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This is VAERS ID 530161

History of Changes from the VAERS Wayback Machine

First Appeared on 6/14/2014

VAERS ID: 530161
VAERS Form:
Age:0.2
Gender:Male
Location:New York
Vaccinated:2014-02-27
Onset:2014-04-16
Submitted:2014-05-05
Entered:2014-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 4394C / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J014280 / 0 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH H50603 / 0 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB396A / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal tenderness, Activated partial thromboplastin time shortened, Haematochezia, Intussusception, Irritability, Vomiting, X-ray, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Abdominal X-ray, Blood test, Occult blood positive

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Prophylaxis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES1405USA000363

Write-up: This spontaneous report as received from a physician concerning a 3 month old male patient with no drug reactions/allergies and no pertinent medical history. On 27-FEB-2014 the patient was vaccinated with the first dose of ROTATEQ, oral (total dose was not reported). There was no concomitant medication. The physician reported that on 16-APR-2014, the patient developed intussusception and blood on his stools after receiving the first dose of either ROTATEQ or ROTARIX. The physician stated that she was not sure which product was administered to the patient and stated that she stocked both products in her office. The physician mentioned that the patient was sent to the emergency room from her office and was then hospitalized overnight at a medical center. The patient was treated with IV fluids and air enema. On an unknown date, an x ray and an unspecified blood work were performed (no result were provided). At the time of the report, in 2014, the patient recovered from intussusception. The physician considered intussusception as life threatening. The causality between intussusception and ROTATEQ was not provided. Lot number A41FB396A is an invalid lot number for ROTATEQ. Additional information has been requested.


Changed on 3/14/2015

VAERS ID: 530161 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:New York
Vaccinated:2014-02-27
Onset:2014-04-16
Submitted:2014-05-05
Entered:2014-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 4394C / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J014280 / 0 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH H50603 / 0 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB396A / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Abdominal tenderness, Activated partial thromboplastin time shortened, Haematochezia, Intussusception, Irritability, Vomiting, X-ray, X-ray abnormal, Enema administration, Ultrasound abdomen abnormal, Abdominal X-ray, Blood test, Occult blood positive

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Prophylaxis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES1405USA000363

Write-up: This spontaneous report as received from a physician concerning a 3 month old male patient with no drug reactions/allergies and no pertinent medical history. On 27-FEB-2014 the patient was vaccinated with the first dose of ROTATEQ, oral (total dose was not reported). There was no concomitant medication. The physician reported that on 16-APR-2014, the patient developed intussusception and blood on his stools after receiving the first dose of either ROTATEQ or ROTARIX. The physician stated that she was not sure which product was administered to the patient and stated that she stocked both products in her office. The physician mentioned that the patient was sent to the emergency room from her office and was then hospitalized overnight at a medical center. The patient was treated with IV fluids and air enema. On an unknown date, an x ray and an unspecified blood work were performed (no result were provided). At the time of the report, in 2014, the patient recovered from intussusception. The physician considered intussusception as life threatening. The causality between intussusception and ROTATEQ was not provided. Lot number A41FB396A is an invalid lot number for ROTATEQ. Additional information has been requested.


Changed on 2/14/2017

VAERS ID: 530161 Before After
VAERS Form:
Age:0.2 0.19
Gender:Male
Location:New York
Vaccinated:2014-02-27
Onset:2014-04-16
Submitted:2014-05-05
Entered:2014-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 4394C / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J014280 / 0 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH H50603 / 0 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB396A / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Haematochezia, Intussusception, X-ray, Enema administration, Blood test

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Prophylaxis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES1405USA000363

Write-up: This spontaneous report as received from a physician concerning a 3 month old male patient with no drug reactions/allergies and no pertinent medical history. On 27-FEB-2014 the patient was vaccinated with the first dose of ROTATEQ, oral (total dose was not reported). There was no concomitant medication. The physician reported that on 16-APR-2014, the patient developed intussusception and blood on his stools after receiving the first dose of either ROTATEQ or ROTARIX. The physician stated that she was not sure which product was administered to the patient and stated that she stocked both products in her office. The physician mentioned that the patient was sent to the emergency room from her office and was then hospitalized overnight at a medical center. The patient was treated with IV fluids and air enema. On an unknown date, an x ray and an unspecified blood work were performed (no result were provided). At the time of the report, in 2014, the patient recovered from intussusception. The physician considered intussusception as life threatening. The causality between intussusception and ROTATEQ was not provided. Lot number A41FB396A is an invalid lot number for ROTATEQ. Additional information has been requested.


Changed on 9/14/2017

VAERS ID: 530161 Before After
VAERS Form:(blank) 1
Age:0.19
Gender:Male
Location:New York
Vaccinated:2014-02-27
Onset:2014-04-16
Submitted:2014-05-05
Entered:2014-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 4394C / 0 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J014280 / 0 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH H50603 / 0 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB396A / 0 1 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Haematochezia, Intussusception, X-ray, Enema administration, Blood test

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Prophylaxis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES1405USA000363

Write-up: This spontaneous report as received from a physician concerning a 3 month old male patient with no drug reactions/allergies and no pertinent medical history. On 27-FEB-2014 the patient was vaccinated with the first dose of ROTATEQ, oral (total dose was not reported). There was no concomitant medication. The physician reported that on 16-APR-2014, the patient developed intussusception and blood on his stools after receiving the first dose of either ROTATEQ or ROTARIX. The physician stated that she was not sure which product was administered to the patient and stated that she stocked both products in her office. The physician mentioned that the patient was sent to the emergency room from her office and was then hospitalized overnight at a medical center. The patient was treated with IV fluids and air enema. On an unknown date, an x ray and an unspecified blood work were performed (no result were provided). At the time of the report, in 2014, the patient recovered from intussusception. The physician considered intussusception as life threatening. The causality between intussusception and ROTATEQ was not provided. Lot number A41FB396A is an invalid lot number for ROTATEQ. Additional information has been requested.


Changed on 2/14/2018

VAERS ID: 530161 Before After
VAERS Form:1
Age:0.19
Gender:Male
Location:New York
Vaccinated:2014-02-27
Onset:2014-04-16
Submitted:2014-05-05
Entered:2014-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 4394C / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J014280 / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH H50603 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB396A / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Haematochezia, Intussusception, X-ray, Enema administration, Blood test

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Prophylaxis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES1405USA000363

Write-up: This spontaneous report as received from a physician concerning a 3 month old male patient with no drug reactions/allergies and no pertinent medical history. On 27-FEB-2014 the patient was vaccinated with the first dose of ROTATEQ, oral (total dose was not reported). There was no concomitant medication. The physician reported that on 16-APR-2014, the patient developed intussusception and blood on his stools after receiving the first dose of either ROTATEQ or ROTARIX. The physician stated that she was not sure which product was administered to the patient and stated that she stocked both products in her office. The physician mentioned that the patient was sent to the emergency room from her office and was then hospitalized overnight at a medical center. The patient was treated with IV fluids and air enema. On an unknown date, an x ray and an unspecified blood work were performed (no result were provided). At the time of the report, in 2014, the patient recovered from intussusception. The physician considered intussusception as life threatening. The causality between intussusception and ROTATEQ was not provided. Lot number A41FB396A is an invalid lot number for ROTATEQ. Additional information has been requested.

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