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This is VAERS ID 263554

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History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 263554
VAERS Form:
Age:0.2
Sex:Unknown
Location:West Virginia
Vaccinated:0000-00-00
Onset:2006-08-31
Submitted:2006-09-22
Entered:2006-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTHB5: ROTAVIRUS VACCINE, LIVE, ORAL, PENTAVALENT (ROTATEQ) / MERCK & CO. INC. - / 0 - / PO

Administered by: Other      Purchased by: Unknown
Symptoms: Respiratory distress, Viral infection

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-08-31
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: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Stool rotavirus antigen 08/31/06 positive for rotavirus.
CDC 'Split Type':

Write-up: Information has been received from a physician concerning a 2-3 month old pt who in 2006 was vaccinated PO with the first 2.0 ml dose of Rotavirus G1 G2 G3 G4 P1 reassortant vaccine live (human Bovine). the physician reported that on approximately 8/31/06", the pt was hospitalized in the ICU with respiratory distress and died. The physician also reported that the pt had tested positive for rotavirus. The physician also considered respiratory distress and rotavirus to be life threatening. The reporting phys


Changed on 12/8/2009

VAERS ID: 263554 Before After
VAERS Form:
Age:0.2
Sex:Unknown
Location:West Virginia
Vaccinated:0000-00-00
Onset:2006-08-31
Submitted:2006-09-22
Entered:2006-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTHB5: ROTAVIRUS VACCINE, LIVE, ORAL, PENTAVALENT (ROTATEQ) ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 0 - / PO

Administered by: Other      Purchased by: Unknown Other
Symptoms: Respiratory distress, Viral infection

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-08-31
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: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Stool rotavirus antigen 08/31/06 positive for rotavirus.
CDC 'Split Type': (blank) WAES0609USA03169

Write-up: Information has been received from a physician concerning a 2-3 month old pt who in 2006 was vaccinated PO with the first 2.0 ml dose of Rotavirus G1 G2 G3 G4 P1 reassortant vaccine live (human Bovine). the physician reported that on approximately 8/31/06", 8/31/06, the pt was hospitalized in the ICU with respiratory distress and died. The physician also reported that the pt had tested positive for rotavirus. The physician also considered respiratory distress and rotavirus to be life threatening. The reporting phys physician, via a follow up telephone call, indicated that she was not the pts physician and did not have any additional information to provided. She did not have the pts name as this was reported to her second hand by and employee at a children''s hospital. No further information is available.


Changed on 1/7/2013

VAERS ID: 263554 Before After
VAERS Form:
Age:0.2
Sex:Unknown
Location:West Virginia
Vaccinated:0000-00-00
Onset:2006-08-31
Submitted:2006-09-22
Entered:2006-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Respiratory distress, Viral infection

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-08-31
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: 0 (blank)     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Stool rotavirus antigen 08/31/06 positive for rotavirus.
CDC 'Split Type': WAES0609USA03169

Write-up: Information has been received from a physician concerning a 2-3 month old pt who in 2006 was vaccinated PO with the first 2.0 ml dose of Rotavirus G1 G2 G3 G4 P1 reassortant vaccine live (human Bovine). the physician reported that on approximately 8/31/06, the pt was hospitalized in the ICU with respiratory distress and died. The physician also reported that the pt had tested positive for rotavirus. The physician also considered respiratory distress and rotavirus to be life threatening. The reporting physician, via a follow up telephone call, indicated that she was not the pts physician and did not have any additional information to provided. provide. She did not have the pts name as this was reported to her second hand by and an employee at a children''s hospital. No further information is available.


Changed on 5/13/2013

VAERS ID: 263554 Before After
VAERS Form:
Age:0.2
Sex:Unknown
Location:West Virginia
Vaccinated:0000-00-00
Onset:2006-08-31
Submitted:2006-09-22
Entered:2006-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Respiratory distress, Viral infection

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-08-31
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Stool rotavirus antigen 08/31/06 positive for rotavirus.
CDC 'Split Type': WAES0609USA03169

Write-up: Information has been received from a physician concerning a 2-3 month old pt who in 2006 was vaccinated PO with the first 2.0 ml dose of Rotavirus G1 G2 G3 G4 P1 reassortant vaccine live (human Bovine). the physician reported that on approximately 8/31/06, the pt was hospitalized in the ICU with respiratory distress and died. The physician also reported that the pt had tested positive for rotavirus. The physician also considered respiratory distress and rotavirus to be life threatening. The reporting physician, via a follow up telephone call, indicated that she was not the pts physician and did not have any additional information to provide. She did not have the pts name as this was reported to her second hand by an employee at a hospital. No further information is available.


