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This is VAERS ID 316703

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 316703
VAERS Form:
Age:0.4
Sex:Male
Location:New York
Vaccinated:2008-05-19
Onset:2008-06-10
Submitted:2008-06-16
Entered:2008-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C65047 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0018 / 1 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: Blood potassium increased, Crying, Drug hypersensitivity, Enema administration, Bowel movement irregularity

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None 7/23/08-records received-HX of runny nose and cough for 2 days.
Preexisting Conditions: None 7/23/08-records received-PMH:lactose intolerance, soy formula. April 08, Ear infections and treated with Amoxicillin which caused bloody diarrhea.
Allergies:
Diagnostic Lab Data: Abdominal air/air enema reduction at hospital. 7/23/08-records received-Air enema successful reduction of intussusception ileo-colic. Potassium 5.4, stool for occult blood negative. WBC 16.7, chem 7 WNL.
CDC 'Split Type':

Write-up: ROTATEQ #3 given on 5/19/08. On 6/10/08 pt diagnosed with intussusception. Treated at hospital. 7/23/08-records received for DOS 6/10/08-Presented with C/O irritability and intermittent crying since 3:00 am. Vomited. No bowel movement since 6/8/08. Subseq"uently had BM in hospital. PE: bowel sounds present. 7/23/08-DC records received for DOS 6/10-6/12/08-DC DX:Intussusception. Status post reduction of intussusception with air enema.


Changed on 12/8/2009

VAERS ID: 316703 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:New York
Vaccinated:2008-05-19
Onset:2008-06-10
Submitted:2008-06-16
Entered:2008-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 1 RL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C65047 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0018 / 1 - / PO

Administered by: Public      Purchased by: Unknown Public
Symptoms: Blood potassium increased, Crying, Drug hypersensitivity, Intussusception, Irritability, Vomiting, White blood cell count increased, Enema administration, Occult blood negative, Bowel movement irregularity

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None 7/23/08-records received-HX of runny nose and cough for 2 days.
Preexisting Conditions: None 7/23/08-records received-PMH:lactose intolerance, soy formula. April 08, Ear infections and treated with Amoxicillin which caused bloody diarrhea.
Allergies:
Diagnostic Lab Data: Abdominal air/air enema reduction at hospital. 7/23/08-records received-Air enema successful reduction of intussusception ileo-colic. Potassium 5.4, stool for occult blood negative. WBC 16.7, chem 7 WNL.
CDC 'Split Type':

Write-up: ROTATEQ #3 given on 5/19/08. On 6/10/08 pt diagnosed with intussusception. Treated at hospital. 7/23/08-records received for DOS 6/10/08-Presented with C/O irritability and intermittent crying since 3:00 am. Vomited. No bowel movement since 6/8/08. Subseq"uently Subsequently had BM in hospital. PE: bowel sounds present. 7/23/08-DC records received for DOS 6/10-6/12/08-DC DX:Intussusception. Status post reduction of intussusception with air enema.


Changed on 3/2/2010

VAERS ID: 316703 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:New York
Vaccinated:2008-05-19
Onset:2008-06-10
Submitted:2008-06-16
Entered:2008-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC C65047 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0018 / 1 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Blood potassium increased, Crying, Drug hypersensitivity, Intussusception, Irritability, Vomiting, White blood cell count increased, Enema administration, Occult blood negative, Bowel movement irregularity

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None 7/23/08-records received-HX of runny nose and cough for 2 days.
Preexisting Conditions: None 7/23/08-records received-PMH:lactose intolerance, soy formula. April 08, Ear infections and treated with Amoxicillin which caused bloody diarrhea.
Allergies:
Diagnostic Lab Data: Abdominal air/air enema reduction at hospital. 7/23/08-records received-Air enema successful reduction of intussusception ileo-colic. Potassium 5.4, stool for occult blood negative. WBC 16.7, chem 7 WNL.
CDC 'Split Type':

Write-up: ROTATEQ #3 given on 5/19/08. On 6/10/08 pt diagnosed with intussusception. Treated at hospital. 7/23/08-records received for DOS 6/10/08-Presented with C/O irritability and intermittent crying since 3:00 am. Vomited. No bowel movement since 6/8/08. Subsequently had BM in hospital. PE: bowel sounds present. 7/23/08-DC records received for DOS 6/10-6/12/08-DC DX:Intussusception. Status post reduction of intussusception with air enema.


