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This is VAERS ID 294451

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 294451
VAERS Form:
Age:0.3
Gender:Male
Location:Virginia
Vaccinated:2007-09-12
Onset:2007-10-21
Submitted:2007-10-22
Entered:2007-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2651AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF116AC / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0873 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B54007F / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1052U / - - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Appendicectomy, Haematochezia, Intussusception, Enema administration, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Colic
Allergies:
Diagnostic Lab Data: Seen at hospital 10/21/07.
CDC 'Split Type':

Write-up: Infant hospitalized for intussusception on 10/21/07-Rotateq given on 7/11/07 and 9/12/07.

Changed on 12/8/2009

VAERS ID: 294451 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Virginia
Vaccinated:2007-09-12
Onset:2007-10-21
Submitted:2007-10-22
Entered:2007-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2651AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF116AC / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0873 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B54007F / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1052U / - - / PO

Administered by: Private      Purchased by: Unknown Private
Symptoms: Appendicectomy, Haematochezia, Intussusception, Surgery, Vomiting, White blood cell count increased, X-ray abnormal, Enema administration, Platelet count increased, Monocyte percentage increased, 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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Colic
Allergies:
Diagnostic Lab Data: Seen at hospital 10/21/07. LABS: Abdominal x-ray abnormal, BE/air enema revealed IS. WBC 19.9 (H), platelets 502,000 (H), monos 12% (H)
CDC 'Split Type':

Write-up: Infant hospitalized for intussusception on 10/21/07-Rotateq given on 7/11/07 and 9/12/07. 10/26/07 Received vax record from reporter which provides RO dose #2 & lot #. VAERS database updated w/same. Record faxed to CDC. 11/13/07 Linked w/296061. 12/4/07 Reviewed hospital medical records which reveal patient experienced vomiting & bloody stools. Admitted 10/21-10/23/2007. BE/air enema diagnosed IS but unable to completely reduce. Did well post operatively & d/c to home. FINAL DX: Intussusception, surgically reduced & appendectomy. Records faxed to CDC.

Changed on 3/2/2010

VAERS ID: 294451 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Virginia
Vaccinated:2007-09-12
Onset:2007-10-21
Submitted:2007-10-22
Entered:2007-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2651AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF116AC / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0873 / 1 RL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B54007F / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1052U / - - / PO

Administered by: Private      Purchased by: Private
Symptoms: Appendicectomy, Haematochezia, Intussusception, Surgery, Vomiting, White blood cell count increased, X-ray abnormal, Enema administration, Platelet count increased, Monocyte percentage increased, 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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Colic
Allergies:
Diagnostic Lab Data: Seen at hospital 10/21/07. LABS: Abdominal x-ray abnormal, BE/air enema revealed IS. WBC 19.9 (H), platelets 502,000 (H), monos 12% (H)
CDC 'Split Type':

Write-up: Infant hospitalized for intussusception on 10/21/07-Rotateq given on 7/11/07 and 9/12/07. 10/26/07 Received vax record from reporter which provides RO dose #2 & lot #. VAERS database updated w/same. Record faxed to CDC. 11/13/07 Linked w/296061. 12/4/07 Reviewed hospital medical records which reveal patient experienced vomiting & bloody stools. Admitted 10/21-10/23/2007. BE/air enema diagnosed IS but unable to completely reduce. Did well post operatively & d/c to home. FINAL DX: Intussusception, surgically reduced & appendectomy. Records faxed to CDC.

Changed on 4/7/2010

VAERS ID: 294451 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Virginia
Vaccinated:2007-09-12
Onset:2007-10-21
Submitted:2007-10-22
Entered:2007-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2651AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF116AC / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0873 / 1 RL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B54007F / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1052U / - - / PO

Administered by: Private      Purchased by: Private
Symptoms: Appendicectomy, Haematochezia, Intussusception, Surgery, Vomiting, White blood cell count increased, X-ray abnormal, Enema administration, Platelet count increased, Monocyte percentage increased, 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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Colic
Allergies:
Diagnostic Lab Data: Seen at hospital 10/21/07. LABS: Abdominal x-ray abnormal, BE/air enema revealed IS. WBC 19.9 (H), platelets 502,000 (H), monos 12% (H)
CDC 'Split Type':

Write-up: Infant hospitalized for intussusception on 10/21/07-Rotateq given on 7/11/07 and 9/12/07. 10/26/07 Received vax record from reporter which provides RO dose #2 & lot #. VAERS database updated w/same. Record faxed to CDC. 11/13/07 Linked w/296061. 12/4/07 Reviewed hospital medical records which reveal patient experienced vomiting & bloody stools. Admitted 10/21-10/23/2007. BE/air enema diagnosed IS but unable to completely reduce. Did well post operatively & d/c to home. FINAL DX: Intussusception, surgically reduced & appendectomy. Records faxed to CDC.

