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This is VAERS ID 271991

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 271991
VAERS Form:
Age:0.5
Gender:Male
Location:Illinois
Vaccinated:2006-12-14
Onset:2007-01-26
Submitted:2007-02-08
Entered:2007-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 2 - / PO

Administered by: Other      Purchased by: Unknown
Symptoms: Barium double contrast, Intussusception, Large intestinal obstruction reduction, Rash, Surgery

Life Threatening? Yes
Birth Defect? No
Died? No
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: NONE
Current Illness:
Preexisting Conditions: NONE PMH: asthma, on steroids.
Allergies:
Diagnostic Lab Data: NONE LABS: all WNL.
CDC 'Split Type':

Write-up: Information has been received from a certified medical assistant concerning a 7-month-old male with no medical history or allergies who on 10-AUG-2006, 12-OCT-2006 and 14-DEC-2006 was vaccinated PO with the first, second and third doses, respectively of R"otateq vaccine (human-bovine) (lot#s 65424B/0577F and 655484/1032F - administration dates not specified). There was no concomitant therapy. The CMA reported that on 26-JAN-2007, the patient presented with a rash and vomiting. The patient was diagnosed wit


Changed on 12/8/2009

VAERS ID: 271991 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Illinois
Vaccinated:2006-12-14
Onset:2007-01-26
Submitted:2007-02-08
Entered:2007-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 2 - / PO

Administered by: Other      Purchased by: Unknown Other
Symptoms: Barium double contrast, Intussusception, Large intestinal obstruction reduction, Rash, Surgery, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? No
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: NONE
Current Illness:
Preexisting Conditions: NONE PMH: asthma, on steroids.
Allergies:
Diagnostic Lab Data: NONE LABS: all WNL.
CDC 'Split Type': (blank) WAES0701USA05034

Write-up: Information has been received from a certified medical assistant concerning a 7-month-old male with no medical history or allergies who on 10-AUG-2006, 12-OCT-2006 and 14-DEC-2006 was vaccinated PO with the first, second and third doses, respectively of R"otateq Rotateq vaccine (human-bovine) (lot#s 65424B/0577F and 655484/1032F - administration dates not specified). There was no concomitant therapy. The CMA reported that on 26-JAN-2007, the patient presented with a rash and vomiting. The patient was diagnosed wit with an ileocolic intussusception that could not be reduced by Barium enema. The patient was subsequently hospitalized and surgical correction was pending. No laboratory/diagnostic tests were performed. At the time of this report, the outcome was unknown. The CMA also considered the patient''s rash and ileocolic intussusception to be life-threatening and other important medical events. Additional information has been requested. 2/22/07 Received medical records from hospital which reveal patient experienced acute onset abdominal pain & vomiting. Hospitalized from 1/26-1/30/07 after being transferred from outlying hospital. BE done x3 at outlying hospital revealed intussusception but was unreducible & so subsequently transferred to higher level of care for management. Air enema done at second hospital also unsuccessful at reducing. Taken emergently to OR for exp lap & reduction w/appendectomy. Uneventful recovery & was d/c to home to be f/u w/peds surgeon & PCP. FINAL DX: Ileocolic Intussusception, surgically reduced.


Changed on 1/5/2010

VAERS ID: 271991 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Illinois
Vaccinated:2006-12-14
Onset:2007-01-26
Submitted:2007-02-08
Entered:2007-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - 1032F / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium double contrast, Intussusception, Large intestinal obstruction reduction, Rash, Surgery, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? No
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: NONE
Current Illness:
Preexisting Conditions: NONE PMH: asthma, on steroids.
Allergies:
Diagnostic Lab Data: NONE LABS: all WNL.
CDC 'Split Type': WAES0701USA05034

