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This is VAERS ID 311538

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 311538
VAERS Form:
Age:0.1
Gender:Male
Location:Illinois
Vaccinated:2008-04-17
Onset:2008-04-30
Submitted:2008-05-02
Entered:2008-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2797AA / 0 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0538U / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0170 / - LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C49916 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1192U / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Abdominal distension, Appendicectomy, Blood culture negative, Culture urine negative, Abdominal X-ray

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 9     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none PMH: thrush. Parents w/nausea & vomiting 1.5 weeks prior.
Allergies:
Diagnostic Lab Data: U/S; MGI of abdomen -$g intussusception LABS: abdominal x-ray & US (+) IS. Fecal occult blood (+). Blood & urine c/s neg.
CDC 'Split Type':

Write-up: Intussusception (bowel obstruction) 2 weeks after Rotateq vaccine given. Vomiting, admitted surgical correction was required. 6/3/08 Reviewed hospital medical records for 4/29-5/6/2008. FINAL DX: intussception, s/p exp lap w/reduction of IS, appendectom"y Records reveal patient experienced emesis x 2 days, lethargy, abdominal distention, dehydration & bloody stool. To OR. Progressed slowly w/bilious emesis developing post op. Eval for recurrence of IS was neg. Gradually improved & d/c to home.


Changed on 12/8/2009

VAERS ID: 311538 Before After
VAERS Form:
Age:0.1
Gender:Male
Location:Illinois
Vaccinated:2008-04-17
Onset:2008-04-30
Submitted:2008-05-02
Entered:2008-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2797AA / 0 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0538U / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0170 / - LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C49916 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1192U / 0 - / PO

Administered by: Private      Purchased by: Unknown Private
Symptoms: Abdominal distension, Appendicectomy, Blood culture negative, Culture urine negative, Dehydration, Haematochezia, Intestinal obstruction, Intussusception, Lethargy, Surgery, Vomiting, X-ray with contrast upper gastrointestinal tract, Explorative laparotomy, Ultrasound scan abnormal, Abdominal X-ray, Occult blood positive

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 9     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none PMH: thrush. Parents w/nausea & vomiting 1.5 weeks prior.
Allergies:
Diagnostic Lab Data: U/S; MGI of abdomen -$g intussusception LABS: abdominal x-ray & US (+) IS. Fecal occult blood (+). Blood & urine c/s neg.
CDC 'Split Type':

Write-up: Intussusception (bowel obstruction) 2 weeks after Rotateq vaccine given. Vomiting, admitted surgical correction was required. 6/3/08 Reviewed hospital medical records for 4/29-5/6/2008. FINAL DX: intussception, s/p exp lap w/reduction of IS, appendectom"y appendectomy Records reveal patient experienced emesis x 2 days, lethargy, abdominal distention, dehydration & bloody stool. To OR. Progressed slowly w/bilious emesis developing post op. Eval for recurrence of IS was neg. Gradually improved & d/c to home.


Changed on 3/2/2010

VAERS ID: 311538 Before After
VAERS Form:
Age:0.1
Gender:Male
Location:Illinois
Vaccinated:2008-04-17
Onset:2008-04-30
Submitted:2008-05-02
Entered:2008-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2797AA / 0 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0538U / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0170 / - LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC C49916 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1192U / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal distension, Appendicectomy, Blood culture negative, Culture urine negative, Dehydration, Haematochezia, Intestinal obstruction, Intussusception, Lethargy, Surgery, Vomiting, X-ray with contrast upper gastrointestinal tract, Explorative laparotomy, Ultrasound scan abnormal, Abdominal X-ray, Occult blood positive

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 9     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none PMH: thrush. Parents w/nausea & vomiting 1.5 weeks prior.
Allergies:
Diagnostic Lab Data: U/S; MGI of abdomen -$g intussusception LABS: abdominal x-ray & US (+) IS. Fecal occult blood (+). Blood & urine c/s neg.
CDC 'Split Type':

Write-up: Intussusception (bowel obstruction) 2 weeks after Rotateq vaccine given. Vomiting, admitted surgical correction was required. 6/3/08 Reviewed hospital medical records for 4/29-5/6/2008. FINAL DX: intussception, s/p exp lap w/reduction of IS, appendectomy Records reveal patient experienced emesis x 2 days, lethargy, abdominal distention, dehydration & bloody stool. To OR. Progressed slowly w/bilious emesis developing post op. Eval for recurrence of IS was neg. Gradually improved & d/c to home.


