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This is VAERS ID 309000

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 309000
VAERS Form:
Age:0.2
Sex:Male
Location:Texas
Vaccinated:2008-03-14
Onset:2008-03-20
Submitted:2008-04-04
Entered:2008-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B139AA / - UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF332AA / - UN / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C45150 / - UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1702U / 0 - / PO

Administered by: Other      Purchased by: Unknown
Symptoms: Abdominal distension, Abdominal pain, Appendicectomy, Barium double contrast, Barium enema 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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None 5/29/08-records received-Upper respiratory infection in near distant past.
Allergies:
Diagnostic Lab Data: Barium enema x-ray 03/21?/08 intussusception not resolved. 5/29/08-records received- US of pylorus negative for pyloric stenosis. Barium enema:colocolic intussusception in to the ascending colon with dilated small bowel. Consistent with ob
CDC 'Split Type':

Write-up: Information has been received from a physician concerning a /"pretty normal healthy/" 9 week old patient who on 14-MAR-2008 was vaccinated PO with the initial 2.0 ml dose of ROTATEQ (lot# 659913/1702U). Concomitant vaccinations included a dose of ACTHIB,"a dose of PREVNAR and a dose of PEDIARIX. On 20-MAR-2008 the patient experienced intussusception and on 21-MAR-2008 was diagnosed with intussusception and was hospitalized for 5 days. The intussusception did not resolve after the barium enema and the pa


Changed on 12/8/2009

VAERS ID: 309000 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Texas
Vaccinated:2008-03-14
Onset:2008-03-20
Submitted:2008-04-04
Entered:2008-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B139AA / - UN / UN
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B139AA / - UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF332AA / - UN / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C45150 / - UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1702U / 0 - / PO

Administered by: Other      Purchased by: Unknown Other
Symptoms: Abdominal distension, Abdominal pain, Appendicectomy, Barium double contrast, Barium enema abnormal, Blood potassium increased, Culture stool negative, Haematochezia, Heart rate increased, Ileus, Intussusception, Irritability, Laparotomy, Vomiting, White blood cell count increased, White blood cells stool negative, Ultrasound abdomen, Neutrophil percentage increased, Monocyte percentage increased, Lymphocyte percentage increased, Gastrointestinal tube insertion, Blood alkaline phosphatase increased, Urine output decreased, Obstruction

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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None 5/29/08-records received-Upper respiratory infection in near distant past.
Allergies:
Diagnostic Lab Data: Barium enema x-ray 03/21?/08 intussusception not resolved. 5/29/08-records received- US of pylorus negative for pyloric stenosis. Barium enema:colocolic intussusception in to the ascending colon with dilated small bowel. Consistent with ob
CDC 'Split Type': (blank) WAES0803USA04749

Write-up: Information has been received from a physician concerning a /"pretty "pretty normal healthy/" healthy" 9 week old patient who on 14-MAR-2008 was vaccinated PO with the initial 2.0 ml dose of ROTATEQ (lot# 659913/1702U). Concomitant vaccinations included a dose of ACTHIB,"a ACTHIB, a dose of PREVNAR and a dose of PEDIARIX. On 20-MAR-2008 the patient experienced intussusception and on 21-MAR-2008 was diagnosed with intussusception and was hospitalized for 5 days. The intussusception did not resolve after the barium enema and the pa patient was taken to surgery for a loop reduction. Per physician, "the patient''s intestines were retracted and did not have to be cut." The patient was discharged on 25-MAR-2008. the physician saw the patient on 27-MAR-2008 and noted that the patient was recovered/resolved when it came to "feeding and everything." The patient''s stitches were still dissolving. There was no product quality complaint. Intussusception was also considered to be immediately life-threatening and an other important medical event (surgery) by the physician. Additional information has been requested. 05/29/08-records received for DOS 3/21-3/25/08-DX DC: Intussusception Status post reduction. Appendectomy. Developed abdominal pain. Increased abdominal distention, emesis morning of admission. Fussy. Heart rate increased. Urine output decreased. Stool bloody. Exploratory laparotomy and incidental appendectomy. Barium enema was unsuccessful. Developed post op ileus. NG placement.


