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This is VAERS ID 297542

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 297542
VAERS Form:
Age:0.2
Gender:Male
Location:Unknown
Vaccinated:2007-08-23
Onset:2007-11-06
Submitted:2007-11-20
Entered:2007-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B133AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF162AB / 0 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B54007E / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0668U / - - / PO

Administered by: Other      Purchased by: Unknown
Symptoms: Dehydration, Haematochezia, Intussusception, Enema administration, Laboratory test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: diagnostic laboratory
CDC 'Split Type':

Write-up: Information has been received from a physician and a nurse concerning a 4 month old male (also reported as 19 weeks old) who on 23-AUG-2007 was vaccinated with Rotateq (Lot # 657615/008U). Concomitant therapy included ActHIB, Prevnar and Pediarix all give"n on 23-AUG-2007. The physician reported that the patient experienced vomiting and blood in the stool and on 06-NOV-2007 the patient was diagnosed with intussusception. The nurse reported that the patient had surgery and is /"doing fairly well now./" Addi


Changed on 12/8/2009

VAERS ID: 297542 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Unknown
Vaccinated:2007-08-23
Onset:2007-11-06
Submitted:2007-11-20
Entered:2007-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B133AA / 0 LL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B133AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF162AB / 0 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B54007E / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0668U / - - / PO

Administered by: Other      Purchased by: Unknown Other
Symptoms: Dehydration, Haematochezia, Intussusception, Nausea, Vomiting, Enema administration, Ultrasound abdomen abnormal, Urine output decreased, Laboratory test, Oral intake reduced

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: diagnostic laboratory laboratory. Labs and Diagnostics: Abdominal US (+) IS. Air Enema (+) for IS
CDC 'Split Type': (blank) WAES0711USA02907

Write-up: Information has been received from a physician and a nurse concerning a 4 month old male (also reported as 19 weeks old) who on 23-AUG-2007 was vaccinated with Rotateq (Lot # 657615/008U). Concomitant therapy included ActHIB, Prevnar and Pediarix all give"n given on 23-AUG-2007. The physician reported that the patient experienced vomiting and blood in the stool and on 06-NOV-2007 the patient was diagnosed with intussusception. The nurse reported that the patient had surgery and is /"doing "doing fairly well now./" Addi now." Additional information has been requested. 11/28/2007 Vax record received. Info updated in VAERS database. 02/01/2008 MR received for DOS 11/6-7/2007 with D/C DX: Dehydration. 2'' DX: Intussusception s/p reduction by air enema. Pt presented to ER with 2 day hx of crampy abdominal pain, and intermittant lethargy, nausea and vomiting. Decreased UO and PO intake. IS noted on Air enema and reduced by same. Pt had one bloody bowel movement then a normal one following. D/C home next day with good po intake and UO.


Changed on 3/2/2010

VAERS ID: 297542 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Unknown
Vaccinated:2007-08-23
Onset:2007-11-06
Submitted:2007-11-20
Entered:2007-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B133AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF162AB / 0 RL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B54007E / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0668U / - - / PO

Administered by: Other      Purchased by: Other
Symptoms: Dehydration, Haematochezia, Intussusception, Nausea, Vomiting, Enema administration, Ultrasound abdomen abnormal, Urine output decreased, Laboratory test, Oral intake reduced

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: diagnostic laboratory. Labs and Diagnostics: Abdominal US (+) IS. Air Enema (+) for IS
CDC 'Split Type': WAES0711USA02907

Write-up: Information has been received from a physician and a nurse concerning a 4 month old male (also reported as 19 weeks old) who on 23-AUG-2007 was vaccinated with Rotateq (Lot # 657615/008U). Concomitant therapy included ActHIB, Prevnar and Pediarix all given on 23-AUG-2007. The physician reported that the patient experienced vomiting and blood in the stool and on 06-NOV-2007 the patient was diagnosed with intussusception. The nurse reported that the patient had surgery and is "doing fairly well now." Additional information has been requested. 11/28/2007 Vax record received. Info updated in VAERS database. 02/01/2008 MR received for DOS 11/6-7/2007 with D/C DX: Dehydration. 2'' DX: Intussusception s/p reduction by air enema. Pt presented to ER with 2 day hx of crampy abdominal pain, and intermittant lethargy, nausea and vomiting. Decreased UO and PO intake. IS noted on Air enema and reduced by same. Pt had one bloody bowel movement then a normal one following. D/C home next day with good po intake and UO.


