National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 317921

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 317921
VAERS Form:
Age:0.3
Sex:Male
Location:New York
Vaccinated:2008-06-16
Onset:2008-06-19
Submitted:2008-06-30
Entered:2008-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2934AA / - LA / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UF440AA / - LA / SC
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR A0996 / - LA / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0210 / - - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal tenderness, Barium enema, Crying, Diet refusal, Discomfort

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: 3     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: X-ray; Ultrasound confirmation and fluroscopic enema procedure. 7/14/08-records received-X-rays: transverse colon consistent with intussusception and stool filled colon. Successful reduction of intussusception with barium enema. 7/25/08-
CDC 'Split Type':

Write-up: Received Rotavirus vaccine on Monday morning(am)(June 16th 2008) by Thursday morning my son had not had regular bowel movements, was discomfort during sleeping hours nights prior, Thursday morning my son began to show signs of being lethargic, refusal to"eat and what ever he did eat he began to vomit and scream in pain. (reportingly a neighbor called the local police to report a child screaming excessively). My son was taken to our pediatrician for examination Thursday (June 19th, 2008) morning at that po


Changed on 12/8/2009

VAERS ID: 317921 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:New York
Vaccinated:2008-06-16
Onset:2008-06-19
Submitted:2008-06-30
Entered:2008-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2934AA / - LA / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UF440AA / - LA / SC
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR A0996 / - LA / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0210 / - - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal tenderness, Barium enema, Crying, Diet refusal, Discomfort, Intussusception, Lethargy, Pain, Screaming, Vomiting, X-ray, X-ray abnormal, Ultrasound scan abnormal, Occult blood negative, Oral intake reduced

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: X-ray; Ultrasound confirmation and fluroscopic enema procedure. 7/14/08-records received-X-rays: transverse colon consistent with intussusception and stool filled colon. Successful reduction of intussusception with barium enema. 7/25/08-
CDC 'Split Type':

Write-up: Received Rotavirus vaccine on Monday morning(am)(June 16th 2008) by Thursday morning my son had not had regular bowel movements, was discomfort during sleeping hours nights prior, Thursday morning my son began to show signs of being lethargic, refusal to"eat to eat and what ever he did eat he began to vomit and scream in pain. (reportingly a neighbor called the local police to report a child screaming excessively). My son was taken to our pediatrician for examination Thursday (June 19th, 2008) morning at that po point the pediatrician recommended my son be taken to a local hospital for an X-Ray & Ultrasound for what appeared to be "Intussusceptions"; Local Hospital confirmed via. x-ray/ultrasound scans "Intussusceptions" but the facilities were unequipped for this type of pediatric condition and recommended my son be taken to "Hospital" immediately where it was confirmed via. scan the Intussusceptions was positive. A procedure was performed via. an "Enema" technique to reduce the intestine. The procedure worked, my son was hospitalized for observation and released on June 21st, 2008. In less than 24 hrs my son was rushed back to "Medical Center" on June 22nd, 2008 for the same condition reoccurring. All the previous signs began in the early morning of the 22nd of June. A scan was performed confirming the Intussusceptions had occurred for the second time in less than a few days apart from the 1st occurrence. The same "Enema" procedure was performed and my son was hospitalized again from June 22nd - to - June 25th.7/14/08-records received for DOS 6/19/08-DX:Intussusception. Presented with irritability and intermittent inconsolability. Tenderness right side of abdomen. Day prior non-bloody non-bilious emesis and 2 non-bloody stools.. 7/25/08-records received for DOS 6/22-6/25/08-DX:Intussusception with successful reduction with air enema. C/O abdominal pain decreased oral intake. Seen prior to this admission for intussusception. No fever, diarrhea, vomiting. Abdomen nondistended, non tender.