Changed on 4/7/2010

VAERS ID: 316703 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:New York
Vaccinated:2008-05-19
Onset:2008-06-10
Submitted:2008-06-16
Entered:2008-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 1 RL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C65047 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0018 / 1 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Blood potassium increased, Crying, Drug hypersensitivity, Intussusception, Irritability, Vomiting, White blood cell count increased, Enema administration, Occult blood negative, Bowel movement irregularity

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None 7/23/08-records received-HX of runny nose and cough for 2 days.
Preexisting Conditions: None 7/23/08-records received-PMH:lactose intolerance, soy formula. April 08, Ear infections and treated with Amoxicillin which caused bloody diarrhea.
Allergies:
Diagnostic Lab Data: Abdominal air/air enema reduction at hospital. 7/23/08-records received-Air enema successful reduction of intussusception ileo-colic. Potassium 5.4, stool for occult blood negative. WBC 16.7, chem 7 WNL.
CDC 'Split Type':

Write-up: ROTATEQ #3 given on 5/19/08. On 6/10/08 pt diagnosed with intussusception. Treated at hospital. 7/23/08-records received for DOS 6/10/08-Presented with C/O irritability and intermittent crying since 3:00 am. Vomited. No bowel movement since 6/8/08. Subsequently had BM in hospital. PE: bowel sounds present. 7/23/08-DC records received for DOS 6/10-6/12/08-DC DX:Intussusception. Status post reduction of intussusception with air enema.


Changed on 8/31/2010

VAERS ID: 316703 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:New York
Vaccinated:2008-05-19
Onset:2008-06-10
Submitted:2008-06-16
Entered:2008-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH C65047 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0018 / 1 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Blood potassium increased, Crying, Drug hypersensitivity, Intussusception, Irritability, Vomiting, White blood cell count increased, Enema administration, Occult blood negative, Bowel movement irregularity

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None 7/23/08-records received-HX of runny nose and cough for 2 days.
Preexisting Conditions: None 7/23/08-records received-PMH:lactose intolerance, soy formula. April 08, Ear infections and treated with Amoxicillin which caused bloody diarrhea.
Allergies:
Diagnostic Lab Data: Abdominal air/air enema reduction at hospital. 7/23/08-records received-Air enema successful reduction of intussusception ileo-colic. Potassium 5.4, stool for occult blood negative. WBC 16.7, chem 7 WNL.
CDC 'Split Type':

Write-up: ROTATEQ #3 given on 5/19/08. On 6/10/08 pt diagnosed with intussusception. Treated at hospital. 7/23/08-records received for DOS 6/10/08-Presented with C/O irritability and intermittent crying since 3:00 am. Vomited. No bowel movement since 6/8/08. Subsequently had BM in hospital. PE: bowel sounds present. 7/23/08-DC records received for DOS 6/10-6/12/08-DC DX:Intussusception. Status post reduction of intussusception with air enema.


Changed on 5/13/2013

VAERS ID: 316703 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:New York
Vaccinated:2008-05-19
Onset:2008-06-10
Submitted:2008-06-16
Entered:2008-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65047 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0018 / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0018 / 1 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Blood potassium increased, Crying, Drug hypersensitivity, Intussusception, Irritability, Vomiting, White blood cell count increased, Enema administration, Occult blood negative, Bowel movement irregularity

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None 7/23/08-records received-HX of runny nose and cough for 2 days.
Preexisting Conditions: None 7/23/08-records received-PMH:lactose intolerance, soy formula. April 08, Ear infections and treated with Amoxicillin which caused bloody diarrhea.
Allergies:
Diagnostic Lab Data: Abdominal air/air enema reduction at hospital. 7/23/08-records received-Air enema successful reduction of intussusception ileo-colic. Potassium 5.4, stool for occult blood negative. WBC 16.7, chem 7 WNL.
CDC 'Split Type':

Write-up: ROTATEQ #3 given on 5/19/08. On 6/10/08 pt diagnosed with intussusception. Treated at hospital. 7/23/08-records received for DOS 6/10/08-Presented with C/O irritability and intermittent crying since 3:00 am. Vomited. No bowel movement since 6/8/08. Subsequently had BM in hospital. PE: bowel sounds present. 7/23/08-DC records received for DOS 6/10-6/12/08-DC DX:Intussusception. Status post reduction of intussusception with air enema.


