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This is VAERS ID 307215

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 307215
VAERS Form:
Age:0.2
Sex:Male
Location:Ohio
Vaccinated:2008-01-15
Onset:2008-01-29
Submitted:2008-03-12
Entered:2008-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B132AA / 0 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF229AA / 0 LL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B54016D / 0 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1388U / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Barium enema, Biopsy rectum normal, Constipation, Cough, Flatulence

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? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound 5/5/08-diagnostic test results received-3/2/08-Rectal biopsy to rule out Hirschsprung''''s-ganglion cells from rectum normal. 3/3/08-single contract barium enema demonstrated rectal intussusception which was reduced. Narrowed recto
CDC 'Split Type':

Write-up: 1/30/08 - 2/27/08 seen for constipation. Diagnosis: Intussusception 12 d. post vaccine. 5/27/08-clinic records for DOS 1/15/08-C/O stuffy nose, cough. Clinic note 2/27/08-C/O constipation only 4 BMs since 1/24/08, soft pudding like forceful flatulence."Fussy. Uncomfortable. PE: Tight anal sphincter some gas after removing finger.


Changed on 12/8/2009

VAERS ID: 307215 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Ohio
Vaccinated:2008-01-15
Onset:2008-01-29
Submitted:2008-03-12
Entered:2008-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B132AA / 0 RL / UN
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B132AA / 0 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF229AA / 0 LL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B54016D / 0 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1388U / 0 - / PO

Administered by: Private      Purchased by: Unknown Private
Symptoms: Barium enema, Biopsy rectum normal, Constipation, Cough, Flatulence, Intussusception, Irritability, Nasal congestion, Ultrasound scan, X-ray normal, Ultrasound scan normal

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? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound 5/5/08-diagnostic test results received-3/2/08-Rectal biopsy to rule out Hirschsprung''''s-ganglion Hirschsprung''s-ganglion cells from rectum normal. 3/3/08-single contract barium enema demonstrated rectal intussusception which was reduced. Narrowed recto
CDC 'Split Type':

Write-up: 1/30/08 - 2/27/08 seen for constipation. Diagnosis: Intussusception 12 d. post vaccine. 5/27/08-clinic records for DOS 1/15/08-C/O stuffy nose, cough. Clinic note 2/27/08-C/O constipation only 4 BMs since 1/24/08, soft pudding like forceful flatulence."Fussy. flatulence. Fussy. Uncomfortable. PE: Tight anal sphincter some gas after removing finger.


Changed on 3/2/2010

VAERS ID: 307215 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Ohio
Vaccinated:2008-01-15
Onset:2008-01-29
Submitted:2008-03-12
Entered:2008-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B132AA / 0 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF229AA / 0 LL / UN
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B54016D / 0 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1388U / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Biopsy rectum normal, Constipation, Cough, Flatulence, Intussusception, Irritability, Nasal congestion, Ultrasound scan, X-ray normal, Ultrasound scan normal

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? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound 5/5/08-diagnostic test results received-3/2/08-Rectal biopsy to rule out Hirschsprung''s-ganglion cells from rectum normal. 3/3/08-single contract barium enema demonstrated rectal intussusception which was reduced. Narrowed recto
CDC 'Split Type':

Write-up: 1/30/08 - 2/27/08 seen for constipation. Diagnosis: Intussusception 12 d. post vaccine. 5/27/08-clinic records for DOS 1/15/08-C/O stuffy nose, cough. Clinic note 2/27/08-C/O constipation only 4 BMs since 1/24/08, soft pudding like forceful flatulence. Fussy. Uncomfortable. PE: Tight anal sphincter some gas after removing finger.


Changed on 4/7/2010

VAERS ID: 307215 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Ohio
Vaccinated:2008-01-15
Onset:2008-01-29
Submitted:2008-03-12
Entered:2008-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B132AA / 0 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF229AA / 0 LL / UN
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B54016D / 0 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1388U / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Biopsy rectum normal, Constipation, Cough, Flatulence, Intussusception, Irritability, Nasal congestion, Ultrasound scan, X-ray normal, Ultrasound scan normal

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? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound 5/5/08-diagnostic test results received-3/2/08-Rectal biopsy to rule out Hirschsprung''s-ganglion cells from rectum normal. 3/3/08-single contract barium enema demonstrated rectal intussusception which was reduced. Narrowed recto
CDC 'Split Type':

Write-up: 1/30/08 - 2/27/08 seen for constipation. Diagnosis: Intussusception 12 d. post vaccine. 5/27/08-clinic records for DOS 1/15/08-C/O stuffy nose, cough. Clinic note 2/27/08-C/O constipation only 4 BMs since 1/24/08, soft pudding like forceful flatulence. Fussy. Uncomfortable. PE: Tight anal sphincter some gas after removing finger.