Changed on 2/13/2013

VAERS ID: 317921 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:New York
Vaccinated:2008-06-16
Onset:2008-06-19
Submitted:2008-06-30
Entered:2008-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2934AA / - LA / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UF440AA / - LA / SC
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR A0996 / - LA / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0210 / - - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal tenderness, Barium enema, Crying, Diet refusal, Discomfort, Intussusception, Lethargy, Pain, Screaming, Vomiting, X-ray, X-ray abnormal, Ultrasound scan abnormal, Occult blood negative, Oral intake reduced

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: X-ray; Ultrasound confirmation and fluroscopic enema procedure. 7/14/08-records received-X-rays: transverse colon consistent with intussusception and stool filled colon. Successful reduction of intussusception with barium enema. 7/25/08- 7/25/08-records received- Stool occult blood negative.
CDC 'Split Type':

Write-up: Received Rotavirus vaccine on Monday morning(am)(June morning (am) (June 16th 2008) by Thursday morning my son had not had regular bowel movements, was discomfort during sleeping hours nights prior, Thursday morning my son began to show signs of being lethargic, refusal to eat and what ever he did eat he began to vomit and scream in pain. (reportingly a neighbor called the local police to report a child screaming excessively). My son was taken to our pediatrician for examination Thursday (June 19th, 2008) morning at that point the pediatrician recommended my son be taken to a local hospital for an X-Ray & Ultrasound for what appeared to be "Intussusceptions"; Local Hospital confirmed via. x-ray/ultrasound scans "Intussusceptions" but the facilities were unequipped for this type of pediatric condition and recommended my son be taken to "Hospital" immediately where it was confirmed via. scan the Intussusceptions was positive. A procedure was performed via. an "Enema" technique to reduce the intestine. The procedure worked, my son was hospitalized for observation and released on June 21st, 2008. In less than 24 hrs my son was rushed back to "Medical Center" on June 22nd, 2008 for the same condition reoccurring. All the previous signs began in the early morning of the 22nd of June. A scan was performed confirming the Intussusceptions had occurred for the second time in less than a few days apart from the 1st occurrence. The same "Enema" procedure was performed and my son was hospitalized again from June 22nd - to - June 25th.7/14/08-records 25th. 7/14/08-records received for DOS 6/19/08-DX:Intussusception. Presented with irritability and intermittent inconsolability. Tenderness right side of abdomen. Day prior non-bloody non-bilious emesis and 2 non-bloody stools.. 7/25/08-records received for DOS 6/22-6/25/08-DX:Intussusception with successful reduction with air enema. C/O abdominal pain decreased oral intake. Seen prior to this admission for intussusception. No fever, diarrhea, vomiting. Abdomen nondistended, non tender.


Changed on 5/13/2013

VAERS ID: 317921 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:New York
Vaccinated:2008-06-16
Onset:2008-06-19
Submitted:2008-06-30
Entered:2008-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2934AA / - LA / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UF440AA / - LA / SC
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR A0996 / - LA / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0210 / - - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0210 / - - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal tenderness, Barium enema, Crying, Diet refusal, Discomfort, Intussusception, Lethargy, Pain, Screaming, Vomiting, X-ray, X-ray abnormal, Ultrasound scan abnormal, Occult blood negative, Oral intake reduced

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: X-ray; Ultrasound confirmation and fluroscopic enema procedure. 7/14/08-records received-X-rays: transverse colon consistent with intussusception and stool filled colon. Successful reduction of intussusception with barium enema. 7/25/08-records received- Stool occult blood negative.
CDC 'Split Type':