Write-up: Information has been received from a certified medical assistant concerning a 7-month-old male with no medical history or allergies who on 10-AUG-2006, 12-OCT-2006 and 14-DEC-2006 was vaccinated PO with the first, second and third doses, respectively of Rotateq vaccine (human-bovine) (lot#s 65424B/0577F and 655484/1032F - administration dates not specified). There was no concomitant therapy. The CMA reported that on 26-JAN-2007, the patient presented with a rash and vomiting. The patient was diagnosed with an ileocolic intussusception that could not be reduced by Barium enema. The patient was subsequently hospitalized and surgical correction was pending. No laboratory/diagnostic tests were performed. At the time of this report, the outcome was unknown. The CMA also considered the patient''s rash and ileocolic intussusception to be life-threatening and other important medical events. Additional information has been requested. 2/22/07 Received medical records from hospital which reveal patient experienced acute onset abdominal pain & vomiting. Hospitalized from 1/26-1/30/07 after being transferred from outlying hospital. BE done x3 at outlying hospital revealed intussusception but was unreducible & so subsequently transferred to higher level of care for management. Air enema done at second hospital also unsuccessful at reducing. Taken emergently to OR for exp lap & reduction w/appendectomy. Uneventful recovery & was d/c to home to be f/u w/peds surgeon & PCP. FINAL DX: Ileocolic Intussusception, surgically reduced.


Changed on 8/31/2010

VAERS ID: 271991 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Illinois
Vaccinated:2006-12-14
Onset:2007-01-26
Submitted:2007-02-08
Entered:2007-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032F / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Large intestinal obstruction reduction, Rash, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? No
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: NONE
Current Illness:
Preexisting Conditions: NONE PMH: asthma, on steroids.
Allergies:
Diagnostic Lab Data: NONE LABS: all WNL.
CDC 'Split Type': WAES0701USA05034

Write-up: Information has been received from a certified medical assistant concerning a 7-month-old male with no medical history or allergies who on 10-AUG-2006, 12-OCT-2006 and 14-DEC-2006 was vaccinated PO with the first, second and third doses, respectively of Rotateq vaccine (human-bovine) (lot#s 65424B/0577F and 655484/1032F - administration dates not specified). There was no concomitant therapy. The CMA reported that on 26-JAN-2007, the patient presented with a rash and vomiting. The patient was diagnosed with an ileocolic intussusception that could not be reduced by Barium enema. The patient was subsequently hospitalized and surgical correction was pending. No laboratory/diagnostic tests were performed. At the time of this report, the outcome was unknown. The CMA also considered the patient''s rash and ileocolic intussusception to be life-threatening and other important medical events. Additional information has been requested. 2/22/07 Received medical records from hospital which reveal patient experienced acute onset abdominal pain & vomiting. Hospitalized from 1/26-1/30/07 after being transferred from outlying hospital. BE done x3 at outlying hospital revealed intussusception but was unreducible & so subsequently transferred to higher level of care for management. Air enema done at second hospital also unsuccessful at reducing. Taken emergently to OR for exp lap & reduction w/appendectomy. Uneventful recovery & was d/c to home to be f/u w/peds surgeon & PCP. FINAL DX: Ileocolic Intussusception, surgically reduced.


Changed on 1/4/2011

VAERS ID: 271991 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Illinois
Vaccinated:2006-12-14
Onset:2007-01-26
Submitted:2007-02-08
Entered:2007-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032F / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Large intestinal obstruction reduction, Rash, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? No
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: NONE
Current Illness:
Preexisting Conditions: NONE PMH: asthma, on steroids.
Allergies:
Diagnostic Lab Data: NONE LABS: all WNL.
CDC 'Split Type': WAES0701USA05034

Write-up: Information has been received from a certified medical assistant concerning a 7-month-old male with no medical history or allergies who on 10-AUG-2006, 12-OCT-2006 and 14-DEC-2006 was vaccinated PO with the first, second and third doses, respectively of Rotateq vaccine (human-bovine) (lot#s 65424B/0577F and 655484/1032F - administration dates not specified). There was no concomitant therapy. The CMA reported that on 26-JAN-2007, the patient presented with a rash and vomiting. The patient was diagnosed with an ileocolic intussusception that could not be reduced by Barium enema. The patient was subsequently hospitalized and surgical correction was pending. No laboratory/diagnostic tests were performed. At the time of this report, the outcome was unknown. The CMA also considered the patient''s rash and ileocolic intussusception to be life-threatening and other important medical events. Additional information has been requested. 2/22/07 Received medical records from hospital which reveal patient experienced acute onset abdominal pain & vomiting. Hospitalized from 1/26-1/30/07 after being transferred from outlying hospital. BE done x3 at outlying hospital revealed intussusception but was unreducible & so subsequently transferred to higher level of care for management. Air enema done at second hospital also unsuccessful at reducing. Taken emergently to OR for exp lap & reduction w/appendectomy. Uneventful recovery & was d/c to home to be f/u w/peds surgeon & PCP. FINAL DX: Ileocolic Intussusception, surgically reduced.


