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This is VAERS ID 294997

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 294997
VAERS Form:
Age:0.3
Gender:Male
Location:Kentucky
Vaccinated:2007-10-05
Onset:2007-10-07
Submitted:2007-10-30
Entered:2007-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0079U / 1 LL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B53981A / 1 LL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0669U / 1 - / PO

Administered by: Other      Purchased by: Unknown
Symptoms: Appendicectomy, Blood gases abnormal, Haematochezia, Enema administration, Explorative laparotomy

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: 2     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Unknown
Current Illness: 1/29/08-records received- Recent hospitalization for gastroenteritis one week prior to this admission. seen in office for C/O de
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Information has been received from a physician concerning a 4 month old male who on 06-OCT-2007 was vaccinated p.o. with a dose (/"1 tube/") of Rotateq. On 07-OCT-2007 the patient experienced bloody stools and was hospitalized due to intussusception on th"e same day. The patient''''s diagnosis was considered to be immediately life threatening. The intussusception was corrected with surgery. No other information was available. Unspecified medical attention was sought. The outcome was reported as recovered. Th


Changed on 12/8/2009

VAERS ID: 294997 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Kentucky
Vaccinated:2007-10-05
Onset:2007-10-07
Submitted:2007-10-30
Entered:2007-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0079U / 1 LL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B53981A / 1 LL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0669U / 1 - / PO

Administered by: Other      Purchased by: Unknown Other
Symptoms: Appendicectomy, Blood gases abnormal, Haematochezia, Intussusception, Nausea, Vomiting, White blood cell count increased, Enema administration, Explorative laparotomy, Abdominal X-ray

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: 2     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Unknown
Current Illness: 1/29/08-records received- Recent hospitalization for gastroenteritis one week prior to this admission. seen in office for C/O de
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 1/29/08-records received-WBC 21.9. Air contrast enema. 9/27/07-flat and upright of abdomen x-ray:abnormal bowel stool and gas pattern with mulitple air filled loops of bowel with air-fluid levels unidentified.
CDC 'Split Type': (blank) WAES0710USA04368

Write-up: Information has been received from a physician concerning a 4 month old male who on 06-OCT-2007 was vaccinated p.o. with a dose (/"1 tube/") ("1 tube") of Rotateq. On 07-OCT-2007 the patient experienced bloody stools and was hospitalized due to intussusception on th"e the same day. The patient''''s patient''s diagnosis was considered to be immediately life threatening. The intussusception was corrected with surgery. No other information was available. Unspecified medical attention was sought. The outcome was reported as recovered. Th There was no product quality complaint. The event was considered to be an other important medical event by the reporter. Additional information has been requested. 9/27/07- Seen on 10/5/07-visit after hospitalization for gastroenteritis. 1/29/08-records received for DOS 10/7-10/9/07-DC DX: Intussusception status post reduction with exploratory laparotomy, manual reduction and incidental appendectomy. C/O nausea, vomiting and bloody stools times 1 day.


Changed on 3/2/2010

VAERS ID: 294997 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Kentucky
Vaccinated:2007-10-05
Onset:2007-10-07
Submitted:2007-10-30
Entered:2007-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0079U / 1 LL / -
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B53981A / 1 LL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0669U / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Appendicectomy, Blood gases abnormal, Haematochezia, Intussusception, Nausea, Vomiting, White blood cell count increased, Enema administration, Explorative laparotomy, Abdominal X-ray

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: 2     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Unknown
Current Illness: 1/29/08-records received- Recent hospitalization for gastroenteritis one week prior to this admission. seen in office for C/O de
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 1/29/08-records received-WBC 21.9. Air contrast enema. 9/27/07-flat and upright of abdomen x-ray:abnormal bowel stool and gas pattern with mulitple air filled loops of bowel with air-fluid levels unidentified.
CDC 'Split Type': WAES0710USA04368

Write-up: Information has been received from a physician concerning a 4 month old male who on 06-OCT-2007 was vaccinated p.o. with a dose ("1 tube") of Rotateq. On 07-OCT-2007 the patient experienced bloody stools and was hospitalized due to intussusception on the same day. The patient''s diagnosis was considered to be immediately life threatening. The intussusception was corrected with surgery. No other information was available. Unspecified medical attention was sought. The outcome was reported as recovered. There was no product quality complaint. The event was considered to be an other important medical event by the reporter. Additional information has been requested. 9/27/07- Seen on 10/5/07-visit after hospitalization for gastroenteritis. 1/29/08-records received for DOS 10/7-10/9/07-DC DX: Intussusception status post reduction with exploratory laparotomy, manual reduction and incidental appendectomy. C/O nausea, vomiting and bloody stools times 1 day.


