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This is VAERS ID 268479

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 268479
VAERS Form:
Age:0.4
Gender:Male
Location:Wisconsin
Vaccinated:2006-09-05
Onset:2006-11-06
Submitted:2006-12-04
Entered:2006-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTHB5: ROTAVIRUS VACCINE, LIVE, ORAL, PENTAVALENT (ROTATEQ) / MERCK & CO. INC. - / 1 - / PO

Administered by: Other      Purchased by: Unknown
Symptoms: Haematochezia, Intussusception

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? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal ultrasound 11/06/06 small bowel intussusception, barium enema X ray 11/06/06 no intussusception.
CDC 'Split Type':

Write-up: Information has been received from a physician concerning a 6 month old male, with no medical history and no allergies, who was vaccinated with a first and second oral dose of rotavirus vaccine on 6/20/06 and 9/5/06, respectively. There was no concomitant"medication. On 11/6/06, the pt was found to have blood in the stool. An abdominal ultrasound showed a small bowel intussusception. A barium enema was done after the ultrasound that showed no intussusception. The small bowel intussusception was found to be


Changed on 12/8/2009

VAERS ID: 268479 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Wisconsin
Vaccinated:2006-09-05
Onset:2006-11-06
Submitted:2006-12-04
Entered:2006-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTHB5: ROTAVIRUS VACCINE, LIVE, ORAL, PENTAVALENT (ROTATEQ) ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 1 - / PO

Administered by: Other      Purchased by: Unknown Other
Symptoms: Haematochezia, Intussusception

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? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal ultrasound 11/06/06 small bowel intussusception, barium enema X ray 11/06/06 no intussusception.
CDC 'Split Type': (blank) WAES0611USA07364

Write-up: Information has been received from a physician concerning a 6 month old male, with no medical history and no allergies, who was vaccinated with a first and second oral dose of rotavirus vaccine on 6/20/06 and 9/5/06, respectively. There was no concomitant"medication. concomitant medication. On 11/6/06, the pt was found to have blood in the stool. An abdominal ultrasound showed a small bowel intussusception. A barium enema was done after the ultrasound that showed no intussusception. The small bowel intussusception was found to be transient and reduced spontaneously. there was no blood in the stool on 11/13/06 and the pt was considered to be recovered by the reporter. Unspecified medical attention was sought. No product quality complaint was involved. No other information was provided. Upon internal review, intussusception was considered to be an other important medical event (OMIC). Additional information has been requested.


Changed on 5/13/2013

VAERS ID: 268479 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Wisconsin
Vaccinated:2006-09-05
Onset:2006-11-06
Submitted:2006-12-04
Entered:2006-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Haematochezia, Intussusception

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? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal ultrasound 11/06/06 small bowel intussusception, barium enema X ray 11/06/06 no intussusception.
CDC 'Split Type': WAES0611USA07364

Write-up: Information has been received from a physician concerning a 6 month old male, with no medical history and no allergies, who was vaccinated with a first and second oral dose of rotavirus vaccine on 6/20/06 and 9/5/06, respectively. There was no concomitant medication. On 11/6/06, the pt was found to have blood in the stool. An abdominal ultrasound showed a small bowel intussusception. A barium enema was done after the ultrasound that showed no intussusception. The small bowel intussusception was found to be transient and reduced spontaneously. there was no blood in the stool on 11/13/06 and the pt was considered to be recovered by the reporter. Unspecified medical attention was sought. No product quality complaint was involved. No other information was provided. Upon internal review, intussusception was considered to be an other important medical event (OMIC). Additional information has been requested.


Changed on 3/14/2014

VAERS ID: 268479 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Wisconsin
Vaccinated:2006-09-05
Onset:2006-11-06
Submitted:2006-12-04
Entered:2006-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - 0146F / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Haematochezia, Intussusception

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? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal ultrasound 11/06/06 small bowel intussusception, barium enema X ray 11/06/06 no intussusception.
CDC 'Split Type': WAES0611USA07364

Write-up: Information has been received from a physician concerning a 6 month old male, with no medical history and no allergies, who was vaccinated with a first and second oral dose of rotavirus vaccine on 6/20/06 and 9/5/06, respectively. There was no concomitant medication. On 11/6/06, the pt was found to have blood in the stool. An abdominal ultrasound showed a small bowel intussusception. A barium enema was done after the ultrasound that showed no intussusception. The small bowel intussusception was found to be transient and reduced spontaneously. there was no blood in the stool on 11/13/06 and the pt was considered to be recovered by the reporter. Unspecified medical attention was sought. No product quality complaint was involved. No other information was provided. Upon internal review, intussusception was considered to be an other important medical event (OMIC). Additional information has been requested.