Changed on 4/7/2010

VAERS ID: 297542 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Unknown
Vaccinated:2007-08-23
Onset:2007-11-06
Submitted:2007-11-20
Entered:2007-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B133AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF162AB / 0 RL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B54007E / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0668U / - - / PO

Administered by: Other      Purchased by: Other
Symptoms: Dehydration, Haematochezia, Intussusception, Nausea, Vomiting, Enema administration, Ultrasound abdomen abnormal, Urine output decreased, Laboratory test, Oral intake reduced

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: diagnostic laboratory. Labs and Diagnostics: Abdominal US (+) IS. Air Enema (+) for IS
CDC 'Split Type': WAES0711USA02907

Write-up: Information has been received from a physician and a nurse concerning a 4 month old male (also reported as 19 weeks old) who on 23-AUG-2007 was vaccinated with Rotateq (Lot # 657615/008U). Concomitant therapy included ActHIB, Prevnar and Pediarix all given on 23-AUG-2007. The physician reported that the patient experienced vomiting and blood in the stool and on 06-NOV-2007 the patient was diagnosed with intussusception. The nurse reported that the patient had surgery and is "doing fairly well now." Additional information has been requested. 11/28/2007 Vax record received. Info updated in VAERS database. 02/01/2008 MR received for DOS 11/6-7/2007 with D/C DX: Dehydration. 2'' DX: Intussusception s/p reduction by air enema. Pt presented to ER with 2 day hx of crampy abdominal pain, and intermittant lethargy, nausea and vomiting. Decreased UO and PO intake. IS noted on Air enema and reduced by same. Pt had one bloody bowel movement then a normal one following. D/C home next day with good po intake and UO.


Changed on 8/31/2010

VAERS ID: 297542 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Unknown
Vaccinated:2007-08-23
Onset:2007-11-06
Submitted:2007-11-20
Entered:2007-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B133AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF162AB / 0 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B54007E / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0668U / - - / PO

Administered by: Other      Purchased by: Other
Symptoms: Dehydration, Haematochezia, Intussusception, Nausea, Vomiting, Enema administration, Ultrasound abdomen abnormal, Urine output decreased, Laboratory test, Oral intake reduced

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: diagnostic laboratory. Labs and Diagnostics: Abdominal US (+) IS. Air Enema (+) for IS
CDC 'Split Type': WAES0711USA02907

Write-up: Information has been received from a physician and a nurse concerning a 4 month old male (also reported as 19 weeks old) who on 23-AUG-2007 was vaccinated with Rotateq (Lot # 657615/008U). Concomitant therapy included ActHIB, Prevnar and Pediarix all given on 23-AUG-2007. The physician reported that the patient experienced vomiting and blood in the stool and on 06-NOV-2007 the patient was diagnosed with intussusception. The nurse reported that the patient had surgery and is "doing fairly well now." Additional information has been requested. 11/28/2007 Vax record received. Info updated in VAERS database. 02/01/2008 MR received for DOS 11/6-7/2007 with D/C DX: Dehydration. 2'' DX: Intussusception s/p reduction by air enema. Pt presented to ER with 2 day hx of crampy abdominal pain, and intermittant lethargy, nausea and vomiting. Decreased UO and PO intake. IS noted on Air enema and reduced by same. Pt had one bloody bowel movement then a normal one following. D/C home next day with good po intake and UO.


Changed on 5/13/2013

VAERS ID: 297542 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Unknown
Vaccinated:2007-08-23
Onset:2007-11-06
Submitted:2007-11-20
Entered:2007-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B133AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF162AB / 0 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54007E / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0668U / - - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0668U / - - / PO

Administered by: Other      Purchased by: Other
Symptoms: Dehydration, Haematochezia, Intussusception, Nausea, Vomiting, Enema administration, Ultrasound abdomen abnormal, Urine output decreased, Laboratory test, Oral intake reduced

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: diagnostic laboratory. Labs and Diagnostics: Abdominal US (+) IS. Air Enema (+) for IS
CDC 'Split Type': WAES0711USA02907

Write-up: Information has been received from a physician and a nurse concerning a 4 month old male (also reported as 19 weeks old) who on 23-AUG-2007 was vaccinated with Rotateq (Lot # 657615/008U). Concomitant therapy included ActHIB, Prevnar and Pediarix all given on 23-AUG-2007. The physician reported that the patient experienced vomiting and blood in the stool and on 06-NOV-2007 the patient was diagnosed with intussusception. The nurse reported that the patient had surgery and is "doing fairly well now." Additional information has been requested. 11/28/2007 Vax record received. Info updated in VAERS database. 02/01/2008 MR received for DOS 11/6-7/2007 with D/C DX: Dehydration. 2'' DX: Intussusception s/p reduction by air enema. Pt presented to ER with 2 day hx of crampy abdominal pain, and intermittant lethargy, nausea and vomiting. Decreased UO and PO intake. IS noted on Air enema and reduced by same. Pt had one bloody bowel movement then a normal one following. D/C home next day with good po intake and UO.


