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This is VAERS ID 315651

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 315651
VAERS Form:
Age:0.4
Sex:Male
Location:California
Vaccinated:2008-06-05
Onset:2008-06-07
Submitted:2008-06-09
Entered:2008-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B143AA / 1 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF263AB / 1 UN / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C65934U / 1 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1928U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal pain, Barium double contrast, Barium enema abnormal, Blood potassium decreased

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: 2     Extended hospital stay? No
Previous Vaccinations: Intussusception~Rotavirus (Rotateq)~2~0~In Patient
Other Medications: None
Current Illness: Possibly tactile fever, per mother''s report. recent vomiting and fever prior to vax
Preexisting Conditions: Noncommunicating hydrocoele. PMH: none except recent vomiting and fever prior to vax
Allergies:
Diagnostic Lab Data: Abdominal Ultrasound showed intussusception 6/8, KUB showed paucity of air in RLQ 6/8. Labs and Diagnostics: KUB with paucity of air in RLQ. Abd US (+) for IS. Barium enema (+) for IS. K+ 3.4. CBC with WBC 19.1, Hgb 9.5. Hct 27.9.
CDC 'Split Type': Noncommunicating hydrocoele. PMH: none except recent vomiting and fever prior to vax

Write-up: Patient was given vaccine on 6/5/08. Mother and father brought in child to Kaiser ED on 6/7/08 for concerns of 5 days of tactile fevers (reportedly before vaccine was given, unknown to MD), 2 days of emesis after feeds, abdominal pain, and one episode of"bloody stool. At ED, MD noted multiple bilious emesis, abdominal pain, bloody mass in rectum, and palpated a /"sausage-shaped/" RLQ mass; patient was also noted to look tired and dehydrated with decrease in urine output, but had no other symptoms. Patie


Changed on 12/8/2009

VAERS ID: 315651 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:California
Vaccinated:2008-06-05
Onset:2008-06-07
Submitted:2008-06-09
Entered:2008-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B143AA / 1 UN / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B143AA / 1 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF263AB / 1 UN / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C65934U / 1 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1928U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal pain, Barium double contrast, Barium enema abnormal, Blood potassium decreased, Dehydration, Fatigue, Full blood count, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Pyrexia, Rectal haemorrhage, Urinary system X-ray, Vomiting, White blood cell count increased, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Gastrointestinal tube insertion, Urine output decreased

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: 2     Extended hospital stay? No
Previous Vaccinations: Intussusception~Rotavirus (Rotateq)~2~0~In Patient
Other Medications: None
Current Illness: Possibly tactile fever, per mother''s report. recent vomiting and fever prior to vax
Preexisting Conditions: Noncommunicating hydrocoele. PMH: none except recent vomiting and fever prior to vax
Allergies:
Diagnostic Lab Data: Abdominal Ultrasound showed intussusception 6/8, KUB showed paucity of air in RLQ 6/8. Labs and Diagnostics: KUB with paucity of air in RLQ. Abd US (+) for IS. Barium enema (+) for IS. K+ 3.4. CBC with WBC 19.1, Hgb 9.5. Hct 27.9.
CDC 'Split Type': Noncommunicating hydrocoele. PMH: none except recent vomiting and fever prior to vax (blank)

Write-up: Patient was given vaccine on 6/5/08. Mother and father brought in child to Kaiser ED on 6/7/08 for concerns of 5 days of tactile fevers (reportedly before vaccine was given, unknown to MD), 2 days of emesis after feeds, abdominal pain, and one episode of"bloody of bloody stool. At ED, MD noted multiple bilious emesis, abdominal pain, bloody mass in rectum, and palpated a /"sausage-shaped/" "sausage-shaped" RLQ mass; patient was also noted to look tired and dehydrated with decrease in urine output, but had no other symptoms. Patie Patient was found to have an ileocolic intussusception upon fluoroscopy and air contrast enema, and was reduced. After over 24 hours of observation and on Flagyl and Rocephin, patient has not had recurrence of symptoms and is tolerating bottle formula, doing well. It is unclear that patient''s intussusception was due to Rotavirus vaccine administration, as patient was febrile prior to administration. 08/08/2008 MR received for DOD 6/7-9/2008 with D/C DX: Intussusception. Pt seen in ER for fever and vomiting 1 day prior to vax admin. Returned 6/7/08 twice with fever and vomiting and inability to maintain po intake. With 2nd visit new onset of bloody stool. Dx with gastroenteritis and again D/c home. Later requested to return to hospital with concern for Intussusception. Pt had continued to vomit multiple times now bilious and green. On PE a sausage shaped abd mass noted. Transfered to higher level of care. Upon arrival US confirmed IS, NG tube placed and pt given barium enema which was successful at reduction. did well post procedure and d/c home next day.


Changed on 2/5/2010

VAERS ID: 315651 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:California
Vaccinated:2008-06-05
Onset:2008-06-07
Submitted:2008-06-09
Entered:2008-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B143AA / 1 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF263AB / 1 UN / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C65934U / 1 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1928U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal pain, Barium double contrast, Barium enema abnormal, Blood potassium decreased, Dehydration, Fatigue, Full blood count, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Pyrexia, Rectal haemorrhage, Urinary system X-ray, Vomiting, White blood cell count increased, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Gastrointestinal tube insertion, Urine output decreased

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: 2     Extended hospital stay? No
Previous Vaccinations: Intussusception~Rotavirus (Rotateq)~2~0~In Patient (Rotateq)~2~0.40~Patient
Other Medications: None
Current Illness: Possibly tactile fever, per mother''s report. recent vomiting and fever prior to vax
Preexisting Conditions: Noncommunicating hydrocoele. PMH: none except recent vomiting and fever prior to vax
Allergies:
Diagnostic Lab Data: Abdominal Ultrasound showed intussusception 6/8, KUB showed paucity of air in RLQ 6/8. Labs and Diagnostics: KUB with paucity of air in RLQ. Abd US (+) for IS. Barium enema (+) for IS. K+ 3.4. CBC with WBC 19.1, Hgb 9.5. Hct 27.9.
CDC 'Split Type':

