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This is VAERS ID 311843

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 311843
VAERS Form:
Age:0.3
Sex:Male
Location:Tennessee
Vaccinated:2008-04-04
Onset:2008-04-23
Submitted:2008-05-05
Entered:2008-05-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 1 LL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C49920 / 1 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1394U / 1 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: Barium double contrast, Blood culture negative, Diarrhoea haemorrhagic, Fatigue, Haematemesis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: 4/25/08 CBC abnl, Blood cultures = negative, Therapeutic air enema - abnormal, KUB abnormal 5/22/08-records received-Abdominal series revealed intussusception reduced with air contrast barium enema. WBC 20, segs increased 82, lymphocytes d
CDC 'Split Type':

Write-up: Rotateq administered 4/4/08. Pt hospitalized 4/25/08 with intussusception which was reduced nonsurgically. Hospitalized x 3 days. 5/13/08-clinic notes received for DOS 4/4/08-well baby visit. DOS 5/5/08-F/U visit for past hospitalization for intussuscepti"on. Successfully reduced with 2 air contrast enemas which demonstrated successful reduction of intussusception. In clinic no C/O. 5/22/08-records received for DOS 4/23/08-Impression: Intussusception status post reduction air contrast barium enema. Presen


Changed on 12/8/2009

VAERS ID: 311843 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Tennessee
Vaccinated:2008-04-04
Onset:2008-04-23
Submitted:2008-05-05
Entered:2008-05-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 1 LL / UN
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 1 LL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C49920 / 1 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1394U / 1 - / PO

Administered by: Public      Purchased by: Unknown Public
Symptoms: Barium double contrast, Blood culture negative, Diarrhoea haemorrhagic, Fatigue, Haematemesis, Intussusception, Lethargy, Lymphocyte count decreased, Urinary system X-ray, Vomiting, White blood cell count increased, Neutrophil percentage increased, Oral intake reduced

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: 4/25/08 CBC abnl, Blood cultures = negative, Therapeutic air enema - abnormal, KUB abnormal 5/22/08-records received-Abdominal series revealed intussusception reduced with air contrast barium enema. WBC 20, segs increased 82, lymphocytes d
CDC 'Split Type':

Write-up: Rotateq administered 4/4/08. Pt hospitalized 4/25/08 with intussusception which was reduced nonsurgically. Hospitalized x 3 days. 5/13/08-clinic notes received for DOS 4/4/08-well baby visit. DOS 5/5/08-F/U visit for past hospitalization for intussuscepti"on. intussusception. Successfully reduced with 2 air contrast enemas which demonstrated successful reduction of intussusception. In clinic no C/O. 5/22/08-records received for DOS 4/23/08-Impression: Intussusception status post reduction air contrast barium enema. Presen Presented to ED with vomiting began on day of seen in ED, vomitus is bilious and blood stained. Some bloody diarrhea. Lethargic and tired, decreased oral intake and normal urine output.


Changed on 3/2/2010

VAERS ID: 311843 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Tennessee
Vaccinated:2008-04-04
Onset:2008-04-23
Submitted:2008-05-05
Entered:2008-05-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 1 LL / UN
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC C49920 / 1 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1394U / 1 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Barium double contrast, Blood culture negative, Diarrhoea haemorrhagic, Fatigue, Haematemesis, Intussusception, Lethargy, Lymphocyte count decreased, Urinary system X-ray, Vomiting, White blood cell count increased, Neutrophil percentage increased, Oral intake reduced

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: 4/25/08 CBC abnl, Blood cultures = negative, Therapeutic air enema - abnormal, KUB abnormal 5/22/08-records received-Abdominal series revealed intussusception reduced with air contrast barium enema. WBC 20, segs increased 82, lymphocytes d
CDC 'Split Type':

Write-up: Rotateq administered 4/4/08. Pt hospitalized 4/25/08 with intussusception which was reduced nonsurgically. Hospitalized x 3 days. 5/13/08-clinic notes received for DOS 4/4/08-well baby visit. DOS 5/5/08-F/U visit for past hospitalization for intussusception. Successfully reduced with 2 air contrast enemas which demonstrated successful reduction of intussusception. In clinic no C/O. 5/22/08-records received for DOS 4/23/08-Impression: Intussusception status post reduction air contrast barium enema. Presented to ED with vomiting began on day of seen in ED, vomitus is bilious and blood stained. Some bloody diarrhea. Lethargic and tired, decreased oral intake and normal urine output.


