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This is VAERS ID 338639

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

VAERS ID: 338639
VAERS Form:
Age:0.5
Gender:Male
Location:Pennsylvania
Vaccinated:2009-01-27
Onset:2009-01-28
Submitted:2009-01-29
Entered:2009-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B149A / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF472AB / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1264X / 2 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal pain, Abdominal tenderness, Barium enema abnormal, Haematochezia, Intussusception, Irritability, Mucous stools, Nausea, Surgery, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Abdominal X-ray, Hypophagia

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None. PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd U/S (+) for IS. Abd X-ray abnormal. BE abnormal.
CDC 'Split Type':

Write-up: Patient received ROTATEQ on 1-27-09, developed intussusception on 1-28-09, required surgical repair 1-28-09. 2/9/2009 MR received for DOS 1/28-31/2009 with D/C DX: Intussusception. Pt presented with bloody, mucus stools, abdominal pain, irritability, nausea, decreased PO and vomiting. PE (+) RLQ tenderness. IS unable to be reduced using Barium Enema so pt taken to OR for surgery-open reduction with appy. Uncomplicated post-op course.


Changed on 5/13/2013

VAERS ID: 338639 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Pennsylvania
Vaccinated:2009-01-27
Onset:2009-01-28
Submitted:2009-01-29
Entered:2009-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B149A / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF472AB / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1264X / 2 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1264X / 2 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal pain, Abdominal tenderness, Barium enema abnormal, Haematochezia, Intussusception, Irritability, Mucous stools, Nausea, Surgery, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Abdominal X-ray, Hypophagia

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None. PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd U/S (+) for IS. Abd X-ray abnormal. BE abnormal.
CDC 'Split Type':

Write-up: Patient received ROTATEQ on 1-27-09, developed intussusception on 1-28-09, required surgical repair 1-28-09. 2/9/2009 MR received for DOS 1/28-31/2009 with D/C DX: Intussusception. Pt presented with bloody, mucus stools, abdominal pain, irritability, nausea, decreased PO and vomiting. PE (+) RLQ tenderness. IS unable to be reduced using Barium Enema so pt taken to OR for surgery-open reduction with appy. Uncomplicated post-op course.


Changed on 4/14/2017

VAERS ID: 338639 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Pennsylvania
Vaccinated:2009-01-27
Onset:2009-01-28
Submitted:2009-01-29
Entered:2009-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B149A / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF472AB / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1264X / 2 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Abdominal pain, Abdominal tenderness, Barium enema abnormal, Haematochezia, Intussusception, Irritability, Mucous stools, Nausea, Surgery, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Abdominal X-ray, Hypophagia

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None. PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd U/S (+) for IS. Abd X-ray abnormal. BE abnormal.
CDC 'Split Type':

Write-up: Patient received ROTATEQ on 1-27-09, developed intussusception on 1-28-09, required surgical repair 1-28-09. 2/9/2009 MR received for DOS 1/28-31/2009 with D/C DX: Intussusception. Pt presented with bloody, mucus stools, abdominal pain, irritability, nausea, decreased PO and vomiting. PE (+) RLQ tenderness. IS unable to be reduced using Barium Enema so pt taken to OR for surgery-open reduction with appy. Uncomplicated post-op course.


Changed on 9/14/2017

VAERS ID: 338639 Before After
VAERS Form:(blank) 1
Age:0.5
Gender:Male
Location:Pennsylvania
Vaccinated:2009-01-27
Onset:2009-01-28
Submitted:2009-01-29
Entered:2009-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B149A / 2 3 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF472AB / 2 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1264X / 2 3 - MO / PO

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

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None. PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd U/S (+) for IS. Abd X-ray abnormal. BE abnormal.
CDC 'Split Type':

Write-up: Patient received ROTATEQ on 1-27-09, developed intussusception on 1-28-09, required surgical repair 1-28-09. 2/9/2009 MR received for DOS 1/28-31/2009 with D/C DX: Intussusception. Pt presented with bloody, mucus stools, abdominal pain, irritability, nausea, decreased PO and vomiting. PE (+) RLQ tenderness. IS unable to be reduced using Barium Enema so pt taken to OR for surgery-open reduction with appy. Uncomplicated post-op course.