Changed on 4/13/2011

VAERS ID: 271991 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Illinois
Vaccinated:2006-12-14
Onset:2007-01-26
Submitted:2007-02-08
Entered:2007-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032F / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium double contrast, Intussusception, Large intestinal obstruction reduction, Rash, Surgery, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? No
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: NONE
Current Illness:
Preexisting Conditions: NONE PMH: asthma, on steroids.
Allergies:
Diagnostic Lab Data: NONE LABS: all WNL.
CDC 'Split Type': WAES0701USA05034

Write-up: Information has been received from a certified medical assistant concerning a 7-month-old male with no medical history or allergies who on 10-AUG-2006, 12-OCT-2006 and 14-DEC-2006 was vaccinated PO with the first, second and third doses, respectively of Rotateq vaccine (human-bovine) (lot#s 65424B/0577F and 655484/1032F - administration dates not specified). There was no concomitant therapy. The CMA reported that on 26-JAN-2007, the patient presented with a rash and vomiting. The patient was diagnosed with an ileocolic intussusception that could not be reduced by Barium enema. The patient was subsequently hospitalized and surgical correction was pending. No laboratory/diagnostic tests were performed. At the time of this report, the outcome was unknown. The CMA also considered the patient''s rash and ileocolic intussusception to be life-threatening and other important medical events. Additional information has been requested. 2/22/07 Received medical records from hospital which reveal patient experienced acute onset abdominal pain & vomiting. Hospitalized from 1/26-1/30/07 after being transferred from outlying hospital. BE done x3 at outlying hospital revealed intussusception but was unreducible & so subsequently transferred to higher level of care for management. Air enema done at second hospital also unsuccessful at reducing. Taken emergently to OR for exp lap & reduction w/appendectomy. Uneventful recovery & was d/c to home to be f/u w/peds surgeon & PCP. FINAL DX: Ileocolic Intussusception, surgically reduced.


Changed on 5/13/2011

VAERS ID: 271991 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Illinois
Vaccinated:2006-12-14
Onset:2007-01-26
Submitted:2007-02-08
Entered:2007-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032F / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium double contrast, Intussusception, Large intestinal obstruction reduction, Rash, Surgery, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? No
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: NONE
Current Illness:
Preexisting Conditions: NONE PMH: asthma, on steroids.
Allergies:
Diagnostic Lab Data: NONE LABS: all WNL.
CDC 'Split Type': WAES0701USA05034

Write-up: Information has been received from a certified medical assistant concerning a 7-month-old male with no medical history or allergies who on 10-AUG-2006, 12-OCT-2006 and 14-DEC-2006 was vaccinated PO with the first, second and third doses, respectively of Rotateq vaccine (human-bovine) (lot#s 65424B/0577F and 655484/1032F - administration dates not specified). There was no concomitant therapy. The CMA reported that on 26-JAN-2007, the patient presented with a rash and vomiting. The patient was diagnosed with an ileocolic intussusception that could not be reduced by Barium enema. The patient was subsequently hospitalized and surgical correction was pending. No laboratory/diagnostic tests were performed. At the time of this report, the outcome was unknown. The CMA also considered the patient''s rash and ileocolic intussusception to be life-threatening and other important medical events. Additional information has been requested. 2/22/07 Received medical records from hospital which reveal patient experienced acute onset abdominal pain & vomiting. Hospitalized from 1/26-1/30/07 after being transferred from outlying hospital. BE done x3 at outlying hospital revealed intussusception but was unreducible & so subsequently transferred to higher level of care for management. Air enema done at second hospital also unsuccessful at reducing. Taken emergently to OR for exp lap & reduction w/appendectomy. Uneventful recovery & was d/c to home to be f/u w/peds surgeon & PCP. FINAL DX: Ileocolic Intussusception, surgically reduced.


