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This is VAERS ID 310921

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 310921
VAERS Form:
Age:0.5
Sex:Male
Location:Massachusetts
Vaccinated:2008-02-08
Onset:2008-03-26
Submitted:2008-04-23
Entered:2008-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21A127AA / 2 LL / IM
FLU: INFLUENZA (FLUZONE) / SANOFI PASTEUR U2523AA / 0 LL / ID
HIBV: HIB (ACTHIB) / SANOFI PASTEUR VF119AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B26510D / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1129V / 2 - / PO

Administered by: Other      Purchased by: Unknown
Symptoms: Abdominal pain, Alanine aminotransferase increased, Appendicectomy, Aspartate aminotransferase increased, Barium enema abnormal

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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 8/11/08-records received-BE performed times 3 unsuccessful reduction of intussusception. WBC 19.40, lymphocyte % 40.0. Alk Phos 325, AST 351, ALT 41.
CDC 'Split Type':

Write-up: Information has been received from a physician concerning an 8 month old male who on 05-OCT-2007, 01-DEC-2007 and 08-FEB-2008 was vaccinated PO with his first, second and third /"standard/" doses of Rotateq. Concomitant vaccinations included /"other rout"ine vaccines./" Subsequently the patient experienced intussusception went to an emergency room and was subsequently hospitalized. The patient had surgery on 14-APR-2008. Subsequently, the patient recovered and was discharged from the hospital. There w


Changed on 12/8/2009

VAERS ID: 310921 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Massachusetts
Vaccinated:2008-02-08
Onset:2008-03-26
Submitted:2008-04-23
Entered:2008-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21A127AA / 2 LL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21A127AA / 2 LL / IM
FLU: INFLUENZA (FLUZONE) INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2523AA / 0 LL / ID
HIBV: HIB (ACTHIB) / SANOFI PASTEUR VF119AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B26510D / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1129V / 2 - / PO

Administered by: Other      Purchased by: Unknown Other
Symptoms: Abdominal pain, Alanine aminotransferase increased, Appendicectomy, Aspartate aminotransferase increased, Barium enema abnormal, Crying, Dyspnoea, Intussusception, Laparotomy, Leukocytosis, Screaming, White blood cell count increased, Lymphocyte percentage decreased, Blood alkaline phosphatase increased

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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 8/11/08-records received-BE performed times 3 unsuccessful reduction of intussusception. WBC 19.40, lymphocyte % 40.0. Alk Phos 325, AST 351, ALT 41.
CDC 'Split Type': (blank) WAES0804USA04007

Write-up: Information has been received from a physician concerning an 8 month old male who on 05-OCT-2007, 01-DEC-2007 and 08-FEB-2008 was vaccinated PO with his first, second and third /"standard/" "standard" doses of Rotateq. Concomitant vaccinations included /"other rout"ine vaccines./" "other routine vaccines." Subsequently the patient experienced intussusception went to an emergency room and was subsequently hospitalized. The patient had surgery on 14-APR-2008. Subsequently, the patient recovered and was discharged from the hospital. There w was no product quality complaint. Intussusception was also considered to be an other important medical event (surgery) by the physician. Additional information has been requested. 8/11/08-records received for DOS 3/26-3/29/08-DC DX: Intussusception. Leukocytosis. Presented to ED with screaming, vomiting and difficulty breathing, abdominal pain, inconsolable. Last BM day before. Exploratory laparotomy with incidental appendectomy.


Changed on 3/2/2010

VAERS ID: 310921 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Massachusetts
Vaccinated:2008-02-08
Onset:2008-03-26
Submitted:2008-04-23
Entered:2008-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21A127AA / 2 LL / IM
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2523AA / 0 LL / ID
HIBV: HIB (ACTHIB) / SANOFI PASTEUR VF119AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B26510D / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1129V / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Alanine aminotransferase increased, Appendicectomy, Aspartate aminotransferase increased, Barium enema abnormal, Crying, Dyspnoea, Intussusception, Laparotomy, Leukocytosis, Screaming, White blood cell count increased, Lymphocyte percentage decreased, Blood alkaline phosphatase increased

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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 8/11/08-records received-BE performed times 3 unsuccessful reduction of intussusception. WBC 19.40, lymphocyte % 40.0. Alk Phos 325, AST 351, ALT 41.
CDC 'Split Type': WAES0804USA04007

Write-up: Information has been received from a physician concerning an 8 month old male who on 05-OCT-2007, 01-DEC-2007 and 08-FEB-2008 was vaccinated PO with his first, second and third "standard" doses of Rotateq. Concomitant vaccinations included "other routine vaccines." Subsequently the patient experienced intussusception went to an emergency room and was subsequently hospitalized. The patient had surgery on 14-APR-2008. Subsequently, the patient recovered and was discharged from the hospital. There was no product quality complaint. Intussusception was also considered to be an other important medical event (surgery) by the physician. Additional information has been requested. 8/11/08-records received for DOS 3/26-3/29/08-DC DX: Intussusception. Leukocytosis. Presented to ED with screaming, vomiting and difficulty breathing, abdominal pain, inconsolable. Last BM day before. Exploratory laparotomy with incidental appendectomy.


