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This is VAERS ID 274158

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

274158
VAERS Form:
Age:0.2
Gender:Female
Location:California
Vaccinated:2007-02-28
Onset:2007-03-08
Submitted:2007-03-16
Entered:2007-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 06E605 / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Barium enema, Blood culture negative, Culture urine negative, Abdominal X-ray

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: TAKING SYNAGIS FOR RSV PROPHYLAXIS
Preexisting Conditions: 34 WEEK PREEMIE
Allergies:
Diagnostic Lab Data: LABS: abdominal x-ray revealed IS. Barium enema reduced IS. WBC 9.2, plt 582, lymphs 40, monos 55, bands 4 & polys 49. UA revealed 3 hyaline casts. Urine & blood c/s were neg.
CDC 'Split Type':

Write-up:PENELOPE WAS ADMITTED WITH INTUSSUSCEPTION NINE DAYS LATER, AND REDUCED SUCCESSFULLY, AT CHILDREN''''S HOSPITAL AT SAN DEIGO


Changed on 12/8/2009

274158 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:California
Vaccinated:2007-02-28
Onset:2007-03-08
Submitted:2007-03-16
Entered:2007-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 06E605 / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Barium enema, Blood culture negative, Culture urine negative, Differential white blood cell count abnormal, Intussusception, Lethargy, Urinary casts, Urine analysis, Vomiting, Platelet count increased, Decreased appetite, Abdominal X-ray

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: TAKING SYNAGIS FOR RSV PROPHYLAXIS
Preexisting Conditions: 34 WEEK PREEMIE PMH: preemie at 34.5 wks, born by c-section.
Allergies:
Diagnostic Lab Data: LABS: abdominal x-ray revealed IS. Barium enema reduced IS. WBC 9.2, plt 582, lymphs 40, monos 55, bands 4 & polys 49. UA revealed 3 hyaline casts. Urine & blood c/s were neg.
CDC 'Split Type':

Write-up:PENELOPE WAS ADMITTED WITH INTUSSUSCEPTION NINE DAYS LATER, AND REDUCED SUCCESSFULLY, AT CHILDREN''''S CHILDREN''S HOSPITAL AT SAN DEIGO 4/3/07 Received medical records from hospital which reveal patient experienced emesis for 3 daysw/decreased feeding beginning 3/5/07 & patient became increasingly lethargic. On exam, palpable mass was felt in abdomen. Kept over night for observation, did well & was d/c to home on 3/9/07. No D/c summary available. FINAL DX: ileocolic intussusception, reduced by barium enema.


Changed on 1/7/2013

274158 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:California
Vaccinated:2007-02-28
Onset:2007-03-08
Submitted:2007-03-16
Entered:2007-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 06E605 / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Barium enema, Blood culture negative, Culture urine negative, Differential white blood cell count abnormal, Intussusception, Lethargy, Urinary casts, Urine analysis, Vomiting, Platelet count increased, Decreased appetite, Abdominal X-ray

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: TAKING SYNAGIS FOR RSV PROPHYLAXIS
Preexisting Conditions: 34 WEEK PREEMIE PMH: preemie at 34.5 wks, born by c-section.
Allergies:
Diagnostic Lab Data: LABS: abdominal x-ray revealed IS. Barium enema reduced IS. WBC 9.2, plt 582, lymphs 40, monos 55, bands 4 & polys 49. UA revealed 3 hyaline casts. Urine & blood c/s were neg.
CDC 'Split Type':

Write-up:PENELOPE PATIENT WAS ADMITTED WITH INTUSSUSCEPTION NINE DAYS LATER, AND REDUCED SUCCESSFULLY, AT CHILDREN''S HOSPITAL AT SAN DEIGO 4/3/07 Received medical records from hospital which reveal patient experienced emesis for 3 daysw/decreased feeding beginning 3/5/07 & patient became increasingly lethargic. On exam, palpable mass was felt in abdomen. Kept over night for observation, did well & was d/c to home on 3/9/07. No D/c summary available. FINAL DX: ileocolic intussusception, reduced by barium enema.