Changed on 8/31/2010

VAERS ID: 307215 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Ohio
Vaccinated:2008-01-15
Onset:2008-01-29
Submitted:2008-03-12
Entered:2008-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B132AA / 0 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF229AA / 0 LL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B54016D / 0 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1388U / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Biopsy rectum normal, Constipation, Cough, Flatulence, Intussusception, Irritability, Nasal congestion, Ultrasound scan, X-ray normal, Ultrasound scan normal

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? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound 5/5/08-diagnostic test results received-3/2/08-Rectal biopsy to rule out Hirschsprung''s-ganglion cells from rectum normal. 3/3/08-single contract barium enema demonstrated rectal intussusception which was reduced. Narrowed recto
CDC 'Split Type':

Write-up: 1/30/08 - 2/27/08 seen for constipation. Diagnosis: Intussusception 12 d. post vaccine. 5/27/08-clinic records for DOS 1/15/08-C/O stuffy nose, cough. Clinic note 2/27/08-C/O constipation only 4 BMs since 1/24/08, soft pudding like forceful flatulence. Fussy. Uncomfortable. PE: Tight anal sphincter some gas after removing finger.


Changed on 5/13/2013

VAERS ID: 307215 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Ohio
Vaccinated:2008-01-15
Onset:2008-01-29
Submitted:2008-03-12
Entered:2008-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B132AA / 0 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF229AA / 0 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54016D / 0 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1388U / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1388U / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Biopsy rectum normal, Constipation, Cough, Flatulence, Intussusception, Irritability, Nasal congestion, Ultrasound scan, X-ray normal, Ultrasound scan normal

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? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound 5/5/08-diagnostic test results received-3/2/08-Rectal biopsy to rule out Hirschsprung''s-ganglion cells from rectum normal. 3/3/08-single contract barium enema demonstrated rectal intussusception which was reduced. Narrowed recto
CDC 'Split Type':

Write-up: 1/30/08 - 2/27/08 seen for constipation. Diagnosis: Intussusception 12 d. post vaccine. 5/27/08-clinic records for DOS 1/15/08-C/O stuffy nose, cough. Clinic note 2/27/08-C/O constipation only 4 BMs since 1/24/08, soft pudding like forceful flatulence. Fussy. Uncomfortable. PE: Tight anal sphincter some gas after removing finger.


Changed on 2/14/2017

VAERS ID: 307215 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Ohio
Vaccinated:2008-01-15
Onset:2008-01-29
Submitted:2008-03-12
Entered:2008-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B132AA / 0 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF229AA / 0 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54016D / 0 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1388U / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium enema, Biopsy rectum normal, Constipation, Cough, Flatulence, Intussusception, Irritability, Nasal congestion, Ultrasound scan, X-ray normal, Ultrasound scan normal

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? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound 5/5/08-diagnostic test results received-3/2/08-Rectal biopsy to rule out Hirschsprung''s-ganglion cells from rectum normal. 3/3/08-single contract barium enema demonstrated rectal intussusception which was reduced. Narrowed recto rectosigmoid ratio noted. Ultrasound spine normal. Supine abdominal fil no signs of obstruction or free area.
CDC 'Split Type':

Write-up: 1/30/08 - 2/27/08 seen for constipation. Diagnosis: Intussusception 12 d. post vaccine. 5/27/08-clinic records for DOS 1/15/08-C/O stuffy nose, cough. Clinic note 2/27/08-C/O constipation only 4 BMs since 1/24/08, soft pudding like forceful flatulence. Fussy. Uncomfortable. PE: Tight anal sphincter some gas after removing finger.


Changed on 9/14/2017

VAERS ID: 307215 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:Ohio
Vaccinated:2008-01-15
Onset:2008-01-29
Submitted:2008-03-12
Entered:2008-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B132AA / 0 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF229AA / 0 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54016D / 0 1 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1388U / 0 1 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Constipation, Intussusception, Ultrasound scan

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? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound 5/5/08-diagnostic test results received-3/2/08-Rectal biopsy to rule out Hirschsprung''s-ganglion cells from rectum normal. 3/3/08-single contract barium enema demonstrated rectal intussusception which was reduced. Narrowed rectosigmoid ratio noted. Ultrasound spine normal. Supine abdominal fil no signs of obstruction or free area.
CDC 'Split Type':

Write-up: 1/30/08 - 2/27/08 seen for constipation. Diagnosis: Intussusception 12 d. post vaccine. 5/27/08-clinic records for DOS 1/15/08-C/O stuffy nose, cough. Clinic note 2/27/08-C/O constipation only 4 BMs since 1/24/08, soft pudding like forceful flatulence. Fussy. Uncomfortable. PE: Tight anal sphincter some gas after removing finger.