Changed on 4/7/2010

VAERS ID: 310921 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Massachusetts
Vaccinated:2008-02-08
Onset:2008-03-26
Submitted:2008-04-23
Entered:2008-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21A127AA / 2 LL / IM
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2523AA / 0 LL / ID
HIBV: HIB (ACTHIB) / SANOFI PASTEUR VF119AA / 2 RL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B26510D / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1129V / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Alanine aminotransferase increased, Appendicectomy, Aspartate aminotransferase increased, Barium enema abnormal, Crying, Dyspnoea, Intussusception, Laparotomy, Leukocytosis, Screaming, White blood cell count increased, Lymphocyte percentage decreased, Blood alkaline phosphatase increased

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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 8/11/08-records received-BE performed times 3 unsuccessful reduction of intussusception. WBC 19.40, lymphocyte % 40.0. Alk Phos 325, AST 351, ALT 41.
CDC 'Split Type': WAES0804USA04007

Write-up: Information has been received from a physician concerning an 8 month old male who on 05-OCT-2007, 01-DEC-2007 and 08-FEB-2008 was vaccinated PO with his first, second and third "standard" doses of Rotateq. Concomitant vaccinations included "other routine vaccines." Subsequently the patient experienced intussusception went to an emergency room and was subsequently hospitalized. The patient had surgery on 14-APR-2008. Subsequently, the patient recovered and was discharged from the hospital. There was no product quality complaint. Intussusception was also considered to be an other important medical event (surgery) by the physician. Additional information has been requested. 8/11/08-records received for DOS 3/26-3/29/08-DC DX: Intussusception. Leukocytosis. Presented to ED with screaming, vomiting and difficulty breathing, abdominal pain, inconsolable. Last BM day before. Exploratory laparotomy with incidental appendectomy.


Changed on 5/11/2010

VAERS ID: 310921 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Massachusetts
Vaccinated:2008-02-08
Onset:2008-03-26
Submitted:2008-04-23
Entered:2008-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21A127AA / 2 LL / IM
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2523AA / 0 LL / ID
HIBV: HIB (ACTHIB) / SANOFI PASTEUR VF119AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B26510D / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1129V / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Alanine aminotransferase increased, Appendicectomy, Aspartate aminotransferase increased, Barium enema abnormal, Crying, Dyspnoea, Intussusception, Laparotomy, Leukocytosis, Screaming, White blood cell count increased, Lymphocyte percentage decreased, Blood alkaline phosphatase increased

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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 8/11/08-records received-BE performed times 3 unsuccessful reduction of intussusception. WBC 19.40, lymphocyte % 40.0. Alk Phos 325, AST 351, ALT 41.
CDC 'Split Type': WAES0804USA04007

Write-up: Information has been received from a physician concerning an 8 month old male who on 05-OCT-2007, 01-DEC-2007 and 08-FEB-2008 was vaccinated PO with his first, second and third "standard" doses of Rotateq. Concomitant vaccinations included "other routine vaccines." Subsequently the patient experienced intussusception went to an emergency room and was subsequently hospitalized. The patient had surgery on 14-APR-2008. Subsequently, the patient recovered and was discharged from the hospital. There was no product quality complaint. Intussusception was also considered to be an other important medical event (surgery) by the physician. Additional information has been requested. 8/11/08-records received for DOS 3/26-3/29/08-DC DX: Intussusception. Leukocytosis. Presented to ED with screaming, vomiting and difficulty breathing, abdominal pain, inconsolable. Last BM day before. Exploratory laparotomy with incidental appendectomy.