Changed on 4/7/2010

VAERS ID: 311843 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Tennessee
Vaccinated:2008-04-04
Onset:2008-04-23
Submitted:2008-05-05
Entered:2008-05-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 1 LL / UN
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C49920 / 1 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1394U / 1 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Barium double contrast, Blood culture negative, Diarrhoea haemorrhagic, Fatigue, Haematemesis, Intussusception, Lethargy, Lymphocyte count decreased, Urinary system X-ray, Vomiting, White blood cell count increased, Neutrophil percentage increased, Oral intake reduced

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: 4/25/08 CBC abnl, Blood cultures = negative, Therapeutic air enema - abnormal, KUB abnormal 5/22/08-records received-Abdominal series revealed intussusception reduced with air contrast barium enema. WBC 20, segs increased 82, lymphocytes d
CDC 'Split Type':

Write-up: Rotateq administered 4/4/08. Pt hospitalized 4/25/08 with intussusception which was reduced nonsurgically. Hospitalized x 3 days. 5/13/08-clinic notes received for DOS 4/4/08-well baby visit. DOS 5/5/08-F/U visit for past hospitalization for intussusception. Successfully reduced with 2 air contrast enemas which demonstrated successful reduction of intussusception. In clinic no C/O. 5/22/08-records received for DOS 4/23/08-Impression: Intussusception status post reduction air contrast barium enema. Presented to ED with vomiting began on day of seen in ED, vomitus is bilious and blood stained. Some bloody diarrhea. Lethargic and tired, decreased oral intake and normal urine output.


Changed on 8/31/2010

VAERS ID: 311843 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Tennessee
Vaccinated:2008-04-04
Onset:2008-04-23
Submitted:2008-05-05
Entered:2008-05-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 1 LL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH C49920 / 1 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1394U / 1 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Barium double contrast, Blood culture negative, Diarrhoea haemorrhagic, Fatigue, Haematemesis, Intussusception, Lethargy, Lymphocyte count decreased, Urinary system X-ray, Vomiting, White blood cell count increased, Neutrophil percentage increased, Oral intake reduced

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: 4/25/08 CBC abnl, Blood cultures = negative, Therapeutic air enema - abnormal, KUB abnormal 5/22/08-records received-Abdominal series revealed intussusception reduced with air contrast barium enema. WBC 20, segs increased 82, lymphocytes d
CDC 'Split Type':

Write-up: Rotateq administered 4/4/08. Pt hospitalized 4/25/08 with intussusception which was reduced nonsurgically. Hospitalized x 3 days. 5/13/08-clinic notes received for DOS 4/4/08-well baby visit. DOS 5/5/08-F/U visit for past hospitalization for intussusception. Successfully reduced with 2 air contrast enemas which demonstrated successful reduction of intussusception. In clinic no C/O. 5/22/08-records received for DOS 4/23/08-Impression: Intussusception status post reduction air contrast barium enema. Presented to ED with vomiting began on day of seen in ED, vomitus is bilious and blood stained. Some bloody diarrhea. Lethargic and tired, decreased oral intake and normal urine output.


Changed on 5/13/2013

VAERS ID: 311843 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Tennessee
Vaccinated:2008-04-04
Onset:2008-04-23
Submitted:2008-05-05
Entered:2008-05-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C49920 / 1 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1394U / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1394U / 1 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Barium double contrast, Blood culture negative, Diarrhoea haemorrhagic, Fatigue, Haematemesis, Intussusception, Lethargy, Lymphocyte count decreased, Urinary system X-ray, Vomiting, White blood cell count increased, Neutrophil percentage increased, Oral intake reduced

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: 4/25/08 CBC abnl, Blood cultures = negative, Therapeutic air enema - abnormal, KUB abnormal 5/22/08-records received-Abdominal series revealed intussusception reduced with air contrast barium enema. WBC 20, segs increased 82, lymphocytes d
CDC 'Split Type':

Write-up: Rotateq administered 4/4/08. Pt hospitalized 4/25/08 with intussusception which was reduced nonsurgically. Hospitalized x 3 days. 5/13/08-clinic notes received for DOS 4/4/08-well baby visit. DOS 5/5/08-F/U visit for past hospitalization for intussusception. Successfully reduced with 2 air contrast enemas which demonstrated successful reduction of intussusception. In clinic no C/O. 5/22/08-records received for DOS 4/23/08-Impression: Intussusception status post reduction air contrast barium enema. Presented to ED with vomiting began on day of seen in ED, vomitus is bilious and blood stained. Some bloody diarrhea. Lethargic and tired, decreased oral intake and normal urine output.


