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This is VAERS ID 270003

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 270003
VAERS Form:
Age:0.2
Gender:Male
Location:Texas
Vaccinated:2006-09-26
Onset:2006-11-18
Submitted:2006-12-21
Entered:2007-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0941F / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Barium double contrast, Diarrhoea haemorrhagic, Gastroenteritis, Hypertension, Decreased appetite

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: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: LABS: US of abdomen revealed RLQ IS. Air contrast enema x 2. Renal US was WNL.
CDC 'Split Type':

Write-up: Information has been received from a physician concerning a 2-month-old male who was vaccinated with the first dose of rotavirus G1 G2 G3 G4 P1 reassortant vaccine live (human-bovine). The physician reported that the patient developed intussusception with"in /"a month of getting vaccinated/". Unspecified medical attention was sought. Subsequently, the patient recovered. It was noted that the patient would not be vaccinated with the second or third dose. Upon internal review, intussusception was determined


Changed on 12/8/2009

VAERS ID: 270003 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Texas
Vaccinated:2006-09-26
Onset:2006-11-18
Submitted:2006-12-21
Entered:2007-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0941F / 0 - / PO

Administered by: Private      Purchased by: Unknown Other
Symptoms: Barium double contrast, Diarrhoea haemorrhagic, Gastroenteritis, Hypertension, Intussusception, Vomiting, Ultrasound abdomen abnormal, Decreased appetite

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: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: LABS: US of abdomen revealed RLQ IS. Air contrast enema x 2. Renal US was WNL.
CDC 'Split Type': (blank) WAES0612USA02208

Write-up: Information has been received from a physician concerning a 2-month-old male who was vaccinated with the first dose of rotavirus G1 G2 G3 G4 P1 reassortant vaccine live (human-bovine). The physician reported that the patient developed intussusception with"in /"a within "a month of getting vaccinated/". vaccinated". Unspecified medical attention was sought. Subsequently, the patient recovered. It was noted that the patient would not be vaccinated with the second or third dose. Upon internal review, intussusception was determined to be an other important medical event (OMIC). Additional information has been requested. 1/18/07 Received medical records from hospital which reveal patient admitted 11/19-11/22/06 for suspected intussusception (IS) after 3 day hx of vomiting, fussiness & decreased oral intake. Seen by PCP for gastroenteritis but did not resolve so went to ER. In ER, given Tigan suppository & after that had bloody stool & bilious emesis. Transferred to larger hospital for further w/u. Surgery consult done. Second attempt to reduce IS with air contrast enema was successful. Emesis resolved. Kept in hospital for observation, did well & was d/c to home for f/u on HTN by PCP. FINAL DX: Intussusception, resolved by air contrast enema; hypertension, resolved.


Changed on 1/5/2010

VAERS ID: 270003 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Texas
Vaccinated:2006-09-26
Onset:2006-11-18
Submitted:2006-12-21
Entered:2007-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 0 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 - / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC - / 0 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0941F / 0 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Barium double contrast, Diarrhoea haemorrhagic, Gastroenteritis, Hypertension, Intussusception, Vomiting, Ultrasound abdomen abnormal, Decreased appetite

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: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: LABS: US of abdomen revealed RLQ IS. Air contrast enema x 2. Renal US was WNL.
CDC 'Split Type': WAES0612USA02208