Write-up: Received Rotavirus vaccine on Monday morning (am) (June 16th 2008) by Thursday morning my son had not had regular bowel movements, was discomfort during sleeping hours nights prior, Thursday morning my son began to show signs of being lethargic, refusal to eat and what ever he did eat he began to vomit and scream in pain. (reportingly a neighbor called the local police to report a child screaming excessively). My son was taken to our pediatrician for examination Thursday (June 19th, 2008) morning at that point the pediatrician recommended my son be taken to a local hospital for an X-Ray & Ultrasound for what appeared to be "Intussusceptions"; Local Hospital confirmed via. x-ray/ultrasound scans "Intussusceptions" but the facilities were unequipped for this type of pediatric condition and recommended my son be taken to "Hospital" immediately where it was confirmed via. scan the Intussusceptions was positive. A procedure was performed via. an "Enema" technique to reduce the intestine. The procedure worked, my son was hospitalized for observation and released on June 21st, 2008. In less than 24 hrs my son was rushed back to "Medical Center" on June 22nd, 2008 for the same condition reoccurring. All the previous signs began in the early morning of the 22nd of June. A scan was performed confirming the Intussusceptions had occurred for the second time in less than a few days apart from the 1st occurrence. The same "Enema" procedure was performed and my son was hospitalized again from June 22nd - to - June 25th. 7/14/08-records received for DOS 6/19/08-DX:Intussusception. Presented with irritability and intermittent inconsolability. Tenderness right side of abdomen. Day prior non-bloody non-bilious emesis and 2 non-bloody stools.. 7/25/08-records received for DOS 6/22-6/25/08-DX:Intussusception with successful reduction with air enema. C/O abdominal pain decreased oral intake. Seen prior to this admission for intussusception. No fever, diarrhea, vomiting. Abdomen nondistended, non tender.


Changed on 2/14/2017

VAERS ID: 317921 Before After
VAERS Form:
Age:0.3 0.34
Sex:Male
Location:New York
Vaccinated:2008-06-16
Onset:2008-06-19
Submitted:2008-06-30
Entered:2008-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2934AA / - LA / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UF440AA / - LA / SC
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR A0996 / - LA / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0210 / - - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal tenderness, Barium enema, Crying, Diet refusal, Discomfort, Intussusception, Lethargy, Pain, Screaming, Vomiting, X-ray, X-ray abnormal, Ultrasound scan abnormal, Occult blood negative, Oral intake reduced

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: X-ray; Ultrasound confirmation and fluroscopic enema procedure. 7/14/08-records received-X-rays: transverse colon consistent with intussusception and stool filled colon. Successful reduction of intussusception with barium enema. 7/25/08-records received- Stool occult blood negative.
CDC 'Split Type':

Write-up: Received Rotavirus vaccine on Monday morning (am) (June 16th 2008) by Thursday morning my son had not had regular bowel movements, was discomfort during sleeping hours nights prior, Thursday morning my son began to show signs of being lethargic, refusal to eat and what ever he did eat he began to vomit and scream in pain. (reportingly a neighbor called the local police to report a child screaming excessively). My son was taken to our pediatrician for examination Thursday (June 19th, 2008) morning at that point the pediatrician recommended my son be taken to a local hospital for an X-Ray & Ultrasound for what appeared to be "Intussusceptions"; Local Hospital confirmed via. x-ray/ultrasound scans "Intussusceptions" but the facilities were unequipped for this type of pediatric condition and recommended my son be taken to "Hospital" immediately where it was confirmed via. scan the Intussusceptions was positive. A procedure was performed via. an "Enema" technique to reduce the intestine. The procedure worked, my son was hospitalized for observation and released on June 21st, 2008. In less than 24 hrs my son was rushed back to "Medical Center" on June 22nd, 2008 for the same condition reoccurring. All the previous signs began in the early morning of the 22nd of June. A scan was performed confirming the Intussusceptions had occurred for the second time in less than a few days apart from the 1st occurrence. The same "Enema" procedure was performed and my son was hospitalized again from June 22nd - to - June 25th. 7/14/08-records received for DOS 6/19/08-DX:Intussusception. Presented with irritability and intermittent inconsolability. Tenderness right side of abdomen. Day prior non-bloody non-bilious emesis and 2 non-bloody stools.. 7/25/08-records received for DOS 6/22-6/25/08-DX:Intussusception with successful reduction with air enema. C/O abdominal pain decreased oral intake. Seen prior to this admission for intussusception. No fever, diarrhea, vomiting. Abdomen nondistended, non tender.


