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This is VAERS ID 312538

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 312538
VAERS Form:
Age:0.2
Sex:Male
Location:Georgia
Vaccinated:2008-03-14
Onset:2008-04-24
Submitted:2008-05-16
Entered:2008-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B136CA / 0 UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF343AD / 0 UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0106X / 0 - / PO

Administered by: Other      Purchased by: Unknown
Symptoms: Abdominal pain, Barium double contrast, Intussusception, Decreased appetite, Colectomy

Life Threatening? No
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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 7/23/08-records received-Barium and air enema revealed intussusception to level of rectum three unsuccessful attempts at reduction.
CDC 'Split Type':

Write-up: Information has been received from a physician concerning an approximately 17 week old male who on 25-MAR-2008 was vaccinated PO with his first 2.0 ml dose of Rotateq. The patient was hospitalized for 8 days from 25-APR-2008 to 02-MAY-2008 with intussusce"ption requiring surgery with a loss of a section of the terminal ileum. The patient was noted to be recovering. There was no product quality complaint. No additional information at this time. Intussusception was also considered to be an other important me


Changed on 12/8/2009

VAERS ID: 312538 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Georgia
Vaccinated:2008-03-14
Onset:2008-04-24
Submitted:2008-05-16
Entered:2008-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B136CA / 0 UN / UN
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B136CA / 0 UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF343AD / 0 UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0106X / 0 - / PO

Administered by: Other      Purchased by: Unknown Other
Symptoms: Abdominal pain, Barium double contrast, Intussusception, Irritability, Lethargy, Rectal haemorrhage, Urine output decreased, Decreased appetite, Colectomy

Life Threatening? No
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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 7/23/08-records received-Barium and air enema revealed intussusception to level of rectum three unsuccessful attempts at reduction.
CDC 'Split Type': (blank) WAES0805USA02081

Write-up: Information has been received from a physician concerning an approximately 17 week old male who on 25-MAR-2008 was vaccinated PO with his first 2.0 ml dose of Rotateq. The patient was hospitalized for 8 days from 25-APR-2008 to 02-MAY-2008 with intussusce"ption intussusception requiring surgery with a loss of a section of the terminal ileum. The patient was noted to be recovering. There was no product quality complaint. No additional information at this time. Intussusception was also considered to be an other important me medical event (surgery) by the physician. Additional information has been requested. 7/23/08-records received for DOS 4/25-4/30/08-DC DX: Intussusception. Presented with 2 day history of abdominal pain and bright red blood per rectum morning of 4/24/08-Not interested in eating and decrease of diapers/decreased urine output. Pain, severe fussiness, lethargy, rectal bleeding. PE: abdomen positive bowel sounds with a palpable wave. Partial colectomy with excision of terminal ileum.


Changed on 5/13/2013

VAERS ID: 312538 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Georgia
Vaccinated:2008-03-14
Onset:2008-04-24
Submitted:2008-05-16
Entered:2008-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B136CA / 0 UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF343AD / 0 UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0106X / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0106X / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Barium double contrast, Intussusception, Irritability, Lethargy, Rectal haemorrhage, Urine output decreased, Decreased appetite, Colectomy

Life Threatening? No
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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 7/23/08-records received-Barium and air enema revealed intussusception to level of rectum three unsuccessful attempts at reduction.
CDC 'Split Type': WAES0805USA02081

Write-up: Information has been received from a physician concerning an approximately 17 week old male who on 25-MAR-2008 was vaccinated PO with his first 2.0 ml dose of Rotateq. The patient was hospitalized for 8 days from 25-APR-2008 to 02-MAY-2008 with intussusception requiring surgery with a loss of a section of the terminal ileum. The patient was noted to be recovering. There was no product quality complaint. No additional information at this time. Intussusception was also considered to be an other important medical event (surgery) by the physician. Additional information has been requested. 7/23/08-records received for DOS 4/25-4/30/08-DC DX: Intussusception. Presented with 2 day history of abdominal pain and bright red blood per rectum morning of 4/24/08-Not interested in eating and decrease of diapers/decreased urine output. Pain, severe fussiness, lethargy, rectal bleeding. PE: abdomen positive bowel sounds with a palpable wave. Partial colectomy with excision of terminal ileum.


