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This is VAERS ID 386473

History of Changes from the VAERS Wayback Machine

First Appeared on 5/11/2010

VAERS ID: 386473
VAERS Form:
Age:0.3
Sex:Male
Location:Alabama
Vaccinated:2010-04-20
Onset:2010-04-21
Submitted:2010-04-30
Entered:2010-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3541AA / - UN / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC 094433 / - UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1180Y / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema, Intussusception

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1004USA04333

Write-up: Information has been received from a registered nurse concerning an about 17 weeks old male patient who on 08-MAR-2010 was vaccinated oral with the first 2 ml dose of ROTATEQ (lot# 664685/1180Y). On 20-APR-2010, the patient was vaccinated oral with the second 2 ml dose of ROTATEQ (lot # 664685/1180Y). Concomitant therapy included PENTACEL and PREVNAR which were administered on 08-MAR-2010 and 20-APR-2010, and hepatitis B virus vaccine (unspecified) (manufactured by GlaxoSmithKline) which was administered on 08-MAR-2010. Subsequently the patient developed intussusception. On 21-APR-2010 the patient went to the hospital and stayed overnight. The patient was given a barium reduction while at the hospital. At the time of this report, the patient was recovering. Additional information has been requested.


Changed on 8/31/2010

VAERS ID: 386473 Before After
VAERS Form:
Age:0.3 0.2
Sex:Male
Location:Alabama
Vaccinated:2010-04-20 2010-03-08
Onset:2010-04-21 2010-04-15
Submitted:2010-04-30
Entered:2010-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3541AA / - UN / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 094433 / - UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1180Y / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema, Intussusception

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1004USA04333

Write-up: Information has been received from a registered nurse concerning an about 17 weeks old male patient who on 08-MAR-2010 was vaccinated oral with the first 2 ml dose of ROTATEQ (lot# 664685/1180Y). On 20-APR-2010, the patient was vaccinated oral with the second 2 ml dose of ROTATEQ (lot # 664685/1180Y). Concomitant therapy included PENTACEL and PREVNAR which were administered on 08-MAR-2010 and 20-APR-2010, and hepatitis B virus vaccine (unspecified) (manufactured by GlaxoSmithKline) which was administered on 08-MAR-2010. Subsequently the patient developed intussusception. On 21-APR-2010 the patient went to the hospital and stayed overnight. The patient was given a barium reduction while at the hospital. At the time of this report, the patient was recovering. Additional information has been requested.


Changed on 4/13/2011

VAERS ID: 386473 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Alabama
Vaccinated:2010-03-08
Onset:2010-04-15
Submitted:2010-04-30
Entered:2010-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3541AA / - UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 094433 / - UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1180Y / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema, Diarrhoea, Haematochezia, Intussusception

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1004USA04333

Write-up: Information has been received from a registered nurse concerning an about 17 weeks old male patient who on 08-MAR-2010 was vaccinated oral with the first 2 ml dose of ROTATEQ (lot# 664685/1180Y). On 20-APR-2010, the patient was vaccinated oral with the second 2 ml dose of ROTATEQ (lot # 664685/1180Y). Concomitant therapy included PENTACEL and PREVNAR which were administered on 08-MAR-2010 and 20-APR-2010, and hepatitis B virus vaccine (unspecified) (manufactured by GlaxoSmithKline) which was administered on 08-MAR-2010. Subsequently the patient developed intussusception. On 21-APR-2010 the patient went to the hospital and stayed overnight. The patient was given a barium reduction while at the hospital. At the time of this report, the patient was recovering. Additional information has been requested.


