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This is VAERS ID 342506

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

VAERS ID: 342506
VAERS Form:
Age:0.3
Sex:Male
Location:Illinois
Vaccinated:2009-03-13
Onset:2009-03-20
Submitted:2009-03-24
Entered:2009-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 1794X / - - / PO
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. AC21B207BA / - - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Haematochezia, Intensive care, Intussusception, Irritability, Urinary system X-ray, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, X-ray gastrointestinal tract normal

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prevacid
Current Illness: Yes, URI
Preexisting Conditions: GERD PMH: constipation.
Allergies:
Diagnostic Lab Data: LABS: KUB revealed dilated central bowel loops & paucity of gas in LLQ. Abdominal US (+) IS in LLQ. Air contrast enema reduced. UGI series WNL.
CDC 'Split Type':

Write-up: Two events of intussusception, each after given rotateq vaccine, the second episode was 7 days after the rotateq was administered. Was life flighted both times. 03/25/09 Received hospital medical records of 2/15-2/17/09 & 3/21/2009. FINAL DX: Intussusception Records reveal patient experienced irritability, emesis, bloody stools. Seen in outlying ER & transferred to higher leve of care. Tx w/IVF, antibiotics. Surgery consult done & PICU. Admitted overnight for observation s/p enema reduction of IS. Radiology noted cecum abnormally positioned in LLQ. Developed increased pain & repeat US (-) for IS. 3/21/09 records consist only of abdominal x-ray & US. X-ray revealed distention of small bowel & possibly large bowel & could not exclude IS; however, US (-) for IS. No further medical records available for this visit.


Changed on 5/13/2013

VAERS ID: 342506 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Illinois
Vaccinated:2009-03-13
Onset:2009-03-20
Submitted:2009-03-24
Entered:2009-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 1794X / - - / PO
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. AC21B207BA / - - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. AC21B207BA / - - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Haematochezia, Intensive care, Intussusception, Irritability, Urinary system X-ray, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, X-ray gastrointestinal tract normal

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prevacid
Current Illness: Yes, URI
Preexisting Conditions: GERD PMH: constipation.
Allergies:
Diagnostic Lab Data: LABS: KUB revealed dilated central bowel loops & paucity of gas in LLQ. Abdominal US (+) IS in LLQ. Air contrast enema reduced. UGI series WNL.
CDC 'Split Type':

Write-up: Two events of intussusception, each after given rotateq vaccine, the second episode was 7 days after the rotateq was administered. Was life flighted both times. 03/25/09 Received hospital medical records of 2/15-2/17/09 & 3/21/2009. FINAL DX: Intussusception Records reveal patient experienced irritability, emesis, bloody stools. Seen in outlying ER & transferred to higher leve of care. Tx w/IVF, antibiotics. Surgery consult done & PICU. Admitted overnight for observation s/p enema reduction of IS. Radiology noted cecum abnormally positioned in LLQ. Developed increased pain & repeat US (-) for IS. 3/21/09 records consist only of abdominal x-ray & US. X-ray revealed distention of small bowel & possibly large bowel & could not exclude IS; however, US (-) for IS. No further medical records available for this visit.


Changed on 4/14/2017

VAERS ID: 342506 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Illinois
Vaccinated:2009-03-13
Onset:2009-03-20
Submitted:2009-03-24
Entered:2009-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 1794X / - - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. AC21B207BA / - - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Barium double contrast, Haematochezia, Intensive care, Intussusception, Irritability, Urinary system X-ray, Vomiting, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, X-ray gastrointestinal tract normal

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prevacid
Current Illness: Yes, URI
Preexisting Conditions: GERD PMH: constipation.
Allergies:
Diagnostic Lab Data: LABS: KUB revealed dilated central bowel loops & paucity of gas in LLQ. Abdominal US (+) IS in LLQ. Air contrast enema reduced. UGI series WNL.
CDC 'Split Type':

Write-up: Two events of intussusception, each after given rotateq vaccine, the second episode was 7 days after the rotateq was administered. Was life flighted both times. 03/25/09 Received hospital medical records of 2/15-2/17/09 & 3/21/2009. FINAL DX: Intussusception Records reveal patient experienced irritability, emesis, bloody stools. Seen in outlying ER & transferred to higher leve of care. Tx w/IVF, antibiotics. Surgery consult done & PICU. Admitted overnight for observation s/p enema reduction of IS. Radiology noted cecum abnormally positioned in LLQ. Developed increased pain & repeat US (-) for IS. 3/21/09 records consist only of abdominal x-ray & US. X-ray revealed distention of small bowel & possibly large bowel & could not exclude IS; however, US (-) for IS. No further medical records available for this visit.