Write-up: Patient was given vaccine on 6/5/08. Mother and father brought in child to Kaiser ED on 6/7/08 for concerns of 5 days of tactile fevers (reportedly before vaccine was given, unknown to MD), 2 days of emesis after feeds, abdominal pain, and one episode of bloody stool. At ED, MD noted multiple bilious emesis, abdominal pain, bloody mass in rectum, and palpated a "sausage-shaped" RLQ mass; patient was also noted to look tired and dehydrated with decrease in urine output, but had no other symptoms. Patient was found to have an ileocolic intussusception upon fluoroscopy and air contrast enema, and was reduced. After over 24 hours of observation and on Flagyl and Rocephin, patient has not had recurrence of symptoms and is tolerating bottle formula, doing well. It is unclear that patient''s intussusception was due to Rotavirus vaccine administration, as patient was febrile prior to administration. 08/08/2008 MR received for DOD 6/7-9/2008 with D/C DX: Intussusception. Pt seen in ER for fever and vomiting 1 day prior to vax admin. Returned 6/7/08 twice with fever and vomiting and inability to maintain po intake. With 2nd visit new onset of bloody stool. Dx with gastroenteritis and again D/c home. Later requested to return to hospital with concern for Intussusception. Pt had continued to vomit multiple times now bilious and green. On PE a sausage shaped abd mass noted. Transfered to higher level of care. Upon arrival US confirmed IS, NG tube placed and pt given barium enema which was successful at reduction. did well post procedure and d/c home next day.


Changed on 3/2/2010

VAERS ID: 315651 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:California
Vaccinated:2008-06-05
Onset:2008-06-07
Submitted:2008-06-09
Entered:2008-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B143AA / 1 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF263AB / 1 UN / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC C65934U / 1 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1928U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal pain, Barium double contrast, Dehydration, Fatigue, Haematochezia, Intussusception, Rectal haemorrhage, Urinary system X-ray, Vomiting, X-ray abnormal, Ultrasound abdomen abnormal, Urine output decreased

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: 2     Extended hospital stay? No
Previous Vaccinations: Intussusception~Rotavirus (Rotateq)~2~0.40~Patient
Other Medications: None
Current Illness: Possibly tactile fever, per mother''s report. recent vomiting and fever prior to vax
Preexisting Conditions: Noncommunicating hydrocoele. PMH: none except recent vomiting and fever prior to vax
Allergies:
Diagnostic Lab Data: Abdominal Ultrasound showed intussusception 6/8, KUB showed paucity of air in RLQ 6/8. Labs and Diagnostics: KUB with paucity of air in RLQ. Abd US (+) for IS. Barium enema (+) for IS. K+ 3.4. CBC with WBC 19.1, Hgb 9.5. Hct 27.9.
CDC 'Split Type':

Write-up: Patient was given vaccine on 6/5/08. Mother and father brought in child to Kaiser ED on 6/7/08 for concerns of 5 days of tactile fevers (reportedly before vaccine was given, unknown to MD), 2 days of emesis after feeds, abdominal pain, and one episode of bloody stool. At ED, MD noted multiple bilious emesis, abdominal pain, bloody mass in rectum, and palpated a "sausage-shaped" RLQ mass; patient was also noted to look tired and dehydrated with decrease in urine output, but had no other symptoms. Patient was found to have an ileocolic intussusception upon fluoroscopy and air contrast enema, and was reduced. After over 24 hours of observation and on Flagyl and Rocephin, patient has not had recurrence of symptoms and is tolerating bottle formula, doing well. It is unclear that patient''s intussusception was due to Rotavirus vaccine administration, as patient was febrile prior to administration. 08/08/2008 MR received for DOD 6/7-9/2008 with D/C DX: Intussusception. Pt seen in ER for fever and vomiting 1 day prior to vax admin. Returned 6/7/08 twice with fever and vomiting and inability to maintain po intake. With 2nd visit new onset of bloody stool. Dx with gastroenteritis and again D/c home. Later requested to return to hospital with concern for Intussusception. Pt had continued to vomit multiple times now bilious and green. On PE a sausage shaped abd mass noted. Transfered to higher level of care. Upon arrival US confirmed IS, NG tube placed and pt given barium enema which was successful at reduction. did well post procedure and d/c home next day.


Changed on 4/7/2010

VAERS ID: 315651 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:California
Vaccinated:2008-06-05
Onset:2008-06-07
Submitted:2008-06-09
Entered:2008-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B143AA / 1 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF263AB / 1 UN / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C65934U / 1 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1928U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal pain, Barium double contrast, Dehydration, Fatigue, Haematochezia, Intussusception, Rectal haemorrhage, Urinary system X-ray, Vomiting, X-ray abnormal, Ultrasound abdomen abnormal, Urine output decreased

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: 2     Extended hospital stay? No
Previous Vaccinations: Intussusception~Rotavirus (Rotateq)~2~0.40~Patient
Other Medications: None
Current Illness: Possibly tactile fever, per mother''s report. recent vomiting and fever prior to vax
Preexisting Conditions: Noncommunicating hydrocoele. PMH: none except recent vomiting and fever prior to vax
Allergies:
Diagnostic Lab Data: Abdominal Ultrasound showed intussusception 6/8, KUB showed paucity of air in RLQ 6/8. Labs and Diagnostics: KUB with paucity of air in RLQ. Abd US (+) for IS. Barium enema (+) for IS. K+ 3.4. CBC with WBC 19.1, Hgb 9.5. Hct 27.9.
CDC 'Split Type':

Write-up: Patient was given vaccine on 6/5/08. Mother and father brought in child to Kaiser ED on 6/7/08 for concerns of 5 days of tactile fevers (reportedly before vaccine was given, unknown to MD), 2 days of emesis after feeds, abdominal pain, and one episode of bloody stool. At ED, MD noted multiple bilious emesis, abdominal pain, bloody mass in rectum, and palpated a "sausage-shaped" RLQ mass; patient was also noted to look tired and dehydrated with decrease in urine output, but had no other symptoms. Patient was found to have an ileocolic intussusception upon fluoroscopy and air contrast enema, and was reduced. After over 24 hours of observation and on Flagyl and Rocephin, patient has not had recurrence of symptoms and is tolerating bottle formula, doing well. It is unclear that patient''s intussusception was due to Rotavirus vaccine administration, as patient was febrile prior to administration. 08/08/2008 MR received for DOD 6/7-9/2008 with D/C DX: Intussusception. Pt seen in ER for fever and vomiting 1 day prior to vax admin. Returned 6/7/08 twice with fever and vomiting and inability to maintain po intake. With 2nd visit new onset of bloody stool. Dx with gastroenteritis and again D/c home. Later requested to return to hospital with concern for Intussusception. Pt had continued to vomit multiple times now bilious and green. On PE a sausage shaped abd mass noted. Transfered to higher level of care. Upon arrival US confirmed IS, NG tube placed and pt given barium enema which was successful at reduction. did well post procedure and d/c home next day.


