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This is VAERS ID 323038

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 323038
VAERS Form:
Age:0.6
Gender:Male
Location:California
Vaccinated:2008-05-22
Onset:2008-07-30
Submitted:2008-08-15
Entered:2008-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC210127AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF295AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C35171 / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0508U / 2 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Abdominal pain, Barium enema, Culture urine negative, Enema administration, Abdominal X-ray

Life Threatening? Yes
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None. PMH: none
Allergies:
Diagnostic Lab Data: Ultrasound. Labs and Diagnostics: Abdominal X-ray non specific. Abdominal US (+) for IS in mid abdomen. Barium Enema (+) for IS. CBC, Chem and UA unremarkable. UC (-).
CDC 'Split Type':

Write-up: Intussusception noted 07/30/2008. Bloody stool, Air intussusception reduction successful, reporting because of association of rotavirus immunization and intussusception. 9/8/2008 MR received for DOS 7/30-31/2008 with D/C DX: S/P Reduction of Intussuscept"ion. Pt presented with abdominal pain, vomiting x10-12 and bloody stool. IS was noted on Barium Enema following a (+) US and reduced successfully. Admitted for observation o/n with no further problems.


Changed on 12/8/2009

VAERS ID: 323038 Before After
VAERS Form:
Age:0.6
Gender:Male
Location:California
Vaccinated:2008-05-22
Onset:2008-07-30
Submitted:2008-08-15
Entered:2008-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC210127AA / 2 RL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC210127AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF295AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C35171 / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0508U / 2 - / PO

Administered by: Private      Purchased by: Unknown Public
Symptoms: Abdominal pain, Barium enema, Culture urine negative, Full blood count normal, Haematochezia, Intussusception, Vomiting, Enema administration, Ultrasound abdomen abnormal, Laboratory test normal, Urine analysis normal, Abdominal X-ray

Life Threatening? Yes
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None. PMH: none
Allergies:
Diagnostic Lab Data: Ultrasound. Labs and Diagnostics: Abdominal X-ray non specific. Abdominal US (+) for IS in mid abdomen. Barium Enema (+) for IS. CBC, Chem and UA unremarkable. UC (-).
CDC 'Split Type':

Write-up: Intussusception noted 07/30/2008. Bloody stool, Air intussusception reduction successful, reporting because of association of rotavirus immunization and intussusception. 9/8/2008 MR received for DOS 7/30-31/2008 with D/C DX: S/P Reduction of Intussuscept"ion. Intussusception. Pt presented with abdominal pain, vomiting x10-12 and bloody stool. IS was noted on Barium Enema following a (+) US and reduced successfully. Admitted for observation o/n with no further problems.


Changed on 3/2/2010

VAERS ID: 323038 Before After
VAERS Form:
Age:0.6
Gender:Male
Location:California
Vaccinated:2008-05-22
Onset:2008-07-30
Submitted:2008-08-15
Entered:2008-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC210127AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF295AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC C35171 / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0508U / 2 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal pain, Barium enema, Culture urine negative, Full blood count normal, Haematochezia, Intussusception, Vomiting, Enema administration, Ultrasound abdomen abnormal, Laboratory test normal, Urine analysis normal, Abdominal X-ray

Life Threatening? Yes
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None. PMH: none
Allergies:
Diagnostic Lab Data: Ultrasound. Labs and Diagnostics: Abdominal X-ray non specific. Abdominal US (+) for IS in mid abdomen. Barium Enema (+) for IS. CBC, Chem and UA unremarkable. UC (-).
CDC 'Split Type':

Write-up: Intussusception noted 07/30/2008. Bloody stool, Air intussusception reduction successful, reporting because of association of rotavirus immunization and intussusception. 9/8/2008 MR received for DOS 7/30-31/2008 with D/C DX: S/P Reduction of Intussusception. Pt presented with abdominal pain, vomiting x10-12 and bloody stool. IS was noted on Barium Enema following a (+) US and reduced successfully. Admitted for observation o/n with no further problems.


