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This is VAERS ID 321975

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 321975
VAERS Form:
Age:0.2
Gender:Female
Location:West Virginia
Vaccinated:2008-06-11
Onset:2008-06-12
Submitted:2008-08-12
Entered:2008-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B182AA / 0 RL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF350AA / 0 LL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C65928 / 0 LL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0142X / 0 - / PO

Administered by: Other      Purchased by: Unknown
Symptoms: Barium enema, Crying, Full blood count, Enema administration, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: PREVACID
Current Illness: Gastrooesophageal reflux
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Diagnostic laboratory, fluoroscopy for barium enema. Labs and Diagnostics: Abdominal X-ray WNL. Barium enema WNL. CBC with Hgb 9.8. Hct 28.4. RBC 3.02. Platlets 534
CDC 'Split Type':

Write-up: Information has been received from a physician concerning a female with reflux who was vaccinated with the first dose of ROTATEQ. Concomitant therapy included PREVACID. It was reported that the patient had intussusception. The patient had inconsolable"crying episodes and fussiness 1 day after receiving her 2 month immunizations. The patient had a normal bowel movement on the morning of 12-Jun-2008 but had episodic crying and later had 3 small bowel movements with specs of blood with a low grade fever.


Changed on 12/8/2009

VAERS ID: 321975 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:West Virginia
Vaccinated:2008-06-11
Onset:2008-06-12
Submitted:2008-08-12
Entered:2008-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B182AA / 0 RL / -
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B182AA / 0 RL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF350AA / 0 LL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C65928 / 0 LL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0142X / 0 - / PO

Administered by: Other      Purchased by: Unknown Other
Symptoms: Barium enema, Crying, Full blood count, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Irritability, Pyrexia, Red blood cell count decreased, Enema administration, Platelet count increased, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: PREVACID
Current Illness: Gastrooesophageal reflux
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Diagnostic laboratory, fluoroscopy for barium enema. Labs and Diagnostics: Abdominal X-ray WNL. Barium enema WNL. CBC with Hgb 9.8. Hct 28.4. RBC 3.02. Platlets 534
CDC 'Split Type': (blank) WAES0808USA01128

Write-up: Information has been received from a physician concerning a female with reflux who was vaccinated with the first dose of ROTATEQ. Concomitant therapy included PREVACID. It was reported that the patient had intussusception. The patient had inconsolable"crying inconsolable crying episodes and fussiness 1 day after receiving her 2 month immunizations. The patient had a normal bowel movement on the morning of 12-Jun-2008 but had episodic crying and later had 3 small bowel movements with specs of blood with a low grade fever. There was no vomiting and the patient was on breast milk. The patient was admitted to the hospital on 12-Jun-2008 and discharged on 13-Jun-2008. It was reported that the patient had fluoroscopy for barium enema. It was reported that the patient recovered from these events on 13-Jun-2008. The reporter considered intussusception, inconsolable crying episodes, fussiness, low grade fever, 3 small bowel movements with specs of blood and episodic crying to be other important medical events. Unspecified medical attention was sought. No product quality complaint. Additional information has been requested. 9/15/2008 D/C summary received for DOS 6/12-13/2008 with D/C DX: Intussusception. Pt presented with inconsolable crying and 3 BMs with blood. PE WNL except for crying. Barium enema done with no residual IS identified. It was felt that the IS was resolved. Pt admitted for observation, had no pain o/n and was able to advance diet. Pt had a slightly heme (+) stool post-procedure.


Changed on 3/2/2010

VAERS ID: 321975 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:West Virginia
Vaccinated:2008-06-11
Onset:2008-06-12
Submitted:2008-08-12
Entered:2008-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B182AA / 0 RL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF350AA / 0 LL / -
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC C65928 / 0 LL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0142X / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema, Crying, Full blood count, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Irritability, Pyrexia, Red blood cell count decreased, Enema administration, Platelet count increased, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: PREVACID
Current Illness: Gastrooesophageal reflux
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Diagnostic laboratory, fluoroscopy for barium enema. Labs and Diagnostics: Abdominal X-ray WNL. Barium enema WNL. CBC with Hgb 9.8. Hct 28.4. RBC 3.02. Platlets 534
CDC 'Split Type': WAES0808USA01128