Changed on 4/14/2017

VAERS ID: 316703 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:New York
Vaccinated:2008-05-19
Onset:2008-06-10
Submitted:2008-06-16
Entered:2008-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65047 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0018 / 1 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Blood potassium increased, Crying, Drug hypersensitivity, Intussusception, Irritability, Vomiting, White blood cell count increased, Enema administration, Occult blood negative, Bowel movement irregularity

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None 7/23/08-records received-HX of runny nose and cough for 2 days.
Preexisting Conditions: None 7/23/08-records received-PMH:lactose intolerance, soy formula. April 08, Ear infections and treated with Amoxicillin which caused bloody diarrhea.
Allergies:
Diagnostic Lab Data: Abdominal air/air enema reduction at hospital. 7/23/08-records received-Air enema successful reduction of intussusception ileo-colic. Potassium 5.4, stool for occult blood negative. WBC 16.7, chem 7 WNL.
CDC 'Split Type':

Write-up: ROTATEQ #3 given on 5/19/08. On 6/10/08 pt diagnosed with intussusception. Treated at hospital. 7/23/08-records received for DOS 6/10/08-Presented with C/O irritability and intermittent crying since 3:00 am. Vomited. No bowel movement since 6/8/08. Subsequently had BM in hospital. PE: bowel sounds present. 7/23/08-DC records received for DOS 6/10-6/12/08-DC DX:Intussusception. Status post reduction of intussusception with air enema.


Changed on 9/14/2017

VAERS ID: 316703 Before After
VAERS Form:(blank) 1
Age:0.4
Sex:Male
Location:New York
Vaccinated:2008-05-19
Onset:2008-06-10
Submitted:2008-06-16
Entered:2008-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 1 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65047 / 1 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0018 / 1 2 - MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Intussusception, Enema administration

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None 7/23/08-records received-HX of runny nose and cough for 2 days.
Preexisting Conditions: None 7/23/08-records received-PMH:lactose intolerance, soy formula. April 08, Ear infections and treated with Amoxicillin which caused bloody diarrhea.
Allergies:
Diagnostic Lab Data: Abdominal air/air enema reduction at hospital. 7/23/08-records received-Air enema successful reduction of intussusception ileo-colic. Potassium 5.4, stool for occult blood negative. WBC 16.7, chem 7 WNL.
CDC 'Split Type':

Write-up: ROTATEQ #3 given on 5/19/08. On 6/10/08 pt diagnosed with intussusception. Treated at hospital. 7/23/08-records received for DOS 6/10/08-Presented with C/O irritability and intermittent crying since 3:00 am. Vomited. No bowel movement since 6/8/08. Subsequently had BM in hospital. PE: bowel sounds present. 7/23/08-DC records received for DOS 6/10-6/12/08-DC DX:Intussusception. Status post reduction of intussusception with air enema.


Changed on 2/14/2018

VAERS ID: 316703 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:New York
Vaccinated:2008-05-19
Onset:2008-06-10
Submitted:2008-06-16
Entered:2008-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65047 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0018 / 2 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Intussusception, Enema administration

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None 7/23/08-records received-HX of runny nose and cough for 2 days.
Preexisting Conditions: None 7/23/08-records received-PMH:lactose intolerance, soy formula. April 08, Ear infections and treated with Amoxicillin which caused bloody diarrhea.
Allergies:
Diagnostic Lab Data: Abdominal air/air enema reduction at hospital. 7/23/08-records received-Air enema successful reduction of intussusception ileo-colic. Potassium 5.4, stool for occult blood negative. WBC 16.7, chem 7 WNL.
CDC 'Split Type':

Write-up: ROTATEQ #3 given on 5/19/08. On 6/10/08 pt diagnosed with intussusception. Treated at hospital. 7/23/08-records received for DOS 6/10/08-Presented with C/O irritability and intermittent crying since 3:00 am. Vomited. No bowel movement since 6/8/08. Subsequently had BM in hospital. PE: bowel sounds present. 7/23/08-DC records received for DOS 6/10-6/12/08-DC DX:Intussusception. Status post reduction of intussusception with air enema.