Changed on 8/31/2010

VAERS ID: 310921 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Massachusetts
Vaccinated:2008-02-08
Onset:2008-03-26
Submitted:2008-04-23
Entered:2008-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21A127AA / 2 LL / IM
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2523AA / 0 LL / ID
HIBV: HIB (ACTHIB) / SANOFI PASTEUR VF119AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B26510D / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1129V / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Coxsackie viral infection, Intussusception, Molluscum contagiosum

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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 8/11/08-records received-BE performed times 3 unsuccessful reduction of intussusception. WBC 19.40, lymphocyte % 40.0. Alk Phos 325, AST 351, ALT 41.
CDC 'Split Type': WAES0804USA04007

Write-up: Information has been received from a physician concerning an 8 month old male who on 05-OCT-2007, 01-DEC-2007 and 08-FEB-2008 was vaccinated PO with his first, second and third "standard" doses of Rotateq. Concomitant vaccinations included "other routine vaccines." Subsequently the patient experienced intussusception went to an emergency room and was subsequently hospitalized. The patient had surgery on 14-APR-2008. Subsequently, the patient recovered and was discharged from the hospital. There was no product quality complaint. Intussusception was also considered to be an other important medical event (surgery) by the physician. Additional information has been requested. 8/11/08-records received for DOS 3/26-3/29/08-DC DX: Intussusception. Leukocytosis. Presented to ED with screaming, vomiting and difficulty breathing, abdominal pain, inconsolable. Last BM day before. Exploratory laparotomy with incidental appendectomy.


Changed on 1/4/2011

VAERS ID: 310921 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Massachusetts
Vaccinated:2008-02-08
Onset:2008-03-26
Submitted:2008-04-23
Entered:2008-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21A127AA / 2 LL / IM
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2523AA / 0 LL / ID
HIBV: HIB (ACTHIB) / SANOFI PASTEUR VF119AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B26510D / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1129V / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Coxsackie viral infection, Intussusception, Molluscum contagiosum

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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 8/11/08-records received-BE performed times 3 unsuccessful reduction of intussusception. WBC 19.40, lymphocyte % 40.0. Alk Phos 325, AST 351, ALT 41.
CDC 'Split Type': WAES0804USA04007

Write-up: Information has been received from a physician concerning an 8 month old male who on 05-OCT-2007, 01-DEC-2007 and 08-FEB-2008 was vaccinated PO with his first, second and third "standard" doses of Rotateq. Concomitant vaccinations included "other routine vaccines." Subsequently the patient experienced intussusception went to an emergency room and was subsequently hospitalized. The patient had surgery on 14-APR-2008. Subsequently, the patient recovered and was discharged from the hospital. There was no product quality complaint. Intussusception was also considered to be an other important medical event (surgery) by the physician. Additional information has been requested. 8/11/08-records received for DOS 3/26-3/29/08-DC DX: Intussusception. Leukocytosis. Presented to ED with screaming, vomiting and difficulty breathing, abdominal pain, inconsolable. Last BM day before. Exploratory laparotomy with incidental appendectomy.


Changed on 4/13/2011

VAERS ID: 310921 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Massachusetts
Vaccinated:2008-02-08
Onset:2008-03-26
Submitted:2008-04-23
Entered:2008-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21A127AA / 2 LL / IM
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2523AA / 0 LL / ID
HIBV: HIB (ACTHIB) / SANOFI PASTEUR VF119AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B26510D / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1129V / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Acoustic stimulation tests normal, Alanine aminotransferase increased, Appendicectomy, Aspartate aminotransferase increased, Barium enema abnormal, Constipation, Coxsackie viral infection, Crying, Dyspnoea, Expressive language disorder, Gastrooesophageal reflux disease, Impaired gastric emptying, Intussusception, Irritability, Laparotomy, Leukocytosis, Molluscum contagiosum, Otitis media, Pharyngitis, Retching, Screaming, Stridor, Upper respiratory tract infection, Weight decreased, White blood cell count increased, Sensory integrative dysfunction, Lymphocyte percentage decreased, Gastrointestinal tube insertion, Blood alkaline phosphatase increased, Feeding disorder, Inflammation, Gross motor delay

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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 8/11/08-records received-BE performed times 3 unsuccessful reduction of intussusception. WBC 19.40, lymphocyte % 40.0. Alk Phos 325, AST 351, ALT 41.
CDC 'Split Type': WAES0804USA04007

Write-up: Information has been received from a physician concerning an 8 month old male who on 05-OCT-2007, 01-DEC-2007 and 08-FEB-2008 was vaccinated PO with his first, second and third "standard" doses of Rotateq. Concomitant vaccinations included "other routine vaccines." Subsequently the patient experienced intussusception went to an emergency room and was subsequently hospitalized. The patient had surgery on 14-APR-2008. Subsequently, the patient recovered and was discharged from the hospital. There was no product quality complaint. Intussusception was also considered to be an other important medical event (surgery) by the physician. Additional information has been requested. 8/11/08-records received for DOS 3/26-3/29/08-DC DX: Intussusception. Leukocytosis. Presented to ED with screaming, vomiting and difficulty breathing, abdominal pain, inconsolable. Last BM day before. Exploratory laparotomy with incidental appendectomy.