Changed on 5/13/2011

VAERS ID: 386473 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Alabama
Vaccinated:2010-03-08
Onset:2010-04-15
Submitted:2010-04-30
Entered:2010-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3541AA / - UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 094433 / - UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1180Y / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema, Diarrhoea, Haematochezia, Intussusception

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1004USA04333

Write-up: Information has been received from a registered nurse concerning an about 17 weeks old male patient who on 08-MAR-2010 was vaccinated oral with the first 2 ml dose of ROTATEQ (lot# 664685/1180Y). On 20-APR-2010, the patient was vaccinated oral with the second 2 ml dose of ROTATEQ (lot # 664685/1180Y). Concomitant therapy included PENTACEL and PREVNAR which were administered on 08-MAR-2010 and 20-APR-2010, and hepatitis B virus vaccine (unspecified) (manufactured by GlaxoSmithKline) which was administered on 08-MAR-2010. Subsequently the patient developed intussusception. On 21-APR-2010 the patient went to the hospital and stayed overnight. The patient was given a barium reduction while at the hospital. At the time of this report, the patient was recovering. Additional information has been requested.


Changed on 6/11/2011

VAERS ID: 386473 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Alabama
Vaccinated:2010-03-08
Onset:2010-04-15
Submitted:2010-04-30
Entered:2010-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3541AA / - UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 094433 / - UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1180Y / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema, Diarrhoea, Haematochezia, Intussusception

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1004USA04333

Write-up: Information has been received from a registered nurse concerning an about 17 weeks old male patient who on 08-MAR-2010 was vaccinated oral with the first 2 ml dose of ROTATEQ (lot# 664685/1180Y). On 20-APR-2010, the patient was vaccinated oral with the second 2 ml dose of ROTATEQ (lot # 664685/1180Y). Concomitant therapy included PENTACEL and PREVNAR which were administered on 08-MAR-2010 and 20-APR-2010, and hepatitis B virus vaccine (unspecified) (manufactured by GlaxoSmithKline) which was administered on 08-MAR-2010. Subsequently the patient developed intussusception. On 21-APR-2010 the patient went to the hospital and stayed overnight. The patient was given a barium reduction while at the hospital. At the time of this report, the patient was recovering. Additional information has been requested.


Changed on 5/13/2013

VAERS ID: 386473 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Alabama
Vaccinated:2010-03-08
Onset:2010-04-15
Submitted:2010-04-30
Entered:2010-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3541AA / - UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 094433 / - UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1180Y / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1180Y / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema, Diarrhoea, Haematochezia, Intussusception

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1004USA04333

Write-up: Information has been received from a registered nurse concerning an about 17 weeks old male patient who on 08-MAR-2010 was vaccinated oral with the first 2 ml dose of ROTATEQ (lot# 664685/1180Y). On 20-APR-2010, the patient was vaccinated oral with the second 2 ml dose of ROTATEQ (lot # 664685/1180Y). Concomitant therapy included PENTACEL and PREVNAR which were administered on 08-MAR-2010 and 20-APR-2010, and hepatitis B virus vaccine (unspecified) (manufactured by GlaxoSmithKline) which was administered on 08-MAR-2010. Subsequently the patient developed intussusception. On 21-APR-2010 the patient went to the hospital and stayed overnight. The patient was given a barium reduction while at the hospital. At the time of this report, the patient was recovering. Additional information has been requested.


Changed on 3/14/2015

VAERS ID: 386473 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Alabama
Vaccinated:2010-03-08
Onset:2010-04-15
Submitted:2010-04-30
Entered:2010-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3541AA / - UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 094433 / - UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1180Y / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema, Diarrhoea, Haematochezia, Intussusception

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1004USA04333

Write-up: Information has been received from a registered nurse concerning an about 17 weeks old male patient who on 08-MAR-2010 was vaccinated oral with the first 2 ml dose of ROTATEQ (lot# 664685/1180Y). On 20-APR-2010, the patient was vaccinated oral with the second 2 ml dose of ROTATEQ (lot # 664685/1180Y). Concomitant therapy included PENTACEL and PREVNAR which were administered on 08-MAR-2010 and 20-APR-2010, and hepatitis B virus vaccine (unspecified) (manufactured by GlaxoSmithKline) which was administered on 08-MAR-2010. Subsequently the patient developed intussusception. On 21-APR-2010 the patient went to the hospital and stayed overnight. The patient was given a barium reduction while at the hospital. At the time of this report, the patient was recovering. Additional information has been requested.