Changed on 6/14/2014

VAERS ID: 263554 Before After
VAERS Form:
Age:0.2
Sex:Unknown
Location:West Virginia
Vaccinated:0000-00-00
Onset:2006-08-31
Submitted:2006-09-22
Entered:2006-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Respiratory distress, Viral infection

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-08-31
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Stool rotavirus antigen 08/31/06 positive for rotavirus.
CDC 'Split Type': WAES0609USA03169

Write-up: Information has been received from a physician concerning a 2-3 month old pt who in 2006 was vaccinated PO with the first 2.0 ml dose of Rotavirus G1 G2 G3 G4 P1 reassortant vaccine live (human Bovine). the physician reported that on approximately 8/31/06, the pt was hospitalized in the ICU with respiratory distress and died. The physician also reported that the pt had tested positive for rotavirus. The physician also considered respiratory distress and rotavirus to be life threatening. The reporting physician, via a follow up telephone call, indicated that she was not the pts physician and did not have any additional information to provide. She did not have the pts name as this was reported to her second hand by an employee at a hospital. No further information is available.


Changed on 3/14/2015

VAERS ID: 263554 Before After
VAERS Form:
Age:0.2
Sex:Unknown
Location:West Virginia
Vaccinated:0000-00-00
Onset:2006-08-31
Submitted:2006-09-22
Entered:2006-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Respiratory distress, Viral infection

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-08-31
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Stool rotavirus antigen 08/31/06 positive for rotavirus.
CDC 'Split Type': WAES0609USA03169

Write-up: Information has been received from a physician concerning a 2-3 month old pt who in 2006 was vaccinated PO with the first 2.0 ml dose of Rotavirus G1 G2 G3 G4 P1 reassortant vaccine live (human Bovine). the physician reported that on approximately 8/31/06, the pt was hospitalized in the ICU with respiratory distress and died. The physician also reported that the pt had tested positive for rotavirus. The physician also considered respiratory distress and rotavirus to be life threatening. The reporting physician, via a follow up telephone call, indicated that she was not the pts physician and did not have any additional information to provide. She did not have the pts name as this was reported to her second hand by an employee at a hospital. No further information is available.


Changed on 2/14/2017

VAERS ID: 263554 Before After
VAERS Form:
Age:0.2 0.17
Sex:Unknown
Location:West Virginia
Vaccinated:0000-00-00
Onset:2006-08-31
Submitted:2006-09-22
Entered:2006-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Respiratory distress, Viral infection

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-08-31
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Stool rotavirus antigen 08/31/06 positive for rotavirus.
CDC 'Split Type': WAES0609USA03169

Write-up: Information has been received from a physician concerning a 2-3 month old pt who in 2006 was vaccinated PO with the first 2.0 ml dose of Rotavirus G1 G2 G3 G4 P1 reassortant vaccine live (human Bovine). the physician reported that on approximately 8/31/06, the pt was hospitalized in the ICU with respiratory distress and died. The physician also reported that the pt had tested positive for rotavirus. The physician also considered respiratory distress and rotavirus to be life threatening. The reporting physician, via a follow up telephone call, indicated that she was not the pts physician and did not have any additional information to provide. She did not have the pts name as this was reported to her second hand by an employee at a hospital. No further information is available.


Changed on 9/14/2017

VAERS ID: 263554 Before After
VAERS Form:(blank) 1
Age:0.17
Sex:Unknown
Location:West Virginia
Vaccinated:0000-00-00
Onset:2006-08-31
Submitted:2006-09-22
Entered:2006-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 0 1 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Respiratory distress, Viral infection

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-08-31
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Stool rotavirus antigen 08/31/06 positive for rotavirus.
CDC 'Split Type': WAES0609USA03169

Write-up: Information has been received from a physician concerning a 2-3 month old pt who in 2006 was vaccinated PO with the first 2.0 ml dose of Rotavirus G1 G2 G3 G4 P1 reassortant vaccine live (human Bovine). the physician reported that on approximately 8/31/06, the pt was hospitalized in the ICU with respiratory distress and died. The physician also reported that the pt had tested positive for rotavirus. The physician also considered respiratory distress and rotavirus to be life threatening. The reporting physician, via a follow up telephone call, indicated that she was not the pts physician and did not have any additional information to provide. She did not have the pts name as this was reported to her second hand by an employee at a hospital. No further information is available.