Changed on 5/13/2011

VAERS ID: 310921 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Massachusetts
Vaccinated:2008-02-08
Onset:2008-03-26
Submitted:2008-04-23
Entered:2008-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21A127AA / 2 LL / IM
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2523AA / 0 LL / ID
HIBV: HIB (ACTHIB) / SANOFI PASTEUR VF119AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B26510D / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1129V / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Acoustic stimulation tests normal, Alanine aminotransferase increased, Appendicectomy, Aspartate aminotransferase increased, Barium enema abnormal, Constipation, Coxsackie viral infection, Crying, Dyspnoea, Expressive language disorder, Gastrooesophageal reflux disease, Impaired gastric emptying, Intussusception, Irritability, Laparotomy, Leukocytosis, Molluscum contagiosum, Otitis media, Pharyngitis, Retching, Screaming, Stridor, Upper respiratory tract infection, Weight decreased, White blood cell count increased, Sensory integrative dysfunction, Lymphocyte percentage decreased, Gastrointestinal tube insertion, Blood alkaline phosphatase increased, Feeding disorder, Inflammation, Gross motor delay

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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 8/11/08-records received-BE performed times 3 unsuccessful reduction of intussusception. WBC 19.40, lymphocyte % 40.0. Alk Phos 325, AST 351, ALT 41.
CDC 'Split Type': WAES0804USA04007

Write-up: Information has been received from a physician concerning an 8 month old male who on 05-OCT-2007, 01-DEC-2007 and 08-FEB-2008 was vaccinated PO with his first, second and third "standard" doses of Rotateq. Concomitant vaccinations included "other routine vaccines." Subsequently the patient experienced intussusception went to an emergency room and was subsequently hospitalized. The patient had surgery on 14-APR-2008. Subsequently, the patient recovered and was discharged from the hospital. There was no product quality complaint. Intussusception was also considered to be an other important medical event (surgery) by the physician. Additional information has been requested. 8/11/08-records received for DOS 3/26-3/29/08-DC DX: Intussusception. Leukocytosis. Presented to ED with screaming, vomiting and difficulty breathing, abdominal pain, inconsolable. Last BM day before. Exploratory laparotomy with incidental appendectomy.


Changed on 6/11/2011

VAERS ID: 310921 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Massachusetts
Vaccinated:2008-02-08
Onset:2008-03-26
Submitted:2008-04-23
Entered:2008-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21A127AA / 2 LL / IM
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2523AA / 0 LL / ID
HIBV: HIB (ACTHIB) / SANOFI PASTEUR VF119AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B26510D / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1129V / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Acoustic stimulation tests normal, Alanine aminotransferase increased, Appendicectomy, Aspartate aminotransferase increased, Barium enema abnormal, Constipation, Coxsackie viral infection, Crying, Dyspnoea, Expressive language disorder, Gastrooesophageal reflux disease, Impaired gastric emptying, Intussusception, Irritability, Laparotomy, Leukocytosis, Molluscum contagiosum, Otitis media, Pharyngitis, Retching, Screaming, Stridor, Upper respiratory tract infection, Weight decreased, White blood cell count increased, Sensory integrative dysfunction, Lymphocyte percentage decreased, Gastrointestinal tube insertion, Blood alkaline phosphatase increased, Feeding disorder, Inflammation, Gross motor delay

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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 8/11/08-records received-BE performed times 3 unsuccessful reduction of intussusception. WBC 19.40, lymphocyte % 40.0. Alk Phos 325, AST 351, ALT 41.
CDC 'Split Type': WAES0804USA04007

Write-up: Information has been received from a physician concerning an 8 month old male who on 05-OCT-2007, 01-DEC-2007 and 08-FEB-2008 was vaccinated PO with his first, second and third "standard" doses of Rotateq. Concomitant vaccinations included "other routine vaccines." Subsequently the patient experienced intussusception went to an emergency room and was subsequently hospitalized. The patient had surgery on 14-APR-2008. Subsequently, the patient recovered and was discharged from the hospital. There was no product quality complaint. Intussusception was also considered to be an other important medical event (surgery) by the physician. Additional information has been requested. 8/11/08-records received for DOS 3/26-3/29/08-DC DX: Intussusception. Leukocytosis. Presented to ED with screaming, vomiting and difficulty breathing, abdominal pain, inconsolable. Last BM day before. Exploratory laparotomy with incidental appendectomy.