Write-up: Information has been received from a physician concerning a 2-month-old male who was vaccinated with the first dose of rotavirus G1 G2 G3 G4 P1 reassortant vaccine live (human-bovine). The physician reported that the patient developed intussusception within "a month of getting vaccinated". Unspecified medical attention was sought. Subsequently, the patient recovered. It was noted that the patient would not be vaccinated with the second or third dose. Upon internal review, intussusception was determined to be an other important medical event (OMIC). Additional information has been requested. 1/18/07 Received medical records from hospital which reveal patient admitted 11/19-11/22/06 for suspected intussusception (IS) after 3 day hx of vomiting, fussiness & decreased oral intake. Seen by PCP for gastroenteritis but did not resolve so went to ER. In ER, given Tigan suppository & after that had bloody stool & bilious emesis. Transferred to larger hospital for further w/u. Surgery consult done. Second attempt to reduce IS with air contrast enema was successful. Emesis resolved. Kept in hospital for observation, did well & was d/c to home for f/u on HTN by PCP. FINAL DX: Intussusception, resolved by air contrast enema; hypertension, resolved. Updated information for VAERS # 270003. Treated at hospital on 11/19/06-11/22/06 for intussusception. Rocovered.


Changed on 3/2/2010

VAERS ID: 270003 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Texas
Vaccinated:2006-09-26
Onset:2006-11-18
Submitted:2006-12-21
Entered:2007-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 0 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 - / -
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC - / 0 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0941F / 0 - / PO

Administered by: Private      Purchased by: Other
Symptoms: 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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: LABS: US of abdomen revealed RLQ IS. Air contrast enema x 2. Renal US was WNL.
CDC 'Split Type': WAES0612USA02208

Write-up: Information has been received from a physician concerning a 2-month-old male who was vaccinated with the first dose of rotavirus G1 G2 G3 G4 P1 reassortant vaccine live (human-bovine). The physician reported that the patient developed intussusception within "a month of getting vaccinated". Unspecified medical attention was sought. Subsequently, the patient recovered. It was noted that the patient would not be vaccinated with the second or third dose. Upon internal review, intussusception was determined to be an other important medical event (OMIC). Additional information has been requested. 1/18/07 Received medical records from hospital which reveal patient admitted 11/19-11/22/06 for suspected intussusception (IS) after 3 day hx of vomiting, fussiness & decreased oral intake. Seen by PCP for gastroenteritis but did not resolve so went to ER. In ER, given Tigan suppository & after that had bloody stool & bilious emesis. Transferred to larger hospital for further w/u. Surgery consult done. Second attempt to reduce IS with air contrast enema was successful. Emesis resolved. Kept in hospital for observation, did well & was d/c to home for f/u on HTN by PCP. FINAL DX: Intussusception, resolved by air contrast enema; hypertension, resolved. Updated information for VAERS # 270003. Treated at hospital on 11/19/06-11/22/06 for intussusception. Rocovered.


Changed on 4/7/2010

VAERS ID: 270003 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Texas
Vaccinated:2006-09-26
Onset:2006-11-18
Submitted:2006-12-21
Entered:2007-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 0 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 - / -
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC - / 0 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0941F / 0 - / PO

Administered by: Private      Purchased by: Other
Symptoms: 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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: LABS: US of abdomen revealed RLQ IS. Air contrast enema x 2. Renal US was WNL.
CDC 'Split Type': WAES0612USA02208

Write-up: Information has been received from a physician concerning a 2-month-old male who was vaccinated with the first dose of rotavirus G1 G2 G3 G4 P1 reassortant vaccine live (human-bovine). The physician reported that the patient developed intussusception within "a month of getting vaccinated". Unspecified medical attention was sought. Subsequently, the patient recovered. It was noted that the patient would not be vaccinated with the second or third dose. Upon internal review, intussusception was determined to be an other important medical event (OMIC). Additional information has been requested. 1/18/07 Received medical records from hospital which reveal patient admitted 11/19-11/22/06 for suspected intussusception (IS) after 3 day hx of vomiting, fussiness & decreased oral intake. Seen by PCP for gastroenteritis but did not resolve so went to ER. In ER, given Tigan suppository & after that had bloody stool & bilious emesis. Transferred to larger hospital for further w/u. Surgery consult done. Second attempt to reduce IS with air contrast enema was successful. Emesis resolved. Kept in hospital for observation, did well & was d/c to home for f/u on HTN by PCP. FINAL DX: Intussusception, resolved by air contrast enema; hypertension, resolved. Updated information for VAERS # 270003. Treated at hospital on 11/19/06-11/22/06 for intussusception. Rocovered.