Changed on 4/7/2010

VAERS ID: 311538 Before After
VAERS Form:
Age:0.1
Gender:Male
Location:Illinois
Vaccinated:2008-04-17
Onset:2008-04-30
Submitted:2008-05-02
Entered:2008-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2797AA / 0 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0538U / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0170 / - LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C49916 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1192U / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal distension, Appendicectomy, Blood culture negative, Culture urine negative, Dehydration, Haematochezia, Intestinal obstruction, Intussusception, Lethargy, Surgery, Vomiting, X-ray with contrast upper gastrointestinal tract, Explorative laparotomy, Ultrasound scan abnormal, Abdominal X-ray, Occult blood positive

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 9     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none PMH: thrush. Parents w/nausea & vomiting 1.5 weeks prior.
Allergies:
Diagnostic Lab Data: U/S; MGI of abdomen -$g intussusception LABS: abdominal x-ray & US (+) IS. Fecal occult blood (+). Blood & urine c/s neg.
CDC 'Split Type':

Write-up: Intussusception (bowel obstruction) 2 weeks after Rotateq vaccine given. Vomiting, admitted surgical correction was required. 6/3/08 Reviewed hospital medical records for 4/29-5/6/2008. FINAL DX: intussception, s/p exp lap w/reduction of IS, appendectomy Records reveal patient experienced emesis x 2 days, lethargy, abdominal distention, dehydration & bloody stool. To OR. Progressed slowly w/bilious emesis developing post op. Eval for recurrence of IS was neg. Gradually improved & d/c to home.


Changed on 8/31/2010

VAERS ID: 311538 Before After
VAERS Form:
Age:0.1
Gender:Male
Location:Illinois
Vaccinated:2008-04-17
Onset:2008-04-30
Submitted:2008-05-02
Entered:2008-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2797AA / 0 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0538U / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0170 / - LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH C49916 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1192U / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal distension, Appendicectomy, Blood culture negative, Culture urine negative, Dehydration, Haematochezia, Intestinal obstruction, Intussusception, Lethargy, Surgery, Vomiting, X-ray with contrast upper gastrointestinal tract, Explorative laparotomy, Ultrasound scan abnormal, Abdominal X-ray, Occult blood positive

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 9     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none PMH: thrush. Parents w/nausea & vomiting 1.5 weeks prior.
Allergies:
Diagnostic Lab Data: U/S; MGI of abdomen -$g intussusception LABS: abdominal x-ray & US (+) IS. Fecal occult blood (+). Blood & urine c/s neg.
CDC 'Split Type':

Write-up: Intussusception (bowel obstruction) 2 weeks after Rotateq vaccine given. Vomiting, admitted surgical correction was required. 6/3/08 Reviewed hospital medical records for 4/29-5/6/2008. FINAL DX: intussception, s/p exp lap w/reduction of IS, appendectomy Records reveal patient experienced emesis x 2 days, lethargy, abdominal distention, dehydration & bloody stool. To OR. Progressed slowly w/bilious emesis developing post op. Eval for recurrence of IS was neg. Gradually improved & d/c to home.


Changed on 5/13/2013

VAERS ID: 311538 Before After
VAERS Form:
Age:0.1
Gender:Male
Location:Illinois
Vaccinated:2008-04-17
Onset:2008-04-30
Submitted:2008-05-02
Entered:2008-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2797AA / 0 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0538U / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0170 / - LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C49916 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1192U / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1192U / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal distension, Appendicectomy, Blood culture negative, Culture urine negative, Dehydration, Haematochezia, Intestinal obstruction, Intussusception, Lethargy, Surgery, Vomiting, X-ray with contrast upper gastrointestinal tract, Explorative laparotomy, Ultrasound scan abnormal, Abdominal X-ray, Occult blood positive

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 9     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none PMH: thrush. Parents w/nausea & vomiting 1.5 weeks prior.
Allergies:
Diagnostic Lab Data: U/S; MGI of abdomen -$g intussusception LABS: abdominal x-ray & US (+) IS. Fecal occult blood (+). Blood & urine c/s neg.
CDC 'Split Type':

Write-up: Intussusception (bowel obstruction) 2 weeks after Rotateq vaccine given. Vomiting, admitted surgical correction was required. 6/3/08 Reviewed hospital medical records for 4/29-5/6/2008. FINAL DX: intussception, s/p exp lap w/reduction of IS, appendectomy Records reveal patient experienced emesis x 2 days, lethargy, abdominal distention, dehydration & bloody stool. To OR. Progressed slowly w/bilious emesis developing post op. Eval for recurrence of IS was neg. Gradually improved & d/c to home.