Changed on 9/14/2017

VAERS ID: 342506 Before After
VAERS Form:(blank) 1
Age:0.3
Sex:Male
Location:Illinois
Vaccinated:2009-03-13
Onset:2009-03-20
Submitted:2009-03-24
Entered:2009-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 1794X / - UNK - MO / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. AC21B207BA / - UNK - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: 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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prevacid
Current Illness: Yes, URI
Preexisting Conditions: GERD PMH: constipation.
Allergies:
Diagnostic Lab Data: LABS: KUB revealed dilated central bowel loops & paucity of gas in LLQ. Abdominal US (+) IS in LLQ. Air contrast enema reduced. UGI series WNL.
CDC 'Split Type':

Write-up: Two events of intussusception, each after given rotateq vaccine, the second episode was 7 days after the rotateq was administered. Was life flighted both times. 03/25/09 Received hospital medical records of 2/15-2/17/09 & 3/21/2009. FINAL DX: Intussusception Records reveal patient experienced irritability, emesis, bloody stools. Seen in outlying ER & transferred to higher leve of care. Tx w/IVF, antibiotics. Surgery consult done & PICU. Admitted overnight for observation s/p enema reduction of IS. Radiology noted cecum abnormally positioned in LLQ. Developed increased pain & repeat US (-) for IS. 3/21/09 records consist only of abdominal x-ray & US. X-ray revealed distention of small bowel & possibly large bowel & could not exclude IS; however, US (-) for IS. No further medical records available for this visit.


Changed on 2/14/2018

VAERS ID: 342506 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Illinois
Vaccinated:2009-03-13
Onset:2009-03-20
Submitted:2009-03-24
Entered:2009-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 1794X / UNK MO / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. AC21B207BA / UNK MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: 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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prevacid
Current Illness: Yes, URI
Preexisting Conditions: GERD PMH: constipation.
Allergies:
Diagnostic Lab Data: LABS: KUB revealed dilated central bowel loops & paucity of gas in LLQ. Abdominal US (+) IS in LLQ. Air contrast enema reduced. UGI series WNL.
CDC 'Split Type':

Write-up: Two events of intussusception, each after given rotateq vaccine, the second episode was 7 days after the rotateq was administered. Was life flighted both times. 03/25/09 Received hospital medical records of 2/15-2/17/09 & 3/21/2009. FINAL DX: Intussusception Records reveal patient experienced irritability, emesis, bloody stools. Seen in outlying ER & transferred to higher leve of care. Tx w/IVF, antibiotics. Surgery consult done & PICU. Admitted overnight for observation s/p enema reduction of IS. Radiology noted cecum abnormally positioned in LLQ. Developed increased pain & repeat US (-) for IS. 3/21/09 records consist only of abdominal x-ray & US. X-ray revealed distention of small bowel & possibly large bowel & could not exclude IS; however, US (-) for IS. No further medical records available for this visit.


Changed on 6/14/2018

VAERS ID: 342506 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Illinois
Vaccinated:2009-03-13
Onset:2009-03-20
Submitted:2009-03-24
Entered:2009-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 1794X / UNK MO / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. AC21B207BA / UNK MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: 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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prevacid
Current Illness: Yes, URI
Preexisting Conditions: GERD PMH: constipation.
Allergies:
Diagnostic Lab Data: LABS: KUB revealed dilated central bowel loops & paucity of gas in LLQ. Abdominal US (+) IS in LLQ. Air contrast enema reduced. UGI series WNL.
CDC 'Split Type':

Write-up: Two events of intussusception, each after given rotateq vaccine, the second episode was 7 days after the rotateq was administered. Was life flighted both times. 03/25/09 Received hospital medical records of 2/15-2/17/09 & 3/21/2009. FINAL DX: Intussusception Records reveal patient experienced irritability, emesis, bloody stools. Seen in outlying ER & transferred to higher leve of care. Tx w/IVF, antibiotics. Surgery consult done & PICU. Admitted overnight for observation s/p enema reduction of IS. Radiology noted cecum abnormally positioned in LLQ. Developed increased pain & repeat US (-) for IS. 3/21/09 records consist only of abdominal x-ray & US. X-ray revealed distention of small bowel & possibly large bowel & could not exclude IS; however, US (-) for IS. No further medical records available for this visit.