Changed on 7/31/2010

VAERS ID: 270003 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Texas
Vaccinated:2006-09-26
Onset:2006-11-18
Submitted:2006-12-21
Entered:2007-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 0 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 - / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC - / 0 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0941F / 0 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Intussusception, Irritability, Ultrasound kidney normal, Hypophagia

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: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: LABS: US of abdomen revealed RLQ IS. Air contrast enema x 2. Renal US was WNL.
CDC 'Split Type': WAES0612USA02208

Write-up: Information has been received from a physician concerning a 2-month-old male who was vaccinated with the first dose of rotavirus G1 G2 G3 G4 P1 reassortant vaccine live (human-bovine). The physician reported that the patient developed intussusception within "a month of getting vaccinated". Unspecified medical attention was sought. Subsequently, the patient recovered. It was noted that the patient would not be vaccinated with the second or third dose. Upon internal review, intussusception was determined to be an other important medical event (OMIC). Additional information has been requested. 1/18/07 Received medical records from hospital which reveal patient admitted 11/19-11/22/06 for suspected intussusception (IS) after 3 day hx of vomiting, fussiness & decreased oral intake. Seen by PCP for gastroenteritis but did not resolve so went to ER. In ER, given Tigan suppository & after that had bloody stool & bilious emesis. Transferred to larger hospital for further w/u. Surgery consult done. Second attempt to reduce IS with air contrast enema was successful. Emesis resolved. Kept in hospital for observation, did well & was d/c to home for f/u on HTN by PCP. FINAL DX: Intussusception, resolved by air contrast enema; hypertension, resolved. Updated information for VAERS # 270003. Treated at hospital on 11/19/06-11/22/06 for intussusception. Rocovered.


Changed on 8/31/2010

VAERS ID: 270003 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Texas
Vaccinated:2006-09-26
Onset:2006-11-18
Submitted:2006-12-21
Entered:2007-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 0 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 - / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH - / 0 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0941F / 0 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Intussusception, Irritability, Ultrasound kidney normal, Hypophagia

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: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: LABS: US of abdomen revealed RLQ IS. Air contrast enema x 2. Renal US was WNL.
CDC 'Split Type': WAES0612USA02208

Write-up: Information has been received from a physician concerning a 2-month-old male who was vaccinated with the first dose of rotavirus G1 G2 G3 G4 P1 reassortant vaccine live (human-bovine). The physician reported that the patient developed intussusception within "a month of getting vaccinated". Unspecified medical attention was sought. Subsequently, the patient recovered. It was noted that the patient would not be vaccinated with the second or third dose. Upon internal review, intussusception was determined to be an other important medical event (OMIC). Additional information has been requested. 1/18/07 Received medical records from hospital which reveal patient admitted 11/19-11/22/06 for suspected intussusception (IS) after 3 day hx of vomiting, fussiness & decreased oral intake. Seen by PCP for gastroenteritis but did not resolve so went to ER. In ER, given Tigan suppository & after that had bloody stool & bilious emesis. Transferred to larger hospital for further w/u. Surgery consult done. Second attempt to reduce IS with air contrast enema was successful. Emesis resolved. Kept in hospital for observation, did well & was d/c to home for f/u on HTN by PCP. FINAL DX: Intussusception, resolved by air contrast enema; hypertension, resolved. Updated information for VAERS # 270003. Treated at hospital on 11/19/06-11/22/06 for intussusception. Rocovered.