Changed on 2/14/2017

VAERS ID: 311843 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Tennessee
Vaccinated:2008-04-04
Onset:2008-04-23
Submitted:2008-05-05
Entered:2008-05-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C49920 / 1 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1394U / 1 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Barium double contrast, Blood culture negative, Diarrhoea haemorrhagic, Fatigue, Haematemesis, Intussusception, Lethargy, Lymphocyte count decreased, Urinary system X-ray, Vomiting, White blood cell count increased, Neutrophil percentage increased, Oral intake reduced

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: 4/25/08 CBC abnl, Blood cultures = negative, Therapeutic air enema - abnormal, KUB abnormal 5/22/08-records received-Abdominal series revealed intussusception reduced with air contrast barium enema. WBC 20, segs increased 82, lymphocytes d decreased 35, blood culture no growth.
CDC 'Split Type':

Write-up: Rotateq administered 4/4/08. Pt hospitalized 4/25/08 with intussusception which was reduced nonsurgically. Hospitalized x 3 days. 5/13/08-clinic notes received for DOS 4/4/08-well baby visit. DOS 5/5/08-F/U visit for past hospitalization for intussusception. Successfully reduced with 2 air contrast enemas which demonstrated successful reduction of intussusception. In clinic no C/O. 5/22/08-records received for DOS 4/23/08-Impression: Intussusception status post reduction air contrast barium enema. Presented to ED with vomiting began on day of seen in ED, vomitus is bilious and blood stained. Some bloody diarrhea. Lethargic and tired, decreased oral intake and normal urine output.


Changed on 9/14/2017

VAERS ID: 311843 Before After
VAERS Form:(blank) 1
Age:0.3
Sex:Male
Location:Tennessee
Vaccinated:2008-04-04
Onset:2008-04-23
Submitted:2008-05-05
Entered:2008-05-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 1 2 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C49920 / 1 2 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1394U / 1 2 - MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Barium double contrast, Blood culture negative, Intussusception, Urinary system X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: 4/25/08 CBC abnl, Blood cultures = negative, Therapeutic air enema - abnormal, KUB abnormal 5/22/08-records received-Abdominal series revealed intussusception reduced with air contrast barium enema. WBC 20, segs increased 82, lymphocytes decreased 35, blood culture no growth.
CDC 'Split Type':

Write-up: Rotateq administered 4/4/08. Pt hospitalized 4/25/08 with intussusception which was reduced nonsurgically. Hospitalized x 3 days. 5/13/08-clinic notes received for DOS 4/4/08-well baby visit. DOS 5/5/08-F/U visit for past hospitalization for intussusception. Successfully reduced with 2 air contrast enemas which demonstrated successful reduction of intussusception. In clinic no C/O. 5/22/08-records received for DOS 4/23/08-Impression: Intussusception status post reduction air contrast barium enema. Presented to ED with vomiting began on day of seen in ED, vomitus is bilious and blood stained. Some bloody diarrhea. Lethargic and tired, decreased oral intake and normal urine output.


Changed on 2/14/2018

VAERS ID: 311843 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Tennessee
Vaccinated:2008-04-04
Onset:2008-04-23
Submitted:2008-05-05
Entered:2008-05-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 2 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C49920 / 2 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1394U / 2 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Barium double contrast, Blood culture negative, Intussusception, Urinary system X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: 4/25/08 CBC abnl, Blood cultures = negative, Therapeutic air enema - abnormal, KUB abnormal 5/22/08-records received-Abdominal series revealed intussusception reduced with air contrast barium enema. WBC 20, segs increased 82, lymphocytes decreased 35, blood culture no growth.
CDC 'Split Type':

Write-up: Rotateq administered 4/4/08. Pt hospitalized 4/25/08 with intussusception which was reduced nonsurgically. Hospitalized x 3 days. 5/13/08-clinic notes received for DOS 4/4/08-well baby visit. DOS 5/5/08-F/U visit for past hospitalization for intussusception. Successfully reduced with 2 air contrast enemas which demonstrated successful reduction of intussusception. In clinic no C/O. 5/22/08-records received for DOS 4/23/08-Impression: Intussusception status post reduction air contrast barium enema. Presented to ED with vomiting began on day of seen in ED, vomitus is bilious and blood stained. Some bloody diarrhea. Lethargic and tired, decreased oral intake and normal urine output.


Changed on 6/14/2018

VAERS ID: 311843 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Tennessee
Vaccinated:2008-04-04
Onset:2008-04-23
Submitted:2008-05-05
Entered:2008-05-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 2 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C49920 / 2 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1394U / 2 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Barium double contrast, Blood culture negative, Intussusception, Urinary system X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: 4/25/08 CBC abnl, Blood cultures = negative, Therapeutic air enema - abnormal, KUB abnormal 5/22/08-records received-Abdominal series revealed intussusception reduced with air contrast barium enema. WBC 20, segs increased 82, lymphocytes decreased 35, blood culture no growth.
CDC 'Split Type':

Write-up: Rotateq administered 4/4/08. Pt hospitalized 4/25/08 with intussusception which was reduced nonsurgically. Hospitalized x 3 days. 5/13/08-clinic notes received for DOS 4/4/08-well baby visit. DOS 5/5/08-F/U visit for past hospitalization for intussusception. Successfully reduced with 2 air contrast enemas which demonstrated successful reduction of intussusception. In clinic no C/O. 5/22/08-records received for DOS 4/23/08-Impression: Intussusception status post reduction air contrast barium enema. Presented to ED with vomiting began on day of seen in ED, vomitus is bilious and blood stained. Some bloody diarrhea. Lethargic and tired, decreased oral intake and normal urine output.