Changed on 5/13/2013

VAERS ID: 310921 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Massachusetts
Vaccinated:2008-02-08
Onset:2008-03-26
Submitted:2008-04-23
Entered:2008-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21A127AA / 2 LL / IM
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2523AA / 0 LL / ID
HIBV: HIB (ACTHIB) / SANOFI PASTEUR VF119AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B26510D / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1129V / 2 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1129V / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Acoustic stimulation tests normal, Alanine aminotransferase increased, Appendicectomy, Aspartate aminotransferase increased, Barium enema abnormal, Constipation, Coxsackie viral infection, Crying, Dyspnoea, Expressive language disorder, Gastrooesophageal reflux disease, Impaired gastric emptying, Intussusception, Irritability, Laparotomy, Leukocytosis, Molluscum contagiosum, Otitis media, Pharyngitis, Retching, Screaming, Stridor, Upper respiratory tract infection, Weight decreased, White blood cell count increased, Sensory integrative dysfunction, Lymphocyte percentage decreased, Gastrointestinal tube insertion, Blood alkaline phosphatase increased, Feeding disorder, Inflammation, Gross motor delay

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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 8/11/08-records received-BE performed times 3 unsuccessful reduction of intussusception. WBC 19.40, lymphocyte % 40.0. Alk Phos 325, AST 351, ALT 41.
CDC 'Split Type': WAES0804USA04007

Write-up: Information has been received from a physician concerning an 8 month old male who on 05-OCT-2007, 01-DEC-2007 and 08-FEB-2008 was vaccinated PO with his first, second and third "standard" doses of Rotateq. Concomitant vaccinations included "other routine vaccines." Subsequently the patient experienced intussusception went to an emergency room and was subsequently hospitalized. The patient had surgery on 14-APR-2008. Subsequently, the patient recovered and was discharged from the hospital. There was no product quality complaint. Intussusception was also considered to be an other important medical event (surgery) by the physician. Additional information has been requested. 8/11/08-records received for DOS 3/26-3/29/08-DC DX: Intussusception. Leukocytosis. Presented to ED with screaming, vomiting and difficulty breathing, abdominal pain, inconsolable. Last BM day before. Exploratory laparotomy with incidental appendectomy.


Changed on 7/7/2013

VAERS ID: 310921 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Massachusetts
Vaccinated:2008-02-08
Onset:2008-03-26
Submitted:2008-04-23
Entered:2008-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21A127AA / 2 LL / IM
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2523AA / 0 LL / ID
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2523AA / 0 LL / ID
HIBV: HIB (ACTHIB) / SANOFI PASTEUR VF119AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B26510D / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1129V / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Acoustic stimulation tests normal, Alanine aminotransferase increased, Appendicectomy, Aspartate aminotransferase increased, Barium enema abnormal, Constipation, Coxsackie viral infection, Crying, Dyspnoea, Expressive language disorder, Gastrooesophageal reflux disease, Impaired gastric emptying, Intussusception, Irritability, Laparotomy, Leukocytosis, Molluscum contagiosum, Otitis media, Pharyngitis, Retching, Screaming, Stridor, Upper respiratory tract infection, Weight decreased, White blood cell count increased, Sensory integrative dysfunction, Lymphocyte percentage decreased, Gastrointestinal tube insertion, Blood alkaline phosphatase increased, Feeding disorder, Inflammation, Gross motor delay

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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 8/11/08-records received-BE performed times 3 unsuccessful reduction of intussusception. WBC 19.40, lymphocyte % 40.0. Alk Phos 325, AST 351, ALT 41.
CDC 'Split Type': WAES0804USA04007

Write-up: Information has been received from a physician concerning an 8 month old male who on 05-OCT-2007, 01-DEC-2007 and 08-FEB-2008 was vaccinated PO with his first, second and third "standard" doses of Rotateq. Concomitant vaccinations included "other routine vaccines." Subsequently the patient experienced intussusception went to an emergency room and was subsequently hospitalized. The patient had surgery on 14-APR-2008. Subsequently, the patient recovered and was discharged from the hospital. There was no product quality complaint. Intussusception was also considered to be an other important medical event (surgery) by the physician. Additional information has been requested. 8/11/08-records received for DOS 3/26-3/29/08-DC DX: Intussusception. Leukocytosis. Presented to ED with screaming, vomiting and difficulty breathing, abdominal pain, inconsolable. Last BM day before. Exploratory laparotomy with incidental appendectomy.