Changed on 4/13/2011

VAERS ID: 270003 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Texas
Vaccinated:2006-09-26
Onset:2006-11-18
Submitted:2006-12-21
Entered:2007-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 0 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / 0 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0941F / 0 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Barium double contrast, Diarrhoea haemorrhagic, Gastroenteritis, Hypertension, Intussusception, Irritability, Ultrasound kidney normal, Vomiting, Ultrasound abdomen abnormal, Hypophagia

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: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: LABS: US of abdomen revealed RLQ IS. Air contrast enema x 2. Renal US was WNL.
CDC 'Split Type': WAES0612USA02208

Write-up: Information has been received from a physician concerning a 2-month-old male who was vaccinated with the first dose of rotavirus G1 G2 G3 G4 P1 reassortant vaccine live (human-bovine). The physician reported that the patient developed intussusception within "a month of getting vaccinated". Unspecified medical attention was sought. Subsequently, the patient recovered. It was noted that the patient would not be vaccinated with the second or third dose. Upon internal review, intussusception was determined to be an other important medical event (OMIC). Additional information has been requested. 1/18/07 Received medical records from hospital which reveal patient admitted 11/19-11/22/06 for suspected intussusception (IS) after 3 day hx of vomiting, fussiness & decreased oral intake. Seen by PCP for gastroenteritis but did not resolve so went to ER. In ER, given Tigan suppository & after that had bloody stool & bilious emesis. Transferred to larger hospital for further w/u. Surgery consult done. Second attempt to reduce IS with air contrast enema was successful. Emesis resolved. Kept in hospital for observation, did well & was d/c to home for f/u on HTN by PCP. FINAL DX: Intussusception, resolved by air contrast enema; hypertension, resolved. Updated information for VAERS # 270003. Treated at hospital on 11/19/06-11/22/06 for intussusception. Rocovered.


Changed on 5/13/2011

VAERS ID: 270003 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Texas
Vaccinated:2006-09-26
Onset:2006-11-18
Submitted:2006-12-21
Entered:2007-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 0 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / 0 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0941F / 0 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Barium double contrast, Diarrhoea haemorrhagic, Gastroenteritis, Hypertension, Intussusception, Irritability, Ultrasound kidney normal, Vomiting, Ultrasound abdomen abnormal, Hypophagia

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: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: LABS: US of abdomen revealed RLQ IS. Air contrast enema x 2. Renal US was WNL.
CDC 'Split Type': WAES0612USA02208

Write-up: Information has been received from a physician concerning a 2-month-old male who was vaccinated with the first dose of rotavirus G1 G2 G3 G4 P1 reassortant vaccine live (human-bovine). The physician reported that the patient developed intussusception within "a month of getting vaccinated". Unspecified medical attention was sought. Subsequently, the patient recovered. It was noted that the patient would not be vaccinated with the second or third dose. Upon internal review, intussusception was determined to be an other important medical event (OMIC). Additional information has been requested. 1/18/07 Received medical records from hospital which reveal patient admitted 11/19-11/22/06 for suspected intussusception (IS) after 3 day hx of vomiting, fussiness & decreased oral intake. Seen by PCP for gastroenteritis but did not resolve so went to ER. In ER, given Tigan suppository & after that had bloody stool & bilious emesis. Transferred to larger hospital for further w/u. Surgery consult done. Second attempt to reduce IS with air contrast enema was successful. Emesis resolved. Kept in hospital for observation, did well & was d/c to home for f/u on HTN by PCP. FINAL DX: Intussusception, resolved by air contrast enema; hypertension, resolved. Updated information for VAERS # 270003. Treated at hospital on 11/19/06-11/22/06 for intussusception. Rocovered.


Changed on 6/11/2011

VAERS ID: 270003 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Texas
Vaccinated:2006-09-26
Onset:2006-11-18
Submitted:2006-12-21
Entered:2007-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 0 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / 0 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0941F / 0 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Barium double contrast, Diarrhoea haemorrhagic, Gastroenteritis, Hypertension, Intussusception, Irritability, Ultrasound kidney normal, Vomiting, Ultrasound abdomen abnormal, Hypophagia

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: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: LABS: US of abdomen revealed RLQ IS. Air contrast enema x 2. Renal US was WNL.
CDC 'Split Type': WAES0612USA02208

