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This is VAERS ID 302536

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 302536
VAERS Form:
Age:0.4
Gender:Male
Location:California
Vaccinated:2007-11-13
Onset:2008-01-02
Submitted:2008-01-11
Entered:2008-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B062 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 6376U / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0126 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B54015D / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1392U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium enema abnormal, Diarrhoea haemorrhagic, Intussusception, Enema administration

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Abdominal U/S: transverse colon intussusception. Labs and Diagnostics: Abd US (+) for IS. Barium enema (+) for IS at level of hepatic flexure.
CDC 'Split Type':

Write-up: Developed 1 d hx of fussiness and vomiting and found to have intussusception and reduced by barium enema. 01/23/2008 Vax record received and Rotateq Lot # updated. It appears that the reported lot # was for the 9/18/07 dose not the 11/13/07 dose. 5/30/2"008 MR received for DOS 1/2-3/2008 with DX: Intussusception. Infant presented to local hospital with belly pain, vomiting and bloody diarrhea. Pt had been feeding poorly and had fewer wet diapers. Reduced by Barium enema and admitted for o/n obs.


Changed on 12/8/2009

VAERS ID: 302536 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:California
Vaccinated:2007-11-13
Onset:2008-01-02
Submitted:2008-01-11
Entered:2008-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B062 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 6376U / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0126 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B54015D / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1392U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium enema abnormal, Diarrhoea haemorrhagic, Intussusception, Irritability, Vomiting, Enema administration, Ultrasound abdomen abnormal, Urine output decreased, Oral intake reduced

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Abdominal U/S: transverse colon intussusception. Labs and Diagnostics: Abd US (+) for IS. Barium enema (+) for IS at level of hepatic flexure.
CDC 'Split Type':

Write-up: Developed 1 d hx of fussiness and vomiting and found to have intussusception and reduced by barium enema. 01/23/2008 Vax record received and Rotateq Lot # updated. It appears that the reported lot # was for the 9/18/07 dose not the 11/13/07 dose. 5/30/2"008 5/30/2008 MR received for DOS 1/2-3/2008 with DX: Intussusception. Infant presented to local hospital with belly pain, vomiting and bloody diarrhea. Pt had been feeding poorly and had fewer wet diapers. Reduced by Barium enema and admitted for o/n obs.


Changed on 3/2/2010

VAERS ID: 302536 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:California
Vaccinated:2007-11-13
Onset:2008-01-02
Submitted:2008-01-11
Entered:2008-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B062 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 6376U / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0126 / 1 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B54015D / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1392U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium enema abnormal, Diarrhoea haemorrhagic, Intussusception, Irritability, Vomiting, Enema administration, Ultrasound abdomen abnormal, Urine output decreased, Oral intake reduced

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Abdominal U/S: transverse colon intussusception. Labs and Diagnostics: Abd US (+) for IS. Barium enema (+) for IS at level of hepatic flexure.
CDC 'Split Type':

Write-up: Developed 1 d hx of fussiness and vomiting and found to have intussusception and reduced by barium enema. 01/23/2008 Vax record received and Rotateq Lot # updated. It appears that the reported lot # was for the 9/18/07 dose not the 11/13/07 dose. 5/30/2008 MR received for DOS 1/2-3/2008 with DX: Intussusception. Infant presented to local hospital with belly pain, vomiting and bloody diarrhea. Pt had been feeding poorly and had fewer wet diapers. Reduced by Barium enema and admitted for o/n obs.


Changed on 4/7/2010

VAERS ID: 302536 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:California
Vaccinated:2007-11-13
Onset:2008-01-02
Submitted:2008-01-11
Entered:2008-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B062 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 6376U / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0126 / 1 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B54015D / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1392U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium enema abnormal, Diarrhoea haemorrhagic, Intussusception, Irritability, Vomiting, Enema administration, Ultrasound abdomen abnormal, Urine output decreased, Oral intake reduced

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Abdominal U/S: transverse colon intussusception. Labs and Diagnostics: Abd US (+) for IS. Barium enema (+) for IS at level of hepatic flexure.
CDC 'Split Type':

Write-up: Developed 1 d hx of fussiness and vomiting and found to have intussusception and reduced by barium enema. 01/23/2008 Vax record received and Rotateq Lot # updated. It appears that the reported lot # was for the 9/18/07 dose not the 11/13/07 dose. 5/30/2008 MR received for DOS 1/2-3/2008 with DX: Intussusception. Infant presented to local hospital with belly pain, vomiting and bloody diarrhea. Pt had been feeding poorly and had fewer wet diapers. Reduced by Barium enema and admitted for o/n obs.