Changed on 3/2/2010

VAERS ID: 309000 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Texas
Vaccinated:2008-03-14
Onset:2008-03-20
Submitted:2008-04-04
Entered:2008-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B139AA / - UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF332AA / - UN / UN
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC C45150 / - UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1702U / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal distension, Abdominal pain, Appendicectomy, Barium double contrast, Barium enema abnormal, Blood potassium increased, Culture stool negative, Haematochezia, Heart rate increased, Ileus, Intussusception, Irritability, Laparotomy, Vomiting, White blood cell count increased, White blood cells stool negative, Ultrasound abdomen, Neutrophil percentage increased, Monocyte percentage increased, Lymphocyte percentage increased, Gastrointestinal tube insertion, Blood alkaline phosphatase increased, Urine output decreased, Obstruction

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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None 5/29/08-records received-Upper respiratory infection in near distant past.
Allergies:
Diagnostic Lab Data: Barium enema x-ray 03/21?/08 intussusception not resolved. 5/29/08-records received- US of pylorus negative for pyloric stenosis. Barium enema:colocolic intussusception in to the ascending colon with dilated small bowel. Consistent with ob
CDC 'Split Type': WAES0803USA04749

Write-up: Information has been received from a physician concerning a "pretty normal healthy" 9 week old patient who on 14-MAR-2008 was vaccinated PO with the initial 2.0 ml dose of ROTATEQ (lot# 659913/1702U). Concomitant vaccinations included a dose of ACTHIB, a dose of PREVNAR and a dose of PEDIARIX. On 20-MAR-2008 the patient experienced intussusception and on 21-MAR-2008 was diagnosed with intussusception and was hospitalized for 5 days. The intussusception did not resolve after the barium enema and the patient was taken to surgery for a loop reduction. Per physician, "the patient''s intestines were retracted and did not have to be cut." The patient was discharged on 25-MAR-2008. the physician saw the patient on 27-MAR-2008 and noted that the patient was recovered/resolved when it came to "feeding and everything." The patient''s stitches were still dissolving. There was no product quality complaint. Intussusception was also considered to be immediately life-threatening and an other important medical event (surgery) by the physician. Additional information has been requested. 05/29/08-records received for DOS 3/21-3/25/08-DX DC: Intussusception Status post reduction. Appendectomy. Developed abdominal pain. Increased abdominal distention, emesis morning of admission. Fussy. Heart rate increased. Urine output decreased. Stool bloody. Exploratory laparotomy and incidental appendectomy. Barium enema was unsuccessful. Developed post op ileus. NG placement.


Changed on 4/7/2010

VAERS ID: 309000 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Texas
Vaccinated:2008-03-14
Onset:2008-03-20
Submitted:2008-04-04
Entered:2008-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B139AA / - UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF332AA / - UN / UN
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C45150 / - UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1702U / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal distension, Abdominal pain, Appendicectomy, Barium double contrast, Barium enema abnormal, Blood potassium increased, Culture stool negative, Haematochezia, Heart rate increased, Ileus, Intussusception, Irritability, Laparotomy, Vomiting, White blood cell count increased, White blood cells stool negative, Ultrasound abdomen, Neutrophil percentage increased, Monocyte percentage increased, Lymphocyte percentage increased, Gastrointestinal tube insertion, Blood alkaline phosphatase increased, Urine output decreased, Obstruction

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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None 5/29/08-records received-Upper respiratory infection in near distant past.
Allergies:
Diagnostic Lab Data: Barium enema x-ray 03/21?/08 intussusception not resolved. 5/29/08-records received- US of pylorus negative for pyloric stenosis. Barium enema:colocolic intussusception in to the ascending colon with dilated small bowel. Consistent with ob
CDC 'Split Type': WAES0803USA04749

Write-up: Information has been received from a physician concerning a "pretty normal healthy" 9 week old patient who on 14-MAR-2008 was vaccinated PO with the initial 2.0 ml dose of ROTATEQ (lot# 659913/1702U). Concomitant vaccinations included a dose of ACTHIB, a dose of PREVNAR and a dose of PEDIARIX. On 20-MAR-2008 the patient experienced intussusception and on 21-MAR-2008 was diagnosed with intussusception and was hospitalized for 5 days. The intussusception did not resolve after the barium enema and the patient was taken to surgery for a loop reduction. Per physician, "the patient''s intestines were retracted and did not have to be cut." The patient was discharged on 25-MAR-2008. the physician saw the patient on 27-MAR-2008 and noted that the patient was recovered/resolved when it came to "feeding and everything." The patient''s stitches were still dissolving. There was no product quality complaint. Intussusception was also considered to be immediately life-threatening and an other important medical event (surgery) by the physician. Additional information has been requested. 05/29/08-records received for DOS 3/21-3/25/08-DX DC: Intussusception Status post reduction. Appendectomy. Developed abdominal pain. Increased abdominal distention, emesis morning of admission. Fussy. Heart rate increased. Urine output decreased. Stool bloody. Exploratory laparotomy and incidental appendectomy. Barium enema was unsuccessful. Developed post op ileus. NG placement.