Changed on 6/11/2011

VAERS ID: 271991 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Illinois
Vaccinated:2006-12-14
Onset:2007-01-26
Submitted:2007-02-08
Entered:2007-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032F / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium double contrast, Intussusception, Large intestinal obstruction reduction, Rash, Surgery, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? No
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: NONE
Current Illness:
Preexisting Conditions: NONE PMH: asthma, on steroids.
Allergies:
Diagnostic Lab Data: NONE LABS: all WNL.
CDC 'Split Type': WAES0701USA05034

Write-up: Information has been received from a certified medical assistant concerning a 7-month-old male with no medical history or allergies who on 10-AUG-2006, 12-OCT-2006 and 14-DEC-2006 was vaccinated PO with the first, second and third doses, respectively of Rotateq vaccine (human-bovine) (lot#s 65424B/0577F and 655484/1032F - administration dates not specified). There was no concomitant therapy. The CMA reported that on 26-JAN-2007, the patient presented with a rash and vomiting. The patient was diagnosed with an ileocolic intussusception that could not be reduced by Barium enema. The patient was subsequently hospitalized and surgical correction was pending. No laboratory/diagnostic tests were performed. At the time of this report, the outcome was unknown. The CMA also considered the patient''s rash and ileocolic intussusception to be life-threatening and other important medical events. Additional information has been requested. 2/22/07 Received medical records from hospital which reveal patient experienced acute onset abdominal pain & vomiting. Hospitalized from 1/26-1/30/07 after being transferred from outlying hospital. BE done x3 at outlying hospital revealed intussusception but was unreducible & so subsequently transferred to higher level of care for management. Air enema done at second hospital also unsuccessful at reducing. Taken emergently to OR for exp lap & reduction w/appendectomy. Uneventful recovery & was d/c to home to be f/u w/peds surgeon & PCP. FINAL DX: Ileocolic Intussusception, surgically reduced.


Changed on 5/13/2013

VAERS ID: 271991 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Illinois
Vaccinated:2006-12-14
Onset:2007-01-26
Submitted:2007-02-08
Entered:2007-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032F / 2 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032F / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium double contrast, Intussusception, Large intestinal obstruction reduction, Rash, Surgery, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? No
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: NONE
Current Illness:
Preexisting Conditions: NONE PMH: asthma, on steroids.
Allergies:
Diagnostic Lab Data: NONE LABS: all WNL.
CDC 'Split Type': WAES0701USA05034

Write-up: Information has been received from a certified medical assistant concerning a 7-month-old male with no medical history or allergies who on 10-AUG-2006, 12-OCT-2006 and 14-DEC-2006 was vaccinated PO with the first, second and third doses, respectively of Rotateq vaccine (human-bovine) (lot#s 65424B/0577F and 655484/1032F - administration dates not specified). There was no concomitant therapy. The CMA reported that on 26-JAN-2007, the patient presented with a rash and vomiting. The patient was diagnosed with an ileocolic intussusception that could not be reduced by Barium enema. The patient was subsequently hospitalized and surgical correction was pending. No laboratory/diagnostic tests were performed. At the time of this report, the outcome was unknown. The CMA also considered the patient''s rash and ileocolic intussusception to be life-threatening and other important medical events. Additional information has been requested. 2/22/07 Received medical records from hospital which reveal patient experienced acute onset abdominal pain & vomiting. Hospitalized from 1/26-1/30/07 after being transferred from outlying hospital. BE done x3 at outlying hospital revealed intussusception but was unreducible & so subsequently transferred to higher level of care for management. Air enema done at second hospital also unsuccessful at reducing. Taken emergently to OR for exp lap & reduction w/appendectomy. Uneventful recovery & was d/c to home to be f/u w/peds surgeon & PCP. FINAL DX: Ileocolic Intussusception, surgically reduced.


