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This is VAERS ID 341098

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

VAERS ID: 341098
VAERS Form:
Age:0.3
Sex:Male
Location:California
Vaccinated:2008-12-08
Onset:2009-01-02
Submitted:2009-03-04
Entered:2009-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3240AA / 1 RL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C83143 / 2 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0593X / 1 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Abdominal pain, Crying, Culture stool, Haematochezia, Intussusception, Irritability, Urinary system X-ray, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound, stool culture 3/11/09-records received-US demonstrated intussusception and x-ray with air enema reduction. 3/17/09-records received-KUB and US showed intussusception.
CDC 'Split Type':

Write-up: Pt experienced vomiting and 1 bloody stool. He was taken to ED where they found he had intussusception. He was treated w/air enema. He was observed for 8 hrs w/o any reoccurance and then released. 3/11/09-records received for DOS 1/6/09-follow up after ER visit for C/O vomiting times 2 days on 1/2/09- 3/17/09-records received for DOS 1/2-1/3/09-DC DX: Intussusception. Presented with 1 day history of vomitng and one bloody stool, abdominal pain, fussy, irritability. Successful reduction via air enema.


Changed on 3/2/2010

VAERS ID: 341098 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:California
Vaccinated:2008-12-08
Onset:2009-01-02
Submitted:2009-03-04
Entered:2009-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3240AA / 1 RL / UN
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC C83143 / 2 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0593X / 1 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Abdominal pain, Crying, Culture stool, Haematochezia, Intussusception, Irritability, Urinary system X-ray, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound, stool culture 3/11/09-records received-US demonstrated intussusception and x-ray with air enema reduction. 3/17/09-records received-KUB and US showed intussusception.
CDC 'Split Type':

Write-up: Pt experienced vomiting and 1 bloody stool. He was taken to ED where they found he had intussusception. He was treated w/air enema. He was observed for 8 hrs w/o any reoccurance and then released. 3/11/09-records received for DOS 1/6/09-follow up after ER visit for C/O vomiting times 2 days on 1/2/09- 3/17/09-records received for DOS 1/2-1/3/09-DC DX: Intussusception. Presented with 1 day history of vomitng and one bloody stool, abdominal pain, fussy, irritability. Successful reduction via air enema.


Changed on 4/7/2010

VAERS ID: 341098 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:California
Vaccinated:2008-12-08
Onset:2009-01-02
Submitted:2009-03-04
Entered:2009-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3240AA / 1 RL / UN
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C83143 / 2 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0593X / 1 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Abdominal pain, Crying, Culture stool, Haematochezia, Intussusception, Irritability, Urinary system X-ray, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound, stool culture 3/11/09-records received-US demonstrated intussusception and x-ray with air enema reduction. 3/17/09-records received-KUB and US showed intussusception.
CDC 'Split Type':

Write-up: Pt experienced vomiting and 1 bloody stool. He was taken to ED where they found he had intussusception. He was treated w/air enema. He was observed for 8 hrs w/o any reoccurance and then released. 3/11/09-records received for DOS 1/6/09-follow up after ER visit for C/O vomiting times 2 days on 1/2/09- 3/17/09-records received for DOS 1/2-1/3/09-DC DX: Intussusception. Presented with 1 day history of vomitng and one bloody stool, abdominal pain, fussy, irritability. Successful reduction via air enema.


Changed on 8/31/2010

VAERS ID: 341098 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:California
Vaccinated:2008-12-08
Onset:2009-01-02
Submitted:2009-03-04
Entered:2009-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3240AA / 1 RL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH C83143 / 2 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0593X / 1 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Abdominal pain, Crying, Culture stool, Haematochezia, Intussusception, Irritability, Urinary system X-ray, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound, stool culture 3/11/09-records received-US demonstrated intussusception and x-ray with air enema reduction. 3/17/09-records received-KUB and US showed intussusception.
CDC 'Split Type':

Write-up: Pt experienced vomiting and 1 bloody stool. He was taken to ED where they found he had intussusception. He was treated w/air enema. He was observed for 8 hrs w/o any reoccurance and then released. 3/11/09-records received for DOS 1/6/09-follow up after ER visit for C/O vomiting times 2 days on 1/2/09- 3/17/09-records received for DOS 1/2-1/3/09-DC DX: Intussusception. Presented with 1 day history of vomitng and one bloody stool, abdominal pain, fussy, irritability. Successful reduction via air enema.


