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This is VAERS ID 273703

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 273703
VAERS Form:
Age:0.5
Gender:Female
Location:Alabama
Vaccinated:2006-11-14
Onset:2007-02-21
Submitted:2007-03-08
Entered:2007-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0577F / 2 - / PO

Administered by: Other      Purchased by: Unknown
Symptoms: Barium double contrast, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Information has been received from a physician concerning a 9 month old white female patient who was vaccinated with a first, second and third oral dose of Rotateq on 01-JUL-2006 (Lot # 653754/0139F), 11-SEP-2006 (Lot # 654248/0577F), and 14-NOV-2006 (Lot"# 654248/0577F). Medical history and drug allergies were reported as unknown. Concomitant therapy was unknown. On 21-FEB-2007 the patient was diagnosed with intussusception. Patient was admitted to hospital on 21-FEB-2007. The patient underwent 2 air enem


Changed on 12/8/2009

VAERS ID: 273703 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Alabama
Vaccinated:2006-11-14
Onset:2007-02-21
Submitted:2007-03-08
Entered:2007-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0577F / 2 - / PO

Administered by: Other      Purchased by: Unknown Other
Symptoms: Barium double contrast, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': (blank) WAES0703USA00661

Write-up: Information has been received from a physician concerning a 9 month old white female patient who was vaccinated with a first, second and third oral dose of Rotateq on 01-JUL-2006 (Lot # 653754/0139F), 11-SEP-2006 (Lot # 654248/0577F), and 14-NOV-2006 (Lot"# (Lot# 654248/0577F). Medical history and drug allergies were reported as unknown. Concomitant therapy was unknown. On 21-FEB-2007 the patient was diagnosed with intussusception. Patient was admitted to hospital on 21-FEB-2007. The patient underwent 2 air enem enemas and the intussusception reversed. On 22-FEB-2007, the patient was discharged from the hospital. Outcome reported as recovered. there was no product quality complaint involved. Additional information has been requested.


Changed on 5/13/2013

VAERS ID: 273703 Before After
VAERS Form:
Age:0.5
Gender:Female
Location:Alabama
Vaccinated:2006-11-14
Onset:2007-02-21
Submitted:2007-03-08
Entered:2007-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0577F / 2 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0577F / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium double contrast, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0703USA00661

Write-up: Information has been received from a physician concerning a 9 month old white female patient who was vaccinated with a first, second and third oral dose of Rotateq on 01-JUL-2006 (Lot # 653754/0139F), 11-SEP-2006 (Lot # 654248/0577F), and 14-NOV-2006 (Lot# 654248/0577F). Medical history and drug allergies were reported as unknown. Concomitant therapy was unknown. On 21-FEB-2007 the patient was diagnosed with intussusception. Patient was admitted to hospital on 21-FEB-2007. The patient underwent 2 air enemas and the intussusception reversed. On 22-FEB-2007, the patient was discharged from the hospital. Outcome reported as recovered. there was no product quality complaint involved. Additional information has been requested.


Changed on 2/14/2017

VAERS ID: 273703 Before After
VAERS Form:
Age:0.5 0.52
Gender:Female
Location:Alabama
Vaccinated:2006-11-14
Onset:2007-02-21
Submitted:2007-03-08
Entered:2007-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0577F / 2 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium double contrast, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0703USA00661

Write-up: Information has been received from a physician concerning a 9 month old white female patient who was vaccinated with a first, second and third oral dose of Rotateq on 01-JUL-2006 (Lot # 653754/0139F), 11-SEP-2006 (Lot # 654248/0577F), and 14-NOV-2006 (Lot# 654248/0577F). Medical history and drug allergies were reported as unknown. Concomitant therapy was unknown. On 21-FEB-2007 the patient was diagnosed with intussusception. Patient was admitted to hospital on 21-FEB-2007. The patient underwent 2 air enemas and the intussusception reversed. On 22-FEB-2007, the patient was discharged from the hospital. Outcome reported as recovered. there was no product quality complaint involved. Additional information has been requested.


Changed on 9/14/2017

VAERS ID: 273703 Before After
VAERS Form:(blank) 1
Age:0.52
Gender:Female
Location:Alabama
Vaccinated:2006-11-14
Onset:2007-02-21
Submitted:2007-03-08
Entered:2007-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0577F / 2 3 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium double contrast, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0703USA00661

Write-up: Information has been received from a physician concerning a 9 month old white female patient who was vaccinated with a first, second and third oral dose of Rotateq on 01-JUL-2006 (Lot # 653754/0139F), 11-SEP-2006 (Lot # 654248/0577F), and 14-NOV-2006 (Lot# 654248/0577F). Medical history and drug allergies were reported as unknown. Concomitant therapy was unknown. On 21-FEB-2007 the patient was diagnosed with intussusception. Patient was admitted to hospital on 21-FEB-2007. The patient underwent 2 air enemas and the intussusception reversed. On 22-FEB-2007, the patient was discharged from the hospital. Outcome reported as recovered. there was no product quality complaint involved. Additional information has been requested.