Changed on 2/14/2017

VAERS ID: 310921 Before After
VAERS Form:
Age:0.5 0.51
Sex:Male
Location:Massachusetts
Vaccinated:2008-02-08
Onset:2008-03-26
Submitted:2008-04-23
Entered:2008-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21A127AA / 2 LL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2523AA / 0 LL / ID
HIBV: HIB (ACTHIB) / SANOFI PASTEUR VF119AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B26510D / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1129V / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Acoustic stimulation tests normal, Alanine aminotransferase increased, Appendicectomy, Aspartate aminotransferase increased, Barium enema abnormal, Constipation, Coxsackie viral infection, Crying, Dyspnoea, Expressive language disorder, Gastrooesophageal reflux disease, Impaired gastric emptying, Intussusception, Irritability, Laparotomy, Leukocytosis, Molluscum contagiosum, Otitis media, Pharyngitis, Retching, Screaming, Stridor, Upper respiratory tract infection, Weight decreased, White blood cell count increased, Sensory integrative dysfunction, Lymphocyte percentage decreased, Gastrointestinal tube insertion, Blood alkaline phosphatase increased, Feeding disorder, Inflammation, Gross motor delay

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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 8/11/08-records received-BE performed times 3 unsuccessful reduction of intussusception. WBC 19.40, lymphocyte % 40.0. Alk Phos 325, AST 351, ALT 41.
CDC 'Split Type': WAES0804USA04007

Write-up: Information has been received from a physician concerning an 8 month old male who on 05-OCT-2007, 01-DEC-2007 and 08-FEB-2008 was vaccinated PO with his first, second and third "standard" doses of Rotateq. Concomitant vaccinations included "other routine vaccines." Subsequently the patient experienced intussusception went to an emergency room and was subsequently hospitalized. The patient had surgery on 14-APR-2008. Subsequently, the patient recovered and was discharged from the hospital. There was no product quality complaint. Intussusception was also considered to be an other important medical event (surgery) by the physician. Additional information has been requested. 8/11/08-records received for DOS 3/26-3/29/08-DC DX: Intussusception. Leukocytosis. Presented to ED with screaming, vomiting and difficulty breathing, abdominal pain, inconsolable. Last BM day before. Exploratory laparotomy with incidental appendectomy.


Changed on 4/14/2017

VAERS ID: 310921 Before After
VAERS Form:
Age:0.51
Sex:Male
Location:Massachusetts
Vaccinated:2008-02-08
Onset:2008-03-26
Submitted:2008-04-23
Entered:2008-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21A127AA / 2 LL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2523AA / 0 LL / ID
HIBV: HIB (ACTHIB) / SANOFI PASTEUR VF119AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B26510D / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1129V / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Acoustic stimulation tests normal, Alanine aminotransferase increased, Appendicectomy, Aspartate aminotransferase increased, Barium enema abnormal, Constipation, Coxsackie viral infection, Crying, Dyspnoea, Expressive language disorder, Gastrooesophageal reflux disease, Impaired gastric emptying, Intussusception, Irritability, Laparotomy, Leukocytosis, Molluscum contagiosum, Otitis media, Pharyngitis, Retching, Screaming, Stridor, Upper respiratory tract infection, Weight decreased, White blood cell count increased, Sensory integrative dysfunction, Lymphocyte percentage decreased, Gastrointestinal tube insertion, Blood alkaline phosphatase increased, Feeding disorder, Inflammation, Gross motor delay

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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 8/11/08-records received-BE performed times 3 unsuccessful reduction of intussusception. WBC 19.40, lymphocyte % 40.0. Alk Phos 325, AST 351, ALT 41.
CDC 'Split Type': WAES0804USA04007

Write-up: Information has been received from a physician concerning an 8 month old male who on 05-OCT-2007, 01-DEC-2007 and 08-FEB-2008 was vaccinated PO with his first, second and third "standard" doses of Rotateq. Concomitant vaccinations included "other routine vaccines." Subsequently the patient experienced intussusception went to an emergency room and was subsequently hospitalized. The patient had surgery on 14-APR-2008. Subsequently, the patient recovered and was discharged from the hospital. There was no product quality complaint. Intussusception was also considered to be an other important medical event (surgery) by the physician. Additional information has been requested. 8/11/08-records received for DOS 3/26-3/29/08-DC DX: Intussusception. Leukocytosis. Presented to ED with screaming, vomiting and difficulty breathing, abdominal pain, inconsolable. Last BM day before. Exploratory laparotomy with incidental appendectomy.