Write-up: Information has been received from a physician concerning a female with reflux who was vaccinated with the first dose of ROTATEQ. Concomitant therapy included PREVACID. It was reported that the patient had intussusception. The patient had inconsolable crying episodes and fussiness 1 day after receiving her 2 month immunizations. The patient had a normal bowel movement on the morning of 12-Jun-2008 but had episodic crying and later had 3 small bowel movements with specs of blood with a low grade fever. There was no vomiting and the patient was on breast milk. The patient was admitted to the hospital on 12-Jun-2008 and discharged on 13-Jun-2008. It was reported that the patient had fluoroscopy for barium enema. It was reported that the patient recovered from these events on 13-Jun-2008. The reporter considered intussusception, inconsolable crying episodes, fussiness, low grade fever, 3 small bowel movements with specs of blood and episodic crying to be other important medical events. Unspecified medical attention was sought. No product quality complaint. Additional information has been requested. 9/15/2008 D/C summary received for DOS 6/12-13/2008 with D/C DX: Intussusception. Pt presented with inconsolable crying and 3 BMs with blood. PE WNL except for crying. Barium enema done with no residual IS identified. It was felt that the IS was resolved. Pt admitted for observation, had no pain o/n and was able to advance diet. Pt had a slightly heme (+) stool post-procedure.


Changed on 4/7/2010

VAERS ID: 321975 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:West Virginia
Vaccinated:2008-06-11
Onset:2008-06-12
Submitted:2008-08-12
Entered:2008-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B182AA / 0 RL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF350AA / 0 LL / -
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C65928 / 0 LL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0142X / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema, Crying, Full blood count, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Irritability, Pyrexia, Red blood cell count decreased, Enema administration, Platelet count increased, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: PREVACID
Current Illness: Gastrooesophageal reflux
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Diagnostic laboratory, fluoroscopy for barium enema. Labs and Diagnostics: Abdominal X-ray WNL. Barium enema WNL. CBC with Hgb 9.8. Hct 28.4. RBC 3.02. Platlets 534
CDC 'Split Type': WAES0808USA01128

Write-up: Information has been received from a physician concerning a female with reflux who was vaccinated with the first dose of ROTATEQ. Concomitant therapy included PREVACID. It was reported that the patient had intussusception. The patient had inconsolable crying episodes and fussiness 1 day after receiving her 2 month immunizations. The patient had a normal bowel movement on the morning of 12-Jun-2008 but had episodic crying and later had 3 small bowel movements with specs of blood with a low grade fever. There was no vomiting and the patient was on breast milk. The patient was admitted to the hospital on 12-Jun-2008 and discharged on 13-Jun-2008. It was reported that the patient had fluoroscopy for barium enema. It was reported that the patient recovered from these events on 13-Jun-2008. The reporter considered intussusception, inconsolable crying episodes, fussiness, low grade fever, 3 small bowel movements with specs of blood and episodic crying to be other important medical events. Unspecified medical attention was sought. No product quality complaint. Additional information has been requested. 9/15/2008 D/C summary received for DOS 6/12-13/2008 with D/C DX: Intussusception. Pt presented with inconsolable crying and 3 BMs with blood. PE WNL except for crying. Barium enema done with no residual IS identified. It was felt that the IS was resolved. Pt admitted for observation, had no pain o/n and was able to advance diet. Pt had a slightly heme (+) stool post-procedure.


Changed on 8/31/2010

VAERS ID: 321975 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:West Virginia
Vaccinated:2008-06-11
Onset:2008-06-12
Submitted:2008-08-12
Entered:2008-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B182AA / 0 RL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF350AA / 0 LL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH C65928 / 0 LL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0142X / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema, Crying, Full blood count, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Irritability, Pyrexia, Red blood cell count decreased, Enema administration, Platelet count increased, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: PREVACID
Current Illness: Gastrooesophageal reflux
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Diagnostic laboratory, fluoroscopy for barium enema. Labs and Diagnostics: Abdominal X-ray WNL. Barium enema WNL. CBC with Hgb 9.8. Hct 28.4. RBC 3.02. Platlets 534
CDC 'Split Type': WAES0808USA01128