Changed on 2/14/2018

VAERS ID: 273703 Before After
VAERS Form:1
Age:0.52
Gender:Female
Location:Alabama
Vaccinated:2006-11-14
Onset:2007-02-21
Submitted:2007-03-08
Entered:2007-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0577F / 3 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium double contrast, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0703USA00661

Write-up: Information has been received from a physician concerning a 9 month old white female patient who was vaccinated with a first, second and third oral dose of Rotateq on 01-JUL-2006 (Lot # 653754/0139F), 11-SEP-2006 (Lot # 654248/0577F), and 14-NOV-2006 (Lot# 654248/0577F). Medical history and drug allergies were reported as unknown. Concomitant therapy was unknown. On 21-FEB-2007 the patient was diagnosed with intussusception. Patient was admitted to hospital on 21-FEB-2007. The patient underwent 2 air enemas and the intussusception reversed. On 22-FEB-2007, the patient was discharged from the hospital. Outcome reported as recovered. there was no product quality complaint involved. Additional information has been requested.


Changed on 6/14/2018

VAERS ID: 273703 Before After
VAERS Form:1
Age:0.52
Gender:Female
Location:Alabama
Vaccinated:2006-11-14
Onset:2007-02-21
Submitted:2007-03-08
Entered:2007-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0577F / 3 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium double contrast, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0703USA00661

Write-up: Information has been received from a physician concerning a 9 month old white female patient who was vaccinated with a first, second and third oral dose of Rotateq on 01-JUL-2006 (Lot # 653754/0139F), 11-SEP-2006 (Lot # 654248/0577F), and 14-NOV-2006 (Lot# 654248/0577F). Medical history and drug allergies were reported as unknown. Concomitant therapy was unknown. On 21-FEB-2007 the patient was diagnosed with intussusception. Patient was admitted to hospital on 21-FEB-2007. The patient underwent 2 air enemas and the intussusception reversed. On 22-FEB-2007, the patient was discharged from the hospital. Outcome reported as recovered. there was no product quality complaint involved. Additional information has been requested.


Changed on 8/14/2018

VAERS ID: 273703 Before After
VAERS Form:1
Age:0.52
Gender:Female
Location:Alabama
Vaccinated:2006-11-14
Onset:2007-02-21
Submitted:2007-03-08
Entered:2007-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0577F / 3 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium double contrast, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0703USA00661

Write-up: Information has been received from a physician concerning a 9 month old white female patient who was vaccinated with a first, second and third oral dose of Rotateq on 01-JUL-2006 (Lot # 653754/0139F), 11-SEP-2006 (Lot # 654248/0577F), and 14-NOV-2006 (Lot# 654248/0577F). Medical history and drug allergies were reported as unknown. Concomitant therapy was unknown. On 21-FEB-2007 the patient was diagnosed with intussusception. Patient was admitted to hospital on 21-FEB-2007. The patient underwent 2 air enemas and the intussusception reversed. On 22-FEB-2007, the patient was discharged from the hospital. Outcome reported as recovered. there was no product quality complaint involved. Additional information has been requested.


Changed on 9/14/2018

VAERS ID: 273703 Before After
VAERS Form:1
Age:0.52
Gender:Female
Location:Alabama
Vaccinated:2006-11-14
Onset:2007-02-21
Submitted:2007-03-08
Entered:2007-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0577F / 3 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Barium double contrast, 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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0703USA00661

Write-up: Information has been received from a physician concerning a 9 month old white female patient who was vaccinated with a first, second and third oral dose of Rotateq on 01-JUL-2006 (Lot # 653754/0139F), 11-SEP-2006 (Lot # 654248/0577F), and 14-NOV-2006 (Lot# 654248/0577F). Medical history and drug allergies were reported as unknown. Concomitant therapy was unknown. On 21-FEB-2007 the patient was diagnosed with intussusception. Patient was admitted to hospital on 21-FEB-2007. The patient underwent 2 air enemas and the intussusception reversed. On 22-FEB-2007, the patient was discharged from the hospital. Outcome reported as recovered. there was no product quality complaint involved. Additional information has been requested.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=273703&WAYBACKHISTORY=ON


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