Changed on 8/14/2018

VAERS ID: 342506 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Illinois
Vaccinated:2009-03-13
Onset:2009-03-20
Submitted:2009-03-24
Entered:2009-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 1794X / UNK MO / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. AC21B207BA / UNK MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: 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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prevacid
Current Illness: Yes, URI
Preexisting Conditions: GERD PMH: constipation.
Allergies:
Diagnostic Lab Data: LABS: KUB revealed dilated central bowel loops & paucity of gas in LLQ. Abdominal US (+) IS in LLQ. Air contrast enema reduced. UGI series WNL.
CDC 'Split Type':

Write-up: Two events of intussusception, each after given rotateq vaccine, the second episode was 7 days after the rotateq was administered. Was life flighted both times. 03/25/09 Received hospital medical records of 2/15-2/17/09 & 3/21/2009. FINAL DX: Intussusception Records reveal patient experienced irritability, emesis, bloody stools. Seen in outlying ER & transferred to higher leve of care. Tx w/IVF, antibiotics. Surgery consult done & PICU. Admitted overnight for observation s/p enema reduction of IS. Radiology noted cecum abnormally positioned in LLQ. Developed increased pain & repeat US (-) for IS. 3/21/09 records consist only of abdominal x-ray & US. X-ray revealed distention of small bowel & possibly large bowel & could not exclude IS; however, US (-) for IS. No further medical records available for this visit.


Changed on 9/14/2018

VAERS ID: 342506 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Illinois
Vaccinated:2009-03-13
Onset:2009-03-20
Submitted:2009-03-24
Entered:2009-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 1794X / UNK MO / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. AC21B207BA / UNK MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: 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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prevacid
Current Illness: Yes, URI
Preexisting Conditions: GERD PMH: constipation.
Allergies:
Diagnostic Lab Data: LABS: KUB revealed dilated central bowel loops & paucity of gas in LLQ. Abdominal US (+) IS in LLQ. Air contrast enema reduced. UGI series WNL.
CDC 'Split Type':

Write-up: Two events of intussusception, each after given rotateq vaccine, the second episode was 7 days after the rotateq was administered. Was life flighted both times. 03/25/09 Received hospital medical records of 2/15-2/17/09 & 3/21/2009. FINAL DX: Intussusception Records reveal patient experienced irritability, emesis, bloody stools. Seen in outlying ER & transferred to higher leve of care. Tx w/IVF, antibiotics. Surgery consult done & PICU. Admitted overnight for observation s/p enema reduction of IS. Radiology noted cecum abnormally positioned in LLQ. Developed increased pain & repeat US (-) for IS. 3/21/09 records consist only of abdominal x-ray & US. X-ray revealed distention of small bowel & possibly large bowel & could not exclude IS; however, US (-) for IS. No further medical records available for this visit.


Changed on 10/14/2018

VAERS ID: 342506 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Illinois
Vaccinated:2009-03-13
Onset:2009-03-20
Submitted:2009-03-24
Entered:2009-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 1794X / UNK MO / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. AC21B207BA / UNK MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: 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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prevacid
Current Illness: Yes, URI
Preexisting Conditions: GERD PMH: constipation.
Allergies:
Diagnostic Lab Data: LABS: KUB revealed dilated central bowel loops & paucity of gas in LLQ. Abdominal US (+) IS in LLQ. Air contrast enema reduced. UGI series WNL.
CDC 'Split Type':

Write-up: Two events of intussusception, each after given rotateq vaccine, the second episode was 7 days after the rotateq was administered. Was life flighted both times. 03/25/09 Received hospital medical records of 2/15-2/17/09 & 3/21/2009. FINAL DX: Intussusception Records reveal patient experienced irritability, emesis, bloody stools. Seen in outlying ER & transferred to higher leve of care. Tx w/IVF, antibiotics. Surgery consult done & PICU. Admitted overnight for observation s/p enema reduction of IS. Radiology noted cecum abnormally positioned in LLQ. Developed increased pain & repeat US (-) for IS. 3/21/09 records consist only of abdominal x-ray & US. X-ray revealed distention of small bowel & possibly large bowel & could not exclude IS; however, US (-) for IS. No further medical records available for this visit.

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