Changed on 6/14/2014

VAERS ID: 271991 Before After
VAERS Form:
Age:0.5
Gender:Male
Location:Illinois
Vaccinated:2006-12-14
Onset:2007-01-26
Submitted:2007-02-08
Entered:2007-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032F / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium double contrast, Intussusception, Large intestinal obstruction reduction, Rash, Surgery, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? No
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: NONE
Current Illness:
Preexisting Conditions: NONE PMH: asthma, on steroids.
Allergies:
Diagnostic Lab Data: NONE LABS: all WNL.
CDC 'Split Type': WAES0701USA05034

Write-up: Information has been received from a certified medical assistant concerning a 7-month-old male with no medical history or allergies who on 10-AUG-2006, 12-OCT-2006 and 14-DEC-2006 was vaccinated PO with the first, second and third doses, respectively of Rotateq vaccine (human-bovine) (lot#s 65424B/0577F and 655484/1032F - administration dates not specified). There was no concomitant therapy. The CMA reported that on 26-JAN-2007, the patient presented with a rash and vomiting. The patient was diagnosed with an ileocolic intussusception that could not be reduced by Barium enema. The patient was subsequently hospitalized and surgical correction was pending. No laboratory/diagnostic tests were performed. At the time of this report, the outcome was unknown. The CMA also considered the patient''s rash and ileocolic intussusception to be life-threatening and other important medical events. Additional information has been requested. 2/22/07 Received medical records from hospital which reveal patient experienced acute onset abdominal pain & vomiting. Hospitalized from 1/26-1/30/07 after being transferred from outlying hospital. BE done x3 at outlying hospital revealed intussusception but was unreducible & so subsequently transferred to higher level of care for management. Air enema done at second hospital also unsuccessful at reducing. Taken emergently to OR for exp lap & reduction w/appendectomy. Uneventful recovery & was d/c to home to be f/u w/peds surgeon & PCP. FINAL DX: Ileocolic Intussusception, surgically reduced.


Changed on 2/14/2017

VAERS ID: 271991 Before After
VAERS Form:
Age:0.5 0.52
Gender:Male
Location:Illinois
Vaccinated:2006-12-14
Onset:2007-01-26
Submitted:2007-02-08
Entered:2007-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032F / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium double contrast, Intussusception, Large intestinal obstruction reduction, Rash, Surgery, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? No
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:
Current Illness:
Preexisting Conditions: NONE PMH: asthma, on steroids.
Allergies:
Diagnostic Lab Data: NONE LABS: all WNL.
CDC 'Split Type': WAES0701USA05034

Write-up: Information has been received from a certified medical assistant concerning a 7-month-old male with no medical history or allergies who on 10-AUG-2006, 12-OCT-2006 and 14-DEC-2006 was vaccinated PO with the first, second and third doses, respectively of Rotateq vaccine (human-bovine) (lot#s 65424B/0577F and 655484/1032F - administration dates not specified). There was no concomitant therapy. The CMA reported that on 26-JAN-2007, the patient presented with a rash and vomiting. The patient was diagnosed with an ileocolic intussusception that could not be reduced by Barium enema. The patient was subsequently hospitalized and surgical correction was pending. No laboratory/diagnostic tests were performed. At the time of this report, the outcome was unknown. The CMA also considered the patient''s rash and ileocolic intussusception to be life-threatening and other important medical events. Additional information has been requested. 2/22/07 Received medical records from hospital which reveal patient experienced acute onset abdominal pain & vomiting. Hospitalized from 1/26-1/30/07 after being transferred from outlying hospital. BE done x3 at outlying hospital revealed intussusception but was unreducible & so subsequently transferred to higher level of care for management. Air enema done at second hospital also unsuccessful at reducing. Taken emergently to OR for exp lap & reduction w/appendectomy. Uneventful recovery & was d/c to home to be f/u w/peds surgeon & PCP. FINAL DX: Ileocolic Intussusception, surgically reduced.


Changed on 5/14/2017

VAERS ID: 271991 Before After
VAERS Form:
Age:0.52
Gender:Male
Location:Illinois
Vaccinated:2006-12-14
Onset:2007-01-26
Submitted:2007-02-08
Entered:2007-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032F / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium double contrast, Intussusception, Large intestinal obstruction reduction, Rash, Surgery, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? No
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: NONE
Current Illness:
Preexisting Conditions: NONE PMH: asthma, on steroids.
Allergies:
Diagnostic Lab Data: NONE LABS: all WNL.
CDC 'Split Type': WAES0701USA05034