Changed on 6/14/2018

VAERS ID: 316703 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:New York
Vaccinated:2008-05-19
Onset:2008-06-10
Submitted:2008-06-16
Entered:2008-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65047 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0018 / 2 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Intussusception, Enema administration

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None 7/23/08-records received-HX of runny nose and cough for 2 days.
Preexisting Conditions: None 7/23/08-records received-PMH:lactose intolerance, soy formula. April 08, Ear infections and treated with Amoxicillin which caused bloody diarrhea.
Allergies:
Diagnostic Lab Data: Abdominal air/air enema reduction at hospital. 7/23/08-records received-Air enema successful reduction of intussusception ileo-colic. Potassium 5.4, stool for occult blood negative. WBC 16.7, chem 7 WNL.
CDC 'Split Type':

Write-up: ROTATEQ #3 given on 5/19/08. On 6/10/08 pt diagnosed with intussusception. Treated at hospital. 7/23/08-records received for DOS 6/10/08-Presented with C/O irritability and intermittent crying since 3:00 am. Vomited. No bowel movement since 6/8/08. Subsequently had BM in hospital. PE: bowel sounds present. 7/23/08-DC records received for DOS 6/10-6/12/08-DC DX:Intussusception. Status post reduction of intussusception with air enema.


Changed on 8/14/2018

VAERS ID: 316703 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:New York
Vaccinated:2008-05-19
Onset:2008-06-10
Submitted:2008-06-16
Entered:2008-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65047 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0018 / 2 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Intussusception, Enema administration

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None 7/23/08-records received-HX of runny nose and cough for 2 days.
Preexisting Conditions: None 7/23/08-records received-PMH:lactose intolerance, soy formula. April 08, Ear infections and treated with Amoxicillin which caused bloody diarrhea.
Allergies:
Diagnostic Lab Data: Abdominal air/air enema reduction at hospital. 7/23/08-records received-Air enema successful reduction of intussusception ileo-colic. Potassium 5.4, stool for occult blood negative. WBC 16.7, chem 7 WNL.
CDC 'Split Type':

Write-up: ROTATEQ #3 given on 5/19/08. On 6/10/08 pt diagnosed with intussusception. Treated at hospital. 7/23/08-records received for DOS 6/10/08-Presented with C/O irritability and intermittent crying since 3:00 am. Vomited. No bowel movement since 6/8/08. Subsequently had BM in hospital. PE: bowel sounds present. 7/23/08-DC records received for DOS 6/10-6/12/08-DC DX:Intussusception. Status post reduction of intussusception with air enema.


Changed on 9/14/2018

VAERS ID: 316703 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:New York
Vaccinated:2008-05-19
Onset:2008-06-10
Submitted:2008-06-16
Entered:2008-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65047 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0018 / 2 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Intussusception, Enema administration

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None 7/23/08-records received-HX of runny nose and cough for 2 days.
Preexisting Conditions: None 7/23/08-records received-PMH:lactose intolerance, soy formula. April 08, Ear infections and treated with Amoxicillin which caused bloody diarrhea.
Allergies:
Diagnostic Lab Data: Abdominal air/air enema reduction at hospital. 7/23/08-records received-Air enema successful reduction of intussusception ileo-colic. Potassium 5.4, stool for occult blood negative. WBC 16.7, chem 7 WNL.
CDC 'Split Type':

Write-up: ROTATEQ #3 given on 5/19/08. On 6/10/08 pt diagnosed with intussusception. Treated at hospital. 7/23/08-records received for DOS 6/10/08-Presented with C/O irritability and intermittent crying since 3:00 am. Vomited. No bowel movement since 6/8/08. Subsequently had BM in hospital. PE: bowel sounds present. 7/23/08-DC records received for DOS 6/10-6/12/08-DC DX:Intussusception. Status post reduction of intussusception with air enema.


Changed on 10/14/2018

VAERS ID: 316703 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:New York
Vaccinated:2008-05-19
Onset:2008-06-10
Submitted:2008-06-16
Entered:2008-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65047 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0018 / 2 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Intussusception, Enema administration

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None 7/23/08-records received-HX of runny nose and cough for 2 days.
Preexisting Conditions: None 7/23/08-records received-PMH:lactose intolerance, soy formula. April 08, Ear infections and treated with Amoxicillin which caused bloody diarrhea.
Allergies:
Diagnostic Lab Data: Abdominal air/air enema reduction at hospital. 7/23/08-records received-Air enema successful reduction of intussusception ileo-colic. Potassium 5.4, stool for occult blood negative. WBC 16.7, chem 7 WNL.
CDC 'Split Type':

Write-up: ROTATEQ #3 given on 5/19/08. On 6/10/08 pt diagnosed with intussusception. Treated at hospital. 7/23/08-records received for DOS 6/10/08-Presented with C/O irritability and intermittent crying since 3:00 am. Vomited. No bowel movement since 6/8/08. Subsequently had BM in hospital. PE: bowel sounds present. 7/23/08-DC records received for DOS 6/10-6/12/08-DC DX:Intussusception. Status post reduction of intussusception with air enema.

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