Changed on 2/14/2017

VAERS ID: 386473 Before After
VAERS Form:
Age:0.2 0.22
Sex:Male
Location:Alabama
Vaccinated:2010-03-08
Onset:2010-04-15
Submitted:2010-04-30
Entered:2010-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3541AA / - UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 094433 / - UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1180Y / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema, Intussusception

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1004USA04333

Write-up: Information has been received from a registered nurse concerning an about 17 weeks old male patient who on 08-MAR-2010 was vaccinated oral with the first 2 ml dose of ROTATEQ (lot# 664685/1180Y). On 20-APR-2010, the patient was vaccinated oral with the second 2 ml dose of ROTATEQ (lot # 664685/1180Y). Concomitant therapy included PENTACEL and PREVNAR which were administered on 08-MAR-2010 and 20-APR-2010, and hepatitis B virus vaccine (unspecified) (manufactured by GlaxoSmithKline) which was administered on 08-MAR-2010. Subsequently the patient developed intussusception. On 21-APR-2010 the patient went to the hospital and stayed overnight. The patient was given a barium reduction while at the hospital. At the time of this report, the patient was recovering. Additional information has been requested.


Changed on 9/14/2017

VAERS ID: 386473 Before After
VAERS Form:(blank) 1
Age:0.22
Sex:Male
Location:Alabama
Vaccinated:2010-03-08
Onset:2010-04-15
Submitted:2010-04-30
Entered:2010-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3541AA / - UNK UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 094433 / - UNK UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1180Y / 1 2 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema, Intussusception

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1004USA04333

Write-up: Information has been received from a registered nurse concerning an about 17 weeks old male patient who on 08-MAR-2010 was vaccinated oral with the first 2 ml dose of ROTATEQ (lot# 664685/1180Y). On 20-APR-2010, the patient was vaccinated oral with the second 2 ml dose of ROTATEQ (lot # 664685/1180Y). Concomitant therapy included PENTACEL and PREVNAR which were administered on 08-MAR-2010 and 20-APR-2010, and hepatitis B virus vaccine (unspecified) (manufactured by GlaxoSmithKline) which was administered on 08-MAR-2010. Subsequently the patient developed intussusception. On 21-APR-2010 the patient went to the hospital and stayed overnight. The patient was given a barium reduction while at the hospital. At the time of this report, the patient was recovering. Additional information has been requested.


Changed on 2/14/2018

VAERS ID: 386473 Before After
VAERS Form:1
Age:0.22
Sex:Male
Location:Alabama
Vaccinated:2010-03-08
Onset:2010-04-15
Submitted:2010-04-30
Entered:2010-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3541AA / UNK UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 094433 / UNK UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1180Y / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema, Intussusception

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1004USA04333

Write-up: Information has been received from a registered nurse concerning an about 17 weeks old male patient who on 08-MAR-2010 was vaccinated oral with the first 2 ml dose of ROTATEQ (lot# 664685/1180Y). On 20-APR-2010, the patient was vaccinated oral with the second 2 ml dose of ROTATEQ (lot # 664685/1180Y). Concomitant therapy included PENTACEL and PREVNAR which were administered on 08-MAR-2010 and 20-APR-2010, and hepatitis B virus vaccine (unspecified) (manufactured by GlaxoSmithKline) which was administered on 08-MAR-2010. Subsequently the patient developed intussusception. On 21-APR-2010 the patient went to the hospital and stayed overnight. The patient was given a barium reduction while at the hospital. At the time of this report, the patient was recovering. Additional information has been requested.


Changed on 6/14/2018

VAERS ID: 386473 Before After
VAERS Form:1
Age:0.22
Sex:Male
Location:Alabama
Vaccinated:2010-03-08
Onset:2010-04-15
Submitted:2010-04-30
Entered:2010-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3541AA / UNK UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 094433 / UNK UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1180Y / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema, Intussusception

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1004USA04333

Write-up: Information has been received from a registered nurse concerning an about 17 weeks old male patient who on 08-MAR-2010 was vaccinated oral with the first 2 ml dose of ROTATEQ (lot# 664685/1180Y). On 20-APR-2010, the patient was vaccinated oral with the second 2 ml dose of ROTATEQ (lot # 664685/1180Y). Concomitant therapy included PENTACEL and PREVNAR which were administered on 08-MAR-2010 and 20-APR-2010, and hepatitis B virus vaccine (unspecified) (manufactured by GlaxoSmithKline) which was administered on 08-MAR-2010. Subsequently the patient developed intussusception. On 21-APR-2010 the patient went to the hospital and stayed overnight. The patient was given a barium reduction while at the hospital. At the time of this report, the patient was recovering. Additional information has been requested.