Write-up: Information has been received from a physician concerning a female with reflux who was vaccinated with the first dose of ROTATEQ. Concomitant therapy included PREVACID. It was reported that the patient had intussusception. The patient had inconsolable crying episodes and fussiness 1 day after receiving her 2 month immunizations. The patient had a normal bowel movement on the morning of 12-Jun-2008 but had episodic crying and later had 3 small bowel movements with specs of blood with a low grade fever. There was no vomiting and the patient was on breast milk. The patient was admitted to the hospital on 12-Jun-2008 and discharged on 13-Jun-2008. It was reported that the patient had fluoroscopy for barium enema. It was reported that the patient recovered from these events on 13-Jun-2008. The reporter considered intussusception, inconsolable crying episodes, fussiness, low grade fever, 3 small bowel movements with specs of blood and episodic crying to be other important medical events. Unspecified medical attention was sought. No product quality complaint. Additional information has been requested. 9/15/2008 D/C summary received for DOS 6/12-13/2008 with D/C DX: Intussusception. Pt presented with inconsolable crying and 3 BMs with blood. PE WNL except for crying. Barium enema done with no residual IS identified. It was felt that the IS was resolved. Pt admitted for observation, had no pain o/n and was able to advance diet. Pt had a slightly heme (+) stool post-procedure.


Changed on 5/13/2013

VAERS ID: 321975 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:West Virginia
Vaccinated:2008-06-11
Onset:2008-06-12
Submitted:2008-08-12
Entered:2008-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B182AA / 0 RL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF350AA / 0 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65928 / 0 LL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0142X / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0142X / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema, Crying, Full blood count, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Irritability, Pyrexia, Red blood cell count decreased, Enema administration, Platelet count increased, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: PREVACID
Current Illness: Gastrooesophageal reflux
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Diagnostic laboratory, fluoroscopy for barium enema. Labs and Diagnostics: Abdominal X-ray WNL. Barium enema WNL. CBC with Hgb 9.8. Hct 28.4. RBC 3.02. Platlets 534
CDC 'Split Type': WAES0808USA01128

Write-up: Information has been received from a physician concerning a female with reflux who was vaccinated with the first dose of ROTATEQ. Concomitant therapy included PREVACID. It was reported that the patient had intussusception. The patient had inconsolable crying episodes and fussiness 1 day after receiving her 2 month immunizations. The patient had a normal bowel movement on the morning of 12-Jun-2008 but had episodic crying and later had 3 small bowel movements with specs of blood with a low grade fever. There was no vomiting and the patient was on breast milk. The patient was admitted to the hospital on 12-Jun-2008 and discharged on 13-Jun-2008. It was reported that the patient had fluoroscopy for barium enema. It was reported that the patient recovered from these events on 13-Jun-2008. The reporter considered intussusception, inconsolable crying episodes, fussiness, low grade fever, 3 small bowel movements with specs of blood and episodic crying to be other important medical events. Unspecified medical attention was sought. No product quality complaint. Additional information has been requested. 9/15/2008 D/C summary received for DOS 6/12-13/2008 with D/C DX: Intussusception. Pt presented with inconsolable crying and 3 BMs with blood. PE WNL except for crying. Barium enema done with no residual IS identified. It was felt that the IS was resolved. Pt admitted for observation, had no pain o/n and was able to advance diet. Pt had a slightly heme (+) stool post-procedure.


Changed on 4/14/2017

VAERS ID: 321975 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:West Virginia
Vaccinated:2008-06-11
Onset:2008-06-12
Submitted:2008-08-12
Entered:2008-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B182AA / 0 RL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF350AA / 0 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65928 / 0 LL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0142X / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema, Crying, Full blood count, Haematochezia, Haematocrit decreased, Haemoglobin decreased, Intussusception, Irritability, Pyrexia, Red blood cell count decreased, Enema administration, Platelet count increased, Abdominal X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: PREVACID
Current Illness: Gastrooesophageal reflux
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Diagnostic laboratory, fluoroscopy for barium enema. Labs and Diagnostics: Abdominal X-ray WNL. Barium enema WNL. CBC with Hgb 9.8. Hct 28.4. RBC 3.02. Platlets 534
CDC 'Split Type': WAES0808USA01128

Write-up: Information has been received from a physician concerning a female with reflux who was vaccinated with the first dose of ROTATEQ. Concomitant therapy included PREVACID. It was reported that the patient had intussusception. The patient had inconsolable crying episodes and fussiness 1 day after receiving her 2 month immunizations. The patient had a normal bowel movement on the morning of 12-Jun-2008 but had episodic crying and later had 3 small bowel movements with specs of blood with a low grade fever. There was no vomiting and the patient was on breast milk. The patient was admitted to the hospital on 12-Jun-2008 and discharged on 13-Jun-2008. It was reported that the patient had fluoroscopy for barium enema. It was reported that the patient recovered from these events on 13-Jun-2008. The reporter considered intussusception, inconsolable crying episodes, fussiness, low grade fever, 3 small bowel movements with specs of blood and episodic crying to be other important medical events. Unspecified medical attention was sought. No product quality complaint. Additional information has been requested. 9/15/2008 D/C summary received for DOS 6/12-13/2008 with D/C DX: Intussusception. Pt presented with inconsolable crying and 3 BMs with blood. PE WNL except for crying. Barium enema done with no residual IS identified. It was felt that the IS was resolved. Pt admitted for observation, had no pain o/n and was able to advance diet. Pt had a slightly heme (+) stool post-procedure.