Write-up: Information has been received from a certified medical assistant concerning a 7-month-old male with no medical history or allergies who on 10-AUG-2006, 12-OCT-2006 and 14-DEC-2006 was vaccinated PO with the first, second and third doses, respectively of Rotateq vaccine (human-bovine) (lot#s 65424B/0577F and 655484/1032F - administration dates not specified). There was no concomitant therapy. The CMA reported that on 26-JAN-2007, the patient presented with a rash and vomiting. The patient was diagnosed with an ileocolic intussusception that could not be reduced by Barium enema. The patient was subsequently hospitalized and surgical correction was pending. No laboratory/diagnostic tests were performed. At the time of this report, the outcome was unknown. The CMA also considered the patient''s rash and ileocolic intussusception to be life-threatening and other important medical events. Additional information has been requested. 2/22/07 Received medical records from hospital which reveal patient experienced acute onset abdominal pain & vomiting. Hospitalized from 1/26-1/30/07 after being transferred from outlying hospital. BE done x3 at outlying hospital revealed intussusception but was unreducible & so subsequently transferred to higher level of care for management. Air enema done at second hospital also unsuccessful at reducing. Taken emergently to OR for exp lap & reduction w/appendectomy. Uneventful recovery & was d/c to home to be f/u w/peds surgeon & PCP. FINAL DX: Ileocolic Intussusception, surgically reduced.


Changed on 9/14/2017

VAERS ID: 271991 Before After
VAERS Form:(blank) 1
Age:0.52
Gender:Male
Location:Illinois
Vaccinated:2006-12-14
Onset:2007-01-26
Submitted:2007-02-08
Entered:2007-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032F / 2 3 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Rash, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? No
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: NONE
Current Illness:
Preexisting Conditions: NONE PMH: asthma, on steroids.
Allergies:
Diagnostic Lab Data: NONE LABS: all WNL.
CDC 'Split Type': WAES0701USA05034

Write-up: Information has been received from a certified medical assistant concerning a 7-month-old male with no medical history or allergies who on 10-AUG-2006, 12-OCT-2006 and 14-DEC-2006 was vaccinated PO with the first, second and third doses, respectively of Rotateq vaccine (human-bovine) (lot#s 65424B/0577F and 655484/1032F - administration dates not specified). There was no concomitant therapy. The CMA reported that on 26-JAN-2007, the patient presented with a rash and vomiting. The patient was diagnosed with an ileocolic intussusception that could not be reduced by Barium enema. The patient was subsequently hospitalized and surgical correction was pending. No laboratory/diagnostic tests were performed. At the time of this report, the outcome was unknown. The CMA also considered the patient''s rash and ileocolic intussusception to be life-threatening and other important medical events. Additional information has been requested. 2/22/07 Received medical records from hospital which reveal patient experienced acute onset abdominal pain & vomiting. Hospitalized from 1/26-1/30/07 after being transferred from outlying hospital. BE done x3 at outlying hospital revealed intussusception but was unreducible & so subsequently transferred to higher level of care for management. Air enema done at second hospital also unsuccessful at reducing. Taken emergently to OR for exp lap & reduction w/appendectomy. Uneventful recovery & was d/c to home to be f/u w/peds surgeon & PCP. FINAL DX: Ileocolic Intussusception, surgically reduced.


Changed on 2/14/2018

VAERS ID: 271991 Before After
VAERS Form:1
Age:0.52
Gender:Male
Location:Illinois
Vaccinated:2006-12-14
Onset:2007-01-26
Submitted:2007-02-08
Entered:2007-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032F / 3 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Rash, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? No
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: NONE
Current Illness:
Preexisting Conditions: NONE PMH: asthma, on steroids.
Allergies:
Diagnostic Lab Data: NONE LABS: all WNL.
CDC 'Split Type': WAES0701USA05034