Changed on 5/13/2013

VAERS ID: 341098 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:California
Vaccinated:2008-12-08
Onset:2009-01-02
Submitted:2009-03-04
Entered:2009-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3240AA / 1 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C83143 / 2 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0593X / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0593X / 1 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Abdominal pain, Crying, Culture stool, Haematochezia, Intussusception, Irritability, Urinary system X-ray, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound, stool culture 3/11/09-records received-US demonstrated intussusception and x-ray with air enema reduction. 3/17/09-records received-KUB and US showed intussusception.
CDC 'Split Type':

Write-up: Pt experienced vomiting and 1 bloody stool. He was taken to ED where they found he had intussusception. He was treated w/air enema. He was observed for 8 hrs w/o any reoccurance and then released. 3/11/09-records received for DOS 1/6/09-follow up after ER visit for C/O vomiting times 2 days on 1/2/09- 3/17/09-records received for DOS 1/2-1/3/09-DC DX: Intussusception. Presented with 1 day history of vomitng and one bloody stool, abdominal pain, fussy, irritability. Successful reduction via air enema.


Changed on 4/14/2017

VAERS ID: 341098 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:California
Vaccinated:2008-12-08
Onset:2009-01-02
Submitted:2009-03-04
Entered:2009-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3240AA / 1 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C83143 / 2 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0593X / 1 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Abdominal pain, Crying, Culture stool, Haematochezia, Intussusception, Irritability, Urinary system X-ray, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound, stool culture 3/11/09-records received-US demonstrated intussusception and x-ray with air enema reduction. 3/17/09-records received-KUB and US showed intussusception.
CDC 'Split Type':

Write-up: Pt experienced vomiting and 1 bloody stool. He was taken to ED where they found he had intussusception. He was treated w/air enema. He was observed for 8 hrs w/o any reoccurance and then released. 3/11/09-records received for DOS 1/6/09-follow up after ER visit for C/O vomiting times 2 days on 1/2/09- 3/17/09-records received for DOS 1/2-1/3/09-DC DX: Intussusception. Presented with 1 day history of vomitng and one bloody stool, abdominal pain, fussy, irritability. Successful reduction via air enema.


Changed on 9/14/2017

VAERS ID: 341098 Before After
VAERS Form:(blank) 1
Age:0.3
Sex:Male
Location:California
Vaccinated:2008-12-08
Onset:2009-01-02
Submitted:2009-03-04
Entered:2009-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3240AA / 1 2 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C83143 / 2 3 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0593X / 1 2 - MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Culture stool, Haematochezia, Intussusception, Vomiting

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound, stool culture 3/11/09-records received-US demonstrated intussusception and x-ray with air enema reduction. 3/17/09-records received-KUB and US showed intussusception.
CDC 'Split Type':

Write-up: Pt experienced vomiting and 1 bloody stool. He was taken to ED where they found he had intussusception. He was treated w/air enema. He was observed for 8 hrs w/o any reoccurance and then released. 3/11/09-records received for DOS 1/6/09-follow up after ER visit for C/O vomiting times 2 days on 1/2/09- 3/17/09-records received for DOS 1/2-1/3/09-DC DX: Intussusception. Presented with 1 day history of vomitng and one bloody stool, abdominal pain, fussy, irritability. Successful reduction via air enema.


Changed on 2/14/2018

VAERS ID: 341098 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:California
Vaccinated:2008-12-08
Onset:2009-01-02
Submitted:2009-03-04
Entered:2009-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3240AA / 2 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C83143 / 3 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0593X / 2 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Culture stool, Haematochezia, Intussusception, Vomiting

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound, stool culture 3/11/09-records received-US demonstrated intussusception and x-ray with air enema reduction. 3/17/09-records received-KUB and US showed intussusception.
CDC 'Split Type':

Write-up: Pt experienced vomiting and 1 bloody stool. He was taken to ED where they found he had intussusception. He was treated w/air enema. He was observed for 8 hrs w/o any reoccurance and then released. 3/11/09-records received for DOS 1/6/09-follow up after ER visit for C/O vomiting times 2 days on 1/2/09- 3/17/09-records received for DOS 1/2-1/3/09-DC DX: Intussusception. Presented with 1 day history of vomitng and one bloody stool, abdominal pain, fussy, irritability. Successful reduction via air enema.