Changed on 8/31/2010

VAERS ID: 309000 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Texas
Vaccinated:2008-03-14
Onset:2008-03-20
Submitted:2008-04-04
Entered:2008-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B139AA / - UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF332AA / - UN / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH C45150 / - UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1702U / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal distension, Abdominal pain, Appendicectomy, Barium double contrast, Barium enema abnormal, Blood potassium increased, Culture stool negative, Haematochezia, Heart rate increased, Ileus, Intussusception, Irritability, Laparotomy, Vomiting, White blood cell count increased, White blood cells stool negative, Ultrasound abdomen, Neutrophil percentage increased, Monocyte percentage increased, Lymphocyte percentage increased, Gastrointestinal tube insertion, Blood alkaline phosphatase increased, Urine output decreased, Obstruction

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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None 5/29/08-records received-Upper respiratory infection in near distant past.
Allergies:
Diagnostic Lab Data: Barium enema x-ray 03/21?/08 intussusception not resolved. 5/29/08-records received- US of pylorus negative for pyloric stenosis. Barium enema:colocolic intussusception in to the ascending colon with dilated small bowel. Consistent with ob
CDC 'Split Type': WAES0803USA04749

Write-up: Information has been received from a physician concerning a "pretty normal healthy" 9 week old patient who on 14-MAR-2008 was vaccinated PO with the initial 2.0 ml dose of ROTATEQ (lot# 659913/1702U). Concomitant vaccinations included a dose of ACTHIB, a dose of PREVNAR and a dose of PEDIARIX. On 20-MAR-2008 the patient experienced intussusception and on 21-MAR-2008 was diagnosed with intussusception and was hospitalized for 5 days. The intussusception did not resolve after the barium enema and the patient was taken to surgery for a loop reduction. Per physician, "the patient''s intestines were retracted and did not have to be cut." The patient was discharged on 25-MAR-2008. the physician saw the patient on 27-MAR-2008 and noted that the patient was recovered/resolved when it came to "feeding and everything." The patient''s stitches were still dissolving. There was no product quality complaint. Intussusception was also considered to be immediately life-threatening and an other important medical event (surgery) by the physician. Additional information has been requested. 05/29/08-records received for DOS 3/21-3/25/08-DX DC: Intussusception Status post reduction. Appendectomy. Developed abdominal pain. Increased abdominal distention, emesis morning of admission. Fussy. Heart rate increased. Urine output decreased. Stool bloody. Exploratory laparotomy and incidental appendectomy. Barium enema was unsuccessful. Developed post op ileus. NG placement.


Changed on 5/13/2013

VAERS ID: 309000 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Texas
Vaccinated:2008-03-14
Onset:2008-03-20
Submitted:2008-04-04
Entered:2008-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B139AA / - UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF332AA / - UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45150 / - UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1702U / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1702U / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal distension, Abdominal pain, Appendicectomy, Barium double contrast, Barium enema abnormal, Blood potassium increased, Culture stool negative, Haematochezia, Heart rate increased, Ileus, Intussusception, Irritability, Laparotomy, Vomiting, White blood cell count increased, White blood cells stool negative, Ultrasound abdomen, Neutrophil percentage increased, Monocyte percentage increased, Lymphocyte percentage increased, Gastrointestinal tube insertion, Blood alkaline phosphatase increased, Urine output decreased, Obstruction

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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None 5/29/08-records received-Upper respiratory infection in near distant past.
Allergies:
Diagnostic Lab Data: Barium enema x-ray 03/21?/08 intussusception not resolved. 5/29/08-records received- US of pylorus negative for pyloric stenosis. Barium enema:colocolic intussusception in to the ascending colon with dilated small bowel. Consistent with ob
CDC 'Split Type': WAES0803USA04749