Changed on 2/14/2018

VAERS ID: 338639 Before After
VAERS Form:1
Age:0.5
Gender:Male
Location:Pennsylvania
Vaccinated:2009-01-27
Onset:2009-01-28
Submitted:2009-01-29
Entered:2009-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B149A / 3 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF472AB / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1264X / 3 MO / PO

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

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None. PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd U/S (+) for IS. Abd X-ray abnormal. BE abnormal.
CDC 'Split Type':

Write-up: Patient received ROTATEQ on 1-27-09, developed intussusception on 1-28-09, required surgical repair 1-28-09. 2/9/2009 MR received for DOS 1/28-31/2009 with D/C DX: Intussusception. Pt presented with bloody, mucus stools, abdominal pain, irritability, nausea, decreased PO and vomiting. PE (+) RLQ tenderness. IS unable to be reduced using Barium Enema so pt taken to OR for surgery-open reduction with appy. Uncomplicated post-op course.


Changed on 6/14/2018

VAERS ID: 338639 Before After
VAERS Form:1
Age:0.5
Gender:Male
Location:Pennsylvania
Vaccinated:2009-01-27
Onset:2009-01-28
Submitted:2009-01-29
Entered:2009-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B149A / 3 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF472AB / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1264X / 3 MO / PO

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

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None. PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd U/S (+) for IS. Abd X-ray abnormal. BE abnormal.
CDC 'Split Type':

Write-up: Patient received ROTATEQ on 1-27-09, developed intussusception on 1-28-09, required surgical repair 1-28-09. 2/9/2009 MR received for DOS 1/28-31/2009 with D/C DX: Intussusception. Pt presented with bloody, mucus stools, abdominal pain, irritability, nausea, decreased PO and vomiting. PE (+) RLQ tenderness. IS unable to be reduced using Barium Enema so pt taken to OR for surgery-open reduction with appy. Uncomplicated post-op course.


Changed on 8/14/2018

VAERS ID: 338639 Before After
VAERS Form:1
Age:0.5
Gender:Male
Location:Pennsylvania
Vaccinated:2009-01-27
Onset:2009-01-28
Submitted:2009-01-29
Entered:2009-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B149A / 3 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF472AB / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1264X / 3 MO / PO

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

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None. PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd U/S (+) for IS. Abd X-ray abnormal. BE abnormal.
CDC 'Split Type':

Write-up: Patient received ROTATEQ on 1-27-09, developed intussusception on 1-28-09, required surgical repair 1-28-09. 2/9/2009 MR received for DOS 1/28-31/2009 with D/C DX: Intussusception. Pt presented with bloody, mucus stools, abdominal pain, irritability, nausea, decreased PO and vomiting. PE (+) RLQ tenderness. IS unable to be reduced using Barium Enema so pt taken to OR for surgery-open reduction with appy. Uncomplicated post-op course.


Changed on 9/14/2018

VAERS ID: 338639 Before After
VAERS Form:1
Age:0.5
Gender:Male
Location:Pennsylvania
Vaccinated:2009-01-27
Onset:2009-01-28
Submitted:2009-01-29
Entered:2009-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B149A / 3 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF472AB / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1264X / 3 MO / PO

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

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None. PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd U/S (+) for IS. Abd X-ray abnormal. BE abnormal.
CDC 'Split Type':

Write-up: Patient received ROTATEQ on 1-27-09, developed intussusception on 1-28-09, required surgical repair 1-28-09. 2/9/2009 MR received for DOS 1/28-31/2009 with D/C DX: Intussusception. Pt presented with bloody, mucus stools, abdominal pain, irritability, nausea, decreased PO and vomiting. PE (+) RLQ tenderness. IS unable to be reduced using Barium Enema so pt taken to OR for surgery-open reduction with appy. Uncomplicated post-op course.


Changed on 10/14/2018

VAERS ID: 338639 Before After
VAERS Form:1
Age:0.5
Gender:Male
Location:Pennsylvania
Vaccinated:2009-01-27
Onset:2009-01-28
Submitted:2009-01-29
Entered:2009-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B149A / 3 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF472AB / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1264X / 3 MO / PO

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

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None. PMH: none
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Abd U/S (+) for IS. Abd X-ray abnormal. BE abnormal.
CDC 'Split Type':

Write-up: Patient received ROTATEQ on 1-27-09, developed intussusception on 1-28-09, required surgical repair 1-28-09. 2/9/2009 MR received for DOS 1/28-31/2009 with D/C DX: Intussusception. Pt presented with bloody, mucus stools, abdominal pain, irritability, nausea, decreased PO and vomiting. PE (+) RLQ tenderness. IS unable to be reduced using Barium Enema so pt taken to OR for surgery-open reduction with appy. Uncomplicated post-op course.

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