Changed on 4/14/2017

VAERS ID: 311538 Before After
VAERS Form:
Age:0.1
Gender:Male
Location:Illinois
Vaccinated:2008-04-17
Onset:2008-04-30
Submitted:2008-05-02
Entered:2008-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2797AA / 0 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0538U / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0170 / - LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C49916 / 0 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1192U / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Abdominal distension, Appendicectomy, Blood culture negative, Culture urine negative, Dehydration, Haematochezia, Intestinal obstruction, Intussusception, Lethargy, Surgery, Vomiting, X-ray with contrast upper gastrointestinal tract, Explorative laparotomy, Ultrasound scan abnormal, Abdominal X-ray, Occult blood positive

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 9     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none PMH: thrush. Parents w/nausea & vomiting 1.5 weeks prior.
Allergies:
Diagnostic Lab Data: U/S; MGI of abdomen -$g intussusception LABS: abdominal x-ray & US (+) IS. Fecal occult blood (+). Blood & urine c/s neg.
CDC 'Split Type':

Write-up: Intussusception (bowel obstruction) 2 weeks after Rotateq vaccine given. Vomiting, admitted surgical correction was required. 6/3/08 Reviewed hospital medical records for 4/29-5/6/2008. FINAL DX: intussception, s/p exp lap w/reduction of IS, appendectomy Records reveal patient experienced emesis x 2 days, lethargy, abdominal distention, dehydration & bloody stool. To OR. Progressed slowly w/bilious emesis developing post op. Eval for recurrence of IS was neg. Gradually improved & d/c to home.


Changed on 9/14/2017

VAERS ID: 311538 Before After
VAERS Form:(blank) 1
Age:0.1
Gender:Male
Location:Illinois
Vaccinated:2008-04-17
Onset:2008-04-30
Submitted:2008-05-02
Entered:2008-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2797AA / 0 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0538U / 0 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0170 / - UNK LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C49916 / 0 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1192U / 0 1 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intestinal obstruction, Intussusception, Surgery, Vomiting, X-ray with contrast upper gastrointestinal tract, Ultrasound scan abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 9     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none PMH: thrush. Parents w/nausea & vomiting 1.5 weeks prior.
Allergies:
Diagnostic Lab Data: U/S; MGI of abdomen -$g intussusception LABS: abdominal x-ray & US (+) IS. Fecal occult blood (+). Blood & urine c/s neg.
CDC 'Split Type':

Write-up: Intussusception (bowel obstruction) 2 weeks after Rotateq vaccine given. Vomiting, admitted surgical correction was required. 6/3/08 Reviewed hospital medical records for 4/29-5/6/2008. FINAL DX: intussception, s/p exp lap w/reduction of IS, appendectomy Records reveal patient experienced emesis x 2 days, lethargy, abdominal distention, dehydration & bloody stool. To OR. Progressed slowly w/bilious emesis developing post op. Eval for recurrence of IS was neg. Gradually improved & d/c to home.


Changed on 2/14/2018

VAERS ID: 311538 Before After
VAERS Form:1
Age:0.1
Gender:Male
Location:Illinois
Vaccinated:2008-04-17
Onset:2008-04-30
Submitted:2008-05-02
Entered:2008-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2797AA / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0538U / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0170 / UNK LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C49916 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1192U / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intestinal obstruction, Intussusception, Surgery, Vomiting, X-ray with contrast upper gastrointestinal tract, Ultrasound scan abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 9     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none PMH: thrush. Parents w/nausea & vomiting 1.5 weeks prior.
Allergies:
Diagnostic Lab Data: U/S; MGI of abdomen -$g intussusception LABS: abdominal x-ray & US (+) IS. Fecal occult blood (+). Blood & urine c/s neg.
CDC 'Split Type':

Write-up: Intussusception (bowel obstruction) 2 weeks after Rotateq vaccine given. Vomiting, admitted surgical correction was required. 6/3/08 Reviewed hospital medical records for 4/29-5/6/2008. FINAL DX: intussception, s/p exp lap w/reduction of IS, appendectomy Records reveal patient experienced emesis x 2 days, lethargy, abdominal distention, dehydration & bloody stool. To OR. Progressed slowly w/bilious emesis developing post op. Eval for recurrence of IS was neg. Gradually improved & d/c to home.


Changed on 6/14/2018

VAERS ID: 311538 Before After
VAERS Form:1
Age:0.1
Gender:Male
Location:Illinois
Vaccinated:2008-04-17
Onset:2008-04-30
Submitted:2008-05-02
Entered:2008-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2797AA / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0538U / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0170 / UNK LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C49916 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1192U / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intestinal obstruction, Intussusception, Surgery, Vomiting, X-ray with contrast upper gastrointestinal tract, Ultrasound scan abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 9     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none PMH: thrush. Parents w/nausea & vomiting 1.5 weeks prior.
Allergies:
Diagnostic Lab Data: U/S; MGI of abdomen -$g intussusception LABS: abdominal x-ray & US (+) IS. Fecal occult blood (+). Blood & urine c/s neg.
CDC 'Split Type':

Write-up: Intussusception (bowel obstruction) 2 weeks after Rotateq vaccine given. Vomiting, admitted surgical correction was required. 6/3/08 Reviewed hospital medical records for 4/29-5/6/2008. FINAL DX: intussception, s/p exp lap w/reduction of IS, appendectomy Records reveal patient experienced emesis x 2 days, lethargy, abdominal distention, dehydration & bloody stool. To OR. Progressed slowly w/bilious emesis developing post op. Eval for recurrence of IS was neg. Gradually improved & d/c to home.