Changed on 8/31/2010

VAERS ID: 315651 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:California
Vaccinated:2008-06-05
Onset:2008-06-07
Submitted:2008-06-09
Entered:2008-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B143AA / 1 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF263AB / 1 UN / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH C65934U / 1 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1928U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal pain, Barium double contrast, Dehydration, Fatigue, Haematochezia, Intussusception, Rectal haemorrhage, Urinary system X-ray, Vomiting, X-ray abnormal, Ultrasound abdomen abnormal, Urine output decreased

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: 2     Extended hospital stay? No
Previous Vaccinations: Intussusception~Rotavirus (Rotateq)~2~0.40~Patient
Other Medications: None
Current Illness: Possibly tactile fever, per mother''s report. recent vomiting and fever prior to vax
Preexisting Conditions: Noncommunicating hydrocoele. PMH: none except recent vomiting and fever prior to vax
Allergies:
Diagnostic Lab Data: Abdominal Ultrasound showed intussusception 6/8, KUB showed paucity of air in RLQ 6/8. Labs and Diagnostics: KUB with paucity of air in RLQ. Abd US (+) for IS. Barium enema (+) for IS. K+ 3.4. CBC with WBC 19.1, Hgb 9.5. Hct 27.9.
CDC 'Split Type':

Write-up: Patient was given vaccine on 6/5/08. Mother and father brought in child to Kaiser ED on 6/7/08 for concerns of 5 days of tactile fevers (reportedly before vaccine was given, unknown to MD), 2 days of emesis after feeds, abdominal pain, and one episode of bloody stool. At ED, MD noted multiple bilious emesis, abdominal pain, bloody mass in rectum, and palpated a "sausage-shaped" RLQ mass; patient was also noted to look tired and dehydrated with decrease in urine output, but had no other symptoms. Patient was found to have an ileocolic intussusception upon fluoroscopy and air contrast enema, and was reduced. After over 24 hours of observation and on Flagyl and Rocephin, patient has not had recurrence of symptoms and is tolerating bottle formula, doing well. It is unclear that patient''s intussusception was due to Rotavirus vaccine administration, as patient was febrile prior to administration. 08/08/2008 MR received for DOD 6/7-9/2008 with D/C DX: Intussusception. Pt seen in ER for fever and vomiting 1 day prior to vax admin. Returned 6/7/08 twice with fever and vomiting and inability to maintain po intake. With 2nd visit new onset of bloody stool. Dx with gastroenteritis and again D/c home. Later requested to return to hospital with concern for Intussusception. Pt had continued to vomit multiple times now bilious and green. On PE a sausage shaped abd mass noted. Transfered to higher level of care. Upon arrival US confirmed IS, NG tube placed and pt given barium enema which was successful at reduction. did well post procedure and d/c home next day.


Changed on 4/13/2011

VAERS ID: 315651 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:California
Vaccinated:2008-06-05
Onset:2008-06-07
Submitted:2008-06-09
Entered:2008-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B143AA / 1 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF263AB / 1 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65934U / 1 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1928U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal pain, Barium double contrast, Barium enema abnormal, Blood potassium decreased, Dehydration, Fatigue, Full blood count, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Pyrexia, Rectal haemorrhage, Urinary system X-ray, Vomiting, White blood cell count increased, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Gastrointestinal tube insertion, Urine output decreased

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: 2     Extended hospital stay? No
Previous Vaccinations: Intussusception~Rotavirus (Rotateq)~2~0.40~Patient
Other Medications: None
Current Illness: Possibly tactile fever, per mother''s report. recent vomiting and fever prior to vax
Preexisting Conditions: Noncommunicating hydrocoele. PMH: none except recent vomiting and fever prior to vax
Allergies:
Diagnostic Lab Data: Abdominal Ultrasound showed intussusception 6/8, KUB showed paucity of air in RLQ 6/8. Labs and Diagnostics: KUB with paucity of air in RLQ. Abd US (+) for IS. Barium enema (+) for IS. K+ 3.4. CBC with WBC 19.1, Hgb 9.5. Hct 27.9.
CDC 'Split Type':

Write-up: Patient was given vaccine on 6/5/08. Mother and father brought in child to Kaiser ED on 6/7/08 for concerns of 5 days of tactile fevers (reportedly before vaccine was given, unknown to MD), 2 days of emesis after feeds, abdominal pain, and one episode of bloody stool. At ED, MD noted multiple bilious emesis, abdominal pain, bloody mass in rectum, and palpated a "sausage-shaped" RLQ mass; patient was also noted to look tired and dehydrated with decrease in urine output, but had no other symptoms. Patient was found to have an ileocolic intussusception upon fluoroscopy and air contrast enema, and was reduced. After over 24 hours of observation and on Flagyl and Rocephin, patient has not had recurrence of symptoms and is tolerating bottle formula, doing well. It is unclear that patient''s intussusception was due to Rotavirus vaccine administration, as patient was febrile prior to administration. 08/08/2008 MR received for DOD 6/7-9/2008 with D/C DX: Intussusception. Pt seen in ER for fever and vomiting 1 day prior to vax admin. Returned 6/7/08 twice with fever and vomiting and inability to maintain po intake. With 2nd visit new onset of bloody stool. Dx with gastroenteritis and again D/c home. Later requested to return to hospital with concern for Intussusception. Pt had continued to vomit multiple times now bilious and green. On PE a sausage shaped abd mass noted. Transfered to higher level of care. Upon arrival US confirmed IS, NG tube placed and pt given barium enema which was successful at reduction. did well post procedure and d/c home next day.


Changed on 5/13/2011

VAERS ID: 315651 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:California
Vaccinated:2008-06-05
Onset:2008-06-07
Submitted:2008-06-09
Entered:2008-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B143AA / 1 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF263AB / 1 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65934U / 1 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1928U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal pain, Barium double contrast, Barium enema abnormal, Blood potassium decreased, Dehydration, Fatigue, Full blood count, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Pyrexia, Rectal haemorrhage, Urinary system X-ray, Vomiting, White blood cell count increased, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Gastrointestinal tube insertion, Urine output decreased

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: 2     Extended hospital stay? No
Previous Vaccinations: Intussusception~Rotavirus (Rotateq)~2~0.40~Patient
Other Medications: None
Current Illness: Possibly tactile fever, per mother''s report. recent vomiting and fever prior to vax
Preexisting Conditions: Noncommunicating hydrocoele. PMH: none except recent vomiting and fever prior to vax
Allergies:
Diagnostic Lab Data: Abdominal Ultrasound showed intussusception 6/8, KUB showed paucity of air in RLQ 6/8. Labs and Diagnostics: KUB with paucity of air in RLQ. Abd US (+) for IS. Barium enema (+) for IS. K+ 3.4. CBC with WBC 19.1, Hgb 9.5. Hct 27.9.
CDC 'Split Type':