Changed on 8/31/2010

VAERS ID: 302536 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:California
Vaccinated:2007-11-13
Onset:2008-01-02
Submitted:2008-01-11
Entered:2008-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B062 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 6376U / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0126 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B54015D / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1392U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium enema abnormal, Diarrhoea haemorrhagic, Intussusception, Irritability, Vomiting, Enema administration, Ultrasound abdomen abnormal, Urine output decreased, Oral intake reduced

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Abdominal U/S: transverse colon intussusception. Labs and Diagnostics: Abd US (+) for IS. Barium enema (+) for IS at level of hepatic flexure.
CDC 'Split Type':

Write-up: Developed 1 d hx of fussiness and vomiting and found to have intussusception and reduced by barium enema. 01/23/2008 Vax record received and Rotateq Lot # updated. It appears that the reported lot # was for the 9/18/07 dose not the 11/13/07 dose. 5/30/2008 MR received for DOS 1/2-3/2008 with DX: Intussusception. Infant presented to local hospital with belly pain, vomiting and bloody diarrhea. Pt had been feeding poorly and had fewer wet diapers. Reduced by Barium enema and admitted for o/n obs.


Changed on 5/13/2013

VAERS ID: 302536 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:California
Vaccinated:2007-11-13
Onset:2008-01-02
Submitted:2008-01-11
Entered:2008-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B062 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 6376U / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0126 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54015D / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1392U / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1392U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium enema abnormal, Diarrhoea haemorrhagic, Intussusception, Irritability, Vomiting, Enema administration, Ultrasound abdomen abnormal, Urine output decreased, Oral intake reduced

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Abdominal U/S: transverse colon intussusception. Labs and Diagnostics: Abd US (+) for IS. Barium enema (+) for IS at level of hepatic flexure.
CDC 'Split Type':

Write-up: Developed 1 d hx of fussiness and vomiting and found to have intussusception and reduced by barium enema. 01/23/2008 Vax record received and Rotateq Lot # updated. It appears that the reported lot # was for the 9/18/07 dose not the 11/13/07 dose. 5/30/2008 MR received for DOS 1/2-3/2008 with DX: Intussusception. Infant presented to local hospital with belly pain, vomiting and bloody diarrhea. Pt had been feeding poorly and had fewer wet diapers. Reduced by Barium enema and admitted for o/n obs.


Changed on 6/14/2014

VAERS ID: 302536 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:California
Vaccinated:2007-11-13
Onset:2008-01-02
Submitted:2008-01-11
Entered:2008-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B062 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 6376U / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0126 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54015D / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1392U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium enema abnormal, Diarrhoea haemorrhagic, Intussusception, Irritability, Vomiting, Enema administration, Ultrasound abdomen abnormal, Urine output decreased, Oral intake reduced

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Abdominal U/S: transverse colon intussusception. Labs and Diagnostics: Abd US (+) for IS. Barium enema (+) for IS at level of hepatic flexure.
CDC 'Split Type':

Write-up: Developed 1 d hx of fussiness and vomiting and found to have intussusception and reduced by barium enema. 01/23/2008 Vax record received and Rotateq Lot # updated. It appears that the reported lot # was for the 9/18/07 dose not the 11/13/07 dose. 5/30/2008 MR received for DOS 1/2-3/2008 with DX: Intussusception. Infant presented to local hospital with belly pain, vomiting and bloody diarrhea. Pt had been feeding poorly and had fewer wet diapers. Reduced by Barium enema and admitted for o/n obs.


Changed on 3/14/2015

VAERS ID: 302536 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:California
Vaccinated:2007-11-13
Onset:2008-01-02
Submitted:2008-01-11
Entered:2008-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B062 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 6376U / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0126 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54015D / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1392U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium enema abnormal, Diarrhoea haemorrhagic, Intussusception, Irritability, Vomiting, Enema administration, Ultrasound abdomen abnormal, Urine output decreased, Oral intake reduced

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Abdominal U/S: transverse colon intussusception. Labs and Diagnostics: Abd US (+) for IS. Barium enema (+) for IS at level of hepatic flexure.
CDC 'Split Type':

Write-up: Developed 1 d hx of fussiness and vomiting and found to have intussusception and reduced by barium enema. 01/23/2008 Vax record received and Rotateq Lot # updated. It appears that the reported lot # was for the 9/18/07 dose not the 11/13/07 dose. 5/30/2008 MR received for DOS 1/2-3/2008 with DX: Intussusception. Infant presented to local hospital with belly pain, vomiting and bloody diarrhea. Pt had been feeding poorly and had fewer wet diapers. Reduced by Barium enema and admitted for o/n obs.


