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| History of Changes from the VAERS Wayback Machine |
| 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
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.
| 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
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.
| 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
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.
| 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
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.
| 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
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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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=530161&WAYBACKHISTORY=ON
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