Changed on 2/14/2018

VAERS ID: 307215 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Ohio
Vaccinated:2008-01-15
Onset:2008-01-29
Submitted:2008-03-12
Entered:2008-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B132AA / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF229AA / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54016D / 1 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1388U / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Constipation, Intussusception, Ultrasound scan

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? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound 5/5/08-diagnostic test results received-3/2/08-Rectal biopsy to rule out Hirschsprung''s-ganglion cells from rectum normal. 3/3/08-single contract barium enema demonstrated rectal intussusception which was reduced. Narrowed rectosigmoid ratio noted. Ultrasound spine normal. Supine abdominal fil no signs of obstruction or free area.
CDC 'Split Type':

Write-up: 1/30/08 - 2/27/08 seen for constipation. Diagnosis: Intussusception 12 d. post vaccine. 5/27/08-clinic records for DOS 1/15/08-C/O stuffy nose, cough. Clinic note 2/27/08-C/O constipation only 4 BMs since 1/24/08, soft pudding like forceful flatulence. Fussy. Uncomfortable. PE: Tight anal sphincter some gas after removing finger.


Changed on 6/14/2018

VAERS ID: 307215 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Ohio
Vaccinated:2008-01-15
Onset:2008-01-29
Submitted:2008-03-12
Entered:2008-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B132AA / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF229AA / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54016D / 1 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1388U / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Constipation, Intussusception, Ultrasound scan

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? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound 5/5/08-diagnostic test results received-3/2/08-Rectal biopsy to rule out Hirschsprung''s-ganglion cells from rectum normal. 3/3/08-single contract barium enema demonstrated rectal intussusception which was reduced. Narrowed rectosigmoid ratio noted. Ultrasound spine normal. Supine abdominal fil no signs of obstruction or free area.
CDC 'Split Type':

Write-up: 1/30/08 - 2/27/08 seen for constipation. Diagnosis: Intussusception 12 d. post vaccine. 5/27/08-clinic records for DOS 1/15/08-C/O stuffy nose, cough. Clinic note 2/27/08-C/O constipation only 4 BMs since 1/24/08, soft pudding like forceful flatulence. Fussy. Uncomfortable. PE: Tight anal sphincter some gas after removing finger.


Changed on 8/14/2018

VAERS ID: 307215 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Ohio
Vaccinated:2008-01-15
Onset:2008-01-29
Submitted:2008-03-12
Entered:2008-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B132AA / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF229AA / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54016D / 1 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1388U / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Constipation, Intussusception, Ultrasound scan

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? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound 5/5/08-diagnostic test results received-3/2/08-Rectal biopsy to rule out Hirschsprung''s-ganglion cells from rectum normal. 3/3/08-single contract barium enema demonstrated rectal intussusception which was reduced. Narrowed rectosigmoid ratio noted. Ultrasound spine normal. Supine abdominal fil no signs of obstruction or free area.
CDC 'Split Type':

Write-up: 1/30/08 - 2/27/08 seen for constipation. Diagnosis: Intussusception 12 d. post vaccine. 5/27/08-clinic records for DOS 1/15/08-C/O stuffy nose, cough. Clinic note 2/27/08-C/O constipation only 4 BMs since 1/24/08, soft pudding like forceful flatulence. Fussy. Uncomfortable. PE: Tight anal sphincter some gas after removing finger.


Changed on 9/14/2018

VAERS ID: 307215 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Ohio
Vaccinated:2008-01-15
Onset:2008-01-29
Submitted:2008-03-12
Entered:2008-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B132AA / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF229AA / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54016D / 1 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1388U / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Constipation, Intussusception, Ultrasound scan

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? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound 5/5/08-diagnostic test results received-3/2/08-Rectal biopsy to rule out Hirschsprung''s-ganglion cells from rectum normal. 3/3/08-single contract barium enema demonstrated rectal intussusception which was reduced. Narrowed rectosigmoid ratio noted. Ultrasound spine normal. Supine abdominal fil no signs of obstruction or free area.
CDC 'Split Type':

Write-up: 1/30/08 - 2/27/08 seen for constipation. Diagnosis: Intussusception 12 d. post vaccine. 5/27/08-clinic records for DOS 1/15/08-C/O stuffy nose, cough. Clinic note 2/27/08-C/O constipation only 4 BMs since 1/24/08, soft pudding like forceful flatulence. Fussy. Uncomfortable. PE: Tight anal sphincter some gas after removing finger.


Changed on 10/14/2018

VAERS ID: 307215 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Ohio
Vaccinated:2008-01-15
Onset:2008-01-29
Submitted:2008-03-12
Entered:2008-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B132AA / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF229AA / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54016D / 1 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1388U / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Constipation, Intussusception, Ultrasound scan

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? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound 5/5/08-diagnostic test results received-3/2/08-Rectal biopsy to rule out Hirschsprung''s-ganglion cells from rectum normal. 3/3/08-single contract barium enema demonstrated rectal intussusception which was reduced. Narrowed rectosigmoid ratio noted. Ultrasound spine normal. Supine abdominal fil no signs of obstruction or free area.
CDC 'Split Type':

Write-up: 1/30/08 - 2/27/08 seen for constipation. Diagnosis: Intussusception 12 d. post vaccine. 5/27/08-clinic records for DOS 1/15/08-C/O stuffy nose, cough. Clinic note 2/27/08-C/O constipation only 4 BMs since 1/24/08, soft pudding like forceful flatulence. Fussy. Uncomfortable. PE: Tight anal sphincter some gas after removing finger.

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