Changed on 9/14/2017

VAERS ID: 317921 Before After
VAERS Form:(blank) 1
Age:0.34
Sex:Male
Location:New York
Vaccinated:2008-06-16
Onset:2008-06-19
Submitted:2008-06-30
Entered:2008-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2934AA / - UNK LA / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UF440AA / - UNK LA / SC
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR A0996 / - UNK LA / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0210 / - UNK - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diet refusal, Discomfort, Intussusception, Lethargy, Pain, Screaming, Vomiting, X-ray, Ultrasound scan abnormal

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: 3     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: X-ray; Ultrasound confirmation and fluroscopic enema procedure. 7/14/08-records received-X-rays: transverse colon consistent with intussusception and stool filled colon. Successful reduction of intussusception with barium enema. 7/25/08-records received- Stool occult blood negative.
CDC 'Split Type':

Write-up: Received Rotavirus vaccine on Monday morning (am) (June 16th 2008) by Thursday morning my son had not had regular bowel movements, was discomfort during sleeping hours nights prior, Thursday morning my son began to show signs of being lethargic, refusal to eat and what ever he did eat he began to vomit and scream in pain. (reportingly a neighbor called the local police to report a child screaming excessively). My son was taken to our pediatrician for examination Thursday (June 19th, 2008) morning at that point the pediatrician recommended my son be taken to a local hospital for an X-Ray & Ultrasound for what appeared to be "Intussusceptions"; Local Hospital confirmed via. x-ray/ultrasound scans "Intussusceptions" but the facilities were unequipped for this type of pediatric condition and recommended my son be taken to "Hospital" immediately where it was confirmed via. scan the Intussusceptions was positive. A procedure was performed via. an "Enema" technique to reduce the intestine. The procedure worked, my son was hospitalized for observation and released on June 21st, 2008. In less than 24 hrs my son was rushed back to "Medical Center" on June 22nd, 2008 for the same condition reoccurring. All the previous signs began in the early morning of the 22nd of June. A scan was performed confirming the Intussusceptions had occurred for the second time in less than a few days apart from the 1st occurrence. The same "Enema" procedure was performed and my son was hospitalized again from June 22nd - to - June 25th. 7/14/08-records received for DOS 6/19/08-DX:Intussusception. Presented with irritability and intermittent inconsolability. Tenderness right side of abdomen. Day prior non-bloody non-bilious emesis and 2 non-bloody stools.. 7/25/08-records received for DOS 6/22-6/25/08-DX:Intussusception with successful reduction with air enema. C/O abdominal pain decreased oral intake. Seen prior to this admission for intussusception. No fever, diarrhea, vomiting. Abdomen nondistended, non tender.


Changed on 2/14/2018

VAERS ID: 317921 Before After
VAERS Form:1
Age:0.34
Sex:Male
Location:New York
Vaccinated:2008-06-16
Onset:2008-06-19
Submitted:2008-06-30
Entered:2008-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2934AA / UNK LA / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UF440AA / UNK LA / SC
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR A0996 / UNK LA / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0210 / UNK MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diet refusal, Discomfort, Intussusception, Lethargy, Pain, Screaming, Vomiting, X-ray, Ultrasound scan abnormal

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: 3     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: X-ray; Ultrasound confirmation and fluroscopic enema procedure. 7/14/08-records received-X-rays: transverse colon consistent with intussusception and stool filled colon. Successful reduction of intussusception with barium enema. 7/25/08-records received- Stool occult blood negative.
CDC 'Split Type':