Changed on 2/14/2017

VAERS ID: 297542 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Unknown
Vaccinated:2007-08-23
Onset:2007-11-06
Submitted:2007-11-20
Entered:2007-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B133AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF162AB / 0 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54007E / 0 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0668U / - - / PO

Administered by: Other      Purchased by: Other
Symptoms: Dehydration, Haematochezia, Intussusception, Nausea, Vomiting, Enema administration, Ultrasound abdomen abnormal, Urine output decreased, Laboratory test, Oral intake reduced

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: diagnostic laboratory. Labs and Diagnostics: Abdominal US (+) IS. Air Enema (+) for IS
CDC 'Split Type': WAES0711USA02907

Write-up: Information has been received from a physician and a nurse concerning a 4 month old male (also reported as 19 weeks old) who on 23-AUG-2007 was vaccinated with Rotateq (Lot # 657615/008U). Concomitant therapy included ActHIB, Prevnar and Pediarix all given on 23-AUG-2007. The physician reported that the patient experienced vomiting and blood in the stool and on 06-NOV-2007 the patient was diagnosed with intussusception. The nurse reported that the patient had surgery and is "doing fairly well now." Additional information has been requested. 11/28/2007 Vax record received. Info updated in VAERS database. 02/01/2008 MR received for DOS 11/6-7/2007 with D/C DX: Dehydration. 2'' DX: Intussusception s/p reduction by air enema. Pt presented to ER with 2 day hx of crampy abdominal pain, and intermittant lethargy, nausea and vomiting. Decreased UO and PO intake. IS noted on Air enema and reduced by same. Pt had one bloody bowel movement then a normal one following. D/C home next day with good po intake and UO.


Changed on 9/14/2017

VAERS ID: 297542 Before After
VAERS Form:(blank) 1
Age:0.2
Gender:Male
Location:Unknown
Vaccinated:2007-08-23
Onset:2007-11-06
Submitted:2007-11-20
Entered:2007-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B133AA / 0 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF162AB / 0 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54007E / 0 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0668U / - UNK - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Haematochezia, Intussusception, Vomiting, Laboratory test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: diagnostic laboratory. Labs and Diagnostics: Abdominal US (+) IS. Air Enema (+) for IS
CDC 'Split Type': WAES0711USA02907

Write-up: Information has been received from a physician and a nurse concerning a 4 month old male (also reported as 19 weeks old) who on 23-AUG-2007 was vaccinated with Rotateq (Lot # 657615/008U). Concomitant therapy included ActHIB, Prevnar and Pediarix all given on 23-AUG-2007. The physician reported that the patient experienced vomiting and blood in the stool and on 06-NOV-2007 the patient was diagnosed with intussusception. The nurse reported that the patient had surgery and is "doing fairly well now." Additional information has been requested. 11/28/2007 Vax record received. Info updated in VAERS database. 02/01/2008 MR received for DOS 11/6-7/2007 with D/C DX: Dehydration. 2'' DX: Intussusception s/p reduction by air enema. Pt presented to ER with 2 day hx of crampy abdominal pain, and intermittant lethargy, nausea and vomiting. Decreased UO and PO intake. IS noted on Air enema and reduced by same. Pt had one bloody bowel movement then a normal one following. D/C home next day with good po intake and UO.


Changed on 2/14/2018

VAERS ID: 297542 Before After
VAERS Form:1
Age:0.2
Gender:Male
Location:Unknown
Vaccinated:2007-08-23
Onset:2007-11-06
Submitted:2007-11-20
Entered:2007-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B133AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF162AB / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54007E / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0668U / UNK MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Haematochezia, Intussusception, Vomiting, Laboratory test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: diagnostic laboratory. Labs and Diagnostics: Abdominal US (+) IS. Air Enema (+) for IS
CDC 'Split Type': WAES0711USA02907

Write-up: Information has been received from a physician and a nurse concerning a 4 month old male (also reported as 19 weeks old) who on 23-AUG-2007 was vaccinated with Rotateq (Lot # 657615/008U). Concomitant therapy included ActHIB, Prevnar and Pediarix all given on 23-AUG-2007. The physician reported that the patient experienced vomiting and blood in the stool and on 06-NOV-2007 the patient was diagnosed with intussusception. The nurse reported that the patient had surgery and is "doing fairly well now." Additional information has been requested. 11/28/2007 Vax record received. Info updated in VAERS database. 02/01/2008 MR received for DOS 11/6-7/2007 with D/C DX: Dehydration. 2'' DX: Intussusception s/p reduction by air enema. Pt presented to ER with 2 day hx of crampy abdominal pain, and intermittant lethargy, nausea and vomiting. Decreased UO and PO intake. IS noted on Air enema and reduced by same. Pt had one bloody bowel movement then a normal one following. D/C home next day with good po intake and UO.


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