Write-up: Information has been received from a physician concerning a "pretty normal healthy" 9 week old patient who on 14-MAR-2008 was vaccinated PO with the initial 2.0 ml dose of ROTATEQ (lot# 659913/1702U). Concomitant vaccinations included a dose of ACTHIB, a dose of PREVNAR and a dose of PEDIARIX. On 20-MAR-2008 the patient experienced intussusception and on 21-MAR-2008 was diagnosed with intussusception and was hospitalized for 5 days. The intussusception did not resolve after the barium enema and the patient was taken to surgery for a loop reduction. Per physician, "the patient''s intestines were retracted and did not have to be cut." The patient was discharged on 25-MAR-2008. the physician saw the patient on 27-MAR-2008 and noted that the patient was recovered/resolved when it came to "feeding and everything." The patient''s stitches were still dissolving. There was no product quality complaint. Intussusception was also considered to be immediately life-threatening and an other important medical event (surgery) by the physician. Additional information has been requested. 05/29/08-records received for DOS 3/21-3/25/08-DX DC: Intussusception Status post reduction. Appendectomy. Developed abdominal pain. Increased abdominal distention, emesis morning of admission. Fussy. Heart rate increased. Urine output decreased. Stool bloody. Exploratory laparotomy and incidental appendectomy. Barium enema was unsuccessful. Developed post op ileus. NG placement.


Changed on 4/14/2017

VAERS ID: 309000 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Texas
Vaccinated:2008-03-14
Onset:2008-03-20
Submitted:2008-04-04
Entered:2008-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B139AA / - UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF332AA / - UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45150 / - UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1702U / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal distension, Abdominal pain, Appendicectomy, Barium double contrast, Barium enema abnormal, Blood potassium increased, Culture stool negative, Haematochezia, Heart rate increased, Ileus, Intussusception, Irritability, Laparotomy, Vomiting, White blood cell count increased, White blood cells stool negative, Ultrasound abdomen, Neutrophil percentage increased, Monocyte percentage increased, Lymphocyte percentage increased, Gastrointestinal tube insertion, Blood alkaline phosphatase increased, Urine output decreased, Obstruction

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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None 5/29/08-records received-Upper respiratory infection in near distant past.
Allergies:
Diagnostic Lab Data: Barium enema x-ray 03/21?/08 intussusception not resolved. 5/29/08-records received- US of pylorus negative for pyloric stenosis. Barium enema:colocolic intussusception in to the ascending colon with dilated small bowel. Consistent with ob obstruction. Hydrostatic reduction attempted, unable to reduce. WBC 18.3, % neutrophils 36, monocytes 10 and lymphocytes 52. Alkaline phos 263. Potassium 5.5. Stool for WBC negative.Stool culture negative.
CDC 'Split Type': WAES0803USA04749

Write-up: Information has been received from a physician concerning a "pretty normal healthy" 9 week old patient who on 14-MAR-2008 was vaccinated PO with the initial 2.0 ml dose of ROTATEQ (lot# 659913/1702U). Concomitant vaccinations included a dose of ACTHIB, a dose of PREVNAR and a dose of PEDIARIX. On 20-MAR-2008 the patient experienced intussusception and on 21-MAR-2008 was diagnosed with intussusception and was hospitalized for 5 days. The intussusception did not resolve after the barium enema and the patient was taken to surgery for a loop reduction. Per physician, "the patient''s intestines were retracted and did not have to be cut." The patient was discharged on 25-MAR-2008. the physician saw the patient on 27-MAR-2008 and noted that the patient was recovered/resolved when it came to "feeding and everything." The patient''s stitches were still dissolving. There was no product quality complaint. Intussusception was also considered to be immediately life-threatening and an other important medical event (surgery) by the physician. Additional information has been requested. 05/29/08-records received for DOS 3/21-3/25/08-DX DC: Intussusception Status post reduction. Appendectomy. Developed abdominal pain. Increased abdominal distention, emesis morning of admission. Fussy. Heart rate increased. Urine output decreased. Stool bloody. Exploratory laparotomy and incidental appendectomy. Barium enema was unsuccessful. Developed post op ileus. NG placement.