Changed on 9/14/2017

VAERS ID: 321975 Before After
VAERS Form:(blank) 1
Age:0.2
Gender:Female
Location:West Virginia
Vaccinated:2008-06-11
Onset:2008-06-12
Submitted:2008-08-12
Entered:2008-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B182AA / 0 1 RL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF350AA / 0 1 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65928 / 0 1 LL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0142X / 0 1 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema, Crying, Haematochezia, Intussusception, Irritability, Pyrexia, 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? Yes
Previous Vaccinations:
Other Medications: PREVACID
Current Illness: Gastrooesophageal reflux
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Diagnostic laboratory, fluoroscopy for barium enema. Labs and Diagnostics: Abdominal X-ray WNL. Barium enema WNL. CBC with Hgb 9.8. Hct 28.4. RBC 3.02. Platlets 534
CDC 'Split Type': WAES0808USA01128

Write-up: Information has been received from a physician concerning a female with reflux who was vaccinated with the first dose of ROTATEQ. Concomitant therapy included PREVACID. It was reported that the patient had intussusception. The patient had inconsolable crying episodes and fussiness 1 day after receiving her 2 month immunizations. The patient had a normal bowel movement on the morning of 12-Jun-2008 but had episodic crying and later had 3 small bowel movements with specs of blood with a low grade fever. There was no vomiting and the patient was on breast milk. The patient was admitted to the hospital on 12-Jun-2008 and discharged on 13-Jun-2008. It was reported that the patient had fluoroscopy for barium enema. It was reported that the patient recovered from these events on 13-Jun-2008. The reporter considered intussusception, inconsolable crying episodes, fussiness, low grade fever, 3 small bowel movements with specs of blood and episodic crying to be other important medical events. Unspecified medical attention was sought. No product quality complaint. Additional information has been requested. 9/15/2008 D/C summary received for DOS 6/12-13/2008 with D/C DX: Intussusception. Pt presented with inconsolable crying and 3 BMs with blood. PE WNL except for crying. Barium enema done with no residual IS identified. It was felt that the IS was resolved. Pt admitted for observation, had no pain o/n and was able to advance diet. Pt had a slightly heme (+) stool post-procedure.


Changed on 2/14/2018

VAERS ID: 321975 Before After
VAERS Form:1
Age:0.2
Gender:Female
Location:West Virginia
Vaccinated:2008-06-11
Onset:2008-06-12
Submitted:2008-08-12
Entered:2008-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B182AA / 1 RL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF350AA / 1 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65928 / 1 LL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0142X / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema, Crying, Haematochezia, Intussusception, Irritability, Pyrexia, 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? Yes
Previous Vaccinations:
Other Medications: PREVACID
Current Illness: Gastrooesophageal reflux
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Diagnostic laboratory, fluoroscopy for barium enema. Labs and Diagnostics: Abdominal X-ray WNL. Barium enema WNL. CBC with Hgb 9.8. Hct 28.4. RBC 3.02. Platlets 534
CDC 'Split Type': WAES0808USA01128

Write-up: Information has been received from a physician concerning a female with reflux who was vaccinated with the first dose of ROTATEQ. Concomitant therapy included PREVACID. It was reported that the patient had intussusception. The patient had inconsolable crying episodes and fussiness 1 day after receiving her 2 month immunizations. The patient had a normal bowel movement on the morning of 12-Jun-2008 but had episodic crying and later had 3 small bowel movements with specs of blood with a low grade fever. There was no vomiting and the patient was on breast milk. The patient was admitted to the hospital on 12-Jun-2008 and discharged on 13-Jun-2008. It was reported that the patient had fluoroscopy for barium enema. It was reported that the patient recovered from these events on 13-Jun-2008. The reporter considered intussusception, inconsolable crying episodes, fussiness, low grade fever, 3 small bowel movements with specs of blood and episodic crying to be other important medical events. Unspecified medical attention was sought. No product quality complaint. Additional information has been requested. 9/15/2008 D/C summary received for DOS 6/12-13/2008 with D/C DX: Intussusception. Pt presented with inconsolable crying and 3 BMs with blood. PE WNL except for crying. Barium enema done with no residual IS identified. It was felt that the IS was resolved. Pt admitted for observation, had no pain o/n and was able to advance diet. Pt had a slightly heme (+) stool post-procedure.