Write-up: Information has been received from a certified medical assistant concerning a 7-month-old male with no medical history or allergies who on 10-AUG-2006, 12-OCT-2006 and 14-DEC-2006 was vaccinated PO with the first, second and third doses, respectively of Rotateq vaccine (human-bovine) (lot#s 65424B/0577F and 655484/1032F - administration dates not specified). There was no concomitant therapy. The CMA reported that on 26-JAN-2007, the patient presented with a rash and vomiting. The patient was diagnosed with an ileocolic intussusception that could not be reduced by Barium enema. The patient was subsequently hospitalized and surgical correction was pending. No laboratory/diagnostic tests were performed. At the time of this report, the outcome was unknown. The CMA also considered the patient''s rash and ileocolic intussusception to be life-threatening and other important medical events. Additional information has been requested. 2/22/07 Received medical records from hospital which reveal patient experienced acute onset abdominal pain & vomiting. Hospitalized from 1/26-1/30/07 after being transferred from outlying hospital. BE done x3 at outlying hospital revealed intussusception but was unreducible & so subsequently transferred to higher level of care for management. Air enema done at second hospital also unsuccessful at reducing. Taken emergently to OR for exp lap & reduction w/appendectomy. Uneventful recovery & was d/c to home to be f/u w/peds surgeon & PCP. FINAL DX: Ileocolic Intussusception, surgically reduced.


Changed on 6/14/2018

VAERS ID: 271991 Before After
VAERS Form:1
Age:0.52
Gender:Male
Location:Illinois
Vaccinated:2006-12-14
Onset:2007-01-26
Submitted:2007-02-08
Entered:2007-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032F / 3 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Rash, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? No
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: NONE
Current Illness:
Preexisting Conditions: NONE PMH: asthma, on steroids.
Allergies:
Diagnostic Lab Data: NONE LABS: all WNL.
CDC 'Split Type': WAES0701USA05034

Write-up: Information has been received from a certified medical assistant concerning a 7-month-old male with no medical history or allergies who on 10-AUG-2006, 12-OCT-2006 and 14-DEC-2006 was vaccinated PO with the first, second and third doses, respectively of Rotateq vaccine (human-bovine) (lot#s 65424B/0577F and 655484/1032F - administration dates not specified). There was no concomitant therapy. The CMA reported that on 26-JAN-2007, the patient presented with a rash and vomiting. The patient was diagnosed with an ileocolic intussusception that could not be reduced by Barium enema. The patient was subsequently hospitalized and surgical correction was pending. No laboratory/diagnostic tests were performed. At the time of this report, the outcome was unknown. The CMA also considered the patient''s rash and ileocolic intussusception to be life-threatening and other important medical events. Additional information has been requested. 2/22/07 Received medical records from hospital which reveal patient experienced acute onset abdominal pain & vomiting. Hospitalized from 1/26-1/30/07 after being transferred from outlying hospital. BE done x3 at outlying hospital revealed intussusception but was unreducible & so subsequently transferred to higher level of care for management. Air enema done at second hospital also unsuccessful at reducing. Taken emergently to OR for exp lap & reduction w/appendectomy. Uneventful recovery & was d/c to home to be f/u w/peds surgeon & PCP. FINAL DX: Ileocolic Intussusception, surgically reduced.


Changed on 8/14/2018

VAERS ID: 271991 Before After
VAERS Form:1
Age:0.52
Gender:Male
Location:Illinois
Vaccinated:2006-12-14
Onset:2007-01-26
Submitted:2007-02-08
Entered:2007-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032F / 3 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Rash, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? No
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: NONE
Current Illness:
Preexisting Conditions: NONE PMH: asthma, on steroids.
Allergies:
Diagnostic Lab Data: NONE LABS: all WNL.
CDC 'Split Type': WAES0701USA05034

Write-up: Information has been received from a certified medical assistant concerning a 7-month-old male with no medical history or allergies who on 10-AUG-2006, 12-OCT-2006 and 14-DEC-2006 was vaccinated PO with the first, second and third doses, respectively of Rotateq vaccine (human-bovine) (lot#s 65424B/0577F and 655484/1032F - administration dates not specified). There was no concomitant therapy. The CMA reported that on 26-JAN-2007, the patient presented with a rash and vomiting. The patient was diagnosed with an ileocolic intussusception that could not be reduced by Barium enema. The patient was subsequently hospitalized and surgical correction was pending. No laboratory/diagnostic tests were performed. At the time of this report, the outcome was unknown. The CMA also considered the patient''s rash and ileocolic intussusception to be life-threatening and other important medical events. Additional information has been requested. 2/22/07 Received medical records from hospital which reveal patient experienced acute onset abdominal pain & vomiting. Hospitalized from 1/26-1/30/07 after being transferred from outlying hospital. BE done x3 at outlying hospital revealed intussusception but was unreducible & so subsequently transferred to higher level of care for management. Air enema done at second hospital also unsuccessful at reducing. Taken emergently to OR for exp lap & reduction w/appendectomy. Uneventful recovery & was d/c to home to be f/u w/peds surgeon & PCP. FINAL DX: Ileocolic Intussusception, surgically reduced.