Changed on 9/14/2017

VAERS ID: 309000 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:Texas
Vaccinated:2008-03-14
Onset:2008-03-20
Submitted:2008-04-04
Entered:2008-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B139AA / - UNK UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF332AA / - UNK UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45150 / - UNK UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1702U / 0 1 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema abnormal, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None 5/29/08-records received-Upper respiratory infection in near distant past.
Allergies:
Diagnostic Lab Data: Barium enema x-ray 03/21?/08 intussusception not resolved. 5/29/08-records received- US of pylorus negative for pyloric stenosis. Barium enema:colocolic intussusception in to the ascending colon with dilated small bowel. Consistent with obstruction. Hydrostatic reduction attempted, unable to reduce. WBC 18.3, % neutrophils 36, monocytes 10 and lymphocytes 52. Alkaline phos 263. Potassium 5.5. Stool for WBC negative.Stool culture negative.
CDC 'Split Type': WAES0803USA04749

Write-up: Information has been received from a physician concerning a "pretty normal healthy" 9 week old patient who on 14-MAR-2008 was vaccinated PO with the initial 2.0 ml dose of ROTATEQ (lot# 659913/1702U). Concomitant vaccinations included a dose of ACTHIB, a dose of PREVNAR and a dose of PEDIARIX. On 20-MAR-2008 the patient experienced intussusception and on 21-MAR-2008 was diagnosed with intussusception and was hospitalized for 5 days. The intussusception did not resolve after the barium enema and the patient was taken to surgery for a loop reduction. Per physician, "the patient''s intestines were retracted and did not have to be cut." The patient was discharged on 25-MAR-2008. the physician saw the patient on 27-MAR-2008 and noted that the patient was recovered/resolved when it came to "feeding and everything." The patient''s stitches were still dissolving. There was no product quality complaint. Intussusception was also considered to be immediately life-threatening and an other important medical event (surgery) by the physician. Additional information has been requested. 05/29/08-records received for DOS 3/21-3/25/08-DX DC: Intussusception Status post reduction. Appendectomy. Developed abdominal pain. Increased abdominal distention, emesis morning of admission. Fussy. Heart rate increased. Urine output decreased. Stool bloody. Exploratory laparotomy and incidental appendectomy. Barium enema was unsuccessful. Developed post op ileus. NG placement.


Changed on 2/14/2018

VAERS ID: 309000 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Texas
Vaccinated:2008-03-14
Onset:2008-03-20
Submitted:2008-04-04
Entered:2008-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B139AA / UNK UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF332AA / UNK UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45150 / UNK UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1702U / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema abnormal, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None 5/29/08-records received-Upper respiratory infection in near distant past.
Allergies:
Diagnostic Lab Data: Barium enema x-ray 03/21?/08 intussusception not resolved. 5/29/08-records received- US of pylorus negative for pyloric stenosis. Barium enema:colocolic intussusception in to the ascending colon with dilated small bowel. Consistent with obstruction. Hydrostatic reduction attempted, unable to reduce. WBC 18.3, % neutrophils 36, monocytes 10 and lymphocytes 52. Alkaline phos 263. Potassium 5.5. Stool for WBC negative.Stool culture negative.
CDC 'Split Type': WAES0803USA04749

Write-up: Information has been received from a physician concerning a "pretty normal healthy" 9 week old patient who on 14-MAR-2008 was vaccinated PO with the initial 2.0 ml dose of ROTATEQ (lot# 659913/1702U). Concomitant vaccinations included a dose of ACTHIB, a dose of PREVNAR and a dose of PEDIARIX. On 20-MAR-2008 the patient experienced intussusception and on 21-MAR-2008 was diagnosed with intussusception and was hospitalized for 5 days. The intussusception did not resolve after the barium enema and the patient was taken to surgery for a loop reduction. Per physician, "the patient''s intestines were retracted and did not have to be cut." The patient was discharged on 25-MAR-2008. the physician saw the patient on 27-MAR-2008 and noted that the patient was recovered/resolved when it came to "feeding and everything." The patient''s stitches were still dissolving. There was no product quality complaint. Intussusception was also considered to be immediately life-threatening and an other important medical event (surgery) by the physician. Additional information has been requested. 05/29/08-records received for DOS 3/21-3/25/08-DX DC: Intussusception Status post reduction. Appendectomy. Developed abdominal pain. Increased abdominal distention, emesis morning of admission. Fussy. Heart rate increased. Urine output decreased. Stool bloody. Exploratory laparotomy and incidental appendectomy. Barium enema was unsuccessful. Developed post op ileus. NG placement.