Changed on 9/14/2017

VAERS ID: 310921 Before After
VAERS Form:(blank) 1
Age:0.51
Sex:Male
Location:Massachusetts
Vaccinated:2008-02-08
Onset:2008-03-26
Submitted:2008-04-23
Entered:2008-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21A127AA / 2 3 LL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2523AA / 0 1 LL / ID
HIBV: HIB (ACTHIB) / SANOFI PASTEUR VF119AA / 2 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B26510D / 2 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1129V / 2 3 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 8/11/08-records received-BE performed times 3 unsuccessful reduction of intussusception. WBC 19.40, lymphocyte % 40.0. Alk Phos 325, AST 351, ALT 41.
CDC 'Split Type': WAES0804USA04007

Write-up: Information has been received from a physician concerning an 8 month old male who on 05-OCT-2007, 01-DEC-2007 and 08-FEB-2008 was vaccinated PO with his first, second and third "standard" doses of Rotateq. Concomitant vaccinations included "other routine vaccines." Subsequently the patient experienced intussusception went to an emergency room and was subsequently hospitalized. The patient had surgery on 14-APR-2008. Subsequently, the patient recovered and was discharged from the hospital. There was no product quality complaint. Intussusception was also considered to be an other important medical event (surgery) by the physician. Additional information has been requested. 8/11/08-records received for DOS 3/26-3/29/08-DC DX: Intussusception. Leukocytosis. Presented to ED with screaming, vomiting and difficulty breathing, abdominal pain, inconsolable. Last BM day before. Exploratory laparotomy with incidental appendectomy.


Changed on 2/14/2018

VAERS ID: 310921 Before After
VAERS Form:1
Age:0.51
Sex:Male
Location:Massachusetts
Vaccinated:2008-02-08
Onset:2008-03-26
Submitted:2008-04-23
Entered:2008-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21A127AA / 3 LL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2523AA / 1 LL / ID
HIBV: HIB (ACTHIB) / SANOFI PASTEUR VF119AA / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B26510D / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1129V / 3 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 8/11/08-records received-BE performed times 3 unsuccessful reduction of intussusception. WBC 19.40, lymphocyte % 40.0. Alk Phos 325, AST 351, ALT 41.
CDC 'Split Type': WAES0804USA04007

Write-up: Information has been received from a physician concerning an 8 month old male who on 05-OCT-2007, 01-DEC-2007 and 08-FEB-2008 was vaccinated PO with his first, second and third "standard" doses of Rotateq. Concomitant vaccinations included "other routine vaccines." Subsequently the patient experienced intussusception went to an emergency room and was subsequently hospitalized. The patient had surgery on 14-APR-2008. Subsequently, the patient recovered and was discharged from the hospital. There was no product quality complaint. Intussusception was also considered to be an other important medical event (surgery) by the physician. Additional information has been requested. 8/11/08-records received for DOS 3/26-3/29/08-DC DX: Intussusception. Leukocytosis. Presented to ED with screaming, vomiting and difficulty breathing, abdominal pain, inconsolable. Last BM day before. Exploratory laparotomy with incidental appendectomy.


Changed on 6/14/2018

VAERS ID: 310921 Before After
VAERS Form:1
Age:0.51
Sex:Male
Location:Massachusetts
Vaccinated:2008-02-08
Onset:2008-03-26
Submitted:2008-04-23
Entered:2008-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21A127AA / 3 LL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2523AA / 1 LL / ID
HIBV: HIB (ACTHIB) / SANOFI PASTEUR VF119AA / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B26510D / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1129V / 3 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 8/11/08-records received-BE performed times 3 unsuccessful reduction of intussusception. WBC 19.40, lymphocyte % 40.0. Alk Phos 325, AST 351, ALT 41.
CDC 'Split Type': WAES0804USA04007

Write-up: Information has been received from a physician concerning an 8 month old male who on 05-OCT-2007, 01-DEC-2007 and 08-FEB-2008 was vaccinated PO with his first, second and third "standard" doses of Rotateq. Concomitant vaccinations included "other routine vaccines." Subsequently the patient experienced intussusception went to an emergency room and was subsequently hospitalized. The patient had surgery on 14-APR-2008. Subsequently, the patient recovered and was discharged from the hospital. There was no product quality complaint. Intussusception was also considered to be an other important medical event (surgery) by the physician. Additional information has been requested. 8/11/08-records received for DOS 3/26-3/29/08-DC DX: Intussusception. Leukocytosis. Presented to ED with screaming, vomiting and difficulty breathing, abdominal pain, inconsolable. Last BM day before. Exploratory laparotomy with incidental appendectomy.