Write-up: Information has been received from a physician concerning a 2-month-old male who was vaccinated with the first dose of rotavirus G1 G2 G3 G4 P1 reassortant vaccine live (human-bovine). The physician reported that the patient developed intussusception within "a month of getting vaccinated". Unspecified medical attention was sought. Subsequently, the patient recovered. It was noted that the patient would not be vaccinated with the second or third dose. Upon internal review, intussusception was determined to be an other important medical event (OMIC). Additional information has been requested. 1/18/07 Received medical records from hospital which reveal patient admitted 11/19-11/22/06 for suspected intussusception (IS) after 3 day hx of vomiting, fussiness & decreased oral intake. Seen by PCP for gastroenteritis but did not resolve so went to ER. In ER, given Tigan suppository & after that had bloody stool & bilious emesis. Transferred to larger hospital for further w/u. Surgery consult done. Second attempt to reduce IS with air contrast enema was successful. Emesis resolved. Kept in hospital for observation, did well & was d/c to home for f/u on HTN by PCP. FINAL DX: Intussusception, resolved by air contrast enema; hypertension, resolved. Updated information for VAERS # 270003. Treated at hospital on 11/19/06-11/22/06 for intussusception. Rocovered.


Changed on 2/13/2013

VAERS ID: 270003 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Texas
Vaccinated:2006-09-26
Onset:2006-11-18
Submitted:2006-12-21
Entered:2007-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 0 - UN / - UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 - UN / - UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / 0 - UN / - UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0941F / 0 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Barium double contrast, Diarrhoea haemorrhagic, Gastroenteritis, Hypertension, Intussusception, Irritability, Ultrasound kidney normal, Vomiting, Ultrasound abdomen abnormal, Hypophagia

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: UNK Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: LABS: US of abdomen revealed RLQ IS. Air contrast enema x 2. Renal US was WNL.
CDC 'Split Type': WAES0612USA02208

Write-up: Information has been received from a physician concerning a 2-month-old male who was vaccinated with the first dose of rotavirus G1 G2 G3 G4 P1 reassortant vaccine live (human-bovine). ROTATEQ. The physician reported that the patient developed intussusception within "a month of getting vaccinated". Unspecified medical attention was sought. Subsequently, the patient recovered. It was noted that the patient would not be vaccinated with the second or third dose. Upon internal review, intussusception was determined to be an other important medical event (OMIC). Additional information has been requested. 1/18/07 Received medical records from hospital which reveal patient admitted 11/19-11/22/06 for suspected intussusception (IS) after 3 day hx of vomiting, fussiness & decreased oral intake. Seen by PCP for gastroenteritis but did not resolve so went to ER. In ER, given Tigan suppository & after that had bloody stool & bilious emesis. Transferred to larger hospital for further w/u. Surgery consult done. Second attempt to reduce IS with air contrast enema was successful. Emesis resolved. Kept in hospital for observation, did well & was d/c to home for f/u on HTN by PCP. FINAL DX: Intussusception, resolved by air contrast enema; hypertension, resolved. Updated information for VAERS # 270003. Treated at hospital on 11/19/06-11/22/06 for intussusception. Rocovered.


Changed on 5/13/2013

VAERS ID: 270003 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Texas
Vaccinated:2006-09-26
Onset:2006-11-18
Submitted:2006-12-21
Entered:2007-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 0 UN / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / 0 UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0941F / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0941F / 0 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Barium double contrast, Diarrhoea haemorrhagic, Gastroenteritis, Hypertension, Intussusception, Irritability, Ultrasound kidney normal, Vomiting, Ultrasound abdomen abnormal, Hypophagia

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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: LABS: US of abdomen revealed RLQ IS. Air contrast enema x 2. Renal US was WNL.
CDC 'Split Type': WAES0612USA02208