Changed on 6/14/2018

VAERS ID: 309000 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Texas
Vaccinated:2008-03-14
Onset:2008-03-20
Submitted:2008-04-04
Entered:2008-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B139AA / UNK UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF332AA / UNK UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45150 / UNK UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1702U / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema abnormal, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None 5/29/08-records received-Upper respiratory infection in near distant past.
Allergies:
Diagnostic Lab Data: Barium enema x-ray 03/21?/08 intussusception not resolved. 5/29/08-records received- US of pylorus negative for pyloric stenosis. Barium enema:colocolic intussusception in to the ascending colon with dilated small bowel. Consistent with obstruction. Hydrostatic reduction attempted, unable to reduce. WBC 18.3, % neutrophils 36, monocytes 10 and lymphocytes 52. Alkaline phos 263. Potassium 5.5. Stool for WBC negative.Stool culture negative.
CDC 'Split Type': WAES0803USA04749

Write-up: Information has been received from a physician concerning a "pretty normal healthy" 9 week old patient who on 14-MAR-2008 was vaccinated PO with the initial 2.0 ml dose of ROTATEQ (lot# 659913/1702U). Concomitant vaccinations included a dose of ACTHIB, a dose of PREVNAR and a dose of PEDIARIX. On 20-MAR-2008 the patient experienced intussusception and on 21-MAR-2008 was diagnosed with intussusception and was hospitalized for 5 days. The intussusception did not resolve after the barium enema and the patient was taken to surgery for a loop reduction. Per physician, "the patient''s intestines were retracted and did not have to be cut." The patient was discharged on 25-MAR-2008. the physician saw the patient on 27-MAR-2008 and noted that the patient was recovered/resolved when it came to "feeding and everything." The patient''s stitches were still dissolving. There was no product quality complaint. Intussusception was also considered to be immediately life-threatening and an other important medical event (surgery) by the physician. Additional information has been requested. 05/29/08-records received for DOS 3/21-3/25/08-DX DC: Intussusception Status post reduction. Appendectomy. Developed abdominal pain. Increased abdominal distention, emesis morning of admission. Fussy. Heart rate increased. Urine output decreased. Stool bloody. Exploratory laparotomy and incidental appendectomy. Barium enema was unsuccessful. Developed post op ileus. NG placement.


Changed on 8/14/2018

VAERS ID: 309000 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Texas
Vaccinated:2008-03-14
Onset:2008-03-20
Submitted:2008-04-04
Entered:2008-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B139AA / UNK UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF332AA / UNK UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45150 / UNK UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1702U / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema abnormal, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None 5/29/08-records received-Upper respiratory infection in near distant past.
Allergies:
Diagnostic Lab Data: Barium enema x-ray 03/21?/08 intussusception not resolved. 5/29/08-records received- US of pylorus negative for pyloric stenosis. Barium enema:colocolic intussusception in to the ascending colon with dilated small bowel. Consistent with obstruction. Hydrostatic reduction attempted, unable to reduce. WBC 18.3, % neutrophils 36, monocytes 10 and lymphocytes 52. Alkaline phos 263. Potassium 5.5. Stool for WBC negative.Stool culture negative.
CDC 'Split Type': WAES0803USA04749

Write-up: Information has been received from a physician concerning a "pretty normal healthy" 9 week old patient who on 14-MAR-2008 was vaccinated PO with the initial 2.0 ml dose of ROTATEQ (lot# 659913/1702U). Concomitant vaccinations included a dose of ACTHIB, a dose of PREVNAR and a dose of PEDIARIX. On 20-MAR-2008 the patient experienced intussusception and on 21-MAR-2008 was diagnosed with intussusception and was hospitalized for 5 days. The intussusception did not resolve after the barium enema and the patient was taken to surgery for a loop reduction. Per physician, "the patient''s intestines were retracted and did not have to be cut." The patient was discharged on 25-MAR-2008. the physician saw the patient on 27-MAR-2008 and noted that the patient was recovered/resolved when it came to "feeding and everything." The patient''s stitches were still dissolving. There was no product quality complaint. Intussusception was also considered to be immediately life-threatening and an other important medical event (surgery) by the physician. Additional information has been requested. 05/29/08-records received for DOS 3/21-3/25/08-DX DC: Intussusception Status post reduction. Appendectomy. Developed abdominal pain. Increased abdominal distention, emesis morning of admission. Fussy. Heart rate increased. Urine output decreased. Stool bloody. Exploratory laparotomy and incidental appendectomy. Barium enema was unsuccessful. Developed post op ileus. NG placement.