Changed on 6/14/2018

VAERS ID: 321975 Before After
VAERS Form:1
Age:0.2
Gender:Female
Location:West Virginia
Vaccinated:2008-06-11
Onset:2008-06-12
Submitted:2008-08-12
Entered:2008-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B182AA / 1 RL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF350AA / 1 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65928 / 1 LL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0142X / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema, Crying, Haematochezia, Intussusception, Irritability, Pyrexia, 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? Yes
Previous Vaccinations:
Other Medications: PREVACID
Current Illness: Gastrooesophageal reflux
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Diagnostic laboratory, fluoroscopy for barium enema. Labs and Diagnostics: Abdominal X-ray WNL. Barium enema WNL. CBC with Hgb 9.8. Hct 28.4. RBC 3.02. Platlets 534
CDC 'Split Type': WAES0808USA01128

Write-up: Information has been received from a physician concerning a female with reflux who was vaccinated with the first dose of ROTATEQ. Concomitant therapy included PREVACID. It was reported that the patient had intussusception. The patient had inconsolable crying episodes and fussiness 1 day after receiving her 2 month immunizations. The patient had a normal bowel movement on the morning of 12-Jun-2008 but had episodic crying and later had 3 small bowel movements with specs of blood with a low grade fever. There was no vomiting and the patient was on breast milk. The patient was admitted to the hospital on 12-Jun-2008 and discharged on 13-Jun-2008. It was reported that the patient had fluoroscopy for barium enema. It was reported that the patient recovered from these events on 13-Jun-2008. The reporter considered intussusception, inconsolable crying episodes, fussiness, low grade fever, 3 small bowel movements with specs of blood and episodic crying to be other important medical events. Unspecified medical attention was sought. No product quality complaint. Additional information has been requested. 9/15/2008 D/C summary received for DOS 6/12-13/2008 with D/C DX: Intussusception. Pt presented with inconsolable crying and 3 BMs with blood. PE WNL except for crying. Barium enema done with no residual IS identified. It was felt that the IS was resolved. Pt admitted for observation, had no pain o/n and was able to advance diet. Pt had a slightly heme (+) stool post-procedure.


Changed on 8/14/2018

VAERS ID: 321975 Before After
VAERS Form:1
Age:0.2
Gender:Female
Location:West Virginia
Vaccinated:2008-06-11
Onset:2008-06-12
Submitted:2008-08-12
Entered:2008-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B182AA / 1 RL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF350AA / 1 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65928 / 1 LL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0142X / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema, Crying, Haematochezia, Intussusception, Irritability, Pyrexia, 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? Yes
Previous Vaccinations:
Other Medications: PREVACID
Current Illness: Gastrooesophageal reflux
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Diagnostic laboratory, fluoroscopy for barium enema. Labs and Diagnostics: Abdominal X-ray WNL. Barium enema WNL. CBC with Hgb 9.8. Hct 28.4. RBC 3.02. Platlets 534
CDC 'Split Type': WAES0808USA01128

Write-up: Information has been received from a physician concerning a female with reflux who was vaccinated with the first dose of ROTATEQ. Concomitant therapy included PREVACID. It was reported that the patient had intussusception. The patient had inconsolable crying episodes and fussiness 1 day after receiving her 2 month immunizations. The patient had a normal bowel movement on the morning of 12-Jun-2008 but had episodic crying and later had 3 small bowel movements with specs of blood with a low grade fever. There was no vomiting and the patient was on breast milk. The patient was admitted to the hospital on 12-Jun-2008 and discharged on 13-Jun-2008. It was reported that the patient had fluoroscopy for barium enema. It was reported that the patient recovered from these events on 13-Jun-2008. The reporter considered intussusception, inconsolable crying episodes, fussiness, low grade fever, 3 small bowel movements with specs of blood and episodic crying to be other important medical events. Unspecified medical attention was sought. No product quality complaint. Additional information has been requested. 9/15/2008 D/C summary received for DOS 6/12-13/2008 with D/C DX: Intussusception. Pt presented with inconsolable crying and 3 BMs with blood. PE WNL except for crying. Barium enema done with no residual IS identified. It was felt that the IS was resolved. Pt admitted for observation, had no pain o/n and was able to advance diet. Pt had a slightly heme (+) stool post-procedure.


