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This is VAERS ID 302939

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 302939
VAERS Form:
Age:0.5
Gender:Male
Location:California
Vaccinated:2007-12-27
Onset:2008-01-04
Submitted:2008-01-16
Entered:2008-01-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS B127AA / 2 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF196AB / 2 RL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B47442L / 2 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0670U / 2 - / PO

Administered by: Other      Purchased by: Unknown
Symptoms: Abdominal pain, Barium enema, Diarrhoea, Full blood count, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: barium enema X-ray 01/??/08. Labs and Diagnsotics: KUB with non-specific bowel gas pattern. Abdominal US (-). Stool heme (+). Barium enema (+) for IS in the ascending colon. CBC with WBCs 21.0. UC no growth.
CDC 'Split Type':

Write-up: Information has been received from a physician concerning a 6 month old male who on 27-DEC-2007 was vaccinated with the third dose of Rotateq. On 04-JAN-2008 the patient experienced intussusception and was hospitalized for an unspecified period of time."The patient had a /"contrast enema/" performed on an unknown date, results not reported. Subsequently, the patient recovered from intussusception. Upon internal review, intussusception is considered an other important medical event. No product quality


Changed on 12/8/2009

VAERS ID: 302939 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:California
Vaccinated:2007-12-27
Onset:2008-01-04
Submitted:2008-01-16
Entered:2008-01-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS B127AA / 2 LL / -
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS B127AA / 2 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF196AB / 2 RL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B47442L / 2 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0670U / 2 - / PO

Administered by: Other      Purchased by: Unknown Other
Symptoms: Abdominal pain, Barium enema, Diarrhoea, Full blood count, Intussusception, Screaming, Urinary system X-ray, White blood cell count increased, Ultrasound abdomen normal, Occult blood positive

Life Threatening? No
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: barium enema X-ray 01/??/08. Labs and Diagnsotics: KUB with non-specific bowel gas pattern. Abdominal US (-). Stool heme (+). Barium enema (+) for IS in the ascending colon. CBC with WBCs 21.0. UC no growth.
CDC 'Split Type': (blank) WAES0801USA02707

Write-up: Information has been received from a physician concerning a 6 month old male who on 27-DEC-2007 was vaccinated with the third dose of Rotateq. On 04-JAN-2008 the patient experienced intussusception and was hospitalized for an unspecified period of time."The time. The patient had a /"contrast enema/" "contrast enema" performed on an unknown date, results not reported. Subsequently, the patient recovered from intussusception. Upon internal review, intussusception is considered an other important medical event. No product quality complaint reported. Additional information has been requested. 01/22/2008 Vax record received and updated in database. 01/29/2008 MR received for DOS 01/4-5/2008 with DX: Intussusception. Child presented to ER with 1 day hx of diarrhea with screaming and abdominal pain. Reduced by Barium Enema. Pt tolerating diet and D/Cd next day.


Changed on 3/2/2010

VAERS ID: 302939 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:California
Vaccinated:2007-12-27
Onset:2008-01-04
Submitted:2008-01-16
Entered:2008-01-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS B127AA / 2 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF196AB / 2 RL / -
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B47442L / 2 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0670U / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Barium enema, Diarrhoea, Full blood count, Intussusception, Screaming, Urinary system X-ray, White blood cell count increased, Ultrasound abdomen normal, Occult blood positive

Life Threatening? No
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: barium enema X-ray 01/??/08. Labs and Diagnsotics: KUB with non-specific bowel gas pattern. Abdominal US (-). Stool heme (+). Barium enema (+) for IS in the ascending colon. CBC with WBCs 21.0. UC no growth.
CDC 'Split Type': WAES0801USA02707

Write-up: Information has been received from a physician concerning a 6 month old male who on 27-DEC-2007 was vaccinated with the third dose of Rotateq. On 04-JAN-2008 the patient experienced intussusception and was hospitalized for an unspecified period of time. The patient had a "contrast enema" performed on an unknown date, results not reported. Subsequently, the patient recovered from intussusception. Upon internal review, intussusception is considered an other important medical event. No product quality complaint reported. Additional information has been requested. 01/22/2008 Vax record received and updated in database. 01/29/2008 MR received for DOS 01/4-5/2008 with DX: Intussusception. Child presented to ER with 1 day hx of diarrhea with screaming and abdominal pain. Reduced by Barium Enema. Pt tolerating diet and D/Cd next day.