Changed on 2/14/2018

VAERS ID: 263554 Before After
VAERS Form:1
Age:0.17
Sex:Unknown
Location:West Virginia
Vaccinated:0000-00-00
Onset:2006-08-31
Submitted:2006-09-22
Entered:2006-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Respiratory distress, Viral infection

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-08-31
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Stool rotavirus antigen 08/31/06 positive for rotavirus.
CDC 'Split Type': WAES0609USA03169

Write-up: Information has been received from a physician concerning a 2-3 month old pt who in 2006 was vaccinated PO with the first 2.0 ml dose of Rotavirus G1 G2 G3 G4 P1 reassortant vaccine live (human Bovine). the physician reported that on approximately 8/31/06, the pt was hospitalized in the ICU with respiratory distress and died. The physician also reported that the pt had tested positive for rotavirus. The physician also considered respiratory distress and rotavirus to be life threatening. The reporting physician, via a follow up telephone call, indicated that she was not the pts physician and did not have any additional information to provide. She did not have the pts name as this was reported to her second hand by an employee at a hospital. No further information is available.


Changed on 6/14/2018

VAERS ID: 263554 Before After
VAERS Form:1
Age:0.17
Sex:Unknown
Location:West Virginia
Vaccinated:0000-00-00
Onset:2006-08-31
Submitted:2006-09-22
Entered:2006-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Respiratory distress, Viral infection

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-08-31
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Stool rotavirus antigen 08/31/06 positive for rotavirus.
CDC 'Split Type': WAES0609USA03169

Write-up: Information has been received from a physician concerning a 2-3 month old pt who in 2006 was vaccinated PO with the first 2.0 ml dose of Rotavirus G1 G2 G3 G4 P1 reassortant vaccine live (human Bovine). the physician reported that on approximately 8/31/06, the pt was hospitalized in the ICU with respiratory distress and died. The physician also reported that the pt had tested positive for rotavirus. The physician also considered respiratory distress and rotavirus to be life threatening. The reporting physician, via a follow up telephone call, indicated that she was not the pts physician and did not have any additional information to provide. She did not have the pts name as this was reported to her second hand by an employee at a hospital. No further information is available.


Changed on 8/14/2018

VAERS ID: 263554 Before After
VAERS Form:1
Age:0.17
Sex:Unknown
Location:West Virginia
Vaccinated:0000-00-00
Onset:2006-08-31
Submitted:2006-09-22
Entered:2006-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Respiratory distress, Viral infection

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-08-31
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Stool rotavirus antigen 08/31/06 positive for rotavirus.
CDC 'Split Type': WAES0609USA03169

Write-up: Information has been received from a physician concerning a 2-3 month old pt who in 2006 was vaccinated PO with the first 2.0 ml dose of Rotavirus G1 G2 G3 G4 P1 reassortant vaccine live (human Bovine). the physician reported that on approximately 8/31/06, the pt was hospitalized in the ICU with respiratory distress and died. The physician also reported that the pt had tested positive for rotavirus. The physician also considered respiratory distress and rotavirus to be life threatening. The reporting physician, via a follow up telephone call, indicated that she was not the pts physician and did not have any additional information to provide. She did not have the pts name as this was reported to her second hand by an employee at a hospital. No further information is available.


Changed on 9/14/2018

VAERS ID: 263554 Before After
VAERS Form:1
Age:0.17
Sex:Unknown
Location:West Virginia
Vaccinated:0000-00-00
Onset:2006-08-31
Submitted:2006-09-22
Entered:2006-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Respiratory distress, Viral infection

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-08-31
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Stool rotavirus antigen 08/31/06 positive for rotavirus.
CDC 'Split Type': WAES0609USA03169

Write-up: Information has been received from a physician concerning a 2-3 month old pt who in 2006 was vaccinated PO with the first 2.0 ml dose of Rotavirus G1 G2 G3 G4 P1 reassortant vaccine live (human Bovine). the physician reported that on approximately 8/31/06, the pt was hospitalized in the ICU with respiratory distress and died. The physician also reported that the pt had tested positive for rotavirus. The physician also considered respiratory distress and rotavirus to be life threatening. The reporting physician, via a follow up telephone call, indicated that she was not the pts physician and did not have any additional information to provide. She did not have the pts name as this was reported to her second hand by an employee at a hospital. No further information is available.


Changed on 10/14/2018

VAERS ID: 263554 Before After
VAERS Form:1
Age:0.17
Sex:Unknown
Location:West Virginia
Vaccinated:0000-00-00
Onset:2006-08-31
Submitted:2006-09-22
Entered:2006-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Respiratory distress, Viral infection

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-08-31
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Stool rotavirus antigen 08/31/06 positive for rotavirus.
CDC 'Split Type': WAES0609USA03169

Write-up: Information has been received from a physician concerning a 2-3 month old pt who in 2006 was vaccinated PO with the first 2.0 ml dose of Rotavirus G1 G2 G3 G4 P1 reassortant vaccine live (human Bovine). the physician reported that on approximately 8/31/06, the pt was hospitalized in the ICU with respiratory distress and died. The physician also reported that the pt had tested positive for rotavirus. The physician also considered respiratory distress and rotavirus to be life threatening. The reporting physician, via a follow up telephone call, indicated that she was not the pts physician and did not have any additional information to provide. She did not have the pts name as this was reported to her second hand by an employee at a hospital. No further information is available.