Changed on 2/14/2017

VAERS ID: 302536 Before After
VAERS Form:
Age:0.4 0.35
Gender:Male
Location:California
Vaccinated:2007-11-13
Onset:2008-01-02
Submitted:2008-01-11
Entered:2008-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B062 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 6376U / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0126 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54015D / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1392U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium enema abnormal, Diarrhoea haemorrhagic, Intussusception, Irritability, Vomiting, Enema administration, Ultrasound abdomen abnormal, Urine output decreased, Oral intake reduced

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Abdominal U/S: transverse colon intussusception. Labs and Diagnostics: Abd US (+) for IS. Barium enema (+) for IS at level of hepatic flexure.
CDC 'Split Type':

Write-up: Developed 1 d hx of fussiness and vomiting and found to have intussusception and reduced by barium enema. 01/23/2008 Vax record received and Rotateq Lot # updated. It appears that the reported lot # was for the 9/18/07 dose not the 11/13/07 dose. 5/30/2008 MR received for DOS 1/2-3/2008 with DX: Intussusception. Infant presented to local hospital with belly pain, vomiting and bloody diarrhea. Pt had been feeding poorly and had fewer wet diapers. Reduced by Barium enema and admitted for o/n obs.


Changed on 4/14/2017

VAERS ID: 302536 Before After
VAERS Form:
Age:0.35
Gender:Male
Location:California
Vaccinated:2007-11-13
Onset:2008-01-02
Submitted:2008-01-11
Entered:2008-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B062 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 6376U / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0126 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54015D / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1392U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Barium enema abnormal, Diarrhoea haemorrhagic, Intussusception, Irritability, Vomiting, Enema administration, Ultrasound abdomen abnormal, Urine output decreased, Oral intake reduced

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Abdominal U/S: transverse colon intussusception. Labs and Diagnostics: Abd US (+) for IS. Barium enema (+) for IS at level of hepatic flexure.
CDC 'Split Type':

Write-up: Developed 1 d hx of fussiness and vomiting and found to have intussusception and reduced by barium enema. 01/23/2008 Vax record received and Rotateq Lot # updated. It appears that the reported lot # was for the 9/18/07 dose not the 11/13/07 dose. 5/30/2008 MR received for DOS 1/2-3/2008 with DX: Intussusception. Infant presented to local hospital with belly pain, vomiting and bloody diarrhea. Pt had been feeding poorly and had fewer wet diapers. Reduced by Barium enema and admitted for o/n obs.


Changed on 9/14/2017

VAERS ID: 302536 Before After
VAERS Form:(blank) 1
Age:0.35
Gender:Male
Location:California
Vaccinated:2007-11-13
Onset:2008-01-02
Submitted:2008-01-11
Entered:2008-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B062 / 1 2 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 6376U / 1 2 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0126 / 1 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54015D / 1 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1392U / 1 2 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception, Irritability, Vomiting, Enema administration, Ultrasound abdomen 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Abdominal U/S: transverse colon intussusception. Labs and Diagnostics: Abd US (+) for IS. Barium enema (+) for IS at level of hepatic flexure.
CDC 'Split Type':

Write-up: Developed 1 d hx of fussiness and vomiting and found to have intussusception and reduced by barium enema. 01/23/2008 Vax record received and Rotateq Lot # updated. It appears that the reported lot # was for the 9/18/07 dose not the 11/13/07 dose. 5/30/2008 MR received for DOS 1/2-3/2008 with DX: Intussusception. Infant presented to local hospital with belly pain, vomiting and bloody diarrhea. Pt had been feeding poorly and had fewer wet diapers. Reduced by Barium enema and admitted for o/n obs.


Changed on 2/14/2018

VAERS ID: 302536 Before After
VAERS Form:1
Age:0.35
Gender:Male
Location:California
Vaccinated:2007-11-13
Onset:2008-01-02
Submitted:2008-01-11
Entered:2008-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B062 / 2 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 6376U / 2 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0126 / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54015D / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1392U / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Intussusception, Irritability, Vomiting, Enema administration, Ultrasound abdomen 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Abdominal U/S: transverse colon intussusception. Labs and Diagnostics: Abd US (+) for IS. Barium enema (+) for IS at level of hepatic flexure.
CDC 'Split Type':

Write-up: Developed 1 d hx of fussiness and vomiting and found to have intussusception and reduced by barium enema. 01/23/2008 Vax record received and Rotateq Lot # updated. It appears that the reported lot # was for the 9/18/07 dose not the 11/13/07 dose. 5/30/2008 MR received for DOS 1/2-3/2008 with DX: Intussusception. Infant presented to local hospital with belly pain, vomiting and bloody diarrhea. Pt had been feeding poorly and had fewer wet diapers. Reduced by Barium enema and admitted for o/n obs.


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