Write-up: Received Rotavirus vaccine on Monday morning (am) (June 16th 2008) by Thursday morning my son had not had regular bowel movements, was discomfort during sleeping hours nights prior, Thursday morning my son began to show signs of being lethargic, refusal to eat and what ever he did eat he began to vomit and scream in pain. (reportingly a neighbor called the local police to report a child screaming excessively). My son was taken to our pediatrician for examination Thursday (June 19th, 2008) morning at that point the pediatrician recommended my son be taken to a local hospital for an X-Ray & Ultrasound for what appeared to be "Intussusceptions"; Local Hospital confirmed via. x-ray/ultrasound scans "Intussusceptions" but the facilities were unequipped for this type of pediatric condition and recommended my son be taken to "Hospital" immediately where it was confirmed via. scan the Intussusceptions was positive. A procedure was performed via. an "Enema" technique to reduce the intestine. The procedure worked, my son was hospitalized for observation and released on June 21st, 2008. In less than 24 hrs my son was rushed back to "Medical Center" on June 22nd, 2008 for the same condition reoccurring. All the previous signs began in the early morning of the 22nd of June. A scan was performed confirming the Intussusceptions had occurred for the second time in less than a few days apart from the 1st occurrence. The same "Enema" procedure was performed and my son was hospitalized again from June 22nd - to - June 25th. 7/14/08-records received for DOS 6/19/08-DX:Intussusception. Presented with irritability and intermittent inconsolability. Tenderness right side of abdomen. Day prior non-bloody non-bilious emesis and 2 non-bloody stools.. 7/25/08-records received for DOS 6/22-6/25/08-DX:Intussusception with successful reduction with air enema. C/O abdominal pain decreased oral intake. Seen prior to this admission for intussusception. No fever, diarrhea, vomiting. Abdomen nondistended, non tender.


Changed on 6/14/2018

VAERS ID: 317921 Before After
VAERS Form:1
Age:0.34
Sex:Male
Location:New York
Vaccinated:2008-06-16
Onset:2008-06-19
Submitted:2008-06-30
Entered:2008-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2934AA / UNK LA / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UF440AA / UNK LA / SC
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR A0996 / UNK LA / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0210 / UNK MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diet refusal, Discomfort, Intussusception, Lethargy, Pain, Screaming, Vomiting, X-ray, Ultrasound scan abnormal

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: 3     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: X-ray; Ultrasound confirmation and fluroscopic enema procedure. 7/14/08-records received-X-rays: transverse colon consistent with intussusception and stool filled colon. Successful reduction of intussusception with barium enema. 7/25/08-records received- Stool occult blood negative.
CDC 'Split Type':

Write-up: Received Rotavirus vaccine on Monday morning (am) (June 16th 2008) by Thursday morning my son had not had regular bowel movements, was discomfort during sleeping hours nights prior, Thursday morning my son began to show signs of being lethargic, refusal to eat and what ever he did eat he began to vomit and scream in pain. (reportingly a neighbor called the local police to report a child screaming excessively). My son was taken to our pediatrician for examination Thursday (June 19th, 2008) morning at that point the pediatrician recommended my son be taken to a local hospital for an X-Ray & Ultrasound for what appeared to be "Intussusceptions"; Local Hospital confirmed via. x-ray/ultrasound scans "Intussusceptions" but the facilities were unequipped for this type of pediatric condition and recommended my son be taken to "Hospital" immediately where it was confirmed via. scan the Intussusceptions was positive. A procedure was performed via. an "Enema" technique to reduce the intestine. The procedure worked, my son was hospitalized for observation and released on June 21st, 2008. In less than 24 hrs my son was rushed back to "Medical Center" on June 22nd, 2008 for the same condition reoccurring. All the previous signs began in the early morning of the 22nd of June. A scan was performed confirming the Intussusceptions had occurred for the second time in less than a few days apart from the 1st occurrence. The same "Enema" procedure was performed and my son was hospitalized again from June 22nd - to - June 25th. 7/14/08-records received for DOS 6/19/08-DX:Intussusception. Presented with irritability and intermittent inconsolability. Tenderness right side of abdomen. Day prior non-bloody non-bilious emesis and 2 non-bloody stools.. 7/25/08-records received for DOS 6/22-6/25/08-DX:Intussusception with successful reduction with air enema. C/O abdominal pain decreased oral intake. Seen prior to this admission for intussusception. No fever, diarrhea, vomiting. Abdomen nondistended, non tender.


