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This is VAERS ID 381719

History of Changes from the VAERS Wayback Machine

First Appeared on 4/7/2010

VAERS ID: 381719
VAERS Form:
Age:0.3
Sex:Male
Location:Virginia
Vaccinated:2010-02-22
Onset:2010-02-27
Submitted:2010-03-02
Entered:2010-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3451AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC E25197 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1442Y / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Clostridium difficile colitis, Haematochezia, Intussusception, Mucous stools, Upper respiratory tract infection, Vomiting, Ultrasound abdomen abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Ultrasound of RLQ of abdomen c/w ileocolic intussusception
CDC 'Split Type':

Write-up: Patient began vomiting 5 days after vaccinations and then developed a copious bloody stool <24 hours after the onset of vomiting. Seen in the ED and diagnosed with intussusception-reduction being attempted.


Changed on 7/31/2010

VAERS ID: 381719 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Virginia
Vaccinated:2010-02-22
Onset:2010-02-27
Submitted:2010-03-02
Entered:2010-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3451AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC E25197 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1442Y / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Clostridium difficile colitis, Haematochezia, Intussusception, Mucous stools, Upper respiratory tract infection, Vomiting, Ultrasound abdomen abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Ultrasound of RLQ of abdomen c/w ileocolic intussusception
CDC 'Split Type':

Write-up: Patient began vomiting 5 days after vaccinations and then developed a copious bloody stool <24 hours after the onset of vomiting. Seen in the ED and diagnosed with intussusception-reduction being attempted.


Changed on 8/31/2010

VAERS ID: 381719 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Virginia
Vaccinated:2010-02-22
Onset:2010-02-27
Submitted:2010-03-02
Entered:2010-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3451AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH E25197 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1442Y / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Haematochezia, Intussusception, Vomiting, Ultrasound abdomen abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Ultrasound of RLQ of abdomen c/w ileocolic intussusception
CDC 'Split Type':

Write-up: Patient began vomiting 5 days after vaccinations and then developed a copious bloody stool <24 hours after the onset of vomiting. Seen in the ED and diagnosed with intussusception-reduction being attempted.


Changed on 4/13/2011

VAERS ID: 381719 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Virginia
Vaccinated:2010-02-22
Onset:2010-02-27
Submitted:2010-03-02
Entered:2010-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3451AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E25197 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1442Y / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Clostridium difficile colitis, Haematochezia, Intussusception, Mucous stools, Upper respiratory tract infection, Vomiting, Ultrasound abdomen abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Ultrasound of RLQ of abdomen c/w ileocolic intussusception
CDC 'Split Type':

Write-up: Patient began vomiting 5 days after vaccinations and then developed a copious bloody stool <24 hours after the onset of vomiting. Seen in the ED and diagnosed with intussusception-reduction being attempted.


Changed on 5/13/2011

VAERS ID: 381719 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Virginia
Vaccinated:2010-02-22
Onset:2010-02-27
Submitted:2010-03-02
Entered:2010-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3451AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E25197 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1442Y / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Clostridium difficile colitis, Haematochezia, Intussusception, Mucous stools, Upper respiratory tract infection, Vomiting, Ultrasound abdomen abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Ultrasound of RLQ of abdomen c/w ileocolic intussusception
CDC 'Split Type':

Write-up: Patient began vomiting 5 days after vaccinations and then developed a copious bloody stool <24 hours after the onset of vomiting. Seen in the ED and diagnosed with intussusception-reduction being attempted.


Changed on 6/11/2011

VAERS ID: 381719 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Virginia
Vaccinated:2010-02-22
Onset:2010-02-27
Submitted:2010-03-02
Entered:2010-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3451AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E25197 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1442Y / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Clostridium difficile colitis, Haematochezia, Intussusception, Mucous stools, Upper respiratory tract infection, Vomiting, Ultrasound abdomen abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Ultrasound of RLQ of abdomen c/w ileocolic intussusception
CDC 'Split Type':

Write-up: Patient began vomiting 5 days after vaccinations and then developed a copious bloody stool <24 hours after the onset of vomiting. Seen in the ED and diagnosed with intussusception-reduction being attempted.


Changed on 5/13/2013

VAERS ID: 381719 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Virginia
Vaccinated:2010-02-22
Onset:2010-02-27
Submitted:2010-03-02
Entered:2010-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3451AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E25197 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1442Y / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1442Y / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Clostridium difficile colitis, Haematochezia, Intussusception, Mucous stools, Upper respiratory tract infection, Vomiting, Ultrasound abdomen abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Ultrasound of RLQ of abdomen c/w ileocolic intussusception
CDC 'Split Type':

Write-up: Patient began vomiting 5 days after vaccinations and then developed a copious bloody stool <24 hours after the onset of vomiting. Seen in the ED and diagnosed with intussusception-reduction being attempted.