Changed on 9/14/2018

VAERS ID: 271991 Before After
VAERS Form:1
Age:0.52
Gender:Male
Location:Illinois
Vaccinated:2006-12-14
Onset:2007-01-26
Submitted:2007-02-08
Entered:2007-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032F / 3 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Rash, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? No
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: NONE
Current Illness:
Preexisting Conditions: NONE PMH: asthma, on steroids.
Allergies:
Diagnostic Lab Data: NONE LABS: all WNL.
CDC 'Split Type': WAES0701USA05034

Write-up: Information has been received from a certified medical assistant concerning a 7-month-old male with no medical history or allergies who on 10-AUG-2006, 12-OCT-2006 and 14-DEC-2006 was vaccinated PO with the first, second and third doses, respectively of Rotateq vaccine (human-bovine) (lot#s 65424B/0577F and 655484/1032F - administration dates not specified). There was no concomitant therapy. The CMA reported that on 26-JAN-2007, the patient presented with a rash and vomiting. The patient was diagnosed with an ileocolic intussusception that could not be reduced by Barium enema. The patient was subsequently hospitalized and surgical correction was pending. No laboratory/diagnostic tests were performed. At the time of this report, the outcome was unknown. The CMA also considered the patient''s rash and ileocolic intussusception to be life-threatening and other important medical events. Additional information has been requested. 2/22/07 Received medical records from hospital which reveal patient experienced acute onset abdominal pain & vomiting. Hospitalized from 1/26-1/30/07 after being transferred from outlying hospital. BE done x3 at outlying hospital revealed intussusception but was unreducible & so subsequently transferred to higher level of care for management. Air enema done at second hospital also unsuccessful at reducing. Taken emergently to OR for exp lap & reduction w/appendectomy. Uneventful recovery & was d/c to home to be f/u w/peds surgeon & PCP. FINAL DX: Ileocolic Intussusception, surgically reduced.


Changed on 10/14/2018

VAERS ID: 271991 Before After
VAERS Form:1
Age:0.52
Gender:Male
Location:Illinois
Vaccinated:2006-12-14
Onset:2007-01-26
Submitted:2007-02-08
Entered:2007-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1032F / 3 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Intussusception, Rash, Vomiting

Life Threatening? Yes
Birth Defect? No
Died? No
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: NONE
Current Illness:
Preexisting Conditions: NONE PMH: asthma, on steroids.
Allergies:
Diagnostic Lab Data: NONE LABS: all WNL.
CDC 'Split Type': WAES0701USA05034

Write-up: Information has been received from a certified medical assistant concerning a 7-month-old male with no medical history or allergies who on 10-AUG-2006, 12-OCT-2006 and 14-DEC-2006 was vaccinated PO with the first, second and third doses, respectively of Rotateq vaccine (human-bovine) (lot#s 65424B/0577F and 655484/1032F - administration dates not specified). There was no concomitant therapy. The CMA reported that on 26-JAN-2007, the patient presented with a rash and vomiting. The patient was diagnosed with an ileocolic intussusception that could not be reduced by Barium enema. The patient was subsequently hospitalized and surgical correction was pending. No laboratory/diagnostic tests were performed. At the time of this report, the outcome was unknown. The CMA also considered the patient''s rash and ileocolic intussusception to be life-threatening and other important medical events. Additional information has been requested. 2/22/07 Received medical records from hospital which reveal patient experienced acute onset abdominal pain & vomiting. Hospitalized from 1/26-1/30/07 after being transferred from outlying hospital. BE done x3 at outlying hospital revealed intussusception but was unreducible & so subsequently transferred to higher level of care for management. Air enema done at second hospital also unsuccessful at reducing. Taken emergently to OR for exp lap & reduction w/appendectomy. Uneventful recovery & was d/c to home to be f/u w/peds surgeon & PCP. FINAL DX: Ileocolic Intussusception, surgically reduced.

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