Changed on 4/7/2010

VAERS ID: 294997 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Kentucky
Vaccinated:2007-10-05
Onset:2007-10-07
Submitted:2007-10-30
Entered:2007-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0079U / 1 LL / -
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B53981A / 1 LL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0669U / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Appendicectomy, Blood gases abnormal, Haematochezia, Intussusception, Nausea, Vomiting, White blood cell count increased, Enema administration, Explorative laparotomy, Abdominal X-ray

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: 2     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Unknown
Current Illness: 1/29/08-records received- Recent hospitalization for gastroenteritis one week prior to this admission. seen in office for C/O de
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 1/29/08-records received-WBC 21.9. Air contrast enema. 9/27/07-flat and upright of abdomen x-ray:abnormal bowel stool and gas pattern with mulitple air filled loops of bowel with air-fluid levels unidentified.
CDC 'Split Type': WAES0710USA04368

Write-up: Information has been received from a physician concerning a 4 month old male who on 06-OCT-2007 was vaccinated p.o. with a dose ("1 tube") of Rotateq. On 07-OCT-2007 the patient experienced bloody stools and was hospitalized due to intussusception on the same day. The patient''s diagnosis was considered to be immediately life threatening. The intussusception was corrected with surgery. No other information was available. Unspecified medical attention was sought. The outcome was reported as recovered. There was no product quality complaint. The event was considered to be an other important medical event by the reporter. Additional information has been requested. 9/27/07- Seen on 10/5/07-visit after hospitalization for gastroenteritis. 1/29/08-records received for DOS 10/7-10/9/07-DC DX: Intussusception status post reduction with exploratory laparotomy, manual reduction and incidental appendectomy. C/O nausea, vomiting and bloody stools times 1 day.


Changed on 8/31/2010

VAERS ID: 294997 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Kentucky
Vaccinated:2007-10-05
Onset:2007-10-07
Submitted:2007-10-30
Entered:2007-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0079U / 1 LL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B53981A / 1 LL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0669U / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Appendicectomy, Blood gases abnormal, Haematochezia, Intussusception, Nausea, Vomiting, White blood cell count increased, Enema administration, Explorative laparotomy, Abdominal X-ray

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: 2     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Unknown
Current Illness: 1/29/08-records received- Recent hospitalization for gastroenteritis one week prior to this admission. seen in office for C/O de
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 1/29/08-records received-WBC 21.9. Air contrast enema. 9/27/07-flat and upright of abdomen x-ray:abnormal bowel stool and gas pattern with mulitple air filled loops of bowel with air-fluid levels unidentified.
CDC 'Split Type': WAES0710USA04368

Write-up: Information has been received from a physician concerning a 4 month old male who on 06-OCT-2007 was vaccinated p.o. with a dose ("1 tube") of Rotateq. On 07-OCT-2007 the patient experienced bloody stools and was hospitalized due to intussusception on the same day. The patient''s diagnosis was considered to be immediately life threatening. The intussusception was corrected with surgery. No other information was available. Unspecified medical attention was sought. The outcome was reported as recovered. There was no product quality complaint. The event was considered to be an other important medical event by the reporter. Additional information has been requested. 9/27/07- Seen on 10/5/07-visit after hospitalization for gastroenteritis. 1/29/08-records received for DOS 10/7-10/9/07-DC DX: Intussusception status post reduction with exploratory laparotomy, manual reduction and incidental appendectomy. C/O nausea, vomiting and bloody stools times 1 day.


Changed on 5/13/2013

VAERS ID: 294997 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Kentucky
Vaccinated:2007-10-05
Onset:2007-10-07
Submitted:2007-10-30
Entered:2007-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0079U / 1 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B53981A / 1 LL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0669U / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0669U / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Appendicectomy, Blood gases abnormal, Haematochezia, Intussusception, Nausea, Vomiting, White blood cell count increased, Enema administration, Explorative laparotomy, Abdominal X-ray

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: 2     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Unknown
Current Illness: 1/29/08-records received- Recent hospitalization for gastroenteritis one week prior to this admission. seen in office for C/O de
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 1/29/08-records received-WBC 21.9. Air contrast enema. 9/27/07-flat and upright of abdomen x-ray:abnormal bowel stool and gas pattern with mulitple air filled loops of bowel with air-fluid levels unidentified.
CDC 'Split Type': WAES0710USA04368

Write-up: Information has been received from a physician concerning a 4 month old male who on 06-OCT-2007 was vaccinated p.o. with a dose ("1 tube") of Rotateq. On 07-OCT-2007 the patient experienced bloody stools and was hospitalized due to intussusception on the same day. The patient''s diagnosis was considered to be immediately life threatening. The intussusception was corrected with surgery. No other information was available. Unspecified medical attention was sought. The outcome was reported as recovered. There was no product quality complaint. The event was considered to be an other important medical event by the reporter. Additional information has been requested. 9/27/07- Seen on 10/5/07-visit after hospitalization for gastroenteritis. 1/29/08-records received for DOS 10/7-10/9/07-DC DX: Intussusception status post reduction with exploratory laparotomy, manual reduction and incidental appendectomy. C/O nausea, vomiting and bloody stools times 1 day.


