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This is VAERS ID 426959

History of Changes from the VAERS Wayback Machine

First Appeared on 7/12/2011

VAERS ID: 426959
VAERS Form:
Age:0.4
Gender:Male
Location:Indiana
Vaccinated:2010-11-29
Onset:2010-12-03
Submitted:2011-07-07
Entered:2011-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3732AA / 1 LG / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E80083 / 1 LG / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB088A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Appendicectomy, Haematochezia, Intestinal dilatation, Intussusception, Irritability, Vomiting, Explorative laparotomy, Painful defaecation, Computerised tomogram abdomen abnormal, Intestinal operation

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amoxicillin suspension 150mg BID 11/18/10-11/27/10
Current Illness: None; Just recovered from viral syndrome/otitis media
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abdominal CT - intussusception with dilation of proximal small bowel loops and air fluid levels
CDC 'Split Type':

Write-up: Upon recent news of concerns of intussusception following ROTARIX, I remembered this young patient''s case. On 12/3/10, he developed painful bowel movements which progressed to bloody stools. He became very fussy and started vomiting later that day. He presented to hospital where abdominal CT revealed an intussusception. He was transferred to Children''s Hospital where he had an exploratory laparotomy. In surgery, they manually reduced his intussusception and performed a prophylactic appendectomy. He recovered well and was discharged on 12/7. Since that time he has remained in good health. I have provided copies of his hospital records.


Changed on 1/7/2013

VAERS ID: 426959 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Indiana
Vaccinated:2010-11-29
Onset:2010-12-03
Submitted:2011-07-07
Entered:2011-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3732AA / 1 LG / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E80083 / 1 LG / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB088A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Appendicectomy, Haematochezia, Intestinal dilatation, Intussusception, Irritability, Vomiting, Explorative laparotomy, Painful defaecation, Computerised tomogram abdomen abnormal, Intestinal operation

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amoxicillin suspension 150mg BID 11/18/10-11/27/10
Current Illness: None; Just recovered from viral syndrome/otitis media
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abdominal CT - intussusception with dilation of proximal small bowel loops and air fluid levels
CDC 'Split Type':

Write-up: Upon recent news of concerns of intussusception following ROTARIX, I remembered this young patient''s case. On 12/3/10, he developed painful bowel movements which progressed to bloody stools. He became very fussy and started vomiting later that day. He presented to hospital where abdominal CT revealed an intussusception. He was transferred to Children''s another Hospital where he had an exploratory laparotomy. In surgery, they manually reduced his intussusception and performed a prophylactic appendectomy. He recovered well and was discharged on 12/7. Since that time he has remained in good health. I have provided copies of his hospital records.


Changed on 5/13/2013

VAERS ID: 426959 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Indiana
Vaccinated:2010-11-29
Onset:2010-12-03
Submitted:2011-07-07
Entered:2011-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3732AA / 1 LG / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E80083 / 1 LG / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB088A / 1 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB088A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Appendicectomy, Haematochezia, Intestinal dilatation, Intussusception, Irritability, Vomiting, Explorative laparotomy, Painful defaecation, Computerised tomogram abdomen abnormal, Intestinal operation

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amoxicillin suspension 150mg BID 11/18/10-11/27/10
Current Illness: None; Just recovered from viral syndrome/otitis media
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abdominal CT - intussusception with dilation of proximal small bowel loops and air fluid levels
CDC 'Split Type':

Write-up: Upon recent news of concerns of intussusception following ROTARIX, I remembered this young patient''s case. On 12/3/10, he developed painful bowel movements which progressed to bloody stools. He became very fussy and started vomiting later that day. He presented to hospital where abdominal CT revealed an intussusception. He was transferred to another Hospital where he had an exploratory laparotomy. In surgery, they manually reduced his intussusception and performed a prophylactic appendectomy. He recovered well and was discharged on 12/7. Since that time he has remained in good health. I have provided copies of his hospital records.


Changed on 6/14/2014

VAERS ID: 426959 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Indiana
Vaccinated:2010-11-29
Onset:2010-12-03
Submitted:2011-07-07
Entered:2011-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3732AA / 1 LG / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E80083 / 1 LG / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB088A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Appendicectomy, Haematochezia, Intestinal dilatation, Intussusception, Irritability, Vomiting, Explorative laparotomy, Painful defaecation, Computerised tomogram abdomen abnormal, Intestinal operation

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amoxicillin suspension 150mg BID 11/18/10-11/27/10
Current Illness: None; Just recovered from viral syndrome/otitis media
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abdominal CT - intussusception with dilation of proximal small bowel loops and air fluid levels
CDC 'Split Type':

Write-up: Upon recent news of concerns of intussusception following ROTARIX, I remembered this young patient''s case. On 12/3/10, he developed painful bowel movements which progressed to bloody stools. He became very fussy and started vomiting later that day. He presented to hospital where abdominal CT revealed an intussusception. He was transferred to another Hospital where he had an exploratory laparotomy. In surgery, they manually reduced his intussusception and performed a prophylactic appendectomy. He recovered well and was discharged on 12/7. Since that time he has remained in good health. I have provided copies of his hospital records.


