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VAERS ID: | 310921 |
VAERS Form: | |
Age: | 0.5 |
Gender: | 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
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
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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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