Changed on 9/14/2018

VAERS ID: 309000 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Texas
Vaccinated:2008-03-14
Onset:2008-03-20
Submitted:2008-04-04
Entered:2008-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B139AA / UNK UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF332AA / UNK UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45150 / UNK UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1702U / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema abnormal, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None 5/29/08-records received-Upper respiratory infection in near distant past.
Allergies:
Diagnostic Lab Data: Barium enema x-ray 03/21?/08 intussusception not resolved. 5/29/08-records received- US of pylorus negative for pyloric stenosis. Barium enema:colocolic intussusception in to the ascending colon with dilated small bowel. Consistent with obstruction. Hydrostatic reduction attempted, unable to reduce. WBC 18.3, % neutrophils 36, monocytes 10 and lymphocytes 52. Alkaline phos 263. Potassium 5.5. Stool for WBC negative.Stool culture negative.
CDC 'Split Type': WAES0803USA04749

Write-up: Information has been received from a physician concerning a "pretty normal healthy" 9 week old patient who on 14-MAR-2008 was vaccinated PO with the initial 2.0 ml dose of ROTATEQ (lot# 659913/1702U). Concomitant vaccinations included a dose of ACTHIB, a dose of PREVNAR and a dose of PEDIARIX. On 20-MAR-2008 the patient experienced intussusception and on 21-MAR-2008 was diagnosed with intussusception and was hospitalized for 5 days. The intussusception did not resolve after the barium enema and the patient was taken to surgery for a loop reduction. Per physician, "the patient''s intestines were retracted and did not have to be cut." The patient was discharged on 25-MAR-2008. the physician saw the patient on 27-MAR-2008 and noted that the patient was recovered/resolved when it came to "feeding and everything." The patient''s stitches were still dissolving. There was no product quality complaint. Intussusception was also considered to be immediately life-threatening and an other important medical event (surgery) by the physician. Additional information has been requested. 05/29/08-records received for DOS 3/21-3/25/08-DX DC: Intussusception Status post reduction. Appendectomy. Developed abdominal pain. Increased abdominal distention, emesis morning of admission. Fussy. Heart rate increased. Urine output decreased. Stool bloody. Exploratory laparotomy and incidental appendectomy. Barium enema was unsuccessful. Developed post op ileus. NG placement.


Changed on 10/14/2018

VAERS ID: 309000 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Texas
Vaccinated:2008-03-14
Onset:2008-03-20
Submitted:2008-04-04
Entered:2008-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B139AA / UNK UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF332AA / UNK UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45150 / UNK UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1702U / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema abnormal, 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)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None 5/29/08-records received-Upper respiratory infection in near distant past.
Allergies:
Diagnostic Lab Data: Barium enema x-ray 03/21?/08 intussusception not resolved. 5/29/08-records received- US of pylorus negative for pyloric stenosis. Barium enema:colocolic intussusception in to the ascending colon with dilated small bowel. Consistent with obstruction. Hydrostatic reduction attempted, unable to reduce. WBC 18.3, % neutrophils 36, monocytes 10 and lymphocytes 52. Alkaline phos 263. Potassium 5.5. Stool for WBC negative.Stool culture negative.
CDC 'Split Type': WAES0803USA04749

Write-up: Information has been received from a physician concerning a "pretty normal healthy" 9 week old patient who on 14-MAR-2008 was vaccinated PO with the initial 2.0 ml dose of ROTATEQ (lot# 659913/1702U). Concomitant vaccinations included a dose of ACTHIB, a dose of PREVNAR and a dose of PEDIARIX. On 20-MAR-2008 the patient experienced intussusception and on 21-MAR-2008 was diagnosed with intussusception and was hospitalized for 5 days. The intussusception did not resolve after the barium enema and the patient was taken to surgery for a loop reduction. Per physician, "the patient''s intestines were retracted and did not have to be cut." The patient was discharged on 25-MAR-2008. the physician saw the patient on 27-MAR-2008 and noted that the patient was recovered/resolved when it came to "feeding and everything." The patient''s stitches were still dissolving. There was no product quality complaint. Intussusception was also considered to be immediately life-threatening and an other important medical event (surgery) by the physician. Additional information has been requested. 05/29/08-records received for DOS 3/21-3/25/08-DX DC: Intussusception Status post reduction. Appendectomy. Developed abdominal pain. Increased abdominal distention, emesis morning of admission. Fussy. Heart rate increased. Urine output decreased. Stool bloody. Exploratory laparotomy and incidental appendectomy. Barium enema was unsuccessful. Developed post op ileus. NG placement.

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