Write-up: Information has been received from a physician concerning a 2-month-old male who was vaccinated with the first dose of ROTATEQ. The physician reported that the patient developed intussusception within "a month of getting vaccinated". Unspecified medical attention was sought. Subsequently, the patient recovered. It was noted that the patient would not be vaccinated with the second or third dose. Upon internal review, intussusception was determined to be an other important medical event (OMIC). Additional information has been requested. 1/18/07 Received medical records from hospital which reveal patient admitted 11/19-11/22/06 for suspected intussusception (IS) after 3 day hx of vomiting, fussiness & decreased oral intake. Seen by PCP for gastroenteritis but did not resolve so went to ER. In ER, given Tigan suppository & after that had bloody stool & bilious emesis. Transferred to larger hospital for further w/u. Surgery consult done. Second attempt to reduce IS with air contrast enema was successful. Emesis resolved. Kept in hospital for observation, did well & was d/c to home for f/u on HTN by PCP. FINAL DX: Intussusception, resolved by air contrast enema; hypertension, resolved. Updated information for VAERS # 270003. Treated at hospital on 11/19/06-11/22/06 for intussusception. Rocovered.


Changed on 6/14/2014

VAERS ID: 270003 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Texas
Vaccinated:2006-09-26
Onset:2006-11-18
Submitted:2006-12-21
Entered:2007-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 0 UN / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / 0 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0941F / 0 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Barium double contrast, Diarrhoea haemorrhagic, Gastroenteritis, Hypertension, Intussusception, Irritability, Ultrasound kidney normal, Vomiting, Ultrasound abdomen abnormal, Hypophagia

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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: LABS: US of abdomen revealed RLQ IS. Air contrast enema x 2. Renal US was WNL.
CDC 'Split Type': WAES0612USA02208

Write-up: Information has been received from a physician concerning a 2-month-old male who was vaccinated with the first dose of ROTATEQ. The physician reported that the patient developed intussusception within "a month of getting vaccinated". Unspecified medical attention was sought. Subsequently, the patient recovered. It was noted that the patient would not be vaccinated with the second or third dose. Upon internal review, intussusception was determined to be an other important medical event (OMIC). Additional information has been requested. 1/18/07 Received medical records from hospital which reveal patient admitted 11/19-11/22/06 for suspected intussusception (IS) after 3 day hx of vomiting, fussiness & decreased oral intake. Seen by PCP for gastroenteritis but did not resolve so went to ER. In ER, given Tigan suppository & after that had bloody stool & bilious emesis. Transferred to larger hospital for further w/u. Surgery consult done. Second attempt to reduce IS with air contrast enema was successful. Emesis resolved. Kept in hospital for observation, did well & was d/c to home for f/u on HTN by PCP. FINAL DX: Intussusception, resolved by air contrast enema; hypertension, resolved. Updated information for VAERS # 270003. Treated at hospital on 11/19/06-11/22/06 for intussusception. Rocovered.


Changed on 3/14/2015

VAERS ID: 270003 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Texas
Vaccinated:2006-09-26
Onset:2006-11-18
Submitted:2006-12-21
Entered:2007-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 0 UN / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / 0 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0941F / 0 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Barium double contrast, Diarrhoea haemorrhagic, Gastroenteritis, Hypertension, Intussusception, Irritability, Ultrasound kidney normal, Vomiting, Ultrasound abdomen abnormal, Hypophagia

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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: LABS: US of abdomen revealed RLQ IS. Air contrast enema x 2. Renal US was WNL.
CDC 'Split Type': WAES0612USA02208