Changed on 4/7/2010

VAERS ID: 323038 Before After
VAERS Form:
Age:0.6
Gender:Male
Location:California
Vaccinated:2008-05-22
Onset:2008-07-30
Submitted:2008-08-15
Entered:2008-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC210127AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF295AA / 2 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C35171 / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0508U / 2 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal pain, Barium enema, Culture urine negative, Full blood count normal, Haematochezia, Intussusception, Vomiting, Enema administration, Ultrasound abdomen abnormal, Laboratory test normal, Urine analysis normal, Abdominal X-ray

Life Threatening? Yes
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None. PMH: none
Allergies:
Diagnostic Lab Data: Ultrasound. Labs and Diagnostics: Abdominal X-ray non specific. Abdominal US (+) for IS in mid abdomen. Barium Enema (+) for IS. CBC, Chem and UA unremarkable. UC (-).
CDC 'Split Type':

Write-up: Intussusception noted 07/30/2008. Bloody stool, Air intussusception reduction successful, reporting because of association of rotavirus immunization and intussusception. 9/8/2008 MR received for DOS 7/30-31/2008 with D/C DX: S/P Reduction of Intussusception. Pt presented with abdominal pain, vomiting x10-12 and bloody stool. IS was noted on Barium Enema following a (+) US and reduced successfully. Admitted for observation o/n with no further problems.


Changed on 8/31/2010

VAERS ID: 323038 Before After
VAERS Form:
Age:0.6
Gender:Male
Location:California
Vaccinated:2008-05-22
Onset:2008-07-30
Submitted:2008-08-15
Entered:2008-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC210127AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF295AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH C35171 / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0508U / 2 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal pain, Barium enema, Culture urine negative, Full blood count normal, Haematochezia, Intussusception, Vomiting, Enema administration, Ultrasound abdomen abnormal, Laboratory test normal, Urine analysis normal, Abdominal X-ray

Life Threatening? Yes
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None. PMH: none
Allergies:
Diagnostic Lab Data: Ultrasound. Labs and Diagnostics: Abdominal X-ray non specific. Abdominal US (+) for IS in mid abdomen. Barium Enema (+) for IS. CBC, Chem and UA unremarkable. UC (-).
CDC 'Split Type':

Write-up: Intussusception noted 07/30/2008. Bloody stool, Air intussusception reduction successful, reporting because of association of rotavirus immunization and intussusception. 9/8/2008 MR received for DOS 7/30-31/2008 with D/C DX: S/P Reduction of Intussusception. Pt presented with abdominal pain, vomiting x10-12 and bloody stool. IS was noted on Barium Enema following a (+) US and reduced successfully. Admitted for observation o/n with no further problems.


Changed on 5/13/2013

VAERS ID: 323038 Before After
VAERS Form:
Age:0.6
Gender:Male
Location:California
Vaccinated:2008-05-22
Onset:2008-07-30
Submitted:2008-08-15
Entered:2008-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC210127AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF295AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C35171 / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0508U / 2 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0508U / 2 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal pain, Barium enema, Culture urine negative, Full blood count normal, Haematochezia, Intussusception, Vomiting, Enema administration, Ultrasound abdomen abnormal, Laboratory test normal, Urine analysis normal, Abdominal X-ray

Life Threatening? Yes
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None. PMH: none
Allergies:
Diagnostic Lab Data: Ultrasound. Labs and Diagnostics: Abdominal X-ray non specific. Abdominal US (+) for IS in mid abdomen. Barium Enema (+) for IS. CBC, Chem and UA unremarkable. UC (-).
CDC 'Split Type':

Write-up: Intussusception noted 07/30/2008. Bloody stool, Air intussusception reduction successful, reporting because of association of rotavirus immunization and intussusception. 9/8/2008 MR received for DOS 7/30-31/2008 with D/C DX: S/P Reduction of Intussusception. Pt presented with abdominal pain, vomiting x10-12 and bloody stool. IS was noted on Barium Enema following a (+) US and reduced successfully. Admitted for observation o/n with no further problems.