Changed on 3/14/2015

VAERS ID: 381719 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Virginia
Vaccinated:2010-02-22
Onset:2010-02-27
Submitted:2010-03-02
Entered:2010-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3451AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E25197 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1442Y / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Barium double contrast, Clostridium difficile colitis, Haematochezia, Intussusception, Mucous stools, Upper respiratory tract infection, Vomiting, Ultrasound abdomen abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Ultrasound of RLQ of abdomen c/w ileocolic intussusception
CDC 'Split Type':

Write-up: Patient began vomiting 5 days after vaccinations and then developed a copious bloody stool <24 hours after the onset of vomiting. Seen in the ED and diagnosed with intussusception-reduction being attempted.


Changed on 2/14/2017

VAERS ID: 381719 Before After
VAERS Form:
Age:0.3 0.34
Sex:Male
Location:Virginia
Vaccinated:2010-02-22
Onset:2010-02-27
Submitted:2010-03-02
Entered:2010-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3451AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E25197 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1442Y / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Haematochezia, Intussusception, Vomiting, Ultrasound abdomen abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Ultrasound of RLQ of abdomen c/w ileocolic intussusception
CDC 'Split Type':

Write-up: Patient began vomiting 5 days after vaccinations and then developed a copious bloody stool <24 hours after the onset of vomiting. Seen in the ED and diagnosed with intussusception-reduction being attempted.


Changed on 9/14/2017

VAERS ID: 381719 Before After
VAERS Form:(blank) 1
Age:0.34
Sex:Male
Location:Virginia
Vaccinated:2010-02-22
Onset:2010-02-27
Submitted:2010-03-02
Entered:2010-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3451AA / 1 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E25197 / 1 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1442Y / 1 2 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Haematochezia, Intussusception, Vomiting, Ultrasound abdomen abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Ultrasound of RLQ of abdomen c/w ileocolic intussusception
CDC 'Split Type':

Write-up: Patient began vomiting 5 days after vaccinations and then developed a copious bloody stool <24 hours after the onset of vomiting. Seen in the ED and diagnosed with intussusception-reduction being attempted.


Changed on 2/14/2018

VAERS ID: 381719 Before After
VAERS Form:1
Age:0.34
Sex:Male
Location:Virginia
Vaccinated:2010-02-22
Onset:2010-02-27
Submitted:2010-03-02
Entered:2010-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3451AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E25197 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1442Y / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Haematochezia, Intussusception, Vomiting, Ultrasound abdomen abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Ultrasound of RLQ of abdomen c/w ileocolic intussusception
CDC 'Split Type':

Write-up: Patient began vomiting 5 days after vaccinations and then developed a copious bloody stool <24 hours after the onset of vomiting. Seen in the ED and diagnosed with intussusception-reduction being attempted.


Changed on 6/14/2018

VAERS ID: 381719 Before After
VAERS Form:1
Age:0.34
Sex:Male
Location:Virginia
Vaccinated:2010-02-22
Onset:2010-02-27
Submitted:2010-03-02
Entered:2010-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3451AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E25197 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1442Y / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Haematochezia, Intussusception, Vomiting, Ultrasound abdomen abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Ultrasound of RLQ of abdomen c/w ileocolic intussusception
CDC 'Split Type':

Write-up: Patient began vomiting 5 days after vaccinations and then developed a copious bloody stool <24 hours after the onset of vomiting. Seen in the ED and diagnosed with intussusception-reduction being attempted.


Changed on 8/14/2018

VAERS ID: 381719 Before After
VAERS Form:1
Age:0.34
Sex:Male
Location:Virginia
Vaccinated:2010-02-22
Onset:2010-02-27
Submitted:2010-03-02
Entered:2010-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3451AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E25197 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1442Y / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Haematochezia, Intussusception, Vomiting, Ultrasound abdomen abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Ultrasound of RLQ of abdomen c/w ileocolic intussusception
CDC 'Split Type':

Write-up: Patient began vomiting 5 days after vaccinations and then developed a copious bloody stool <24 hours after the onset of vomiting. Seen in the ED and diagnosed with intussusception-reduction being attempted.


Changed on 9/14/2018

VAERS ID: 381719 Before After
VAERS Form:1
Age:0.34
Sex:Male
Location:Virginia
Vaccinated:2010-02-22
Onset:2010-02-27
Submitted:2010-03-02
Entered:2010-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3451AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E25197 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1442Y / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Haematochezia, Intussusception, Vomiting, Ultrasound abdomen abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Ultrasound of RLQ of abdomen c/w ileocolic intussusception
CDC 'Split Type':

Write-up: Patient began vomiting 5 days after vaccinations and then developed a copious bloody stool <24 hours after the onset of vomiting. Seen in the ED and diagnosed with intussusception-reduction being attempted.


Changed on 10/14/2018

VAERS ID: 381719 Before After
VAERS Form:1
Age:0.34
Sex:Male
Location:Virginia
Vaccinated:2010-02-22
Onset:2010-02-27
Submitted:2010-03-02
Entered:2010-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3451AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH E25197 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1442Y / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Haematochezia, Intussusception, Vomiting, Ultrasound abdomen abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Ultrasound of RLQ of abdomen c/w ileocolic intussusception
CDC 'Split Type':

Write-up: Patient began vomiting 5 days after vaccinations and then developed a copious bloody stool <24 hours after the onset of vomiting. Seen in the ED and diagnosed with intussusception-reduction being attempted.

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