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VAERS ID: | 293751 |
VAERS Form: | |
Age: | 0.4 |
Sex: | Male |
Location: | Illinois |
Vaccinated: | 2007-08-13 |
Onset: | 2007-09-16 |
Submitted: | 2007-10-12 |
Entered: | 2007-10-19 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B137BA / 1 | RL / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 02564 / 1 | LL / IM |
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC | B08692D / 1 | LL / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0694F / 1 | - / PO |
Administered by: Private Purchased by: Unknown
Symptoms: Barium enema abnormal, Haematochezia, Intussusception, Irritability, Neutrophil percentage increased
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: 1
Write-up: Rotateq vaccine given 8-13-07. Infant diagnosed and treated for intussusception 9/16/07.
Vaccinated: | 2007-08-13 |
Onset: | 2007-09-16 |
Submitted: | 2007-10-12 |
Entered: | 2007-10-19 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B137BA / 1 | RL / IM |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B137BA / 1 | RL / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 02564 / 1 | LL / IM |
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC | B08692D / 1 | LL / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0694F / 1 | - / PO |
Administered by: Private Purchased by: Unknown Public
Symptoms: Barium enema abnormal, Haematochezia, Intussusception, Irritability, Vomiting, X-ray with contrast upper gastrointestinal tract, Neutrophil percentage increased
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: 1
Write-up: Rotateq vaccine given 8-13-07. Infant diagnosed and treated for intussusception 9/16/07. 9/16/07.12/10/07-records received for DOS 9/16/07-DC DX: Intussusception. Barium enema reduction of colo-colonic intussusception with reflux of contrast into the terminal ileum. C/O vomiting and blood stools. Fussy.
Vaccinated: | 2007-08-13 |
Onset: | 2007-09-16 |
Submitted: | 2007-10-12 |
Entered: | 2007-10-19 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B137BA / 1 | RL / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 02564 / 1 | LL / IM |
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC | B08692D / 1 | LL / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0694F / 1 | - / PO |
Administered by: Private Purchased by: Public
Symptoms: Barium enema abnormal, Haematochezia, Intussusception, Irritability, Vomiting, X-ray with contrast upper gastrointestinal tract, Neutrophil percentage increased
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: 1
Write-up: Rotateq vaccine given 8-13-07. Infant diagnosed and treated for intussusception 9/16/07.12/10/07-records received for DOS 9/16/07-DC DX: Intussusception. Barium enema reduction of colo-colonic intussusception with reflux of contrast into the terminal ileum. C/O vomiting and blood stools. Fussy.
Vaccinated: | 2007-08-13 |
Onset: | 2007-09-16 |
Submitted: | 2007-10-12 |
Entered: | 2007-10-19 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B137BA / 1 | RL / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 02564 / 1 | LL / IM |
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC | B08692D / 1 | LL / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0694F / 1 | - / PO |
Administered by: Private Purchased by: Public
Symptoms: Barium enema abnormal, Haematochezia, Intussusception, Irritability, Vomiting, X-ray with contrast upper gastrointestinal tract, Neutrophil percentage increased
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: 1
Write-up: Rotateq vaccine given 8-13-07. Infant diagnosed and treated for intussusception 9/16/07.12/10/07-records received for DOS 9/16/07-DC DX: Intussusception. Barium enema reduction of colo-colonic intussusception with reflux of contrast into the terminal ileum. C/O vomiting and blood stools. Fussy.
Vaccinated: | 2007-08-13 |
Onset: | 2007-09-16 |
Submitted: | 2007-10-12 |
Entered: | 2007-10-19 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B137BA / 1 | RL / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 02564 / 1 | LL / IM |
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH | B08692D / 1 | LL / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0694F / 1 | - / PO |
Administered by: Private Purchased by: Public
Symptoms: Barium enema abnormal, Haematochezia, Intussusception, Irritability, Vomiting, X-ray with contrast upper gastrointestinal tract, Neutrophil percentage increased
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: 1
Write-up: Rotateq vaccine given 8-13-07. Infant diagnosed and treated for intussusception 9/16/07.12/10/07-records received for DOS 9/16/07-DC DX: Intussusception. Barium enema reduction of colo-colonic intussusception with reflux of contrast into the terminal ileum. C/O vomiting and blood stools. Fussy.
Vaccinated: | 2007-08-13 |
Onset: | 2007-09-16 |
Submitted: | 2007-10-12 |
Entered: | 2007-10-19 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B137BA / 1 | RL / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 02564 / 1 | LL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B08692D / 1 | LL / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0694F / 1 | - / PO |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0694F / 1 | - / PO |
Administered by: Private Purchased by: Public
Symptoms: Barium enema abnormal, Haematochezia, Intussusception, Irritability, Vomiting, X-ray with contrast upper gastrointestinal tract, Neutrophil percentage increased
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: 1
Write-up: Rotateq vaccine given 8-13-07. Infant diagnosed and treated for intussusception 9/16/07.12/10/07-records received for DOS 9/16/07-DC DX: Intussusception. Barium enema reduction of colo-colonic intussusception with reflux of contrast into the terminal ileum. C/O vomiting and blood stools. Fussy.