Changed on 6/14/2014

VAERS ID: 268479 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Wisconsin
Vaccinated:2006-09-05
Onset:2006-11-06
Submitted:2006-12-04
Entered:2006-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0146F / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Haematochezia, Intussusception

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? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal ultrasound 11/06/06 small bowel intussusception, barium enema X ray 11/06/06 no intussusception.
CDC 'Split Type': WAES0611USA07364

Write-up: Information has been received from a physician concerning a 6 month old male, with no medical history and no allergies, who was vaccinated with a first and second oral dose of rotavirus vaccine on 6/20/06 and 9/5/06, respectively. There was no concomitant medication. On 11/6/06, the pt was found to have blood in the stool. An abdominal ultrasound showed a small bowel intussusception. A barium enema was done after the ultrasound that showed no intussusception. The small bowel intussusception was found to be transient and reduced spontaneously. there was no blood in the stool on 11/13/06 and the pt was considered to be recovered by the reporter. Unspecified medical attention was sought. No product quality complaint was involved. No other information was provided. Upon internal review, intussusception was considered to be an other important medical event (OMIC). Additional information has been requested.


Changed on 3/14/2015

VAERS ID: 268479 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Wisconsin
Vaccinated:2006-09-05
Onset:2006-11-06
Submitted:2006-12-04
Entered:2006-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0146F / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Haematochezia, Intussusception

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? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal ultrasound 11/06/06 small bowel intussusception, barium enema X ray 11/06/06 no intussusception.
CDC 'Split Type': WAES0611USA07364

Write-up: Information has been received from a physician concerning a 6 month old male, with no medical history and no allergies, who was vaccinated with a first and second oral dose of rotavirus vaccine on 6/20/06 and 9/5/06, respectively. There was no concomitant medication. On 11/6/06, the pt was found to have blood in the stool. An abdominal ultrasound showed a small bowel intussusception. A barium enema was done after the ultrasound that showed no intussusception. The small bowel intussusception was found to be transient and reduced spontaneously. there was no blood in the stool on 11/13/06 and the pt was considered to be recovered by the reporter. Unspecified medical attention was sought. No product quality complaint was involved. No other information was provided. Upon internal review, intussusception was considered to be an other important medical event (OMIC). Additional information has been requested.


Changed on 2/14/2017

VAERS ID: 268479 Before After
VAERS Form:
Age:0.4 0.38
Gender:Male
Location:Wisconsin
Vaccinated:2006-09-05
Onset:2006-11-06
Submitted:2006-12-04
Entered:2006-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0146F / 1 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Haematochezia, Intussusception

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? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal ultrasound 11/06/06 small bowel intussusception, barium enema X ray 11/06/06 no intussusception.
CDC 'Split Type': WAES0611USA07364

Write-up: Information has been received from a physician concerning a 6 month old male, with no medical history and no allergies, who was vaccinated with a first and second oral dose of rotavirus vaccine on 6/20/06 and 9/5/06, respectively. There was no concomitant medication. On 11/6/06, the pt was found to have blood in the stool. An abdominal ultrasound showed a small bowel intussusception. A barium enema was done after the ultrasound that showed no intussusception. The small bowel intussusception was found to be transient and reduced spontaneously. there was no blood in the stool on 11/13/06 and the pt was considered to be recovered by the reporter. Unspecified medical attention was sought. No product quality complaint was involved. No other information was provided. Upon internal review, intussusception was considered to be an other important medical event (OMIC). Additional information has been requested.


Changed on 9/14/2017

VAERS ID: 268479 Before After
VAERS Form:(blank) 1
Age:0.38
Gender:Male
Location:Wisconsin
Vaccinated:2006-09-05
Onset:2006-11-06
Submitted:2006-12-04
Entered:2006-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0146F / 1 2 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Haematochezia, Intussusception

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? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal ultrasound 11/06/06 small bowel intussusception, barium enema X ray 11/06/06 no intussusception.
CDC 'Split Type': WAES0611USA07364

Write-up: Information has been received from a physician concerning a 6 month old male, with no medical history and no allergies, who was vaccinated with a first and second oral dose of rotavirus vaccine on 6/20/06 and 9/5/06, respectively. There was no concomitant medication. On 11/6/06, the pt was found to have blood in the stool. An abdominal ultrasound showed a small bowel intussusception. A barium enema was done after the ultrasound that showed no intussusception. The small bowel intussusception was found to be transient and reduced spontaneously. there was no blood in the stool on 11/13/06 and the pt was considered to be recovered by the reporter. Unspecified medical attention was sought. No product quality complaint was involved. No other information was provided. Upon internal review, intussusception was considered to be an other important medical event (OMIC). Additional information has been requested.