Changed on 8/31/2010

VAERS ID: 294451 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Virginia
Vaccinated:2007-09-12
Onset:2007-10-21
Submitted:2007-10-22
Entered:2007-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2651AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF116AC / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0873 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B54007F / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1052U / - - / PO

Administered by: Private      Purchased by: Private
Symptoms: Appendicectomy, Haematochezia, Intussusception, Surgery, Vomiting, White blood cell count increased, X-ray abnormal, Enema administration, Platelet count increased, Monocyte percentage increased, 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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Colic
Allergies:
Diagnostic Lab Data: Seen at hospital 10/21/07. LABS: Abdominal x-ray abnormal, BE/air enema revealed IS. WBC 19.9 (H), platelets 502,000 (H), monos 12% (H)
CDC 'Split Type':

Write-up: Infant hospitalized for intussusception on 10/21/07-Rotateq given on 7/11/07 and 9/12/07. 10/26/07 Received vax record from reporter which provides RO dose #2 & lot #. VAERS database updated w/same. Record faxed to CDC. 11/13/07 Linked w/296061. 12/4/07 Reviewed hospital medical records which reveal patient experienced vomiting & bloody stools. Admitted 10/21-10/23/2007. BE/air enema diagnosed IS but unable to completely reduce. Did well post operatively & d/c to home. FINAL DX: Intussusception, surgically reduced & appendectomy. Records faxed to CDC.

Changed on 5/13/2013

VAERS ID: 294451 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Virginia
Vaccinated:2007-09-12
Onset:2007-10-21
Submitted:2007-10-22
Entered:2007-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2651AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF116AC / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0873 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54007F / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1052U / - - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1052U / - - / PO

Administered by: Private      Purchased by: Private
Symptoms: Appendicectomy, Haematochezia, Intussusception, Surgery, Vomiting, White blood cell count increased, X-ray abnormal, Enema administration, Platelet count increased, Monocyte percentage increased, 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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Colic
Allergies:
Diagnostic Lab Data: Seen at hospital 10/21/07. LABS: Abdominal x-ray abnormal, BE/air enema revealed IS. WBC 19.9 (H), platelets 502,000 (H), monos 12% (H)
CDC 'Split Type':

Write-up: Infant hospitalized for intussusception on 10/21/07-Rotateq given on 7/11/07 and 9/12/07. 10/26/07 Received vax record from reporter which provides RO dose #2 & lot #. VAERS database updated w/same. Record faxed to CDC. 11/13/07 Linked w/296061. 12/4/07 Reviewed hospital medical records which reveal patient experienced vomiting & bloody stools. Admitted 10/21-10/23/2007. BE/air enema diagnosed IS but unable to completely reduce. Did well post operatively & d/c to home. FINAL DX: Intussusception, surgically reduced & appendectomy. Records faxed to CDC.

Changed on 2/14/2017

VAERS ID: 294451 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Virginia
Vaccinated:2007-09-12
Onset:2007-10-21
Submitted:2007-10-22
Entered:2007-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2651AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF116AC / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0873 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54007F / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1052U / - - / PO

Administered by: Private      Purchased by: Private
Symptoms: Appendicectomy, Haematochezia, Intussusception, Surgery, Vomiting, White blood cell count increased, X-ray abnormal, Enema administration, Platelet count increased, Monocyte percentage increased, 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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Colic
Allergies:
Diagnostic Lab Data: Seen at hospital 10/21/07. LABS: Abdominal x-ray abnormal, BE/air enema revealed IS. WBC 19.9 (H), platelets 502,000 (H), monos 12% (H)
CDC 'Split Type':

Write-up: Infant hospitalized for intussusception on 10/21/07-Rotateq given on 7/11/07 and 9/12/07. 10/26/07 Received vax record from reporter which provides RO dose #2 & lot #. VAERS database updated w/same. Record faxed to CDC. 11/13/07 Linked w/296061. 12/4/07 Reviewed hospital medical records which reveal patient experienced vomiting & bloody stools. Admitted 10/21-10/23/2007. BE/air enema diagnosed IS but unable to completely reduce. Did well post operatively & d/c to home. FINAL DX: Intussusception, surgically reduced & appendectomy. Records faxed to CDC.