Changed on 8/14/2018

VAERS ID: 311843 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Tennessee
Vaccinated:2008-04-04
Onset:2008-04-23
Submitted:2008-05-05
Entered:2008-05-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 2 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C49920 / 2 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1394U / 2 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Barium double contrast, Blood culture negative, Intussusception, Urinary system X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: 4/25/08 CBC abnl, Blood cultures = negative, Therapeutic air enema - abnormal, KUB abnormal 5/22/08-records received-Abdominal series revealed intussusception reduced with air contrast barium enema. WBC 20, segs increased 82, lymphocytes decreased 35, blood culture no growth.
CDC 'Split Type':

Write-up: Rotateq administered 4/4/08. Pt hospitalized 4/25/08 with intussusception which was reduced nonsurgically. Hospitalized x 3 days. 5/13/08-clinic notes received for DOS 4/4/08-well baby visit. DOS 5/5/08-F/U visit for past hospitalization for intussusception. Successfully reduced with 2 air contrast enemas which demonstrated successful reduction of intussusception. In clinic no C/O. 5/22/08-records received for DOS 4/23/08-Impression: Intussusception status post reduction air contrast barium enema. Presented to ED with vomiting began on day of seen in ED, vomitus is bilious and blood stained. Some bloody diarrhea. Lethargic and tired, decreased oral intake and normal urine output.


Changed on 9/14/2018

VAERS ID: 311843 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Tennessee
Vaccinated:2008-04-04
Onset:2008-04-23
Submitted:2008-05-05
Entered:2008-05-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 2 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C49920 / 2 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1394U / 2 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Barium double contrast, Blood culture negative, Intussusception, Urinary system X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: 4/25/08 CBC abnl, Blood cultures = negative, Therapeutic air enema - abnormal, KUB abnormal 5/22/08-records received-Abdominal series revealed intussusception reduced with air contrast barium enema. WBC 20, segs increased 82, lymphocytes decreased 35, blood culture no growth.
CDC 'Split Type':

Write-up: Rotateq administered 4/4/08. Pt hospitalized 4/25/08 with intussusception which was reduced nonsurgically. Hospitalized x 3 days. 5/13/08-clinic notes received for DOS 4/4/08-well baby visit. DOS 5/5/08-F/U visit for past hospitalization for intussusception. Successfully reduced with 2 air contrast enemas which demonstrated successful reduction of intussusception. In clinic no C/O. 5/22/08-records received for DOS 4/23/08-Impression: Intussusception status post reduction air contrast barium enema. Presented to ED with vomiting began on day of seen in ED, vomitus is bilious and blood stained. Some bloody diarrhea. Lethargic and tired, decreased oral intake and normal urine output.


Changed on 10/14/2018

VAERS ID: 311843 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Tennessee
Vaccinated:2008-04-04
Onset:2008-04-23
Submitted:2008-05-05
Entered:2008-05-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 2 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C49920 / 2 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1394U / 2 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Barium double contrast, Blood culture negative, Intussusception, Urinary system X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: 4/25/08 CBC abnl, Blood cultures = negative, Therapeutic air enema - abnormal, KUB abnormal 5/22/08-records received-Abdominal series revealed intussusception reduced with air contrast barium enema. WBC 20, segs increased 82, lymphocytes decreased 35, blood culture no growth.
CDC 'Split Type':

Write-up: Rotateq administered 4/4/08. Pt hospitalized 4/25/08 with intussusception which was reduced nonsurgically. Hospitalized x 3 days. 5/13/08-clinic notes received for DOS 4/4/08-well baby visit. DOS 5/5/08-F/U visit for past hospitalization for intussusception. Successfully reduced with 2 air contrast enemas which demonstrated successful reduction of intussusception. In clinic no C/O. 5/22/08-records received for DOS 4/23/08-Impression: Intussusception status post reduction air contrast barium enema. Presented to ED with vomiting began on day of seen in ED, vomitus is bilious and blood stained. Some bloody diarrhea. Lethargic and tired, decreased oral intake and normal urine output.

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