Changed on 8/14/2018

VAERS ID: 310921 Before After
VAERS Form:1
Age:0.51
Sex:Male
Location:Massachusetts
Vaccinated:2008-02-08
Onset:2008-03-26
Submitted:2008-04-23
Entered:2008-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21A127AA / 3 LL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2523AA / 1 LL / ID
HIBV: HIB (ACTHIB) / SANOFI PASTEUR VF119AA / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B26510D / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1129V / 3 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 8/11/08-records received-BE performed times 3 unsuccessful reduction of intussusception. WBC 19.40, lymphocyte % 40.0. Alk Phos 325, AST 351, ALT 41.
CDC 'Split Type': WAES0804USA04007

Write-up: Information has been received from a physician concerning an 8 month old male who on 05-OCT-2007, 01-DEC-2007 and 08-FEB-2008 was vaccinated PO with his first, second and third "standard" doses of Rotateq. Concomitant vaccinations included "other routine vaccines." Subsequently the patient experienced intussusception went to an emergency room and was subsequently hospitalized. The patient had surgery on 14-APR-2008. Subsequently, the patient recovered and was discharged from the hospital. There was no product quality complaint. Intussusception was also considered to be an other important medical event (surgery) by the physician. Additional information has been requested. 8/11/08-records received for DOS 3/26-3/29/08-DC DX: Intussusception. Leukocytosis. Presented to ED with screaming, vomiting and difficulty breathing, abdominal pain, inconsolable. Last BM day before. Exploratory laparotomy with incidental appendectomy.


Changed on 9/14/2018

VAERS ID: 310921 Before After
VAERS Form:1
Age:0.51
Sex:Male
Location:Massachusetts
Vaccinated:2008-02-08
Onset:2008-03-26
Submitted:2008-04-23
Entered:2008-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21A127AA / 3 LL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2523AA / 1 LL / ID
HIBV: HIB (ACTHIB) / SANOFI PASTEUR VF119AA / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B26510D / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1129V / 3 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 8/11/08-records received-BE performed times 3 unsuccessful reduction of intussusception. WBC 19.40, lymphocyte % 40.0. Alk Phos 325, AST 351, ALT 41.
CDC 'Split Type': WAES0804USA04007

Write-up: Information has been received from a physician concerning an 8 month old male who on 05-OCT-2007, 01-DEC-2007 and 08-FEB-2008 was vaccinated PO with his first, second and third "standard" doses of Rotateq. Concomitant vaccinations included "other routine vaccines." Subsequently the patient experienced intussusception went to an emergency room and was subsequently hospitalized. The patient had surgery on 14-APR-2008. Subsequently, the patient recovered and was discharged from the hospital. There was no product quality complaint. Intussusception was also considered to be an other important medical event (surgery) by the physician. Additional information has been requested. 8/11/08-records received for DOS 3/26-3/29/08-DC DX: Intussusception. Leukocytosis. Presented to ED with screaming, vomiting and difficulty breathing, abdominal pain, inconsolable. Last BM day before. Exploratory laparotomy with incidental appendectomy.


Changed on 10/14/2018

VAERS ID: 310921 Before After
VAERS Form:1
Age:0.51
Sex:Male
Location:Massachusetts
Vaccinated:2008-02-08
Onset:2008-03-26
Submitted:2008-04-23
Entered:2008-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21A127AA / 3 LL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2523AA / 1 LL / ID
HIBV: HIB (ACTHIB) / SANOFI PASTEUR VF119AA / 3 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B26510D / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1129V / 3 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 8/11/08-records received-BE performed times 3 unsuccessful reduction of intussusception. WBC 19.40, lymphocyte % 40.0. Alk Phos 325, AST 351, ALT 41.
CDC 'Split Type': WAES0804USA04007

Write-up: Information has been received from a physician concerning an 8 month old male who on 05-OCT-2007, 01-DEC-2007 and 08-FEB-2008 was vaccinated PO with his first, second and third "standard" doses of Rotateq. Concomitant vaccinations included "other routine vaccines." Subsequently the patient experienced intussusception went to an emergency room and was subsequently hospitalized. The patient had surgery on 14-APR-2008. Subsequently, the patient recovered and was discharged from the hospital. There was no product quality complaint. Intussusception was also considered to be an other important medical event (surgery) by the physician. Additional information has been requested. 8/11/08-records received for DOS 3/26-3/29/08-DC DX: Intussusception. Leukocytosis. Presented to ED with screaming, vomiting and difficulty breathing, abdominal pain, inconsolable. Last BM day before. Exploratory laparotomy with incidental appendectomy.

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