Changed on 9/14/2017

VAERS ID: 294451 Before After
VAERS Form:(blank) 1
Age:0.3
Gender:Male
Location:Virginia
Vaccinated:2007-09-12
Onset:2007-10-21
Submitted:2007-10-22
Entered:2007-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2651AA / 1 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF116AC / 1 2 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0873 / 1 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54007F / 1 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1052U / - UNK - MO / PO

Administered by: Private      Purchased by: Private
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Colic
Allergies:
Diagnostic Lab Data: Seen at hospital 10/21/07. LABS: Abdominal x-ray abnormal, BE/air enema revealed IS. WBC 19.9 (H), platelets 502,000 (H), monos 12% (H)
CDC 'Split Type':

Write-up: Infant hospitalized for intussusception on 10/21/07-Rotateq given on 7/11/07 and 9/12/07. 10/26/07 Received vax record from reporter which provides RO dose #2 & lot #. VAERS database updated w/same. Record faxed to CDC. 11/13/07 Linked w/296061. 12/4/07 Reviewed hospital medical records which reveal patient experienced vomiting & bloody stools. Admitted 10/21-10/23/2007. BE/air enema diagnosed IS but unable to completely reduce. Did well post operatively & d/c to home. FINAL DX: Intussusception, surgically reduced & appendectomy. Records faxed to CDC.

Changed on 2/14/2018

VAERS ID: 294451 Before After
VAERS Form:1
Age:0.3
Gender:Male
Location:Virginia
Vaccinated:2007-09-12
Onset:2007-10-21
Submitted:2007-10-22
Entered:2007-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2651AA / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF116AC / 2 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0873 / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54007F / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1052U / UNK MO / PO

Administered by: Private      Purchased by: Private
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Colic
Allergies:
Diagnostic Lab Data: Seen at hospital 10/21/07. LABS: Abdominal x-ray abnormal, BE/air enema revealed IS. WBC 19.9 (H), platelets 502,000 (H), monos 12% (H)
CDC 'Split Type':

Write-up: Infant hospitalized for intussusception on 10/21/07-Rotateq given on 7/11/07 and 9/12/07. 10/26/07 Received vax record from reporter which provides RO dose #2 & lot #. VAERS database updated w/same. Record faxed to CDC. 11/13/07 Linked w/296061. 12/4/07 Reviewed hospital medical records which reveal patient experienced vomiting & bloody stools. Admitted 10/21-10/23/2007. BE/air enema diagnosed IS but unable to completely reduce. Did well post operatively & d/c to home. FINAL DX: Intussusception, surgically reduced & appendectomy. Records faxed to CDC.

Changed on 6/14/2018

VAERS ID: 294451 Before After
VAERS Form:1
Age:0.3
Gender:Male
Location:Virginia
Vaccinated:2007-09-12
Onset:2007-10-21
Submitted:2007-10-22
Entered:2007-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2651AA / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF116AC / 2 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Z0873 / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54007F / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1052U / UNK MO / PO

Administered by: Private      Purchased by: Private
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Colic
Allergies:
Diagnostic Lab Data: Seen at hospital 10/21/07. LABS: Abdominal x-ray abnormal, BE/air enema revealed IS. WBC 19.9 (H), platelets 502,000 (H), monos 12% (H)
CDC 'Split Type':

Write-up: Infant hospitalized for intussusception on 10/21/07-Rotateq given on 7/11/07 and 9/12/07. 10/26/07 Received vax record from reporter which provides RO dose #2 & lot #. VAERS database updated w/same. Record faxed to CDC. 11/13/07 Linked w/296061. 12/4/07 Reviewed hospital medical records which reveal patient experienced vomiting & bloody stools. Admitted 10/21-10/23/2007. BE/air enema diagnosed IS but unable to completely reduce. Did well post operatively & d/c to home. FINAL DX: Intussusception, surgically reduced & appendectomy. Records faxed to CDC.

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