Changed on 6/14/2018

VAERS ID: 341098 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:California
Vaccinated:2008-12-08
Onset:2009-01-02
Submitted:2009-03-04
Entered:2009-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3240AA / 2 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C83143 / 3 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0593X / 2 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Culture stool, Haematochezia, Intussusception, Vomiting

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound, stool culture 3/11/09-records received-US demonstrated intussusception and x-ray with air enema reduction. 3/17/09-records received-KUB and US showed intussusception.
CDC 'Split Type':

Write-up: Pt experienced vomiting and 1 bloody stool. He was taken to ED where they found he had intussusception. He was treated w/air enema. He was observed for 8 hrs w/o any reoccurance and then released. 3/11/09-records received for DOS 1/6/09-follow up after ER visit for C/O vomiting times 2 days on 1/2/09- 3/17/09-records received for DOS 1/2-1/3/09-DC DX: Intussusception. Presented with 1 day history of vomitng and one bloody stool, abdominal pain, fussy, irritability. Successful reduction via air enema.


Changed on 8/14/2018

VAERS ID: 341098 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:California
Vaccinated:2008-12-08
Onset:2009-01-02
Submitted:2009-03-04
Entered:2009-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3240AA / 2 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C83143 / 3 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0593X / 2 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Culture stool, Haematochezia, Intussusception, Vomiting

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound, stool culture 3/11/09-records received-US demonstrated intussusception and x-ray with air enema reduction. 3/17/09-records received-KUB and US showed intussusception.
CDC 'Split Type':

Write-up: Pt experienced vomiting and 1 bloody stool. He was taken to ED where they found he had intussusception. He was treated w/air enema. He was observed for 8 hrs w/o any reoccurance and then released. 3/11/09-records received for DOS 1/6/09-follow up after ER visit for C/O vomiting times 2 days on 1/2/09- 3/17/09-records received for DOS 1/2-1/3/09-DC DX: Intussusception. Presented with 1 day history of vomitng and one bloody stool, abdominal pain, fussy, irritability. Successful reduction via air enema.


Changed on 9/14/2018

VAERS ID: 341098 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:California
Vaccinated:2008-12-08
Onset:2009-01-02
Submitted:2009-03-04
Entered:2009-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3240AA / 2 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C83143 / 3 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0593X / 2 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Culture stool, Haematochezia, Intussusception, Vomiting

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound, stool culture 3/11/09-records received-US demonstrated intussusception and x-ray with air enema reduction. 3/17/09-records received-KUB and US showed intussusception.
CDC 'Split Type':

Write-up: Pt experienced vomiting and 1 bloody stool. He was taken to ED where they found he had intussusception. He was treated w/air enema. He was observed for 8 hrs w/o any reoccurance and then released. 3/11/09-records received for DOS 1/6/09-follow up after ER visit for C/O vomiting times 2 days on 1/2/09- 3/17/09-records received for DOS 1/2-1/3/09-DC DX: Intussusception. Presented with 1 day history of vomitng and one bloody stool, abdominal pain, fussy, irritability. Successful reduction via air enema.


Changed on 10/14/2018

VAERS ID: 341098 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:California
Vaccinated:2008-12-08
Onset:2009-01-02
Submitted:2009-03-04
Entered:2009-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3240AA / 2 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C83143 / 3 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0593X / 2 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Culture stool, Haematochezia, Intussusception, Vomiting

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Ultrasound, stool culture 3/11/09-records received-US demonstrated intussusception and x-ray with air enema reduction. 3/17/09-records received-KUB and US showed intussusception.
CDC 'Split Type':

Write-up: Pt experienced vomiting and 1 bloody stool. He was taken to ED where they found he had intussusception. He was treated w/air enema. He was observed for 8 hrs w/o any reoccurance and then released. 3/11/09-records received for DOS 1/6/09-follow up after ER visit for C/O vomiting times 2 days on 1/2/09- 3/17/09-records received for DOS 1/2-1/3/09-DC DX: Intussusception. Presented with 1 day history of vomitng and one bloody stool, abdominal pain, fussy, irritability. Successful reduction via air enema.

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