Changed on 4/7/2010

VAERS ID: 302939 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:California
Vaccinated:2007-12-27
Onset:2008-01-04
Submitted:2008-01-16
Entered:2008-01-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS B127AA / 2 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF196AB / 2 RL / -
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B47442L / 2 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0670U / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Barium enema, Diarrhoea, Full blood count, Intussusception, Screaming, Urinary system X-ray, White blood cell count increased, Ultrasound abdomen normal, Occult blood positive

Life Threatening? No
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: barium enema X-ray 01/??/08. Labs and Diagnsotics: KUB with non-specific bowel gas pattern. Abdominal US (-). Stool heme (+). Barium enema (+) for IS in the ascending colon. CBC with WBCs 21.0. UC no growth.
CDC 'Split Type': WAES0801USA02707

Write-up: Information has been received from a physician concerning a 6 month old male who on 27-DEC-2007 was vaccinated with the third dose of Rotateq. On 04-JAN-2008 the patient experienced intussusception and was hospitalized for an unspecified period of time. The patient had a "contrast enema" performed on an unknown date, results not reported. Subsequently, the patient recovered from intussusception. Upon internal review, intussusception is considered an other important medical event. No product quality complaint reported. Additional information has been requested. 01/22/2008 Vax record received and updated in database. 01/29/2008 MR received for DOS 01/4-5/2008 with DX: Intussusception. Child presented to ER with 1 day hx of diarrhea with screaming and abdominal pain. Reduced by Barium Enema. Pt tolerating diet and D/Cd next day.


Changed on 8/31/2010

VAERS ID: 302939 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:California
Vaccinated:2007-12-27
Onset:2008-01-04
Submitted:2008-01-16
Entered:2008-01-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS B127AA / 2 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF196AB / 2 RL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B47442L / 2 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0670U / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Barium enema, Diarrhoea, Full blood count, Intussusception, Screaming, Urinary system X-ray, White blood cell count increased, Ultrasound abdomen normal, Occult blood positive

Life Threatening? No
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: barium enema X-ray 01/??/08. Labs and Diagnsotics: KUB with non-specific bowel gas pattern. Abdominal US (-). Stool heme (+). Barium enema (+) for IS in the ascending colon. CBC with WBCs 21.0. UC no growth.
CDC 'Split Type': WAES0801USA02707

Write-up: Information has been received from a physician concerning a 6 month old male who on 27-DEC-2007 was vaccinated with the third dose of Rotateq. On 04-JAN-2008 the patient experienced intussusception and was hospitalized for an unspecified period of time. The patient had a "contrast enema" performed on an unknown date, results not reported. Subsequently, the patient recovered from intussusception. Upon internal review, intussusception is considered an other important medical event. No product quality complaint reported. Additional information has been requested. 01/22/2008 Vax record received and updated in database. 01/29/2008 MR received for DOS 01/4-5/2008 with DX: Intussusception. Child presented to ER with 1 day hx of diarrhea with screaming and abdominal pain. Reduced by Barium Enema. Pt tolerating diet and D/Cd next day.


Changed on 5/13/2013

VAERS ID: 302939 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:California
Vaccinated:2007-12-27
Onset:2008-01-04
Submitted:2008-01-16
Entered:2008-01-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS B127AA / 2 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF196AB / 2 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47442L / 2 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0670U / 2 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0670U / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Barium enema, Diarrhoea, Full blood count, Intussusception, Screaming, Urinary system X-ray, White blood cell count increased, Ultrasound abdomen normal, Occult blood positive

Life Threatening? No
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: barium enema X-ray 01/??/08. Labs and Diagnsotics: KUB with non-specific bowel gas pattern. Abdominal US (-). Stool heme (+). Barium enema (+) for IS in the ascending colon. CBC with WBCs 21.0. UC no growth.
CDC 'Split Type': WAES0801USA02707

Write-up: Information has been received from a physician concerning a 6 month old male who on 27-DEC-2007 was vaccinated with the third dose of Rotateq. On 04-JAN-2008 the patient experienced intussusception and was hospitalized for an unspecified period of time. The patient had a "contrast enema" performed on an unknown date, results not reported. Subsequently, the patient recovered from intussusception. Upon internal review, intussusception is considered an other important medical event. No product quality complaint reported. Additional information has been requested. 01/22/2008 Vax record received and updated in database. 01/29/2008 MR received for DOS 01/4-5/2008 with DX: Intussusception. Child presented to ER with 1 day hx of diarrhea with screaming and abdominal pain. Reduced by Barium Enema. Pt tolerating diet and D/Cd next day.