Changed on 4/14/2017

VAERS ID: 323038 Before After
VAERS Form:
Age:0.6
Gender:Male
Location:California
Vaccinated:2008-05-22
Onset:2008-07-30
Submitted:2008-08-15
Entered:2008-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC210127AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF295AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C35171 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0508U / 2 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal pain, Barium enema, Culture urine negative, Full blood count normal, Haematochezia, Intussusception, Vomiting, Enema administration, Ultrasound abdomen abnormal, Laboratory test normal, Urine analysis normal, Abdominal X-ray

Life Threatening? Yes
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None. PMH: none
Allergies:
Diagnostic Lab Data: Ultrasound. Labs and Diagnostics: Abdominal X-ray non specific. Abdominal US (+) for IS in mid abdomen. Barium Enema (+) for IS. CBC, Chem and UA unremarkable. UC (-).
CDC 'Split Type':

Write-up: Intussusception noted 07/30/2008. Bloody stool, Air intussusception reduction successful, reporting because of association of rotavirus immunization and intussusception. 9/8/2008 MR received for DOS 7/30-31/2008 with D/C DX: S/P Reduction of Intussusception. Pt presented with abdominal pain, vomiting x10-12 and bloody stool. IS was noted on Barium Enema following a (+) US and reduced successfully. Admitted for observation o/n with no further problems.


Changed on 9/14/2017

VAERS ID: 323038 Before After
VAERS Form:(blank) 1
Age:0.6
Gender:Male
Location:California
Vaccinated:2008-05-22
Onset:2008-07-30
Submitted:2008-08-15
Entered:2008-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC210127AA / 2 3 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF295AA / 2 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C35171 / 2 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0508U / 2 3 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Haematochezia, Intussusception

Life Threatening? Yes
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None. PMH: none
Allergies:
Diagnostic Lab Data: Ultrasound. Labs and Diagnostics: Abdominal X-ray non specific. Abdominal US (+) for IS in mid abdomen. Barium Enema (+) for IS. CBC, Chem and UA unremarkable. UC (-).
CDC 'Split Type':

Write-up: Intussusception noted 07/30/2008. Bloody stool, Air intussusception reduction successful, reporting because of association of rotavirus immunization and intussusception. 9/8/2008 MR received for DOS 7/30-31/2008 with D/C DX: S/P Reduction of Intussusception. Pt presented with abdominal pain, vomiting x10-12 and bloody stool. IS was noted on Barium Enema following a (+) US and reduced successfully. Admitted for observation o/n with no further problems.


Changed on 2/14/2018

VAERS ID: 323038 Before After
VAERS Form:1
Age:0.6
Gender:Male
Location:California
Vaccinated:2008-05-22
Onset:2008-07-30
Submitted:2008-08-15
Entered:2008-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC210127AA / 3 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF295AA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C35171 / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0508U / 3 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Haematochezia, Intussusception

Life Threatening? Yes
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None. PMH: none
Allergies:
Diagnostic Lab Data: Ultrasound. Labs and Diagnostics: Abdominal X-ray non specific. Abdominal US (+) for IS in mid abdomen. Barium Enema (+) for IS. CBC, Chem and UA unremarkable. UC (-).
CDC 'Split Type':

Write-up: Intussusception noted 07/30/2008. Bloody stool, Air intussusception reduction successful, reporting because of association of rotavirus immunization and intussusception. 9/8/2008 MR received for DOS 7/30-31/2008 with D/C DX: S/P Reduction of Intussusception. Pt presented with abdominal pain, vomiting x10-12 and bloody stool. IS was noted on Barium Enema following a (+) US and reduced successfully. Admitted for observation o/n with no further problems.