Changed on 8/14/2018

VAERS ID: 311538 Before After
VAERS Form:1
Age:0.1
Gender:Male
Location:Illinois
Vaccinated:2008-04-17
Onset:2008-04-30
Submitted:2008-05-02
Entered:2008-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2797AA / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0538U / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0170 / UNK LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C49916 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1192U / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intestinal obstruction, Intussusception, Surgery, Vomiting, X-ray with contrast upper gastrointestinal tract, Ultrasound scan abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 9     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none PMH: thrush. Parents w/nausea & vomiting 1.5 weeks prior.
Allergies:
Diagnostic Lab Data: U/S; MGI of abdomen -$g intussusception LABS: abdominal x-ray & US (+) IS. Fecal occult blood (+). Blood & urine c/s neg.
CDC 'Split Type':

Write-up: Intussusception (bowel obstruction) 2 weeks after Rotateq vaccine given. Vomiting, admitted surgical correction was required. 6/3/08 Reviewed hospital medical records for 4/29-5/6/2008. FINAL DX: intussception, s/p exp lap w/reduction of IS, appendectomy Records reveal patient experienced emesis x 2 days, lethargy, abdominal distention, dehydration & bloody stool. To OR. Progressed slowly w/bilious emesis developing post op. Eval for recurrence of IS was neg. Gradually improved & d/c to home.


Changed on 9/14/2018

VAERS ID: 311538 Before After
VAERS Form:1
Age:0.1
Gender:Male
Location:Illinois
Vaccinated:2008-04-17
Onset:2008-04-30
Submitted:2008-05-02
Entered:2008-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2797AA / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0538U / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0170 / UNK LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C49916 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1192U / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intestinal obstruction, Intussusception, Surgery, Vomiting, X-ray with contrast upper gastrointestinal tract, Ultrasound scan abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 9     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none PMH: thrush. Parents w/nausea & vomiting 1.5 weeks prior.
Allergies:
Diagnostic Lab Data: U/S; MGI of abdomen -$g intussusception LABS: abdominal x-ray & US (+) IS. Fecal occult blood (+). Blood & urine c/s neg.
CDC 'Split Type':

Write-up: Intussusception (bowel obstruction) 2 weeks after Rotateq vaccine given. Vomiting, admitted surgical correction was required. 6/3/08 Reviewed hospital medical records for 4/29-5/6/2008. FINAL DX: intussception, s/p exp lap w/reduction of IS, appendectomy Records reveal patient experienced emesis x 2 days, lethargy, abdominal distention, dehydration & bloody stool. To OR. Progressed slowly w/bilious emesis developing post op. Eval for recurrence of IS was neg. Gradually improved & d/c to home.


Changed on 10/14/2018

VAERS ID: 311538 Before After
VAERS Form:1
Age:0.1
Gender:Male
Location:Illinois
Vaccinated:2008-04-17
Onset:2008-04-30
Submitted:2008-05-02
Entered:2008-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2797AA / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0538U / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0170 / UNK LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C49916 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1192U / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Intestinal obstruction, Intussusception, Surgery, Vomiting, X-ray with contrast upper gastrointestinal tract, Ultrasound scan abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 9     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none PMH: thrush. Parents w/nausea & vomiting 1.5 weeks prior.
Allergies:
Diagnostic Lab Data: U/S; MGI of abdomen -$g intussusception LABS: abdominal x-ray & US (+) IS. Fecal occult blood (+). Blood & urine c/s neg.
CDC 'Split Type':

Write-up: Intussusception (bowel obstruction) 2 weeks after Rotateq vaccine given. Vomiting, admitted surgical correction was required. 6/3/08 Reviewed hospital medical records for 4/29-5/6/2008. FINAL DX: intussception, s/p exp lap w/reduction of IS, appendectomy Records reveal patient experienced emesis x 2 days, lethargy, abdominal distention, dehydration & bloody stool. To OR. Progressed slowly w/bilious emesis developing post op. Eval for recurrence of IS was neg. Gradually improved & d/c to home.

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