Changed on 2/14/2017

VAERS ID: 302939 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:California
Vaccinated:2007-12-27
Onset:2008-01-04
Submitted:2008-01-16
Entered:2008-01-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS B127AA / 2 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF196AB / 2 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47442L / 2 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0670U / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Barium enema, Diarrhoea, Full blood count, Intussusception, Screaming, Urinary system X-ray, White blood cell count increased, Ultrasound abdomen normal, Occult blood positive

Life Threatening? No
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: barium enema X-ray 01/??/08. Labs and Diagnsotics: KUB with non-specific bowel gas pattern. Abdominal US (-). Stool heme (+). Barium enema (+) for IS in the ascending colon. CBC with WBCs 21.0. UC no growth.
CDC 'Split Type': WAES0801USA02707

Write-up: Information has been received from a physician concerning a 6 month old male who on 27-DEC-2007 was vaccinated with the third dose of Rotateq. On 04-JAN-2008 the patient experienced intussusception and was hospitalized for an unspecified period of time. The patient had a "contrast enema" performed on an unknown date, results not reported. Subsequently, the patient recovered from intussusception. Upon internal review, intussusception is considered an other important medical event. No product quality complaint reported. Additional information has been requested. 01/22/2008 Vax record received and updated in database. 01/29/2008 MR received for DOS 01/4-5/2008 with DX: Intussusception. Child presented to ER with 1 day hx of diarrhea with screaming and abdominal pain. Reduced by Barium Enema. Pt tolerating diet and D/Cd next day.


Changed on 9/14/2017

VAERS ID: 302939 Before After
VAERS Form:(blank) 1
Age:0.5
Gender:Male
Location:California
Vaccinated:2007-12-27
Onset:2008-01-04
Submitted:2008-01-16
Entered:2008-01-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS B127AA / 2 3 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF196AB / 2 3 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47442L / 2 3 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0670U / 2 3 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: barium enema X-ray 01/??/08. Labs and Diagnsotics: KUB with non-specific bowel gas pattern. Abdominal US (-). Stool heme (+). Barium enema (+) for IS in the ascending colon. CBC with WBCs 21.0. UC no growth.
CDC 'Split Type': WAES0801USA02707

Write-up: Information has been received from a physician concerning a 6 month old male who on 27-DEC-2007 was vaccinated with the third dose of Rotateq. On 04-JAN-2008 the patient experienced intussusception and was hospitalized for an unspecified period of time. The patient had a "contrast enema" performed on an unknown date, results not reported. Subsequently, the patient recovered from intussusception. Upon internal review, intussusception is considered an other important medical event. No product quality complaint reported. Additional information has been requested. 01/22/2008 Vax record received and updated in database. 01/29/2008 MR received for DOS 01/4-5/2008 with DX: Intussusception. Child presented to ER with 1 day hx of diarrhea with screaming and abdominal pain. Reduced by Barium Enema. Pt tolerating diet and D/Cd next day.


Changed on 2/14/2018

VAERS ID: 302939 Before After
VAERS Form:1
Age:0.5
Gender:Male
Location:California
Vaccinated:2007-12-27
Onset:2008-01-04
Submitted:2008-01-16
Entered:2008-01-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS B127AA / 3 LL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF196AB / 3 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B47442L / 3 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0670U / 3 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: barium enema X-ray 01/??/08. Labs and Diagnsotics: KUB with non-specific bowel gas pattern. Abdominal US (-). Stool heme (+). Barium enema (+) for IS in the ascending colon. CBC with WBCs 21.0. UC no growth.
CDC 'Split Type': WAES0801USA02707

Write-up: Information has been received from a physician concerning a 6 month old male who on 27-DEC-2007 was vaccinated with the third dose of Rotateq. On 04-JAN-2008 the patient experienced intussusception and was hospitalized for an unspecified period of time. The patient had a "contrast enema" performed on an unknown date, results not reported. Subsequently, the patient recovered from intussusception. Upon internal review, intussusception is considered an other important medical event. No product quality complaint reported. Additional information has been requested. 01/22/2008 Vax record received and updated in database. 01/29/2008 MR received for DOS 01/4-5/2008 with DX: Intussusception. Child presented to ER with 1 day hx of diarrhea with screaming and abdominal pain. Reduced by Barium Enema. Pt tolerating diet and D/Cd next day.


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