Write-up: Patient was given vaccine on 6/5/08. Mother and father brought in child to Kaiser ED on 6/7/08 for concerns of 5 days of tactile fevers (reportedly before vaccine was given, unknown to MD), 2 days of emesis after feeds, abdominal pain, and one episode of bloody stool. At ED, MD noted multiple bilious emesis, abdominal pain, bloody mass in rectum, and palpated a "sausage-shaped" RLQ mass; patient was also noted to look tired and dehydrated with decrease in urine output, but had no other symptoms. Patient was found to have an ileocolic intussusception upon fluoroscopy and air contrast enema, and was reduced. After over 24 hours of observation and on Flagyl and Rocephin, patient has not had recurrence of symptoms and is tolerating bottle formula, doing well. It is unclear that patient''s intussusception was due to Rotavirus vaccine administration, as patient was febrile prior to administration. 08/08/2008 MR received for DOD 6/7-9/2008 with D/C DX: Intussusception. Pt seen in ER for fever and vomiting 1 day prior to vax admin. Returned 6/7/08 twice with fever and vomiting and inability to maintain po intake. With 2nd visit new onset of bloody stool. Dx with gastroenteritis and again D/c home. Later requested to return to hospital with concern for Intussusception. Pt had continued to vomit multiple times now bilious and green. On PE a sausage shaped abd mass noted. Transfered to higher level of care. Upon arrival US confirmed IS, NG tube placed and pt given barium enema which was successful at reduction. did well post procedure and d/c home next day.


Changed on 6/11/2011

VAERS ID: 315651 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:California
Vaccinated:2008-06-05
Onset:2008-06-07
Submitted:2008-06-09
Entered:2008-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B143AA / 1 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF263AB / 1 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65934U / 1 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1928U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal pain, Barium double contrast, Barium enema abnormal, Blood potassium decreased, Dehydration, Fatigue, Full blood count, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Pyrexia, Rectal haemorrhage, Urinary system X-ray, Vomiting, White blood cell count increased, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Gastrointestinal tube insertion, Urine output decreased

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: 2     Extended hospital stay? No
Previous Vaccinations: Intussusception~Rotavirus (Rotateq)~2~0.40~Patient
Other Medications: None
Current Illness: Possibly tactile fever, per mother''s report. recent vomiting and fever prior to vax
Preexisting Conditions: Noncommunicating hydrocoele. PMH: none except recent vomiting and fever prior to vax
Allergies:
Diagnostic Lab Data: Abdominal Ultrasound showed intussusception 6/8, KUB showed paucity of air in RLQ 6/8. Labs and Diagnostics: KUB with paucity of air in RLQ. Abd US (+) for IS. Barium enema (+) for IS. K+ 3.4. CBC with WBC 19.1, Hgb 9.5. Hct 27.9.
CDC 'Split Type':

Write-up: Patient was given vaccine on 6/5/08. Mother and father brought in child to Kaiser ED on 6/7/08 for concerns of 5 days of tactile fevers (reportedly before vaccine was given, unknown to MD), 2 days of emesis after feeds, abdominal pain, and one episode of bloody stool. At ED, MD noted multiple bilious emesis, abdominal pain, bloody mass in rectum, and palpated a "sausage-shaped" RLQ mass; patient was also noted to look tired and dehydrated with decrease in urine output, but had no other symptoms. Patient was found to have an ileocolic intussusception upon fluoroscopy and air contrast enema, and was reduced. After over 24 hours of observation and on Flagyl and Rocephin, patient has not had recurrence of symptoms and is tolerating bottle formula, doing well. It is unclear that patient''s intussusception was due to Rotavirus vaccine administration, as patient was febrile prior to administration. 08/08/2008 MR received for DOD 6/7-9/2008 with D/C DX: Intussusception. Pt seen in ER for fever and vomiting 1 day prior to vax admin. Returned 6/7/08 twice with fever and vomiting and inability to maintain po intake. With 2nd visit new onset of bloody stool. Dx with gastroenteritis and again D/c home. Later requested to return to hospital with concern for Intussusception. Pt had continued to vomit multiple times now bilious and green. On PE a sausage shaped abd mass noted. Transfered to higher level of care. Upon arrival US confirmed IS, NG tube placed and pt given barium enema which was successful at reduction. did well post procedure and d/c home next day.


Changed on 5/13/2013

VAERS ID: 315651 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:California
Vaccinated:2008-06-05
Onset:2008-06-07
Submitted:2008-06-09
Entered:2008-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B143AA / 1 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF263AB / 1 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65934U / 1 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1928U / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1928U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal pain, Barium double contrast, Barium enema abnormal, Blood potassium decreased, Dehydration, Fatigue, Full blood count, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Pyrexia, Rectal haemorrhage, Urinary system X-ray, Vomiting, White blood cell count increased, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Gastrointestinal tube insertion, Urine output decreased

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: 2     Extended hospital stay? No
Previous Vaccinations: Intussusception~Rotavirus (Rotateq)~2~0.40~Patient
Other Medications: None
Current Illness: Possibly tactile fever, per mother''s report. recent vomiting and fever prior to vax
Preexisting Conditions: Noncommunicating hydrocoele. PMH: none except recent vomiting and fever prior to vax
Allergies:
Diagnostic Lab Data: Abdominal Ultrasound showed intussusception 6/8, KUB showed paucity of air in RLQ 6/8. Labs and Diagnostics: KUB with paucity of air in RLQ. Abd US (+) for IS. Barium enema (+) for IS. K+ 3.4. CBC with WBC 19.1, Hgb 9.5. Hct 27.9.
CDC 'Split Type':

Write-up: Patient was given vaccine on 6/5/08. Mother and father brought in child to Kaiser ED on 6/7/08 for concerns of 5 days of tactile fevers (reportedly before vaccine was given, unknown to MD), 2 days of emesis after feeds, abdominal pain, and one episode of bloody stool. At ED, MD noted multiple bilious emesis, abdominal pain, bloody mass in rectum, and palpated a "sausage-shaped" RLQ mass; patient was also noted to look tired and dehydrated with decrease in urine output, but had no other symptoms. Patient was found to have an ileocolic intussusception upon fluoroscopy and air contrast enema, and was reduced. After over 24 hours of observation and on Flagyl and Rocephin, patient has not had recurrence of symptoms and is tolerating bottle formula, doing well. It is unclear that patient''s intussusception was due to Rotavirus vaccine administration, as patient was febrile prior to administration. 08/08/2008 MR received for DOD 6/7-9/2008 with D/C DX: Intussusception. Pt seen in ER for fever and vomiting 1 day prior to vax admin. Returned 6/7/08 twice with fever and vomiting and inability to maintain po intake. With 2nd visit new onset of bloody stool. Dx with gastroenteritis and again D/c home. Later requested to return to hospital with concern for Intussusception. Pt had continued to vomit multiple times now bilious and green. On PE a sausage shaped abd mass noted. Transfered to higher level of care. Upon arrival US confirmed IS, NG tube placed and pt given barium enema which was successful at reduction. did well post procedure and d/c home next day.