Changed on 8/14/2018

VAERS ID: 317921 Before After
VAERS Form:1
Age:0.34
Sex:Male
Location:New York
Vaccinated:2008-06-16
Onset:2008-06-19
Submitted:2008-06-30
Entered:2008-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2934AA / UNK LA / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UF440AA / UNK LA / SC
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR A0996 / UNK LA / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0210 / UNK MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diet refusal, Discomfort, Intussusception, Lethargy, Pain, Screaming, Vomiting, X-ray, Ultrasound scan abnormal

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: 3     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: X-ray; Ultrasound confirmation and fluroscopic enema procedure. 7/14/08-records received-X-rays: transverse colon consistent with intussusception and stool filled colon. Successful reduction of intussusception with barium enema. 7/25/08-records received- Stool occult blood negative.
CDC 'Split Type':

Write-up: Received Rotavirus vaccine on Monday morning (am) (June 16th 2008) by Thursday morning my son had not had regular bowel movements, was discomfort during sleeping hours nights prior, Thursday morning my son began to show signs of being lethargic, refusal to eat and what ever he did eat he began to vomit and scream in pain. (reportingly a neighbor called the local police to report a child screaming excessively). My son was taken to our pediatrician for examination Thursday (June 19th, 2008) morning at that point the pediatrician recommended my son be taken to a local hospital for an X-Ray & Ultrasound for what appeared to be "Intussusceptions"; Local Hospital confirmed via. x-ray/ultrasound scans "Intussusceptions" but the facilities were unequipped for this type of pediatric condition and recommended my son be taken to "Hospital" immediately where it was confirmed via. scan the Intussusceptions was positive. A procedure was performed via. an "Enema" technique to reduce the intestine. The procedure worked, my son was hospitalized for observation and released on June 21st, 2008. In less than 24 hrs my son was rushed back to "Medical Center" on June 22nd, 2008 for the same condition reoccurring. All the previous signs began in the early morning of the 22nd of June. A scan was performed confirming the Intussusceptions had occurred for the second time in less than a few days apart from the 1st occurrence. The same "Enema" procedure was performed and my son was hospitalized again from June 22nd - to - June 25th. 7/14/08-records received for DOS 6/19/08-DX:Intussusception. Presented with irritability and intermittent inconsolability. Tenderness right side of abdomen. Day prior non-bloody non-bilious emesis and 2 non-bloody stools.. 7/25/08-records received for DOS 6/22-6/25/08-DX:Intussusception with successful reduction with air enema. C/O abdominal pain decreased oral intake. Seen prior to this admission for intussusception. No fever, diarrhea, vomiting. Abdomen nondistended, non tender.


Changed on 9/14/2018

VAERS ID: 317921 Before After
VAERS Form:1
Age:0.34
Sex:Male
Location:New York
Vaccinated:2008-06-16
Onset:2008-06-19
Submitted:2008-06-30
Entered:2008-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2934AA / UNK LA / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UF440AA / UNK LA / SC
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR A0996 / UNK LA / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0210 / UNK MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diet refusal, Discomfort, Intussusception, Lethargy, Pain, Screaming, Vomiting, X-ray, Ultrasound scan abnormal

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: 3     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: X-ray; Ultrasound confirmation and fluroscopic enema procedure. 7/14/08-records received-X-rays: transverse colon consistent with intussusception and stool filled colon. Successful reduction of intussusception with barium enema. 7/25/08-records received- Stool occult blood negative.
CDC 'Split Type':