Changed on 5/13/2013

274158 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:California
Vaccinated:2007-02-28
Onset:2007-03-08
Submitted:2007-03-16
Entered:2007-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 06E605 / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 06E605 / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Barium enema, Blood culture negative, Culture urine negative, Differential white blood cell count abnormal, Intussusception, Lethargy, Urinary casts, Urine analysis, Vomiting, Platelet count increased, Decreased appetite, Abdominal X-ray

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: TAKING SYNAGIS FOR RSV PROPHYLAXIS
Preexisting Conditions: 34 WEEK PREEMIE PMH: preemie at 34.5 wks, born by c-section.
Allergies:
Diagnostic Lab Data: LABS: abdominal x-ray revealed IS. Barium enema reduced IS. WBC 9.2, plt 582, lymphs 40, monos 55, bands 4 & polys 49. UA revealed 3 hyaline casts. Urine & blood c/s were neg.
CDC 'Split Type':

Write-up:PATIENT WAS ADMITTED WITH INTUSSUSCEPTION NINE DAYS LATER, AND REDUCED SUCCESSFULLY, AT HOSPITAL 4/3/07 Received medical records from hospital which reveal patient experienced emesis for 3 daysw/decreased feeding beginning 3/5/07 & patient became increasingly lethargic. On exam, palpable mass was felt in abdomen. Kept over night for observation, did well & was d/c to home on 3/9/07. No D/c summary available. FINAL DX: ileocolic intussusception, reduced by barium enema.


Changed on 6/14/2014

274158 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:California
Vaccinated:2007-02-28
Onset:2007-03-08
Submitted:2007-03-16
Entered:2007-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 06E605 / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Barium enema, Blood culture negative, Culture urine negative, Differential white blood cell count abnormal, Intussusception, Lethargy, Urinary casts, Urine analysis, Vomiting, Platelet count increased, Decreased appetite, Abdominal X-ray

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: TAKING SYNAGIS FOR RSV PROPHYLAXIS
Preexisting Conditions: 34 WEEK PREEMIE PMH: preemie at 34.5 wks, born by c-section.
Allergies:
Diagnostic Lab Data: LABS: abdominal x-ray revealed IS. Barium enema reduced IS. WBC 9.2, plt 582, lymphs 40, monos 55, bands 4 & polys 49. UA revealed 3 hyaline casts. Urine & blood c/s were neg.
CDC 'Split Type':

Write-up:PATIENT WAS ADMITTED WITH INTUSSUSCEPTION NINE DAYS LATER, AND REDUCED SUCCESSFULLY, AT HOSPITAL 4/3/07 Received medical records from hospital which reveal patient experienced emesis for 3 daysw/decreased feeding beginning 3/5/07 & patient became increasingly lethargic. On exam, palpable mass was felt in abdomen. Kept over night for observation, did well & was d/c to home on 3/9/07. No D/c summary available. FINAL DX: ileocolic intussusception, reduced by barium enema.


Changed on 3/14/2015

274158 Before After
VAERS Form:
Age:0.2
Gender:Female
Location:California
Vaccinated:2007-02-28
Onset:2007-03-08
Submitted:2007-03-16
Entered:2007-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 06E605 / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Barium enema, Blood culture negative, Culture urine negative, Differential white blood cell count abnormal, Intussusception, Lethargy, Urinary casts, Urine analysis, Vomiting, Platelet count increased, Decreased appetite, Abdominal X-ray

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: TAKING SYNAGIS FOR RSV PROPHYLAXIS
Preexisting Conditions: 34 WEEK PREEMIE PMH: preemie at 34.5 wks, born by c-section.
Allergies:
Diagnostic Lab Data: LABS: abdominal x-ray revealed IS. Barium enema reduced IS. WBC 9.2, plt 582, lymphs 40, monos 55, bands 4 & polys 49. UA revealed 3 hyaline casts. Urine & blood c/s were neg.
CDC 'Split Type':

Write-up:PATIENT WAS ADMITTED WITH INTUSSUSCEPTION NINE DAYS LATER, AND REDUCED SUCCESSFULLY, AT HOSPITAL 4/3/07 Received medical records from hospital which reveal patient experienced emesis for 3 daysw/decreased feeding beginning 3/5/07 & patient became increasingly lethargic. On exam, palpable mass was felt in abdomen. Kept over night for observation, did well & was d/c to home on 3/9/07. No D/c summary available. FINAL DX: ileocolic intussusception, reduced by barium enema.