Write-up: Information has been received from a physician concerning a 2-month-old male who was vaccinated with the first dose of ROTATEQ. The physician reported that the patient developed intussusception within "a month of getting vaccinated". Unspecified medical attention was sought. Subsequently, the patient recovered. It was noted that the patient would not be vaccinated with the second or third dose. Upon internal review, intussusception was determined to be an other important medical event (OMIC). Additional information has been requested. 1/18/07 Received medical records from hospital which reveal patient admitted 11/19-11/22/06 for suspected intussusception (IS) after 3 day hx of vomiting, fussiness & decreased oral intake. Seen by PCP for gastroenteritis but did not resolve so went to ER. In ER, given Tigan suppository & after that had bloody stool & bilious emesis. Transferred to larger hospital for further w/u. Surgery consult done. Second attempt to reduce IS with air contrast enema was successful. Emesis resolved. Kept in hospital for observation, did well & was d/c to home for f/u on HTN by PCP. FINAL DX: Intussusception, resolved by air contrast enema; hypertension, resolved. Updated information for VAERS # 270003. Treated at hospital on 11/19/06-11/22/06 for intussusception. Rocovered.


Changed on 2/14/2017

VAERS ID: 270003 Before After
VAERS Form:
Age:0.2 0.17
Gender:Male
Location:Texas
Vaccinated:2006-09-26
Onset:2006-11-18
Submitted:2006-12-21
Entered:2007-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 0 UN / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / 0 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0941F / 0 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Barium double contrast, Diarrhoea haemorrhagic, Gastroenteritis, Hypertension, Intussusception, Irritability, Ultrasound kidney normal, Vomiting, Ultrasound abdomen abnormal, Hypophagia

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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: LABS: US of abdomen revealed RLQ IS. Air contrast enema x 2. Renal US was WNL.
CDC 'Split Type': WAES0612USA02208

Write-up: Information has been received from a physician concerning a 2-month-old male who was vaccinated with the first dose of ROTATEQ. The physician reported that the patient developed intussusception within "a month of getting vaccinated". Unspecified medical attention was sought. Subsequently, the patient recovered. It was noted that the patient would not be vaccinated with the second or third dose. Upon internal review, intussusception was determined to be an other important medical event (OMIC). Additional information has been requested. 1/18/07 Received medical records from hospital which reveal patient admitted 11/19-11/22/06 for suspected intussusception (IS) after 3 day hx of vomiting, fussiness & decreased oral intake. Seen by PCP for gastroenteritis but did not resolve so went to ER. In ER, given Tigan suppository & after that had bloody stool & bilious emesis. Transferred to larger hospital for further w/u. Surgery consult done. Second attempt to reduce IS with air contrast enema was successful. Emesis resolved. Kept in hospital for observation, did well & was d/c to home for f/u on HTN by PCP. FINAL DX: Intussusception, resolved by air contrast enema; hypertension, resolved. Updated information for VAERS # 270003. Treated at hospital on 11/19/06-11/22/06 for intussusception. Rocovered.


Changed on 5/14/2017

VAERS ID: 270003 Before After
VAERS Form:
Age:0.17
Gender:Male
Location:Texas
Vaccinated:2006-09-26
Onset:2006-11-18
Submitted:2006-12-21
Entered:2007-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 0 UN / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / 0 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0941F / 0 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Barium double contrast, Diarrhoea haemorrhagic, Gastroenteritis, Hypertension, Intussusception, Irritability, Ultrasound kidney normal, Vomiting, Ultrasound abdomen abnormal, Hypophagia

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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: LABS: US of abdomen revealed RLQ IS. Air contrast enema x 2. Renal US was WNL.
CDC 'Split Type': WAES0612USA02208

Write-up: Information has been received from a physician concerning a 2-month-old male who was vaccinated with the first dose of ROTATEQ. The physician reported that the patient developed intussusception within "a month of getting vaccinated". Unspecified medical attention was sought. Subsequently, the patient recovered. It was noted that the patient would not be vaccinated with the second or third dose. Upon internal review, intussusception was determined to be an other important medical event (OMIC). Additional information has been requested. 1/18/07 Received medical records from hospital which reveal patient admitted 11/19-11/22/06 for suspected intussusception (IS) after 3 day hx of vomiting, fussiness & decreased oral intake. Seen by PCP for gastroenteritis but did not resolve so went to ER. In ER, given Tigan suppository & after that had bloody stool & bilious emesis. Transferred to larger hospital for further w/u. Surgery consult done. Second attempt to reduce IS with air contrast enema was successful. Emesis resolved. Kept in hospital for observation, did well & was d/c to home for f/u on HTN by PCP. FINAL DX: Intussusception, resolved by air contrast enema; hypertension, resolved. Updated information for VAERS # 270003. Treated at hospital on 11/19/06-11/22/06 for intussusception. Rocovered.