Changed on 4/14/2017

VAERS ID: 312538 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Georgia
Vaccinated:2008-03-14
Onset:2008-04-24
Submitted:2008-05-16
Entered:2008-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B136CA / 0 UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF343AD / 0 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0106X / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Barium double contrast, Intussusception, Irritability, Lethargy, Rectal haemorrhage, Urine output decreased, Decreased appetite, Colectomy

Life Threatening? No
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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 7/23/08-records received-Barium and air enema revealed intussusception to level of rectum three unsuccessful attempts at reduction.
CDC 'Split Type': WAES0805USA02081

Write-up: Information has been received from a physician concerning an approximately 17 week old male who on 25-MAR-2008 was vaccinated PO with his first 2.0 ml dose of Rotateq. The patient was hospitalized for 8 days from 25-APR-2008 to 02-MAY-2008 with intussusception requiring surgery with a loss of a section of the terminal ileum. The patient was noted to be recovering. There was no product quality complaint. No additional information at this time. Intussusception was also considered to be an other important medical event (surgery) by the physician. Additional information has been requested. 7/23/08-records received for DOS 4/25-4/30/08-DC DX: Intussusception. Presented with 2 day history of abdominal pain and bright red blood per rectum morning of 4/24/08-Not interested in eating and decrease of diapers/decreased urine output. Pain, severe fussiness, lethargy, rectal bleeding. PE: abdomen positive bowel sounds with a palpable wave. Partial colectomy with excision of terminal ileum.


Changed on 9/14/2017

VAERS ID: 312538 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:Georgia
Vaccinated:2008-03-14
Onset:2008-04-24
Submitted:2008-05-16
Entered:2008-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B136CA / 0 1 UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF343AD / 0 1 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0106X / 0 1 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception

Life Threatening? No
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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 7/23/08-records received-Barium and air enema revealed intussusception to level of rectum three unsuccessful attempts at reduction.
CDC 'Split Type': WAES0805USA02081

Write-up: Information has been received from a physician concerning an approximately 17 week old male who on 25-MAR-2008 was vaccinated PO with his first 2.0 ml dose of Rotateq. The patient was hospitalized for 8 days from 25-APR-2008 to 02-MAY-2008 with intussusception requiring surgery with a loss of a section of the terminal ileum. The patient was noted to be recovering. There was no product quality complaint. No additional information at this time. Intussusception was also considered to be an other important medical event (surgery) by the physician. Additional information has been requested. 7/23/08-records received for DOS 4/25-4/30/08-DC DX: Intussusception. Presented with 2 day history of abdominal pain and bright red blood per rectum morning of 4/24/08-Not interested in eating and decrease of diapers/decreased urine output. Pain, severe fussiness, lethargy, rectal bleeding. PE: abdomen positive bowel sounds with a palpable wave. Partial colectomy with excision of terminal ileum.


Changed on 2/14/2018

VAERS ID: 312538 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Georgia
Vaccinated:2008-03-14
Onset:2008-04-24
Submitted:2008-05-16
Entered:2008-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B136CA / 1 UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF343AD / 1 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0106X / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception

Life Threatening? No
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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 7/23/08-records received-Barium and air enema revealed intussusception to level of rectum three unsuccessful attempts at reduction.
CDC 'Split Type': WAES0805USA02081

Write-up: Information has been received from a physician concerning an approximately 17 week old male who on 25-MAR-2008 was vaccinated PO with his first 2.0 ml dose of Rotateq. The patient was hospitalized for 8 days from 25-APR-2008 to 02-MAY-2008 with intussusception requiring surgery with a loss of a section of the terminal ileum. The patient was noted to be recovering. There was no product quality complaint. No additional information at this time. Intussusception was also considered to be an other important medical event (surgery) by the physician. Additional information has been requested. 7/23/08-records received for DOS 4/25-4/30/08-DC DX: Intussusception. Presented with 2 day history of abdominal pain and bright red blood per rectum morning of 4/24/08-Not interested in eating and decrease of diapers/decreased urine output. Pain, severe fussiness, lethargy, rectal bleeding. PE: abdomen positive bowel sounds with a palpable wave. Partial colectomy with excision of terminal ileum.


Changed on 6/14/2018

VAERS ID: 312538 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Georgia
Vaccinated:2008-03-14
Onset:2008-04-24
Submitted:2008-05-16
Entered:2008-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B136CA / 1 UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF343AD / 1 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0106X / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception

Life Threatening? No
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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 7/23/08-records received-Barium and air enema revealed intussusception to level of rectum three unsuccessful attempts at reduction.
CDC 'Split Type': WAES0805USA02081

Write-up: Information has been received from a physician concerning an approximately 17 week old male who on 25-MAR-2008 was vaccinated PO with his first 2.0 ml dose of Rotateq. The patient was hospitalized for 8 days from 25-APR-2008 to 02-MAY-2008 with intussusception requiring surgery with a loss of a section of the terminal ileum. The patient was noted to be recovering. There was no product quality complaint. No additional information at this time. Intussusception was also considered to be an other important medical event (surgery) by the physician. Additional information has been requested. 7/23/08-records received for DOS 4/25-4/30/08-DC DX: Intussusception. Presented with 2 day history of abdominal pain and bright red blood per rectum morning of 4/24/08-Not interested in eating and decrease of diapers/decreased urine output. Pain, severe fussiness, lethargy, rectal bleeding. PE: abdomen positive bowel sounds with a palpable wave. Partial colectomy with excision of terminal ileum.