Changed on 6/14/2014

VAERS ID: 315651 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:California
Vaccinated:2008-06-05
Onset:2008-06-07
Submitted:2008-06-09
Entered:2008-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B143AA / 1 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF263AB / 1 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65934U / 1 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1928U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal pain, Barium double contrast, Barium enema abnormal, Blood potassium decreased, Dehydration, Fatigue, Full blood count, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Pyrexia, Rectal haemorrhage, Urinary system X-ray, Vomiting, White blood cell count increased, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Gastrointestinal tube insertion, Urine output decreased

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: 2     Extended hospital stay? No
Previous Vaccinations: Intussusception~Rotavirus (Rotateq)~2~0.40~Patient
Other Medications: None
Current Illness: Possibly tactile fever, per mother''s report. recent vomiting and fever prior to vax
Preexisting Conditions: Noncommunicating hydrocoele. PMH: none except recent vomiting and fever prior to vax
Allergies:
Diagnostic Lab Data: Abdominal Ultrasound showed intussusception 6/8, KUB showed paucity of air in RLQ 6/8. Labs and Diagnostics: KUB with paucity of air in RLQ. Abd US (+) for IS. Barium enema (+) for IS. K+ 3.4. CBC with WBC 19.1, Hgb 9.5. Hct 27.9.
CDC 'Split Type':

Write-up: Patient was given vaccine on 6/5/08. Mother and father brought in child to Kaiser ED on 6/7/08 for concerns of 5 days of tactile fevers (reportedly before vaccine was given, unknown to MD), 2 days of emesis after feeds, abdominal pain, and one episode of bloody stool. At ED, MD noted multiple bilious emesis, abdominal pain, bloody mass in rectum, and palpated a "sausage-shaped" RLQ mass; patient was also noted to look tired and dehydrated with decrease in urine output, but had no other symptoms. Patient was found to have an ileocolic intussusception upon fluoroscopy and air contrast enema, and was reduced. After over 24 hours of observation and on Flagyl and Rocephin, patient has not had recurrence of symptoms and is tolerating bottle formula, doing well. It is unclear that patient''s intussusception was due to Rotavirus vaccine administration, as patient was febrile prior to administration. 08/08/2008 MR received for DOD 6/7-9/2008 with D/C DX: Intussusception. Pt seen in ER for fever and vomiting 1 day prior to vax admin. Returned 6/7/08 twice with fever and vomiting and inability to maintain po intake. With 2nd visit new onset of bloody stool. Dx with gastroenteritis and again D/c home. Later requested to return to hospital with concern for Intussusception. Pt had continued to vomit multiple times now bilious and green. On PE a sausage shaped abd mass noted. Transfered to higher level of care. Upon arrival US confirmed IS, NG tube placed and pt given barium enema which was successful at reduction. did well post procedure and d/c home next day.


Changed on 3/14/2015

VAERS ID: 315651 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:California
Vaccinated:2008-06-05
Onset:2008-06-07
Submitted:2008-06-09
Entered:2008-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B143AA / 1 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF263AB / 1 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65934U / 1 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1928U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal pain, Barium double contrast, Barium enema abnormal, Blood potassium decreased, Dehydration, Fatigue, Full blood count, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Pyrexia, Rectal haemorrhage, Urinary system X-ray, Vomiting, White blood cell count increased, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Gastrointestinal tube insertion, Urine output decreased

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: 2     Extended hospital stay? No
Previous Vaccinations: Intussusception~Rotavirus (Rotateq)~2~0.40~Patient
Other Medications: None
Current Illness: Possibly tactile fever, per mother''s report. recent vomiting and fever prior to vax
Preexisting Conditions: Noncommunicating hydrocoele. PMH: none except recent vomiting and fever prior to vax
Allergies:
Diagnostic Lab Data: Abdominal Ultrasound showed intussusception 6/8, KUB showed paucity of air in RLQ 6/8. Labs and Diagnostics: KUB with paucity of air in RLQ. Abd US (+) for IS. Barium enema (+) for IS. K+ 3.4. CBC with WBC 19.1, Hgb 9.5. Hct 27.9.
CDC 'Split Type':

Write-up: Patient was given vaccine on 6/5/08. Mother and father brought in child to Kaiser ED on 6/7/08 for concerns of 5 days of tactile fevers (reportedly before vaccine was given, unknown to MD), 2 days of emesis after feeds, abdominal pain, and one episode of bloody stool. At ED, MD noted multiple bilious emesis, abdominal pain, bloody mass in rectum, and palpated a "sausage-shaped" RLQ mass; patient was also noted to look tired and dehydrated with decrease in urine output, but had no other symptoms. Patient was found to have an ileocolic intussusception upon fluoroscopy and air contrast enema, and was reduced. After over 24 hours of observation and on Flagyl and Rocephin, patient has not had recurrence of symptoms and is tolerating bottle formula, doing well. It is unclear that patient''s intussusception was due to Rotavirus vaccine administration, as patient was febrile prior to administration. 08/08/2008 MR received for DOD 6/7-9/2008 with D/C DX: Intussusception. Pt seen in ER for fever and vomiting 1 day prior to vax admin. Returned 6/7/08 twice with fever and vomiting and inability to maintain po intake. With 2nd visit new onset of bloody stool. Dx with gastroenteritis and again D/c home. Later requested to return to hospital with concern for Intussusception. Pt had continued to vomit multiple times now bilious and green. On PE a sausage shaped abd mass noted. Transfered to higher level of care. Upon arrival US confirmed IS, NG tube placed and pt given barium enema which was successful at reduction. did well post procedure and d/c home next day.