Changed on 2/14/2018

VAERS ID: 268479 Before After
VAERS Form:1
Age:0.38
Gender:Male
Location:Wisconsin
Vaccinated:2006-09-05
Onset:2006-11-06
Submitted:2006-12-04
Entered:2006-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0146F / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Haematochezia, Intussusception

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? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal ultrasound 11/06/06 small bowel intussusception, barium enema X ray 11/06/06 no intussusception.
CDC 'Split Type': WAES0611USA07364

Write-up: Information has been received from a physician concerning a 6 month old male, with no medical history and no allergies, who was vaccinated with a first and second oral dose of rotavirus vaccine on 6/20/06 and 9/5/06, respectively. There was no concomitant medication. On 11/6/06, the pt was found to have blood in the stool. An abdominal ultrasound showed a small bowel intussusception. A barium enema was done after the ultrasound that showed no intussusception. The small bowel intussusception was found to be transient and reduced spontaneously. there was no blood in the stool on 11/13/06 and the pt was considered to be recovered by the reporter. Unspecified medical attention was sought. No product quality complaint was involved. No other information was provided. Upon internal review, intussusception was considered to be an other important medical event (OMIC). Additional information has been requested.


Changed on 6/14/2018

VAERS ID: 268479 Before After
VAERS Form:1
Age:0.38
Gender:Male
Location:Wisconsin
Vaccinated:2006-09-05
Onset:2006-11-06
Submitted:2006-12-04
Entered:2006-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0146F / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Haematochezia, Intussusception

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? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal ultrasound 11/06/06 small bowel intussusception, barium enema X ray 11/06/06 no intussusception.
CDC 'Split Type': WAES0611USA07364

Write-up: Information has been received from a physician concerning a 6 month old male, with no medical history and no allergies, who was vaccinated with a first and second oral dose of rotavirus vaccine on 6/20/06 and 9/5/06, respectively. There was no concomitant medication. On 11/6/06, the pt was found to have blood in the stool. An abdominal ultrasound showed a small bowel intussusception. A barium enema was done after the ultrasound that showed no intussusception. The small bowel intussusception was found to be transient and reduced spontaneously. there was no blood in the stool on 11/13/06 and the pt was considered to be recovered by the reporter. Unspecified medical attention was sought. No product quality complaint was involved. No other information was provided. Upon internal review, intussusception was considered to be an other important medical event (OMIC). Additional information has been requested.


Changed on 8/14/2018

VAERS ID: 268479 Before After
VAERS Form:1
Age:0.38
Gender:Male
Location:Wisconsin
Vaccinated:2006-09-05
Onset:2006-11-06
Submitted:2006-12-04
Entered:2006-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0146F / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Haematochezia, Intussusception

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? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal ultrasound 11/06/06 small bowel intussusception, barium enema X ray 11/06/06 no intussusception.
CDC 'Split Type': WAES0611USA07364

Write-up: Information has been received from a physician concerning a 6 month old male, with no medical history and no allergies, who was vaccinated with a first and second oral dose of rotavirus vaccine on 6/20/06 and 9/5/06, respectively. There was no concomitant medication. On 11/6/06, the pt was found to have blood in the stool. An abdominal ultrasound showed a small bowel intussusception. A barium enema was done after the ultrasound that showed no intussusception. The small bowel intussusception was found to be transient and reduced spontaneously. there was no blood in the stool on 11/13/06 and the pt was considered to be recovered by the reporter. Unspecified medical attention was sought. No product quality complaint was involved. No other information was provided. Upon internal review, intussusception was considered to be an other important medical event (OMIC). Additional information has been requested.


Changed on 9/14/2018

VAERS ID: 268479 Before After
VAERS Form:1
Age:0.38
Gender:Male
Location:Wisconsin
Vaccinated:2006-09-05
Onset:2006-11-06
Submitted:2006-12-04
Entered:2006-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0146F / 2 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Haematochezia, Intussusception

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? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Abdominal ultrasound 11/06/06 small bowel intussusception, barium enema X ray 11/06/06 no intussusception.
CDC 'Split Type': WAES0611USA07364

Write-up: Information has been received from a physician concerning a 6 month old male, with no medical history and no allergies, who was vaccinated with a first and second oral dose of rotavirus vaccine on 6/20/06 and 9/5/06, respectively. There was no concomitant medication. On 11/6/06, the pt was found to have blood in the stool. An abdominal ultrasound showed a small bowel intussusception. A barium enema was done after the ultrasound that showed no intussusception. The small bowel intussusception was found to be transient and reduced spontaneously. there was no blood in the stool on 11/13/06 and the pt was considered to be recovered by the reporter. Unspecified medical attention was sought. No product quality complaint was involved. No other information was provided. Upon internal review, intussusception was considered to be an other important medical event (OMIC). Additional information has been requested.

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