. Barium enema successfuly reduced IS.
CDC 'Split Type': WAES0710USA01435

Write-up: Information has been received from a physician concerning a male who on 11-SEP-2007 was vaccinated with a second oral dose of Rotateq. Concomitant therapy included sulfamethoxazole/trimethoprim (BACTRIM) for an ear infection. Subsequently the patient experienced intussusception. The patient was taken to the emergency room and was treated with an air enema reduction. It was reported that the patient recovered. The patient''s intussusception was considered to be immediately life-threatening by the reporter. Additional information has been requested. 10/18/2007 Vax record recieved and info updated in VAERS database. 10/30/2007 MR received for hospital DOS 9/27-30/2007 for D/C DX of Reduced Intussusception on air enema. Infant presented to the ER with intractable vomiting and dark, bloody bowel movements as well as excessive sleep. PE (+) for lack of bowel sounds, lethargy, and depressed fontenelle. (+) Currant jelly stool in ER. Barium enema successfuly reduced IS.

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