Changed on 9/14/2017

VAERS ID: 270003 Before After
VAERS Form:(blank) 1
Age:0.17
Gender:Male
Location:Texas
Vaccinated:2006-09-26
Onset:2006-11-18
Submitted:2006-12-21
Entered:2007-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 0 1 UN / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 1 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / 0 1 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0941F / 0 1 - MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Intussusception, Irritability, Ultrasound kidney normal, Hypophagia

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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: LABS: US of abdomen revealed RLQ IS. Air contrast enema x 2. Renal US was WNL.
CDC 'Split Type': WAES0612USA02208

Write-up: Information has been received from a physician concerning a 2-month-old male who was vaccinated with the first dose of ROTATEQ. The physician reported that the patient developed intussusception within "a month of getting vaccinated". Unspecified medical attention was sought. Subsequently, the patient recovered. It was noted that the patient would not be vaccinated with the second or third dose. Upon internal review, intussusception was determined to be an other important medical event (OMIC). Additional information has been requested. 1/18/07 Received medical records from hospital which reveal patient admitted 11/19-11/22/06 for suspected intussusception (IS) after 3 day hx of vomiting, fussiness & decreased oral intake. Seen by PCP for gastroenteritis but did not resolve so went to ER. In ER, given Tigan suppository & after that had bloody stool & bilious emesis. Transferred to larger hospital for further w/u. Surgery consult done. Second attempt to reduce IS with air contrast enema was successful. Emesis resolved. Kept in hospital for observation, did well & was d/c to home for f/u on HTN by PCP. FINAL DX: Intussusception, resolved by air contrast enema; hypertension, resolved. Updated information for VAERS # 270003. Treated at hospital on 11/19/06-11/22/06 for intussusception. Rocovered.


Changed on 2/14/2018

VAERS ID: 270003 Before After
VAERS Form:1
Age:0.17
Gender:Male
Location:Texas
Vaccinated:2006-09-26
Onset:2006-11-18
Submitted:2006-12-21
Entered:2007-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 UN / UN
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / 1 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0941F / 1 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Intussusception, Irritability, Ultrasound kidney normal, Hypophagia

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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: LABS: US of abdomen revealed RLQ IS. Air contrast enema x 2. Renal US was WNL.
CDC 'Split Type': WAES0612USA02208

Write-up: Information has been received from a physician concerning a 2-month-old male who was vaccinated with the first dose of ROTATEQ. The physician reported that the patient developed intussusception within "a month of getting vaccinated". Unspecified medical attention was sought. Subsequently, the patient recovered. It was noted that the patient would not be vaccinated with the second or third dose. Upon internal review, intussusception was determined to be an other important medical event (OMIC). Additional information has been requested. 1/18/07 Received medical records from hospital which reveal patient admitted 11/19-11/22/06 for suspected intussusception (IS) after 3 day hx of vomiting, fussiness & decreased oral intake. Seen by PCP for gastroenteritis but did not resolve so went to ER. In ER, given Tigan suppository & after that had bloody stool & bilious emesis. Transferred to larger hospital for further w/u. Surgery consult done. Second attempt to reduce IS with air contrast enema was successful. Emesis resolved. Kept in hospital for observation, did well & was d/c to home for f/u on HTN by PCP. FINAL DX: Intussusception, resolved by air contrast enema; hypertension, resolved. Updated information for VAERS # 270003. Treated at hospital on 11/19/06-11/22/06 for intussusception. Rocovered.


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