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This is VAERS ID 535973

History of Changes from the VAERS Wayback Machine

First Appeared on 7/14/2014

535973
VAERS Form:
Age:0.4
Gender:Male
Location:Florida
Vaccinated:2014-06-30
Onset:2014-07-05
Submitted:2014-07-08
Entered:2014-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ML5D7 / - RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J013944 / - LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH H35260 / - LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB420A / - - / PO

Administered by: Private      Purchased by: Public
Symptoms: Faeces discoloured, Intensive care, Intestinal obstruction, Intussusception, Rectal haemorrhage, Somnolence, Vomiting, Ultrasound abdomen abnormal, Decreased appetite, Occult blood positive, Urinary system x-ray abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: NO
Preexisting Conditions: UMBILICAL HERNIA - 553.1
Allergies:
Diagnostic Lab Data: KUB & Ultra Sound
CDC 'Split Type':

Write-up:This 4 month old has increased sleepiness and decreased appetite followed by onset of bright red blood per rectum. He than had 2 bowel movements, which were described as melanotic or very dark stool that was heme-positive. At an outside hospital, he had 2 episodes of emesis, which had bilious tinge. He was transfered to ICU at the hospital. KUB and ultrasound were obtained. KUB was suggestive of bowel obstruction. Ultrasound was notable for intussusception. The patient did undergo a hydrostatic reduction and was found to have an ilecolonic intussuseption to the level of the splenic flexure. Parents report no fever or diarrhea. Patient did receive the Rotarix vaccine on June 30, 2014. The patient is shedding virus in the stool. The child is otherwise well grown and healthy without any signficant clinical symptoms prior to the hours, according to the parents.


Changed on 9/14/2014

535973 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Florida
Vaccinated:2014-06-30
Onset:2014-07-05
Submitted:2014-07-08
Entered:2014-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ML5D7 / - 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J013944 / - 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH H35260 / - 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB420A / - 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Faeces discoloured, Intensive care, Intestinal obstruction, Intussusception, Rectal haemorrhage, Somnolence, Vomiting, Ultrasound abdomen abnormal, Decreased appetite, Occult blood positive, Urinary system x-ray abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No Yes
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: (blank) 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: NO
Preexisting Conditions: UMBILICAL HERNIA - 553.1
Allergies:
Diagnostic Lab Data: KUB & Ultra Sound
CDC 'Split Type':

Write-up:This 4 month old has increased sleepiness and decreased appetite followed by onset of bright red blood per rectum. He than had 2 bowel movements, which were described as melanotic or very dark stool that was heme-positive. At an outside hospital, he had 2 episodes of emesis, which had bilious tinge. He was transfered to ICU at the hospital. KUB and ultrasound were obtained. KUB was suggestive of bowel obstruction. Ultrasound was notable for intussusception. The patient did undergo a hydrostatic reduction and was found to have an ilecolonic intussuseption to the level of the splenic flexure. Parents report no fever or diarrhea. Patient did receive the Rotarix vaccine on June 30, 2014. The patient is shedding virus in the stool. The child is otherwise well grown and healthy without any signficant clinical symptoms prior to the hours, according to the parents.


Changed on 2/14/2017

535973 Before After
VAERS Form:
Age:0.4 0.36
Gender:Male
Location:Florida
Vaccinated:2014-06-30
Onset:2014-07-05
Submitted:2014-07-08
Entered:2014-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ML5D7 / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J013944 / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH H35260 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB420A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Faeces discoloured, Intensive care, Intestinal obstruction, Intussusception, Rectal haemorrhage, Somnolence, Vomiting, Ultrasound abdomen abnormal, Decreased appetite, Occult blood positive, Urinary system x-ray abnormal

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: NO
Preexisting Conditions: UMBILICAL HERNIA - 553.1
Allergies:
Diagnostic Lab Data: KUB & Ultra Sound
CDC 'Split Type':

Write-up:This 4 month old has increased sleepiness and decreased appetite followed by onset of bright red blood per rectum. He than had 2 bowel movements, which were described as melanotic or very dark stool that was heme-positive. At an outside hospital, he had 2 episodes of emesis, which had bilious tinge. He was transfered to ICU at the hospital. KUB and ultrasound were obtained. KUB was suggestive of bowel obstruction. Ultrasound was notable for intussusception. The patient did undergo a hydrostatic reduction and was found to have an ilecolonic intussuseption to the level of the splenic flexure. Parents report no fever or diarrhea. Patient did receive the Rotarix vaccine on June 30, 2014. The patient is shedding virus in the stool. The child is otherwise well grown and healthy without any signficant clinical symptoms prior to the hours, according to the parents.


Changed on 9/14/2017

535973 Before After
VAERS Form:(blank) 1
Age:0.36
Gender:Male
Location:Florida
Vaccinated:2014-06-30
Onset:2014-07-05
Submitted:2014-07-08
Entered:2014-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS ML5D7 / 1 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. J013944 / 1 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH H35260 / 1 2 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB420A / 1 2 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Faeces discoloured, Intensive care, Intestinal obstruction, Intussusception, Rectal haemorrhage, Somnolence, Vomiting, Ultrasound abdomen abnormal, Decreased appetite, Occult blood positive, Urinary system x-ray abnormal

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: NO
Preexisting Conditions: UMBILICAL HERNIA - 553.1
Allergies:
Diagnostic Lab Data: KUB & Ultra Sound
CDC 'Split Type':

Write-up:This 4 month old has increased sleepiness and decreased appetite followed by onset of bright red blood per rectum. He than had 2 bowel movements, which were described as melanotic or very dark stool that was heme-positive. At an outside hospital, he had 2 episodes of emesis, which had bilious tinge. He was transfered to ICU at the hospital. KUB and ultrasound were obtained. KUB was suggestive of bowel obstruction. Ultrasound was notable for intussusception. The patient did undergo a hydrostatic reduction and was found to have an ilecolonic intussuseption to the level of the splenic flexure. Parents report no fever or diarrhea. Patient did receive the Rotarix vaccine on June 30, 2014. The patient is shedding virus in the stool. The child is otherwise well grown and healthy without any signficant clinical symptoms prior to the hours, according to the parents.


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