Changed on 2/14/2017

VAERS ID: 315651 Before After
VAERS Form:
Age:0.4 0.44
Sex:Male
Location:California
Vaccinated:2008-06-05
Onset:2008-06-07
Submitted:2008-06-09
Entered:2008-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B143AA / 1 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF263AB / 1 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65934U / 1 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1928U / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal pain, Barium double contrast, Barium enema abnormal, Blood potassium decreased, Dehydration, Fatigue, Full blood count, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Pyrexia, Rectal haemorrhage, Urinary system X-ray, Vomiting, White blood cell count increased, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Gastrointestinal tube insertion, Urine output decreased

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: 2     Extended hospital stay? No
Previous Vaccinations: Intussusception~Rotavirus (Rotateq)~2~0.40~Patient
Other Medications: None
Current Illness: Possibly tactile fever, per mother''s report. recent vomiting and fever prior to vax
Preexisting Conditions: Noncommunicating hydrocoele. PMH: none except recent vomiting and fever prior to vax
Allergies:
Diagnostic Lab Data: Abdominal Ultrasound showed intussusception 6/8, KUB showed paucity of air in RLQ 6/8. Labs and Diagnostics: KUB with paucity of air in RLQ. Abd US (+) for IS. Barium enema (+) for IS. K+ 3.4. CBC with WBC 19.1, Hgb 9.5. Hct 27.9.
CDC 'Split Type':

Write-up: Patient was given vaccine on 6/5/08. Mother and father brought in child to ED on 6/7/08 for concerns of 5 days of tactile fevers (reportedly before vaccine was given, unknown to MD), 2 days of emesis after feeds, abdominal pain, and one episode of bloody stool. At ED, MD noted multiple bilious emesis, abdominal pain, bloody mass in rectum, and palpated a "sausage-shaped" RLQ mass; patient was also noted to look tired and dehydrated with decrease in urine output, but had no other symptoms. Patient was found to have an ileocolic intussusception upon fluoroscopy and air contrast enema, and was reduced. After over 24 hours of observation and on Flagyl and Rocephin, patient has not had recurrence of symptoms and is tolerating bottle formula, doing well. It is unclear that patient''s intussusception was due to Rotavirus vaccine administration, as patient was febrile prior to administration. 08/08/2008 MR received for DOD 6/7-9/2008 with D/C DX: Intussusception. Pt seen in ER for fever and vomiting 1 day prior to vax admin. Returned 6/7/08 twice with fever and vomiting and inability to maintain po intake. With 2nd visit new onset of bloody stool. Dx with gastroenteritis and again D/c home. Later requested to return to hospital with concern for Intussusception. Pt had continued to vomit multiple times now bilious and green. On PE a sausage shaped abd mass noted. Transfered to higher level of care. Upon arrival US confirmed IS, NG tube placed and pt given barium enema which was successful at reduction. did well post procedure and d/c home next day.


Changed on 9/14/2017

VAERS ID: 315651 Before After
VAERS Form:(blank) 1
Age:0.44
Sex:Male
Location:California
Vaccinated:2008-06-05
Onset:2008-06-07
Submitted:2008-06-09
Entered:2008-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B143AA / 1 2 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF263AB / 1 2 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65934U / 1 2 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1928U / 1 2 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal pain, Barium double contrast, Dehydration, Fatigue, Haematochezia, Intussusception, Rectal haemorrhage, Urinary system X-ray, Vomiting, X-ray abnormal, Ultrasound abdomen abnormal, Urine output decreased

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: 2     Extended hospital stay? No
Previous Vaccinations: Intussusception~Rotavirus (Rotateq)~2~0.40~Patient
Other Medications: None
Current Illness: Possibly tactile fever, per mother''s report. recent vomiting and fever prior to vax
Preexisting Conditions: Noncommunicating hydrocoele. PMH: none except recent vomiting and fever prior to vax
Allergies:
Diagnostic Lab Data: Abdominal Ultrasound showed intussusception 6/8, KUB showed paucity of air in RLQ 6/8. Labs and Diagnostics: KUB with paucity of air in RLQ. Abd US (+) for IS. Barium enema (+) for IS. K+ 3.4. CBC with WBC 19.1, Hgb 9.5. Hct 27.9.
CDC 'Split Type':

Write-up: Patient was given vaccine on 6/5/08. Mother and father brought in child to ED on 6/7/08 for concerns of 5 days of tactile fevers (reportedly before vaccine was given, unknown to MD), 2 days of emesis after feeds, abdominal pain, and one episode of bloody stool. At ED, MD noted multiple bilious emesis, abdominal pain, bloody mass in rectum, and palpated a "sausage-shaped" RLQ mass; patient was also noted to look tired and dehydrated with decrease in urine output, but had no other symptoms. Patient was found to have an ileocolic intussusception upon fluoroscopy and air contrast enema, and was reduced. After over 24 hours of observation and on Flagyl and Rocephin, patient has not had recurrence of symptoms and is tolerating bottle formula, doing well. It is unclear that patient''s intussusception was due to Rotavirus vaccine administration, as patient was febrile prior to administration. 08/08/2008 MR received for DOD 6/7-9/2008 with D/C DX: Intussusception. Pt seen in ER for fever and vomiting 1 day prior to vax admin. Returned 6/7/08 twice with fever and vomiting and inability to maintain po intake. With 2nd visit new onset of bloody stool. Dx with gastroenteritis and again D/c home. Later requested to return to hospital with concern for Intussusception. Pt had continued to vomit multiple times now bilious and green. On PE a sausage shaped abd mass noted. Transfered to higher level of care. Upon arrival US confirmed IS, NG tube placed and pt given barium enema which was successful at reduction. did well post procedure and d/c home next day.