Changed on 6/14/2018

VAERS ID: 323038 Before After
VAERS Form:1
Age:0.6
Gender:Male
Location:California
Vaccinated:2008-05-22
Onset:2008-07-30
Submitted:2008-08-15
Entered:2008-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC210127AA / 3 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF295AA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C35171 / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0508U / 3 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Haematochezia, Intussusception

Life Threatening? Yes
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None. PMH: none
Allergies:
Diagnostic Lab Data: Ultrasound. Labs and Diagnostics: Abdominal X-ray non specific. Abdominal US (+) for IS in mid abdomen. Barium Enema (+) for IS. CBC, Chem and UA unremarkable. UC (-).
CDC 'Split Type':

Write-up: Intussusception noted 07/30/2008. Bloody stool, Air intussusception reduction successful, reporting because of association of rotavirus immunization and intussusception. 9/8/2008 MR received for DOS 7/30-31/2008 with D/C DX: S/P Reduction of Intussusception. Pt presented with abdominal pain, vomiting x10-12 and bloody stool. IS was noted on Barium Enema following a (+) US and reduced successfully. Admitted for observation o/n with no further problems.


Changed on 8/14/2018

VAERS ID: 323038 Before After
VAERS Form:1
Age:0.6
Gender:Male
Location:California
Vaccinated:2008-05-22
Onset:2008-07-30
Submitted:2008-08-15
Entered:2008-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC210127AA / 3 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF295AA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C35171 / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0508U / 3 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Haematochezia, Intussusception

Life Threatening? Yes
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None. PMH: none
Allergies:
Diagnostic Lab Data: Ultrasound. Labs and Diagnostics: Abdominal X-ray non specific. Abdominal US (+) for IS in mid abdomen. Barium Enema (+) for IS. CBC, Chem and UA unremarkable. UC (-).
CDC 'Split Type':

Write-up: Intussusception noted 07/30/2008. Bloody stool, Air intussusception reduction successful, reporting because of association of rotavirus immunization and intussusception. 9/8/2008 MR received for DOS 7/30-31/2008 with D/C DX: S/P Reduction of Intussusception. Pt presented with abdominal pain, vomiting x10-12 and bloody stool. IS was noted on Barium Enema following a (+) US and reduced successfully. Admitted for observation o/n with no further problems.


Changed on 9/14/2018

VAERS ID: 323038 Before After
VAERS Form:1
Age:0.6
Gender:Male
Location:California
Vaccinated:2008-05-22
Onset:2008-07-30
Submitted:2008-08-15
Entered:2008-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC210127AA / 3 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF295AA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C35171 / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0508U / 3 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Haematochezia, Intussusception

Life Threatening? Yes
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None. PMH: none
Allergies:
Diagnostic Lab Data: Ultrasound. Labs and Diagnostics: Abdominal X-ray non specific. Abdominal US (+) for IS in mid abdomen. Barium Enema (+) for IS. CBC, Chem and UA unremarkable. UC (-).
CDC 'Split Type':

Write-up: Intussusception noted 07/30/2008. Bloody stool, Air intussusception reduction successful, reporting because of association of rotavirus immunization and intussusception. 9/8/2008 MR received for DOS 7/30-31/2008 with D/C DX: S/P Reduction of Intussusception. Pt presented with abdominal pain, vomiting x10-12 and bloody stool. IS was noted on Barium Enema following a (+) US and reduced successfully. Admitted for observation o/n with no further problems.


Changed on 10/14/2018

VAERS ID: 323038 Before After
VAERS Form:1
Age:0.6
Gender:Male
Location:California
Vaccinated:2008-05-22
Onset:2008-07-30
Submitted:2008-08-15
Entered:2008-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC210127AA / 3 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF295AA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C35171 / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0508U / 3 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Haematochezia, Intussusception

Life Threatening? Yes
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None. PMH: none
Allergies:
Diagnostic Lab Data: Ultrasound. Labs and Diagnostics: Abdominal X-ray non specific. Abdominal US (+) for IS in mid abdomen. Barium Enema (+) for IS. CBC, Chem and UA unremarkable. UC (-).
CDC 'Split Type':

Write-up: Intussusception noted 07/30/2008. Bloody stool, Air intussusception reduction successful, reporting because of association of rotavirus immunization and intussusception. 9/8/2008 MR received for DOS 7/30-31/2008 with D/C DX: S/P Reduction of Intussusception. Pt presented with abdominal pain, vomiting x10-12 and bloody stool. IS was noted on Barium Enema following a (+) US and reduced successfully. Admitted for observation o/n with no further problems.

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