Changed on 4/14/2017

VAERS ID: 294997 Before After
VAERS Form:
Age:0.3
Gender:Male
Location:Kentucky
Vaccinated:2007-10-05
Onset:2007-10-07
Submitted:2007-10-30
Entered:2007-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0079U / 1 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B53981A / 1 LL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0669U / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Appendicectomy, Blood gases abnormal, Haematochezia, Intussusception, Nausea, Vomiting, White blood cell count increased, Enema administration, Explorative laparotomy, Abdominal X-ray

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: 2     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Unknown
Current Illness: 1/29/08-records received- Recent hospitalization for gastroenteritis one week prior to this admission. seen in office for C/O de dehydration, vomiting and diarrhea.
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 1/29/08-records received-WBC 21.9. Air contrast enema. 9/27/07-flat and upright of abdomen x-ray:abnormal bowel stool and gas pattern with mulitple air filled loops of bowel with air-fluid levels unidentified.
CDC 'Split Type': WAES0710USA04368

Write-up: Information has been received from a physician concerning a 4 month old male who on 06-OCT-2007 was vaccinated p.o. with a dose ("1 tube") of Rotateq. On 07-OCT-2007 the patient experienced bloody stools and was hospitalized due to intussusception on the same day. The patient''s diagnosis was considered to be immediately life threatening. The intussusception was corrected with surgery. No other information was available. Unspecified medical attention was sought. The outcome was reported as recovered. There was no product quality complaint. The event was considered to be an other important medical event by the reporter. Additional information has been requested. 9/27/07- Seen on 10/5/07-visit after hospitalization for gastroenteritis. 1/29/08-records received for DOS 10/7-10/9/07-DC DX: Intussusception status post reduction with exploratory laparotomy, manual reduction and incidental appendectomy. C/O nausea, vomiting and bloody stools times 1 day.


Changed on 9/14/2017

VAERS ID: 294997 Before After
VAERS Form:(blank) 1
Age:0.3
Gender:Male
Location:Kentucky
Vaccinated:2007-10-05
Onset:2007-10-07
Submitted:2007-10-30
Entered:2007-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0079U / 1 2 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B53981A / 1 2 LL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0669U / 1 2 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Haematochezia, 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: 2     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Unknown
Current Illness: 1/29/08-records received- Recent hospitalization for gastroenteritis one week prior to this admission. seen in office for C/O dehydration, vomiting and diarrhea.
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 1/29/08-records received-WBC 21.9. Air contrast enema. 9/27/07-flat and upright of abdomen x-ray:abnormal bowel stool and gas pattern with mulitple air filled loops of bowel with air-fluid levels unidentified.
CDC 'Split Type': WAES0710USA04368

Write-up: Information has been received from a physician concerning a 4 month old male who on 06-OCT-2007 was vaccinated p.o. with a dose ("1 tube") of Rotateq. On 07-OCT-2007 the patient experienced bloody stools and was hospitalized due to intussusception on the same day. The patient''s diagnosis was considered to be immediately life threatening. The intussusception was corrected with surgery. No other information was available. Unspecified medical attention was sought. The outcome was reported as recovered. There was no product quality complaint. The event was considered to be an other important medical event by the reporter. Additional information has been requested. 9/27/07- Seen on 10/5/07-visit after hospitalization for gastroenteritis. 1/29/08-records received for DOS 10/7-10/9/07-DC DX: Intussusception status post reduction with exploratory laparotomy, manual reduction and incidental appendectomy. C/O nausea, vomiting and bloody stools times 1 day.


Changed on 2/14/2018

VAERS ID: 294997 Before After
VAERS Form:1
Age:0.3
Gender:Male
Location:Kentucky
Vaccinated:2007-10-05
Onset:2007-10-07
Submitted:2007-10-30
Entered:2007-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0079U / 2 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B53981A / 2 LL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0669U / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Haematochezia, 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: 2     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Unknown
Current Illness: 1/29/08-records received- Recent hospitalization for gastroenteritis one week prior to this admission. seen in office for C/O dehydration, vomiting and diarrhea.
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 1/29/08-records received-WBC 21.9. Air contrast enema. 9/27/07-flat and upright of abdomen x-ray:abnormal bowel stool and gas pattern with mulitple air filled loops of bowel with air-fluid levels unidentified.
CDC 'Split Type': WAES0710USA04368

Write-up: Information has been received from a physician concerning a 4 month old male who on 06-OCT-2007 was vaccinated p.o. with a dose ("1 tube") of Rotateq. On 07-OCT-2007 the patient experienced bloody stools and was hospitalized due to intussusception on the same day. The patient''s diagnosis was considered to be immediately life threatening. The intussusception was corrected with surgery. No other information was available. Unspecified medical attention was sought. The outcome was reported as recovered. There was no product quality complaint. The event was considered to be an other important medical event by the reporter. Additional information has been requested. 9/27/07- Seen on 10/5/07-visit after hospitalization for gastroenteritis. 1/29/08-records received for DOS 10/7-10/9/07-DC DX: Intussusception status post reduction with exploratory laparotomy, manual reduction and incidental appendectomy. C/O nausea, vomiting and bloody stools times 1 day.


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