Changed on 2/14/2018

VAERS ID: 315651 Before After
VAERS Form:1
Age:0.44
Sex:Male
Location:California
Vaccinated:2008-06-05
Onset:2008-06-07
Submitted:2008-06-09
Entered:2008-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B143AA / 2 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF263AB / 2 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65934U / 2 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1928U / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal pain, Barium double contrast, Dehydration, Fatigue, Haematochezia, Intussusception, Rectal haemorrhage, Urinary system X-ray, Vomiting, X-ray abnormal, Ultrasound abdomen abnormal, Urine output decreased

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: 2     Extended hospital stay? No
Previous Vaccinations: Intussusception~Rotavirus (Rotateq)~2~0.40~Patient
Other Medications: None
Current Illness: Possibly tactile fever, per mother''s report. recent vomiting and fever prior to vax
Preexisting Conditions: Noncommunicating hydrocoele. PMH: none except recent vomiting and fever prior to vax
Allergies:
Diagnostic Lab Data: Abdominal Ultrasound showed intussusception 6/8, KUB showed paucity of air in RLQ 6/8. Labs and Diagnostics: KUB with paucity of air in RLQ. Abd US (+) for IS. Barium enema (+) for IS. K+ 3.4. CBC with WBC 19.1, Hgb 9.5. Hct 27.9.
CDC 'Split Type':

Write-up: Patient was given vaccine on 6/5/08. Mother and father brought in child to ED on 6/7/08 for concerns of 5 days of tactile fevers (reportedly before vaccine was given, unknown to MD), 2 days of emesis after feeds, abdominal pain, and one episode of bloody stool. At ED, MD noted multiple bilious emesis, abdominal pain, bloody mass in rectum, and palpated a "sausage-shaped" RLQ mass; patient was also noted to look tired and dehydrated with decrease in urine output, but had no other symptoms. Patient was found to have an ileocolic intussusception upon fluoroscopy and air contrast enema, and was reduced. After over 24 hours of observation and on Flagyl and Rocephin, patient has not had recurrence of symptoms and is tolerating bottle formula, doing well. It is unclear that patient''s intussusception was due to Rotavirus vaccine administration, as patient was febrile prior to administration. 08/08/2008 MR received for DOD 6/7-9/2008 with D/C DX: Intussusception. Pt seen in ER for fever and vomiting 1 day prior to vax admin. Returned 6/7/08 twice with fever and vomiting and inability to maintain po intake. With 2nd visit new onset of bloody stool. Dx with gastroenteritis and again D/c home. Later requested to return to hospital with concern for Intussusception. Pt had continued to vomit multiple times now bilious and green. On PE a sausage shaped abd mass noted. Transfered to higher level of care. Upon arrival US confirmed IS, NG tube placed and pt given barium enema which was successful at reduction. did well post procedure and d/c home next day.


Changed on 6/14/2018

VAERS ID: 315651 Before After
VAERS Form:1
Age:0.44
Sex:Male
Location:California
Vaccinated:2008-06-05
Onset:2008-06-07
Submitted:2008-06-09
Entered:2008-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B143AA / 2 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF263AB / 2 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65934U / 2 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1928U / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal pain, Barium double contrast, Dehydration, Fatigue, Haematochezia, Intussusception, Rectal haemorrhage, Urinary system X-ray, Vomiting, X-ray abnormal, Ultrasound abdomen abnormal, Urine output decreased

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: 2     Extended hospital stay? No
Previous Vaccinations: Intussusception~Rotavirus (Rotateq)~2~0.40~Patient
Other Medications: None
Current Illness: Possibly tactile fever, per mother''s report. recent vomiting and fever prior to vax
Preexisting Conditions: Noncommunicating hydrocoele. PMH: none except recent vomiting and fever prior to vax
Allergies:
Diagnostic Lab Data: Abdominal Ultrasound showed intussusception 6/8, KUB showed paucity of air in RLQ 6/8. Labs and Diagnostics: KUB with paucity of air in RLQ. Abd US (+) for IS. Barium enema (+) for IS. K+ 3.4. CBC with WBC 19.1, Hgb 9.5. Hct 27.9.
CDC 'Split Type':

Write-up: Patient was given vaccine on 6/5/08. Mother and father brought in child to ED on 6/7/08 for concerns of 5 days of tactile fevers (reportedly before vaccine was given, unknown to MD), 2 days of emesis after feeds, abdominal pain, and one episode of bloody stool. At ED, MD noted multiple bilious emesis, abdominal pain, bloody mass in rectum, and palpated a "sausage-shaped" RLQ mass; patient was also noted to look tired and dehydrated with decrease in urine output, but had no other symptoms. Patient was found to have an ileocolic intussusception upon fluoroscopy and air contrast enema, and was reduced. After over 24 hours of observation and on Flagyl and Rocephin, patient has not had recurrence of symptoms and is tolerating bottle formula, doing well. It is unclear that patient''s intussusception was due to Rotavirus vaccine administration, as patient was febrile prior to administration. 08/08/2008 MR received for DOD 6/7-9/2008 with D/C DX: Intussusception. Pt seen in ER for fever and vomiting 1 day prior to vax admin. Returned 6/7/08 twice with fever and vomiting and inability to maintain po intake. With 2nd visit new onset of bloody stool. Dx with gastroenteritis and again D/c home. Later requested to return to hospital with concern for Intussusception. Pt had continued to vomit multiple times now bilious and green. On PE a sausage shaped abd mass noted. Transfered to higher level of care. Upon arrival US confirmed IS, NG tube placed and pt given barium enema which was successful at reduction. did well post procedure and d/c home next day.


Changed on 8/14/2018

VAERS ID: 315651 Before After
VAERS Form:1
Age:0.44
Sex:Male
Location:California
Vaccinated:2008-06-05
Onset:2008-06-07
Submitted:2008-06-09
Entered:2008-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B143AA / 2 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF263AB / 2 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65934U / 2 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1928U / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal pain, Barium double contrast, Dehydration, Fatigue, Haematochezia, Intussusception, Rectal haemorrhage, Urinary system X-ray, Vomiting, X-ray abnormal, Ultrasound abdomen abnormal, Urine output decreased

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: 2     Extended hospital stay? No
Previous Vaccinations: Intussusception~Rotavirus (Rotateq)~2~0.40~Patient
Other Medications: None
Current Illness: Possibly tactile fever, per mother''s report. recent vomiting and fever prior to vax
Preexisting Conditions: Noncommunicating hydrocoele. PMH: none except recent vomiting and fever prior to vax
Allergies:
Diagnostic Lab Data: Abdominal Ultrasound showed intussusception 6/8, KUB showed paucity of air in RLQ 6/8. Labs and Diagnostics: KUB with paucity of air in RLQ. Abd US (+) for IS. Barium enema (+) for IS. K+ 3.4. CBC with WBC 19.1, Hgb 9.5. Hct 27.9.
CDC 'Split Type':

Write-up: Patient was given vaccine on 6/5/08. Mother and father brought in child to ED on 6/7/08 for concerns of 5 days of tactile fevers (reportedly before vaccine was given, unknown to MD), 2 days of emesis after feeds, abdominal pain, and one episode of bloody stool. At ED, MD noted multiple bilious emesis, abdominal pain, bloody mass in rectum, and palpated a "sausage-shaped" RLQ mass; patient was also noted to look tired and dehydrated with decrease in urine output, but had no other symptoms. Patient was found to have an ileocolic intussusception upon fluoroscopy and air contrast enema, and was reduced. After over 24 hours of observation and on Flagyl and Rocephin, patient has not had recurrence of symptoms and is tolerating bottle formula, doing well. It is unclear that patient''s intussusception was due to Rotavirus vaccine administration, as patient was febrile prior to administration. 08/08/2008 MR received for DOD 6/7-9/2008 with D/C DX: Intussusception. Pt seen in ER for fever and vomiting 1 day prior to vax admin. Returned 6/7/08 twice with fever and vomiting and inability to maintain po intake. With 2nd visit new onset of bloody stool. Dx with gastroenteritis and again D/c home. Later requested to return to hospital with concern for Intussusception. Pt had continued to vomit multiple times now bilious and green. On PE a sausage shaped abd mass noted. Transfered to higher level of care. Upon arrival US confirmed IS, NG tube placed and pt given barium enema which was successful at reduction. did well post procedure and d/c home next day.