Write-up: Received Rotavirus vaccine on Monday morning (am) (June 16th 2008) by Thursday morning my son had not had regular bowel movements, was discomfort during sleeping hours nights prior, Thursday morning my son began to show signs of being lethargic, refusal to eat and what ever he did eat he began to vomit and scream in pain. (reportingly a neighbor called the local police to report a child screaming excessively). My son was taken to our pediatrician for examination Thursday (June 19th, 2008) morning at that point the pediatrician recommended my son be taken to a local hospital for an X-Ray & Ultrasound for what appeared to be "Intussusceptions"; Local Hospital confirmed via. x-ray/ultrasound scans "Intussusceptions" but the facilities were unequipped for this type of pediatric condition and recommended my son be taken to "Hospital" immediately where it was confirmed via. scan the Intussusceptions was positive. A procedure was performed via. an "Enema" technique to reduce the intestine. The procedure worked, my son was hospitalized for observation and released on June 21st, 2008. In less than 24 hrs my son was rushed back to "Medical Center" on June 22nd, 2008 for the same condition reoccurring. All the previous signs began in the early morning of the 22nd of June. A scan was performed confirming the Intussusceptions had occurred for the second time in less than a few days apart from the 1st occurrence. The same "Enema" procedure was performed and my son was hospitalized again from June 22nd - to - June 25th. 7/14/08-records received for DOS 6/19/08-DX:Intussusception. Presented with irritability and intermittent inconsolability. Tenderness right side of abdomen. Day prior non-bloody non-bilious emesis and 2 non-bloody stools.. 7/25/08-records received for DOS 6/22-6/25/08-DX:Intussusception with successful reduction with air enema. C/O abdominal pain decreased oral intake. Seen prior to this admission for intussusception. No fever, diarrhea, vomiting. Abdomen nondistended, non tender.


Changed on 10/14/2018

VAERS ID: 317921 Before After
VAERS Form:1
Age:0.34
Sex:Male
Location:New York
Vaccinated:2008-06-16
Onset:2008-06-19
Submitted:2008-06-30
Entered:2008-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2934AA / UNK LA / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UF440AA / UNK LA / SC
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR A0996 / UNK LA / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0210 / UNK MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Diet refusal, Discomfort, Intussusception, Lethargy, Pain, Screaming, Vomiting, X-ray, Ultrasound scan abnormal

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: 3     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: X-ray; Ultrasound confirmation and fluroscopic enema procedure. 7/14/08-records received-X-rays: transverse colon consistent with intussusception and stool filled colon. Successful reduction of intussusception with barium enema. 7/25/08-records received- Stool occult blood negative.
CDC 'Split Type':

Write-up: Received Rotavirus vaccine on Monday morning (am) (June 16th 2008) by Thursday morning my son had not had regular bowel movements, was discomfort during sleeping hours nights prior, Thursday morning my son began to show signs of being lethargic, refusal to eat and what ever he did eat he began to vomit and scream in pain. (reportingly a neighbor called the local police to report a child screaming excessively). My son was taken to our pediatrician for examination Thursday (June 19th, 2008) morning at that point the pediatrician recommended my son be taken to a local hospital for an X-Ray & Ultrasound for what appeared to be "Intussusceptions"; Local Hospital confirmed via. x-ray/ultrasound scans "Intussusceptions" but the facilities were unequipped for this type of pediatric condition and recommended my son be taken to "Hospital" immediately where it was confirmed via. scan the Intussusceptions was positive. A procedure was performed via. an "Enema" technique to reduce the intestine. The procedure worked, my son was hospitalized for observation and released on June 21st, 2008. In less than 24 hrs my son was rushed back to "Medical Center" on June 22nd, 2008 for the same condition reoccurring. All the previous signs began in the early morning of the 22nd of June. A scan was performed confirming the Intussusceptions had occurred for the second time in less than a few days apart from the 1st occurrence. The same "Enema" procedure was performed and my son was hospitalized again from June 22nd - to - June 25th. 7/14/08-records received for DOS 6/19/08-DX:Intussusception. Presented with irritability and intermittent inconsolability. Tenderness right side of abdomen. Day prior non-bloody non-bilious emesis and 2 non-bloody stools.. 7/25/08-records received for DOS 6/22-6/25/08-DX:Intussusception with successful reduction with air enema. C/O abdominal pain decreased oral intake. Seen prior to this admission for intussusception. No fever, diarrhea, vomiting. Abdomen nondistended, non tender.

New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=317921&WAYBACKHISTORY=ON


Copyright © 2020 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166