Vaccinated: | 2007-08-13 |
Onset: | 2007-09-16 |
Submitted: | 2007-10-12 |
Entered: | 2007-10-19 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B137BA / 1 | RL / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 02564 / 1 | LL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B08692D / 1 | LL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0694F / 1 | - / PO |
Administered by: Private Purchased by: Public
Symptoms: Barium enema abnormal, Haematochezia, Intussusception, Irritability, Vomiting, X-ray with contrast upper gastrointestinal tract, Neutrophil percentage increased
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: 1
Write-up: Rotateq vaccine given 8-13-07. Infant diagnosed and treated for intussusception 9/16/07.12/10/07-records received for DOS 9/16/07-DC DX: Intussusception. Barium enema reduction of colo-colonic intussusception with reflux of contrast into the terminal ileum. C/O vomiting and blood stools. Fussy.
Vaccinated: | 2007-08-13 |
Onset: | 2007-09-16 |
Submitted: | 2007-10-12 |
Entered: | 2007-10-19 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B137BA / 1 2 | RL / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 02564 / 1 2 | LL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B08692D / 1 2 | LL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0694F / 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: 1
Write-up: Rotateq vaccine given 8-13-07. Infant diagnosed and treated for intussusception 9/16/07.12/10/07-records received for DOS 9/16/07-DC DX: Intussusception. Barium enema reduction of colo-colonic intussusception with reflux of contrast into the terminal ileum. C/O vomiting and blood stools. Fussy.
Vaccinated: | 2007-08-13 |
Onset: | 2007-09-16 |
Submitted: | 2007-10-12 |
Entered: | 2007-10-19 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B137BA / 2 | RL / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 02564 / 2 | LL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B08692D / 2 | LL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0694F / 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: 1
Write-up: Rotateq vaccine given 8-13-07. Infant diagnosed and treated for intussusception 9/16/07.12/10/07-records received for DOS 9/16/07-DC DX: Intussusception. Barium enema reduction of colo-colonic intussusception with reflux of contrast into the terminal ileum. C/O vomiting and blood stools. Fussy.
Vaccinated: | 2007-08-13 |
Onset: | 2007-09-16 |
Submitted: | 2007-10-12 |
Entered: | 2007-10-19 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B137BA / 2 | RL / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 02564 / 2 | LL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B08692D / 2 | LL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0694F / 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: 1
Write-up: Rotateq vaccine given 8-13-07. Infant diagnosed and treated for intussusception 9/16/07.12/10/07-records received for DOS 9/16/07-DC DX: Intussusception. Barium enema reduction of colo-colonic intussusception with reflux of contrast into the terminal ileum. C/O vomiting and blood stools. Fussy.
Vaccinated: | 2007-08-13 |
Onset: | 2007-09-16 |
Submitted: | 2007-10-12 |
Entered: | 2007-10-19 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B137BA / 2 | RL / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 02564 / 2 | LL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B08692D / 2 | LL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0694F / 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: 1
Write-up: Rotateq vaccine given 8-13-07. Infant diagnosed and treated for intussusception 9/16/07.12/10/07-records received for DOS 9/16/07-DC DX: Intussusception. Barium enema reduction of colo-colonic intussusception with reflux of contrast into the terminal ileum. C/O vomiting and blood stools. Fussy.
Vaccinated: | 2007-08-13 |
Onset: | 2007-09-16 |
Submitted: | 2007-10-12 |
Entered: | 2007-10-19 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B137BA / 2 | RL / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 02564 / 2 | LL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B08692D / 2 | LL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0694F / 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: 1
Write-up: Rotateq vaccine given 8-13-07. Infant diagnosed and treated for intussusception 9/16/07.12/10/07-records received for DOS 9/16/07-DC DX: Intussusception. Barium enema reduction of colo-colonic intussusception with reflux of contrast into the terminal ileum. C/O vomiting and blood stools. Fussy.
Vaccinated: | 2007-08-13 |
Onset: | 2007-09-16 |
Submitted: | 2007-10-12 |
Entered: | 2007-10-19 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B137BA / 2 | RL / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 02564 / 2 | LL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B08692D / 2 | LL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0694F / 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: 1
Write-up: Rotateq vaccine given 8-13-07. Infant diagnosed and treated for intussusception 9/16/07.12/10/07-records received for DOS 9/16/07-DC DX: Intussusception. Barium enema reduction of colo-colonic intussusception with reflux of contrast into the terminal ileum. C/O vomiting and blood stools. Fussy.
Vaccinated: | 2007-08-13 |
Onset: | 2007-09-16 |
Submitted: | 2007-10-12 |
Entered: | 2007-10-19 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B137BA / 2 | RL / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 02564 / 2 | LL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B08692D / 2 | LL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0694F / 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: 1
Write-up: Rotateq vaccine given 8-13-07. Infant diagnosed and treated for intussusception 9/16/07.12/10/07-records received for DOS 9/16/07-DC DX: Intussusception. Barium enema reduction of colo-colonic intussusception with reflux of contrast into the terminal ileum. C/O vomiting and blood stools. Fussy.
Vaccinated: | 2007-08-13 |
Onset: | 2007-09-16 |
Submitted: | 2007-10-12 |
Entered: | 2007-10-19 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS | AC21B137BA / 2 | RL / IM |
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. | 02564 / 2 | LL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | B08692D / 2 | LL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0694F / 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: 1
Write-up: Rotateq vaccine given 8-13-07. Infant diagnosed and treated for intussusception 9/16/07.12/10/07-records received for DOS 9/16/07-DC DX: Intussusception. Barium enema reduction of colo-colonic intussusception with reflux of contrast into the terminal ileum. C/O vomiting and blood stools. Fussy.
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