Changed on 9/14/2018

VAERS ID: 315651 Before After
VAERS Form:1
Age:0.44
Sex:Male
Location:California
Vaccinated:2008-06-05
Onset:2008-06-07
Submitted:2008-06-09
Entered:2008-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B143AA / 2 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF263AB / 2 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65934U / 2 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1928U / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal pain, Barium double contrast, Dehydration, Fatigue, Haematochezia, Intussusception, Rectal haemorrhage, Urinary system X-ray, Vomiting, X-ray abnormal, Ultrasound abdomen abnormal, Urine output decreased

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: 2     Extended hospital stay? No
Previous Vaccinations: Intussusception~Rotavirus (Rotateq)~2~0.40~Patient
Other Medications: None
Current Illness: Possibly tactile fever, per mother''s report. recent vomiting and fever prior to vax
Preexisting Conditions: Noncommunicating hydrocoele. PMH: none except recent vomiting and fever prior to vax
Allergies:
Diagnostic Lab Data: Abdominal Ultrasound showed intussusception 6/8, KUB showed paucity of air in RLQ 6/8. Labs and Diagnostics: KUB with paucity of air in RLQ. Abd US (+) for IS. Barium enema (+) for IS. K+ 3.4. CBC with WBC 19.1, Hgb 9.5. Hct 27.9.
CDC 'Split Type':

Write-up: Patient was given vaccine on 6/5/08. Mother and father brought in child to ED on 6/7/08 for concerns of 5 days of tactile fevers (reportedly before vaccine was given, unknown to MD), 2 days of emesis after feeds, abdominal pain, and one episode of bloody stool. At ED, MD noted multiple bilious emesis, abdominal pain, bloody mass in rectum, and palpated a "sausage-shaped" RLQ mass; patient was also noted to look tired and dehydrated with decrease in urine output, but had no other symptoms. Patient was found to have an ileocolic intussusception upon fluoroscopy and air contrast enema, and was reduced. After over 24 hours of observation and on Flagyl and Rocephin, patient has not had recurrence of symptoms and is tolerating bottle formula, doing well. It is unclear that patient''s intussusception was due to Rotavirus vaccine administration, as patient was febrile prior to administration. 08/08/2008 MR received for DOD 6/7-9/2008 with D/C DX: Intussusception. Pt seen in ER for fever and vomiting 1 day prior to vax admin. Returned 6/7/08 twice with fever and vomiting and inability to maintain po intake. With 2nd visit new onset of bloody stool. Dx with gastroenteritis and again D/c home. Later requested to return to hospital with concern for Intussusception. Pt had continued to vomit multiple times now bilious and green. On PE a sausage shaped abd mass noted. Transfered to higher level of care. Upon arrival US confirmed IS, NG tube placed and pt given barium enema which was successful at reduction. did well post procedure and d/c home next day.


Changed on 10/14/2018

VAERS ID: 315651 Before After
VAERS Form:1
Age:0.44
Sex:Male
Location:California
Vaccinated:2008-06-05
Onset:2008-06-07
Submitted:2008-06-09
Entered:2008-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B143AA / 2 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF263AB / 2 UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65934U / 2 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1928U / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal pain, Barium double contrast, Dehydration, Fatigue, Haematochezia, Intussusception, Rectal haemorrhage, Urinary system X-ray, Vomiting, X-ray abnormal, Ultrasound abdomen abnormal, Urine output decreased

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: 2     Extended hospital stay? No
Previous Vaccinations: Intussusception~Rotavirus (Rotateq)~2~0.40~Patient
Other Medications: None
Current Illness: Possibly tactile fever, per mother''s report. recent vomiting and fever prior to vax
Preexisting Conditions: Noncommunicating hydrocoele. PMH: none except recent vomiting and fever prior to vax
Allergies:
Diagnostic Lab Data: Abdominal Ultrasound showed intussusception 6/8, KUB showed paucity of air in RLQ 6/8. Labs and Diagnostics: KUB with paucity of air in RLQ. Abd US (+) for IS. Barium enema (+) for IS. K+ 3.4. CBC with WBC 19.1, Hgb 9.5. Hct 27.9.
CDC 'Split Type':

Write-up: Patient was given vaccine on 6/5/08. Mother and father brought in child to ED on 6/7/08 for concerns of 5 days of tactile fevers (reportedly before vaccine was given, unknown to MD), 2 days of emesis after feeds, abdominal pain, and one episode of bloody stool. At ED, MD noted multiple bilious emesis, abdominal pain, bloody mass in rectum, and palpated a "sausage-shaped" RLQ mass; patient was also noted to look tired and dehydrated with decrease in urine output, but had no other symptoms. Patient was found to have an ileocolic intussusception upon fluoroscopy and air contrast enema, and was reduced. After over 24 hours of observation and on Flagyl and Rocephin, patient has not had recurrence of symptoms and is tolerating bottle formula, doing well. It is unclear that patient''s intussusception was due to Rotavirus vaccine administration, as patient was febrile prior to administration. 08/08/2008 MR received for DOD 6/7-9/2008 with D/C DX: Intussusception. Pt seen in ER for fever and vomiting 1 day prior to vax admin. Returned 6/7/08 twice with fever and vomiting and inability to maintain po intake. With 2nd visit new onset of bloody stool. Dx with gastroenteritis and again D/c home. Later requested to return to hospital with concern for Intussusception. Pt had continued to vomit multiple times now bilious and green. On PE a sausage shaped abd mass noted. Transfered to higher level of care. Upon arrival US confirmed IS, NG tube placed and pt given barium enema which was successful at reduction. did well post procedure and d/c home next day.

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