Changed on 8/14/2018

VAERS ID: 312538 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Georgia
Vaccinated:2008-03-14
Onset:2008-04-24
Submitted:2008-05-16
Entered:2008-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B136CA / 1 UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF343AD / 1 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0106X / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception

Life Threatening? No
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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 7/23/08-records received-Barium and air enema revealed intussusception to level of rectum three unsuccessful attempts at reduction.
CDC 'Split Type': WAES0805USA02081

Write-up: Information has been received from a physician concerning an approximately 17 week old male who on 25-MAR-2008 was vaccinated PO with his first 2.0 ml dose of Rotateq. The patient was hospitalized for 8 days from 25-APR-2008 to 02-MAY-2008 with intussusception requiring surgery with a loss of a section of the terminal ileum. The patient was noted to be recovering. There was no product quality complaint. No additional information at this time. Intussusception was also considered to be an other important medical event (surgery) by the physician. Additional information has been requested. 7/23/08-records received for DOS 4/25-4/30/08-DC DX: Intussusception. Presented with 2 day history of abdominal pain and bright red blood per rectum morning of 4/24/08-Not interested in eating and decrease of diapers/decreased urine output. Pain, severe fussiness, lethargy, rectal bleeding. PE: abdomen positive bowel sounds with a palpable wave. Partial colectomy with excision of terminal ileum.


Changed on 9/14/2018

VAERS ID: 312538 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Georgia
Vaccinated:2008-03-14
Onset:2008-04-24
Submitted:2008-05-16
Entered:2008-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B136CA / 1 UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF343AD / 1 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0106X / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception

Life Threatening? No
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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 7/23/08-records received-Barium and air enema revealed intussusception to level of rectum three unsuccessful attempts at reduction.
CDC 'Split Type': WAES0805USA02081

Write-up: Information has been received from a physician concerning an approximately 17 week old male who on 25-MAR-2008 was vaccinated PO with his first 2.0 ml dose of Rotateq. The patient was hospitalized for 8 days from 25-APR-2008 to 02-MAY-2008 with intussusception requiring surgery with a loss of a section of the terminal ileum. The patient was noted to be recovering. There was no product quality complaint. No additional information at this time. Intussusception was also considered to be an other important medical event (surgery) by the physician. Additional information has been requested. 7/23/08-records received for DOS 4/25-4/30/08-DC DX: Intussusception. Presented with 2 day history of abdominal pain and bright red blood per rectum morning of 4/24/08-Not interested in eating and decrease of diapers/decreased urine output. Pain, severe fussiness, lethargy, rectal bleeding. PE: abdomen positive bowel sounds with a palpable wave. Partial colectomy with excision of terminal ileum.


Changed on 10/14/2018

VAERS ID: 312538 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Georgia
Vaccinated:2008-03-14
Onset:2008-04-24
Submitted:2008-05-16
Entered:2008-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B136CA / 1 UN / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF343AD / 1 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0106X / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception

Life Threatening? No
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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 7/23/08-records received-Barium and air enema revealed intussusception to level of rectum three unsuccessful attempts at reduction.
CDC 'Split Type': WAES0805USA02081

Write-up: Information has been received from a physician concerning an approximately 17 week old male who on 25-MAR-2008 was vaccinated PO with his first 2.0 ml dose of Rotateq. The patient was hospitalized for 8 days from 25-APR-2008 to 02-MAY-2008 with intussusception requiring surgery with a loss of a section of the terminal ileum. The patient was noted to be recovering. There was no product quality complaint. No additional information at this time. Intussusception was also considered to be an other important medical event (surgery) by the physician. Additional information has been requested. 7/23/08-records received for DOS 4/25-4/30/08-DC DX: Intussusception. Presented with 2 day history of abdominal pain and bright red blood per rectum morning of 4/24/08-Not interested in eating and decrease of diapers/decreased urine output. Pain, severe fussiness, lethargy, rectal bleeding. PE: abdomen positive bowel sounds with a palpable wave. Partial colectomy with excision of terminal ileum.

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