Changed on 3/14/2015

VAERS ID: 426959 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Indiana
Vaccinated:2010-11-29
Onset:2010-12-03
Submitted:2011-07-07
Entered:2011-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3732AA / 1 LG / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E80083 / 1 LG / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB088A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Appendicectomy, Haematochezia, Intestinal dilatation, Intussusception, Irritability, Vomiting, Explorative laparotomy, Painful defaecation, Computerised tomogram abdomen abnormal, Intestinal operation

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amoxicillin suspension 150mg BID 11/18/10-11/27/10
Current Illness: None; Just recovered from viral syndrome/otitis media
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abdominal CT - intussusception with dilation of proximal small bowel loops and air fluid levels
CDC 'Split Type':

Write-up: Upon recent news of concerns of intussusception following ROTARIX, I remembered this young patient''s case. On 12/3/10, he developed painful bowel movements which progressed to bloody stools. He became very fussy and started vomiting later that day. He presented to hospital where abdominal CT revealed an intussusception. He was transferred to another Hospital where he had an exploratory laparotomy. In surgery, they manually reduced his intussusception and performed a prophylactic appendectomy. He recovered well and was discharged on 12/7. Since that time he has remained in good health. I have provided copies of his hospital records.


Changed on 2/14/2017

VAERS ID: 426959 Before After
VAERS Form:
Age:0.4 0.35
Gender:Male
Location:Indiana
Vaccinated:2010-11-29
Onset:2010-12-03
Submitted:2011-07-07
Entered:2011-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3732AA / 1 LG / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E80083 / 1 LG / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB088A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Appendicectomy, Haematochezia, Intestinal dilatation, Intussusception, Irritability, Vomiting, Explorative laparotomy, Painful defaecation, Computerised tomogram abdomen abnormal, Intestinal operation

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amoxicillin suspension 150mg BID 11/18/10-11/27/10
Current Illness: None; Just recovered from viral syndrome/otitis media
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abdominal CT - intussusception with dilation of proximal small bowel loops and air fluid levels
CDC 'Split Type':

Write-up: Upon recent news of concerns of intussusception following ROTARIX, I remembered this young patient''s case. On 12/3/10, he developed painful bowel movements which progressed to bloody stools. He became very fussy and started vomiting later that day. He presented to hospital where abdominal CT revealed an intussusception. He was transferred to another Hospital where he had an exploratory laparotomy. In surgery, they manually reduced his intussusception and performed a prophylactic appendectomy. He recovered well and was discharged on 12/7. Since that time he has remained in good health. I have provided copies of his hospital records.


Changed on 9/14/2017

VAERS ID: 426959 Before After
VAERS Form:(blank) 1
Age:0.35
Gender:Male
Location:Indiana
Vaccinated:2010-11-29
Onset:2010-12-03
Submitted:2011-07-07
Entered:2011-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3732AA / 1 2 LG / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E80083 / 1 2 LG / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB088A / 1 2 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Appendicectomy, Haematochezia, Intestinal dilatation, Intussusception, Irritability, Vomiting, Explorative laparotomy, Painful defaecation, Computerised tomogram abdomen abnormal, Intestinal operation

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amoxicillin suspension 150mg BID 11/18/10-11/27/10
Current Illness: None; Just recovered from viral syndrome/otitis media
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abdominal CT - intussusception with dilation of proximal small bowel loops and air fluid levels
CDC 'Split Type':

Write-up: Upon recent news of concerns of intussusception following ROTARIX, I remembered this young patient''s case. On 12/3/10, he developed painful bowel movements which progressed to bloody stools. He became very fussy and started vomiting later that day. He presented to hospital where abdominal CT revealed an intussusception. He was transferred to another Hospital where he had an exploratory laparotomy. In surgery, they manually reduced his intussusception and performed a prophylactic appendectomy. He recovered well and was discharged on 12/7. Since that time he has remained in good health. I have provided copies of his hospital records.