Changed on 12/24/2020

VAERS ID: 263554 Before After
VAERS Form:1
Age:0.17
Sex:Unknown
Location:West Virginia
Vaccinated:0000-00-00
Onset:2006-08-31
Submitted:2006-09-22
Entered:2006-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Respiratory distress, Viral infection

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-08-31
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Stool rotavirus antigen 08/31/06 positive for rotavirus.
CDC 'Split Type': WAES0609USA03169

Write-up: Information has been received from a physician concerning a 2-3 month old pt who in 2006 was vaccinated PO with the first 2.0 ml dose of Rotavirus G1 G2 G3 G4 P1 reassortant vaccine live (human Bovine). the physician reported that on approximately 8/31/06, the pt was hospitalized in the ICU with respiratory distress and died. The physician also reported that the pt had tested positive for rotavirus. The physician also considered respiratory distress and rotavirus to be life threatening. The reporting physician, via a follow up telephone call, indicated that she was not the pts physician and did not have any additional information to provide. She did not have the pts name as this was reported to her second hand by an employee at a hospital. No further information is available.


Changed on 12/30/2020

VAERS ID: 263554 Before After
VAERS Form:1
Age:0.17
Sex:Unknown
Location:West Virginia
Vaccinated:0000-00-00
Onset:2006-08-31
Submitted:2006-09-22
Entered:2006-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Respiratory distress, Viral infection

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-08-31
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Stool rotavirus antigen 08/31/06 positive for rotavirus.
CDC 'Split Type': WAES0609USA03169

Write-up: Information has been received from a physician concerning a 2-3 month old pt who in 2006 was vaccinated PO with the first 2.0 ml dose of Rotavirus G1 G2 G3 G4 P1 reassortant vaccine live (human Bovine). the physician reported that on approximately 8/31/06, the pt was hospitalized in the ICU with respiratory distress and died. The physician also reported that the pt had tested positive for rotavirus. The physician also considered respiratory distress and rotavirus to be life threatening. The reporting physician, via a follow up telephone call, indicated that she was not the pts physician and did not have any additional information to provide. She did not have the pts name as this was reported to her second hand by an employee at a hospital. No further information is available.


Changed on 5/7/2021

VAERS ID: 263554 Before After
VAERS Form:1
Age:0.17
Sex:Unknown
Location:West Virginia
Vaccinated:0000-00-00
Onset:2006-08-31
Submitted:2006-09-22
Entered:2006-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Respiratory distress, Viral infection

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-08-31
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Stool rotavirus antigen 08/31/06 positive for rotavirus.
CDC 'Split Type': WAES0609USA03169

Write-up: Information has been received from a physician concerning a 2-3 month old pt who in 2006 was vaccinated PO with the first 2.0 ml dose of Rotavirus G1 G2 G3 G4 P1 reassortant vaccine live (human Bovine). the physician reported that on approximately 8/31/06, the pt was hospitalized in the ICU with respiratory distress and died. The physician also reported that the pt had tested positive for rotavirus. The physician also considered respiratory distress and rotavirus to be life threatening. The reporting physician, via a follow up telephone call, indicated that she was not the pts physician and did not have any additional information to provide. She did not have the pts name as this was reported to her second hand by an employee at a hospital. No further information is available.


Changed on 5/21/2021

VAERS ID: 263554 Before After
VAERS Form:1
Age:0.17
Sex:Unknown
Location:West Virginia
Vaccinated:0000-00-00
Onset:2006-08-31
Submitted:2006-09-22
Entered:2006-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Respiratory distress, Viral infection

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-08-31
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Stool rotavirus antigen 08/31/06 positive for rotavirus.
CDC 'Split Type': WAES0609USA03169

Write-up: Information has been received from a physician concerning a 2-3 month old pt who in 2006 was vaccinated PO with the first 2.0 ml dose of Rotavirus G1 G2 G3 G4 P1 reassortant vaccine live (human Bovine). the physician reported that on approximately 8/31/06, the pt was hospitalized in the ICU with respiratory distress and died. The physician also reported that the pt had tested positive for rotavirus. The physician also considered respiratory distress and rotavirus to be life threatening. The reporting physician, via a follow up telephone call, indicated that she was not the pts physician and did not have any additional information to provide. She did not have the pts name as this was reported to her second hand by an employee at a hospital. No further information is available.

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