Changed on 9/14/2018

VAERS ID: 321975 Before After
VAERS Form:1
Age:0.2
Gender:Female
Location:West Virginia
Vaccinated:2008-06-11
Onset:2008-06-12
Submitted:2008-08-12
Entered:2008-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B182AA / 1 RL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF350AA / 1 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65928 / 1 LL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0142X / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema, Crying, Haematochezia, Intussusception, Irritability, Pyrexia, 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? Yes
Previous Vaccinations:
Other Medications: PREVACID
Current Illness: Gastrooesophageal reflux
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Diagnostic laboratory, fluoroscopy for barium enema. Labs and Diagnostics: Abdominal X-ray WNL. Barium enema WNL. CBC with Hgb 9.8. Hct 28.4. RBC 3.02. Platlets 534
CDC 'Split Type': WAES0808USA01128

Write-up: Information has been received from a physician concerning a female with reflux who was vaccinated with the first dose of ROTATEQ. Concomitant therapy included PREVACID. It was reported that the patient had intussusception. The patient had inconsolable crying episodes and fussiness 1 day after receiving her 2 month immunizations. The patient had a normal bowel movement on the morning of 12-Jun-2008 but had episodic crying and later had 3 small bowel movements with specs of blood with a low grade fever. There was no vomiting and the patient was on breast milk. The patient was admitted to the hospital on 12-Jun-2008 and discharged on 13-Jun-2008. It was reported that the patient had fluoroscopy for barium enema. It was reported that the patient recovered from these events on 13-Jun-2008. The reporter considered intussusception, inconsolable crying episodes, fussiness, low grade fever, 3 small bowel movements with specs of blood and episodic crying to be other important medical events. Unspecified medical attention was sought. No product quality complaint. Additional information has been requested. 9/15/2008 D/C summary received for DOS 6/12-13/2008 with D/C DX: Intussusception. Pt presented with inconsolable crying and 3 BMs with blood. PE WNL except for crying. Barium enema done with no residual IS identified. It was felt that the IS was resolved. Pt admitted for observation, had no pain o/n and was able to advance diet. Pt had a slightly heme (+) stool post-procedure.


Changed on 10/14/2018

VAERS ID: 321975 Before After
VAERS Form:1
Age:0.2
Gender:Female
Location:West Virginia
Vaccinated:2008-06-11
Onset:2008-06-12
Submitted:2008-08-12
Entered:2008-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B182AA / 1 RL / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF350AA / 1 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C65928 / 1 LL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0142X / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema, Crying, Haematochezia, Intussusception, Irritability, Pyrexia, 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? Yes
Previous Vaccinations:
Other Medications: PREVACID
Current Illness: Gastrooesophageal reflux
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Diagnostic laboratory, fluoroscopy for barium enema. Labs and Diagnostics: Abdominal X-ray WNL. Barium enema WNL. CBC with Hgb 9.8. Hct 28.4. RBC 3.02. Platlets 534
CDC 'Split Type': WAES0808USA01128

Write-up: Information has been received from a physician concerning a female with reflux who was vaccinated with the first dose of ROTATEQ. Concomitant therapy included PREVACID. It was reported that the patient had intussusception. The patient had inconsolable crying episodes and fussiness 1 day after receiving her 2 month immunizations. The patient had a normal bowel movement on the morning of 12-Jun-2008 but had episodic crying and later had 3 small bowel movements with specs of blood with a low grade fever. There was no vomiting and the patient was on breast milk. The patient was admitted to the hospital on 12-Jun-2008 and discharged on 13-Jun-2008. It was reported that the patient had fluoroscopy for barium enema. It was reported that the patient recovered from these events on 13-Jun-2008. The reporter considered intussusception, inconsolable crying episodes, fussiness, low grade fever, 3 small bowel movements with specs of blood and episodic crying to be other important medical events. Unspecified medical attention was sought. No product quality complaint. Additional information has been requested. 9/15/2008 D/C summary received for DOS 6/12-13/2008 with D/C DX: Intussusception. Pt presented with inconsolable crying and 3 BMs with blood. PE WNL except for crying. Barium enema done with no residual IS identified. It was felt that the IS was resolved. Pt admitted for observation, had no pain o/n and was able to advance diet. Pt had a slightly heme (+) stool post-procedure.

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