Changed on 8/14/2018

VAERS ID: 386473 Before After
VAERS Form:1
Age:0.22
Sex:Male
Location:Alabama
Vaccinated:2010-03-08
Onset:2010-04-15
Submitted:2010-04-30
Entered:2010-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3541AA / UNK UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 094433 / UNK UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1180Y / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema, Intussusception

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1004USA04333

Write-up: Information has been received from a registered nurse concerning an about 17 weeks old male patient who on 08-MAR-2010 was vaccinated oral with the first 2 ml dose of ROTATEQ (lot# 664685/1180Y). On 20-APR-2010, the patient was vaccinated oral with the second 2 ml dose of ROTATEQ (lot # 664685/1180Y). Concomitant therapy included PENTACEL and PREVNAR which were administered on 08-MAR-2010 and 20-APR-2010, and hepatitis B virus vaccine (unspecified) (manufactured by GlaxoSmithKline) which was administered on 08-MAR-2010. Subsequently the patient developed intussusception. On 21-APR-2010 the patient went to the hospital and stayed overnight. The patient was given a barium reduction while at the hospital. At the time of this report, the patient was recovering. Additional information has been requested.


Changed on 9/14/2018

VAERS ID: 386473 Before After
VAERS Form:1
Age:0.22
Sex:Male
Location:Alabama
Vaccinated:2010-03-08
Onset:2010-04-15
Submitted:2010-04-30
Entered:2010-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3541AA / UNK UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 094433 / UNK UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1180Y / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema, Intussusception

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1004USA04333

Write-up: Information has been received from a registered nurse concerning an about 17 weeks old male patient who on 08-MAR-2010 was vaccinated oral with the first 2 ml dose of ROTATEQ (lot# 664685/1180Y). On 20-APR-2010, the patient was vaccinated oral with the second 2 ml dose of ROTATEQ (lot # 664685/1180Y). Concomitant therapy included PENTACEL and PREVNAR which were administered on 08-MAR-2010 and 20-APR-2010, and hepatitis B virus vaccine (unspecified) (manufactured by GlaxoSmithKline) which was administered on 08-MAR-2010. Subsequently the patient developed intussusception. On 21-APR-2010 the patient went to the hospital and stayed overnight. The patient was given a barium reduction while at the hospital. At the time of this report, the patient was recovering. Additional information has been requested.


Changed on 10/14/2018

VAERS ID: 386473 Before After
VAERS Form:1
Age:0.22
Sex:Male
Location:Alabama
Vaccinated:2010-03-08
Onset:2010-04-15
Submitted:2010-04-30
Entered:2010-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3541AA / UNK UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 094433 / UNK UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1180Y / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium enema, Intussusception

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1004USA04333

Write-up: Information has been received from a registered nurse concerning an about 17 weeks old male patient who on 08-MAR-2010 was vaccinated oral with the first 2 ml dose of ROTATEQ (lot# 664685/1180Y). On 20-APR-2010, the patient was vaccinated oral with the second 2 ml dose of ROTATEQ (lot # 664685/1180Y). Concomitant therapy included PENTACEL and PREVNAR which were administered on 08-MAR-2010 and 20-APR-2010, and hepatitis B virus vaccine (unspecified) (manufactured by GlaxoSmithKline) which was administered on 08-MAR-2010. Subsequently the patient developed intussusception. On 21-APR-2010 the patient went to the hospital and stayed overnight. The patient was given a barium reduction while at the hospital. At the time of this report, the patient was recovering. Additional information has been requested.

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