Changed on 2/14/2018

VAERS ID: 426959 Before After
VAERS Form:1
Age:0.35
Gender:Male
Location:Indiana
Vaccinated:2010-11-29
Onset:2010-12-03
Submitted:2011-07-07
Entered:2011-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3732AA / 2 LG / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E80083 / 2 LG / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB088A / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Appendicectomy, Haematochezia, Intestinal dilatation, Intussusception, Irritability, Vomiting, Explorative laparotomy, Painful defaecation, Computerised tomogram abdomen abnormal, Intestinal operation

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amoxicillin suspension 150mg BID 11/18/10-11/27/10
Current Illness: None; Just recovered from viral syndrome/otitis media
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abdominal CT - intussusception with dilation of proximal small bowel loops and air fluid levels
CDC 'Split Type':

Write-up: Upon recent news of concerns of intussusception following ROTARIX, I remembered this young patient''s case. On 12/3/10, he developed painful bowel movements which progressed to bloody stools. He became very fussy and started vomiting later that day. He presented to hospital where abdominal CT revealed an intussusception. He was transferred to another Hospital where he had an exploratory laparotomy. In surgery, they manually reduced his intussusception and performed a prophylactic appendectomy. He recovered well and was discharged on 12/7. Since that time he has remained in good health. I have provided copies of his hospital records.


Changed on 6/14/2018

VAERS ID: 426959 Before After
VAERS Form:1
Age:0.35
Gender:Male
Location:Indiana
Vaccinated:2010-11-29
Onset:2010-12-03
Submitted:2011-07-07
Entered:2011-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3732AA / 2 LG / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E80083 / 2 LG / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB088A / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Appendicectomy, Haematochezia, Intestinal dilatation, Intussusception, Irritability, Vomiting, Explorative laparotomy, Painful defaecation, Computerised tomogram abdomen abnormal, Intestinal operation

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amoxicillin suspension 150mg BID 11/18/10-11/27/10
Current Illness: None; Just recovered from viral syndrome/otitis media
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abdominal CT - intussusception with dilation of proximal small bowel loops and air fluid levels
CDC 'Split Type':

Write-up: Upon recent news of concerns of intussusception following ROTARIX, I remembered this young patient''s case. On 12/3/10, he developed painful bowel movements which progressed to bloody stools. He became very fussy and started vomiting later that day. He presented to hospital where abdominal CT revealed an intussusception. He was transferred to another Hospital where he had an exploratory laparotomy. In surgery, they manually reduced his intussusception and performed a prophylactic appendectomy. He recovered well and was discharged on 12/7. Since that time he has remained in good health. I have provided copies of his hospital records.


Changed on 8/14/2018

VAERS ID: 426959 Before After
VAERS Form:1
Age:0.35
Gender:Male
Location:Indiana
Vaccinated:2010-11-29
Onset:2010-12-03
Submitted:2011-07-07
Entered:2011-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3732AA / 2 LG / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E80083 / 2 LG / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB088A / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Appendicectomy, Haematochezia, Intestinal dilatation, Intussusception, Irritability, Vomiting, Explorative laparotomy, Painful defaecation, Computerised tomogram abdomen abnormal, Intestinal operation

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amoxicillin suspension 150mg BID 11/18/10-11/27/10
Current Illness: None; Just recovered from viral syndrome/otitis media
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abdominal CT - intussusception with dilation of proximal small bowel loops and air fluid levels
CDC 'Split Type':

Write-up: Upon recent news of concerns of intussusception following ROTARIX, I remembered this young patient''s case. On 12/3/10, he developed painful bowel movements which progressed to bloody stools. He became very fussy and started vomiting later that day. He presented to hospital where abdominal CT revealed an intussusception. He was transferred to another Hospital where he had an exploratory laparotomy. In surgery, they manually reduced his intussusception and performed a prophylactic appendectomy. He recovered well and was discharged on 12/7. Since that time he has remained in good health. I have provided copies of his hospital records.


Changed on 9/14/2018

VAERS ID: 426959 Before After
VAERS Form:1
Age:0.35
Gender:Male
Location:Indiana
Vaccinated:2010-11-29
Onset:2010-12-03
Submitted:2011-07-07
Entered:2011-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3732AA / 2 LG / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E80083 / 2 LG / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB088A / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Appendicectomy, Haematochezia, Intestinal dilatation, Intussusception, Irritability, Vomiting, Explorative laparotomy, Painful defaecation, Computerised tomogram abdomen abnormal, Intestinal operation

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amoxicillin suspension 150mg BID 11/18/10-11/27/10
Current Illness: None; Just recovered from viral syndrome/otitis media
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abdominal CT - intussusception with dilation of proximal small bowel loops and air fluid levels
CDC 'Split Type':

Write-up: Upon recent news of concerns of intussusception following ROTARIX, I remembered this young patient''s case. On 12/3/10, he developed painful bowel movements which progressed to bloody stools. He became very fussy and started vomiting later that day. He presented to hospital where abdominal CT revealed an intussusception. He was transferred to another Hospital where he had an exploratory laparotomy. In surgery, they manually reduced his intussusception and performed a prophylactic appendectomy. He recovered well and was discharged on 12/7. Since that time he has remained in good health. I have provided copies of his hospital records.

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