Changed on 2/14/2017

274158 Before After
VAERS Form:
Age:0.2 0.18
Gender:Female
Location:California
Vaccinated:2007-02-28
Onset:2007-03-08
Submitted:2007-03-16
Entered:2007-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 06E605 / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Barium enema, Blood culture negative, Culture urine negative, Differential white blood cell count abnormal, Intussusception, Lethargy, Urinary casts, Urine analysis, Vomiting, Platelet count increased, Decreased appetite, Abdominal X-ray

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: TAKING SYNAGIS FOR RSV PROPHYLAXIS
Preexisting Conditions: 34 WEEK PREEMIE PMH: preemie at 34.5 wks, born by c-section.
Allergies:
Diagnostic Lab Data: LABS: abdominal x-ray revealed IS. Barium enema reduced IS. WBC 9.2, plt 582, lymphs 40, monos 55, bands 4 & polys 49. UA revealed 3 hyaline casts. Urine & blood c/s were neg.
CDC 'Split Type':

Write-up:PATIENT WAS ADMITTED WITH INTUSSUSCEPTION NINE DAYS LATER, AND REDUCED SUCCESSFULLY, AT HOSPITAL 4/3/07 Received medical records from hospital which reveal patient experienced emesis for 3 daysw/decreased feeding beginning 3/5/07 & patient became increasingly lethargic. On exam, palpable mass was felt in abdomen. Kept over night for observation, did well & was d/c to home on 3/9/07. No D/c summary available. FINAL DX: ileocolic intussusception, reduced by barium enema.


Changed on 5/14/2017

274158 Before After
VAERS Form:
Age:0.18
Gender:Female
Location:California
Vaccinated:2007-02-28
Onset:2007-03-08
Submitted:2007-03-16
Entered:2007-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 06E605 / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Barium enema, Blood culture negative, Culture urine negative, Differential white blood cell count abnormal, Intussusception, Lethargy, Urinary casts, Urine analysis, Vomiting, Platelet count increased, Decreased appetite, Abdominal X-ray

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: TAKING SYNAGIS FOR RSV PROPHYLAXIS
Preexisting Conditions: 34 WEEK PREEMIE PMH: preemie at 34.5 wks, born by c-section.
Allergies:
Diagnostic Lab Data: LABS: abdominal x-ray revealed IS. Barium enema reduced IS. WBC 9.2, plt 582, lymphs 40, monos 55, bands 4 & polys 49. UA revealed 3 hyaline casts. Urine & blood c/s were neg.
CDC 'Split Type':

Write-up:PATIENT WAS ADMITTED WITH INTUSSUSCEPTION NINE DAYS LATER, AND REDUCED SUCCESSFULLY, AT HOSPITAL 4/3/07 Received medical records from hospital which reveal patient experienced emesis for 3 daysw/decreased feeding beginning 3/5/07 & patient became increasingly lethargic. On exam, palpable mass was felt in abdomen. Kept over night for observation, did well & was d/c to home on 3/9/07. No D/c summary available. FINAL DX: ileocolic intussusception, reduced by barium enema.


Changed on 9/14/2017

274158 Before After
VAERS Form:(blank) 1
Age:0.18
Gender:Female
Location:California
Vaccinated:2007-02-28
Onset:2007-03-08
Submitted:2007-03-16
Entered:2007-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 06E605 / 1 2 - MO / PO

Administered by: Unknown      Purchased by: Unknown
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: TAKING SYNAGIS FOR RSV PROPHYLAXIS
Preexisting Conditions: 34 WEEK PREEMIE PMH: preemie at 34.5 wks, born by c-section.
Allergies:
Diagnostic Lab Data: LABS: abdominal x-ray revealed IS. Barium enema reduced IS. WBC 9.2, plt 582, lymphs 40, monos 55, bands 4 & polys 49. UA revealed 3 hyaline casts. Urine & blood c/s were neg.
CDC 'Split Type':

Write-up:PATIENT WAS ADMITTED WITH INTUSSUSCEPTION NINE DAYS LATER, AND REDUCED SUCCESSFULLY, AT HOSPITAL 4/3/07 Received medical records from hospital which reveal patient experienced emesis for 3 daysw/decreased feeding beginning 3/5/07 & patient became increasingly lethargic. On exam, palpable mass was felt in abdomen. Kept over night for observation, did well & was d/c to home on 3/9/07. No D/c summary available. FINAL DX: ileocolic intussusception, reduced by barium enema.


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